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Shah UA, Ballinger TJ, Bhandari R, Dieli-Conwright CM, Guertin KA, Hibler EA, Kalam F, Lohmann AE, Ippolito JE. Imaging modalities for measuring body composition in patients with cancer: opportunities and challenges. J Natl Cancer Inst Monogr 2023; 2023:56-67. [PMID: 37139984 PMCID: PMC10157788 DOI: 10.1093/jncimonographs/lgad001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/15/2022] [Accepted: 12/30/2022] [Indexed: 05/05/2023] Open
Abstract
Body composition assessment (ie, the measurement of muscle and adiposity) impacts several cancer-related outcomes including treatment-related toxicities, treatment responses, complications, and prognosis. Traditional modalities for body composition measurement include body mass index, body circumference, skinfold thickness, and bioelectrical impedance analysis; advanced imaging modalities include dual energy x-ray absorptiometry, computerized tomography, magnetic resonance imaging, and positron emission tomography. Each modality has its advantages and disadvantages, thus requiring an individualized approach in identifying the most appropriate measure for specific clinical or research situations. Advancements in imaging approaches have led to an abundance of available data, however, the lack of standardized thresholds for classification of abnormal muscle mass or adiposity has been a barrier to adopting these measurements widely in research and clinical care. In this review, we discuss the different modalities in detail and provide guidance on their unique opportunities and challenges.
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Affiliation(s)
- Urvi A Shah
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Tarah J Ballinger
- Department of Medicine, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Rusha Bhandari
- Department of Pediatrics, City of Hope, Duarte, CA, USA
- Department of Population Science, City of Hope, Duarte, CA, USA
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Kristin A Guertin
- Department of Public Health Sciences, University of Connecticut Health, Farmington, CT, USA
| | - Elizabeth A Hibler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Faiza Kalam
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ana Elisa Lohmann
- Department of Medical Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Joseph E Ippolito
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St Louis, MO, USA
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Josselyn N, MacLean MT, Jean C, Fuchs B, Moon BF, Hwuang E, Iyer SK, Litt H, Han Y, Kaghazchi F, Bravo PE, Witschey WR. Classification of Myocardial 18F-FDG PET Uptake Patterns Using Deep Learning. Radiol Artif Intell 2021; 3:e200148. [PMID: 34350405 DOI: 10.1148/ryai.2021200148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 02/17/2021] [Accepted: 03/11/2021] [Indexed: 11/11/2022]
Abstract
Purpose To perform automated myocardial segmentation and uptake classification from whole-body fluorine 18 fluorodeoxyglucose (FDG) PET. Materials and Methods In this retrospective study, consecutive patients who underwent FDG PET imaging for oncologic indications were included (July-August 2018). The left ventricle (LV) on whole-body FDG PET images was manually segmented and classified as showing no myocardial uptake, diffuse uptake, or partial uptake. A total of 609 patients (mean age, 64 years ± 14 [standard deviation]; 309 women) were included and split between training (60%, 365 patients), validation (20%, 122 patients), and testing (20%, 122 patients) datasets. Two sequential neural networks were developed to automatically segment the LV and classify the myocardial uptake pattern using segmentation and classification training data provided by human experts. Linear regression was performed to correlate findings from human experts and deep learning. Classification performance was evaluated using receiver operating characteristic (ROC) analysis. Results There was moderate agreement of uptake pattern between experts and deep learning (as a fraction of correctly categorized images) with 78% (36 of 46) for no uptake, 71% (34 of 48) for diffuse uptake, and 71% (20 of 28) for partial uptake. There was no bias in LV volume for partial or diffuse uptake categories (P = .56); however, deep learning underestimated LV volumes in the no uptake category. There was good correlation for LV volume (R 2 = 0.35, b = .71). ROC analysis showed the area under the curve for classifying no uptake and diffuse uptake was high (> 0.90) but lower for partial uptake (0.77). The feasibility of a myocardial uptake index (MUI) for quantifying the degree of myocardial activity patterns was shown, and there was excellent visual agreement between MUI and uptake patterns. Conclusion Deep learning was able to segment and classify myocardial uptake patterns on FDG PET images.Keywords: PET, Heart, Computer Aided Diagnosis, Computer Application-Detection/DiagnosisSupplemental material is available for this article.©RSNA, 2021.
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Affiliation(s)
- Nicholas Josselyn
- Departments of Radiology (N.J., M.T.M., C.J., B.F., H.L., Y.H., F.K., P.E.B., W.R.W.), Bioengineering (B.F.M., E.H., S.K.I.), and Medicine (Y.H., P.B.), Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, South Pavilion, Room 11-155, Philadelphia, PA 19104
| | - Matthew T MacLean
- Departments of Radiology (N.J., M.T.M., C.J., B.F., H.L., Y.H., F.K., P.E.B., W.R.W.), Bioengineering (B.F.M., E.H., S.K.I.), and Medicine (Y.H., P.B.), Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, South Pavilion, Room 11-155, Philadelphia, PA 19104
| | - Christopher Jean
- Departments of Radiology (N.J., M.T.M., C.J., B.F., H.L., Y.H., F.K., P.E.B., W.R.W.), Bioengineering (B.F.M., E.H., S.K.I.), and Medicine (Y.H., P.B.), Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, South Pavilion, Room 11-155, Philadelphia, PA 19104
| | - Ben Fuchs
- Departments of Radiology (N.J., M.T.M., C.J., B.F., H.L., Y.H., F.K., P.E.B., W.R.W.), Bioengineering (B.F.M., E.H., S.K.I.), and Medicine (Y.H., P.B.), Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, South Pavilion, Room 11-155, Philadelphia, PA 19104
| | - Brianna F Moon
- Departments of Radiology (N.J., M.T.M., C.J., B.F., H.L., Y.H., F.K., P.E.B., W.R.W.), Bioengineering (B.F.M., E.H., S.K.I.), and Medicine (Y.H., P.B.), Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, South Pavilion, Room 11-155, Philadelphia, PA 19104
| | - Eileen Hwuang
- Departments of Radiology (N.J., M.T.M., C.J., B.F., H.L., Y.H., F.K., P.E.B., W.R.W.), Bioengineering (B.F.M., E.H., S.K.I.), and Medicine (Y.H., P.B.), Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, South Pavilion, Room 11-155, Philadelphia, PA 19104
| | - Srikant Kamesh Iyer
- Departments of Radiology (N.J., M.T.M., C.J., B.F., H.L., Y.H., F.K., P.E.B., W.R.W.), Bioengineering (B.F.M., E.H., S.K.I.), and Medicine (Y.H., P.B.), Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, South Pavilion, Room 11-155, Philadelphia, PA 19104
| | - Harold Litt
- Departments of Radiology (N.J., M.T.M., C.J., B.F., H.L., Y.H., F.K., P.E.B., W.R.W.), Bioengineering (B.F.M., E.H., S.K.I.), and Medicine (Y.H., P.B.), Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, South Pavilion, Room 11-155, Philadelphia, PA 19104
| | - Yuchi Han
- Departments of Radiology (N.J., M.T.M., C.J., B.F., H.L., Y.H., F.K., P.E.B., W.R.W.), Bioengineering (B.F.M., E.H., S.K.I.), and Medicine (Y.H., P.B.), Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, South Pavilion, Room 11-155, Philadelphia, PA 19104
| | - Fatemeh Kaghazchi
- Departments of Radiology (N.J., M.T.M., C.J., B.F., H.L., Y.H., F.K., P.E.B., W.R.W.), Bioengineering (B.F.M., E.H., S.K.I.), and Medicine (Y.H., P.B.), Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, South Pavilion, Room 11-155, Philadelphia, PA 19104
| | - Paco E Bravo
- Departments of Radiology (N.J., M.T.M., C.J., B.F., H.L., Y.H., F.K., P.E.B., W.R.W.), Bioengineering (B.F.M., E.H., S.K.I.), and Medicine (Y.H., P.B.), Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, South Pavilion, Room 11-155, Philadelphia, PA 19104
| | - Walter R Witschey
- Departments of Radiology (N.J., M.T.M., C.J., B.F., H.L., Y.H., F.K., P.E.B., W.R.W.), Bioengineering (B.F.M., E.H., S.K.I.), and Medicine (Y.H., P.B.), Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, South Pavilion, Room 11-155, Philadelphia, PA 19104
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