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Shi B, Xue K, Yin Y, Xu Q, Shi B, Wu D, Ye J. Grading of clear cell renal cell carcinoma using diffusion MRI with a fractional order calculus model. Acta Radiol 2022; 64:421-430. [PMID: 35040361 DOI: 10.1177/02841851211072482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The fractional order calculus (FROC) model has been developed to describe restrained motion of water molecules as well as microstructural heterogeneity, providing a novel tool for non-invasive tumor grading. PURPOSE To evaluate the role of the FROC model in characterizing clear cell renal cell carcinoma (ccRCC) grades. MATERIAL AND METHODS A total of 59 patients diagnosed with ccRCC were included in this prospective study. The diffusion metrics derived from the mono-exponential model (apparent diffusion coefficient [ADC]), intra-voxel incoherent motion [IVIM] model [D, D*, f], and FROC model [Dfroc, β, μ]) were calculated and compared between low- and high-grade ccRCCs. Binary logistic regression analysis was performed to establish the diagnostic models. Receiver operating characteristic (ROC) analysis and DeLong test were performed to evaluate and compare the diagnostic performance of metrics in grading ccRCC. RESULTS All the metrics except D* and f exhibited statistical differences between low- and high-grade ccRCCs. ROC analysis showed individual FROC parameters, μ, Dfroc, and β, outperformed ADC and IVIM parameters in grading ccRCC. For single parameter, μ demonstrated the highest AUC value, sensitivity, and diagnostic accuracy in discriminating the two ccRCC groups while β exhibited the optimal specificity. Importantly, the combination of Dfroc, μ, and β could further improve the diagnostic performance. CONCLUSION The FROC parameters were superior to ADC and IVIM parameters in grading ccRCC, indicating the great potential of the FROC model in distinguishing low- and high-grade ccRCCs.
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Affiliation(s)
- Bowen Shi
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, PR China
| | - Ke Xue
- Central Research Institute, United Imaging Healthcare, Shanghai, PR China
| | - Yili Yin
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, PR China
| | - Qing Xu
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, PR China
| | - Binbin Shi
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, PR China
| | - Dongmei Wu
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronics Science, East China Normal University, Shanghai, PR China
| | - Jing Ye
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, PR China
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Ursprung S, Woitek R, McLean MA, Priest AN, Crispin-Ortuzar M, Brodie CR, Gill AB, Gehrung M, Beer L, Riddick ACP, Field-Rayner J, Grist JT, Deen SS, Riemer F, Kaggie JD, Zaccagna F, Duarte JAG, Locke MJ, Frary A, Aho TF, Armitage JN, Casey R, Mendichovszky IA, Welsh SJ, Barrett T, Graves MJ, Eisen T, Mitchell TJ, Warren AY, Brindle KM, Sala E, Stewart GD, Gallagher FA. Hyperpolarized 13C-Pyruvate Metabolism as a Surrogate for Tumor Grade and Poor Outcome in Renal Cell Carcinoma-A Proof of Principle Study. Cancers (Basel) 2022; 14:335. [PMID: 35053497 PMCID: PMC8773685 DOI: 10.3390/cancers14020335] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 02/01/2023] Open
Abstract
Differentiating aggressive clear cell renal cell carcinoma (ccRCC) from indolent lesions is challenging using conventional imaging. This work prospectively compared the metabolic imaging phenotype of renal tumors using carbon-13 MRI following injection of hyperpolarized [1-13C]pyruvate (HP-13C-MRI) and validated these findings with histopathology. Nine patients with treatment-naïve renal tumors (6 ccRCCs, 1 liposarcoma, 1 pheochromocytoma, 1 oncocytoma) underwent pre-operative HP-13C-MRI and conventional proton (1H) MRI. Multi-regional tissue samples were collected using patient-specific 3D-printed tumor molds for spatial registration between imaging and molecular analysis. The apparent exchange rate constant (kPL) between 13C-pyruvate and 13C-lactate was calculated. Immunohistochemistry for the pyruvate transporter (MCT1) from 44 multi-regional samples, as well as associations between MCT1 expression and outcome in the TCGA-KIRC dataset, were investigated. Increasing kPL in ccRCC was correlated with increasing overall tumor grade (ρ = 0.92, p = 0.009) and MCT1 expression (r = 0.89, p = 0.016), with similar results acquired from the multi-regional analysis. Conventional 1H-MRI parameters did not discriminate tumor grades. The correlation between MCT1 and ccRCC grade was confirmed within a TCGA dataset (p < 0.001), where MCT1 expression was a predictor of overall and disease-free survival. In conclusion, metabolic imaging using HP-13C-MRI differentiates tumor aggressiveness in ccRCC and correlates with the expression of MCT1, a predictor of survival. HP-13C-MRI may non-invasively characterize metabolic phenotypes within renal cancer.
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Affiliation(s)
- Stephan Ursprung
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Ramona Woitek
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Mary A. McLean
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Andrew N. Priest
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
- Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Mireia Crispin-Ortuzar
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
| | - Cara R. Brodie
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
| | - Andrew B. Gill
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Marcel Gehrung
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
| | - Lucian Beer
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Antony C. P. Riddick
- Department of Urology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; (A.C.P.R.); (T.F.A.); (J.N.A.)
| | - Johanna Field-Rayner
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - James T. Grist
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Surrin S. Deen
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
- Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Frank Riemer
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Joshua D. Kaggie
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Fulvio Zaccagna
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Joao A. G. Duarte
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Matthew J. Locke
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Amy Frary
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Tevita F. Aho
- Department of Urology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; (A.C.P.R.); (T.F.A.); (J.N.A.)
| | - James N. Armitage
- Department of Urology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; (A.C.P.R.); (T.F.A.); (J.N.A.)
| | - Ruth Casey
- Department of Endocrinology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Iosif A. Mendichovszky
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
- Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Sarah J. Welsh
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Oncology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Tristan Barrett
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Martin J. Graves
- Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Tim Eisen
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Oncology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Thomas J. Mitchell
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Urology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; (A.C.P.R.); (T.F.A.); (J.N.A.)
- Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK
- Wellcome Sanger Institute, Hinxton CB10 1RQ, UK
| | - Anne Y. Warren
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Pathology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Kevin M. Brindle
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
| | - Evis Sala
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
| | - Grant D. Stewart
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Urology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; (A.C.P.R.); (T.F.A.); (J.N.A.)
- Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Ferdia A. Gallagher
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0QQ, UK; (S.U.); (R.W.); (M.A.M.); (M.C.-O.); (C.R.B.); (A.B.G.); (M.G.); (L.B.); (J.F.-R.); (S.S.D.); (F.R.); (J.D.K.); (F.Z.); (J.A.G.D.); (M.J.L.); (A.F.); (I.A.M.); (S.J.W.); (T.B.); (T.E.); (T.J.M.); (A.Y.W.); (K.M.B.); (E.S.); (G.D.S.)
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; (A.N.P.); (J.T.G.)
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Xv Y, Lv F, Guo H, Zhou X, Tan H, Xiao M, Zheng Y. Machine learning-based CT radiomics approach for predicting WHO/ISUP nuclear grade of clear cell renal cell carcinoma: an exploratory and comparative study. Insights Imaging 2021; 12:170. [PMID: 34800179 PMCID: PMC8605949 DOI: 10.1186/s13244-021-01107-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/09/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose To investigate the predictive performance of machine learning-based CT radiomics for differentiating between low- and high-nuclear grade of clear cell renal cell carcinomas (CCRCCs). Methods This retrospective study enrolled 406 patients with pathologically confirmed low- and high-nuclear grade of CCRCCs according to the WHO/ISUP grading system, which were divided into the training and testing cohorts. Radiomics features were extracted from nephrographic-phase CT images using PyRadiomics. A support vector machine (SVM) combined with three feature selection algorithms such as least absolute shrinkage and selection operator (LASSO), recursive feature elimination (RFE), and ReliefF was performed to determine the most suitable classification model, respectively. Clinicoradiological, radiomics, and combined models were constructed using the radiological and clinical characteristics with significant differences between the groups, selected radiomics features, and a combination of both, respectively. Model performance was evaluated by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analyses. Results SVM-ReliefF algorithm outperformed SVM-LASSO and SVM-RFE in distinguishing low- from high-grade CCRCCs. The combined model showed better prediction performance than the clinicoradiological and radiomics models (p < 0.05, DeLong test), which achieved the highest efficacy, with an area under the ROC curve (AUC) value of 0.887 (95% confidence interval [CI] 0.798–0.952), 0.859 (95% CI 0.748–0.935), and 0.828 (95% CI 0.731–0.929) in the training, validation, and testing cohorts, respectively. The calibration and decision curves also indicated the favorable performance of the combined model. Conclusion A combined model incorporating the radiomics features and clinicoradiological characteristics can better predict the WHO/ISUP nuclear grade of CCRCC preoperatively, thus providing effective and noninvasive assessment. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01107-1.
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Affiliation(s)
- Yingjie Xv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, Yuzhong, China.,Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, Yuzhong, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, Yuzhong, China
| | - Haoming Guo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, Yuzhong, China
| | - Xiang Zhou
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, Yuzhong, China
| | - Hao Tan
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, Yuzhong, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, Yuzhong, China.
| | - Yineng Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, Yuzhong, China.
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Tsili AC, Moulopoulos LA, Varakarakis IΜ, Argyropoulou MI. Cross-sectional imaging assessment of renal masses with emphasis on MRI. Acta Radiol 2021; 63:1570-1587. [PMID: 34709096 DOI: 10.1177/02841851211052999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Magnetic resonance imaging (MRI) is a useful complementary imaging tool for the diagnosis and characterization of renal masses, as it provides both morphologic and functional information. A core MRI protocol for renal imaging should include a T1-weighted sequence with in- and opposed-phase images (or, alternatively with DIXON technique), T2-weighted and diffusion-weighted images as well as a dynamic contrast-enhanced sequence with subtraction images, followed by a delayed post-contrast T1-weighted sequence. The main advantages of MRI over computed tomography include increased sensitivity for contrast enhancement, less sensitivity for detection of calcifications, absence of pseudoenhancement, and lack of radiation exposure. MRI may be applied for renal cystic lesion characterization, differentiation of renal cell carcinoma (RCC) from benign solid renal tumors, RCC histologic grading, staging, post-treatment follow-up, and active surveillance of patients with treated or untreated RCC.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Lia-Angela Moulopoulos
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Ioannis Μ Varakarakis
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, School of Medicine, University of Ioannina, Ioannina, Greece
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