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Guo J, Goyal M, Xi Y, Hinojosa L, Haddad G, Albayrak E, Pedrosa I. Style Transfer-assisted Deep Learning Method for Kidney Segmentation at Multiphase MRI. Radiol Artif Intell 2023; 5:e230043. [PMID: 38074795 PMCID: PMC10698598 DOI: 10.1148/ryai.230043] [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: 02/12/2023] [Revised: 07/28/2023] [Accepted: 08/30/2023] [Indexed: 02/12/2024]
Abstract
Purpose To develop and validate a semisupervised style transfer-assisted deep learning method for automated segmentation of the kidneys using multiphase contrast-enhanced (MCE) MRI acquisitions. Materials and Methods This retrospective, Health Insurance Portability and Accountability Act-compliant, institutional review board-approved study included 125 patients (mean age, 57.3 years; 67 male, 58 female) with renal masses. Cohort 1 consisted of 102 coronal T2-weighted MRI acquisitions and 27 MCE MRI acquisitions during the corticomedullary phase. Cohort 2 comprised 92 MCE MRI acquisitions (23 acquisitions during four phases each, including precontrast, corticomedullary, early nephrographic, and nephrographic phases). The kidneys were manually segmented on T2-weighted images. A cycle-consistent generative adversarial network (CycleGAN) was trained to generate anatomically coregistered synthetic corticomedullary style images using T2-weighted images as input. Synthetic images for precontrast, early nephrographic, and nephrographic phases were then generated using the synthetic corticomedullary images as input. Mask region-based convolutional neural networks were trained on the four synthetic phase series for kidney segmentation using T2-weighted masks. Segmentation performance was evaluated in a different cohort of 20 originally acquired MCE MRI examinations by using Dice and Jaccard scores. Results The CycleGAN network successfully generated anatomically coregistered synthetic MCE MRI-like datasets from T2-weighted acquisitions. The proposed deep learning approach for kidney segmentation achieved high mean Dice scores in all four phases of the original MCE MRI acquisitions (0.91 for precontrast, 0.92 for corticomedullary, 0.91 for early nephrographic, and 0.93 for nephrographic). Conclusion The proposed deep learning approach achieved high performance in kidney segmentation on different MCE MRI acquisitions.Keywords: Kidney Segmentation, Generative Adversarial Network, CycleGAN, Convolutional Neural Network, Transfer Learning Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
| | | | - Yin Xi
- From the Department of Radiology (J.G., M.G., Y.X., L.H., G.H., E.A.,
I.P.), Department of Urology (I.P.), and Advanced Imaging Research Center
(I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite
202, Dallas, TX 75390-9085
| | - Lauren Hinojosa
- From the Department of Radiology (J.G., M.G., Y.X., L.H., G.H., E.A.,
I.P.), Department of Urology (I.P.), and Advanced Imaging Research Center
(I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite
202, Dallas, TX 75390-9085
| | - Gaelle Haddad
- From the Department of Radiology (J.G., M.G., Y.X., L.H., G.H., E.A.,
I.P.), Department of Urology (I.P.), and Advanced Imaging Research Center
(I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite
202, Dallas, TX 75390-9085
| | - Emin Albayrak
- From the Department of Radiology (J.G., M.G., Y.X., L.H., G.H., E.A.,
I.P.), Department of Urology (I.P.), and Advanced Imaging Research Center
(I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite
202, Dallas, TX 75390-9085
| | - Ivan Pedrosa
- From the Department of Radiology (J.G., M.G., Y.X., L.H., G.H., E.A.,
I.P.), Department of Urology (I.P.), and Advanced Imaging Research Center
(I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite
202, Dallas, TX 75390-9085
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Pedrosa I, Cadeddu JA. How We Do It: Managing the Indeterminate Renal Mass with the MRI Clear Cell Likelihood Score. Radiology 2021; 302:256-269. [PMID: 34904873 PMCID: PMC8805575 DOI: 10.1148/radiol.210034] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The widespread use of cross-sectional imaging has led to a continuous increase in the number of incidentally detected indeterminate renal masses. Frequently, these clinical scenarios involve an older patient with comorbidities and a small renal mass (≤4 cm). Despite aggressive treatment in early stages of the disease, a clear positive effect in reducing kidney cancer-specific mortality is lacking, indicating that many renal cancers exhibit an indolent oncologic behavior. Furthermore, in general, one in five small renal masses is histologically benign and may not benefit from aggressive treatment. Although active surveillance is increasingly recognized as a management option for some patients, the absence of reliable clinical and imaging predictive biologic markers of aggressiveness can contribute to patient anxiety and limit its use in clinical practice. A standardized approach to the image interpretation of solid renal masses has not been broadly implemented. The clear cell likelihood score (ccLS) derived from multiparametric MRI is useful in noninvasively identifying the clear cell subtype, the most common and aggressive form of kidney cancer. Herein, a review of the ccLS is presented, including a step-by-step guide for image interpretation and additional guidance for its implementation in clinical practice.
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Affiliation(s)
- Ivan Pedrosa
- From the Department of Radiology (I.P., J.A.C.), Department of Urology (I.P., J.A.C.), and Advanced Imaging Research Center (I.P.), University of Texas Southwestern, 5323 Harry Hines Blvd, Clements Imaging Bldg, Ste 2202, MC 9085, Dallas, TX 75390
| | - Jeffrey A. Cadeddu
- From the Department of Radiology (I.P., J.A.C.), Department of Urology (I.P., J.A.C.), and Advanced Imaging Research Center (I.P.), University of Texas Southwestern, 5323 Harry Hines Blvd, Clements Imaging Bldg, Ste 2202, MC 9085, Dallas, TX 75390
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Brunsing RL, Fowler KJ, Yokoo T, Cunha GM, Sirlin CB, Marks RM. Alternative approach of hepatocellular carcinoma surveillance: abbreviated MRI. HEPATOMA RESEARCH 2020; 6:59. [PMID: 33381651 PMCID: PMC7771881 DOI: 10.20517/2394-5079.2020.50] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This review focuses on emerging abbreviated magnetic resonance imaging (AMRI) surveillance of patients with chronic liver disease for hepatocellular carcinoma (HCC). This surveillance strategy has been proposed as a high-sensitivity alternative to ultrasound for identification of patients with early-stage HCC, particularly in patients with cirrhosis or obesity, in whom sonographic visualization of small tumors may be compromised. Three general AMRI approaches have been developed and studied in the literature - non-contrast AMRI, dynamic contrast-enhanced AMRI, and hepatobiliary phase contrast-enhanced AMRI - each comprising a small number of selected sequences specifically tailored for HCC detection. The rationale, general technique, advantages and disadvantages, and diagnostic performance of each AMRI approach is explained. Additionally, current gaps in knowledge and future directions are discussed. Based on emerging evidence, we cautiously recommend the use of AMRI for HCC surveillance in situations where ultrasound is compromised.
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Affiliation(s)
- Ryan L. Brunsing
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Kathryn J. Fowler
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA 92093, USA
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Guilherme Moura Cunha
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA 92093, USA
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA 92093, USA
| | - Robert M. Marks
- Department of Radiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
- Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD 20892, USA
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Yokoo T, Singal AG, Diaz de Leon A, Ananthakrishnan L, Fetzer DT, Pedrosa I, Khatri G. Prevalence and clinical significance of discordant LI-RADS ® observations on multiphase contrast-enhanced MRI in patients with cirrhosis. Abdom Radiol (NY) 2020; 45:177-187. [PMID: 31342103 DOI: 10.1007/s00261-019-02133-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine the prevalence and clinical significance of discordant LI-RADS® (Liver Imaging Reporting and Data System) liver observations on multiphase contrast-enhanced (MCE) magnetic resonance imaging (MRI) in patients with cirrhosis. METHODS This cross-sectional study included 93 cirrhosis patients who underwent 1.5 or 3 T MCE MRI for evaluation of hepatocellular carcinoma (HCC). Two abdominal radiologists independently reviewed T1-, T2-, diffusion-weighted unenhanced images as well as MCE T1-weighted fat-suppressed images and reported liver observations using LI-RADS®. Concordance were recorded for detection (co-detected by both radiologists or not), size category (< 10; 10-19; ≥ 20 mm), and LI-RADS® category assignment as reportable (LR-3/4/5/M) and actionable (LR-4/5/M). The overall concordance (i.e., concordant in detection, size, and LR-category) was calculated with 95% confidence interval [CI], and separately for detection, size, and LR-category. Clinical significance of discordance was assessed as impact on follow-up imaging, referral for biopsy, liver transplant eligibility, or treatment modality. RESULTS Reportable and actionable observations were overall concordant between two radiologists only in 32.3% [24.6, 41.0] and 40.1% [29.5, 51.5] of cases, respectively. Poor overall concordance was related to detection concordance of 52.0% [44.3, 59.5] and 62.5% [52.3, 71.8], as well as LR-category concordance of 73.7% [61.6, 83.1] and 70.9% [57.3, 81.6], for reportable and actionable observations, respectively. Discordant LI-RADS® observations would have impacted clinical management in 30 subjects (43.5%), most (66.7%) of whom were due to discordant detection. CONCLUSION Discordant MRI LI-RADS® observations are common in patients with cirrhosis and may have potential implications for patient management.
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Affiliation(s)
- Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA.
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Amit G Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alberto Diaz de Leon
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA
| | - Lakshmi Ananthakrishnan
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA
| | - David T Fetzer
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA
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Khatri G, Pedrosa I, Ananthakrishnan L, Leon AD, Fetzer DT, Leyendecker J, Singal AG, Xi Y, Yopp A, Yokoo T. Abbreviated‐protocol screening MRI vs. complete‐protocol diagnostic MRI for detection of hepatocellular carcinoma in patients with cirrhosis: An equivalence study using LI‐RADS v2018. J Magn Reson Imaging 2019; 51:415-425. [DOI: 10.1002/jmri.26835] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Gaurav Khatri
- Department of RadiologyUniversity of Texas Southwestern Medical Center Dallas Texas
| | - Ivan Pedrosa
- Department of RadiologyUniversity of Texas Southwestern Medical Center Dallas Texas
| | | | - Alberto Diaz Leon
- Department of RadiologyUniversity of Texas Southwestern Medical Center Dallas Texas
| | - David T. Fetzer
- Department of RadiologyUniversity of Texas Southwestern Medical Center Dallas Texas
| | - John Leyendecker
- Department of RadiologyUniversity of Texas Southwestern Medical Center Dallas Texas
| | - Amit G. Singal
- Department of Internal MedicineUniversity of Texas Southwestern Medical Center Dallas Texas
| | - Yin Xi
- Department of RadiologyUniversity of Texas Southwestern Medical Center Dallas Texas
| | - Adam Yopp
- Department of SurgeryUniversity of Texas Southwestern Medical Center Dallas Texas
| | - Takeshi Yokoo
- Department of RadiologyUniversity of Texas Southwestern Medical Center Dallas Texas
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