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Gegin S, Pazarlı AC, Özdemir B, Özdemir L, Aksu EA. The Effect of Hounsfield Unit Value on the Differentiation of Malignant/Benign Mediastinal Lymphadenopathy and Masses Diagnosed by Endobronchial Ultrasonography. Cancer Manag Res 2024; 16:1013-1020. [PMID: 39157714 PMCID: PMC11330239 DOI: 10.2147/cmar.s473653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/03/2024] [Indexed: 08/20/2024] Open
Abstract
Aim In cases where standardized maximum uptake (SUVmax) values in positron emission tomography (PET-CT) were not sufficient to differentiate mediastinal lymphadenopathy and masses from malignant or benign, the contribution of Hounsfield unit (HU) values in thorax computed tomography to the diagnosis was evaluated. Material Method The study was conducted by evaluating the data of 182 patients between 2019 and 2023. HU values on non-contrast thorax computed tomography and PET-CT SUVmax values of biopsied masses and lymph nodes were compared with histopathological diagnoses. Results Patients, 58 females (31.9%) and 124 males (68.1%), who underwent EBUS were included in the study. Biopsies were taken from 233 stations (199 lymph nodes, 34 masses) from 182 patients. A total of 135 of the biopsies taken from 233 stations were histopathologically malignant and 98 were benign. While PET-CT SUVmax values of cases with benign histopathology were 4.5 ± 3.5, it was 7.6 ± 4.2 in patients with malignant pathology (p<0.05). The HU value on non-contrast thorax tomography in patients with benign histopathology was 43.1 ± 15.7, and in patients with malignant histopathology it was 40.5 ± 13.7 (p>0.05). When HU was compared according to lung cancer type, it was found to be significantly higher in non-small cell lung cancer (p=0.035). A weak (r=0.182) positive and significant relationship (p<0.01) was found between PET-CT values and HU values in thorax computed tomography. Conclusion While positron emission tomography maintains its importance in the differentiation of mediastinal lymphadenopathy and masses from malignant to non-malignant, it was concluded that HU values in computed tomography are not sufficient to distinguish malignant/non-malignant.
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Affiliation(s)
- Savaş Gegin
- Samsun Training and Research Hospital, Pulmonology Clinic, Samsun, Türkiye
| | - Ahmet Cemal Pazarlı
- Tokat Gaziosmanpaşa University, Faculty of Medicine, Department of Pulmonary Diseases, Tokat, Türkiye
| | - Burcu Özdemir
- Samsun Training and Research Hospital, Pulmonology Clinic, Samsun, Türkiye
| | - Levent Özdemir
- Samsun Training and Research Hospital, Pulmonology Clinic, Samsun, Türkiye
| | - Esra Arslan Aksu
- Samsun University Faculty of Medicine, Pulmonology Department, Samsun, Türkiye
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Erdur AC, Rusche D, Scholz D, Kiechle J, Fischer S, Llorián-Salvador Ó, Buchner JA, Nguyen MQ, Etzel L, Weidner J, Metz MC, Wiestler B, Schnabel J, Rueckert D, Combs SE, Peeken JC. Deep learning for autosegmentation for radiotherapy treatment planning: State-of-the-art and novel perspectives. Strahlenther Onkol 2024:10.1007/s00066-024-02262-2. [PMID: 39105745 DOI: 10.1007/s00066-024-02262-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/13/2024] [Indexed: 08/07/2024]
Abstract
The rapid development of artificial intelligence (AI) has gained importance, with many tools already entering our daily lives. The medical field of radiation oncology is also subject to this development, with AI entering all steps of the patient journey. In this review article, we summarize contemporary AI techniques and explore the clinical applications of AI-based automated segmentation models in radiotherapy planning, focusing on delineation of organs at risk (OARs), the gross tumor volume (GTV), and the clinical target volume (CTV). Emphasizing the need for precise and individualized plans, we review various commercial and freeware segmentation tools and also state-of-the-art approaches. Through our own findings and based on the literature, we demonstrate improved efficiency and consistency as well as time savings in different clinical scenarios. Despite challenges in clinical implementation such as domain shifts, the potential benefits for personalized treatment planning are substantial. The integration of mathematical tumor growth models and AI-based tumor detection further enhances the possibilities for refining target volumes. As advancements continue, the prospect of one-stop-shop segmentation and radiotherapy planning represents an exciting frontier in radiotherapy, potentially enabling fast treatment with enhanced precision and individualization.
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Affiliation(s)
- Ayhan Can Erdur
- Institute for Artificial Intelligence and Informatics in Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany.
- Department of Radiation Oncology, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany.
| | - Daniel Rusche
- Department of Radiation Oncology, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
| | - Daniel Scholz
- Institute for Artificial Intelligence and Informatics in Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
- Department of Neuroradiology, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
| | - Johannes Kiechle
- Department of Radiation Oncology, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
- Institute for Computational Imaging and AI in Medicine, Technical University of Munich, Lichtenberg Str. 2a, 85748, Garching, Bavaria, Germany
- Munich Center for Machine Learning (MCML), Technical University of Munich, Arcisstraße 21, 80333, Munich, Bavaria, Germany
- Konrad Zuse School of Excellence in Reliable AI (relAI), Technical University of Munich, Walther-von-Dyck-Straße 10, 85748, Garching, Bavaria, Germany
| | - Stefan Fischer
- Department of Radiation Oncology, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
- Institute for Computational Imaging and AI in Medicine, Technical University of Munich, Lichtenberg Str. 2a, 85748, Garching, Bavaria, Germany
- Munich Center for Machine Learning (MCML), Technical University of Munich, Arcisstraße 21, 80333, Munich, Bavaria, Germany
| | - Óscar Llorián-Salvador
- Department of Radiation Oncology, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
- Department for Bioinformatics and Computational Biology - i12, Technical University of Munich, Boltzmannstraße 3, 85748, Garching, Bavaria, Germany
- Institute of Organismic and Molecular Evolution, Johannes Gutenberg University Mainz (JGU), Hüsch-Weg 15, 55128, Mainz, Rhineland-Palatinate, Germany
| | - Josef A Buchner
- Department of Radiation Oncology, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
| | - Mai Q Nguyen
- Department of Radiation Oncology, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
| | - Lucas Etzel
- Department of Radiation Oncology, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Bavaria, Germany
| | - Jonas Weidner
- Institute for Artificial Intelligence and Informatics in Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
- Department of Neuroradiology, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
| | - Marie-Christin Metz
- Department of Neuroradiology, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
| | - Julia Schnabel
- Institute for Computational Imaging and AI in Medicine, Technical University of Munich, Lichtenberg Str. 2a, 85748, Garching, Bavaria, Germany
- Munich Center for Machine Learning (MCML), Technical University of Munich, Arcisstraße 21, 80333, Munich, Bavaria, Germany
- Konrad Zuse School of Excellence in Reliable AI (relAI), Technical University of Munich, Walther-von-Dyck-Straße 10, 85748, Garching, Bavaria, Germany
- Institute of Machine Learning in Biomedical Imaging, Helmholtz Munich, Ingolstädter Landstraße 1, 85764, Neuherberg, Bavaria, Germany
- School of Biomedical Engineering & Imaging Sciences, King's College London, Strand, WC2R 2LS, London, London, UK
| | - Daniel Rueckert
- Institute for Artificial Intelligence and Informatics in Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
- Faculty of Engineering, Department of Computing, Imperial College London, Exhibition Rd, SW7 2BX, London, London, UK
| | - Stephanie E Combs
- Department of Radiation Oncology, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Bavaria, Germany
- Partner Site Munich, German Consortium for Translational Cancer Research (DKTK), Munich, Bavaria, Germany
| | - Jan C Peeken
- Department of Radiation Oncology, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str., 81675, Munich, Bavaria, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Bavaria, Germany
- Partner Site Munich, German Consortium for Translational Cancer Research (DKTK), Munich, Bavaria, Germany
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Umutlu L, Nensa F, Demircioglu A, Antoch G, Herrmann K, Forsting M, Grueneisen JS. Radiomics Analysis of Multiparametric PET/MRI for N- and M-Staging in Patients with Primary Cervical Cancer. Nuklearmedizin 2024; 63:34-42. [PMID: 38325362 DOI: 10.1055/a-2157-6867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
PURPOSE The aim of this study was to investigate the potential of multiparametric 18F-FDG PET/MR imaging as a platform for radiomics analysis and machine learning algorithms based on primary cervical cancers to predict N- and M-stage in patients. MATERIALS AND METHODS A total of 30 patients with histopathological confirmation of primary and untreated cervical cancer were prospectively enrolled for a multiparametric 18F-FDG PET/MR examination, comprising a dedicated protocol for imaging of the female pelvis. The primary tumor in the uterine cervix was manually segmented on post-contrast T1-weighted images. Quantitative features were extracted from the segmented tumors using the Radiomic Image Processing Toolbox for the R software environment for statistical computing and graphics. 45 different image features were calculated from non-enhanced as well as post-contrast T1-weighted TSE images, T2-weighted TSE images, the ADC map, the parametric Ktrans, Kep, Ve and iAUC maps and PET images, respectively. Statistical analysis and modeling was performed using Python 3.5 and the scikit-learn software machine learning library for the Python programming language. RESULTS Prediction of M-stage was superior when compared to N-stage. Prediction of M-stage using SVM with SVM-RFE as feature selection obtained the highest performance providing sensitivity of 91 % and specificity of 92 %. Using receiver operating characteristic (ROC) analysis of the pooled predictions, the area under the curve (AUC) was 0.97. Prediction of N-stage using RBF-SVM with MIFS as feature selection reached sensitivity of 83 %, specificity of 67 % and an AUC of 0.82. CONCLUSION M- and N-stage can be predicted based on isolated radiomics analyses of the primary tumor in cervical cancers, thus serving as a template for noninvasive tumor phenotyping and patient stratification using high-dimensional feature vectors extracted from multiparametric PET/MRI data. KEY POINTS · Radiomics analysis based on multiparametric PET/MRI enables prediction of the metastatic status of cervical cancers. · Prediction of M-stage is superior to N-stage. · Multiparametric PET/MRI displays a valuable platform for radiomics analyses .
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Affiliation(s)
- Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Aydin Demircioglu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Johannes Stefan Grueneisen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
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Chen K, Hou L, Chen M, Li S, Shi Y, Raynor WY, Yang H. Predicting the Efficacy of SBRT for Lung Cancer with 18F-FDG PET/CT Radiogenomics. Life (Basel) 2023; 13:life13040884. [PMID: 37109413 PMCID: PMC10142286 DOI: 10.3390/life13040884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/18/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Purpose: to develop a radiogenomic model on the basis of 18F-FDG PET/CT radiomics and clinical-parameter EGFR for predicting PFS stratification in lung-cancer patients after SBRT treatment. Methods: A total of 123 patients with lung cancer who had undergone 18F-FDG PET/CT examination before SBRT from September 2014 to December 2021 were retrospectively analyzed. All patients’ PET/CT images were manually segmented, and the radiomic features were extracted. LASSO regression was used to select radiomic features. Logistic regression analysis was used to screen clinical features to establish the clinical EGFR model, and a radiogenomic model was constructed by combining radiomics and clinical EGFR. We used the receiver operating characteristic curve and calibration curve to assess the efficacy of the models. The decision curve and influence curve analysis were used to evaluate the clinical value of the models. The bootstrap method was used to validate the radiogenomic model, and the mean AUC was calculated to assess the model. Results: A total of 2042 radiomics features were extracted. Five radiomic features were related to the PFS stratification of lung-cancer patients with SBRT. T-stage and overall stages (TNM) were independent factors for predicting PFS stratification. AUCs under the ROC curve of the radiomics, clinical EGFR, and radiogenomic models were 0.84, 0.67, and 0.86, respectively. The calibration curve shows that the predicted value of the radiogenomic model was in good agreement with the actual value. The decision and influence curve showed that the model had high clinical application values. After Bootstrap validation, the mean AUC of the radiogenomic model was 0.850(95%CI 0.849–0.851). Conclusions: The radiogenomic model based on 18F-FDG PET/CT radiomics and clinical EGFR has good application value in predicting the PFS stratification of lung-cancer patients after SBRT treatment.
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Affiliation(s)
- Kuifei Chen
- Taizhou Hospital of Zhejiang Province, Shaoxing University, Taizhou 317000, China
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou 317000, China
| | - Liqiao Hou
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou 317000, China
| | - Meng Chen
- Taizhou Hospital of Zhejiang Province, Shaoxing University, Taizhou 317000, China
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou 317000, China
| | - Shuling Li
- Taizhou Hospital of Zhejiang Province, Shaoxing University, Taizhou 317000, China
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou 317000, China
| | - Yangyang Shi
- Department of Radiation Oncology, University of Arizona, Tucson, AZ 85724, USA
| | - William Y. Raynor
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Haihua Yang
- Taizhou Hospital of Zhejiang Province, Shaoxing University, Taizhou 317000, China
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou 317000, China
- Correspondence: or
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Ley S. [Lesions of the visceral mediastinum]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:172-179. [PMID: 36715716 DOI: 10.1007/s00117-023-01116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND The visceral or middle mediastinum contains nonvascular (trachea, carina, esophagus, and lymph nodes) and vascular structures (heart, ascending aorta, aortic arch, descending aorta, superior vena cava, intrapericardial pulmonary arteries, thoracic duct). OBJECTIVES The various pathologies of the visceral mediastinum and imaging features are presented. MATERIALS AND METHODS Plain film radiography shows the gross anatomy and allows visualization of larger pathologies. However, for detailed anatomic and structural classification more sophisticated imaging techniques are required. Especially computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) are well suited for structural and functional assessment of mediastinal lesions. CONCLUSION This article summarizes the major pathologies of the visceral mediastinum.
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Affiliation(s)
- Sebastian Ley
- Diagnostische und Interventionelle Radiologie, Artemed Klinikum München Süd & Internistisches Klinikum München Süd, Am Isarkanal 30, 81379, München, Deutschland.
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Abdollahi H, Chin E, Clark H, Hyde DE, Thomas S, Wu J, Uribe CF, Rahmim A. Radiomics-guided radiation therapy: opportunities and challenges. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac6fab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/13/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Radiomics is an advanced image-processing framework, which extracts image features and considers them as biomarkers towards personalized medicine. Applications include disease detection, diagnosis, prognosis, and therapy response assessment/prediction. As radiation therapy aims for further individualized treatments, radiomics could play a critical role in various steps before, during and after treatment. Elucidation of the concept of radiomics-guided radiation therapy (RGRT) is the aim of this review, attempting to highlight opportunities and challenges underlying the use of radiomics to guide clinicians and physicists towards more effective radiation treatments. This work identifies the value of RGRT in various steps of radiotherapy from patient selection to follow-up, and subsequently provides recommendations to improve future radiotherapy using quantitative imaging features.
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Manafi-Farid R, Askari E, Shiri I, Pirich C, Asadi M, Khateri M, Zaidi H, Beheshti M. [ 18F]FDG-PET/CT radiomics and artificial intelligence in lung cancer: Technical aspects and potential clinical applications. Semin Nucl Med 2022; 52:759-780. [PMID: 35717201 DOI: 10.1053/j.semnuclmed.2022.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 02/07/2023]
Abstract
Lung cancer is the second most common cancer and the leading cause of cancer-related death worldwide. Molecular imaging using [18F]fluorodeoxyglucose Positron Emission Tomography and/or Computed Tomography ([18F]FDG-PET/CT) plays an essential role in the diagnosis, evaluation of response to treatment, and prediction of outcomes. The images are evaluated using qualitative and conventional quantitative indices. However, there is far more information embedded in the images, which can be extracted by sophisticated algorithms. Recently, the concept of uncovering and analyzing the invisible data extracted from medical images, called radiomics, is gaining more attention. Currently, [18F]FDG-PET/CT radiomics is growingly evaluated in lung cancer to discover if it enhances the diagnostic performance or implication of [18F]FDG-PET/CT in the management of lung cancer. In this review, we provide a short overview of the technical aspects, as they are discussed in different articles of this special issue. We mainly focus on the diagnostic performance of the [18F]FDG-PET/CT-based radiomics and the role of artificial intelligence in non-small cell lung cancer, impacting the early detection, staging, prediction of tumor subtypes, biomarkers, and patient's outcomes.
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Affiliation(s)
- Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Emran Askari
- Department of Nuclear Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Isaac Shiri
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Mahboobeh Asadi
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maziar Khateri
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland; Geneva University Neurocenter, Geneva University, Geneva, Switzerland; Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
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Liang G, Yu W, Liu SQ, Xie MG, Liu M. The value of radiomics based on dual-energy CT for differentiating benign from malignant solitary pulmonary nodules. BMC Med Imaging 2022; 22:95. [PMID: 35597900 PMCID: PMC9123722 DOI: 10.1186/s12880-022-00824-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/12/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate the value of monochromatic dual-energy CT (DECT) images based on radiomics in differentiating benign from malignant solitary pulmonary nodules. MATERIALS AND METHODS This retrospective study was approved by the institutional review board, and informed consent was waived. Pathologically confirmed lung nodules smaller than 3 cm with integrated arterial phase and venous phase (AP and VP) gemstone spectral imaging were retrospectively identified. After extracting the radiomic features of each case, principal component analysis (PCA) was used for feature selection, and after training with the logistic regression method, three classification models (ModelAP, ModelVP and ModelCombination) were constructed. The performance was assessed by the area under the receiver operating curve (AUC), and the efficacy of the models was validated using an independent cohort. RESULTS A total of 153 patients were included and divided into a training cohort (n = 107) and a validation cohort (n = 46). A total of 1130 radiomic features were extracted from each case. The PCA method selected 22, 25 and 35 principal components to construct the three models. The diagnostic accuracy of ModelAP, ModelVP and ModelCombination was 0.8043, 0.6739, and 0.7826 in the validation set, with AUCs of 0.8148 (95% CI 0.682-0.948), 0.7485 (95% CI 0.602-0.895), and 0.8772 (95% CI 0.780-0.974), respectively. The DeLong test showed that there were significant differences in the AUCs between ModelAP and ModelCombination (P = 0.0396) and between ModelVP and ModelCombination (P = 0.0465). However, the difference in AUCs between ModelAP and ModelVP was not significant (P = 0.5061). These results demonstrate that ModelCombination shows a better performance than the other models. Decision curve analysis proved the clinical utility of this model. CONCLUSIONS We developed a radiomics model based on monochromatic DECT images to identify solitary pulmonary nodules. This model could serve as an effective tool for discriminating benign from malignant pulmonary nodules in patients. The combination of arterial phase and venous phase imaging could significantly improve the model performance.
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Affiliation(s)
- Gao Liang
- Department of Radiology, Hospital of ChengDu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Wei Yu
- Department of Radiology, Hospital of ChengDu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Shu-Qin Liu
- Department of Radiology, Hospital of ChengDu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Ming-Guo Xie
- Department of Radiology, Hospital of ChengDu University of Traditional Chinese Medicine, Chengdu, 610075, China.
| | - Min Liu
- Toxicology Department, WestChina-Frontier PharmaTech Co., Ltd. (WCFP), Chengdu, 610075, China
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Differentiating Central Lung Tumors from Atelectasis with Contrast-Enhanced CT-Based Radiomics Features. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5522452. [PMID: 34820455 PMCID: PMC8608546 DOI: 10.1155/2021/5522452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/20/2021] [Indexed: 01/29/2023]
Abstract
Objectives To evaluate the utility of radiomics features in differentiating central lung cancers and atelectasis on contrast-enhanced computed tomography (CT) images. This study is retrospective. Materials and Methods In this study, 36 patients with central pulmonary cancer and atelectasis between July 2013 and June 2018 were identified. A total of 1,653 2D and 2,327 3D radiomics features were extracted from segmented lung cancers and atelectasis on contrast-enhanced CT. The refined features were investigated for usefulness in classifying lung cancer and atelectasis according to the information gain, and 10 models were trained based on these features. The classification model is trained and tested at the region level and pixel level, respectively. Results Among all the extracted features, 334 2D features and 1,507 3D features had an information gain (IG) greater than 0.1. The highest accuracy (AC) of the region classifiers was 0.9375. The best Dice score, Hausdorff distance, and voxel AC were 0.2076, 45.28, and 0.8675, respectively. Conclusions Radiomics features derived from contrast-enhanced CT images can differentiate lung cancers and atelectasis at the regional and voxel levels.
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Thoracic imaging radiomics for staging lung cancer: a systematic review and radiomic quality assessment. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00474-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Churchill IF, Gatti AA, Hylton DA, Sullivan KA, Patel YS, Leontiadis GI, Farrokhyar F, Hanna WC. An Artificial Intelligence Algorithm to Predict Nodal Metastasis in Lung Cancer. Ann Thorac Surg 2021; 114:248-256. [PMID: 34370986 DOI: 10.1016/j.athoracsur.2021.06.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/18/2021] [Accepted: 06/15/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Endobronchial Ultrasound (EBUS) features have high accuracy for predicting lymph node (LN) malignancy. However, their clinical application remains limited due to high operator dependency. We hypothesized that an Artificial Intelligence algorithm (NeuralSeg) is capable of accurately identifying and predicting LN malignancy based on EBUS images. METHODS In the derivation phase, EBUS images were segmented twice by an endosonographer and used as controls in 5-fold cross-validation training of NeuralSeg. In the validation phase, the algorithm was tested on new images it had not seen before. Logistic regression and receiver operator characteristic curves were used to determine NeuralSeg's capability of discrimination between benign and malignant LNs, using pathologic specimens as gold standard. RESULTS In total, 298 LNs from 140 patients were used for derivation and 108 LNs from 47 patients for validation. In the derivation cohort, NeuralSeg was able to predict malignant LNs with an accuracy of 73.8% (95% CI: 68.4% to 78.7%). In the validation cohort, NeuralSeg had an accuracy of 72.9% (95% CI: 63.5% to 81.0%), a specificity of 90.8% (95% CI: 81.9% to 96.2%) and negative predictive value (NPV) of 75.9% (95% CI: 71.5% to 79.9%). NeuralSeg showed higher diagnostic discrimination during validation compared to derivation (c-statistic= 0.75 [95% CI: 0.65-0.85] vs c-statistic=0.63 [95% CI: 0.54-0.72]). CONCLUSIONS NeuralSeg is able to accurately rule out nodal metastasis and can possibly be used as an adjunct to EBUS when nodal biopsy is not possible or inconclusive. Future work to evaluate the algorithm in a clinical trial will be required.
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Affiliation(s)
- Isabella F Churchill
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Thoracic Surgery, Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | | | - Danielle A Hylton
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Thoracic Surgery, Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Kerrie A Sullivan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Thoracic Surgery, Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Yogita S Patel
- Division of Thoracic Surgery, Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Grigorious I Leontiadis
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Thoracic Surgery, Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Waël C Hanna
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Thoracic Surgery, Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
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12
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Zheng K, Wang X, Jiang C, Tang Y, Fang Z, Hou J, Zhu Z, Hu S. Pre-Operative Prediction of Mediastinal Node Metastasis Using Radiomics Model Based on 18F-FDG PET/CT of the Primary Tumor in Non-Small Cell Lung Cancer Patients. Front Med (Lausanne) 2021; 8:673876. [PMID: 34222284 PMCID: PMC8249728 DOI: 10.3389/fmed.2021.673876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/11/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose: We investigated whether a fluorine-18-fluorodeoxy glucose positron emission tomography/computed tomography (18F-FDG PET/CT)-based radiomics model (RM) could predict the pathological mediastinal lymph node staging (pN staging) in patients with non-small cell lung cancer (NSCLC) undergoing surgery. Methods: A total of 716 patients with a clinicopathological diagnosis of NSCLC were included in this retrospective study. The prediction model was developed in a training cohort that consisted of 501 patients. Radiomics features were extracted from the 18F-FDG PET/CT of the primary tumor. Support vector machine and extremely randomized trees were used to build the RM. Internal validation was assessed. An independent testing cohort contained the remaining 215 patients. The performances of the RM and clinical node staging (cN staging) in predicting pN staging (pN0 vs. pN1 and N2) were compared for each cohort. The area under the curve (AUC) of the receiver operating characteristic curve was applied to assess the model's performance. Results: The AUC of the RM [0.81 (95% CI, 0.771–0.848); sensitivity: 0.794; specificity: 0.704] for the predictive performance of pN1 and N2 was significantly better than that of cN in the training cohort [0.685 (95% CI, 0.644–0.728); sensitivity: 0.804; specificity: 0.568], (P-value = 8.29e-07, as assessed by the Delong test). In the testing cohort, the AUC of the RM [0.766 (95% CI, 0.702–0.830); sensitivity: 0.688; specificity: 0.704] was also significantly higher than that of cN [0.685 (95% CI, 0.619–0.747); sensitivity: 0.799; specificity: 0.568], (P = 0.0371, Delong test). Conclusions: The RM based on 18F-FDG PET/CT has a potential for the pN staging in patients with NSCLC, suggesting that therapeutic planning could be tailored according to the predictions.
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Affiliation(s)
- Kai Zheng
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China.,Positron Emission Tomography/Computed Tomography (PET/CT) Center, Hunan Cancer Hospital, Changsha, China.,The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xinrong Wang
- General Electric (GE) Healthcare (China), Shanghai, China
| | - Chengzhi Jiang
- Positron Emission Tomography/Computed Tomography (PET/CT) Center, Hunan Cancer Hospital, Changsha, China
| | - Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Zhihui Fang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Jiale Hou
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Zehua Zhu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, China
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13
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Jiang YQ, Gao Q, Chen H, Shi XX, Wu JB, Chen Y, Zhang Y, Pang HW, Lin S. Positron Emission Tomography-Based Short-Term Efficacy Evaluation and Prediction in Patients With Non-Small Cell Lung Cancer Treated With Hypo-Fractionated Radiotherapy. Front Oncol 2021; 11:590836. [PMID: 33718144 PMCID: PMC7947869 DOI: 10.3389/fonc.2021.590836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/18/2021] [Indexed: 12/29/2022] Open
Abstract
Background Positron emission tomography is known to provide more accurate estimates than computed tomography when staging non–small cell lung cancer. The aims of this prospective study were to contrast the short-term efficacy of the two imaging methods while evaluating the effects of hypo-fractionated radiotherapy in non-small cell lung cancer, and to establish a short-term efficacy prediction model based on the radiomics features of positron emission tomography. Methods This nonrandomized-controlled trial was conducted from March 2015 to June 2019. Thirty-one lesions of 30 patients underwent the delineation of the regions of interest on positron emission tomography and computed tomography 1 month before, and 3 months after hypo-fractionated radiotherapy. Each patient was evaluated for the differences in local objective response rate between the two images. The Kaplan Meier method was used to analyze the local objective response and subsequent survival duration of the two imaging methods. The 3D Slicer was used to extract the radiomics features based on positron emission tomography. Least absolute shrinkage and selection operator regression was used to eliminate redundant features, and logistic regression analysis was used to develop the curative-effect-predicting model, which was displayed through a radiomics nomogram. Receiver operating characteristic curve and decision curve were used to evaluate the accuracy and clinical usefulness of the prediction model. Results Positron emission tomography-based local objective response rate was significantly higher than that based on computed tomography [70.97% (22/31) and 12.90% (4/31), respectively (p<0.001)]. The mean survival time of responders and non-responders assessed by positron emission tomography was 28.6 months vs. 11.4 months (p=0.29), whereas that assessed by computed tomography was 24.5 months vs. 26 months (p=0.66), respectively. Three radiomics features were screened to establish a personalized prediction nomogram with high area under curve (0.94, 95% CI 0.85–0.99, p<0.001). The decision curve showed a high clinical value of the radiomics nomogram. Conclusions We recommend positron emission tomography for evaluating the short-term efficacy of hypo-fractionated radiotherapy in non-small cell lung cancer, and that the radiomics nomogram could be an important technique for the prediction of short-term efficacy, which might enable an improved and precise treatment. Registration number/URL ChiCTR1900027768/http://www.chictr.org.cn/showprojen.aspx?proj=46057
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Affiliation(s)
- Yi-Qing Jiang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qin Gao
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Han Chen
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiang-Xiang Shi
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jing-Bo Wu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yue Chen
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yan Zhang
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hao-Wen Pang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Sheng Lin
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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14
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Peeken JC, Shouman MA, Kroenke M, Rauscher I, Maurer T, Gschwend JE, Eiber M, Combs SE. A CT-based radiomics model to detect prostate cancer lymph node metastases in PSMA radioguided surgery patients. Eur J Nucl Med Mol Imaging 2020; 47:2968-2977. [PMID: 32468251 PMCID: PMC7680305 DOI: 10.1007/s00259-020-04864-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE In recurrent prostate carcinoma, determination of the site of recurrence is crucial to guide personalized therapy. In contrast to prostate-specific membrane antigen (PSMA)-positron emission tomography (PET) imaging, computed tomography (CT) has only limited capacity to detect lymph node metastases (LNM). We sought to develop a CT-based radiomic model to predict LNM status using a PSMA radioguided surgery (RGS) cohort with histological confirmation of all suspected lymph nodes (LNs). METHODS Eighty patients that received RGS for resection of PSMA PET/CT-positive LNMs were analyzed. Forty-seven patients (87 LNs) that received inhouse imaging were used as training cohort. Thirty-three patients (62 LNs) that received external imaging were used as testing cohort. As gold standard, histological confirmation was available for all LNs. After preprocessing, 156 radiomic features analyzing texture, shape, intensity, and local binary patterns (LBP) were extracted. The least absolute shrinkage and selection operator (radiomic models) and logistic regression (conventional parameters) were used for modeling. RESULTS Texture and shape features were largely correlated to LN volume. A combined radiomic model achieved the best predictive performance with a testing-AUC of 0.95. LBP features showed the highest contribution to model performance. This model significantly outperformed all conventional CT parameters including LN short diameter (AUC 0.84), LN volume (AUC 0.80), and an expert rating (AUC 0.67). In lymph node-specific decision curve analysis, there was a clinical net benefit above LN short diameter. CONCLUSION The best radiomic model outperformed conventional measures for detection of LNM demonstrating an incremental value of radiomic features.
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Affiliation(s)
- Jan C Peeken
- Department of Radiation Oncology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany.
- Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany.
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.
| | - Mohamed A Shouman
- Department of Radiation Oncology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany
| | - Markus Kroenke
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Institute for Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Tobias Maurer
- Institute for Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Department of Urology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology and Martini-Klinik, University Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Eiber
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany
- Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
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15
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Yoo J, Cheon M, Park YJ, Hyun SH, Zo JI, Um SW, Won HH, Lee KH, Kim BT, Choi JY. Machine learning-based diagnostic method of pre-therapeutic 18F-FDG PET/CT for evaluating mediastinal lymph nodes in non-small cell lung cancer. Eur Radiol 2020; 31:4184-4194. [PMID: 33241521 DOI: 10.1007/s00330-020-07523-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/08/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We aimed to find the best machine learning (ML) model using 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for evaluating metastatic mediastinal lymph nodes (MedLNs) in non-small cell lung cancer, and compare the diagnostic results with those of nuclear medicine physicians. METHODS A total of 1329 MedLNs were reviewed. Boosted decision tree, logistic regression, support vector machine, neural network, and decision forest models were compared. The diagnostic performance of the best ML model was compared with that of physicians. The ML method was divided into ML with quantitative variables only (MLq) and adding clinical information (MLc). We performed an analysis based on the 18F-FDG-avidity of the MedLNs. RESULTS The boosted decision tree model obtained higher sensitivity and negative predictive values but lower specificity and positive predictive values than the physicians. There was no significant difference between the accuracy of the physicians and MLq (79.8% vs. 76.8%, p = 0.067). The accuracy of MLc was significantly higher than that of the physicians (81.0% vs. 76.8%, p = 0.009). In MedLNs with low 18F-FDG-avidity, ML had significantly higher accuracy than the physicians (70.0% vs. 63.3%, p = 0.018). CONCLUSION Although there was no significant difference in accuracy between the MLq and physicians, the diagnostic performance of MLc was better than that of MLq or of the physicians. The ML method appeared to be useful for evaluating low metabolic MedLNs. Therefore, adding clinical information to the quantitative variables from 18F-FDG PET/CT can improve the diagnostic results of ML. KEY POINTS • Machine learning using two-class boosted decision tree model revealed the highest value of area under curve, and it showed higher sensitivity and negative predictive values but lower specificity and positive predictive values than nuclear medicine physicians. • The diagnostic results from machine learning method after adding clinical information to the quantitative variables improved accuracy significantly than nuclear medicine physicians. • Machine learning could improve the diagnostic significance of metastatic mediastinal lymph nodes, especially in mediastinal lymph nodes with low 18F-FDG-avidity.
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Affiliation(s)
- Jang Yoo
- Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul, South Korea.,Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Miju Cheon
- Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Yong Jin Park
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Hyup Hyun
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Ill Zo
- Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong-Hee Won
- Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Samsung Medical Center, Seoul, South Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung-Tae Kim
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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16
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2-[ 18F]FDG PET/CT radiomics in lung cancer: An overview of the technical aspect and its emerging role in management of the disease. Methods 2020; 188:84-97. [PMID: 32497604 DOI: 10.1016/j.ymeth.2020.05.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/15/2022] Open
Abstract
Lung cancer is the most common cancer, worldwide, and a major health issue with a remarkable mortality rate. 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT) plays an indispensable role in the management of lung cancer patients. Long-established quantitative parameters such as size, density, and metabolic activity have been and are being employed in the current practice to enhance interpretation and improve diagnostic and prognostic value. The introduction of radiomics analysis revolutionized the quantitative evaluation of medical imaging, revealing data within images beyond visual interpretation. The "big data" are extracted from high-quality images and are converted into information that correlates to relevant genetic, pathologic, clinical, or prognostic features. Technically advanced, diverse methods have been implemented in different studies. The standardization of image acquisition, segmentation and features analysis is still a debated issue. Importantly, a body of features has been extracted and employed for diagnosis, staging, risk stratification, prognostication, and therapeutic response. 2-[18F]FDG PET/CT-derived features show promising value in non-invasively diagnosing the malignant nature of pulmonary nodules, differentiating lung cancer subtypes, and predicting response to different therapies as well as survival. In this review article, we aimed to provide an overview of the technical aspects used in radiomics analysis in non-small cell lung cancer (NSCLC) and elucidate the role of 2-[18F]FDG PET/CT-derived radiomics in the diagnosis, prognostication, and therapeutic response.
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17
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Cui X, Heuvelmans MA, Han D, Zhao Y, Fan S, Zheng S, Sidorenkov G, Groen HJM, Dorrius MD, Oudkerk M, de Bock GH, Vliegenthart R, Ye Z. Comparison of Veterans Affairs, Mayo, Brock classification models and radiologist diagnosis for classifying the malignancy of pulmonary nodules in Chinese clinical population. Transl Lung Cancer Res 2019; 8:605-613. [PMID: 31737497 DOI: 10.21037/tlcr.2019.09.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Several classification models based on Western population have been developed to help clinicians to classify the malignancy probability of pulmonary nodules. However, the diagnostic performance of these Western models in Chinese population is unknown. This paper aimed to compare the diagnostic performance of radiologist evaluation of malignancy probability and three classification models (Mayo Clinic, Veterans Affairs, and Brock University) in Chinese clinical pulmonology patients. Methods This single-center retrospective study included clinical patients from Tianjin Medical University Cancer Institute and Hospital with new, CT-detected pulmonary nodules in 2013. Patients with a nodule with diameter of 4-25 mm, and histological diagnosis or 2-year follow-up were included. Analysis of area under the receiver operating characteristic curve (AUC), decision curve analysis (DCA) and threshold of decision analysis was used to evaluate the diagnostic performance of radiologist diagnosis and the three classification models, with histological diagnosis or 2-year follow-up as the reference. Results In total, 277 patients (286 nodules) were included. Two hundred and seven of 286 nodules (72.4%) in 203 patients were malignant. AUC of the Mayo model (0.77; 95% CI: 0.72-0.82) and Brock model (0.77; 95% CI: 0.72-0.82) were similar to radiologist diagnosis (0.78; 95% CI: 0.73-0.83; P=0.68, P=0.71, respectively). The diagnostic performance of the VA model (AUC: 0.66) was significantly lower than that of radiologist diagnosis (P=0.003). A three-class classifying threshold analysis and DCA showed that the radiologist evaluation had higher discriminatory power for malignancy than the three classification models. Conclusions In a cohort of Chinese clinical pulmonology patients, radiologist evaluation of lung nodule malignancy probability demonstrated higher diagnostic performance than Mayo, Brock, and VA classification models. To optimize nodule diagnosis and management, a new model with more radiological characteristics could be valuable.
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Affiliation(s)
- Xiaonan Cui
- Department of Radiology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Centre of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolein A Heuvelmans
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Pulmonology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Daiwei Han
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Yingru Zhao
- Department of Radiology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Centre of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Shuxuan Fan
- Department of Radiology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Centre of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Sunyi Zheng
- Department of Radiotherapy, Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Grigory Sidorenkov
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry J M Groen
- Department of Pulmonary Diseases, Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Monique D Dorrius
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands.,i-DNA BV, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Zhaoxiang Ye
- Department of Radiology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Centre of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
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18
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[Study Progress of Radiomics in Precision Medicine for Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:385-388. [PMID: 31196373 PMCID: PMC6580079 DOI: 10.3779/j.issn.1009-3419.2019.06.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Precision medicine, imaging first. Radiomics, a method of machine learning in artificial intelligence, provides valuable diagnostic, prognostic or predictive information through quantitative analysis on the tumor's region of interest to support personalized clinical decisions and improve individualized treatment, which could lay a solid foundation for achieving the precision medicine. This review provides a latest advance of the radiomic application of the precision medicine for lung cancer.
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Prediction of Lymph Node Maximum Standardized Uptake Value in Patients With Cancer Using a 3D Convolutional Neural Network: A Proof-of-Concept Study. AJR Am J Roentgenol 2019; 212:238-244. [DOI: 10.2214/ajr.18.20094] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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20
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OPPORTUNITIES OF POSITRON-EMMISION TOMOGRAPHY IN RADIATION THERAPY OF LUNG CANCER PATIENTS. WORLD OF MEDICINE AND BIOLOGY 2019. [DOI: 10.26724/2079-8334-2019-4-70-163-167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Jiang C, Chen Y, Zhu Y, Xu Y. Systematic review and meta-analysis of the accuracy of 18F-FDG PET/CT for detection of regional lymph node metastasis in esophageal squamous cell carcinoma. J Thorac Dis 2018; 10:6066-6076. [PMID: 30622778 DOI: 10.21037/jtd.2018.10.57] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background We performed a systematic review and meta-analysis to assess the accuracy of 18F-fluorodeoxyglucose positron emission tomography with computer tomography (18F-FDG PET/CT) for detection of regional lymph node metastasis in esophageal squamous cell carcinoma in per-patient and per-nodal station basis. Methods Electronic databases were researched for studies assessing the sensitivity and specificity of PET/CT to detect the regional lymph node metastasis published between January 2006 and December 2017 on esophageal squamous cell carcinoma. STATA software was performed to assess the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odd ratio (DOR) and summary receiver operating characteristic (SROC) curve. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) and Deeks' Funnel Plot Asymmetry Test were performed to evaluate the study quality and publication bias of included studies. Results Nineteen studies were eligible for meta-analysis, comprising 1,089 patients with esophageal cancer who underwent 18F-FDG PET/CT before surgery. According to the content of the article, we divided the selected studies into per-patient basis group and per-nodal basis group (one of the articles was involved in both groups). For the per-nodal station basis group (12 studies, 5,681 stations), the pooled sensitivity and specificity estimates of 18F-FDG PET/CT for detecting regional lymph node metastasis were 66% [95% confidence interval (CI): 51-78%] and 96% (95% CI: 92-98%), respectively. The corresponding values on a per-patient basis group (8 studies; 506 patients) were 65% (95% CI: 49-78%) and 81% (95% CI: 69-89%) in sensitivity and specificity, respectively. Conclusions Overall, 18F-FDG PET/CT have a moderate to low sensitivity and a high to moderate specificity for detection of regional nodal metastasis in esophageal cancer. Therefore, since the false rate is considerable, extending the extent of lymph node dissection or radiotherapy target volume is necessary after diagnosis of regional nodal metastasis by 18F-FDG PET/CT.
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Affiliation(s)
- Chenxue Jiang
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yun Chen
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yaoyao Zhu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yapping Xu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Li K, Shen M, Geng H, Zheng L, Cao Y. Computed Tomographic Studies of Noncalcified Nodules Related to Neuroendocrine Lung Tumor Using 68Gallium-Tagged Somatostatin Variant for Improvement in Diagnosis: A Non-Experimental, Non-Randomized, Cross-Sectional Study. Med Sci Monit 2018; 24:4501-4509. [PMID: 29959846 PMCID: PMC6055512 DOI: 10.12659/msm.908545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background 18Fluoro-fluorodeoxyglucose (FDG)- based positron-emission computed tomography (PET) has less specificity for noncalcified nodules (NNs). Somatostatin receptors affect the expression of normal and malignant cells. The purpose of the study was to compare the sensitivity, specificity, and accuracy of 68Gallium-tagged DOTA-octreotate (Ga-tDO) with that of FDG PET for diagnosis of newly detected and/or untreated NNs in lung cancer patients. Material/Methods A total of 45 patients with lung cancer were included in the cross-sectional study and underwent Ga-tDO and FDG PET. We further confirmed observed outcomes by testing immune histochemical staining for subtype 2A of somatostatin receptor in a granuloma tissue array. The chi-square test was performed for sensitivity and specificity of predictive values among the 3 diagnostic modalities. McNemar’s test was performed to compare accuracy between Ga-tDO and FDG PET. Results were considered significant at 95% confidence level. Results Ga-tDO had less sensitivity (69% vs. 89%) but more specificity (91% vs. 78%) than FDG PET. Ga-tDO and FDG PET were characterized as 36 and 6 and in 36 and 3 lesions as accurate and inaccurate, respectively. There was an insignificant difference between Ga-tDO and FDG PET regarding diagnostic accuracy (p=0.7). Dosimetry results showed that the lungs were one of the least critically affected organs. Conclusions Ga-tDO was more specific but less sensitive than FDG PET scanning and imaging.
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Affiliation(s)
- Ketian Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Jiamusi University, Jamusi, Heilongjiang, China (mainland)
| | - Mingge Shen
- Department of Emergency Medicine, The First Affiliated Hospital of Jiamusi University, Jamusi, Heilongjiang, China (mainland)
| | - Hang Geng
- Department of Radiology, The First Affiliated Hospital of Jiamusi University, Jamusi, Heilongjiang, China (mainland)
| | - Linyi Zheng
- Department of Cardiology No. 1, The First Affiliated Hospital of Jiamusi University, Jamusi, Heilongjiang, China (mainland)
| | - Yujie Cao
- Department of Emergency Medicine, The First Affiliated Hospital of Jiamusi University, Jamusi, Heilongjiang, China (mainland)
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Impact of Computer-Aided CT and PET Analysis on Non-invasive T Staging in Patients with Lung Cancer and Atelectasis. Mol Imaging Biol 2018; 20:1044-1052. [PMID: 29679299 DOI: 10.1007/s11307-018-1196-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Tumor delineation within an atelectasis in lung cancer patients is not always accurate. When T staging is done by integrated 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG)-positron emission tomography (PET)/X-ray computer tomography (CT), tumors of neuroendocrine differentiation and slowly growing tumors can present with reduced FDG uptake, thus aggravating an exact T staging. In order to further exhaust information derived from [18F]FDG-PET/CT, we evaluated the impact of CT density and maximum standardized uptake value (SUVmax) for the classification of different tumor subtypes within a surrounding atelectasis, as well as possible cutoff values for the differentiation between the primary tumor and atelectatic lung tissue. PROCEDURES Seventy-two patients with histologically proven lung cancer and adjacent atelectasis were investigated. Non-contrast-enhanced [18F]FDG-PET/CT was performed within 2 weeks before surgery/biopsy. Boundaries of the primary within the atelectasis were determined visually on the basis of [18F]FDG uptake; CT density was quantified manually within each primary and each atelectasis. RESULTS CT density of the primary (36.4 Hounsfield units (HU) ± 6.2) was significantly higher compared to that of atelectatic lung (24.3 HU ± 8.3; p < 0.01), irrespective of the histological subtype. The discrimination between different malignant tumors using density analysis failed. SUVmax was increased in squamous cell carcinomas compared to adenocarcinomas. Irrespective of the malignant subtype, a possible cutoff value of 24 HU may help to exclude the presence of a primary in lesions below 24 HU, whereas a density above a threshold of 40 HU can help to exclude atelectatic lung. CONCLUSION Density measurements in patients with lung cancer and surrounding atelectasis may help to delineate the primary tumor, irrespective of the specific lung cancer subtype. This could improve T staging and radiation treatment planning (RTP) without additional application of a contrast agent in CT, or an additional magnetic resonance imaging (MRI), even in cases of lung tumors of neuroendocrine differentiation or in slowly growing tumors with less avidity to [18F]FDG.
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Ability of FDG PET and CT radiomics features to differentiate between primary and metastatic lung lesions. Eur J Nucl Med Mol Imaging 2018; 45:1649-1660. [DOI: 10.1007/s00259-018-3987-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/22/2018] [Indexed: 01/18/2023]
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Sun Y, Hu P, Wang J, Shen L, Xia F, Qing G, Hu W, Zhang Z, Xin C, Peng W, Tong T, Gu Y. Radiomic features of pretreatment MRI could identify T stage in patients with rectal cancer: Preliminary findings. J Magn Reson Imaging 2018; 48:615-621. [PMID: 29437279 DOI: 10.1002/jmri.25969] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/24/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Recent studies have shown that magnetic resonance (MR) radiomic analysis is feasible and has some value in identifying tumor characteristics, but there are few data regarding the role of MR-based radiomic features in rectal cancer. PURPOSE The aim of this study was to determine whether radiomic features extracted from T2 -weighted imaging (T2 WI) can identify pathological features in rectal cancer. STUDY TYPE Retrospective study. POPULATION/SUBJECTS A cohort comprising 119 rectal cancer patients who underwent surgery between January 2015 and November 2016. FIELD STRENGTH/SEQUENCE 3.0T, axial high-resolution T2 -weighted turbo spin echo (TSE) sequence. ASSESSMENT Patients were classified according to pathological features such as T stage, N stage, perineural invasion, histological grade, lymph-vascular invasion, tumor deposits, and circumferential resection margin (CRM). The whole tumor volume (WTV) was distinguished, and segments were quantified on axial high-resolution T2 WI by a radiologist. A total of 256 radiomic features were extracted. STATISTICAL TESTS To achieve reliable results, cluster analysis and least absolute shrinkage and selection operator (LASSO) were implemented. In the cluster analysis, the patients were divided into two groups, and chi-square tests were performed to investigate the relationship between the pathological features and the radiomic-based clusters. The area under the curve (AUC) was calculated to evaluate the predictability of the model in the LASSO analysis. RESULTS The cluster results revealed that patients could be stratified into two groups, and the chi-square test results indicated that the pT stage was correlated with the radiomic feature cluster results (P = 0.002). The prediction model AUC for the diagnostic T stage was 0.852 (95% confidence interval: 0.677-1; sensitivity: 79.0%, specificity: 82.0%). DATA CONCLUSION The use of MRI-derived radiomic features to identify the T stage is feasible in rectal cancer. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Yiqun Sun
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Panpan Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lijun Shen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fan Xia
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Gan Qing
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chao Xin
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tong Tong
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Harrington C, Smith L, Bisland J, López González E, Jamieson N, Paterson S, Stanley AJ. Mediastinal node staging by positron emission tomography-computed tomography and selective endoscopic ultrasound with fine needle aspiration for patients with upper gastrointestinal cancer: Results from a regional centre. World J Gastrointest Endosc 2018; 10:37-44. [PMID: 29375740 PMCID: PMC5769002 DOI: 10.4253/wjge.v10.i1.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/25/2017] [Accepted: 11/20/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and positron emission tomography-computed tomography (PET-CT) in the nodal staging of upper gastrointestinal (GI) cancer in a tertiary referral centre.
METHODS We performed a retrospective review of prospectively recorded data held on all patients with a diagnosis of upper GI cancer made between January 2009 and December 2015. Only those patients who had both a PET-CT and EUS with FNA sampling of a mediastinal node distant from the primary tumour were included. Using a positive EUS-FNA result as the gold standard for lymph node involvement, the sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy of PET-CT in the staging of mediastinal lymph nodes were calculated. The impact on therapeutic strategy of adding EUS-FNA to PET-CT was assessed.
RESULTS One hundred and twenty one patients were included. Sixty nine patients had a diagnosis of oesophageal adenocarcinoma (Thirty one of whom were junctional), forty eight had oesophageal squamous cell carcinoma and four had gastric adenocarcinoma. The FNA results were inadequate in eleven cases and the PET-CT findings were indeterminate in two cases, therefore thirteen patients (10.7%) were excluded from further analysis. There was concordance between PET-CT and EUS-FNA findings in seventy one of the remaining one hundred and eight patients (65.7%). The sensitivity, specificity, PPV and NPV values of PET-CT were 92.5%, 50%, 52.1% and 91.9% respectively. There was discordance between PET-CT and EUS-FNA findings in thirty seven out of one hundred and eight patients (34.3%). MDT discussion led to a radical treatment pathway in twenty seven of these cases, after the final tumour stage was altered as a direct consequence of the EUS-FNA findings. Of these patients, fourteen (51.9%) experienced clinical remission of a median of nine months (range three to forty two months).
CONCLUSION EUS-FNA leads to altered staging of upper GI cancer, resulting in more patients receiving radical treatment that would have been the case using PET-CT staging alone.
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Affiliation(s)
- Chris Harrington
- Glasgow Royal Infirmary, Glasgow G4 0ET, United Kingdom
- Forth Valley Royal Hospital, Larbert FK5 4WR, United Kingdom
| | - Lyn Smith
- Glasgow Royal Infirmary, Glasgow G4 0ET, United Kingdom
| | | | - Elisabet López González
- Glasgow Royal Infirmary, Glasgow G4 0ET, United Kingdom
- Hospital Vega Baja, Orihuela 03314, Spain
| | - Neil Jamieson
- Glasgow Royal Infirmary, Glasgow G4 0ET, United Kingdom
- Raigmore Hospital, Inverness IV2 3UJ, United Kingdom
| | - Stuart Paterson
- Glasgow Royal Infirmary, Glasgow G4 0ET, United Kingdom
- Forth Valley Royal Hospital, Larbert FK5 4WR, United Kingdom
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