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Chen HY, Pan Y, Chen JY, Chen J, Liu LL, Yang YB, Li K, Ma Q, Shi L, Yu RS, Shao GL. Machine Learning Methods Based on CT Features Differentiate G1/G2 From G3 Pancreatic Neuroendocrine Tumors. Acad Radiol 2024; 31:1898-1905. [PMID: 38052672 DOI: 10.1016/j.acra.2023.10.040] [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: 08/05/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 12/07/2023]
Abstract
RATIONALE AND OBJECTIVES To identify CT features for distinguishing grade 1 (G1)/grade 2 (G2) from grade 3 (G3) pancreatic neuroendocrine tumors (PNETs) using different machine learning (ML) methods. MATERIALS AND METHODS A total of 147 patients with 155 lesions confirmed by pathology were retrospectively included. Clinical-demographic and radiological CT features was collected. The entire cohort was separated into training and validation groups at a 7:3 ratio. Least absolute shrinkage and selection operator (LASSO) algorithm and principal component analysis (PCA) were used to select features. Three ML methods, namely logistic regression (LR), support vector machine (SVM), and K-nearest neighbor (KNN) were used to build a differential model. Receiver operating characteristic (ROC) curves and precision-recall curves for each ML method were generated. The area under the curve (AUC), accuracy rate, sensitivity, and specificity were calculated. RESULTS G3 PNETs were more likely to present with invasive behaviors and lower enhancement than G1/G2 PNETs. The LR classifier yielded the highest AUC of 0.964 (95% confidence interval [CI]: 0.930, 0.972), with 95.4% accuracy rate, 95.7% sensitivity, and 92.9% specificity, followed by SVM (AUC: 0.957) and KNN (AUC: 0.893) in the training group. In the validation group, the SVM classier reached the highest AUC of 0.952 (95% CI: 0.860, 0.981), with 91.5% accuracy rate, 97.3% sensitivity, and 70% specificity, followed by LR (AUC: 0.949) and KNN (AUC: 0.923). CONCLUSIONS The LR and SVM classifiers had the best performance in the training group and validation group, respectively. ML method could be helpful in differentiating between G1/G2 and G3 PNETs.
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Affiliation(s)
- Hai-Yan Chen
- Department of Radiology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, Zhejiang, China (H.-Y.C., J.-Y.C., L.-L.L., Y.-B.Y., K.L., Q.M., L.S.)
| | - Yao Pan
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, China (Y.P., R.-S.Y.)
| | - Jie-Yu Chen
- Department of Radiology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, Zhejiang, China (H.-Y.C., J.-Y.C., L.-L.L., Y.-B.Y., K.L., Q.M., L.S.)
| | - Jia Chen
- Research Center for Healthcare Data Science, Zhejiang Lab, Hangzhou 311121, Zhejiang Province, China (J.C.)
| | - Lu-Lu Liu
- Department of Radiology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, Zhejiang, China (H.-Y.C., J.-Y.C., L.-L.L., Y.-B.Y., K.L., Q.M., L.S.)
| | - Yong-Bo Yang
- Department of Radiology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, Zhejiang, China (H.-Y.C., J.-Y.C., L.-L.L., Y.-B.Y., K.L., Q.M., L.S.)
| | - Kai Li
- Department of Radiology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, Zhejiang, China (H.-Y.C., J.-Y.C., L.-L.L., Y.-B.Y., K.L., Q.M., L.S.)
| | - Qian Ma
- Department of Radiology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, Zhejiang, China (H.-Y.C., J.-Y.C., L.-L.L., Y.-B.Y., K.L., Q.M., L.S.)
| | - Lei Shi
- Department of Radiology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, Zhejiang, China (H.-Y.C., J.-Y.C., L.-L.L., Y.-B.Y., K.L., Q.M., L.S.)
| | - Ri-Sheng Yu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, China (Y.P., R.-S.Y.)
| | - Guo-Liang Shao
- Department of Interventional Radiology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, Zhejiang Province, China (G.-L.S.); Clinical Research Center of Hepatobiliary and pancreatic diseases of Zhejiang Province, Hangzhou 310006, Zhejiang Province, China (G.-L.S.).
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Liu W, Xie T, Chen L, Tang W, Zhang Z, Wang Y, Deng W, Xie X, Zhou Z. Dual-layer spectral detector CT: A noninvasive preoperative tool for predicting histopathological differentiation in pancreatic ductal adenocarcinoma. Eur J Radiol 2024; 173:111327. [PMID: 38330535 DOI: 10.1016/j.ejrad.2024.111327] [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: 08/31/2023] [Revised: 12/26/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To predict histopathological differentiation grades in patients with pancreatic ductal adenocarcinoma (PDAC) before surgery with quantitative and qualitative variables obtained from dual-layer spectral detector CT (DLCT). METHODS Totally 128 patients with histopathologically confirmed PDAC and preoperative DLCT were retrospectively enrolled and categorized into the low-grade (LG) (well and moderately differentiated, n = 82) and high-grade (HG) (poorly differentiated, n = 46) subgroups. Both conventional and spectral variables for PDAC were measured. The ratio of iodine concentration (IC) values in arterial phase(AP) and venous phase (VP) was defined as iodine enhancement fraction_AP/VP (IEF_AP/VP). Necrosis was visually assessed on both conventional CT images (necrosis_con) and virtual mono-energetic images (VMIs) at 40 keV (necrosis_40keV). Forward stepwise logistic regression method was conducted to perform univariable and multivariable analysis. Receiver operating characteristic (ROC) curves and the DeLong method were used to evaluate and compare the efficiencies of variables in predicting tumor grade. RESULTS Necrosis_con (odds ratio [OR] = 2.84, 95% confidence interval [CI]: 1.13-7.13; p < 0.001) was an independent predictor among conventional variables, and necrosis_40keV (OR = 5.82, 95% CI: 1.98-17.11; p = 0.001) and IEF_AP/VP (OR = 1.12, 95% CI:1.07-1.17; p < 0.001) were independent predictors among spectral variables for distinguishing LG PDAC from HG PDAC. IEF_AP/VP (AUC = 0.754, p = 0.016) and combination model (AUC = 0.812, p < 0.001) had better predictive performances than necrosis_con (AUC = 0.580). The combination model yielded the highest sensitivity (72%) and accuracy (79%), while IEF_AP/VP exhibited the highest specificity (89%). CONCLUSION Variables derived from DLCT have the potential to preoperatively evaluate PDAC tumor grade. Furthermore, spectral variables and their combination exhibited superior predictive performances than conventional CT variables.
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Affiliation(s)
- Wei Liu
- Department of Radiology, Fudan University Shanghai Cancer Center & Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Tiansong Xie
- Department of Radiology, Fudan University Shanghai Cancer Center & Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Lei Chen
- Department of Radiology, Minhang Branch, Fudan University Shanghai Cancer Center, Shanghai 201100, China
| | - Wei Tang
- Department of Radiology, Fudan University Shanghai Cancer Center & Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Zehua Zhang
- Department of Radiology, Minhang Branch, Fudan University Shanghai Cancer Center, Shanghai 201100, China
| | - Yu Wang
- Clinical and Technical Support, Philips Healthcare, Shanghai 200072, China
| | - Weiwei Deng
- Clinical and Technical Support, Philips Healthcare, Shanghai 200072, China
| | - Xuebin Xie
- Department of Radiology, Kiang Wu Hospital, Macao 999078, China.
| | - Zhengrong Zhou
- Department of Radiology, Fudan University Shanghai Cancer Center & Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Radiology, Minhang Branch, Fudan University Shanghai Cancer Center, Shanghai 201100, China.
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Hu X, Shi S, Wang Y, Yuan J, Chen M, Wei L, Deng W, Feng ST, Peng Z, Luo Y. Dual-energy CT improves differentiation of non-hypervascular pancreatic neuroendocrine neoplasms from CA 19-9-negative pancreatic ductal adenocarcinomas. LA RADIOLOGIA MEDICA 2024; 129:1-13. [PMID: 37861978 DOI: 10.1007/s11547-023-01733-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE To evaluate the utility of dual-energy CT (DECT) in differentiating non-hypervascular pancreatic neuroendocrine neoplasms (PNENs) from pancreatic ductal adenocarcinomas (PDACs) with negative carbohydrate antigen 19-9 (CA 19-9). METHODS This retrospective study included 26 and 39 patients with pathologically confirmed non-hypervascular PNENs and CA 19-9-negative PDACs, respectively, who underwent contrast-enhanced DECT before treatment between June 2019 and December 2021. The clinical, conventional CT qualitative, conventional CT quantitative, and DECT quantitative parameters of the two groups were compared using univariate analysis and selected by least absolute shrinkage and selection operator regression (LASSO) analysis. Multivariate logistic regression analyses were performed to build qualitative, conventional CT quantitative, DECT quantitative, and comprehensive models. The areas under the receiver operating characteristic curve (AUCs) of the models were compared using DeLong's test. RESULTS The AUCs of the DECT quantitative (based on normalized iodine concentrations [nICs] in the arterial and portal venous phases: 0.918; 95% confidence interval [CI] 0.852-0.985) and comprehensive (based on tumour location and nICs in the arterial and portal venous phases: 0.966; 95% CI 0.889-0.995) models were higher than those of the qualitative (based on tumour location: 0.782; 95% CI 0.665-0.899) and conventional CT quantitative (based on normalized conventional CT attenuation in the arterial phase: 0.665; 95% CI 0.533-0.797; all P < 0.05) models. The DECT quantitative and comprehensive models had comparable performances (P = 0.076). CONCLUSIONS Higher nICs in the arterial and portal venous phases were associated with higher blood supply improving the identification of non-hypervascular PNENs.
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Affiliation(s)
- Xuefang Hu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518000, Guangdong, China
| | - Siya Shi
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Yangdi Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Jiaxin Yuan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Mingjie Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Luyong Wei
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Weiwei Deng
- Clinical and Technical Support, Philips Healthcare China, Shanghai, 200072, China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Zhenpeng Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China.
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China.
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Wang S, Zhang Y, Xu Y, Yang P, Liu C, Gong H, Lei J. Progress in the application of dual-energy CT in pancreatic diseases. Eur J Radiol 2023; 168:111090. [PMID: 37742372 DOI: 10.1016/j.ejrad.2023.111090] [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: 07/01/2023] [Revised: 08/19/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
Pancreatic diseases are difficult to diagnose due to their insidious onset and complex pathophysiological developmental characteristics. In recent years, dual-energy computed tomography (DECT) imaging technology has rapidly advanced. DECT can quantitatively extract and analyze medical imaging features and establish a correlation between these features and clinical results. This feature enables the adoption of more modern and accurate clinical diagnosis and treatment strategies for patients with pancreatic diseases so as to achieve the goal of non-invasive, low-cost, and personalized treatment. The purpose of this review is to elaborate on the application of DECT for the diagnosis, biological characterization, and prediction of the survival of patients with pancreatic diseases (including pancreatitis, pancreatic cancer, pancreatic cystic tumor, pancreatic neuroendocrine tumor, and pancreatic injury) and to summarize its current limitations and future research prospects.
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Affiliation(s)
- Sha Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China
| | - Yanli Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China; Department of Radiology, The First Hospital of Lanzhou University, Lanzhou 730000, China; Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou 730000, China
| | - Yongsheng Xu
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China; Department of Radiology, The First Hospital of Lanzhou University, Lanzhou 730000, China; Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou 730000, China
| | - Pengcheng Yang
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Chuncui Liu
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China
| | - Hengxin Gong
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China
| | - Junqiang Lei
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China; Department of Radiology, The First Hospital of Lanzhou University, Lanzhou 730000, China; Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou 730000, China.
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Tan X, Yang X, Hu S, Chen X, Sun Z. A nomogram for predicting postoperative complications based on tumor spectral CT parameters and visceral fat area in gastric cancer patients. Eur J Radiol 2023; 167:111072. [PMID: 37666073 DOI: 10.1016/j.ejrad.2023.111072] [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: 05/17/2023] [Revised: 08/12/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To construct a nomogram combining tumor spectral CT parameters and visceral fat area (VFA) to predict postoperative complications (POCs) in patients with gastric cancer (GC). METHOD This retrospective study included 101 GC patients who underwent preoperative abdominal spectral CT scan and were divided into two groups (37 with POCs and 64 without POCs) according to the Clavien-Dindo classification standard. Logistic regression was used to establish spectral, VFA, and combined models for predicting POCs. The combined prediction model was presented as a nomogram, and the diagnostic performance of each model was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS The AUCs of the VFA and spectral model were 0.71 (95% CI: 0.62-0.80) and 0.81 (95% CI: 0.72-0.88), respectively. VFA, the slope of spectral curve (λ) in venous phase (λ-VP) and tumor Hounsfield units on monoenergetic images 40 keV in VP (MonoE40keV-VP) were independent predictors of POCs in GC. The nomogram yielded an AUC of 0.89 (95% CI: 0.81-0.94). The combined model was superior to the VFA or spectral models by comparing their AUCs (P = 0.000 and 0.022). CONCLUSIONS The nomogram based on two tumor spectral parameters (λ-VP, MonoE40keV-VP) and VFA could serve as a convenient tool for predicting the POCs of GC patients.
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Affiliation(s)
- Xiaoying Tan
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi City 214062, Jiangsu Province, China
| | - Xiao Yang
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi City 214062, Jiangsu Province, China
| | - Shudong Hu
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi City 214062, Jiangsu Province, China
| | - Xingbiao Chen
- Department of Clinical Science, Philips Healthcare, Shanghai 200233, China
| | - Zongqiong Sun
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi City 214062, Jiangsu Province, China.
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Wang Y, Tian W, Tian S, He L, Xia J, Zhang J. Spectral CT - a new supplementary method for preoperative assessment of pathological grades of esophageal squamous cell carcinoma. BMC Med Imaging 2023; 23:110. [PMID: 37612644 PMCID: PMC10464448 DOI: 10.1186/s12880-023-01068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/31/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Spectral CT imaging parameters have been reported to be useful in the differentiation of pathological grades in different malignancies. This study aims to investigate the value of spectral CT in the quantitative assessment of esophageal squamous cell carcinoma (ESCC) with different degrees of differentiation. METHODS There were 191 patients with proven ESCC who underwent enhanced spectral CT from June 2018 to March 2020 retrospectively enrolled. These patients were divided into three groups based on pathological results: well differentiated ESCC, moderately differentiated ESCC, and poorly differentiated ESCC. Virtual monoenergetic 40 keV-equivalent image (VMI40keV), iodine concentration (IC), water concentration (WC), effective atomic number (Eff-Z), and the slope of the spectral curve(λHU) of the arterial phase (AP) and venous phase (VP) were measured or calculated. The quantitative parameters of the three groups were compared by using one-way ANOVA and pairwise comparisons were performed with LSD. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of these parameters in poorly differentiated groups and non-poorly differentiated groups. RESULTS There were significant differences in VMI40keV, IC, Eff-Z, and λHU in AP and VP among the three groups (all p < 0.05) except for WC (p > 0.05). The VMI40keV, IC, Eff-Z, and λHU in the poorly differentiated group were significantly higher than those in the other groups both in AP and VP (all p < 0.05). In the ROC analysis, IC performed the best in the identification of the poorly differentiated group and non-poorly differentiated group in VP (AUC = 0.729, Sensitivity = 0.829, and Specificity = 0.569 under the threshold of 21.08 mg/ml). CONCLUSIONS Quantitative parameters of spectral CT could offer supplemental information for the preoperative differential diagnosis of ESCC with different degrees of differentiation.
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Affiliation(s)
- Yi Wang
- Department of Radiology, Taizhou People's Hospital, NO.366 Taihu Road, Yiyaogaoxin District, Taizhou, 225300, Jiangsu, China
| | - Weizhong Tian
- Department of Radiology, Taizhou People's Hospital, NO.366 Taihu Road, Yiyaogaoxin District, Taizhou, 225300, Jiangsu, China
| | - Shuangfeng Tian
- Department of Radiology, Taizhou People's Hospital, NO.366 Taihu Road, Yiyaogaoxin District, Taizhou, 225300, Jiangsu, China
| | - Liang He
- Department of Radiology, Taizhou People's Hospital, NO.366 Taihu Road, Yiyaogaoxin District, Taizhou, 225300, Jiangsu, China
| | - Jianguo Xia
- Department of Radiology, Taizhou People's Hospital, NO.366 Taihu Road, Yiyaogaoxin District, Taizhou, 225300, Jiangsu, China.
| | - Ji Zhang
- Department of Radiology, Taizhou People's Hospital, NO.366 Taihu Road, Yiyaogaoxin District, Taizhou, 225300, Jiangsu, China.
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Lim W, Sodemann EB, Büttner L, Jonczyk M, Lüdemann WM, Kahn J, Geisel D, Jann H, Aigner A, Böning G. Spectral Computed Tomography-Derived Iodine Content and Tumor Response in the Follow-Up of Neuroendocrine Tumors-A Single-Center Experience. Curr Oncol 2023; 30:1502-1515. [PMID: 36826076 PMCID: PMC9954990 DOI: 10.3390/curroncol30020115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/08/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
Spectral computed tomography (SCT) allows iodine content (IC) calculation for characterization of hypervascularized neoplasms and thus might help in the staging of neuroendocrine tumors (NETs). This single-center prospective study analyzed the association between SCT-derived IC and tumor response in the follow-up of metastasized NETs. Twenty-six patients with a median age of 70 years (range 51-85) with histologically proven NETs and a total of 78 lesions underwent SCT for staging. Because NETS are rare, no primary NET types were excluded. Lesions and intralesional hotspots were measured in virtual images and iodine maps. Tumor response was classified as progressive or nonprogressive at study endpoint. Generalized estimating equations served to estimate associations between IC and tumor response, additionally stratified by lesion location. Most commonly affected sites were the lymph nodes, liver, pancreas, and bones. Median time between SCT and endpoint was 64 weeks (range 5-260). Despite statistical imprecision in the estimate, patients with higher IC in lymphonodular metastases had lower odds for disease progression (adjusted OR = 0.21, 95% CI: 0.02-2.02). Opposite tendencies were observed in hepatic and pancreatic metastases in unadjusted analyses, which vanished after adjusting for therapy and primary tumor grade.
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Affiliation(s)
- Winna Lim
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
- Correspondence:
| | - Elisa Birgit Sodemann
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Laura Büttner
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Martin Jonczyk
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Willie Magnus Lüdemann
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Johannes Kahn
- Institute of Neuroradiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Henning Jann
- Department of Hepatology and Gastroenterology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Annette Aigner
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Georg Böning
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
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Qualitative imaging features of pancreatic neuroendocrine neoplasms predict histopathologic characteristics including tumor grade and patient outcome. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3971-3985. [PMID: 35166939 DOI: 10.1007/s00261-022-03430-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To identify PanNEN imaging features associated with tumor grade and aggressive histopathological features. METHODS Associations between histopathological and imaging features of resected PanNEN were retrospectively tested. Histopathologic features included WHO grade, lymphovascular invasion (LVI), growth pattern (infiltrative, circumscribed), and intratumoral fibrosis (mature, immature). Imaging features included size, degree/uniformity of enhancement, progressive enhancement, contour, infiltrative appearance (infiltrativeim), calcifications, cystic components, tumor thrombus, vascular occlusion (VO), duct dilatation, and atrophy. Multinomial logistic regression analyses evaluated the magnitude of associations. Association of variables with outcome was assessed using Cox-proportional hazards regression. RESULTS 133 patients were included. 3 imaging features (infiltrativeim, ill-defined contour [contourill], and VO) were associated with all histopathologic parameters and poor outcome. Increase in grade increased odds of contourill by 15.6 times (p = 0.0001, 95% CI 3.8-64.4). PanNEN with VO were 51.1 times (p = 0.0002, 6.5-398.6) more likely to demonstrate LVI. For PanNEN with contourill, infiltrative growth pattern was 51.3 times (p < 0.0001, 9.1-288.4), and fibrosis was 14 times (p = 0.0065, 2.1-93.7) more likely. Contourill was associated with decreased recurrence-free survival (p = 0.0003, HR 18.29, 3.83-87.3) and VO (p = 0.0004, HR6.08, 2.22-16.68) with decreased overall survival. CONCLUSIONS Infiltrativeim, contourill, and VO on imaging are associated with higher grade/histopathological parameters linked to tumor aggression, and poor outcome.
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Fu M, Yu L, Yang L, Chen Y, Chen X, Hu Q, Sun H. Gender differences in pancreatic neuroendocrine neoplasms: A retrospective study based on the population of Hubei Province, China. Front Endocrinol (Lausanne) 2022; 13:885895. [PMID: 36004340 PMCID: PMC9393376 DOI: 10.3389/fendo.2022.885895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aims of the present study were to investigate gender differences in the clinicopathological features, distant metastasis and prognosis of pancreatic neuroendocrine neoplasms (pNENs) in a Chinese population, and to identify any important gaps in the classification and management of pNENs relative to gender. METHODS Retrospective collection of the clinicopathological data of 193 patients with pathologically confirmed pNENs were analyzed and follow up was extended to observe the prognosis of the disease. Differences between genders in basic characteristics, clinical symptoms, comorbidities, and tumor parameters were analyzed. RESULTS There was no significant difference in females and males, however, moderately higher for females (52.8% vs. 47.2%), with the largest subgroup being 40~60 years of age (54.9%). Age at onset (P=0.002) and age at diagnosis (P=0.005) were both younger in females compared to males. Males lived more in urban areas and females lived more in rural areas (P=0.047). The proportion of smokers and alcohol drinkers was significantly higher in males than in females (P < 0.001). Non-functional pNENs were more frequent in males and functional pNENs in females (P=0.032). In women, functional status of the tumor was significantly associated with metastatic outcome (P=0.007) and functional tumors proved to be a protective factor compared to non-functional tumors (OR=0.090,95% CI: 0.011~ 0.752). There were no gender differences in tumor size, location, grade, stage or prognosis. CONCLUSIONS Gender differences in some clinicopathological features, and distant metastasis in patients with pNENs were identified, which suggested certain management details that justified emphasis based on gender.
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Affiliation(s)
- Mengfei Fu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Endocrinology, Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Li Yu
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liu Yang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Endocrinology, Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Yang Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Endocrinology, Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Xiao Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Endocrinology, Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Qinyu Hu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Endocrinology, Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Hui Sun
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Endocrinology, Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
- *Correspondence: Hui Sun,
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Spectral CT in clinical routine imaging of neuroendocrine neoplasms. Clin Radiol 2021; 76:348-357. [PMID: 33610290 DOI: 10.1016/j.crad.2020.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022]
Abstract
AIM To evaluate the potential of new spectral computed tomography (SCT)-based tools in patients with neuroendocrine neoplasms (NEN). MATERIAL AND METHODS Eighty-eight consecutive patients with NENs were included prospectively. The patients underwent multiphase CT with spectral and standard mode. The signal-to-noise ratio (SNR)/contrast-to-noise-ratio (CNR)tumour-to-liver, iodine concentrations (ICs, total tumour/hotspot) and attenuation slopes in virtual monochromatic images (VMIs) were used to assess NEN-specific SCT values in primary tumours and metastatic lesions and investigate a possible lesion contrast improvement as well as possible correlations of SCT parameters to primary tumour location and tumour grade. Furthermore, the usability of SCT parameters to differentiate between the primary tumour and metastatic lesions, and to predict tumour response after 6-months follow-up was analyzed. The applied dose of spectral and standard mode was compared intra-individually. RESULTS SNR/CNRtumour-to-liver significantly increased in low-energy VMIs. NENs showed significant differences in ICs between primary and metastatic lesions for both absolute and normalised values (p<0.001) regardless of whether the total tumour or the hotspot was measured. There was also a significant difference in the attenuation slope (p<0.001). No significant correlations were found between SCT and tumour grade. A tumour response prediction by SCT parameters was not possible. The applied dose was comparable between the scan modes. CONCLUSION SCT was comparable regarding applied dose, improved tumour contrast, and contributed to differentiation between primary NEN and metastasis.
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Bicci E, Cozzi D, Ferrari R, Grazzini G, Pradella S, Miele V. Pancreatic neuroendocrine tumours: spectrum of imaging findings. Gland Surg 2020; 9:2215-2224. [PMID: 33447574 DOI: 10.21037/gs-20-537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Pancreatic neuroendocrine tumours (pNETs) are rare and heterogeneous group of neoplasms presenting with a wide variety of symptoms and biological behaviour, from indolent to aggressive ones. pNETs are stratified into functional or non-functional, because of their ability to produce metabolically active hormones. pNETs can be an isolate phenomenon or a part of a hereditary syndrome like von Hippel-Lindau syndrome or neurofibromatosis-1. The incidence has increased in the last years, also because of the improvement of cross-sectional imaging. Computed tomography (CT), magnetic resonance imaging (MRI) and functional imaging are the mainstay imaging modalities used for tumour detection and disease extension assessment, due to easy availability and better contrast/spatial resolution. Radiological imaging plays a fundamental role in detection, characterization and surveillance of pNETs and is involved in almost every stage of patients' management. Moreover, with specific indications and techniques, interventional radiology can also play a role in therapeutic management. Surgery is the treatment of choice, consisting of either partial pancreatectomy or enucleation of the primary tumour. This article reviews the radiologic features of different pNETs as well as imaging mimics, in order to help radiologists to avoid potential pitfalls, to reach the correct diagnosis and to support the multidisciplinary team in establishing the right treatment.
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Affiliation(s)
- Eleonora Bicci
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Riccardo Ferrari
- Department of Emergency Radiology, San Camillo Forlanini Hospital, Rome, Italy
| | - Giulia Grazzini
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Silvia Pradella
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
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