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Zhang D, Du J, Shi J, Zhang Y, Jia S, Liu X, Wu Y, An Y, Zhu S, Pan D, Zhang W, Zhang Y, Feng S. A fully automatic MRI-guided decision support system for lumbar disc herniation using machine learning. JOR Spine 2024; 7:e1342. [PMID: 38817341 PMCID: PMC11137648 DOI: 10.1002/jsp2.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/25/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024] Open
Abstract
Background Normalized decision support system for lumbar disc herniation (LDH) will improve reproducibility compared with subjective clinical diagnosis and treatment. Magnetic resonance imaging (MRI) plays an essential role in the evaluation of LDH. This study aimed to develop an MRI-based decision support system for LDH, which evaluates lumbar discs in a reproducible, consistent, and reliable manner. Methods The research team proposed a system based on machine learning that was trained and tested by a large, manually labeled data set comprising 217 patients' MRI scans (3255 lumbar discs). The system analyzes the radiological features of identified discs to diagnose herniation and classifies discs by Pfirrmann grade and MSU classification. Based on the assessment, the system provides clinical advice. Results Eventually, the accuracy of the diagnosis process reached 95.83%. An 83.5% agreement was observed between the system's prediction and the ground-truth in the Pfirrmann grade. In the case of MSU classification, 95.0% precision was achieved. With the assistance of this system, the accuracy, interpretation efficiency and interrater agreement among surgeons were improved substantially. Conclusion This system showed considerable accuracy and efficiency, and therefore could serve as an objective reference for the diagnosis and treatment procedure in clinical practice.
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Affiliation(s)
- Di Zhang
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Jiawei Du
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Jiaxiao Shi
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Yundong Zhang
- Beijing Longwood Valley CompanyBeijingPeople's Republic of China
| | - Siyue Jia
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Xingyu Liu
- Beijing Longwood Valley CompanyBeijingPeople's Republic of China
| | - Yu Wu
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Yicheng An
- Beijing Longwood Valley CompanyBeijingPeople's Republic of China
| | - Shibo Zhu
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Dayu Pan
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Wei Zhang
- School of Control Science and Engineering, Shandong UniversityJinanPeople's Republic of China
| | - Yiling Zhang
- Beijing Longwood Valley CompanyBeijingPeople's Republic of China
| | - Shiqing Feng
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
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Tang J, Zheng X, Wang X, Mao Q, Xie L, Wang R. Computer-aided detection of prostate cancer in early stages using multi-parameter MRI: A promising approach for early diagnosis. Technol Health Care 2024; 32:125-133. [PMID: 38759043 PMCID: PMC11191472 DOI: 10.3233/thc-248011] [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] [Indexed: 05/19/2024]
Abstract
BACKGROUND Transrectal ultrasound-guided prostate biopsy is the gold standard diagnostic test for prostate cancer, but it is an invasive examination of non-targeted puncture and has a high false-negative rate. OBJECTIVE In this study, we aimed to develop a computer-assisted prostate cancer diagnosis method based on multiparametric MRI (mpMRI) images. METHODS We retrospectively collected 106 patients who underwent radical prostatectomy after diagnosis with prostate biopsy. mpMRI images, including T2 weighted imaging (T2WI), diffusion weighted imaging (DWI), and dynamic-contrast enhanced (DCE), and were accordingly analyzed. We extracted the region of interest (ROI) about the tumor and benign area on the three sequential MRI axial images at the same level. The ROI data of 433 mpMRI images were obtained, of which 202 were benign and 231 were malignant. Of those, 50 benign and 50 malignant images were used for training, and the 333 images were used for verification. Five main feature groups, including histogram, GLCM, GLGCM, wavelet-based multi-fractional Brownian motion features and Minkowski function features, were extracted from the mpMRI images. The selected characteristic parameters were analyzed by MATLAB software, and three analysis methods with higher accuracy were selected. RESULTS Through prostate cancer identification based on mpMRI images, we found that the system uses 58 texture features and 3 classification algorithms, including Support Vector Machine (SVM), K-nearest Neighbor (KNN), and Ensemble Learning (EL), performed well. In the T2WI-based classification results, the SVM achieved the optimal accuracy and AUC values of 64.3% and 0.67. In the DCE-based classification results, the SVM achieved the optimal accuracy and AUC values of 72.2% and 0.77. In the DWI-based classification results, the ensemble learning achieved optimal accuracy as well as AUC values of 75.1% and 0.82. In the classification results based on all data combinations, the SVM achieved the optimal accuracy and AUC values of 66.4% and 0.73. CONCLUSION The proposed computer-aided diagnosis system provides a good assessment of the diagnosis of the prostate cancer, which may reduce the burden of radiologists and improve the early diagnosis of prostate cancer.
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Affiliation(s)
- Jianer Tang
- Department of Urology, First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang, China
- Department of Urology, First Affiliated Hospital of Huzhou Teachers College, Huzhou, Zhejiang, China
| | - Xiangyi Zheng
- Department of Urology, First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiao Wang
- Department of Urology, First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang, China
| | - Qiqi Mao
- Department of Urology, First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang, China
| | - Liping Xie
- Department of Urology, First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang, China
| | - Rongjiang Wang
- Department of Urology, First Affiliated Hospital of Huzhou Teachers College, Huzhou, Zhejiang, China
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Tsui JMG, Kehayias CE, Leeman JE, Nguyen PL, Peng L, Yang DD, Moningi S, Martin N, Orio PF, D'Amico AV, Bredfeldt JS, Lee LK, Guthier CV, King MT. Assessing the Feasibility of Using Artificial Intelligence-Segmented Dominant Intraprostatic Lesion for Focal Intraprostatic Boost With External Beam Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 118:74-84. [PMID: 37517600 DOI: 10.1016/j.ijrobp.2023.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE The delineation of dominant intraprostatic gross tumor volumes (GTVs) on multiparametric magnetic resonance imaging (mpMRI) can be subject to interobserver variability. We evaluated whether deep learning artificial intelligence (AI)-segmented GTVs can provide a similar degree of intraprostatic boosting with external beam radiation therapy (EBRT) as radiation oncologist (RO)-delineated GTVs. METHODS AND MATERIALS We identified 124 patients who underwent mpMRI followed by EBRT between 2010 and 2013. A reference GTV was delineated by an RO and approved by a board-certified radiologist. We trained an AI algorithm for GTV delineation on 89 patients, and tested the algorithm on 35 patients, each with at least 1 PI-RADS (Prostate Imaging Reporting and Data System) 4 or 5 lesion (46 total lesions). We then asked 5 additional ROs to independently delineate GTVs on the test set. We compared lesion detectability and geometric accuracy of the GTVs from AI and 5 ROs against the reference GTV. Then, we generated EBRT plans (77 Gy prostate) that boosted each observer-specific GTV to 95 Gy. We compared reference GTV dose (D98%) across observers using a mixed-effects model. RESULTS On a lesion level, AI GTV exhibited a sensitivity of 82.6% and positive predictive value of 86.4%. Respective ranges among the 5 RO GTVs were 84.8% to 95.7% and 95.1% to 100.0%. Among 30 GTVs mutually identified by all observers, no significant differences in Dice coefficient were detected between AI and any of the 5 ROs. Across all patients, only 2 of 5 ROs had a reference GTV D98% that significantly differed from that of AI by 2.56 Gy (P = .02) and 3.20 Gy (P = .003). The presence of false-negative (-5.97 Gy; P < .001) but not false-positive (P = .24) lesions was associated with reference GTV D98%. CONCLUSIONS AI-segmented GTVs demonstrate potential for intraprostatic boosting, although the degree of boosting may be adversely affected by false-negative lesions. Prospective review of AI-segmented GTVs remains essential.
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Affiliation(s)
- James M G Tsui
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Christopher E Kehayias
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jonathan E Leeman
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Luke Peng
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - David D Yang
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Shalini Moningi
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Neil Martin
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Peter F Orio
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anthony V D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jeremy S Bredfeldt
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Leslie K Lee
- Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Christian V Guthier
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Martin T King
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
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Bertelli E, Mercatelli L, Marzi C, Pachetti E, Baccini M, Barucci A, Colantonio S, Gherardini L, Lattavo L, Pascali MA, Agostini S, Miele V. Machine and Deep Learning Prediction Of Prostate Cancer Aggressiveness Using Multiparametric MRI. Front Oncol 2022; 11:802964. [PMID: 35096605 PMCID: PMC8792745 DOI: 10.3389/fonc.2021.802964] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer (PCa) is the most frequent male malignancy and the assessment of PCa aggressiveness, for which a biopsy is required, is fundamental for patient management. Currently, multiparametric (mp) MRI is strongly recommended before biopsy. Quantitative assessment of mpMRI might provide the radiologist with an objective and noninvasive tool for supporting the decision-making in clinical practice and decreasing intra- and inter-reader variability. In this view, high dimensional radiomics features and Machine Learning (ML) techniques, along with Deep Learning (DL) methods working on raw images directly, could assist the radiologist in the clinical workflow. The aim of this study was to develop and validate ML/DL frameworks on mpMRI data to characterize PCas according to their aggressiveness. We optimized several ML/DL frameworks on T2w, ADC and T2w+ADC data, using a patient-based nested validation scheme. The dataset was composed of 112 patients (132 peripheral lesions with Prostate Imaging Reporting and Data System (PI-RADS) score ≥ 3) acquired following both PI-RADS 2.0 and 2.1 guidelines. Firstly, ML/DL frameworks trained and validated on PI-RADS 2.0 data were tested on both PI-RADS 2.0 and 2.1 data. Then, we trained, validated and tested ML/DL frameworks on a multi PI-RADS dataset. We reported the performances in terms of Area Under the Receiver Operating curve (AUROC), specificity and sensitivity. The ML/DL frameworks trained on T2w data achieved the overall best performance. Notably, ML and DL frameworks trained and validated on PI-RADS 2.0 data obtained median AUROC values equal to 0.750 and 0.875, respectively, on unseen PI-RADS 2.0 test set. Similarly, ML/DL frameworks trained and validated on multi PI-RADS T2w data showed median AUROC values equal to 0.795 and 0.750, respectively, on unseen multi PI-RADS test set. Conversely, all the ML/DL frameworks trained and validated on PI-RADS 2.0 data, achieved AUROC values no better than the chance level when tested on PI-RADS 2.1 data. Both ML/DL techniques applied on mpMRI seem to be a valid aid in predicting PCa aggressiveness. In particular, ML/DL frameworks fed with T2w images data (objective, fast and non-invasive) show good performances and might support decision-making in patient diagnostic and therapeutic management, reducing intra- and inter-reader variability.
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Affiliation(s)
- Elena Bertelli
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Laura Mercatelli
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Chiara Marzi
- “Nello Carrara” Institute of Applied Physics (IFAC), National Research Council of Italy (CNR), Sesto Fiorentino, Italy
| | - Eva Pachetti
- “Alessandro Faedo” Institute of Information Science and Technologies (ISTI), National Research Council of Italy (CNR), Pisa, Italy
- Department of Information Engineering (DII), University of Pisa, Pisa, Italy
| | - Michela Baccini
- “Giuseppe Parenti” Department of Statistics, Computer Science, Applications(DiSIA), University of Florence, Florence, Italy
- Florence Center for Data Science, University of Florence, Florence, Italy
| | - Andrea Barucci
- “Nello Carrara” Institute of Applied Physics (IFAC), National Research Council of Italy (CNR), Sesto Fiorentino, Italy
| | - Sara Colantonio
- “Alessandro Faedo” Institute of Information Science and Technologies (ISTI), National Research Council of Italy (CNR), Pisa, Italy
| | - Luca Gherardini
- “Giuseppe Parenti” Department of Statistics, Computer Science, Applications(DiSIA), University of Florence, Florence, Italy
| | - Lorenzo Lattavo
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Maria Antonietta Pascali
- “Alessandro Faedo” Institute of Information Science and Technologies (ISTI), National Research Council of Italy (CNR), Pisa, Italy
| | - Simone Agostini
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Florence, Italy
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Jin J, Zhang L, Leng E, Metzger GJ, Koopmeiners JS. Multi-resolution super learner for voxel-wise classification of prostate cancer using multi-parametric MRI. J Appl Stat 2021; 50:805-826. [PMID: 36819087 PMCID: PMC9930806 DOI: 10.1080/02664763.2021.2017411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
Multi-parametric MRI (mpMRI) is a critical tool in prostate cancer (PCa) diagnosis and management. To further advance the use of mpMRI in patient care, computer aided diagnostic methods are under continuous development for supporting/supplanting standard radiological interpretation. While voxel-wise PCa classification models are the gold standard, few if any approaches have incorporated the inherent structure of the mpMRI data, such as spatial heterogeneity and between-voxel correlation, into PCa classification. We propose a machine learning-based method to fill in this gap. Our method uses an ensemble learning approach to capture regional heterogeneity in the data, where classifiers are developed at multiple resolutions and combined using the super learner algorithm, and further account for between-voxel correlation through a Gaussian kernel smoother. It allows any type of classifier to be the base learner and can be extended to further classify PCa sub-categories. We introduce the algorithms for binary PCa classification, as well as for classifying the ordinal clinical significance of PCa for which a weighted likelihood approach is implemented to improve the detection of less prevalent cancer categories. The proposed method has shown important advantages over conventional modeling and machine learning approaches in simulations and application to our motivating patient data.
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Affiliation(s)
- Jin Jin
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lin Zhang
- Devision of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Ethan Leng
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | | | - Joseph S. Koopmeiners
- Devision of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Rezaeijo SM, Hashemi B, Mofid B, Bakhshandeh M, Mahdavi A, Hashemi MS. The feasibility of a dose painting procedure to treat prostate cancer based on mpMR images and hierarchical clustering. Radiat Oncol 2021; 16:182. [PMID: 34544468 PMCID: PMC8454023 DOI: 10.1186/s13014-021-01906-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We aimed to assess the feasibility of a dose painting (DP) procedure, known as simultaneous integrated boost intensity modulated radiation Therapy (SIB-IMRT), for treating prostate cancer with dominant intraprostatic lesions (DILs) based on multi-parametric magnetic resonance (mpMR) images and hierarchical clustering with a machine learning technique. METHODS The mpMR images of 120 patients were used to create hierarchical clustering and draw a dendrogram. Three clusters were selected for performing agglomerative clustering. Then, the DIL acquired from the mpMR images of 20 patients were categorized into three groups to have them treated with a DP procedure being composed of three planning target volumes (PTVs) determined as PTV1, PTV2, and PTV3 in treatment plans. The DP procedure was carried out on the patients wherein a total dose of 80, 85 and 91 Gy were delivered to the PTV1, PTV2, and PTV3, respectively. Dosimetric and radiobiologic parameters [Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP)] of the DP procedure were compared with those of the conventional IMRT and Three-Dimensional Conformal Radiation Therapy (3DCRT) procedures carried out on another group of 20 patients. A post-treatment follow-up was also made four months after the radiotherapy procedures. RESULTS All the dosimetric variables and the NTCPs of the organs at risks (OARs) revealed no significant difference between the DP and IMRT procedures. Regarding the TCP of three investigated PTVs, significant differences were observed between the DP versus IMRT and also DP versus 3DCRT procedures. At post-treatment follow-up, the DIL volumes and apparent diffusion coefficient (ADC) values in the DP group differed significantly (p-value < 0.001) from those of the IMRT. However, the whole prostate ADC and prostate-specific antigen (PSA) indicated no significant difference (p-value > 0.05) between the DP versus IMRT. CONCLUSIONS The results of this comprehensive clinical trial illustrated the feasibility of our DP procedure for treating prostate cancer based on mpMR images validated with acquired patients' dosimetric and radiobiologic assessment and their follow-ups. This study confirms significant potential of the proposed DP procedure as a promising treatment planning to achieve effective dose escalation and treatment for prostate cancer. TRIAL REGISTRATION IRCT20181006041257N1; Iranian Registry of Clinical Trials, Registered: 23 October 2019, https://en.irct.ir/trial/34305 .
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Affiliation(s)
- Seyed Masoud Rezaeijo
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Al-Ahmad and Chamran Cross, 1411713116 Tehran, Iran
| | - Bijan Hashemi
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Al-Ahmad and Chamran Cross, 1411713116 Tehran, Iran
| | - Bahram Mofid
- Department of Radiation Oncology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Bakhshandeh
- Department of Radiology Technology, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Mahdavi
- Department of Radiology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Yu H, Zhang X. Synthesis of Prostate MR Images for Classification Using Capsule Network-Based GAN Model. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5736. [PMID: 33050243 PMCID: PMC7601698 DOI: 10.3390/s20205736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/30/2020] [Accepted: 10/07/2020] [Indexed: 01/22/2023]
Abstract
Prostate cancer remains a major health concern among elderly men. Deep learning is a state-of-the-art technique for MR image-based prostate cancer diagnosis, but one of major bottlenecks is the severe lack of annotated MR images. The traditional and Generative Adversarial Network (GAN)-based data augmentation methods cannot ensure the quality and the diversity of generated training samples. In this paper, we have proposed a novel GAN model for synthesis of MR images by utilizing its powerful ability in modeling the complex data distributions. The proposed model is designed based on the architecture of deep convolutional GAN. To learn the more equivariant representation of images that is robust to the changes in the pose and spatial relationship of objects in the images, the capsule network is applied to replace CNN used in the discriminator of regular GAN. Meanwhile, the least squares loss has been adopted for both the generator and discriminator in the proposed GAN to address the vanishing gradient problem of sigmoid cross entropy loss function in regular GAN. Extensive experiments are conducted on the simulated and real MR images. The results demonstrate that the proposed capsule network-based GAN model can generate more realistic and higher quality MR images than the compared GANs. The quantitative comparisons show that among all evaluated models, the proposed GAN generally achieves the smallest Kullback-Leibler divergence values for image generation task and provides the best classification performance when it is introduced into the deep learning method for image classification task.
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Affiliation(s)
- Houqiang Yu
- Ministry of Education Key Laboratory of Molecular Biophysics, Department of Biomedical Engineering, School of Life Science and Technology, Huazhong University of Science and Technology, No 1037, Luoyu Road, Wuhan 430074, China;
- Department of Mathematics and Statistics, Hubei University of Science and Technology, No 88, Xianning Road, Xianning 437000, China
| | - Xuming Zhang
- Ministry of Education Key Laboratory of Molecular Biophysics, Department of Biomedical Engineering, School of Life Science and Technology, Huazhong University of Science and Technology, No 1037, Luoyu Road, Wuhan 430074, China;
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Application of hierarchical clustering to multi-parametric MR in prostate: Differentiation of tumor and normal tissue with high accuracy. Magn Reson Imaging 2020; 74:90-95. [PMID: 32926991 DOI: 10.1016/j.mri.2020.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Hierarchical clustering (HC), an unsupervised machine learning (ML) technique, was applied to multi-parametric MR (mp-MR) for prostate cancer (PCa). The aim of this study is to demonstrate HC can diagnose PCa in a straightforward interpretable way, in contrast to deep learning (DL) techniques. METHODS HC was constructed using mp-MR including intravoxel incoherent motion, diffusion kurtosis imaging, and dynamic contrast-enhanced MRI from 40 tumor and normal tissues in peripheral zone (PZ) and 23 tumor and normal tissues in transition zone (TZ). HC model was optimized by assessing the combinations of several dissimilarity and linkage methods. Goodness of HC model was validated by internal methods. RESULTS Accuracy for differentiating tumor and normal tissue by optimal HC model was 96.3% in PZ and 97.8% in TZ, comparable to current clinical standards. Relationship between input (DWI and permeability parameters) and output (tumor and normal tissue cluster) was shown by heat maps, consistent with literature. CONCLUSION HC can accurately differentiate PCa and normal tissue, comparable to state-of-the-art diffusion based parameters. Contrary to DL techniques, HC is an operator-independent ML technique producing results that can be interpreted such that the results can be knowledgeably judged.
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9
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A Prostate MRI Segmentation Tool Based on Active Contour Models Using a Gradient Vector Flow. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10186163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Medical support systems used to assist in the diagnosis of prostate lesions generally related to prostate segmentation is one of the majors focus of interest in recent literature. The main problem encountered in the diagnosis of a prostate study is the localization of a Regions of Interest (ROI) containing a tumor tissue. In this paper, a new GUI tool based on a semi-automatic prostate segmentation is presented. The main rationale behind this tool and the focus of this article is facilitate the time consuming segmentation process used for annotating images in the clinical practice, enabling the radiologists to use novel and easy to use semi-automatic segmentation techniques instead of manual segmentation. In this work, a detailed specification of the proposed segmentation algorithm using an Active Contour Models (ACM) aided with a Gradient Vector Flow (GVF) component is defined. The purpose is to help the manual segmentation process of the main ROIs of prostate gland zones. Finally, an experimental case of use and a discussion part of the results are presented.
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10
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Bielak L, Wiedenmann N, Nicolay NH, Lottner T, Fischer J, Bunea H, Grosu AL, Bock M. Automatic Tumor Segmentation With a Convolutional Neural Network in Multiparametric MRI: Influence of Distortion Correction. ACTA ACUST UNITED AC 2020; 5:292-299. [PMID: 31572790 PMCID: PMC6752289 DOI: 10.18383/j.tom.2019.00010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Precise tumor segmentation is a crucial task in radiation therapy planning. Convolutional neural networks (CNNs) are among the highest scoring automatic approaches for tumor segmentation. We investigate the difference in segmentation performance of geometrically distorted and corrected diffusion-weighted data using data of patients with head and neck tumors; 18 patients with head and neck tumors underwent multiparametric magnetic resonance imaging, including T2w, T1w, T2*, perfusion (ktrans), and apparent diffusion coefficient (ADC) measurements. Owing to strong geometrical distortions in diffusion-weighted echo planar imaging in the head and neck region, ADC data were additionally distortion corrected. To investigate the influence of geometrical correction, first 14 CNNs were trained on data with geometrically corrected ADC and another 14 CNNs were trained using data without the correction on different samples of 13 patients for training and 4 patients for validation each. The different sets were each trained from scratch using randomly initialized weights, but the training data distributions were pairwise equal for corrected and uncorrected data. Segmentation performance was evaluated on the remaining 1 test-patient for each of the 14 sets. The CNN segmentation performance scored an average Dice coefficient of 0.40 ± 0.18 for data including distortion-corrected ADC and 0.37 ± 0.21 for uncorrected data. Paired t test revealed that the performance was not significantly different (P = .313). Thus, geometrical distortion on diffusion-weighted imaging data in patients with head and neck tumor does not significantly impair CNN segmentation performance in use.
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Affiliation(s)
- Lars Bielak
- Radiology, Medical Physics.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Nicole Wiedenmann
- Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; and.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Nils Henrik Nicolay
- Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; and.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | | | | | - Hatice Bunea
- Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; and.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Anca-Ligia Grosu
- Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; and.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Michael Bock
- Radiology, Medical Physics.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
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Wildeboer RR, van Sloun RJG, Wijkstra H, Mischi M. Artificial intelligence in multiparametric prostate cancer imaging with focus on deep-learning methods. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 189:105316. [PMID: 31951873 DOI: 10.1016/j.cmpb.2020.105316] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/09/2019] [Accepted: 01/04/2020] [Indexed: 05/16/2023]
Abstract
Prostate cancer represents today the most typical example of a pathology whose diagnosis requires multiparametric imaging, a strategy where multiple imaging techniques are combined to reach an acceptable diagnostic performance. However, the reviewing, weighing and coupling of multiple images not only places additional burden on the radiologist, it also complicates the reviewing process. Prostate cancer imaging has therefore been an important target for the development of computer-aided diagnostic (CAD) tools. In this survey, we discuss the advances in CAD for prostate cancer over the last decades with special attention to the deep-learning techniques that have been designed in the last few years. Moreover, we elaborate and compare the methods employed to deliver the CAD output to the operator for further medical decision making.
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Affiliation(s)
- Rogier R Wildeboer
- Lab of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, De Zaale, 5600 MB, Eindhoven, the Netherlands.
| | - Ruud J G van Sloun
- Lab of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, De Zaale, 5600 MB, Eindhoven, the Netherlands.
| | - Hessel Wijkstra
- Lab of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, De Zaale, 5600 MB, Eindhoven, the Netherlands; Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Massimo Mischi
- Lab of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, De Zaale, 5600 MB, Eindhoven, the Netherlands
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12
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Gates EDH, Lin JS, Weinberg JS, Prabhu SS, Hamilton J, Hazle JD, Fuller GN, Baladandayuthapani V, Fuentes DT, Schellingerhout D. Imaging-Based Algorithm for the Local Grading of Glioma. AJNR Am J Neuroradiol 2020; 41:400-407. [PMID: 32029466 DOI: 10.3174/ajnr.a6405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Gliomas are highly heterogeneous tumors, and optimal treatment depends on identifying and locating the highest grade disease present. Imaging techniques for doing so are generally not validated against the histopathologic criterion standard. The purpose of this work was to estimate the local glioma grade using a machine learning model trained on preoperative image data and spatially specific tumor samples. The value of imaging in patients with brain tumor can be enhanced if pathologic data can be estimated from imaging input using predictive models. MATERIALS AND METHODS Patients with gliomas were enrolled in a prospective clinical imaging trial between 2013 and 2016. MR imaging was performed with anatomic, diffusion, permeability, and perfusion sequences, followed by image-guided stereotactic biopsy before resection. An imaging description was developed for each biopsy, and multiclass machine learning models were built to predict the World Health Organization grade. Models were assessed on classification accuracy, Cohen κ, precision, and recall. RESULTS Twenty-three patients (with 7/9/7 grade II/III/IV gliomas) had analyzable imaging-pathologic pairs, yielding 52 biopsy sites. The random forest method was the best algorithm tested. Tumor grade was predicted at 96% accuracy (κ = 0.93) using 4 inputs (T2, ADC, CBV, and transfer constant from dynamic contrast-enhanced imaging). By means of the conventional imaging only, the overall accuracy decreased (89% overall, κ = 0.79) and 43% of high-grade samples were misclassified as lower-grade disease. CONCLUSIONS We found that local pathologic grade can be predicted with a high accuracy using clinical imaging data. Advanced imaging data improved this accuracy, adding value to conventional imaging. Confirmatory imaging trials are justified.
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Affiliation(s)
- E D H Gates
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas.,University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences (E.D.H.G.), Houston, Texas
| | - J S Lin
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas.,Baylor College of Medicine (J.S.L.), Houston, Texas.,Department of Bioengineering (J.S.L.), Rice University, Houston, Texas
| | - J S Weinberg
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - S S Prabhu
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Hamilton
- Radiology Partners (J.H.), Houston, Texas
| | - J D Hazle
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G N Fuller
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - V Baladandayuthapani
- Department of Computational Medicine and Bioinformatics (V.B.), University of Michigan School of Public Health, Ann Arbor, Michigan
| | - D T Fuentes
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - D Schellingerhout
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
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13
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Cuocolo R, Cipullo MB, Stanzione A, Ugga L, Romeo V, Radice L, Brunetti A, Imbriaco M. Machine learning applications in prostate cancer magnetic resonance imaging. Eur Radiol Exp 2019; 3:35. [PMID: 31392526 PMCID: PMC6686027 DOI: 10.1186/s41747-019-0109-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022] Open
Abstract
With this review, we aimed to provide a synopsis of recently proposed applications of machine learning (ML) in radiology focusing on prostate magnetic resonance imaging (MRI). After defining the difference between ML and classical rule-based algorithms and the distinction among supervised, unsupervised and reinforcement learning, we explain the characteristic of deep learning (DL), a particular new type of ML, including its structure mimicking human neural networks and its 'black box' nature. Differences in the pipeline for applying ML and DL to prostate MRI are highlighted. The following potential clinical applications in different settings are outlined, many of them based only on MRI-unenhanced sequences: gland segmentation; assessment of lesion aggressiveness to distinguish between clinically significant and indolent cancers, allowing for active surveillance; cancer detection/diagnosis and localisation (transition versus peripheral zone, use of prostate imaging reporting and data system (PI-RADS) version 2), reading reproducibility, differentiation of cancers from prostatitis benign hyperplasia; local staging and pre-treatment assessment (detection of extraprostatic disease extension, planning of radiation therapy); and prediction of biochemical recurrence. Results are promising, but clinical applicability still requires more robust validation across scanner vendors, field strengths and institutions.
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Affiliation(s)
- Renato Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Maria Brunella Cipullo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Leonardo Radice
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
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14
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Decision Support Systems in Prostate Cancer Treatment: An Overview. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4961768. [PMID: 31281840 PMCID: PMC6590598 DOI: 10.1155/2019/4961768] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/02/2019] [Accepted: 05/06/2019] [Indexed: 12/11/2022]
Abstract
Background A multifactorial decision support system (mDSS) is a tool designed to improve the clinical decision-making process, while using clinical inputs for an individual patient to generate case-specific advice. The study provides an overview of the literature to analyze current available mDSS focused on prostate cancer (PCa), in order to better understand the availability of decision support tools as well as where the current literature is lacking. Methods We performed a MEDLINE literature search in July 2018. We divided the included studies into different sections: diagnostic, which aids in detection or staging of PCa; treatment, supporting the decision between treatment modalities; and patient, which focusses on informing the patient. We manually screened and excluded studies that did not contain an mDSS concerning prostate cancer and study proposals. Results Our search resulted in twelve diagnostic mDSS; six treatment mDSS; two patient mDSS; and eight papers that could improve mDSS. Conclusions Diagnosis mDSS is well represented in the literature as well as treatment mDSS considering external-beam radiotherapy; however, there is a lack of mDSS for other treatment modalities. The development of patient decision aids is a new field of research, and few successes have been made for PCa patients. These tools can improve personalized medicine but need to overcome a number of difficulties to be successful and require more research.
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15
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MR Imaging-Histology Correlation by Tailored 3D-Printed Slicer in Oncological Assessment. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:1071453. [PMID: 31275082 PMCID: PMC6560325 DOI: 10.1155/2019/1071453] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/12/2019] [Indexed: 12/14/2022]
Abstract
3D printing and reverse engineering are innovative technologies that are revolutionizing scientific research in the health sciences and related clinical practice. Such technologies are able to improve the development of various custom-made medical devices while also lowering design and production costs. Recent advances allow the printing of particularly complex prototypes whose geometry is drawn from precise computer models designed on in vivo imaging data. This review summarizes a new method for histological sample processing (applicable to e.g., the brain, prostate, liver, and renal mass) which employs a personalized mold developed from diagnostic images through computer-aided design software and 3D printing. Through positioning the custom mold in a coherent manner with respect to the organ of interest (as delineated by in vivo imaging data), the cutting instrument can be precisely guided in order to obtain blocks of tissue which correspond with high accuracy to the slices imaged. This approach appeared crucial for validation of new quantitative imaging tools, for an accurate imaging-histopathological correlation and for the assessment of radiogenomic features extracted from oncological lesions. The aim of this review is to define and describe 3D printing technologies which are applicable to oncological assessment and slicer design, highlighting the radiological and pathological perspective as well as recent applications of this approach for the histological validation of and correlation with MR images.
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16
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Bi WL, Hosny A, Schabath MB, Giger ML, Birkbak NJ, Mehrtash A, Allison T, Arnaout O, Abbosh C, Dunn IF, Mak RH, Tamimi RM, Tempany CM, Swanton C, Hoffmann U, Schwartz LH, Gillies RJ, Huang RY, Aerts HJWL. Artificial intelligence in cancer imaging: Clinical challenges and applications. CA Cancer J Clin 2019; 69:127-157. [PMID: 30720861 PMCID: PMC6403009 DOI: 10.3322/caac.21552] [Citation(s) in RCA: 635] [Impact Index Per Article: 127.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Judgement, as one of the core tenets of medicine, relies upon the integration of multilayered data with nuanced decision making. Cancer offers a unique context for medical decisions given not only its variegated forms with evolution of disease but also the need to take into account the individual condition of patients, their ability to receive treatment, and their responses to treatment. Challenges remain in the accurate detection, characterization, and monitoring of cancers despite improved technologies. Radiographic assessment of disease most commonly relies upon visual evaluations, the interpretations of which may be augmented by advanced computational analyses. In particular, artificial intelligence (AI) promises to make great strides in the qualitative interpretation of cancer imaging by expert clinicians, including volumetric delineation of tumors over time, extrapolation of the tumor genotype and biological course from its radiographic phenotype, prediction of clinical outcome, and assessment of the impact of disease and treatment on adjacent organs. AI may automate processes in the initial interpretation of images and shift the clinical workflow of radiographic detection, management decisions on whether or not to administer an intervention, and subsequent observation to a yet to be envisioned paradigm. Here, the authors review the current state of AI as applied to medical imaging of cancer and describe advances in 4 tumor types (lung, brain, breast, and prostate) to illustrate how common clinical problems are being addressed. Although most studies evaluating AI applications in oncology to date have not been vigorously validated for reproducibility and generalizability, the results do highlight increasingly concerted efforts in pushing AI technology to clinical use and to impact future directions in cancer care.
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Affiliation(s)
- Wenya Linda Bi
- Assistant Professor of Neurosurgery, Department of Neurosurgery, Brigham and Women’s Hospital, Dana‐Farber Cancer InstituteHarvard Medical SchoolBostonMA
| | - Ahmed Hosny
- Research Scientist, Department of Radiation Oncology, Brigham and Women’s Hospital, Dana‐Farber Cancer InstituteHarvard Medical SchoolBostonMA
| | - Matthew B. Schabath
- Associate Member, Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center and Research InstituteTampaFL
| | - Maryellen L. Giger
- Professor of Radiology, Department of RadiologyUniversity of ChicagoChicagoIL
| | - Nicolai J. Birkbak
- Research Associate, The Francis Crick InstituteLondonUnited Kingdom
- Research Associate, University College London Cancer InstituteLondonUnited Kingdom
| | - Alireza Mehrtash
- Research Assistant, Department of Radiology, Brigham and Women’s Hospital, Dana‐Farber Cancer InstituteHarvard Medical SchoolBostonMA
- Research Assistant, Department of Electrical and Computer EngineeringUniversity of British ColumbiaVancouverBCCanada
| | - Tavis Allison
- Research Assistant, Department of RadiologyColumbia University College of Physicians and SurgeonsNew YorkNY
- Research Assistant, Department of RadiologyNew York Presbyterian HospitalNew YorkNY
| | - Omar Arnaout
- Assistant Professor of Neurosurgery, Department of Neurosurgery, Brigham and Women’s Hospital, Dana‐Farber Cancer InstituteHarvard Medical SchoolBostonMA
| | - Christopher Abbosh
- Research Fellow, The Francis Crick InstituteLondonUnited Kingdom
- Research Fellow, University College London Cancer InstituteLondonUnited Kingdom
| | - Ian F. Dunn
- Associate Professor of Neurosurgery, Department of Neurosurgery, Brigham and Women’s Hospital, Dana‐Farber Cancer InstituteHarvard Medical SchoolBostonMA
| | - Raymond H. Mak
- Associate Professor, Department of Radiation Oncology, Brigham and Women’s Hospital, Dana‐Farber Cancer InstituteHarvard Medical SchoolBostonMA
| | - Rulla M. Tamimi
- Associate Professor, Department of MedicineBrigham and Women’s Hospital, Dana‐Farber Cancer Institute, Harvard Medical SchoolBostonMA
| | - Clare M. Tempany
- Professor of Radiology, Department of Radiology, Brigham and Women’s Hospital, Dana‐Farber Cancer InstituteHarvard Medical SchoolBostonMA
| | - Charles Swanton
- Professor, The Francis Crick InstituteLondonUnited Kingdom
- Professor, University College London Cancer InstituteLondonUnited Kingdom
| | - Udo Hoffmann
- Professor of Radiology, Department of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA
| | - Lawrence H. Schwartz
- Professor of Radiology, Department of RadiologyColumbia University College of Physicians and SurgeonsNew YorkNY
- Chair, Department of RadiologyNew York Presbyterian HospitalNew YorkNY
| | - Robert J. Gillies
- Professor of Radiology, Department of Cancer PhysiologyH. Lee Moffitt Cancer Center and Research InstituteTampaFL
| | - Raymond Y. Huang
- Assistant Professor, Department of Radiology, Brigham and Women’s Hospital, Dana‐Farber Cancer InstituteHarvard Medical SchoolBostonMA
| | - Hugo J. W. L. Aerts
- Associate Professor, Departments of Radiation Oncology and Radiology, Brigham and Women’s Hospital, Dana‐Farber Cancer InstituteHarvard Medical SchoolBostonMA
- Professor in AI in Medicine, Radiology and Nuclear Medicine, GROWMaastricht University Medical Centre (MUMC+)MaastrichtThe Netherlands
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Sun Y, Reynolds HM, Parameswaran B, Wraith D, Finnegan ME, Williams S, Haworth A. Multiparametric MRI and radiomics in prostate cancer: a review. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:3-25. [PMID: 30762223 DOI: 10.1007/s13246-019-00730-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 01/22/2019] [Indexed: 12/30/2022]
Abstract
Multiparametric MRI (mpMRI) is an imaging modality that combines anatomical MR imaging with one or more functional MRI sequences. It has become a versatile tool for detecting and characterising prostate cancer (PCa). The traditional role of mpMRI was confined to PCa staging, but due to the advanced imaging techniques, its role has expanded to various stages in clinical practises including tumour detection, disease monitor during active surveillance and sequential imaging for patient follow-up. Meanwhile, with the growing speed of data generation and the increasing volume of imaging data, it is highly demanded to apply computerised methods to process mpMRI data and extract useful information. Hence quantitative analysis for imaging data using radiomics has become an emerging paradigm. The application of radiomics approaches in prostate cancer has not only enabled automatic localisation of the disease but also provided a non-invasive solution to assess tumour biology (e.g. aggressiveness and the presence of hypoxia). This article reviews mpMRI and its expanding role in PCa detection, staging and patient management. Following that, an overview of prostate radiomics will be provided, with a special focus on its current applications as well as its future directions.
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Affiliation(s)
- Yu Sun
- University of Sydney, Sydney, Australia. .,Peter MacCallum Cancer Centre, Melbourne, Australia.
| | | | | | - Darren Wraith
- Queensland University of Technology, Brisbane, Australia
| | - Mary E Finnegan
- Imperial College Healthcare NHS Trust, London, UK.,Imperial College London, London, UK
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18
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Co-trained convolutional neural networks for automated detection of prostate cancer in multi-parametric MRI. Med Image Anal 2017; 42:212-227. [DOI: 10.1016/j.media.2017.08.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 11/20/2022]
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Bjurlin MA, Taneja SS. Prediagnostic Risk Assessment with Prostate MRI and MRI-Targeted Biopsy. Urol Clin North Am 2017; 44:535-546. [DOI: 10.1016/j.ucl.2017.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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20
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Thon A, Teichgräber U, Tennstedt-Schenk C, Hadjidemetriou S, Winzler S, Malich A, Papageorgiou I. Computer aided detection in prostate cancer diagnostics: A promising alternative to biopsy? A retrospective study from 104 lesions with histological ground truth. PLoS One 2017; 12:e0185995. [PMID: 29023572 PMCID: PMC5638330 DOI: 10.1371/journal.pone.0185995] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/22/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Prostate cancer (PCa) diagnosis by means of multiparametric magnetic resonance imaging (mpMRI) is a current challenge for the development of computer-aided detection (CAD) tools. An innovative CAD-software (Watson Elementary™) was proposed to achieve high sensitivity and specificity, as well as to allege a correlate to Gleason grade. AIM/OBJECTIVE To assess the performance of Watson Elementary™ in automated PCa diagnosis in our hospital´s database of MRI-guided prostate biopsies. METHODS The evaluation was retrospective for 104 lesions (47 PCa, 57 benign) from 79, 64.61±6.64 year old patients using 3T T2-weighted imaging, Apparent Diffusion Coefficient (ADC) maps and dynamic contrast enhancement series. Watson Elementary™ utilizes signal intensity, diffusion properties and kinetic profile to compute a proportional Gleason grade predictor, termed Malignancy Attention Index (MAI). The analysis focused on (i) the CAD sensitivity and specificity to classify suspect lesions and (ii) the MAI correlation with the histopathological ground truth. RESULTS The software revealed a sensitivity of 46.80% for PCa classification. The specificity for PCa was found to be 75.43% with a positive predictive value of 61.11%, a negative predictive value of 63.23% and a false discovery rate of 38.89%. CAD classified PCa and benign lesions with equal probability (P 0.06, χ2 test). Accordingly, receiver operating characteristic analysis suggests a poor predictive value for MAI with an area under curve of 0.65 (P 0.02), which is not superior to the performance of board certified observers. Moreover, MAI revealed no significant correlation with Gleason grade (P 0.60, Pearson´s correlation). CONCLUSION The tested CAD software for mpMRI analysis was a weak PCa biomarker in this dataset. Targeted prostate biopsy and histology remains the gold standard for prostate cancer diagnosis.
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Affiliation(s)
- Anika Thon
- Institute of Diagnostic and Interventional Radiology, Department of Experimental Radiology, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
- Institute of Radiology, Suedharz Hospital Nordhausen gGmbH, Nordhausen, Germany
| | - Ulf Teichgräber
- Institute of Diagnostic and Interventional Radiology, Department of Experimental Radiology, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | | | - Stathis Hadjidemetriou
- Department of Electrical Engineering and Informatics, Cyprus University of Technology, Limassol, Cyprus
| | - Sven Winzler
- Institute of Radiology, Suedharz Hospital Nordhausen gGmbH, Nordhausen, Germany
| | - Ansgar Malich
- Institute of Radiology, Suedharz Hospital Nordhausen gGmbH, Nordhausen, Germany
| | - Ismini Papageorgiou
- Institute of Radiology, Suedharz Hospital Nordhausen gGmbH, Nordhausen, Germany
- * E-mail:
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Abstract
Multi-parametric magnetic resonance imaging (mp-MRI) has an increasingly important role in the diagnosis of prostate cancer. Due to the large amount of data and variations in mp-MRI, tumor detection can be affected by multiple factors, such as the observer's clinical experience, image quality, and appearance of the lesions. In order to improve the quantitative assessment of the disease and reduce the reporting time, various computer-aided diagnosis (CAD) systems have been designed to help radiologists identify lesions. This manuscript presents an overview of the literature regarding prostate CAD using mp-MRI, while focusing on the studies of the most recent five years. Current prostate CAD technologies and their utilization are discussed in this review.
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Focal therapy for prostate cancer: the technical challenges. J Contemp Brachytherapy 2017; 9:383-389. [PMID: 28951759 PMCID: PMC5611463 DOI: 10.5114/jcb.2017.69809] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/24/2017] [Indexed: 12/16/2022] Open
Abstract
Focal therapy for prostate cancer has been proposed as an alternative treatment to whole gland therapy, offering the opportunity for tumor dose escalation and/or reduced toxicity. Brachytherapy, either low-dose-rate or high-dose-rate, provides an ideal approach, offering both precision in dose delivery and opportunity for a highly conformal, non-uniform dose distribution. Whilst multiple consensus documents have published clinical guidelines for patient selection, there are insufficient data to provide clear guidelines on target volume delineation, treatment planning margins, treatment planning approaches, and many other technical issues that should be considered before implementing a focal brachytherapy program. Without consensus guidelines, there is the potential for a diversity of practices to develop, leading to challenges in interpreting outcome data from multiple centers. This article provides an overview of the technical considerations for the implementation of a clinical service, and discusses related topics that should be considered in the design of clinical trials to ensure precise and accurate methods are applied for focal brachytherapy treatments.
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Dinh CV, Steenbergen P, Ghobadi G, van der Poel H, Heijmink SW, de Jong J, Isebaert S, Haustermans K, Lerut E, Oyen R, Ou Y, Christos D, van der Heide UA. Multicenter validation of prostate tumor localization using multiparametric MRI and prior knowledge. Med Phys 2017; 44:949-961. [DOI: 10.1002/mp.12086] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 12/12/2016] [Accepted: 12/26/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | | | | | | | - Jeroen de Jong
- The Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Sofie Isebaert
- University of Leuven; University Hospitals Leuven; Leuven Belgium
| | | | - Evelyne Lerut
- University of Leuven; University Hospitals Leuven; Leuven Belgium
| | - Raymond Oyen
- University of Leuven; University Hospitals Leuven; Leuven Belgium
| | - Yangming Ou
- Massachusetts General Hospital; Boston MA USA
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Reda I, Shalaby A, Elmogy M, Elfotouh AA, Khalifa F, El-Ghar MA, Hosseini-Asl E, Gimel'farb G, Werghi N, El-Baz A. A comprehensive non-invasive framework for diagnosing prostate cancer. Comput Biol Med 2016; 81:148-158. [PMID: 28063376 DOI: 10.1016/j.compbiomed.2016.12.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/16/2016] [Accepted: 12/17/2016] [Indexed: 02/08/2023]
Abstract
Early detection of prostate cancer increases chances of patients' survival. Our automated non-invasive system for computer-aided diagnosis (CAD) of prostate cancer segments the prostate on diffusion-weighted magnetic resonance images (DW-MRI) acquired at different b-values, estimates its apparent diffusion coefficients (ADC), and classifies their descriptors - empirical cumulative distribution functions (CDF) - with a trained deep learning network. To segment the prostate, an evolving geometric (level-set-based) deformable model is guided by a speed function depending on intensity attributes extracted from the DW-MRI with nonnegative matrix factorization (NMF). For a more robust evolution, the attributes are fused with a probabilistic shape prior and estimated spatial dependencies between prostate voxels. To preserve continuity, the ADCs of the segmented prostate volume at different b-values are normalized and refined using a generalized Gauss-Markov random field image model. The CDFs of the refined ADCs at different b-values are considered global water diffusion features and used to distinguish between benign and malignant prostates. A deep learning network of stacked non-negativity-constrained auto-encoders (SNCAE) is trained to classify the benign or malignant prostates on the basis of the constructed CDFs. Our experiments on 53 clinical DW-MRI data sets resulted in 92.3% accuracy, 83.3% sensitivity, and 100% specificity, indicating that the proposed CAD system could be used as a reliable non-invasive diagnostic tool.
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Affiliation(s)
- Islam Reda
- Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt; Bioengineering Department, University of Louisville, Louisville KY 40292, USA
| | - Ahmed Shalaby
- Bioengineering Department, University of Louisville, Louisville KY 40292, USA
| | - Mohammed Elmogy
- Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt; Bioengineering Department, University of Louisville, Louisville KY 40292, USA
| | - Ahmed Abou Elfotouh
- Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt
| | - Fahmi Khalifa
- Bioengineering Department, University of Louisville, Louisville KY 40292, USA; Electronics and Communication Engineering Department, Mansoura University, Mansoura, Egypt
| | - Mohamed Abou El-Ghar
- Radiology Department, Urology and Nephrology Center, University of Mansoura, Egypt
| | - Ehsan Hosseini-Asl
- Electrical and Computer Engineering, University of Louisville, Louisville KY 40292, USA
| | - Georgy Gimel'farb
- Department of Computer Science, University of Auckland, Auckland, New Zealand
| | - Naoufel Werghi
- Khalifa University of Science Technology and Research, Abu Dhabi, UAE
| | - Ayman El-Baz
- Bioengineering Department, University of Louisville, Louisville KY 40292, USA.
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25
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Ginsburg SB, Algohary A, Pahwa S, Gulani V, Ponsky L, Aronen HJ, Boström PJ, Böhm M, Haynes AM, Brenner P, Delprado W, Thompson J, Pulbrock M, Taimen P, Villani R, Stricker P, Rastinehad AR, Jambor I, Madabhushi A. Radiomic features for prostate cancer detection on MRI differ between the transition and peripheral zones: Preliminary findings from a multi-institutional study. J Magn Reson Imaging 2016; 46:184-193. [PMID: 27990722 DOI: 10.1002/jmri.25562] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/03/2016] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To evaluate in a multi-institutional study whether radiomic features useful for prostate cancer (PCa) detection from 3 Tesla (T) multi-parametric MRI (mpMRI) in the transition zone (TZ) differ from those in the peripheral zone (PZ). MATERIALS AND METHODS 3T mpMRI, including T2-weighted (T2w), apparent diffusion coefficient (ADC) maps, and dynamic contrast-enhanced MRI (DCE-MRI), were retrospectively obtained from 80 patients at three institutions. This study was approved by the institutional review board of each participating institution. First-order statistical, co-occurrence, and wavelet features were extracted from T2w MRI and ADC maps, and contrast kinetic features were extracted from DCE-MRI. Feature selection was performed to identify 10 features for PCa detection in the TZ and PZ, respectively. Two logistic regression classifiers used these features to detect PCa and were evaluated by area under the receiver-operating characteristic curve (AUC). Classifier performance was compared with a zone-ignorant classifier. RESULTS Radiomic features that were identified as useful for PCa detection differed between TZ and PZ. When classification was performed on a per-voxel basis, a PZ-specific classifier detected PZ tumors on an independent test set with significantly higher accuracy (AUC = 0.61-0.71) than a zone-ignorant classifier trained to detect cancer throughout the entire prostate (P < 0.05). When classifiers were evaluated on MRI data from multiple institutions, statistically similar AUC values (P > 0.14) were obtained for all institutions. CONCLUSION A zone-aware classifier significantly improves the accuracy of cancer detection in the PZ. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:184-193.
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Affiliation(s)
- Shoshana B Ginsburg
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ahmad Algohary
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Shivani Pahwa
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Vikas Gulani
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lee Ponsky
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Maret Böhm
- Garvan Institute of Medical Research, Sydney, Australia
| | | | - Phillip Brenner
- Department of Urology, St. Vincent's Hospital, Sydney, Australia
| | | | | | | | - Pekka Taimen
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Robert Villani
- Department of Radiology, Hofstra North Shore-LIJ, New Hyde Park, New York, USA
| | - Phillip Stricker
- Department of Urology, St. Vincent's Hospital, Sydney, Australia
| | - Ardeshir R Rastinehad
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Manhattan, New York, USA
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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Liu L, Tian Z, Zhang Z, Fei B. Computer-aided Detection of Prostate Cancer with MRI: Technology and Applications. Acad Radiol 2016; 23:1024-46. [PMID: 27133005 PMCID: PMC5355004 DOI: 10.1016/j.acra.2016.03.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 01/10/2023]
Abstract
One in six men will develop prostate cancer in his lifetime. Early detection and accurate diagnosis of the disease can improve cancer survival and reduce treatment costs. Recently, imaging of prostate cancer has greatly advanced since the introduction of multiparametric magnetic resonance imaging (mp-MRI). Mp-MRI consists of T2-weighted sequences combined with functional sequences including dynamic contrast-enhanced MRI, diffusion-weighted MRI, and magnetic resonance spectroscopy imaging. Because of the big data and variations in imaging sequences, detection can be affected by multiple factors such as observer variability and visibility and complexity of the lesions. To improve quantitative assessment of the disease, various computer-aided detection systems have been designed to help radiologists in their clinical practice. This review paper presents an overview of literatures on computer-aided detection of prostate cancer with mp-MRI, which include the technology and its applications. The aim of the survey is threefold: an introduction for those new to the field, an overview for those working in the field, and a reference for those searching for literature on a specific application.
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Affiliation(s)
- Lizhi Liu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1841 Clifton Road NE, Atlanta, GA 30329; Center of Medical Imaging and Image-guided Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Zhiqiang Tian
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1841 Clifton Road NE, Atlanta, GA 30329
| | - Zhenfeng Zhang
- Center of Medical Imaging and Image-guided Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Baowei Fei
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1841 Clifton Road NE, Atlanta, GA 30329; Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, 1841 Clifton Road NE, Atlanta, Georgia 30329; Winship Cancer Institute of Emory University, 1841 Clifton Road NE, Atlanta, Georgia 30329.
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Roethke MC, Kuru TH, Mueller-Wolf MB, Agterhuis E, Edler C, Hohenfellner M, Schlemmer HP, Hadaschik BA. Evaluation of an Automated Analysis Tool for Prostate Cancer Prediction Using Multiparametric Magnetic Resonance Imaging. PLoS One 2016; 11:e0159803. [PMID: 27454770 PMCID: PMC4959716 DOI: 10.1371/journal.pone.0159803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 07/10/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance of an automated analysis tool for the assessment of prostate cancer based on multiparametric magnetic resonance imaging (mpMRI) of the prostate. METHODS A fully automated analysis tool was used for a retrospective analysis of mpMRI sets (T2-weighted, T1-weighted dynamic contrast-enhanced, and diffusion-weighted sequences). The software provided a malignancy prediction value for each image pixel, defined as Malignancy Attention Index (MAI) that can be depicted as a colour map overlay on the original images. The malignancy maps were compared to histopathology derived from a combination of MRI-targeted and systematic transperineal MRI/TRUS-fusion biopsies. RESULTS In total, mpMRI data of 45 patients were evaluated. With a sensitivity of 85.7% (with 95% CI of 65.4-95.0), a specificity of 87.5% (with 95% CI of 69.0-95.7) and a diagnostic accuracy of 86.7% (with 95% CI of 73.8-93.8) for detection of prostate cancer, the automated analysis results corresponded well with the reported diagnostic accuracies by human readers based on the PI-RADS system in the current literature. CONCLUSION The study revealed comparable diagnostic accuracies for the detection of prostate cancer of a user-independent MAI-based automated analysis tool and PI-RADS-scoring-based human reader analysis of mpMRI. Thus, the analysis tool could serve as a detection support system for less experienced readers. The results of the study also suggest the potential of MAI-based analysis for advanced lesion assessments, such as cancer extent and staging prediction.
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Affiliation(s)
- Matthias C. Roethke
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- * E-mail:
| | - Timur H. Kuru
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - Maya B. Mueller-Wolf
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Christopher Edler
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Boris A. Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
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Rampun A, Chen Z, Malcolm P, Tiddeman B, Zwiggelaar R. Computer-aided diagnosis: detection and localization of prostate cancer within the peripheral zone. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2016; 32:e02745. [PMID: 26313267 DOI: 10.1002/cnm.2745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 05/21/2015] [Accepted: 08/24/2015] [Indexed: 06/04/2023]
Abstract
We propose a methodology for prostate cancer detection and localization within the peripheral zone based on combining multiple segmentation techniques. We extract four image features using Gaussian and median filters. Subsequently, we use each image feature separately to generate binary segmentations. Finally, we take the intersection of all four binary segmentations, incorporating a model of the peripheral zone, and perform erosion to remove small false-positive regions. The initial evaluation of this method is based on 275 MRI images from 37 patients, and 86% of the slices were classified correctly with 87% and 86% sensitivity and specificity achieved, respectively. This paper makes two contributions: firstly, a novel computer-aided diagnosis approach, which is based on combining multiple segmentation techniques using only a small number of simple image features, and secondly, the development of the proposed method and its application in prostate cancer detection and localization using a single MRI modality with the results comparable with the state-of-the-art multimodality and advanced computer vision methods in the literature. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Andrik Rampun
- Department of Computer Science, Aberystwyth University, Aberystwyth, SY23 3DB, UK
| | - Zhili Chen
- Information and Control Engineering Faculty, Shenyang Jianzhu University, Liaoning, 110168, China
| | - Paul Malcolm
- Department of Radiology, Norfolk Norwich University Hospital, Norwich, NR4 7UY, UK
| | - Bernie Tiddeman
- Department of Computer Science, Aberystwyth University, Aberystwyth, SY23 3DB, UK
| | - Reyer Zwiggelaar
- Department of Computer Science, Aberystwyth University, Aberystwyth, SY23 3DB, UK
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Kwak JT, Xu S, Wood BJ, Turkbey B, Choyke PL, Pinto PA, Wang S, Summers RM. Automated prostate cancer detection using T2-weighted and high-b-value diffusion-weighted magnetic resonance imaging. Med Phys 2016; 42:2368-78. [PMID: 25979032 DOI: 10.1118/1.4918318] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE The authors propose a computer-aided diagnosis (CAD) system for prostate cancer to aid in improving the accuracy, reproducibility, and standardization of multiparametric magnetic resonance imaging (MRI). METHODS The proposed system utilizes two MRI sequences [T2-weighted MRI and high-b-value (b = 2000 s/mm(2)) diffusion-weighted imaging (DWI)] and texture features based on local binary patterns. A three-stage feature selection method is employed to provide the most discriminative features. The authors included a total of 244 patients. Training the CAD system on 108 patients (78 MR-positive prostate cancers and 105 benign MR-positive lesions), two validation studies were retrospectively performed on 136 patients (68 MR-positive prostate cancers, 111 benign MR-positive lesions, and 117 MR-negative benign lesions). RESULTS In distinguishing cancer from MR-positive benign lesions, an area under receiver operating characteristic curve (AUC) of 0.83 [95% confidence interval (CI): 0.76-0.89] was achieved. For cancer vs MR-positive or MR-negative benign lesions, the authors obtained an AUC of 0.89 AUC (95% CI: 0.84-0.93). The performance of the CAD system was not dependent on the specific regions of the prostate, e.g., a peripheral zone or transition zone. Moreover, the CAD system outperformed other combinations of MRI sequences: T2W MRI, high-b-value DWI, and the standard apparent diffusion coefficient (ADC) map of DWI. CONCLUSIONS The novel CAD system is able to detect the discriminative texture features for cancer detection and localization and is a promising tool for improving the quality and efficiency of prostate cancer diagnosis.
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Affiliation(s)
- Jin Tae Kwak
- Center for Interventional Oncology, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892
| | - Sheng Xu
- Center for Interventional Oncology, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892
| | - Bradford J Wood
- Center for Interventional Oncology, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Shijun Wang
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892
| | - Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892
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30
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Magnetic resonance imaging for prostate cancer radiotherapy. Phys Med 2016; 32:446-51. [PMID: 26858164 DOI: 10.1016/j.ejmp.2016.01.484] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/13/2016] [Accepted: 01/26/2016] [Indexed: 11/21/2022] Open
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31
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Metzger GJ, Kalavagunta C, Spilseth B, Bolan PJ, Li X, Hutter D, Nam JW, Johnson AD, Henriksen JC, Moench L, Konety B, Warlick CA, Schmechel SC, Koopmeiners JS. Detection of Prostate Cancer: Quantitative Multiparametric MR Imaging Models Developed Using Registered Correlative Histopathology. Radiology 2016; 279:805-16. [PMID: 26761720 DOI: 10.1148/radiol.2015151089] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To develop multiparametric magnetic resonance (MR) imaging models to generate a quantitative, user-independent, voxel-wise composite biomarker score (CBS) for detection of prostate cancer by using coregistered correlative histopathologic results, and to compare performance of CBS-based detection with that of single quantitative MR imaging parameters. Materials and Methods Institutional review board approval and informed consent were obtained. Patients with a diagnosis of prostate cancer underwent multiparametric MR imaging before surgery for treatment. All MR imaging voxels in the prostate were classified as cancer or noncancer on the basis of coregistered histopathologic data. Predictive models were developed by using more than one quantitative MR imaging parameter to generate CBS maps. Model development and evaluation of quantitative MR imaging parameters and CBS were performed separately for the peripheral zone and the whole gland. Model accuracy was evaluated by using the area under the receiver operating characteristic curve (AUC), and confidence intervals were calculated with the bootstrap procedure. The improvement in classification accuracy was evaluated by comparing the AUC for the multiparametric model and the single best-performing quantitative MR imaging parameter at the individual level and in aggregate. Results Quantitative T2, apparent diffusion coefficient (ADC), volume transfer constant (K(trans)), reflux rate constant (kep), and area under the gadolinium concentration curve at 90 seconds (AUGC90) were significantly different between cancer and noncancer voxels (P < .001), with ADC showing the best accuracy (peripheral zone AUC, 0.82; whole gland AUC, 0.74). Four-parameter models demonstrated the best performance in both the peripheral zone (AUC, 0.85; P = .010 vs ADC alone) and whole gland (AUC, 0.77; P = .043 vs ADC alone). Individual-level analysis showed statistically significant improvement in AUC in 82% (23 of 28) and 71% (24 of 34) of patients with peripheral-zone and whole-gland models, respectively, compared with ADC alone. Model-based CBS maps for cancer detection showed improved visualization of cancer location and extent. Conclusion Quantitative multiparametric MR imaging models developed by using coregistered correlative histopathologic data yielded a voxel-wise CBS that outperformed single quantitative MR imaging parameters for detection of prostate cancer, especially when the models were assessed at the individual level. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Gregory J Metzger
- From the Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455 (G.J.M., C.K., B.S., P.J.B., X.L., D.H., J.W.N.), Department of Laboratory Medicine and Pathology (A.D.J., J.C.H., L.M., S.C.S.), Department of Urologic Surgery, Institute of Prostate and Urologic Cancers (B.K., C.A.W.), and Division of Biostatistics (J.S.K.)
| | - Chaitanya Kalavagunta
- From the Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455 (G.J.M., C.K., B.S., P.J.B., X.L., D.H., J.W.N.), Department of Laboratory Medicine and Pathology (A.D.J., J.C.H., L.M., S.C.S.), Department of Urologic Surgery, Institute of Prostate and Urologic Cancers (B.K., C.A.W.), and Division of Biostatistics (J.S.K.)
| | - Benjamin Spilseth
- From the Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455 (G.J.M., C.K., B.S., P.J.B., X.L., D.H., J.W.N.), Department of Laboratory Medicine and Pathology (A.D.J., J.C.H., L.M., S.C.S.), Department of Urologic Surgery, Institute of Prostate and Urologic Cancers (B.K., C.A.W.), and Division of Biostatistics (J.S.K.)
| | - Patrick J Bolan
- From the Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455 (G.J.M., C.K., B.S., P.J.B., X.L., D.H., J.W.N.), Department of Laboratory Medicine and Pathology (A.D.J., J.C.H., L.M., S.C.S.), Department of Urologic Surgery, Institute of Prostate and Urologic Cancers (B.K., C.A.W.), and Division of Biostatistics (J.S.K.)
| | - Xiufeng Li
- From the Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455 (G.J.M., C.K., B.S., P.J.B., X.L., D.H., J.W.N.), Department of Laboratory Medicine and Pathology (A.D.J., J.C.H., L.M., S.C.S.), Department of Urologic Surgery, Institute of Prostate and Urologic Cancers (B.K., C.A.W.), and Division of Biostatistics (J.S.K.)
| | - Diane Hutter
- From the Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455 (G.J.M., C.K., B.S., P.J.B., X.L., D.H., J.W.N.), Department of Laboratory Medicine and Pathology (A.D.J., J.C.H., L.M., S.C.S.), Department of Urologic Surgery, Institute of Prostate and Urologic Cancers (B.K., C.A.W.), and Division of Biostatistics (J.S.K.)
| | - Jung W Nam
- From the Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455 (G.J.M., C.K., B.S., P.J.B., X.L., D.H., J.W.N.), Department of Laboratory Medicine and Pathology (A.D.J., J.C.H., L.M., S.C.S.), Department of Urologic Surgery, Institute of Prostate and Urologic Cancers (B.K., C.A.W.), and Division of Biostatistics (J.S.K.)
| | - Andrew D Johnson
- From the Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455 (G.J.M., C.K., B.S., P.J.B., X.L., D.H., J.W.N.), Department of Laboratory Medicine and Pathology (A.D.J., J.C.H., L.M., S.C.S.), Department of Urologic Surgery, Institute of Prostate and Urologic Cancers (B.K., C.A.W.), and Division of Biostatistics (J.S.K.)
| | - Jonathan C Henriksen
- From the Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455 (G.J.M., C.K., B.S., P.J.B., X.L., D.H., J.W.N.), Department of Laboratory Medicine and Pathology (A.D.J., J.C.H., L.M., S.C.S.), Department of Urologic Surgery, Institute of Prostate and Urologic Cancers (B.K., C.A.W.), and Division of Biostatistics (J.S.K.)
| | - Laura Moench
- From the Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455 (G.J.M., C.K., B.S., P.J.B., X.L., D.H., J.W.N.), Department of Laboratory Medicine and Pathology (A.D.J., J.C.H., L.M., S.C.S.), Department of Urologic Surgery, Institute of Prostate and Urologic Cancers (B.K., C.A.W.), and Division of Biostatistics (J.S.K.)
| | - Badrinath Konety
- From the Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455 (G.J.M., C.K., B.S., P.J.B., X.L., D.H., J.W.N.), Department of Laboratory Medicine and Pathology (A.D.J., J.C.H., L.M., S.C.S.), Department of Urologic Surgery, Institute of Prostate and Urologic Cancers (B.K., C.A.W.), and Division of Biostatistics (J.S.K.)
| | - Christopher A Warlick
- From the Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455 (G.J.M., C.K., B.S., P.J.B., X.L., D.H., J.W.N.), Department of Laboratory Medicine and Pathology (A.D.J., J.C.H., L.M., S.C.S.), Department of Urologic Surgery, Institute of Prostate and Urologic Cancers (B.K., C.A.W.), and Division of Biostatistics (J.S.K.)
| | - Stephen C Schmechel
- From the Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455 (G.J.M., C.K., B.S., P.J.B., X.L., D.H., J.W.N.), Department of Laboratory Medicine and Pathology (A.D.J., J.C.H., L.M., S.C.S.), Department of Urologic Surgery, Institute of Prostate and Urologic Cancers (B.K., C.A.W.), and Division of Biostatistics (J.S.K.)
| | - Joseph S Koopmeiners
- From the Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455 (G.J.M., C.K., B.S., P.J.B., X.L., D.H., J.W.N.), Department of Laboratory Medicine and Pathology (A.D.J., J.C.H., L.M., S.C.S.), Department of Urologic Surgery, Institute of Prostate and Urologic Cancers (B.K., C.A.W.), and Division of Biostatistics (J.S.K.)
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Gatidis S, Schmidt H, Claussen CD, Schwenzer NF. [Multiparametric imaging with simultaneous MRI/PET: Methodological aspects and possible clinical applications]. Z Rheumatol 2015; 74:878-85. [PMID: 26589201 DOI: 10.1007/s00393-015-0011-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Combined MRI/PET enables the acquisition of a variety of imaging parameters during one examination, including anatomical and functional information such as perfusion, diffusion, and metabolism. OBJECTIVE The present article summarizes these methods and their applications in multiparametric imaging via MRI/PET. RESULTS Numerous studies have shown that the combination of these parameters can improve diagnostic accuracy for many applications, including the imaging of oncological, neurological, and inflammatory conditions. Because of the amount and the complexity of the acquired multiparametric data, there is a need for advanced analysis tools, such as methods of parameter selection and data classification. DISCUSSION Currently, the clinical application of this process still has limitations. On the one hand, software for the fast calculation and standardized evaluation of the imaging data acquired is still lacking. On the other hand, there are deficiencies when comparing the results because of a lack of standardization of the assessment and diagnostic procedure.
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Affiliation(s)
- S Gatidis
- Abteilung für Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - H Schmidt
- Abteilung für Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - C D Claussen
- Abteilung für Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - N F Schwenzer
- Abteilung für Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland.
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Giannini V, Mazzetti S, Vignati A, Russo F, Bollito E, Porpiglia F, Stasi M, Regge D. A fully automatic computer aided diagnosis system for peripheral zone prostate cancer detection using multi-parametric magnetic resonance imaging. Comput Med Imaging Graph 2015; 46 Pt 2:219-26. [PMID: 26391055 DOI: 10.1016/j.compmedimag.2015.09.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/09/2015] [Accepted: 09/02/2015] [Indexed: 01/23/2023]
Abstract
Multiparametric (mp)-Magnetic Resonance Imaging (MRI) is emerging as a powerful test to diagnose and stage prostate cancer (PCa). However, its interpretation is a time consuming and complex feat requiring dedicated radiologists. Computer-aided diagnosis (CAD) tools could allow better integration of data deriving from the different MRI sequences in order to obtain accurate, reproducible, non-operator dependent information useful to identify and stage PCa. In this paper, we present a fully automatic CAD system conceived as a 2-stage process. First, a malignancy probability map for all voxels within the prostate is created. Then, a candidate segmentation step is performed to highlight suspected areas, thus evaluating both the sensitivity and the number of false positive (FP) regions detected by the system. Training and testing of the CAD scheme is performed using whole-mount histological sections as the reference standard. On a cohort of 56 patients (i.e. 65 lesions) the area under the ROC curve obtained during the voxel-wise step was 0.91, while, in the second step, a per-patient sensitivity of 97% was reached, with a median number of FP equal to 3 in the whole prostate. The system here proposed could be potentially used as first or second reader to manage patients suspected to have PCa, thus reducing both the radiologist's reporting time and the inter-reader variability. As an innovative setup, it could also be used to help the radiologist in setting the MRI-guided biopsy target.
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Affiliation(s)
- Valentina Giannini
- Department of Radiology at Candiolo Cancer Institute-FPO, IRCCS, Strada Provinciale 142 km 3.95, 10060 Candiolo, Italy.
| | - Simone Mazzetti
- Department of Radiology at Candiolo Cancer Institute-FPO, IRCCS, Strada Provinciale 142 km 3.95, 10060 Candiolo, Italy
| | - Anna Vignati
- Department of Radiology at Candiolo Cancer Institute-FPO, IRCCS, Strada Provinciale 142 km 3.95, 10060 Candiolo, Italy
| | - Filippo Russo
- Department of Radiology at Candiolo Cancer Institute-FPO, IRCCS, Strada Provinciale 142 km 3.95, 10060 Candiolo, Italy
| | - Enrico Bollito
- Division of Pathology at the University of Turin, San Luigi Hospital, Regione Gonzole, 10, 10043 Orbassano, Italy
| | - Francesco Porpiglia
- Division of Urology and Department of Oncology at the University of Turin, San Luigi Hospital, Regione Gonzole, 10, 10043 Orbassano, Italy
| | - Michele Stasi
- Department of Medical Physics at Candiolo Cancer Institute-FPO, IRCCS, Strada Provinciale 142 km 3.95, 10060 Candiolo, Italy
| | - Daniele Regge
- Department of Radiology at Candiolo Cancer Institute-FPO, IRCCS, Strada Provinciale 142 km 3.95, 10060 Candiolo, Italy
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Le JD, Huang J, Marks LS. Targeted prostate biopsy: value of multiparametric magnetic resonance imaging in detection of localized cancer. Asian J Androl 2015; 16:522-9. [PMID: 24589455 PMCID: PMC4104074 DOI: 10.4103/1008-682x.122864] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Prostate cancer is the second most common cancer in men, with 1.1 million new cases worldwide reported by the World Health Organization in one recent year. Transrectal ultrasound (TRUS)-guided biopsy has been used for the diagnosis of prostate cancer for over 2 decades, but the technique is usually blind to cancer location. Moreover, the false negative rate of TRUS biopsy has been reported to be as high as 47%. Multiparametric magnetic resonance imaging (mp-MRI) includes T1- and T2-weighted imaging as well as dynamic contrast-enhanced (DCE) and diffusion-weighted imaging (DWI). mp-MRI is a major advance in the imaging of prostate cancer, enabling targeted biopsy of suspicious lesions. Evolving targeted biopsy techniques-including direct in-bore biopsy, cognitive fusion and software-based MRI-ultrasound (MRI-US) fusion-have led to a several-fold improvement in cancer detection compared to the earlier method. Importantly, the detection of clinically significant cancers has been greatly facilitated by targeting, compared to systematic biopsy alone. Targeted biopsy via MRI-US fusion may dramatically alter the way prostate cancer is diagnosed and managed.
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Affiliation(s)
| | | | - Leonard S Marks
- Department of Urology, University of California, Los Angeles, USA
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Gatidis S, Scharpf M, Martirosian P, Bezrukov I, Küstner T, Hennenlotter J, Kruck S, Kaufmann S, Schraml C, la Fougère C, Schwenzer NF, Schmidt H. Combined unsupervised-supervised classification of multiparametric PET/MRI data: application to prostate cancer. NMR IN BIOMEDICINE 2015; 28:914-922. [PMID: 26014883 DOI: 10.1002/nbm.3329] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 03/18/2015] [Accepted: 04/23/2015] [Indexed: 06/04/2023]
Abstract
Multiparametric medical imaging data can be large and are often complex. Machine learning algorithms can assist in image interpretation when reliable training data exist. In most cases, however, knowledge about ground truth (e.g. histology) and thus training data is limited, which makes application of machine learning algorithms difficult. The purpose of this study was to design and implement a learning algorithm for classification of multidimensional medical imaging data that is robust and accurate even with limited prior knowledge and that allows for generalization and application to unseen data. Local prostate cancer was chosen as a model for application and validation. 16 patients underwent combined simultaneous [(11) C]-choline positron emission tomography (PET)/MRI. The following imaging parameters were acquired: T2 signal intensities, apparent diffusion coefficients, parameters Ktrans and Kep from dynamic contrast-enhanced MRI, and PET standardized uptake values (SUVs). A spatially constrained fuzzy c-means algorithm (sFCM) was applied to the single datasets and the resulting labeled data were used for training of a support vector machine (SVM) classifier. Accuracy and false positive and false negative rates of the proposed algorithm were determined in comparison with manual tumor delineation. For five of the 16 patients rates were also determined in comparison with the histopathological standard of reference. The combined sFCM/SVM algorithm proposed in this study revealed reliable classification results consistent with the histopathological reference standard and comparable to those of manual tumor delineation. sFCM/SVM generally performed better than unsupervised sFCM alone. We observed an improvement in accuracy with increasing number of imaging parameters used for clustering and SVM training. In particular, including PET SUVs as an additional parameter markedly improved classification results. A variety of applications are conceivable, especially for imaging of tissues without easily available histopathological correlation.
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Affiliation(s)
- Sergios Gatidis
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Germany
| | - Markus Scharpf
- Department of Pathology and Neuropathology, General Pathology, Eberhard Karls University Tübingen, Germany
| | - Petros Martirosian
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Germany
| | - Ilja Bezrukov
- Department of Empirical Inference, Max Planck Institute for Intelligent Systems, Tübingen, Germany
- Department of Radiology, Preclinical Imaging and Radiopharmacy, Laboratory for Preclinical Imaging and Imaging Technology of the Werner Siemens Foundation, Eberhard Karls University Tübingen, Germany
| | - Thomas Küstner
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Germany
| | | | - Stephan Kruck
- Department of Urology, Eberhard Karls University Tübingen, Germany
| | - Sascha Kaufmann
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Germany
| | - Christina Schraml
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Germany
| | - Christian la Fougère
- Department of Radiology, Nuclear Medicine, Eberhard Karls University Tübingen, Germany
| | - Nina F Schwenzer
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Germany
| | - Holger Schmidt
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Germany
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Riches SF, Payne GS, Morgan VA, Dearnaley D, Morgan S, Partridge M, Livni N, Ogden C, deSouza NM. Multivariate modelling of prostate cancer combining magnetic resonance derived T2, diffusion, dynamic contrast-enhanced and spectroscopic parameters. Eur Radiol 2015; 25:1247-56. [PMID: 25749786 DOI: 10.1007/s00330-014-3479-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 10/23/2014] [Accepted: 10/28/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objectives are determine the optimal combination of MR parameters for discriminating tumour within the prostate using linear discriminant analysis (LDA) and to compare model accuracy with that of an experienced radiologist. METHODS Multiparameter MRIs in 24 patients before prostatectomy were acquired. Tumour outlines from whole-mount histology, T2-defined peripheral zone (PZ), and central gland (CG) were superimposed onto slice-matched parametric maps. T2, Apparent Diffusion Coefficient, initial area under the gadolinium curve, vascular parameters (K(trans),Kep,Ve), and (choline+polyamines+creatine)/citrate were compared between tumour and non-tumour tissues. Receiver operating characteristic (ROC) curves determined sensitivity and specificity at spectroscopic voxel resolution and per lesion, and LDA determined the optimal multiparametric model for identifying tumours. Accuracy was compared with an expert observer. RESULTS Tumours were significantly different from PZ and CG for all parameters (all p < 0.001). Area under the ROC curve for discriminating tumour from non-tumour was significantly greater (p < 0.001) for the multiparametric model than for individual parameters; at 90 % specificity, sensitivity was 41 % (MRSI voxel resolution) and 59 % per lesion. At this specificity, an expert observer achieved 28 % and 49 % sensitivity, respectively. CONCLUSION The model was more accurate when parameters from all techniques were included and performed better than an expert observer evaluating these data. KEY POINTS • The combined model increases diagnostic accuracy in prostate cancer compared with individual parameters • The optimal combined model includes parameters from diffusion, spectroscopy, perfusion, and anatominal MRI • The computed model improves tumour detection compared to an expert viewing parametric maps.
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Affiliation(s)
- S F Riches
- CRUK & EPSRC Cancer Imaging Centre, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, Surrey, UK,
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Steenbergen P, Haustermans K, Lerut E, Oyen R, De Wever L, Van den Bergh L, Kerkmeijer LG, Pameijer FA, Veldhuis WB, van der Voort van Zyp JR, Pos FJ, Heijmink SW, Kalisvaart R, Teertstra HJ, Dinh CV, Ghobadi G, van der Heide UA. Prostate tumor delineation using multiparametric magnetic resonance imaging: Inter-observer variability and pathology validation. Radiother Oncol 2015; 115:186-90. [PMID: 25935742 DOI: 10.1016/j.radonc.2015.04.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 03/27/2015] [Accepted: 04/19/2015] [Indexed: 12/19/2022]
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Mata C, Walker PM, Oliver A, Brunotte F, Martí J, Lalande A. ProstateAnalyzer: Web-based medical application for the management of prostate cancer using multiparametric MR imaging. Inform Health Soc Care 2015; 41:286-306. [PMID: 25710606 DOI: 10.3109/17538157.2015.1008488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES In this paper, we present ProstateAnalyzer, a new web-based medical tool for prostate cancer diagnosis. ProstateAnalyzer allows the visualization and analysis of magnetic resonance images (MRI) in a single framework. METHODS ProstateAnalyzer recovers the data from a PACS server and displays all the associated MRI images in the same framework, usually consisting of 3D T2-weighted imaging for anatomy, dynamic contrast-enhanced MRI for perfusion, diffusion-weighted imaging in the form of an apparent diffusion coefficient (ADC) map and MR Spectroscopy. ProstateAnalyzer allows annotating regions of interest in a sequence and propagates them to the others. RESULTS From a representative case, the results using the four visualization platforms are fully detailed, showing the interaction among them. The tool has been implemented as a Java-based applet application to facilitate the portability of the tool to the different computer architectures and software and allowing the possibility to work remotely via the web. CONCLUSION ProstateAnalyzer enables experts to manage prostate cancer patient data set more efficiently. The tool allows delineating annotations by experts and displays all the required information for use in diagnosis. According to the current European Society of Urogenital Radiology guidelines, it also includes the PI-RADS structured reporting scheme.
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Affiliation(s)
- Christian Mata
- a Department of Computer Architecture and Technology , University of Girona , Girona , Spain .,b Laboratoire Electronique Informatique et Image (Le2I) , Université de Bourgogne , Dijon , France
| | - Paul M Walker
- b Laboratoire Electronique Informatique et Image (Le2I) , Université de Bourgogne , Dijon , France .,c Department of NMR Spectroscopy , University Hospital , Dijon , France
| | - Arnau Oliver
- a Department of Computer Architecture and Technology , University of Girona , Girona , Spain
| | - François Brunotte
- b Laboratoire Electronique Informatique et Image (Le2I) , Université de Bourgogne , Dijon , France .,c Department of NMR Spectroscopy , University Hospital , Dijon , France
| | - Joan Martí
- a Department of Computer Architecture and Technology , University of Girona , Girona , Spain
| | - Alain Lalande
- b Laboratoire Electronique Informatique et Image (Le2I) , Université de Bourgogne , Dijon , France .,c Department of NMR Spectroscopy , University Hospital , Dijon , France
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Dikaios N, Alkalbani J, Sidhu HS, Fujiwara T, Abd-Alazeez M, Kirkham A, Allen C, Ahmed H, Emberton M, Freeman A, Halligan S, Taylor S, Atkinson D, Punwani S. Logistic regression model for diagnosis of transition zone prostate cancer on multi-parametric MRI. Eur Radiol 2015; 25:523-32. [PMID: 25226842 PMCID: PMC4291517 DOI: 10.1007/s00330-014-3386-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/05/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We aimed to develop logistic regression (LR) models for classifying prostate cancer within the transition zone on multi-parametric magnetic resonance imaging (mp-MRI). METHODS One hundred and fifty-five patients (training cohort, 70 patients; temporal validation cohort, 85 patients) underwent mp-MRI and transperineal-template-prostate-mapping (TPM) biopsy. Positive cores were classified by cancer definitions: (1) any-cancer; (2) definition-1 [≥Gleason 4 + 3 or ≥ 6 mm cancer core length (CCL)] [high risk significant]; and (3) definition-2 (≥Gleason 3 + 4 or ≥ 4 mm CCL) cancer [intermediate-high risk significant]. For each, logistic-regression mp-MRI models were derived from the training cohort and validated internally and with the temporal cohort. Sensitivity/specificity and the area under the receiver operating characteristic (ROC-AUC) curve were calculated. LR model performance was compared to radiologists' performance. RESULTS Twenty-eight of 70 patients from the training cohort, and 25/85 patients from the temporal validation cohort had significant cancer on TPM. The ROC-AUC of the LR model for classification of cancer was 0.73/0.67 at internal/temporal validation. The radiologist A/B ROC-AUC was 0.65/0.74 (temporal cohort). For patients scored by radiologists as Prostate Imaging Reporting and Data System (Pi-RADS) score 3, sensitivity/specificity of radiologist A 'best guess' and LR model was 0.14/0.54 and 0.71/0.61, respectively; and radiologist B 'best guess' and LR model was 0.40/0.34 and 0.50/0.76, respectively. CONCLUSIONS LR models can improve classification of Pi-RADS score 3 lesions similar to experienced radiologists. KEY POINTS • MRI helps find prostate cancer in the anterior of the gland • Logistic regression models based on mp-MRI can classify prostate cancer • Computers can help confirm cancer in areas doctors are uncertain about.
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Affiliation(s)
- Nikolaos Dikaios
- Centre for Medical Imaging, University College London, 3rd Floor East Wing, 250 Euston Road, London, UK NW1 2PG
- Departments of Radiology, University College London Hospital, 235 Euston Road, London, UK NW1 2BU
| | - Jokha Alkalbani
- Centre for Medical Imaging, University College London, 3rd Floor East Wing, 250 Euston Road, London, UK NW1 2PG
| | - Harbir Singh Sidhu
- Centre for Medical Imaging, University College London, 3rd Floor East Wing, 250 Euston Road, London, UK NW1 2PG
| | - Taiki Fujiwara
- Centre for Medical Imaging, University College London, 3rd Floor East Wing, 250 Euston Road, London, UK NW1 2PG
| | - Mohamed Abd-Alazeez
- Research Department of Urology, University College London, London, UK NW1 2PG
| | - Alex Kirkham
- Departments of Radiology, University College London Hospital, 235 Euston Road, London, UK NW1 2BU
| | - Clare Allen
- Departments of Radiology, University College London Hospital, 235 Euston Road, London, UK NW1 2BU
| | - Hashim Ahmed
- Research Department of Urology, University College London, London, UK NW1 2PG
| | - Mark Emberton
- Research Department of Urology, University College London, London, UK NW1 2PG
| | - Alex Freeman
- Department of Histopathology, University College London Hospital, London, UK NW1 2PG
| | - Steve Halligan
- Centre for Medical Imaging, University College London, 3rd Floor East Wing, 250 Euston Road, London, UK NW1 2PG
- Departments of Radiology, University College London Hospital, 235 Euston Road, London, UK NW1 2BU
| | - Stuart Taylor
- Centre for Medical Imaging, University College London, 3rd Floor East Wing, 250 Euston Road, London, UK NW1 2PG
- Departments of Radiology, University College London Hospital, 235 Euston Road, London, UK NW1 2BU
| | - David Atkinson
- Centre for Medical Imaging, University College London, 3rd Floor East Wing, 250 Euston Road, London, UK NW1 2PG
- Departments of Radiology, University College London Hospital, 235 Euston Road, London, UK NW1 2BU
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, 3rd Floor East Wing, 250 Euston Road, London, UK NW1 2PG
- Departments of Radiology, University College London Hospital, 235 Euston Road, London, UK NW1 2BU
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Betrouni N, Makni N, Lakroum S, Mordon S, Villers A, Puech P. Computer-aided analysis of prostate multiparametric MR images: an unsupervised fusion-based approach. Int J Comput Assist Radiol Surg 2015; 10:1515-26. [PMID: 25605298 DOI: 10.1007/s11548-015-1151-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/06/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study is to provide an automatic framework for computer-aided analysis of multiparametric magnetic resonance (mp-MR) images of prostate. METHOD We introduce a novel method for the unsupervised analysis of the images. An evidential C-means classifier was adapted for use with a segmentation scheme to address multisource data and to manage conflicts and redundancy. RESULTS Experiments were conducted using data from 15 patients. The evaluation protocol consisted in evaluating the method abilities to classify prostate tissues, showing the same behaviour on the mp-MR images, into homogeneous classes. As the actual diagnosis was available, thanks to the correlation with histopathological findings, the assessment focused on the ability to segment cancer foci. The method exhibited global sensitivity and specificity of 70 and 88 %, respectively. CONCLUSION The preliminary results obtained by these initial experiments showed that the method can be applied in clinical routine practice to help making decision especially for practitioners with limited experience in prostate MRI analysis.
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Affiliation(s)
- N Betrouni
- INSERM, U703, 152, rue du Docteur Yersin, 59120, Loos, CHRU de Lille, France,
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Muller BG, van den Bos W, Pinto PA, de la Rosette JJ. Imaging modalities in focal therapy: patient selection, treatment guidance, and follow-up. Curr Opin Urol 2014; 24:218-24. [PMID: 24637316 DOI: 10.1097/mou.0000000000000041] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Focal therapy for prostate cancer is emerging as a management option between active surveillance and radical treatments. In this article, we present two of the most important imaging modalities in focal therapy, multiparametric MRI (mpMRI) and ultrasonography. We review the recent advances within these two platforms. RECENT FINDINGS State-of-the-art imaging in all phases of focal therapy is essential for treatment safety. In patient selection, treatment guidance, and follow-up, different aspects of imaging are important. mpMRI is an imaging technology with high imaging resolution and contrast. This makes it an excellent technology for patient selection and treatment planning and follow-up. Ultrasound has the unique property of real-time image acquisition. This makes it an excellent technology for real-time treatment guidance. There are multiple novelties in these two platforms that have increased the accuracy considerably. Examples in ultrasound are contrast-enhanced ultrasonography, elastography, shear-wave elastography, and histoscanning. In mpMRI, these advantages consist of multiple sequences combined to one image and magnetic resonance thermometry. SUMMARY Standardization of multiparametric transrectal ultrasound and mpMRI is of paramount importance. For targeted treatment and follow-up, a good negative predictive value of the test is important. There is much to gain from both of these developing fields and imaging accuracy of the two platforms is comparable. Standardization in conduct and interpretation, three-dimensional reconstruction, and fusion of the two platforms can make focal therapy the standard of care for prostate cancer.
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Affiliation(s)
- Berrend G Muller
- aDepartment of Urology, AMC University Hospital, Amsterdam, The Netherlands bDepartment of Urology, National Cancer Institute, Bethesda, Maryland, USA
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Computer aided-diagnosis of prostate cancer on multiparametric MRI: a technical review of current research. BIOMED RESEARCH INTERNATIONAL 2014; 2014:789561. [PMID: 25525604 PMCID: PMC4267002 DOI: 10.1155/2014/789561] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/28/2014] [Indexed: 11/18/2022]
Abstract
Prostate cancer (PCa) is the most commonly diagnosed cancer among men in the United States. In this paper, we survey computer aided-diagnosis (CADx) systems that use multiparametric magnetic resonance imaging (MP-MRI) for detection and diagnosis of prostate cancer. We review and list mainstream techniques that are commonly utilized in image segmentation, registration, feature extraction, and classification. The performances of 15 state-of-the-art prostate CADx systems are compared through the area under their receiver operating characteristic curves (AUC). Challenges and potential directions to further the research of prostate CADx are discussed in this paper. Further improvements should be investigated to make prostate CADx systems useful in clinical practice.
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Yamamoto H, Nir D, Vyas L, Chang RT, Popert R, Cahill D, Challacombe B, Dasgupta P, Chandra A. A Workflow to Improve the Alignment of Prostate Imaging with Whole-mount Histopathology. Acad Radiol 2014; 21:1009-19. [PMID: 25018073 DOI: 10.1016/j.acra.2014.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/22/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES Evaluation of prostate imaging tests against whole-mount histology specimens requires accurate alignment between radiologic and histologic data sets. Misalignment results in false-positive and -negative zones as assessed by imaging. We describe a workflow for three-dimensional alignment of prostate imaging data against whole-mount prostatectomy reference specimens and assess its performance against a standard workflow. MATERIALS AND METHODS Ethical approval was granted. Patients underwent motorized transrectal ultrasound (Prostate Histoscanning) to generate a three-dimensional image of the prostate before radical prostatectomy. The test workflow incorporated steps for axial alignment between imaging and histology, size adjustments following formalin fixation, and use of custom-made parallel cutters and digital caliper instruments. The control workflow comprised freehand cutting and assumed homogeneous block thicknesses at the same relative angles between pathology and imaging sections. RESULTS Thirty radical prostatectomy specimens were histologically and radiologically processed, either by an alignment-optimized workflow (n = 20) or a control workflow (n = 10). The optimized workflow generated tissue blocks of heterogeneous thicknesses but with no significant drifting in the cutting plane. The control workflow resulted in significantly nonparallel blocks, accurately matching only one out of four histology blocks to their respective imaging data. The image-to-histology alignment accuracy was 20% greater in the optimized workflow (P < .0001), with higher sensitivity (85% vs. 69%) and specificity (94% vs. 73%) for margin prediction in a 5 × 5-mm grid analysis. CONCLUSIONS A significantly better alignment was observed in the optimized workflow. Evaluation of prostate imaging biomarkers using whole-mount histology references should include a test-to-reference spatial alignment workflow.
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Guerrero-Preston R, Michailidi C, Marchionni L, Pickering CR, Frederick MJ, Myers JN, Yegnasubramanian S, Hadar T, Noordhuis MG, Zizkova V, Fertig E, Agrawal N, Westra W, Koch W, Califano J, Velculescu VE, Sidransky D. Key tumor suppressor genes inactivated by "greater promoter" methylation and somatic mutations in head and neck cancer. Epigenetics 2014; 9:1031-46. [PMID: 24786473 PMCID: PMC4143405 DOI: 10.4161/epi.29025] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Tumor suppressor genes (TSGs) are commonly inactivated by somatic mutation and/or promoter methylation; yet, recent high-throughput genomic studies have not identified key TSGs inactivated by both mechanisms. We pursued an integrated molecular analysis based on methylation binding domain sequencing (MBD-seq), 450K Methylation arrays, whole exome sequencing, and whole genome gene expression arrays in primary head and neck squamous cell carcinoma (HNSCC) tumors and matched uvulopalatopharyngoplasty tissue samples (UPPPs). We uncovered 186 downregulated genes harboring cancer specific promoter methylation including PAX1 and PAX5 and we identified 10 key tumor suppressor genes (GABRB3, HOXC12, PARP15, SLCO4C1, CDKN2A, PAX1, PIK3AP1, HOXC6, PLCB1, and ZIC4) inactivated by both promoter methylation and/or somatic mutation. Among the novel tumor suppressor genes discovered with dual mechanisms of inactivation, we found a high frequency of genomic and epigenomic alterations in the PAX gene family of transcription factors, which selectively impact canonical NOTCH and TP53 pathways to determine cell fate, cell survival, and genome maintenance. Our results highlight the importance of assessing TSGs at the genomic and epigenomic level to identify key pathways in HNSCC, deregulated by simultaneous promoter methylation and somatic mutations.
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Affiliation(s)
- Rafael Guerrero-Preston
- Department of Otolaryngology and Head and Neck Surgery; Johns Hopkins University; School of Medicine; Baltimore, MD USA; Department of Obstetrics and Gynecology; University of Puerto Rico School of Medicine; Río Piedras, Puerto Rico
| | - Christina Michailidi
- Department of Otolaryngology and Head and Neck Surgery; Johns Hopkins University; School of Medicine; Baltimore, MD USA
| | - Luigi Marchionni
- Department of Oncology Biostatistics; Johns Hopkins University; School of Medicine; Baltimore, MD USA
| | - Curtis R Pickering
- Department of Head and Neck Surgery; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Mitchell J Frederick
- Department of Head and Neck Surgery; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | | | - Tal Hadar
- Department of Otolaryngology and Head and Neck Surgery; Johns Hopkins University; School of Medicine; Baltimore, MD USA
| | - Maartje G Noordhuis
- Department of Otolaryngology and Head and Neck Surgery; Johns Hopkins University; School of Medicine; Baltimore, MD USA; Department of Otorhinolaryngology-Head and Neck Surgery; University of Groningen; University Medical Center; Groningen, The Netherlands
| | - Veronika Zizkova
- Department of Otolaryngology and Head and Neck Surgery; Johns Hopkins University; School of Medicine; Baltimore, MD USA; Laboratory of Molecular Pathology and Institute of Molecular and Translational Medicine; Faculty of Medicine and Dentistry; Palacky University; Olomouc, Czech Republic
| | - Elana Fertig
- Division of Biostatistics and Bioinformatics; Department of Oncology; Sidney Kimmel Comprehensive Cancer Center; Baltimore, MD USA
| | - Nishant Agrawal
- Department of Otolaryngology and Head and Neck Surgery; Johns Hopkins University; School of Medicine; Baltimore, MD USA; Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins University; Baltimore, MD USA
| | - William Westra
- Department of Otolaryngology and Head and Neck Surgery; Johns Hopkins University; School of Medicine; Baltimore, MD USA
| | - Wayne Koch
- Department of Otolaryngology and Head and Neck Surgery; Johns Hopkins University; School of Medicine; Baltimore, MD USA
| | - Joseph Califano
- Department of Otolaryngology and Head and Neck Surgery; Johns Hopkins University; School of Medicine; Baltimore, MD USA; Milton J. Dance Head and Neck Center; Greater Baltimore Medical Center; Baltimore, MD USA
| | - Victor E Velculescu
- Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins University; Baltimore, MD USA
| | - David Sidransky
- Department of Otolaryngology and Head and Neck Surgery; Johns Hopkins University; School of Medicine; Baltimore, MD USA
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Shukla-Dave A, Hricak H. Role of MRI in prostate cancer detection. NMR IN BIOMEDICINE 2014; 27:16-24. [PMID: 23495081 DOI: 10.1002/nbm.2934] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/08/2013] [Accepted: 01/25/2013] [Indexed: 06/01/2023]
Abstract
The standard approach for the detection of prostate cancer--prostate-specific antigen (PSA) screening followed by transrectal ultrasonography (TRUS)-guided biopsy--has low sensitivity and provides limited information about the true extent and aggressiveness of the cancer. Improved methods are needed to assess the extent and aggressiveness of the cancer and to identify patients who will benefit from therapy. In recent years, there has been tremendous development of acquisition and processing tools for physiological and metabolic MRI techniques which play a potential role in the detection, localization and characterization of prostate cancer, such as dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted MRI (DW-MRI) and/or proton MR spectroscopic imaging ((1)H MRSI). The standard protocol for prostate MRI without the use of a contrast agent involves multi-planar T1 -weighted MRI, T2 -weighted MRI and DW-MRI. This review discusses the potential role of MRI in the detection of prostate cancer, specifically describing the status of MRI as a tool for guiding targeted prostate biopsies and for detecting cancer in the untreated and treated gland. In addition, future areas of MRI research are briefly discussed. Groups conducting clinical trials should consider the recommendations put forward by the European Consensus Meeting, which state that the minimum requirements for prostate MRI are T1 -weighted MRI, T2 -weighted MRI, DCE-MRI (which involves the use of a contrast agent) and DW-MRI with a pelvic phased-array coil and propose the use of transperineal template mapping biopsies as the optimal reference standard.
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Affiliation(s)
- Amita Shukla-Dave
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Bauman G, Haider M, Van der Heide UA, Ménard C. Boosting imaging defined dominant prostatic tumors: a systematic review. Radiother Oncol 2013; 107:274-81. [PMID: 23791306 DOI: 10.1016/j.radonc.2013.04.027] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 04/08/2013] [Accepted: 04/21/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Dominant cancer foci within the prostate are associated with sites of local recurrence post radiotherapy. In this systematic review we sought to address the question: "what is the clinical evidence to support differential boosting to an imaging defined GTV volume within the prostate when delivered by external beam or brachytherapy". MATERIALS AND METHODS A systematic review was conducted to identify clinical series reporting the use of radiation boosts to imaging defined GTVs. RESULTS Thirteen papers describing 11 unique patient series and 833 patients in total were identified. Methods and details of GTV definition and treatment varied substantially between series. GTV boosts were on average 8 Gy (range 3-35 Gy) for external beam, or 150% for brachytherapy (range 130-155%) and GTV volumes were small (<10 ml). Reported toxicity rates were low and may reflect the modest boost doses, small volumes and conservative DVH constraints employed in most studies. Variability in patient populations, study methodologies and outcomes reporting precluded conclusions regarding efficacy. CONCLUSIONS Despite a large cohort of patients treated differential boosts to imaging defined intra-prostatic targets, conclusions regarding optimal techniques and/or efficacy of this approach are elusive, and this approach cannot be considered standard of care. There is a need to build consensus and evidence. Ongoing prospective randomized trials are underway and will help to better define the role of differential prostate boosts based on imaging defined GTVs.
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Affiliation(s)
- Glenn Bauman
- Department of Oncology, London Health Sciences Centre and University of Western Ontario and Western University, Canada.
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Mazzetti S, Gliozzi AS, Bracco C, Russo F, Regge D, Stasi M. Comparison between PUN and Tofts models in the quantification of dynamic contrast-enhanced MR imaging. Phys Med Biol 2012. [PMID: 23202297 DOI: 10.1088/0031-9155/57/24/8443] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Dynamic contrast-enhanced study in magnetic resonance imaging (DCE-MRI) is an important tool in oncology to visualize tissues vascularization and to define tumour aggressiveness on the basis of an altered perfusion and permeability. Pharmacokinetic models are generally used to extract hemodynamic parameters, providing a quantitative description of the contrast uptake and wash-out. Empirical functions can also be used to fit experimental data without the need of any assumption about tumour physiology, as in pharmacokinetic models, increasing their diagnostic utility, in particular when automatic diagnosis systems are implemented on the basis of an MRI multi-parametric approach. Phenomenological universalities (PUN) represent a novel tool for experimental research and offer a simple and systematic method to represent a set of data independent of the application field. DCE-MRI acquisitions can thus be advantageously evaluated by the extended PUN class, providing a convenient diagnostic tool to analyse functional studies, adding a new set of features for the classification of malignant and benign lesions in computer aided detection systems. In this work the Tofts pharmacokinetic model and the class EU1 generated by the PUN description were compared in the study of DCE-MRI of the prostate, evaluating complexity of model implementation, goodness of fitting results, classification performances and computational cost. The mean R² obtained with the EU1 and Tofts model were equal to 0.96 and 0.90, respectively, and the classification performances achieved by the EU1 model and the Tofts implementation discriminated malignant from benign tissues with an area under the receiver operating characteristic curve equal to 0.92 and 0.91, respectively. Furthermore, the EU1 model has a simpler functional form which reduces implementation complexity and computational time, requiring 6 min to complete a patient elaboration process, instead of 8 min needed for the Tofts model analysis.
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Affiliation(s)
- S Mazzetti
- Institute for Cancer Research and Treatment, Strada Provinciale 142, km 3.95, 10060 Candiolo, Torino, Italy.
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