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Li S, Hu Y, Tian C, Luan J, Zhang X, Wei Q, Li X, Bian Y. Prediction of EGFR-TP53 genes co-mutations in patients with lung adenocarcinoma (LUAD) by 18F-FDG PET/CT radiomics. Clin Transl Oncol 2024:10.1007/s12094-024-03685-0. [PMID: 39251494 DOI: 10.1007/s12094-024-03685-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 08/20/2024] [Indexed: 09/11/2024]
Abstract
PURPOSE This retrospective study was undertaken to assess the predictive efficacy of 18F-FDG PET/CT -derived radiomic features concerning the co-mutation status of epidermal growth factor receptor (EGFR) and TP53 in LUAD. METHODS A cohort of 150 LUAD patients underwent pretreatment 18F-FDG PET/CT scans with known mutation status of EGFR and TP53 were collected. The feature extraction based on their PET/CT images utilized the Pyradiomics package based on the 3D Slicer. The optimal radiomic features were selected through correlation analysis and the Gradient Boosting Decision Tree (GBDT) algorithm, followed by the construction of the radiomic model. The clinical model incorporated meaningful clinical variables, whereas the complex model integrated both the radiomic and clinical models. The area under the receiver operating characteristic curve (AUC) facilitated the comparison of prediction performance across the three models. The DCA gauged the clinical utility of these models. RESULTS The patient cohort was randomly allocated into a training set (n = 105) and a validation set (n = 45) in a 7:3 ratio. Eleven PET and eleven CT optimal radiomic features were selected to construct the radiomic model. The model showed a good ability to discriminate the co-occurrence of EGFR and TP53, with AUC equal to 0.850 in the training set, and 0.748 in the validation set, compared with 0.750 and 0.626 for the clinical model. The complex model exhibited the highest AUC values, with 0.880 and 0.794 in both sets, but there were no significant differences compared to the radiomic model. The DCA revealed favorable clinical value. CONCLUSION
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Affiliation(s)
- Shuheng Li
- Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
- Department of Nuclear Medicine, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Yujing Hu
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Congna Tian
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Jiusong Luan
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Xinchao Zhang
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Qiang Wei
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Xiaodong Li
- Department of Nuclear Medicine, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Yanzhu Bian
- Hebei Medical University, Shijiazhuang, Hebei, China.
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China.
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Liang C, Zheng M, Zou H, Han Y, Zhan Y, Xing Y, Liu C, Zuo C, Zou J. Deep learning-based image analysis predicts PD-L1 status from 18F-FDG PET/CT images in non-small-cell lung cancer. Front Oncol 2024; 14:1402994. [PMID: 39301549 PMCID: PMC11410585 DOI: 10.3389/fonc.2024.1402994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 07/25/2024] [Indexed: 09/22/2024] Open
Abstract
Background There is still a lack of clinically validated biomarkers to screen lung cancer patients suitable for programmed dead cell-1 (PD-1)/programmed dead cell receptor-1 (PD-L1) immunotherapy. Detection of PD-L1 expression is invasively operated, and some PD-L1-negative patients can also benefit from immunotherapy; thus, the joint modeling of both deep learning images and clinical features was used to improve the prediction performance of PD-L1 expression in non-small cell lung cancer (NSCLC). Methods Retrospective collection of 101 patients diagnosed with pathology in our hospital who underwent 18F FDG PET/CT scans, with lung cancer tissue Tumor Propulsion Score (TPS) ≥1% as a positive expression. Lesions were extracted after preprocessing PET/CT images, and using deep learning 3D DenseNet121 to learn lesions in PET, CT, and PET/CT images, 1,024 fully connected features were extracted; clinical features (age, gender, smoking/no smoking history, lesion diameter, lesion volume, maximum standard uptake value of lesions [SUVmax], mean standard uptake value of lesions [SUVmean], total lesion glycolysis [TLG]) were combined for joint modeling based on the structured data Category Embedding Model. Results Area under a receiver operating characteristic (ROC) curve (AUC) and accuracy of predicting PD-L1 positive for PET, CT, and PET/CT test groups were 0.814 ± 0.0152, 0.7212 ± 0.0861, and 0.90 ± 0.0605, 0.806 ± 0.023, 0.70 ± 0.074, and 0.950 ± 0.0250, respectively. After joint clinical feature modeling, the AUC and accuracy of predicting PD-L1 positive for PET/CT were 0.96 ± 0.00905 and 0.950 ± 0.0250, respectively. Conclusion This study combines the features of 18F-FDG PET/CT images with clinical features using deep learning to predict the expression of PD-L1 in NSCLC, suggesting that 18F-FDG PET/CT images can be conducted as biomarkers for PD-L1 expression.
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Affiliation(s)
- Chen Liang
- Department of Nuclear Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Meiyu Zheng
- Department of Nuclear Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Han Zou
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yu Han
- Department of Nuclear Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Yingying Zhan
- Department of Nuclear Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Yu Xing
- Department of Nuclear Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Chang Liu
- Department of Nuclear Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Chao Zuo
- Department of Nuclear Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Jinhai Zou
- Department of Nuclear Medicine, Cangzhou Central Hospital, Cangzhou, China
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Yuan H, Liu E, Zhang G, Lai C, Zhang Q, Shang Y, Cheng Z, Jiang L. Diagnostic efficacy of [ 68Ga]Ga-DOTA-GPFAPI-04 in patients with solid tumors in a head-to-head comparison with [ 18F]F-FDG: results from a prospective clinical study. Eur J Nucl Med Mol Imaging 2024; 51:3360-3372. [PMID: 38727829 DOI: 10.1007/s00259-024-06756-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/04/2024] [Indexed: 09/03/2024]
Abstract
PURPOSE To identify the biodistribution and diagnostic performance of a novel fibroblast activation protein (FAP) targeted positron emission tomography (PET) tracer, [68Ga]Ga-DOTA-GPFAPI-04, in patients with solid tumors in a head-to-head comparison with [18F]F-FDG. METHODS Twenty-six patients histologically proven with cancers of nasopharyngeal (n = 5), esophagus (n = 5), gastro-esophagus (n = 1), stomach (n = 7), liver (n = 3), and colorectum (n = 5) were recruited for [68Ga]Ga-DOTA-GPFAPI-04 and [18F]F-FDG PET/CT scans on consecutive days. The primary endpoint was the diagnostic efficacy, with the histological diagnosis and the follow-up results selected as the gold standard. The secondary endpoint was the background uptake pattern. Two experienced nuclear medicine physicians who were blinded to the gold standard results while having essential awareness of the clinical context reviewed the images and labeled lesions by consensus for subsequent software-assisted lesion segmentation. Additionally, background organs were automatically segmented, assisted by artificial intelligence. Volume, mean, and maximum standard uptake values (SUVmean and SUVmax) of all segmentations were recorded. P < 0.05 was deemed as statistically significant. RESULTS Significant glandular uptake of [68Ga]Ga-DOTA-GPFAPI-04 was detected in the thyroid, pancreas, and submandibular glands, while moderate uptake was observed in the parotid glands. The myocardium and myometrium exhibited 2-3 times higher uptake of the radiotracer than that of the background levels in blood and liver. A total of 349 targeted lesions, consisting of 324 malignancies and 25 benign lesions, were segmented. [68Ga]Ga-DOTA-GPFAPI-04 is more sensitive than [18F]F-FDG, especially for abdominopelvic dissemination (1.000 vs. 0.475, P < 0.001). Interestingly, [18F]F-FDG demonstrated higher sensitivity for lung metastasis compared to [68Ga]Ga-DOTA-GPFAPI-04 (0.845 vs. 0.682, P = 0.003). The high glandular uptake made it difficult to delineate lesions in close proximity and masked two metastatic lesions in these organs. CONCLUSION Despite prominent glandular uptake, [68Ga]Ga-DOTA-GPFAPI-04 demonstrates favorable diagnostic performance. It is a promising probe scaffold for further development of FAP-targeted tumor theranostic agents.
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Affiliation(s)
- Hui Yuan
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, China
| | - Entao Liu
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, China
| | - Guojin Zhang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, China
| | - Chaoquan Lai
- Institute of Molecular Medicine, College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Qing Zhang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, China
| | - Yuxiang Shang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, China
| | - Zhen Cheng
- State Key Laboratory of Drug Research, Molecular Imaging Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China.
- Drug Discovery Shandong Laboratory, Bohai Rim Advanced Research Institute for Drug Discovery, Yantai, Shandong, China.
- University of Chinese Academy of Sciences, Beijing, China.
| | - Lei Jiang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China.
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Tian C, Hu Y, Li S, Zhang X, Wei Q, Li K, Chen X, Zheng L, Yang X, Qin Y, Bian Y. Peri- and intra-nodular radiomic features based on 18F-FDG PET/CT to distinguish lung adenocarcinomas from pulmonary granulomas. Front Med (Lausanne) 2024; 11:1453421. [PMID: 39175818 PMCID: PMC11339787 DOI: 10.3389/fmed.2024.1453421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 07/23/2024] [Indexed: 08/24/2024] Open
Abstract
Objective To compare the effectiveness of radiomic features based on 18F-FDG PET/CT images within (intranodular) and around (perinodular) lung nodules/masses in distinguishing between lung adenocarcinoma and pulmonary granulomas. Methods For this retrospective study, 18F-FDG PET/CT images were collected for 228 patients. Patients diagnosed with lung adenocarcinoma (n = 156) or granulomas (n = 72) were randomly assigned to a training (n = 159) and validation (n = 69) groups. The volume of interest (VOI) of intranodular, perinodular (1-5 voxels, termed Lesion_margin1 to Lesion_margin5) and total area (intra- plus perinodular region, termed Lesion_total1 to Lesion_total5) on PET/CT images were delineated using PETtumor and Marge tool of segmentation editor. A total of 1,037 radiomic features were extracted separately from PET and CT images, and the optimal features were selected to develop radiomic models. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC). Results Good and acceptable performance was, respectively, observed in the training (AUC = 0.868, p < 0.001) and validation (AUC = 0.715, p = 0.004) sets for the intranodular radiomic model. Among the perinodular models, the Lesion_margin2 model demonstrated the highest AUC in both sets (0.883 and 0.616, p < 0.001 and p = 0.122). Similarly, in terms of total models, Lesion_total2 model was found to outperform others in the training (AUC = 0.879, p < 0.001) and validation (AUC = 0.742, p = 0.001) sets, slightly surpassing the intranodular model. Conclusion When intra- and perinodular radiomic features extracted from the immediate vicinity of the nodule/mass up to 2 voxels distance on 18F-FDG PET/CT imaging are combined, improved differential diagnostic performance in distinguishing between lung adenocarcinomas and granulomas is achieved compared to the intra- and perinodular radiomic features alone.
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Affiliation(s)
- Congna Tian
- Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yujing Hu
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Shuheng Li
- Department of Nuclear Medicine, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Xinchao Zhang
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Qiang Wei
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Kang Li
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Xiaolin Chen
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lu Zheng
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Xin Yang
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yanan Qin
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yanzhu Bian
- Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
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Garrido-Hernandez G, Henjum H, Winter RM, Alsaker MD, Danielsen S, Boer CG, Ytre-Hauge KS, Redalen KR. Interim 18F-FDG-PET based response-adaptive dose escalation of proton therapy for head and neck cancer: a treatment planning feasibility study. Phys Med 2024; 123:103404. [PMID: 38852365 DOI: 10.1016/j.ejmp.2024.103404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 05/06/2024] [Accepted: 06/05/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Image-driven dose escalation to tumor subvolumes has been proposed to improve treatment outcome in head and neck cancer (HNC). We used 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) acquired at baseline and into treatment (interim) to identify biologic target volumes (BTVs). We assessed the feasibility of interim dose escalation to the BTV with proton therapy by simulating the effects to organs at risk (OARs). METHODS We used the semiautomated just-enough-interaction (JEI) method to identify BTVs in 18F-FDG-PET images from nine HNC patients. Between baseline and interim FDG-PET, patients received photon radiotherapy. BTV was identified assuming that high standardized uptake value (SUV) at interim reflected tumor radioresistance. Using Eclipse (Varian Medical Systems), we simulated a 10% (6.8 Gy(RBE1.1)) and 20% (13.6 Gy(RBE1.1)) dose escalation to the BTV with protons and compared results with proton plans without dose escalation. RESULTS At interim 18F-FDG-PET, radiotherapy resulted in reduced SUV compared to baseline. However, spatial overlap between high-SUV regions at baseline and interim allowed for BTV identification. Proton therapy planning demonstrated that dose escalation to the BTV was feasible, and except for some 20% dose escalation plans, OAR doses did not significantly increase. CONCLUSION Our in silico analysis demonstrated the potential for interim 18F-FDG-PET response-adaptive dose escalation to the BTV with proton therapy. This approach may give more efficient treatment to HNC with radioresistant tumor subvolumes without increasing normal tissue toxicity. Studies in larger cohorts are required to determine the full potential for interim 18F-FDG-PET-guided dose escalation of proton therapy in HNC.
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Affiliation(s)
| | - Helge Henjum
- Department of Physics and Technology, University of Bergen, Bergen, Norway
| | - René Mario Winter
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mirjam Delange Alsaker
- Department of Radiotherapy, Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Signe Danielsen
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway; Department of Oncology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | | | - Kathrine Røe Redalen
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
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Nemoto H, Saito M, Satoh Y, Komiyama T, Marino K, Aoki S, Suzuki H, Sano N, Nonaka H, Watanabe H, Funayama S, Onishi H. Evaluation of the performance of both machine learning models using PET and CT radiomics for predicting recurrence following lung stereotactic body radiation therapy: A single-institutional study. J Appl Clin Med Phys 2024; 25:e14322. [PMID: 38436611 PMCID: PMC11244675 DOI: 10.1002/acm2.14322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/14/2024] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Abstract
PURPOSE Predicting recurrence following stereotactic body radiotherapy (SBRT) for non-small cell lung cancer provides important information for the feasibility of the individualized radiotherapy and allows to select the appropriate treatment strategy based on the risk of recurrence. In this study, we evaluated the performance of both machine learning models using positron emission tomography (PET) and computed tomography (CT) radiomic features for predicting recurrence after SBRT. METHODS Planning CT and PET images of 82 non-small cell lung cancer patients who performed SBRT at our hospital were used. First, tumors were delineated on each CT and PET of each patient, and 111 unique radiomic features were extracted, respectively. Next, the 10 features were selected using three different feature selection algorithms, respectively. Recurrence prediction models based on the selected features and four different machine learning algorithms were developed, respectively. Finally, we compared the predictive performance of each model for each recurrence pattern using the mean area under the curve (AUC) calculated following the 0.632+ bootstrap method. RESULTS The highest performance for local recurrence, regional lymph node metastasis, and distant metastasis were observed in models using Support vector machine with PET features (mean AUC = 0.646), Naive Bayes with PET features (mean AUC = 0.611), and Support vector machine with CT features (mean AUC = 0.645), respectively. CONCLUSIONS We comprehensively evaluated the performance of prediction model developed for recurrence following SBRT. The model in this study would provide information to predict the recurrence pattern and assist in making treatment strategies.
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Affiliation(s)
- Hikaru Nemoto
- Department of Advanced Biomedical ImagingUniversity of YamanashiChuoYamanashiJapan
- Department of RadiologyUniversity of YamanashiChuoYamanashiJapan
| | - Masahide Saito
- Department of RadiologyUniversity of YamanashiChuoYamanashiJapan
| | - Yoko Satoh
- Imaging CenterFujita Medical Innovation Center TokyoTokyoJapan
| | | | - Kan Marino
- Department of RadiologyUniversity of YamanashiChuoYamanashiJapan
| | - Shinichi Aoki
- Department of RadiologyUniversity of YamanashiChuoYamanashiJapan
| | - Hidekazu Suzuki
- Department of RadiologyUniversity of YamanashiChuoYamanashiJapan
| | - Naoki Sano
- Department of RadiologyUniversity of YamanashiChuoYamanashiJapan
| | - Hotaka Nonaka
- Department of RadiologyFuji City General HospitalFujiShizuokaJapan
| | - Hiroaki Watanabe
- Department of RadiologyYamanashi Central HospitalKofuYamanashiJapan
| | - Satoshi Funayama
- Department of RadiologyHamamatsu University school of medicineHamamatsuShizuokaJapan
| | - Hiroshi Onishi
- Department of RadiologyUniversity of YamanashiChuoYamanashiJapan
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Philip MM, Watts J, Moeini SNM, Musheb M, McKiddie F, Welch A, Nath M. Comparison of semi-automatic and manual segmentation methods for tumor delineation on head and neck squamous cell carcinoma (HNSCC) positron emission tomography (PET) images. Phys Med Biol 2024; 69:095005. [PMID: 38530298 DOI: 10.1088/1361-6560/ad37ea] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/26/2024] [Indexed: 03/27/2024]
Abstract
Objective. Accurate and reproducible tumor delineation on positron emission tomography (PET) images is required to validate predictive and prognostic models based on PET radiomic features. Manual segmentation of tumors is time-consuming whereas semi-automatic methods are easily implementable and inexpensive. This study assessed the reliability of semi-automatic segmentation methods over manual segmentation for tumor delineation in head and neck squamous cell carcinoma (HNSCC) PET images.Approach. We employed manual and six semi-automatic segmentation methods (just enough interaction (JEI), watershed, grow from seeds (GfS), flood filling (FF), 30% SUVmax and 40%SUVmax threshold) using 3D slicer software to extract 128 radiomic features from FDG-PET images of 100 HNSCC patients independently by three operators. We assessed the distributional properties of all features and considered 92 log-transformed features for subsequent analysis. For each paired comparison of a feature, we fitted a separate linear mixed effect model using the method (two levels; manual versus one semi-automatic method) as a fixed effect and the subject and the operator as the random effects. We estimated different statistics-the intraclass correlation coefficient agreement (aICC), limits of agreement (LoA), total deviation index (TDI), coverage probability (CP) and coefficient of individual agreement (CIA)-to evaluate the agreement between the manual and semi-automatic methods.Main results. Accounting for all statistics across 92 features, the JEI method consistently demonstrated acceptable agreement with the manual method, with median values of aICC = 0.86, TDI = 0.94, CP = 0.66, and CIA = 0.91.Significance. This study demonstrated that JEI method is a reliable semi-automatic method for tumor delineation on HNSCC PET images.
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Affiliation(s)
- Mahima Merin Philip
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom
| | - Jessica Watts
- National Health Service Grampian, Aberdeen AB15 6RE, United Kingdom
| | | | - Mohammed Musheb
- National Health Service Highland, Inverness IV2 3BW, United Kingdom
| | - Fergus McKiddie
- National Health Service Grampian, Aberdeen AB15 6RE, United Kingdom
| | - Andy Welch
- Institute of Education in Healthcare and Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom
| | - Mintu Nath
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom
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Shao X, Ge X, Gao J, Niu R, Shi Y, Shao X, Jiang Z, Li R, Wang Y. Transfer learning-based PET/CT three-dimensional convolutional neural network fusion of image and clinical information for prediction of EGFR mutation in lung adenocarcinoma. BMC Med Imaging 2024; 24:54. [PMID: 38438844 PMCID: PMC10913633 DOI: 10.1186/s12880-024-01232-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND To introduce a three-dimensional convolutional neural network (3D CNN) leveraging transfer learning for fusing PET/CT images and clinical data to predict EGFR mutation status in lung adenocarcinoma (LADC). METHODS Retrospective data from 516 LADC patients, encompassing preoperative PET/CT images, clinical information, and EGFR mutation status, were divided into training (n = 404) and test sets (n = 112). Several deep learning models were developed utilizing transfer learning, involving CT-only and PET-only models. A dual-stream model fusing PET and CT and a three-stream transfer learning model (TS_TL) integrating clinical data were also developed. Image preprocessing includes semi-automatic segmentation, resampling, and image cropping. Considering the impact of class imbalance, the performance of the model was evaluated using ROC curves and AUC values. RESULTS TS_TL model demonstrated promising performance in predicting the EGFR mutation status, with an AUC of 0.883 (95%CI = 0.849-0.917) in the training set and 0.730 (95%CI = 0.629-0.830) in the independent test set. Particularly in advanced LADC, the model achieved an AUC of 0.871 (95%CI = 0.823-0.919) in the training set and 0.760 (95%CI = 0.638-0.881) in the test set. The model identified distinct activation areas in solid or subsolid lesions associated with wild and mutant types. Additionally, the patterns captured by the model were significantly altered by effective tyrosine kinase inhibitors treatment, leading to notable changes in predicted mutation probabilities. CONCLUSION PET/CT deep learning model can act as a tool for predicting EGFR mutation in LADC. Additionally, it offers clinicians insights for treatment decisions through evaluations both before and after treatment.
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Affiliation(s)
- Xiaonan Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, 213003, China.
| | - Xinyu Ge
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, 213003, China
| | - Jianxiong Gao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, 213003, China
| | - Rong Niu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, 213003, China
| | - Yunmei Shi
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, 213003, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, 213003, China
| | - Zhenxing Jiang
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Renyuan Li
- Interdisciplinary Institute of Neuroscience and Technology, School of Medicine, Zhejiang University, Hangzhou, 310009, China
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310058, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, 213003, China.
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Kluge K, Haberl D, Einspieler H, Rasul S, Gutschmayer S, Kenner L, Kramer G, Grubmüller B, Shariat S, Haug A, Hacker M. Antihormonal-Treatment Status Affects 68Ga-PSMA-HBED-CC PET Biodistribution in Patients with Prostate Cancer. J Nucl Med 2023; 64:1730-1736. [PMID: 37734840 DOI: 10.2967/jnumed.123.265980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/31/2023] [Indexed: 09/23/2023] Open
Abstract
Androgen deprivation therapy (ADT) is known to influence the prostate-specific membrane antigen (PSMA) expression of prostate cancer, potentially complicating the interpretation of PSMA ligand PET findings and affecting PSMA radioligand therapy. However, the impact of ADT on PSMA ligand biodistribution in nontumorous organs is not well understood. Methods: Men (n = 112) with histologically proven prostate cancer who underwent 68Ga-PSMA-HBED-CC (68Ga-PSMA-11) PET/CT between November 2015 and July 2021 at the Medical University Vienna with known ADT status were retrospectively recruited. Fifty-six patients were on gonadotropin-releasing hormone-interfering ADT at the time of imaging (ADT group), whereas 56 patients with no history of ADT served as a control group. Physiologically PSMA-expressing organs (salivary glands, kidneys, liver, and spleen) were delineated, and their uptake was compared according to their data distributions. Multivariate regression analysis assessed the relationship between renal, hepatic, splenic, and salivary gland uptake and the explanatory variables metabolic tumor volume, glomerular filtration rate, and ADT status. Results: ADT was associated with lower levels of PSMA uptake in the kidneys (SUVmean: Δ[ADT - control] = -7.89; 95% CI, -10.73 to -5.04; P < 0.001), liver (SUVpeak: Δ[ADT - control] = -2.3; 95% CI, -5.72 to -0.93; P = 0.003), spleen (SUVpeak: Δ[ADT - control] = -1.27; 95% CI, -3.61 to -0.16; P = 0.033), and salivary glands (SUVmean: Δ[ADT - control] = -1.04; 95% CI, -2.48 to -0.13; P = 0.027). In a multivariate analysis, ADT was found to be associated with lower renal (SUVmean: β = -7.95; 95% CI, -11.06 to -4.84; P < 0.0001), hepatic (SUVpeak: β = -7.85; 95% CI, -11.78 to -3.91; P < 0.0001), splenic (SUVpeak: β = -5.83; 95% CI, -9.95 to -1.7; P = 0.006), and salivary gland (SUVmean: β = -1.47; 95% CI, -2.76 to -0.17; P = 0.027) uptake. A higher glomerular filtration rate was associated with a higher renal SUVmean (β = 0.16; 95% CI, 0.05 to 0.26; P = 0.0034). Conclusion: These findings suggest that ADT systemically modulates PSMA expression, which may have implications for treatment-optimizing and side-effect-minimizing strategies for PSMA radioligand therapies, particularly those using more potent 225Ac-labeled PSMA conjugates.
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Affiliation(s)
- Kilian Kluge
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Applied Metabolomics, Medical University of Vienna, Vienna, Austria
| | - David Haberl
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Applied Metabolomics, Medical University of Vienna, Vienna, Austria
| | - Holger Einspieler
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Sazan Rasul
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Lukas Kenner
- Christian Doppler Laboratory for Applied Metabolomics, Medical University of Vienna, Vienna, Austria
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Bernhard Grubmüller
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology and Andrology, University Hospital Krems, Krems, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Shahrokh Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
- Division of Urology, Department of Special Surgery, University of Jordan, Amman, Jordan
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; and
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Alexander Haug
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Applied Metabolomics, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria;
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10
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Xiong X, Smith BJ, Graves SA, Graham MM, Buatti JM, Beichel RR. Head and Neck Cancer Segmentation in FDG PET Images: Performance Comparison of Convolutional Neural Networks and Vision Transformers. Tomography 2023; 9:1933-1948. [PMID: 37888743 PMCID: PMC10611182 DOI: 10.3390/tomography9050151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
Convolutional neural networks (CNNs) have a proven track record in medical image segmentation. Recently, Vision Transformers were introduced and are gaining popularity for many computer vision applications, including object detection, classification, and segmentation. Machine learning algorithms such as CNNs or Transformers are subject to an inductive bias, which can have a significant impact on the performance of machine learning models. This is especially relevant for medical image segmentation applications where limited training data are available, and a model's inductive bias should help it to generalize well. In this work, we quantitatively assess the performance of two CNN-based networks (U-Net and U-Net-CBAM) and three popular Transformer-based segmentation network architectures (UNETR, TransBTS, and VT-UNet) in the context of HNC lesion segmentation in volumetric [F-18] fluorodeoxyglucose (FDG) PET scans. For performance assessment, 272 FDG PET-CT scans of a clinical trial (ACRIN 6685) were utilized, which includes a total of 650 lesions (primary: 272 and secondary: 378). The image data used are highly diverse and representative for clinical use. For performance analysis, several error metrics were utilized. The achieved Dice coefficient ranged from 0.833 to 0.809 with the best performance being achieved by CNN-based approaches. U-Net-CBAM, which utilizes spatial and channel attention, showed several advantages for smaller lesions compared to the standard U-Net. Furthermore, our results provide some insight regarding the image features relevant for this specific segmentation application. In addition, results highlight the need to utilize primary as well as secondary lesions to derive clinically relevant segmentation performance estimates avoiding biases.
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Affiliation(s)
- Xiaofan Xiong
- Department of Biomedical Engineering, The University of Iowa, Iowa City, IA 52242, USA
| | - Brian J. Smith
- Department of Biostatistics, The University of Iowa, Iowa City, IA 52242, USA
| | - Stephen A. Graves
- Department of Radiology, The University of Iowa, Iowa City, IA 52242, USA; (S.A.G.)
| | - Michael M. Graham
- Department of Radiology, The University of Iowa, Iowa City, IA 52242, USA; (S.A.G.)
| | - John M. Buatti
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Reinhard R. Beichel
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA 52242, USA
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11
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Shiyam Sundar LK, Lassen ML, Gutschmayer S, Ferrara D, Calabrò A, Yu J, Kluge K, Wang Y, Nardo L, Hasbak P, Kjaer A, Abdelhafez YG, Wang G, Cherry SR, Spencer BA, Badawi RD, Beyer T, Muzik O. Fully Automated, Fast Motion Correction of Dynamic Whole-Body and Total-Body PET/CT Imaging Studies. J Nucl Med 2023; 64:1145-1153. [PMID: 37290795 DOI: 10.2967/jnumed.122.265362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/09/2023] [Indexed: 06/10/2023] Open
Abstract
We introduce the Fast Algorithm for Motion Correction (FALCON) software, which allows correction of both rigid and nonlinear motion artifacts in dynamic whole-body (WB) images, irrespective of the PET/CT system or the tracer. Methods: Motion was corrected using affine alignment followed by a diffeomorphic approach to account for nonrigid deformations. In both steps, images were registered using multiscale image alignment. Moreover, the frames suited to successful motion correction were automatically estimated by calculating the initial normalized cross-correlation metric between the reference frame and the other moving frames. To evaluate motion correction performance, WB dynamic image sequences from 3 different PET/CT systems (Biograph mCT, Biograph Vision 600, and uEXPLORER) using 6 different tracers (18F-FDG, 18F-fluciclovine, 68Ga-PSMA, 68Ga-DOTATATE, 11C-Pittsburgh compound B, and 82Rb) were considered. Motion correction accuracy was assessed using 4 different measures: change in volume mismatch between individual WB image volumes to assess gross body motion, change in displacement of a large organ (liver dome) within the torso due to respiration, change in intensity in small tumor nodules due to motion blur, and constancy of activity concentration levels. Results: Motion correction decreased gross body motion artifacts and reduced volume mismatch across dynamic frames by about 50%. Moreover, large-organ motion correction was assessed on the basis of correction of liver dome motion, which was removed entirely in about 70% of all cases. Motion correction also improved tumor intensity, resulting in an average increase in tumor SUVs by 15%. Large deformations seen in gated cardiac 82Rb images were managed without leading to anomalous distortions or substantial intensity changes in the resulting images. Finally, the constancy of activity concentration levels was reasonably preserved (<2% change) in large organs before and after motion correction. Conclusion: FALCON allows fast and accurate correction of rigid and nonrigid WB motion artifacts while being insensitive to scanner hardware or tracer distribution, making it applicable to a wide range of PET imaging scenarios.
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Affiliation(s)
- Lalith Kumar Shiyam Sundar
- Quantitative Imaging and Medical Physics Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Martin Lyngby Lassen
- Department of Clinical Physiology, Nuclear Medicine, and PET and Cluster for Molecular Imaging Section 4011, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sebastian Gutschmayer
- Quantitative Imaging and Medical Physics Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Daria Ferrara
- Quantitative Imaging and Medical Physics Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Anna Calabrò
- Department of Radiology, University of California-Davis, Davis, California
| | - Josef Yu
- Quantitative Imaging and Medical Physics Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Kilian Kluge
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Yiran Wang
- Department of Radiology, University of California-Davis, Davis, California
| | - Lorenzo Nardo
- Department of Radiology, University of California-Davis, Davis, California
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine, and PET and Cluster for Molecular Imaging Section 4011, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine, and PET and Cluster for Molecular Imaging Section 4011, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Guobao Wang
- Department of Radiology, University of California-Davis, Davis, California
| | - Simon R Cherry
- Department of Radiology, University of California-Davis, Davis, California
- Department of Biomedical Engineering, University of California-Davis, Davis, California; and
| | - Benjamin A Spencer
- Department of Radiology, University of California-Davis, Davis, California
| | - Ramsey D Badawi
- Department of Radiology, University of California-Davis, Davis, California
- Department of Biomedical Engineering, University of California-Davis, Davis, California; and
| | - Thomas Beyer
- Quantitative Imaging and Medical Physics Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Otto Muzik
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
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12
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Xue B, Wang X. Predictive value of PET metabolic parameters for occult lymph node metastases in PET/CT defined node-negative patients with advanced epithelial ovarian cancer. Sci Rep 2023; 13:9439. [PMID: 37296189 PMCID: PMC10256759 DOI: 10.1038/s41598-023-36640-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023] Open
Abstract
Accurate lymph node metastasis (LNM) prediction is crucial for patients with advanced epithelial ovarian cancer (AEOC) since it guides the decisions about lymphadenectomy. Previous studies have shown that occult lymph node metastasis (OLNM) is common in AEOC. The objective of our study is to quantitatively assess the probability of occult lymph node metastasis defined by 18F-Fluorodeoxyglucose PET/CT in AEOC and explore relationship between OLNM and PET metabolic parameters. The patients with pathologically confirmed AEOC who underwent PET/CT for preoperative staging at our institute were reviewed. Univariate and multivariate analysis were performed to evaluate the predictive value of PET/CT-related metabolic parameters for OLNM. The result of our study showed metastatic TLG index had a better diagnostic performance than other PET/CT-related metabolic parameters. Two variables were independently and significantly associated with OLNM in multivariate analysis: metastatic TLG index and primary tumor location. The logistic model combining metastatic TLG index, primary tumor location, and CA125 might be a promising tool to effectively predict the individualized possibility of OLNM for AEOC patients.
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Affiliation(s)
- Bing Xue
- Department of Nuclear Medicine, The Fourth Affiliated Hospital of China Medical University, Shenyang, 110032, China
| | - Xihai Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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13
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Gao J, Niu R, Shi Y, Shao X, Jiang Z, Ge X, Wang Y, Shao X. The predictive value of [ 18F]FDG PET/CT radiomics combined with clinical features for EGFR mutation status in different clinical staging of lung adenocarcinoma. EJNMMI Res 2023; 13:26. [PMID: 37014500 PMCID: PMC10073367 DOI: 10.1186/s13550-023-00977-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/24/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND This study aims to construct radiomics models based on [18F]FDG PET/CT using multiple machine learning methods to predict the EGFR mutation status of lung adenocarcinoma and evaluate whether incorporating clinical parameters can improve the performance of radiomics models. METHODS A total of 515 patients were retrospectively collected and divided into a training set (n = 404) and an independent testing set (n = 111) according to their examination time. After semi-automatic segmentation of PET/CT images, the radiomics features were extracted, and the best feature sets of CT, PET, and PET/CT modalities were screened out. Nine radiomics models were constructed using logistic regression (LR), random forest (RF), and support vector machine (SVM) methods. According to the performance in the testing set, the best model of the three modalities was kept, and its radiomics score (Rad-score) was calculated. Furthermore, combined with the valuable clinical parameters (gender, smoking history, nodule type, CEA, SCC-Ag), a joint radiomics model was built. RESULTS Compared with LR and SVM, the RF Rad-score showed the best performance among the three radiomics models of CT, PET, and PET/CT (training and testing sets AUC: 0.688, 0.666, and 0.698 vs. 0.726, 0.678, and 0.704). Among the three joint models, the PET/CT joint model performed the best (training and testing sets AUC: 0.760 vs. 0.730). The further stratified analysis found that CT_RF had the best prediction effect for stage I-II lesions (training set and testing set AUC: 0.791 vs. 0.797), while PET/CT joint model had the best prediction effect for stage III-IV lesions (training and testing sets AUC: 0.722 vs. 0.723). CONCLUSIONS Combining with clinical parameters can improve the predictive performance of PET/CT radiomics model, especially for patients with advanced lung adenocarcinoma.
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Affiliation(s)
- Jianxiong Gao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, 213003, China
| | - Rong Niu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, 213003, China
| | - Yunmei Shi
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, 213003, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, 213003, China
| | - Zhenxing Jiang
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Xinyu Ge
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, 213003, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, 213003, China
| | - Xiaonan Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, 213003, China.
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, China.
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14
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Onozato Y, Iwata T, Uematsu Y, Shimizu D, Yamamoto T, Matsui Y, Ogawa K, Kuyama J, Sakairi Y, Kawakami E, Iizasa T, Yoshino I. Predicting pathological highly invasive lung cancer from preoperative [ 18F]FDG PET/CT with multiple machine learning models. Eur J Nucl Med Mol Imaging 2023; 50:715-726. [PMID: 36385219 PMCID: PMC9852187 DOI: 10.1007/s00259-022-06038-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE The efficacy of sublobar resection of primary lung cancer have been proven in recent years. However, sublobar resection for highly invasive lung cancer increases local recurrence. We developed and validated multiple machine learning models predicting pathological invasiveness of lung cancer based on preoperative [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) radiomic features. METHODS Overall, 873 patients who underwent lobectomy or segmentectomy for primary lung cancer were enrolled. Radiomics features were extracted from preoperative PET/CT images with the PyRadiomics package. Seven machine learning models and an ensemble of all models (ENS) were evaluated after 100 iterations. In addition, the probability of highly invasive lung cancer was calculated in a nested cross-validation to assess the calibration plot and clinical usefulness and to compare to consolidation tumour ratio (CTR) on CT images, one of the generally used diagnostic criteria. RESULTS In the training set, when PET and CT features were combined, all models achieved an area under the curve (AUC) of ≥ 0.880. In the test set, ENS showed the highest mean AUC of 0.880 and smallest standard deviation of 0.0165, and when the cutoff was 0.5, accuracy of 0.804, F1 of 0.851, precision of 0.821, and recall of 0.885. In the nested cross-validation, the AUC of 0.882 (95% CI: 0.860-0.905) showed a high discriminative ability, and the calibration plot indicated consistency with a Brier score of 0.131. A decision curve analysis showed that the ENS was valid with a threshold probability ranging from 3 to 98%. Accuracy showed an improvement of more than 8% over the CTR. CONCLUSION The machine learning model based on preoperative [18F]FDG PET/CT images was able to predict pathological highly invasive lung cancer with high discriminative ability and stability. The calibration plot showed good consistency, suggesting its usefulness in quantitative risk assessment.
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Affiliation(s)
- Yuki Onozato
- Division of Thoracic Surgery, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Takekazu Iwata
- Division of Thoracic Surgery, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Yasufumi Uematsu
- Division of Thoracic Surgery, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Daiki Shimizu
- Division of Thoracic Surgery, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Takayoshi Yamamoto
- Division of Thoracic Surgery, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Yukiko Matsui
- Division of Thoracic Surgery, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Kazuyuki Ogawa
- Division of Nuclear Medicine, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Junpei Kuyama
- Division of Nuclear Medicine, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Eiryo Kawakami
- Department of Artificial Intelligence Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toshihiko Iizasa
- Division of Thoracic Surgery, Chiba Cancer Centre, 666-2, Nitona-Cho, Chuo-Ku, Chiba, 260-8717 Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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15
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Chen S, Han X, Tian G, Cao Y, Zheng X, Li X, Li Y. Using stacked deep learning models based on PET/CT images and clinical data to predict EGFR mutations in lung cancer. Front Med (Lausanne) 2022; 9:1041034. [PMID: 36300191 PMCID: PMC9588917 DOI: 10.3389/fmed.2022.1041034] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/26/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose To determine whether stacked deep learning models based on PET/CT images and clinical data can help to predict epidermal growth factor receptor (EGFR) mutations in lung cancer. Methods We analyzed data from two public datasets of patients who underwent 18F-FDG PET/CT. Three PET deep learning ResNet models and one CT deep learning ResNet model were trained as low-level predictors based on PET and CT images, respectively. A high-level Support Vector Machine model (Stack PET/CT and Clinical model) was trained using the prediction results of the low-level predictors and clinical data. The clinical data included sex, age, smoking history, SUVmax and SUVmean of the lesion. Fivefold cross-validation was used in this study to validate the prediction performance of the models. The predictive performance of the models was evaluated by receiver operator characteristic (ROC) curves. The area under the curve (AUC) was calculated. Results One hundred forty-seven patients were included in this study. Among them, 37/147 cases were EGFR mutations, and 110/147 cases were EGFR wild-type. The ROC analysis showed that the Stack PET/CT & Clinical model had the best performance (AUC = 0.85 ± 0.09), with 0.76, 0.85 and 0.83 in sensitivity, specificity and accuracy, respectively. Three ResNet PET models had relatively higher AUCs (0.82 ± 0.07, 0.80 ± 0.08 and 0.79 ± 0.07) and outperformed the CT model (AUC = 0.58 ± 0.12). Conclusion Using stack generalization, the deep learning model was able to efficiently combine the anatomic and biological imaging information gathered from PET/CT images with clinical data. This stacked deep learning model showed a strong ability to predict EGFR mutations with high accuracy.
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Affiliation(s)
- Song Chen
- Department of Nuclear Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Xiangjun Han
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Guangwei Tian
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Yu Cao
- School of Information and Control Engineering, Liaoning Petrochemical University, Fushun, China
| | - Xuting Zheng
- Department of Infectious Disease, The First Hospital of China Medical University, Shenyang, China
| | - Xuena Li
- Department of Nuclear Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Yaming Li
- Department of Nuclear Medicine, The First Hospital of China Medical University, Shenyang, China,*Correspondence: Yaming Li
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Volpe S, Pepa M, Zaffaroni M, Bellerba F, Santamaria R, Marvaso G, Isaksson LJ, Gandini S, Starzyńska A, Leonardi MC, Orecchia R, Alterio D, Jereczek-Fossa BA. Machine Learning for Head and Neck Cancer: A Safe Bet?-A Clinically Oriented Systematic Review for the Radiation Oncologist. Front Oncol 2021; 11:772663. [PMID: 34869010 PMCID: PMC8637856 DOI: 10.3389/fonc.2021.772663] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/25/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Machine learning (ML) is emerging as a feasible approach to optimize patients' care path in Radiation Oncology. Applications include autosegmentation, treatment planning optimization, and prediction of oncological and toxicity outcomes. The purpose of this clinically oriented systematic review is to illustrate the potential and limitations of the most commonly used ML models in solving everyday clinical issues in head and neck cancer (HNC) radiotherapy (RT). MATERIALS AND METHODS Electronic databases were screened up to May 2021. Studies dealing with ML and radiomics were considered eligible. The quality of the included studies was rated by an adapted version of the qualitative checklist originally developed by Luo et al. All statistical analyses were performed using R version 3.6.1. RESULTS Forty-eight studies (21 on autosegmentation, four on treatment planning, 12 on oncological outcome prediction, 10 on toxicity prediction, and one on determinants of postoperative RT) were included in the analysis. The most common imaging modality was computed tomography (CT) (40%) followed by magnetic resonance (MR) (10%). Quantitative image features were considered in nine studies (19%). No significant differences were identified in global and methodological scores when works were stratified per their task (i.e., autosegmentation). DISCUSSION AND CONCLUSION The range of possible applications of ML in the field of HN Radiation Oncology is wide, albeit this area of research is relatively young. Overall, if not safe yet, ML is most probably a bet worth making.
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Affiliation(s)
- Stefania Volpe
- Division of Radiation Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Matteo Pepa
- Division of Radiation Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Federica Bellerba
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Riccardo Santamaria
- Division of Radiation Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Lars Johannes Isaksson
- Division of Radiation Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sara Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Anna Starzyńska
- Department of Oral Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Maria Cristina Leonardi
- Division of Radiation Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Shao X, Niu R, Shao X, Gao J, Shi Y, Jiang Z, Wang Y. Application of dual-stream 3D convolutional neural network based on 18F-FDG PET/CT in distinguishing benign and invasive adenocarcinoma in ground-glass lung nodules. EJNMMI Phys 2021; 8:74. [PMID: 34727258 PMCID: PMC8561359 DOI: 10.1186/s40658-021-00423-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/25/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose This work aims to train, validate, and test a dual-stream three-dimensional convolutional neural network (3D-CNN) based on fluorine 18 (18F)-fluorodeoxyglucose (FDG) PET/CT to distinguish benign lesions and invasive adenocarcinoma (IAC) in ground-glass nodules (GGNs). Methods We retrospectively analyzed patients with suspicious GGNs who underwent 18F-FDG PET/CT in our hospital from November 2011 to November 2020. The patients with benign lesions or IAC were selected for this study. According to the ratio of 7:3, the data were randomly divided into training data and testing data. Partial image feature extraction software was used to segment PET and CT images, and the training data after using the data augmentation were used for the training and validation (fivefold cross-validation) of the three CNNs (PET, CT, and PET/CT networks). Results A total of 23 benign nodules and 92 IAC nodules from 106 patients were included in this study. In the training set, the performance of PET network (accuracy, sensitivity, and specificity of 0.92 ± 0.02, 0.97 ± 0.03, and 0.76 ± 0.15) was better than the CT network (accuracy, sensitivity, and specificity of 0.84 ± 0.03, 0.90 ± 0.07, and 0.62 ± 0.16) (especially accuracy was significant, P-value was 0.001); in the testing set, the performance of both networks declined. However, the accuracy and sensitivity of PET network were still higher than that of CT network (0.76 vs. 0.67; 0.85 vs. 0.70). For dual-stream PET/CT network, its performance was almost the same as PET network in the training set (P-value was 0.372–1.000), while in the testing set, although its performance decreased, the accuracy and sensitivity (0.85 and 0.96) were still higher than both CT and PET networks. Moreover, the accuracy of PET/CT network was higher than two nuclear medicine physicians [physician 1 (3-year experience): 0.70 and physician 2 (10-year experience): 0.73]. Conclusion The 3D-CNN based on 18F-FDG PET/CT can be used to distinguish benign lesions and IAC in GGNs, and the performance is better when both CT and PET images are used together. Supplementary Information The online version contains supplementary material available at 10.1186/s40658-021-00423-1.
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Affiliation(s)
- Xiaonan Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, China
| | - Rong Niu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, China
| | - Jianxiong Gao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, China
| | - Yunmei Shi
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, China
| | - Zhenxing Jiang
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China. .,Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, China.
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18
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Shiri I, Arabi H, Sanaat A, Jenabi E, Becker M, Zaidi H. Fully Automated Gross Tumor Volume Delineation From PET in Head and Neck Cancer Using Deep Learning Algorithms. Clin Nucl Med 2021; 46:872-883. [PMID: 34238799 DOI: 10.1097/rlu.0000000000003789] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The availability of automated, accurate, and robust gross tumor volume (GTV) segmentation algorithms is critical for the management of head and neck cancer (HNC) patients. In this work, we evaluated 3 state-of-the-art deep learning algorithms combined with 8 different loss functions for PET image segmentation using a comprehensive training set and evaluated its performance on an external validation set of HNC patients. PATIENTS AND METHODS 18F-FDG PET/CT images of 470 patients presenting with HNC on which manually defined GTVs serving as standard of reference were used for training (340 patients), evaluation (30 patients), and testing (100 patients from different centers) of these algorithms. PET image intensity was converted to SUVs and normalized in the range (0-1) using the SUVmax of the whole data set. PET images were cropped to 12 × 12 × 12 cm3 subvolumes using isotropic voxel spacing of 3 × 3 × 3 mm3 containing the whole tumor and neighboring background including lymph nodes. We used different approaches for data augmentation, including rotation (-15 degrees, +15 degrees), scaling (-20%, 20%), random flipping (3 axes), and elastic deformation (sigma = 1 and proportion to deform = 0.7) to increase the number of training sets. Three state-of-the-art networks, including Dense-VNet, NN-UNet, and Res-Net, with 8 different loss functions, including Dice, generalized Wasserstein Dice loss, Dice plus XEnt loss, generalized Dice loss, cross-entropy, sensitivity-specificity, and Tversky, were used. Overall, 28 different networks were built. Standard image segmentation metrics, including Dice similarity, image-derived PET metrics, first-order, and shape radiomic features, were used for performance assessment of these algorithms. RESULTS The best results in terms of Dice coefficient (mean ± SD) were achieved by cross-entropy for Res-Net (0.86 ± 0.05; 95% confidence interval [CI], 0.85-0.87), Dense-VNet (0.85 ± 0.058; 95% CI, 0.84-0.86), and Dice plus XEnt for NN-UNet (0.87 ± 0.05; 95% CI, 0.86-0.88). The difference between the 3 networks was not statistically significant (P > 0.05). The percent relative error (RE%) of SUVmax quantification was less than 5% in networks with a Dice coefficient more than 0.84, whereas a lower RE% (0.41%) was achieved by Res-Net with cross-entropy loss. For maximum 3-dimensional diameter and sphericity shape features, all networks achieved a RE ≤ 5% and ≤10%, respectively, reflecting a small variability. CONCLUSIONS Deep learning algorithms exhibited promising performance for automated GTV delineation on HNC PET images. Different loss functions performed competitively when using different networks and cross-entropy for Res-Net, Dense-VNet, and Dice plus XEnt for NN-UNet emerged as reliable networks for GTV delineation. Caution should be exercised for clinical deployment owing to the occurrence of outliers in deep learning-based algorithms.
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Affiliation(s)
- Isaac Shiri
- From the Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
| | - Hossein Arabi
- From the Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
| | - Amirhossein Sanaat
- From the Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
| | - Elnaz Jenabi
- Research Centre for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Jaudet C, Weyts K, Lechervy A, Batalla A, Bardet S, Corroyer-Dulmont A. The Impact of Artificial Intelligence CNN Based Denoising on FDG PET Radiomics. Front Oncol 2021; 11:692973. [PMID: 34504782 PMCID: PMC8421788 DOI: 10.3389/fonc.2021.692973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/26/2021] [Indexed: 12/22/2022] Open
Abstract
Background With a constantly increasing number of diagnostic images performed each year, Artificial Intelligence (AI) denoising methods offer an opportunity to respond to the growing demand. However, it may affect information in the image in an unknown manner. This study quantifies the effect of AI-based denoising on FDG PET textural information in comparison to a convolution with a standard gaussian postfilter (EARL1). Methods The study was carried out on 113 patients who underwent a digital FDG PET/CT (VEREOS, Philips Healthcare). 101 FDG avid lesions were segmented semi-automatically by a nuclear medicine physician. VOIs in the liver and lung as reference organs were contoured. PET textural features were extracted with pyradiomics. Texture features from AI denoised and EARL1 versus original PET images were compared with a Concordance Correlation Coefficient (CCC). Features with CCC values ≥ 0.85 threshold were considered concordant. Scatter plots of variable pairs with R2 coefficients of the more relevant features were computed. A Wilcoxon signed rank test to compare the absolute values between AI denoised and original images was performed. Results The ratio of concordant features was 90/104 (86.5%) in AI denoised versus 46/104 (44.2%) with EARL1 denoising. In the reference organs, the concordant ratio for AI and EARL1 denoised images was low, respectively 12/104 (11.5%) and 7/104 (6.7%) in the liver, 26/104 (25%) and 24/104 (23.1%) in the lung. SUVpeak was stable after the application of both algorithms in comparison to SUVmax. Scatter plots of variable pairs showed that AI filtering affected more lower versus high intensity regions unlike EARL1 gaussian post filters, affecting both in a similar way. In lesions, the majority of texture features 79/100 (79%) were significantly (p<0.05) different between AI denoised and original PET images. Conclusions Applying an AI-based denoising on FDG PET images maintains most of the lesion’s texture information in contrast to EARL1-compatible Gaussian filter. Predictive features of a trained model could be thus the same, however with an adapted threshold. Artificial intelligence based denoising in PET is a very promising approach as it adapts the denoising in function of the tissue type, preserving information where it should.
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Affiliation(s)
- Cyril Jaudet
- Medical Physics Department, CLCC François Baclesse, Caen, France
| | - Kathleen Weyts
- Nuclear Medicine Department, CLCC François Baclesse, Caen, France
| | - Alexis Lechervy
- UMR GREYC, Normandie Univ, UNICAEN, ENSICAEN, CNRS, Caen, France
| | - Alain Batalla
- Medical Physics Department, CLCC François Baclesse, Caen, France
| | - Stéphane Bardet
- Nuclear Medicine Department, CLCC François Baclesse, Caen, France
| | - Aurélien Corroyer-Dulmont
- Medical Physics Department, CLCC François Baclesse, Caen, France.,Normandie Univ, UNICAEN, CEA, CNRS, ISTCT/CERVOxy group, GIP CYCERON, Caen, France
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20
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Yang FJ, Ai SY, Wu R, Lv Y, Xie HF, Dong Y, Meng QL, Wang F. Impact of total variation regularized expectation maximization reconstruction on the image quality of 68Ga-PSMA PET: a phantom and patient study. Br J Radiol 2021; 94:20201356. [PMID: 33571001 PMCID: PMC8010539 DOI: 10.1259/bjr.20201356] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To investigate the impact of total variation regularized expectation maximization (TVREM) reconstruction on the image quality of 68Ga-PSMA-11 PET/CT using phantom and patient data. METHODS Images of a phantom with small hot sphere inserts and 20 prostate cancer patients were acquired with a digital PET/CT using list-mode and reconstructed with ordered subset expectation maximization (OSEM) and TVREM with seven penalisation factors between 0.01 and 0.42 for 2 and 3 minutes-per-bed (m/b) acquisition. The contrast recovery (CR) and background variability (BV) of the phantom, image noise of the liver, and SUVmax of the lesions were measured. Qualitative image quality was scored by two radiologists using a 5-point scale (1-poor, 5-excellent). RESULTS The performance of CR, BV, and image noise, and the gain of SUVmax was higher for TVREM 2 m/b groups with the penalization of 0.07 to 0.28 compared to OSEM 3 m/b group (all p < 0.05). The image noise of OSEM 3 m/b group was equivalent to TVREM 2 and 3 m/b groups with a penalization of 0.14 and 0.07, while lesions' SUVmax increased 15 and 20%. The highest qualitative score was attained at the penalization of 0.21 (3.30 ± 0.66) for TVREM 2 m/b groups and the penalization 0.14 (3.80 ± 0.41) for 3 m/b group that equal to or greater than OSEM 3 m/b group (2.90 ± 0.45, p = 0.2 and p < 0.001). CONCLUSIONS TVREM improves lesion contrast and reduces image noise, which allows shorter acquisition with preserved image quality for PSMA PET/CT. ADVANCES IN KNOWLEDGE TVREM reconstruction with optimized penalization factors can generate higher quality PSMA-PET images for prostate cancer diagnosis.
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Affiliation(s)
- Feng-Jiao Yang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Shu-Yue Ai
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Runze Wu
- United Imaging Healthcare, Shanghai 201870, China
| | - Yang Lv
- United Imaging Healthcare, Shanghai 201870, China
| | - Hui-Fang Xie
- United Imaging Healthcare, Shanghai 201870, China
| | - Yun Dong
- United Imaging Healthcare, Shanghai 201870, China
| | - Qing-Le Meng
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
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21
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olde Heuvel J, de Wit-van der Veen BJ, Sinaasappel M, Slump CH, Stokkel MPM. Early differences in dynamic uptake of 68Ga-PSMA-11 in primary prostate cancer: A test-retest study. PLoS One 2021; 16:e0246394. [PMID: 33529259 PMCID: PMC7853454 DOI: 10.1371/journal.pone.0246394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Dynamic PET/CT allows visualization of pharmacokinetics over the time, in contrast to static whole body PET/CT. The objective of this study was to assess 68Ga-PSMA-11 uptake in pathological lesions and benign tissue, within 30 minutes after injection in primary prostate cancer (PCa) patients in test-retest setting. MATERIALS AND METHODS Five patients, with biopsy proven PCa, were scanned dynamically in list mode for 30 minutes on a digital PET/CT-scanner directly after an intravenous bolus injection of 100 MBq 68Ga-PSMA-11. Approximately 45 minutes after injection a static whole body scan was acquired, followed by a one bed position scan of the pelvic region. The scans were repeated approximately four weeks later, without any intervention in between. Semi-quantitative assessment was performed using regions-of-interest in the prostate tumor, bladder, gluteal muscle and iliac artery. Time-activity curves were extracted from the counts in these regions and the intra-patient variability between both scans was assessed. RESULTS The uptake of the iliac artery and gluteal muscle reached a plateau after 5 and 3 minutes, respectively. The population fell apart in two groups with respect to tumor uptake: in some patients the tumor uptake reached a plateau after 5 minutes, whereas in other patients the uptake kept increasing, which correlated with larger tumor volumes on PET/CT scan. Median intra-patient variation between both scans was 12.2% for artery, 9.7% for tumor, 32.7% for the bladder and 14.1% for the gluteal muscle. CONCLUSION Dynamic 68Ga-PSMA-11 PET/CT scans, with a time interval of four weeks, are reproducible with a 10% variation in uptake in the primary prostate tumor. An uptake plateau was reached for the iliac artery and gluteal muscle within 5 minutes post-injection. A larger tumor volume seems to be related to continued tumor uptake. This information might be relevant for both response monitoring and PSMA-based radionuclide therapies.
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Affiliation(s)
- J. olde Heuvel
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Robotics and Mechatronics, Technical Medical Centre, University of Twente, The Netherlands
| | - B. J. de Wit-van der Veen
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - M. Sinaasappel
- Department of Medical Physics, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - C. H. Slump
- Robotics and Mechatronics, Technical Medical Centre, University of Twente, The Netherlands
| | - M. P. M. Stokkel
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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22
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Peeken JC, Shouman MA, Kroenke M, Rauscher I, Maurer T, Gschwend JE, Eiber M, Combs SE. A CT-based radiomics model to detect prostate cancer lymph node metastases in PSMA radioguided surgery patients. Eur J Nucl Med Mol Imaging 2020; 47:2968-2977. [PMID: 32468251 PMCID: PMC7680305 DOI: 10.1007/s00259-020-04864-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE In recurrent prostate carcinoma, determination of the site of recurrence is crucial to guide personalized therapy. In contrast to prostate-specific membrane antigen (PSMA)-positron emission tomography (PET) imaging, computed tomography (CT) has only limited capacity to detect lymph node metastases (LNM). We sought to develop a CT-based radiomic model to predict LNM status using a PSMA radioguided surgery (RGS) cohort with histological confirmation of all suspected lymph nodes (LNs). METHODS Eighty patients that received RGS for resection of PSMA PET/CT-positive LNMs were analyzed. Forty-seven patients (87 LNs) that received inhouse imaging were used as training cohort. Thirty-three patients (62 LNs) that received external imaging were used as testing cohort. As gold standard, histological confirmation was available for all LNs. After preprocessing, 156 radiomic features analyzing texture, shape, intensity, and local binary patterns (LBP) were extracted. The least absolute shrinkage and selection operator (radiomic models) and logistic regression (conventional parameters) were used for modeling. RESULTS Texture and shape features were largely correlated to LN volume. A combined radiomic model achieved the best predictive performance with a testing-AUC of 0.95. LBP features showed the highest contribution to model performance. This model significantly outperformed all conventional CT parameters including LN short diameter (AUC 0.84), LN volume (AUC 0.80), and an expert rating (AUC 0.67). In lymph node-specific decision curve analysis, there was a clinical net benefit above LN short diameter. CONCLUSION The best radiomic model outperformed conventional measures for detection of LNM demonstrating an incremental value of radiomic features.
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Affiliation(s)
- Jan C Peeken
- Department of Radiation Oncology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany.
- Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany.
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.
| | - Mohamed A Shouman
- Department of Radiation Oncology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany
| | - Markus Kroenke
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Institute for Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Tobias Maurer
- Institute for Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Department of Urology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology and Martini-Klinik, University Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Eiber
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany
- Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
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23
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Ghattas AE, Beichel RR, Smith BJ. A unified framework for simultaneous assessment of accuracy, between-, and within-reader variability of image segmentations. Stat Methods Med Res 2020; 29:3135-3152. [DOI: 10.1177/0962280220920894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Medical imaging is utilized in a wide range of clinical applications. To enable a detailed quantitative analysis, medical images must often be segmented to label (delineate) structures of interest; for example, a tumor. Frequently, manual segmentation is utilized in clinical practice (e.g., in radiation oncology) to define such structures of interest. However, it can be quite time consuming and subject to substantial between-, and within-reader variability. A more reproducible, less variable, and more time efficient segmentation approach is likely to improve medical treatment. This potential has spurred the development of segmentation algorithms which harness computational power. Segmentation algorithms’ widespread use is limited due to difficulty in quantifying their performance relative to manual segmentation, which itself is subject to variation. This paper presents a statistical model which simultaneously estimates segmentation method accuracy, and between- and within-reader variability. The model is simultaneously fit for multiple segmentation methods within a unified Bayesian framework. The Bayesian model is compared to other methods used in literature via a simulation study, and application to head and neck cancer PET/CT data. The modeling framework is flexible and can be employed in numerous comparison applications. Several alternate applications are discussed in the paper.
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Affiliation(s)
| | - Reinhard R Beichel
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA
| | - Brian J Smith
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
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24
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Fedorov A, Beichel R, Kalpathy-Cramer J, Clunie D, Onken M, Riesmeier J, Herz C, Bauer C, Beers A, Fillion-Robin JC, Lasso A, Pinter C, Pieper S, Nolden M, Maier-Hein K, Herrmann MD, Saltz J, Prior F, Fennessy F, Buatti J, Kikinis R. Quantitative Imaging Informatics for Cancer Research. JCO Clin Cancer Inform 2020; 4:444-453. [PMID: 32392097 PMCID: PMC7265794 DOI: 10.1200/cci.19.00165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2020] [Indexed: 01/06/2023] Open
Abstract
PURPOSE We summarize Quantitative Imaging Informatics for Cancer Research (QIICR; U24 CA180918), one of the first projects funded by the National Cancer Institute (NCI) Informatics Technology for Cancer Research program. METHODS QIICR was motivated by the 3 use cases from the NCI Quantitative Imaging Network. 3D Slicer was selected as the platform for implementation of open-source quantitative imaging (QI) tools. Digital Imaging and Communications in Medicine (DICOM) was chosen for standardization of QI analysis outputs. Support of improved integration with community repositories focused on The Cancer Imaging Archive (TCIA). Priorities included improved capabilities of the standard, toolkits and tools, reference datasets, collaborations, and training and outreach. RESULTS Fourteen new tools to support head and neck cancer, glioblastoma, and prostate cancer QI research were introduced and downloaded over 100,000 times. DICOM was amended, with over 40 correction proposals addressing QI needs. Reference implementations of the standard in a popular toolkit and standalone tools were introduced. Eight datasets exemplifying the application of the standard and tools were contributed. An open demonstration/connectathon was organized, attracting the participation of academic groups and commercial vendors. Integration of tools with TCIA was improved by implementing programmatic communication interface and by refining best practices for QI analysis results curation. CONCLUSION Tools, capabilities of the DICOM standard, and datasets we introduced found adoption and utility within the cancer imaging community. A collaborative approach is critical to addressing challenges in imaging informatics at the national and international levels. Numerous challenges remain in establishing and maintaining the infrastructure of analysis tools and standardized datasets for the imaging community. Ideas and technology developed by the QIICR project are contributing to the NCI Imaging Data Commons currently being developed.
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Affiliation(s)
- Andrey Fedorov
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | - Christian Herz
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | - Marco Nolden
- German Cancer Research Center, Heidelberg, Germany
| | | | - Markus D. Herrmann
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Fred Prior
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Fiona Fennessy
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | - Ron Kikinis
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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Ulrich EJ, Menda Y, Boles Ponto LL, Anderson CM, Smith BJ, Sunderland JJ, Graham MM, Buatti JM, Beichel RR. FLT PET Radiomics for Response Prediction to Chemoradiation Therapy in Head and Neck Squamous Cell Cancer. ACTA ACUST UNITED AC 2020; 5:161-169. [PMID: 30854454 PMCID: PMC6403029 DOI: 10.18383/j.tom.2018.00038] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Radiomics is an image analysis approach for extracting large amounts of quantitative information from medical images using a variety of computational methods. Our goal was to evaluate the utility of radiomic feature analysis from 18F-fluorothymidine positron emission tomography (FLT PET) obtained at baseline in prediction of treatment response in patients with head and neck cancer. Thirty patients with advanced-stage oropharyngeal or laryngeal cancer, treated with definitive chemoradiation therapy, underwent FLT PET imaging before treatment. In total, 377 radiomic features of FLT uptake and feature variants were extracted from volumes of interest; these features variants were defined by either the primary tumor or the total lesion burden, which consisted of the primary tumor and all FLT-avid nodes. Feature variants included normalized measurements of uptake, which were calculated by dividing lesion uptake values by the mean uptake value in the bone marrow. Feature reduction was performed using clustering to remove redundancy, leaving 172 representative features. Effects of these features on progression-free survival were modeled with Cox regression and P-values corrected for multiple comparisons. In total, 9 features were considered significant. Our results suggest that smaller, more homogenous lesions at baseline were associated with better prognosis. In addition, features extracted from total lesion burden had a higher concordance index than primary tumor features for 8 of the 9 significant features. Furthermore, total lesion burden features showed lower interobserver variability.
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Affiliation(s)
- Ethan J Ulrich
- Departments of Electrical and Computer Engineering.,Biomedical Engineering
| | | | | | | | | | | | | | | | - Reinhard R Beichel
- Departments of Electrical and Computer Engineering.,Internal Medicine, University of Iowa, Iowa City, IA
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Guo Z, Guo N, Gong K, Zhong S, Li Q. Gross tumor volume segmentation for head and neck cancer radiotherapy using deep dense multi-modality network. Phys Med Biol 2019; 64:205015. [PMID: 31514173 PMCID: PMC7186044 DOI: 10.1088/1361-6560/ab440d] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In radiation therapy, the accurate delineation of gross tumor volume (GTV) is crucial for treatment planning. However, it is challenging for head and neck cancer (HNC) due to the morphology complexity of various organs in the head, low targets to background contrast and potential artifacts on conventional planning CT images. Thus, manual delineation of GTV on anatomical images is extremely time consuming and suffers from inter-observer variability that leads to planning uncertainty. With the wide use of PET/CT imaging in oncology, complementary functional and anatomical information can be utilized for tumor contouring and bring a significant advantage for radiation therapy planning. In this study, by taking advantage of multi-modality PET and CT images, we propose an automatic GTV segmentation framework based on deep learning for HNC. The backbone of this segmentation framework is based on 3D convolution with dense connections which enables a better information propagation and takes full advantage of the features extracted from multi-modality input images. We evaluate our proposed framework on a dataset including 250 HNC patients. Each patient receives both planning CT and PET/CT imaging before radiation therapy (RT). Manually delineated GTV contours by radiation oncologists are used as ground truth in this study. To further investigate the advantage of our proposed Dense-Net framework, we also compared with the framework using 3D U-Net which is the state-of-the-art in segmentation tasks. Meanwhile, for each frame, the performance comparison between single modality input (PET or CT image) and multi-modality input (both PET/CT) is conducted. Dice coefficient, mean surface distance (MSD), 95th-percentile Hausdorff distance (HD95) and displacement of mass centroid (DMC) are calculated for quantitative evaluation. The dataset is split into train (140 patients), validation (35 patients) and test (75 patients) groups to optimize the network. Based on the results on independent test group, our proposed multi-modality Dense-Net (Dice 0.73) shows better performance than the compared network (Dice 0.71). Furthermore, the proposed Dense-Net structure has less trainable parameters than the 3D U-Net, which reduces the prediction variability. In conclusion, our proposed multi-modality Dense-Net can enable satisfied GTV segmentation for HNC using multi-modality images and yield superior performance than conventional methods. Our proposed method provides an automatic, fast and consistent solution for GTV segmentation and shows potentials to be generally applied for radiation therapy planning of a variety of cancer (e.g. lung, sarcoma, liver and so on).
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Affiliation(s)
- Zhe Guo
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China 100081
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA 02114
| | - Ning Guo
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA 02114
| | - Kuang Gong
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA 02114
| | - Shun’an Zhong
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China 100081
| | - Quanzheng Li
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA 02114
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Beichel RR, Ulrich EJ, Smith BJ, Bauer C, Brown B, Casavant T, Sunderland JJ, Graham MM, Buatti JM. FDG PET based prediction of response in head and neck cancer treatment: Assessment of new quantitative imaging features. PLoS One 2019; 14:e0215465. [PMID: 31002689 PMCID: PMC6474600 DOI: 10.1371/journal.pone.0215465] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/02/2019] [Indexed: 01/09/2023] Open
Abstract
Introduction 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is now a standard diagnostic imaging test performed in patients with head and neck cancer for staging, re-staging, radiotherapy planning, and outcome assessment. Currently, quantitative analysis of FDG PET scans is limited to simple metrics like maximum standardized uptake value, metabolic tumor volume, or total lesion glycolysis, which have limited predictive value. The goal of this work was to assess the predictive potential of new (i.e., nonstandard) quantitative imaging features on head and neck cancer outcome. Methods This retrospective study analyzed fifty-eight pre- and post-treatment FDG PET scans of patients with head and neck squamous cell cancer to calculate five standard and seventeen new features at baseline and post-treatment. Cox survival regression was used to assess the predictive potential of each quantitative imaging feature on disease-free survival. Results Analysis showed that the post-treatment change of the average tracer uptake in the rim background region immediately adjacent to the tumor normalized by uptake in the liver represents a novel PET feature that is associated with disease-free survival (HR 1.95; 95% CI 1.27, 2.99) and has good discriminative performance (c index 0.791). Conclusion The reported findings define a promising new direction for quantitative imaging biomarker research in head and neck squamous cell cancer and highlight the potential role of new radiomics features in oncology decision making as part of precision medicine.
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Affiliation(s)
- Reinhard R. Beichel
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, United States of America
- Department of Internal Medicine, The University of Iowa, Iowa City, United States of America
- * E-mail:
| | - Ethan J. Ulrich
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, United States of America
| | - Brian J. Smith
- Department of Biostatistics, The University of Iowa, Iowa City, United States of America
| | - Christian Bauer
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, United States of America
| | - Bartley Brown
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, United States of America
| | - Thomas Casavant
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, United States of America
| | - John J. Sunderland
- Department of Radiology, The University of Iowa, Iowa City, United States of America
| | - Michael M. Graham
- Department of Radiology, The University of Iowa, Iowa City, United States of America
| | - John M. Buatti
- Department of Radiation Oncology, The University of Iowa, Iowa City, United States of America
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Lian C, Ruan S, Denoeux T, Li H, Vera P. Joint Tumor Segmentation in PET-CT Images Using Co-Clustering and Fusion Based on Belief Functions. IEEE TRANSACTIONS ON IMAGE PROCESSING : A PUBLICATION OF THE IEEE SIGNAL PROCESSING SOCIETY 2019; 28:755-766. [PMID: 30296224 PMCID: PMC8191586 DOI: 10.1109/tip.2018.2872908] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Precise delineation of target tumor is a key factor to ensure the effectiveness of radiation therapy. While hybrid positron emission tomography-computed tomography (PET-CT) has become a standard imaging tool in the practice of radiation oncology, many existing automatic/semi-automatic methods still perform tumor segmentation on mono-modal images. In this paper, a co-clustering algorithm is proposed to concurrently segment 3D tumors in PET-CT images, considering that the two complementary imaging modalities can combine functional and anatomical information to improve segmentation performance. The theory of belief functions is adopted in the proposed method to model, fuse, and reason with uncertain and imprecise knowledge from noisy and blurry PET-CT images. To ensure reliable segmentation for each modality, the distance metric for the quantification of clustering distortions and spatial smoothness is iteratively adapted during the clustering procedure. On the other hand, to encourage consistent segmentation between different modalities, a specific context term is proposed in the clustering objective function. Moreover, during the iterative optimization process, clustering results for the two distinct modalities are further adjusted via a belief-functions-based information fusion strategy. The proposed method has been evaluated on a data set consisting of 21 paired PET-CT images for non-small cell lung cancer patients. The quantitative and qualitative evaluations show that our proposed method performs well compared with the state-of-the-art methods.
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Zhong Z, Kim Y, Plichta K, Allen BG, Zhou L, Buatti J, Wu X. Simultaneous cosegmentation of tumors in PET-CT images using deep fully convolutional networks. Med Phys 2019; 46:619-633. [PMID: 30537103 PMCID: PMC6527327 DOI: 10.1002/mp.13331] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 11/11/2018] [Accepted: 11/12/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To investigate the use and efficiency of 3-D deep learning, fully convolutional networks (DFCN) for simultaneous tumor cosegmentation on dual-modality nonsmall cell lung cancer (NSCLC) and positron emission tomography (PET)-computed tomography (CT) images. METHODS We used DFCN cosegmentation for NSCLC tumors in PET-CT images, considering both the CT and PET information. The proposed DFCN-based cosegmentation method consists of two coupled three-dimensional (3D)-UNets with an encoder-decoder architecture, which can communicate with the other in order to share complementary information between PET and CT. The weighted average sensitivity and positive predictive values denoted as Scores, dice similarity coefficients (DSCs), and the average symmetric surface distances were used to assess the performance of the proposed approach on 60 pairs of PET/CTs. A Simultaneous Truth and Performance Level Estimation Algorithm (STAPLE) of 3 expert physicians' delineations were used as a reference. The proposed DFCN framework was compared to 3 graph-based cosegmentation methods. RESULTS Strong agreement was observed when using the STAPLE references for the proposed DFCN cosegmentation on the PET-CT images. The average DSCs on CT and PET are 0.861 ± 0.037 and 0.828 ± 0.087, respectively, using DFCN, compared to 0.638 ± 0.165 and 0.643 ± 0.141, respectively, when using the graph-based cosegmentation method. The proposed DFCN cosegmentation using both PET and CT also outperforms the deep learning method using either PET or CT alone. CONCLUSIONS The proposed DFCN cosegmentation is able to outperform existing graph-based segmentation methods. The proposed DFCN cosegmentation shows promise for further integration with quantitative multimodality imaging tools in clinical trials.
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Affiliation(s)
- Zisha Zhong
- Department of Electrical and Computer EngineeringThe University of IowaIowa CityIA52242USA
- Department of Radiation OncologyUniversity of Iowa Hospitals and ClinicsIowa CityIA52242USA
| | - Yusung Kim
- Department of Radiation OncologyUniversity of Iowa Hospitals and ClinicsIowa CityIA52242USA
| | - Kristin Plichta
- Department of Radiation OncologyUniversity of Iowa Hospitals and ClinicsIowa CityIA52242USA
| | - Bryan G. Allen
- Department of Radiation OncologyUniversity of Iowa Hospitals and ClinicsIowa CityIA52242USA
| | - Leixin Zhou
- Department of Electrical and Computer EngineeringThe University of IowaIowa CityIA52242USA
- Department of Radiation OncologyUniversity of Iowa Hospitals and ClinicsIowa CityIA52242USA
| | - John Buatti
- Department of Radiation OncologyUniversity of Iowa Hospitals and ClinicsIowa CityIA52242USA
| | - Xiaodong Wu
- Department of Electrical and Computer EngineeringThe University of IowaIowa CityIA52242USA
- Department of Radiation OncologyUniversity of Iowa Hospitals and ClinicsIowa CityIA52242USA
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Press RH, Shu HKG, Shim H, Mountz JM, Kurland BF, Wahl RL, Jones EF, Hylton NM, Gerstner ER, Nordstrom RJ, Henderson L, Kurdziel KA, Vikram B, Jacobs MA, Holdhoff M, Taylor E, Jaffray DA, Schwartz LH, Mankoff DA, Kinahan PE, Linden HM, Lambin P, Dilling TJ, Rubin DL, Hadjiiski L, Buatti JM. The Use of Quantitative Imaging in Radiation Oncology: A Quantitative Imaging Network (QIN) Perspective. Int J Radiat Oncol Biol Phys 2018; 102:1219-1235. [PMID: 29966725 PMCID: PMC6348006 DOI: 10.1016/j.ijrobp.2018.06.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/25/2018] [Accepted: 06/14/2018] [Indexed: 02/07/2023]
Abstract
Modern radiation therapy is delivered with great precision, in part by relying on high-resolution multidimensional anatomic imaging to define targets in space and time. The development of quantitative imaging (QI) modalities capable of monitoring biologic parameters could provide deeper insight into tumor biology and facilitate more personalized clinical decision-making. The Quantitative Imaging Network (QIN) was established by the National Cancer Institute to advance and validate these QI modalities in the context of oncology clinical trials. In particular, the QIN has significant interest in the application of QI to widen the therapeutic window of radiation therapy. QI modalities have great promise in radiation oncology and will help address significant clinical needs, including finer prognostication, more specific target delineation, reduction of normal tissue toxicity, identification of radioresistant disease, and clearer interpretation of treatment response. Patient-specific QI is being incorporated into radiation treatment design in ways such as dose escalation and adaptive replanning, with the intent of improving outcomes while lessening treatment morbidities. This review discusses the current vision of the QIN, current areas of investigation, and how the QIN hopes to enhance the integration of QI into the practice of radiation oncology.
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Affiliation(s)
- Robert H. Press
- Dept. of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Hui-Kuo G. Shu
- Dept. of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Hyunsuk Shim
- Dept. of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - James M. Mountz
- Dept. of Radiology, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Ella F. Jones
- Dept. of Radiology, University of California, San Francisco, San Francisco, CA
| | - Nola M. Hylton
- Dept. of Radiology, University of California, San Francisco, San Francisco, CA
| | - Elizabeth R. Gerstner
- Dept. of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Lori Henderson
- Cancer Imaging Program, National Cancer Institute, Bethesda, MD
| | | | - Bhadrasain Vikram
- Radiation Research Program/Division of Cancer Treatment & Diagnosis, National Cancer Institute, Bethesda, MD
| | - Michael A. Jacobs
- Dept. of Radiology and Radiological Science, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore MD
| | - Matthias Holdhoff
- Brain Cancer Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore MD
| | - Edward Taylor
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - David A. Jaffray
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | | | - David A. Mankoff
- Dept. of Radiology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Philippe Lambin
- Dept. of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Thomas J. Dilling
- Dept. of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | - John M. Buatti
- Dept. of Radiation Oncology, University of Iowa, Iowa City, IA
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Taghanaki SA, Duggan N, Ma H, Hou X, Celler A, Benard F, Hamarneh G. Segmentation-free direct tumor volume and metabolic activity estimation from PET scans. Comput Med Imaging Graph 2018; 63:52-66. [DOI: 10.1016/j.compmedimag.2017.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/16/2017] [Accepted: 12/20/2017] [Indexed: 11/29/2022]
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Altazi BA, Zhang GG, Fernandez DC, Montejo ME, Hunt D, Werner J, Biagioli MC, Moros EG. Reproducibility of F18-FDG PET radiomic features for different cervical tumor segmentation methods, gray-level discretization, and reconstruction algorithms. J Appl Clin Med Phys 2017; 18:32-48. [PMID: 28891217 PMCID: PMC5689938 DOI: 10.1002/acm2.12170] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 01/18/2023] Open
Abstract
Site‐specific investigations of the role of radiomics in cancer diagnosis and therapy are emerging. We evaluated the reproducibility of radiomic features extracted from 18Flourine–fluorodeoxyglucose (18F‐FDG) PET images for three parameters: manual versus computer‐aided segmentation methods, gray‐level discretization, and PET image reconstruction algorithms. Our cohort consisted of pretreatment PET/CT scans from 88 cervical cancer patients. Two board‐certified radiation oncologists manually segmented the metabolic tumor volume (MTV1 and MTV2) for each patient. For comparison, we used a graphical‐based method to generate semiautomated segmented volumes (GBSV). To address any perturbations in radiomic feature values, we down‐sampled the tumor volumes into three gray‐levels: 32, 64, and 128 from the original gray‐level of 256. Finally, we analyzed the effect on radiomic features on PET images of eight patients due to four PET 3D‐reconstruction algorithms: maximum likelihood‐ordered subset expectation maximization (OSEM) iterative reconstruction (IR) method, fourier rebinning‐ML‐OSEM (FOREIR), FORE‐filtered back projection (FOREFBP), and 3D‐Reprojection (3DRP) analytical method. We extracted 79 features from all segmentation method, gray‐levels of down‐sampled volumes, and PET reconstruction algorithms. The features were extracted using gray‐level co‐occurrence matrices (GLCM), gray‐level size zone matrices (GLSZM), gray‐level run‐length matrices (GLRLM), neighborhood gray‐tone difference matrices (NGTDM), shape‐based features (SF), and intensity histogram features (IHF). We computed the Dice coefficient between each MTV and GBSV to measure segmentation accuracy. Coefficient values close to one indicate high agreement, and values close to zero indicate low agreement. We evaluated the effect on radiomic features by calculating the mean percentage differences (d¯) between feature values measured from each pair of parameter elements (i.e. segmentation methods: MTV1‐MTV2, MTV1‐GBSV, MTV2‐GBSV; gray‐levels: 64‐32, 64‐128, and 64‐256; reconstruction algorithms: OSEM‐FORE‐OSEM, OSEM‐FOREFBP, and OSEM‐3DRP). We used |d¯| as a measure of radiomic feature reproducibility level, where any feature scored |d¯| ±SD ≤ |25|% ± 35% was considered reproducible. We used Bland–Altman analysis to evaluate the mean, standard deviation (SD), and upper/lower reproducibility limits (U/LRL) for radiomic features in response to variation in each testing parameter. Furthermore, we proposed U/LRL as a method to classify the level of reproducibility: High— ±1% ≤ U/LRL ≤ ±30%; Intermediate— ±30% < U/LRL ≤ ±45%; Low— ±45 < U/LRL ≤ ±50%. We considered any feature below the low level as nonreproducible (NR). Finally, we calculated the interclass correlation coefficient (ICC) to evaluate the reliability of radiomic feature measurements for each parameter. The segmented volumes of 65 patients (81.3%) scored Dice coefficient >0.75 for all three volumes. The result outcomes revealed a tendency of higher radiomic feature reproducibility among segmentation pair MTV1‐GBSV than MTV2‐GBSV, gray‐level pairs of 64‐32 and 64‐128 than 64‐256, and reconstruction algorithm pairs of OSEM‐FOREIR and OSEM‐FOREFBP than OSEM‐3DRP. Although the choice of cervical tumor segmentation method, gray‐level value, and reconstruction algorithm may affect radiomic features, some features were characterized by high reproducibility through all testing parameters. The number of radiomic features that showed insensitivity to variations in segmentation methods, gray‐level discretization, and reconstruction algorithms was 10 (13%), 4 (5%), and 1 (1%), respectively. These results suggest that a careful analysis of the effects of these parameters is essential prior to any radiomics clinical application.
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Affiliation(s)
- Baderaldeen A Altazi
- Department of Radiation Oncology, H.L. Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Physics, University of South Florida, Tampa, FL, USA.,Department of Radiation Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Geoffrey G Zhang
- Department of Radiation Oncology, H.L. Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Physics, University of South Florida, Tampa, FL, USA
| | - Daniel C Fernandez
- Department of Radiation Oncology, H.L. Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Michael E Montejo
- Department of Radiation Oncology, H.L. Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Dylan Hunt
- Department of Radiation Oncology, H.L. Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Joan Werner
- Department of Radiation Oncology, H.L. Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Eduardo G Moros
- Department of Radiation Oncology, H.L. Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Physics, University of South Florida, Tampa, FL, USA
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Patwardhan KA, Beichel RR, Smith BJ, Mart C, Plichta KA, Chang T, Sonka M, Graham MM, Magnotta V, Casavant T, Buatti JM. Development of a radiobiological evaluation tool to assess the expected clinical impacts of contouring accuracy between manual and semi-automated segmentation algorithms. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:3409-3412. [PMID: 29060629 DOI: 10.1109/embc.2017.8037588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
RADEval is a tool developed to assess the expected clinical impact of contouring accuracy when comparing manual contouring and semi-automated segmentation. The RADEval tool, designed to process large scale datasets, imported a total of 2,760 segmentation datasets, along with a Simultaneous Truth and Performance Level Estimation (STAPLE) to act as ground truth tumor segmentations. Virtual dose-maps were created within RADEval and two different tumor control probability (TCP) values using a Logistic and a Poisson TCP models were calculated in RADEval using each STAPLE and each dose-map. RADEval also virtually generated a ring of normal tissue. To evaluate clinical impact, two different uncomplicated TCP (UTCP) values were calculated in RADEval by using two TCP-NTCP correlation parameters (δ = 0 and 1). NTCP values showed that semi-automatic segmentation resulted in lower NTCP with an average 1.5 - 1.6 % regardless of STAPLE design. This was true even though each normal tissue was created from each STAPLE (p <; 0.00001). TCP and UTCP presented no statistically significant differences (p ≥ 0.1884). The intra-operator standard deviations (SDs) for TCP, NTCP and UTCP were significantly lower for the semi-automatic segmentation method regardless of STAPLE design (p <; 0.0331). Both intra-and inter-operator SDs of TCP, NTCP and UTCP were significantly lower for semi-automatic segmentation for the STAPLE 1 design (p <;0.0331). RADEval was able to efficiently process 4,920 datasets of two STAPLE designs and successfully assess the expected clinical impact of contouring accuracy.
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Hatt M, Lee JA, Schmidtlein CR, Naqa IE, Caldwell C, De Bernardi E, Lu W, Das S, Geets X, Gregoire V, Jeraj R, MacManus MP, Mawlawi OR, Nestle U, Pugachev AB, Schöder H, Shepherd T, Spezi E, Visvikis D, Zaidi H, Kirov AS. Classification and evaluation strategies of auto-segmentation approaches for PET: Report of AAPM task group No. 211. Med Phys 2017; 44:e1-e42. [PMID: 28120467 DOI: 10.1002/mp.12124] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 12/09/2016] [Accepted: 01/04/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The purpose of this educational report is to provide an overview of the present state-of-the-art PET auto-segmentation (PET-AS) algorithms and their respective validation, with an emphasis on providing the user with help in understanding the challenges and pitfalls associated with selecting and implementing a PET-AS algorithm for a particular application. APPROACH A brief description of the different types of PET-AS algorithms is provided using a classification based on method complexity and type. The advantages and the limitations of the current PET-AS algorithms are highlighted based on current publications and existing comparison studies. A review of the available image datasets and contour evaluation metrics in terms of their applicability for establishing a standardized evaluation of PET-AS algorithms is provided. The performance requirements for the algorithms and their dependence on the application, the radiotracer used and the evaluation criteria are described and discussed. Finally, a procedure for algorithm acceptance and implementation, as well as the complementary role of manual and auto-segmentation are addressed. FINDINGS A large number of PET-AS algorithms have been developed within the last 20 years. Many of the proposed algorithms are based on either fixed or adaptively selected thresholds. More recently, numerous papers have proposed the use of more advanced image analysis paradigms to perform semi-automated delineation of the PET images. However, the level of algorithm validation is variable and for most published algorithms is either insufficient or inconsistent which prevents recommending a single algorithm. This is compounded by the fact that realistic image configurations with low signal-to-noise ratios (SNR) and heterogeneous tracer distributions have rarely been used. Large variations in the evaluation methods used in the literature point to the need for a standardized evaluation protocol. CONCLUSIONS Available comparison studies suggest that PET-AS algorithms relying on advanced image analysis paradigms provide generally more accurate segmentation than approaches based on PET activity thresholds, particularly for realistic configurations. However, this may not be the case for simple shape lesions in situations with a narrower range of parameters, where simpler methods may also perform well. Recent algorithms which employ some type of consensus or automatic selection between several PET-AS methods have potential to overcome the limitations of the individual methods when appropriately trained. In either case, accuracy evaluation is required for each different PET scanner and scanning and image reconstruction protocol. For the simpler, less robust approaches, adaptation to scanning conditions, tumor type, and tumor location by optimization of parameters is necessary. The results from the method evaluation stage can be used to estimate the contouring uncertainty. All PET-AS contours should be critically verified by a physician. A standard test, i.e., a benchmark dedicated to evaluating both existing and future PET-AS algorithms needs to be designed, to aid clinicians in evaluating and selecting PET-AS algorithms and to establish performance limits for their acceptance for clinical use. The initial steps toward designing and building such a standard are undertaken by the task group members.
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Affiliation(s)
- Mathieu Hatt
- INSERM, UMR 1101, LaTIM, University of Brest, IBSAM, Brest, France
| | - John A Lee
- Université catholique de Louvain (IREC/MIRO) & FNRS, Brussels, 1200, Belgium
| | | | | | - Curtis Caldwell
- Sunnybrook Health Sciences Center, Toronto, ON, M4N 3M5, Canada
| | | | - Wei Lu
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Shiva Das
- University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Xavier Geets
- Université catholique de Louvain (IREC/MIRO) & FNRS, Brussels, 1200, Belgium
| | - Vincent Gregoire
- Université catholique de Louvain (IREC/MIRO) & FNRS, Brussels, 1200, Belgium
| | - Robert Jeraj
- University of Wisconsin, Madison, WI, 53705, USA
| | | | | | - Ursula Nestle
- Universitätsklinikum Freiburg, Freiburg, 79106, Germany
| | - Andrei B Pugachev
- University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Heiko Schöder
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | | | - Emiliano Spezi
- School of Engineering, Cardiff University, Cardiff, Wales, United Kingdom
| | | | - Habib Zaidi
- Geneva University Hospital, Geneva, CH-1211, Switzerland
| | - Assen S Kirov
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
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Beichel RR, Smith BJ, Bauer C, Ulrich EJ, Ahmadvand P, Budzevich MM, Gillies RJ, Goldgof D, Grkovski M, Hamarneh G, Huang Q, Kinahan PE, Laymon CM, Mountz JM, Muzi JP, Muzi M, Nehmeh S, Oborski MJ, Tan Y, Zhao B, Sunderland JJ, Buatti JM. Multi-site quality and variability analysis of 3D FDG PET segmentations based on phantom and clinical image data. Med Phys 2017; 44:479-496. [PMID: 28205306 DOI: 10.1002/mp.12041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Radiomics utilizes a large number of image-derived features for quantifying tumor characteristics that can in turn be correlated with response and prognosis. Unfortunately, extraction and analysis of such image-based features is subject to measurement variability and bias. The challenge for radiomics is particularly acute in Positron Emission Tomography (PET) where limited resolution, a high noise component related to the limited stochastic nature of the raw data, and the wide variety of reconstruction options confound quantitative feature metrics. Extracted feature quality is also affected by tumor segmentation methods used to define regions over which to calculate features, making it challenging to produce consistent radiomics analysis results across multiple institutions that use different segmentation algorithms in their PET image analysis. Understanding each element contributing to these inconsistencies in quantitative image feature and metric generation is paramount for ultimate utilization of these methods in multi-institutional trials and clinical oncology decision making. METHODS To assess segmentation quality and consistency at the multi-institutional level, we conducted a study of seven institutional members of the National Cancer Institute Quantitative Imaging Network. For the study, members were asked to segment a common set of phantom PET scans acquired over a range of imaging conditions as well as a second set of head and neck cancer (HNC) PET scans. Segmentations were generated at each institution using their preferred approach. In addition, participants were asked to repeat segmentations with a time interval between initial and repeat segmentation. This procedure resulted in overall 806 phantom insert and 641 lesion segmentations. Subsequently, the volume was computed from the segmentations and compared to the corresponding reference volume by means of statistical analysis. RESULTS On the two test sets (phantom and HNC PET scans), the performance of the seven segmentation approaches was as follows. On the phantom test set, the mean relative volume errors ranged from 29.9 to 87.8% of the ground truth reference volumes, and the repeat difference for each institution ranged between -36.4 to 39.9%. On the HNC test set, the mean relative volume error ranged between -50.5 to 701.5%, and the repeat difference for each institution ranged between -37.7 to 31.5%. In addition, performance measures per phantom insert/lesion size categories are given in the paper. On phantom data, regression analysis resulted in coefficient of variation (CV) components of 42.5% for scanners, 26.8% for institutional approaches, 21.1% for repeated segmentations, 14.3% for relative contrasts, 5.3% for count statistics (acquisition times), and 0.0% for repeated scans. Analysis showed that the CV components for approaches and repeated segmentations were significantly larger on the HNC test set with increases by 112.7% and 102.4%, respectively. CONCLUSION Analysis results underline the importance of PET scanner reconstruction harmonization and imaging protocol standardization for quantification of lesion volumes. In addition, to enable a distributed multi-site analysis of FDG PET images, harmonization of analysis approaches and operator training in combination with highly automated segmentation methods seems to be advisable. Future work will focus on quantifying the impact of segmentation variation on radiomics system performance.
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Affiliation(s)
- Reinhard R Beichel
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA, USA.,Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
| | - Brian J Smith
- Department of Biostatistics, The University of Iowa, Iowa City, IA, USA
| | - Christian Bauer
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA, USA
| | - Ethan J Ulrich
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA, USA.,Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA
| | - Payam Ahmadvand
- School of Computing Science, Simon Fraser University, Burnaby, Canada
| | | | | | - Dmitry Goldgof
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, USA
| | - Milan Grkovski
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ghassan Hamarneh
- School of Computing Science, Simon Fraser University, Burnaby, Canada
| | - Qiao Huang
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Paul E Kinahan
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Charles M Laymon
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - James M Mountz
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - John P Muzi
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Mark Muzi
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Sadek Nehmeh
- National Center for Cancer Care and Research, Doha, Qatar
| | - Matthew J Oborski
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yongqiang Tan
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Binsheng Zhao
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | | | - John M Buatti
- Department of Radiation Oncology, The University of Iowa, Iowa City, IA, USA
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36
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Zhang L, Kong H, Liu S, Wang T, Chen S, Sonka M. Graph-based segmentation of abnormal nuclei in cervical cytology. Comput Med Imaging Graph 2017; 56:38-48. [PMID: 28222324 DOI: 10.1016/j.compmedimag.2017.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 11/15/2016] [Accepted: 01/26/2017] [Indexed: 02/05/2023]
Abstract
A general method is reported for improving the segmentation of abnormal cell nuclei in cervical cytology images. In automation-assisted reading of cervical cytology, one of the essential steps is the segmentation of nuclei. Despite some progress, there is a need to improve the sensitivity, particularly the segmentation of abnormal nuclei. Our method starts with pre-segmenting the nucleus to define the coarse center and size of nucleus, which is used to construct a graph by image unfolding that maps ellipse-like border in the Cartesian coordinate system to lines in the polar coordinate system. The cost function jointly reflects properties of nucleus border and nucleus region. The prior constraints regarding the context of nucleus-cytoplasm position are utilized to modify the local cost functions. The globally optimal path in the constructed graph is then identified by dynamic programming with an iterative approach ensuring an optimal closed contour. Validation of our method was performed on abnormal nuclei from two cervical cell image datasets, Herlev and H&E stained manual liquid-based cytology (HEMLBC). Compared with five state-of-the-art approaches, our graph-search based method shows superior performance.
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Affiliation(s)
- Ling Zhang
- Department of Biomedical Engineering, School of Medicine, Shenzhen University, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen 518060, China; Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA 52242, USA.
| | - Hui Kong
- School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Shaoxiong Liu
- Department of Pathology, People's Hospital of Nanshan District, Shenzhen 518052, China
| | - Tianfu Wang
- Department of Biomedical Engineering, School of Medicine, Shenzhen University, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen 518060, China.
| | - Siping Chen
- Department of Biomedical Engineering, School of Medicine, Shenzhen University, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen 518060, China.
| | - Milan Sonka
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA 52242, USA
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37
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Fedorov A, Clunie D, Ulrich E, Bauer C, Wahle A, Brown B, Onken M, Riesmeier J, Pieper S, Kikinis R, Buatti J, Beichel RR. DICOM for quantitative imaging biomarker development: a standards based approach to sharing clinical data and structured PET/CT analysis results in head and neck cancer research. PeerJ 2016; 4:e2057. [PMID: 27257542 PMCID: PMC4888317 DOI: 10.7717/peerj.2057] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/29/2016] [Indexed: 12/29/2022] Open
Abstract
Background. Imaging biomarkers hold tremendous promise for precision medicine clinical applications. Development of such biomarkers relies heavily on image post-processing tools for automated image quantitation. Their deployment in the context of clinical research necessitates interoperability with the clinical systems. Comparison with the established outcomes and evaluation tasks motivate integration of the clinical and imaging data, and the use of standardized approaches to support annotation and sharing of the analysis results and semantics. We developed the methodology and tools to support these tasks in Positron Emission Tomography and Computed Tomography (PET/CT) quantitative imaging (QI) biomarker development applied to head and neck cancer (HNC) treatment response assessment, using the Digital Imaging and Communications in Medicine (DICOM(®)) international standard and free open-source software. Methods. Quantitative analysis of PET/CT imaging data collected on patients undergoing treatment for HNC was conducted. Processing steps included Standardized Uptake Value (SUV) normalization of the images, segmentation of the tumor using manual and semi-automatic approaches, automatic segmentation of the reference regions, and extraction of the volumetric segmentation-based measurements. Suitable components of the DICOM standard were identified to model the various types of data produced by the analysis. A developer toolkit of conversion routines and an Application Programming Interface (API) were contributed and applied to create a standards-based representation of the data. Results. DICOM Real World Value Mapping, Segmentation and Structured Reporting objects were utilized for standards-compliant representation of the PET/CT QI analysis results and relevant clinical data. A number of correction proposals to the standard were developed. The open-source DICOM toolkit (DCMTK) was improved to simplify the task of DICOM encoding by introducing new API abstractions. Conversion and visualization tools utilizing this toolkit were developed. The encoded objects were validated for consistency and interoperability. The resulting dataset was deposited in the QIN-HEADNECK collection of The Cancer Imaging Archive (TCIA). Supporting tools for data analysis and DICOM conversion were made available as free open-source software. Discussion. We presented a detailed investigation of the development and application of the DICOM model, as well as the supporting open-source tools and toolkits, to accommodate representation of the research data in QI biomarker development. We demonstrated that the DICOM standard can be used to represent the types of data relevant in HNC QI biomarker development, and encode their complex relationships. The resulting annotated objects are amenable to data mining applications, and are interoperable with a variety of systems that support the DICOM standard.
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Affiliation(s)
- Andriy Fedorov
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States of America
- Harvard Medical School, Harvard University, Boston, MA, United States of America
| | - David Clunie
- PixelMed Publishing, LLC, Bangor, PA, United States of America
| | - Ethan Ulrich
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, United States of America
- Iowa Institute for Biomedical Imaging, University of Iowa, Iowa City, IA, United States of America
| | - Christian Bauer
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, United States of America
- Iowa Institute for Biomedical Imaging, University of Iowa, Iowa City, IA, United States of America
| | - Andreas Wahle
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, United States of America
- Iowa Institute for Biomedical Imaging, University of Iowa, Iowa City, IA, United States of America
| | - Bartley Brown
- Center for Bioinformatics and Computational Biology, University of Iowa, Iowa City, IA, United States of America
| | | | | | - Steve Pieper
- Isomics, Inc., Cambridge, MA, United States of America
| | - Ron Kikinis
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States of America
- Harvard Medical School, Harvard University, Boston, MA, United States of America
- Fraunhofer MEVIS, Bremen, Germany
- Mathematics/Computer Science Faculty, University of Bremen, Bremen, Germany
| | - John Buatti
- Department of Radiation Oncology, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
| | - Reinhard R. Beichel
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, United States of America
- Iowa Institute for Biomedical Imaging, University of Iowa, Iowa City, IA, United States of America
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
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