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Chang CC, Lin CY, Liu YS, Chen YY, Huang WL, Lai WW, Yen YT, Ma MC, Tseng YL. Therapeutic Decision Making in Prevascular Mediastinal Tumors Using CT Radiomics and Clinical Features: Upfront Surgery or Pretreatment Needle Biopsy? Cancers (Basel) 2024; 16:773. [PMID: 38398164 PMCID: PMC10886806 DOI: 10.3390/cancers16040773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
The study aimed to develop machine learning (ML) classification models for differentiating patients who needed direct surgery from patients who needed core needle biopsy among patients with prevascular mediastinal tumor (PMT). Patients with PMT who received a contrast-enhanced computed tomography (CECT) scan and initial management for PMT between January 2010 and December 2020 were included in this retrospective study. Fourteen ML algorithms were used to construct candidate classification models via the voting ensemble approach, based on preoperative clinical data and radiomic features extracted from the CECT. The classification accuracy of clinical diagnosis was 86.1%. The first ensemble learning model was built by randomly choosing seven ML models from a set of fourteen ML models and had a classification accuracy of 88.0% (95% CI = 85.8 to 90.3%). The second ensemble learning model was the combination of five ML models, including NeuralNetFastAI, NeuralNetTorch, RandomForest with Entropy, RandomForest with Gini, and XGBoost, and had a classification accuracy of 90.4% (95% CI = 87.9 to 93.0%), which significantly outperformed clinical diagnosis (p < 0.05). Due to the superior performance, the voting ensemble learning clinical-radiomic classification model may be used as a clinical decision support system to facilitate the selection of the initial management of PMT.
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Affiliation(s)
- Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
| | - Chia-Ying Lin
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-Y.L.); (Y.-S.L.)
| | - Yi-Sheng Liu
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-Y.L.); (Y.-S.L.)
| | - Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
| | - Wu-Wei Lai
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
- Division of Thoracic Surgery, Department of Surgery, An-Nan Hospital, China Medical University, Tainan 70965, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
- Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Mi-Chia Ma
- Department of Statistics and Institute of Data Science, National Cheng Kung University, Tainan 701401, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
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Ahuja J, Strange CD, Agrawal R, Erasmus LT, Truong MT. Approach to Imaging of Mediastinal Masses. Diagnostics (Basel) 2023; 13:3171. [PMID: 37891992 PMCID: PMC10606219 DOI: 10.3390/diagnostics13203171] [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: 09/08/2023] [Revised: 10/04/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
Mediastinal masses present a diagnostic challenge due to their diverse etiologies. Accurate localization and internal characteristics of the mass are the two most important factors to narrow the differential diagnosis or provide a specific diagnosis. The International Thymic Malignancy Interest Group (ITMIG) classification is the standard classification system used to localize mediastinal masses. Computed tomography (CT) and magnetic resonance imaging (MRI) are the two most commonly used imaging modalities for characterization of the mediastinal masses.
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Affiliation(s)
- Jitesh Ahuja
- Department of Thoracic Imaging, The University of Texas MD Andeson Cancer Center, Houston, TX 77030, USA; (C.D.S.); (R.A.); (M.T.T.)
| | - Chad D. Strange
- Department of Thoracic Imaging, The University of Texas MD Andeson Cancer Center, Houston, TX 77030, USA; (C.D.S.); (R.A.); (M.T.T.)
| | - Rishi Agrawal
- Department of Thoracic Imaging, The University of Texas MD Andeson Cancer Center, Houston, TX 77030, USA; (C.D.S.); (R.A.); (M.T.T.)
| | - Lauren T. Erasmus
- Department of Anatomy and Cell Biology, Faculty of Sciences, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Mylene T. Truong
- Department of Thoracic Imaging, The University of Texas MD Andeson Cancer Center, Houston, TX 77030, USA; (C.D.S.); (R.A.); (M.T.T.)
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Nakazono T, Yamaguchi K, Egashira R, Iyadomi M, Fujiki K, Takayanagi S, Mizuguchi M, Irie H. MRI Findings and Differential Diagnosis of Anterior Mediastinal Solid Tumors. Magn Reson Med Sci 2023; 22:415-433. [PMID: 35296589 PMCID: PMC10552663 DOI: 10.2463/mrms.rev.2021-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 01/25/2022] [Indexed: 11/09/2022] Open
Abstract
The anterior mediastinum is the most common location of mediastinal tumors, and thymic epithelial tumors are the most common mediastinal tumors. It is important to differentiate thymic epithelial tumors from malignant lymphomas and malignant germ cell tumors because of the different treatment strategies. Dynamic contrast-enhanced MRI and diffusion-weighted imaging can provide additional information on the differential diagnosis. Chemical shift imaging can detect tiny fat tissues in the lesion and is useful in differentiating thymic hyperplasia from other solid tumors such as thymomas. MRI findings reflect histopathological features of mediastinal tumors, and a comprehensive evaluation of MRI sequences is important for estimation of the histopathological features of the tumor. In this manuscript, we describe the MRI findings of anterior mediastinal solid tumors and the role of MRI in the differential diagnosis.
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Affiliation(s)
- Takahiko Nakazono
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Saga, Japan
| | - Ken Yamaguchi
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Saga, Japan
| | - Ryoko Egashira
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Saga, Japan
| | - Mizuki Iyadomi
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Saga, Japan
| | - Kazuya Fujiki
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Saga, Japan
| | - Sachiho Takayanagi
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Saga, Japan
| | - Masanobu Mizuguchi
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Saga, Japan
| | - Hiroyuki Irie
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Saga, Japan
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Tang R, Liang H, Guo Y, Li Z, Liu Z, Lin X, Yan Z, Liu J, Xu X, Shao W, Li S, Liang W, Wang W, Cui F, He H, Yang C, Jiang L, Wang H, Chen H, Guo C, Zhang H, Gao Z, He Y, Chen X, Zhao L, Yu H, Hu J, Zhao J, Li B, Yin C, Mao W, Lin W, Xie Y, Liu J, Li X, Wu D, Hou Q, Chen Y, Chen D, Xue Y, Liang Y, Tang W, Wang Q, Li E, Liu H, Wang G, Yu P, Chen C, Zheng B, Chen H, Zhang Z, Wang L, Wang A, Li Z, Fu J, Zhang G, Zhang J, Liu B, Zhao J, Deng B, Han Y, Leng X, Li Z, Zhang M, Liu C, Wang T, Luo Z, Yang C, Guo X, Ma K, Wang L, Jiang W, Han X, Wang Q, Qiao K, Xia Z, Zheng S, Xu C, Peng J, Wu S, Zhang Z, Huang H, Pang D, Liu Q, Li J, Ding X, Liu X, Zhong L, Lu Y, Xu F, Dai Q, He J. Pan-mediastinal neoplasm diagnosis via nationwide federated learning: a multicentre cohort study. Lancet Digit Health 2023; 5:e560-e570. [PMID: 37625894 DOI: 10.1016/s2589-7500(23)00106-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/10/2023] [Accepted: 05/17/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Mediastinal neoplasms are typical thoracic diseases with increasing incidence in the general global population and can lead to poor prognosis. In clinical practice, the mediastinum's complex anatomic structures and intertype confusion among different mediastinal neoplasm pathologies severely hinder accurate diagnosis. To solve these difficulties, we organised a multicentre national collaboration on the basis of privacy-secured federated learning and developed CAIMEN, an efficient chest CT-based artificial intelligence (AI) mediastinal neoplasm diagnosis system. METHODS In this multicentre cohort study, 7825 mediastinal neoplasm cases and 796 normal controls were collected from 24 centres in China to develop CAIMEN. We further enhanced CAIMEN with several novel algorithms in a multiview, knowledge-transferred, multilevel decision-making pattern. CAIMEN was tested by internal (929 cases at 15 centres), external (1216 cases at five centres and a real-world cohort of 11 162 cases), and human-AI (60 positive cases from four centres and radiologists from 15 institutions) test sets to evaluate its detection, segmentation, and classification performance. FINDINGS In the external test experiments, the area under the receiver operating characteristic curve for detecting mediastinal neoplasms of CAIMEN was 0·973 (95% CI 0·969-0·977). In the real-world cohort, CAIMEN detected 13 false-negative cases confirmed by radiologists. The dice score for segmenting mediastinal neoplasms of CAIMEN was 0·765 (0·738-0·792). The mediastinal neoplasm classification top-1 and top-3 accuracy of CAIMEN were 0·523 (0·497-0·554) and 0·799 (0·778-0·822), respectively. In the human-AI test experiments, CAIMEN outperformed clinicians with top-1 and top-3 accuracy of 0·500 (0·383-0·633) and 0·800 (0·700-0·900), respectively. Meanwhile, with assistance from the computer aided diagnosis software based on CAIMEN, the 46 clinicians improved their average top-1 accuracy by 19·1% (0·345-0·411) and top-3 accuracy by 13·0% (0·545-0·616). INTERPRETATION For mediastinal neoplasms, CAIMEN can produce high diagnostic accuracy and assist the diagnosis of human experts, showing its potential for clinical practice. FUNDING National Key R&D Program of China, National Natural Science Foundation of China, and Beijing Natural Science Foundation.
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Affiliation(s)
- Ruijie Tang
- School of Software, Beijing National Research Center for Information Science and Technology, Institute for Brain and Cognitive Sciences, Tsinghua University, Beijing, China
| | - Hengrui Liang
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuchen Guo
- Institute for Brain and Cognitive Sciences, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing, China
| | - Zhigang Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhichao Liu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xu Lin
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zeping Yan
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Association of Thoracic Disease, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Xu
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenlong Shao
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shuben Li
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Wang
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fei Cui
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huanghe He
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chao Yang
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Long Jiang
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haixuan Wang
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huai Chen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chenguang Guo
- Guangdong Association of Thoracic Disease, Guangzhou, China
| | - Haipeng Zhang
- Guangdong Association of Thoracic Disease, Guangzhou, China
| | - Zebin Gao
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Yuwei He
- Hangzhou Zhuoxi Institute of Brain and Intelligence, Hangzhou, China
| | - Xiangru Chen
- Hangzhou Zhuoxi Institute of Brain and Intelligence, Hangzhou, China
| | - Lei Zhao
- Department of Physiology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
| | - Hong Yu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiangang Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bin Li
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Ci Yin
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Wenjie Mao
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Wanli Lin
- Department of Thoracic Surgery, Gaozhou People's Hospital, Gaozhou, China
| | - Yujie Xie
- Department of Thoracic Surgery, Gaozhou People's Hospital, Gaozhou, China
| | - Jixian Liu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiaoqiang Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Dingwang Wu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Qinghua Hou
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yongbing Chen
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Donglai Chen
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yuhang Xue
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Liang
- Department of Cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Wenfang Tang
- Department of Cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Qi Wang
- Department of Respiratory Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Encheng Li
- Department of Respiratory Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Guan Wang
- Department of Thoracic Surgery, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Pingwen Yu
- Department of Thoracic Surgery, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bin Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hao Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhe Zhang
- Department of Thoracic Surgery, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Lunqing Wang
- Department of Thoracic Surgery, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Ailin Wang
- Department of Thoracic Surgery, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Zongqi Li
- Department of Thoracic Surgery, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Junke Fu
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jia Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bohao Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jian Zhao
- Department of Chest Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Boyun Deng
- Department of Thoracic Surgery, Central People's Hospital of Zhanjiang, Zhanjiang, China
| | - Yongtao Han
- Division of Thoracic Surgery, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuefeng Leng
- Division of Thoracic Surgery, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhiyu Li
- Division of Thoracic Surgery, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Man Zhang
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Department of Thoracic Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Changling Liu
- Department of Thoracic Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Tianhu Wang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhilin Luo
- Department of Thoracic Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chenglin Yang
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xiaotong Guo
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Kai Ma
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Lixu Wang
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Wenjun Jiang
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Xu Han
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Qing Wang
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Kun Qiao
- Department of Thoracic Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Zhaohua Xia
- Department of Thoracic Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Shuo Zheng
- Department of Thoracic Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Chenyang Xu
- Department of Thoracic Surgery, Ganzhou People's Hospital, Ganzhou, China
| | - Jidong Peng
- Department of Radiology, Ganzhou People's Hospital, Ganzhou, China
| | - Shilong Wu
- Department of Thoracic Surgery, Ganzhou People's Hospital, Ganzhou, China
| | - Zhifeng Zhang
- Department of Cardiothoracic Surgery, Jieyang People's Hospital, Jieyang, China
| | - Haoda Huang
- Department of Cardiothoracic Surgery, Jieyang People's Hospital, Jieyang, China
| | - Dazhi Pang
- Department of Thoracic Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Qiao Liu
- Department of Thoracic Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jinglong Li
- Department of Thoracic Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xueru Ding
- Department of Thoracic Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiang Liu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Liucheng Zhong
- Department of Radiology, Huizhou First People's Hospital, Huizhou, China
| | - Yutong Lu
- School of Computer Science and Engineering, Sun Yat-sen University, National Supercomputer Center, Guangzhou, China
| | - Feng Xu
- School of Software, Beijing National Research Center for Information Science and Technology, Institute for Brain and Cognitive Sciences, Tsinghua University, Beijing, China.
| | - Qionghai Dai
- Institute for Brain and Cognitive Sciences, Department of Automation, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing, China.
| | - Jianxing He
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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5
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Borgheresi A, Agostini A, Pierpaoli L, Bruno A, Valeri T, Danti G, Bicci E, Gabelloni M, De Muzio F, Brunese MC, Bruno F, Palumbo P, Fusco R, Granata V, Gandolfo N, Miele V, Barile A, Giovagnoni A. Tips and Tricks in Thoracic Radiology for Beginners: A Findings-Based Approach. Tomography 2023; 9:1153-1186. [PMID: 37368547 DOI: 10.3390/tomography9030095] [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: 05/05/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This review has the purpose of illustrating schematically and comprehensively the key concepts for the beginner who approaches chest radiology for the first time. The approach to thoracic imaging may be challenging for the beginner due to the wide spectrum of diseases, their overlap, and the complexity of radiological findings. The first step consists of the proper assessment of the basic imaging findings. This review is divided into three main districts (mediastinum, pleura, focal and diffuse diseases of the lung parenchyma): the main findings will be discussed in a clinical scenario. Radiological tips and tricks, and relative clinical background, will be provided to orient the beginner toward the differential diagnoses of the main thoracic diseases.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Luca Pierpaoli
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Alessandra Bruno
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Tommaso Valeri
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Eleonora Bicci
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, 16149 Genoa, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
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6
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Takumi K, Nagano H, Oose A, Gohara M, Kamimura K, Nakajo M, Harada-Takeda A, Ueda K, Tabata K, Yoshiura T. Extracellular volume fraction derived from equilibrium contrast-enhanced CT as a diagnostic parameter in anterior mediastinal tumors. Eur J Radiol 2023; 165:110891. [PMID: 37245341 DOI: 10.1016/j.ejrad.2023.110891] [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: 04/10/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE To assess the usefulness of extracellular volume (ECV) fraction derived from equilibrium contrast-enhanced CT (CECT) for diagnosing anterior mediastinal tumors. METHOD This study included 161 histologically confirmed anterior mediastinal tumors (55 low-risk thymomas, 57 high-risk thymomas, 32 thymic carcinomas, and 17 malignant lymphomas) that were assessed by pretreatment CECT. ECV fraction was calculated using measurements obtained within the lesion and the aorta on unenhanced and equilibrium phase CECT. ECV fraction was compared among anterior mediastinal tumors using one-way ANOVA or t-test. Receiver-operating characteristic (ROC) curve analysis was performed to evaluate the ability of ECV fraction to differentiate thymic carcinomas/lymphomas from thymomas. RESULTS ECV fraction differed significantly among the anterior mediastinal tumors (p < 0.001). ECV fraction of thymic carcinomas was significantly higher than those of low-risk thymomas, high-risk thymomas, and lymphomas (p < 0.001, p < 0.001, and p = 0.006, respectively). ECV fraction of lymphomas was significantly higher than that of low-risk thymomas (p < 0.001). ECV fraction was significantly higher in thymic carcinomas/lymphomas than in thymomas (40.1 % vs. 27.7 %, p < 0.001). The optimal cutoff value to differentiate thymic carcinomas/lymphomas from thymomas was 38.5 % (AUC, 0.805; 95 %CI, 0.736-0.863). CONCLUSIONS ECV fraction derived from equilibrium CECT is helpful in diagnosing anterior mediastinal tumors. High ECV fraction is indicative of thymic carcinomas/lymphomas, particularly thymic carcinomas.
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Affiliation(s)
- Koji Takumi
- Departments of Radiology Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan.
| | - Hiroaki Nagano
- Departments of Radiology Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan
| | - Arata Oose
- Departments of Radiology Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan
| | - Misaki Gohara
- Departments of Radiology Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan
| | - Kiyohisa Kamimura
- Departments of Radiology Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan
| | - Masatoyo Nakajo
- Departments of Radiology Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan
| | - Aya Harada-Takeda
- General Thoracic Surgery Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan
| | - Kazuhiro Ueda
- General Thoracic Surgery Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan
| | - Kazuhiro Tabata
- Human Pathology Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan
| | - Takashi Yoshiura
- Departments of Radiology Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan
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7
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Chang CC, Tang EK, Wei YF, Lin CY, Wu FZ, Wu MT, Liu YS, Yen YT, Ma MC, Tseng YL. Clinical radiomics-based machine learning versus three-dimension convolutional neural network analysis for differentiation of thymic epithelial tumors from other prevascular mediastinal tumors on chest computed tomography scan. Front Oncol 2023; 13:1105100. [PMID: 37143945 PMCID: PMC10151670 DOI: 10.3389/fonc.2023.1105100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Purpose To compare the diagnostic performance of radiomic analysis with machine learning (ML) model with a convolutional neural network (CNN) in differentiating thymic epithelial tumors (TETs) from other prevascular mediastinal tumors (PMTs). Methods A retrospective study was performed in patients with PMTs and undergoing surgical resection or biopsy in National Cheng Kung University Hospital, Tainan, Taiwan, E-Da Hospital, Kaohsiung, Taiwan, and Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan between January 2010 and December 2019. Clinical data including age, sex, myasthenia gravis (MG) symptoms and pathologic diagnosis were collected. The datasets were divided into UECT (unenhanced computed tomography) and CECT (enhanced computed tomography) for analysis and modelling. Radiomics model and 3D CNN model were used to differentiate TETs from non-TET PMTs (including cyst, malignant germ cell tumor, lymphoma and teratoma). The macro F1-score and receiver operating characteristic (ROC) analysis were performed to evaluate the prediction models. Result In the UECT dataset, there were 297 patients with TETs and 79 patients with other PMTs. The performance of radiomic analysis with machine learning model using LightGBM with Extra Tree (macro F1-Score = 83.95%, ROC-AUC = 0.9117) had better performance than the 3D CNN model (macro F1-score = 75.54%, ROC-AUC = 0.9015). In the CECT dataset, there were 296 patients with TETs and 77 patients with other PMTs. The performance of radiomic analysis with machine learning model using LightGBM with Extra Tree (macro F1-Score = 85.65%, ROC-AUC = 0.9464) had better performance than the 3D CNN model (macro F1-score = 81.01%, ROC-AUC = 0.9275). Conclusion Our study revealed that the individualized prediction model integrating clinical information and radiomic features using machine learning demonstrated better predictive performance in the differentiation of TETs from other PMTs at chest CT scan than 3D CNN model.
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Affiliation(s)
- Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - En-Kuei Tang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yu-Feng Wei
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Chest Medicine, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Chia-Ying Lin
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fu-Zong Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Faculty of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Education, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Ming-Ting Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Sheng Liu
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- *Correspondence: Yi-Ting Yen, ; Mi-Chia Ma,
| | - Mi-Chia Ma
- Department of Statistics and Institute of Data Science, National Cheng Kung University, Tainan, Taiwan
- *Correspondence: Yi-Ting Yen, ; Mi-Chia Ma,
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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8
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Jiao J, Yu J, Chen C, Chen T, Zheng T, He L, Zeng Q. Thoracoscopic approach for massive thymic hyperplasia in an infant: Case report and literature review. Front Pediatr 2023; 11:1144384. [PMID: 36937950 PMCID: PMC10014623 DOI: 10.3389/fped.2023.1144384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
Introduction Massive thymic hyperplasia (MTH) is a very rare entity, with fewer than 20 cases reported in the literature in infancy. Most patients have respiratory symptoms and the enlarged thymus gland occupies one side of the thoracic cavity. Posterolateral thoracotomy or median sternotomy is the main treatment for MTH in infants. We report a case of an infant with MTH in which the enlarged thymus occupied his bilateral thoracic cavity and he underwent video-assisted thoracoscopic surgery (VATS). In addition, we reviewed and summarized the relevant literature. Case Report A 4-month-old boy was admitted to the hospital with no apparent cause of dyspnea for 18 days, with cough and sputum. On examination, the patient was found to have cyanotic lips, diminished breath sounds in both lungs, and a positive three concave sign. There was no fever or ptosis. Preoperative imaging showed large soft tissue shadows in the bilateral thoracic cavity, with basic symmetry between the right and left sides. Tumor markers were within the normal range. Ultrasound-guided fine needle biopsy showed normal thymic structures with no evidence of malignancy. As his symptoms worsened, he eventually underwent unilateral thoracic approach video-assisted thoracoscopic exploratory surgery, during which a large mass occupying the bilateral thoracic cavity was removed in a separate block and part of the thymus in the left lobe was preserved. Pathological examination confirmed true thymic hyperplasia (TTH). No relevant complications occurred at the 2-month postoperative follow-up. Conclusion In infants, MTH occupying the bilateral thoracic cavity can produce severe respiratory and circulatory symptoms due to occupying effects. Although a definitive preoperative diagnosis is sometimes difficult, after combining computed tomography (CT) and fine needle biopsy to exclude evidence of other malignancies, the enlarged thymus occupying the bilateral thoracic cavity can be resected via VATS. Whether the enlarged thymus occupies the bilateral thoracic cavity and the size of the thymus are not absolute contraindications to thoracoscopic surgery. The method is safe, feasible, and minimally invasive to the patient.
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Affiliation(s)
- Jinghua Jiao
- Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jie Yu
- Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Chenghao Chen
- Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Tian Chen
- Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Tiehua Zheng
- Department of Anesthesiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Lejian He
- Department of Pathology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Qi Zeng
- Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- Correspondence: Qi Zeng
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Wang G, Du L, Lu X, Liu J, Zhang M, Pan Y, Meng X, Xu X, Guan Z, Yang J. Multiparameter diagnostic model based on 18F-FDG PET and clinical characteristics can differentiate thymic epithelial tumors from thymic lymphomas. BMC Cancer 2022; 22:895. [PMID: 35974323 PMCID: PMC9382789 DOI: 10.1186/s12885-022-09988-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance of combined multiparametric 18F-fluorodeoxyglucose positron emission tomography (18FDG PET) with clinical characteristics in differentiating thymic epithelial tumors (TETs) from thymic lymphomas. PATIENTS AND METHODS A total of 173 patients with 80 TETs and 93 thymic lymphomas who underwent 18F-FDG PET/CT before treatment were enrolled in this retrospective study. All patients were confirmed by pathology, and baseline characteristics and clinical data were also collected. The semi-parameters of 18F-FDG PET/CT, including lesion size, SUVmax (maximum standard uptake value), SUVmean (mean standard uptake value), TLG (total lesion glycolysis), MTV (metabolic tumor volume) and SUVR (tumor-to-normal liver standard uptake value ratio) were evaluated. The differential diagnostic efficacy was evaluated using the receiver operating characteristic (ROC) curve. Integrated discriminatory improvement (IDI) and net reclassification improvement (NRI), and Delong test were used to evaluate the improvement in diagnostic efficacy. The clinical efficacy was evaluated by decision curve analysis (DCA). RESULTS Age, clinical symptoms, and metabolic parameters differed significantly between patients with TETs and thymic lymphomas. The ROC curve analysis of SUVR showed the highest differentiating diagnostic value (sensitivity = 0.763; specificity = 0.888; area under the curve [AUC] = 0.881). The combined diagnostics model of age, clinical symptoms and SUVR resulted in the highest AUC of 0.964 (sensitivity = 0.882, specificity = 0.963). Compared with SUVR, the diagnostic efficiency of the model was improved significantly. The DCA also confirmed the clinical efficacy of the model. CONCLUSIONS The multiparameter diagnosis model based on 18F-FDG PET and clinical characteristics had excellent value in the differential diagnosis of TETs and thymic lymphomas.
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Affiliation(s)
- Guanyun Wang
- Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xicheng District, Beijing, 100050, China.,Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Lei Du
- Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xia Lu
- Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Jiajin Liu
- Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Mingyu Zhang
- Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Yue Pan
- Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xiaolin Meng
- Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xiaodan Xu
- Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Zhiwei Guan
- Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Jigang Yang
- Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xicheng District, Beijing, 100050, China.
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10
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Efficacy of contrast-enhanced ultrasound-guided percutaneous core needle biopsy in anterior mediastinal masses. J Interv Med 2022; 5:159-165. [PMID: 36317148 PMCID: PMC9617154 DOI: 10.1016/j.jimed.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the efficacy and safety of percutaneous core needle biopsy (PCNB) using ultrasound (US)-guided and contrast-enhanced ultrasound (CEUS)-guided procedures for anterior mediastinal masses (AMMs). Methods In total, 284 consecutive patients (166 men, 118 women; mean age, 43.0 ± 18.4 years) who underwent PCNB for AMMs were enrolled. Patients were divided into the US-guided group (n = 133) and the CEUS-guided group (n = 151). PCNB was performed using a core needle (16-gauge or 18-gauge). Internal necrosis, diagnostic yield, and diagnostic accuracy were compared between the two groups. Results The predominant final diagnosis of the cases in this study was thymoma (29.7%), lymphoma (20.5%), thymic carcinoma (13.3%), and germ cell tumour (13.3%), respectively. There was no significant difference in patient age, sex, number of percutaneous biopsies, or display rate of internal necrosis on conventional US between the two groups. The rate of internal necrosis of the lesions was significantly higher after contrast agent injection (72.2% vs. 41.7%; P < 0.001). The CEUS-guided group had a higher diagnostic yield than the US-guided group (100% vs. 89.5%, P < 0.001). There was no significant difference between the diagnostic accuracy of the CEUS-guided and US-guided groups (97.3% vs. 97.4%; P = 1.000). None of the patients experienced adverse reactions or complications after US-guided or CEUS-guided PCNB. Conclusions CEUS-guided PCNB can improve the diagnostic yield by optimizing the biopsy procedure.
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11
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Zhou Z, Qu Y, Zhou Y, Wang B, Hu W, Cao Y. Development and Validation of a CT-Based Radiomics Nomogram in Patients With Anterior Mediastinal Mass: Individualized Options for Preoperative Patients. Front Oncol 2022; 12:869253. [PMID: 35875092 PMCID: PMC9304864 DOI: 10.3389/fonc.2022.869253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/09/2022] [Indexed: 11/20/2022] Open
Abstract
Background To improve the preoperative diagnostic accuracy and reduce the non-therapeutic thymectomy rate, we established a comprehensive predictive nomogram based on radiomics data and computed tomography (CT) features and further explored its potential use in clinical decision-making for anterior mediastinal masses (AMMs). Methods A total of 280 patients, including 280 with unenhanced CT (UECT) and 241 with contrast-enhanced CT (CECT) scans, all of whom had undergone thymectomy for AMM with confirmed histopathology, were enrolled in this study. A total of 1,288 radiomics features were extracted from each labeled mass. The least absolute shrinkage and selection operator model was used to select the optimal radiomics features in the training set to construct the radscore. Multivariate logistic regression analysis was conducted to establish a combined clinical radiographic radscore model, and an individualized prediction nomogram was developed. Results In the UECT dataset, radscore and the UECT ratio were selected for the nomogram. The combined model achieved higher accuracy (AUC: 0.870) than the clinical model (AUC: 0.752) for the prediction of therapeutic thymectomy probability. In the CECT dataset, the clinical and combined models achieved higher accuracy (AUC: 0.851 and 0.836, respectively) than the radscore model (AUC: 0.618) for the prediction of therapeutic thymectomy probability. Conclusions In patients who underwent UECT only, a nomogram integrating the radscore and the UECT ratio achieved good accuracy in predicting therapeutic thymectomy in AMMs. However, the use of radiomics in patients with CECT scans did not improve prediction performance; therefore, a clinical model is recommended.
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Affiliation(s)
- Zhou Zhou
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yanjuan Qu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yurong Zhou
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Binchen Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Weidong Hu
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yiyuan Cao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- *Correspondence: Yiyuan Cao,
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12
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Lin CY, Yen YT, Huang LT, Chen TY, Liu YS, Tang SY, Huang WL, Chen YY, Lai CH, Fang YHD, Chang CC, Tseng YL. An MRI-Based Clinical-Perfusion Model Predicts Pathological Subtypes of Prevascular Mediastinal Tumors. Diagnostics (Basel) 2022; 12:diagnostics12040889. [PMID: 35453937 PMCID: PMC9026802 DOI: 10.3390/diagnostics12040889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/18/2022] [Accepted: 03/31/2022] [Indexed: 12/10/2022] Open
Abstract
This study aimed to build machine learning prediction models for predicting pathological subtypes of prevascular mediastinal tumors (PMTs). The candidate predictors were clinical variables and dynamic contrast–enhanced MRI (DCE-MRI)–derived perfusion parameters. The clinical data and preoperative DCE–MRI images of 62 PMT patients, including 17 patients with lymphoma, 31 with thymoma, and 14 with thymic carcinoma, were retrospectively analyzed. Six perfusion parameters were calculated as candidate predictors. Univariate receiver-operating-characteristic curve analysis was performed to evaluate the performance of the prediction models. A predictive model was built based on multi-class classification, which detected lymphoma, thymoma, and thymic carcinoma with sensitivity of 52.9%, 74.2%, and 92.8%, respectively. In addition, two predictive models were built based on binary classification for distinguishing Hodgkin from non-Hodgkin lymphoma and for distinguishing invasive from noninvasive thymoma, with sensitivity of 75% and 71.4%, respectively. In addition to two perfusion parameters (efflux rate constant from tissue extravascular extracellular space into the blood plasma, and extravascular extracellular space volume per unit volume of tissue), age and tumor volume were also essential parameters for predicting PMT subtypes. In conclusion, our machine learning–based predictive model, constructed with clinical data and perfusion parameters, may represent a useful tool for differential diagnosis of PMT subtypes.
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Affiliation(s)
- Chia-Ying Lin
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (C.-Y.L.); (L.-T.H.); (Y.-S.L.)
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-T.Y.); (W.-L.H.); (Y.-Y.C.); (Y.-L.T.)
- Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Li-Ting Huang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (C.-Y.L.); (L.-T.H.); (Y.-S.L.)
| | - Tsai-Yun Chen
- Division of Hematology and Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Yi-Sheng Liu
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (C.-Y.L.); (L.-T.H.); (Y.-S.L.)
| | - Shih-Yao Tang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 704, Taiwan;
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-T.Y.); (W.-L.H.); (Y.-Y.C.); (Y.-L.T.)
| | - Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-T.Y.); (W.-L.H.); (Y.-Y.C.); (Y.-L.T.)
| | - Chao-Han Lai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Yu-Hua Dean Fang
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Correspondence: (Y.-H.D.F.); (C.-C.C.)
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-T.Y.); (W.-L.H.); (Y.-Y.C.); (Y.-L.T.)
- Correspondence: (Y.-H.D.F.); (C.-C.C.)
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-T.Y.); (W.-L.H.); (Y.-Y.C.); (Y.-L.T.)
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Fusco R, Grassi R, Granata V, Setola SV, Grassi F, Cozzi D, Pecori B, Izzo F, Petrillo A. Artificial Intelligence and COVID-19 Using Chest CT Scan and Chest X-ray Images: Machine Learning and Deep Learning Approaches for Diagnosis and Treatment. J Pers Med 2021; 11:993. [PMID: 34683133 PMCID: PMC8540782 DOI: 10.3390/jpm11100993] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To report an overview and update on Artificial Intelligence (AI) and COVID-19 using chest Computed Tomography (CT) scan and chest X-ray images (CXR). Machine Learning and Deep Learning Approaches for Diagnosis and Treatment were identified. METHODS Several electronic datasets were analyzed. The search covered the years from January 2019 to June 2021. The inclusion criteria were studied evaluating the use of AI methods in COVID-19 disease reporting performance results in terms of accuracy or precision or area under Receiver Operating Characteristic (ROC) curve (AUC). RESULTS Twenty-two studies met the inclusion criteria: 13 papers were based on AI in CXR and 10 based on AI in CT. The summarized mean value of the accuracy and precision of CXR in COVID-19 disease were 93.7% ± 10.0% of standard deviation (range 68.4-99.9%) and 95.7% ± 7.1% of standard deviation (range 83.0-100.0%), respectively. The summarized mean value of the accuracy and specificity of CT in COVID-19 disease were 89.1% ± 7.3% of standard deviation (range 78.0-99.9%) and 94.5 ± 6.4% of standard deviation (range 86.0-100.0%), respectively. No statistically significant difference in summarized accuracy mean value between CXR and CT was observed using the Chi square test (p value > 0.05). CONCLUSIONS Summarized accuracy of the selected papers is high but there was an important variability; however, less in CT studies compared to CXR studies. Nonetheless, AI approaches could be used in the identification of disease clusters, monitoring of cases, prediction of the future outbreaks, mortality risk, COVID-19 diagnosis, and disease management.
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Affiliation(s)
- Roberta Fusco
- IGEA SpA Medical Division—Oncology, Via Casarea 65, Casalnuovo di Napoli, 80013 Naples, Italy;
| | - Roberta Grassi
- Division of Radiology, Università Degli Studi Della Campania Luigi Vanvitelli, 80138 Naples, Italy; (R.G.); (F.G.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy; (S.V.S.); (A.P.)
| | - Sergio Venanzio Setola
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy; (S.V.S.); (A.P.)
| | - Francesca Grassi
- Division of Radiology, Università Degli Studi Della Campania Luigi Vanvitelli, 80138 Naples, Italy; (R.G.); (F.G.)
| | - Diletta Cozzi
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy;
| | - Biagio Pecori
- Division of Radiotherapy and Innovative Technologies, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy;
| | - Francesco Izzo
- Division of Hepatobiliary Surgery, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy;
| | - Antonella Petrillo
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy; (S.V.S.); (A.P.)
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