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Park S, Lee JM, Park J, Lee J, Bae JS, Kim JH, Joo I. Volumetric CT Texture Analysis of Intrahepatic Mass-Forming Cholangiocarcinoma for the Prediction of Postoperative Outcomes: Fully Automatic Tumor Segmentation Versus Semi-Automatic Segmentation. Korean J Radiol 2021; 22:1797-1808. [PMID: 34402247 PMCID: PMC8546140 DOI: 10.3348/kjr.2021.0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/08/2021] [Accepted: 04/27/2021] [Indexed: 11/15/2022] Open
Abstract
Objective To determine whether volumetric CT texture analysis (CTTA) using fully automatic tumor segmentation can help predict recurrence-free survival (RFS) in patients with intrahepatic mass-forming cholangiocarcinomas (IMCCs) after surgical resection. Materials and Methods This retrospective study analyzed the preoperative CT scans of 89 patients with IMCCs (64 male; 25 female; mean age, 62.1 years; range, 38–78 years) who underwent surgical resection between January 2005 and December 2016. Volumetric CTTA of IMCCs was performed in late arterial phase images using both fully automatic and semi-automatic liver tumor segmentation techniques. The time spent on segmentation and texture analysis was compared, and the first-order and second-order texture parameters and shape features were extracted. The reliability of CTTA parameters between the techniques was evaluated using intraclass correlation coefficients (ICCs). Intra- and interobserver reproducibility of volumetric CTTAs were also obtained using ICCs. Cox proportional hazard regression were used to predict RFS using CTTA parameters and clinicopathological parameters. Results The time spent on fully automatic tumor segmentation and CTTA was significantly shorter than that for semi-automatic segmentation: mean ± standard deviation of 1 minutes 37 seconds ± 50 seconds vs. 10 minutes 48 seconds ± 13 minutes 44 seconds (p < 0.001). ICCs of the texture features between the two techniques ranged from 0.215 to 0.980. ICCs for the intraobserver and interobserver reproducibility using fully automatic segmentation were 0.601–0.997 and 0.177–0.984, respectively. Multivariable analysis identified lower first-order mean (hazard ratio [HR], 0.982; p = 0.010), larger pathologic tumor size (HR, 1.171; p < 0.001), and positive lymph node involvement (HR, 2.193; p = 0.014) as significant parameters for shorter RFS using fully automatic segmentation. Conclusion Volumetric CTTA parameters obtained using fully automatic segmentation could be utilized as prognostic markers in patients with IMCC, with comparable reproducibility in significantly less time compared with semi-automatic segmentation.
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Affiliation(s)
- Sungeun Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Konkuk University Medical Center, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| | - Junghoan Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jihyuk Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Maas M, Beets-Tan R, Gaubert JY, Gomez Munoz F, Habert P, Klompenhouwer LG, Vilares Morgado P, Schaefer N, Cornelis FH, Solomon SB, van der Reijd D, Bilbao JI. Follow-up after radiological intervention in oncology: ECIO-ESOI evidence and consensus-based recommendations for clinical practice. Insights Imaging 2020; 11:83. [PMID: 32676924 PMCID: PMC7366866 DOI: 10.1186/s13244-020-00884-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/20/2020] [Indexed: 12/19/2022] Open
Abstract
Interventional radiology plays an important and increasing role in cancer treatment. Follow-up is important to be able to assess treatment success and detect locoregional and distant recurrence and recommendations for follow-up are needed. At ECIO 2018, a joint ECIO-ESOI session was organized to establish follow-up recommendations for oncologic intervention in liver, renal, and lung cancer. Treatments included thermal ablation, TACE, and TARE. In total five topics were evaluated: ablation in colorectal liver metastases (CRLM), TARE in CRLM, TACE and TARE in HCC, ablation in renal cancer, and ablation in lung cancer. Evaluated modalities were FDG-PET-CT, CT, MRI, and (contrast-enhanced) ultrasound. Prior to the session, five experts were selected and performed a systematic review and presented statements, which were voted on in a telephone conference prior to the meeting by all panelists. These statements were presented and discussed at the ECIO-ESOI session at ECIO 2018. This paper presents the recommendations that followed from these initiatives. Based on expert opinions and the available evidence, follow-up schedules were proposed for liver cancer, renal cancer, and lung cancer. FDG-PET-CT, CT, and MRI are the recommended modalities, but one should beware of false-positive signs of residual tumor or recurrence due to inflammation early after the intervention. There is a need for prospective preferably multicenter studies to validate new techniques and new response criteria. This paper presents recommendations that can be used in clinical practice to perform the follow-up of patients with liver, lung, and renal cancer who were treated with interventional locoregional therapies.
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Affiliation(s)
- Monique Maas
- Dept of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina Beets-Tan
- Dept of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jean-Yves Gaubert
- Dept of Radiology, CHU Hospital Timone, Marseille, France.,Aix Marseille Univ, LIIE, Marseille, France
| | - Fernando Gomez Munoz
- Dept of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Dept of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Paul Habert
- Dept of Radiology, CHU Hospital Timone, Marseille, France.,Aix Marseille Univ, LIIE, Marseille, France
| | | | | | - Niklaus Schaefer
- Dept of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Stephen B Solomon
- Dept of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Jose Ignacio Bilbao
- Dept of Radiology, University Clinic of Navarra, Calle Benjamín de Tudela, 2, 31008, Pamplona, Navarra, Spain.
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Jirapatnakul A, Reeves AP, Lewis S, Chen X, Ma T, Yip R, Chin X, Liu S, Perumalswami PV, Yankelevitz DF, Crane M, Branch AD, Henschke CI. Automated measurement of liver attenuation to identify moderate-to-severe hepatic steatosis from chest CT scans. Eur J Radiol 2019; 122:108723. [PMID: 31778964 DOI: 10.1016/j.ejrad.2019.108723] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/16/2019] [Accepted: 10/22/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Develop and validate an automated method for measuring liver attenuation in non-contrast low-dose chest CT (LDCT) scans and compare it to the standard manual method for identifying moderate-to-severe hepatic steatosis (HS). METHOD The automated method identifies a region below the right lung within the liver and uses statistical sampling techniques to exclude non-liver parenchyma. The method was used to assess moderate-to-severe HS on two IRB-approved cohorts: 1) 24 patients with liver disease examined between 1/2013-1/2017 with non-contrast chest CT and abdominal MRI scans obtained within three months of liver biopsy, and 2) 319 lung screening participants with baseline LDCT performed between 8/2011-1/2017. Agreement between the manual and automated CT methods, the manual MRI method, and pathology for determining moderate-to-severe HS was assessed using Cohen's Kappa by applying a 40 HU threshold to the CT method and 17.4% fat fraction to MRI. Agreement between the manual and automated CT methods was assessed using the intraclass correlation coefficient (ICC). Variability was assessed using Bland-Altman limits of agreement (LoA). RESULTS In the first cohort, the manual and automated CT methods had almost perfect agreement (ICC = 0.97, κ = 1.00) with LoA of -7.6 to 4.7 HU. Both manual and automated CT methods had almost perfect agreement with MRI (κ = 0.90) and substantial agreement with pathology (κ = 0.77). In the second cohort, the manual and automated CT methods had almost perfect agreement (ICC = 0.94, κ = 0.87). LoA were -10.6 to 5.2 HU. CONCLUSION Automated measurements of liver attenuation from LDCT scans can be used to identify moderate-to-severe HS on LDCT.
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Affiliation(s)
- Artit Jirapatnakul
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States
| | - Anthony P Reeves
- School of Electrical and Computer Engineering, Cornell University, 392 Rhodes Hall, Ithaca, NY 14853, United States
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States
| | - Xiangmeng Chen
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States; Department of Radiology, The First Affiliated Hospital of Jinan University, Huangpu West Ave No. 613, Guangzhou, Guangdong, China; Department of Radiology, Jiangmen Central Hospital, No. 18 Zicha Road, Jiangmen, Guangdong, China
| | - Teng Ma
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States; Department of Radiology, Jiangmen Central Hospital, No. 18 Zicha Road, Jiangmen, Guangdong, China
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States
| | - Xing Chin
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States
| | - Shuang Liu
- School of Electrical and Computer Engineering, Cornell University, 392 Rhodes Hall, Ithaca, NY 14853, United States
| | - Ponni V Perumalswami
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1123, New York, NY 10029, United States
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States
| | - Michael Crane
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY 10029, United States
| | - Andrea D Branch
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1123, New York, NY 10029, United States
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States.
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Ahn SJ, Kim JH, Lee SM, Park SJ, Han JK. CT reconstruction algorithms affect histogram and texture analysis: evidence for liver parenchyma, focal solid liver lesions, and renal cysts. Eur Radiol 2018; 29:4008-4015. [PMID: 30456584 DOI: 10.1007/s00330-018-5829-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/20/2018] [Accepted: 10/12/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE To determine the effects of different reconstruction algorithms on histogram and texture features in different targets. MATERIALS AND METHODS Among 3620 patients, 480 had normal liver parenchyma, 494 had focal solid liver lesions (metastases = 259; hepatocellular carcinoma = 99; hemangioma = 78; abscess = 32; and cholangiocarcinoma = 26), and 488 had renal cysts. CT images were reconstructed with filtered back-projection (FBP), hybrid iterative reconstruction (HIR), and iterative model reconstruction (IMR) algorithms. Computerized histogram and texture analyses were performed by extracting 11 features. RESULTS Different reconstruction algorithms had distinct, significant effects. IMR had a greater effect than HIR. For instance, IMR had a significant effect on five features of liver parenchyma, nine features of focal liver lesions, and four features of renal cysts on portal-phase scans and four, eight, and four features, respectively, on precontrast scans (p < 0.05). Meanwhile, different algorithms had a greater effect on focal liver lesions (six in HIR and nine in IMR on portal-phase, three in HIR, and eight in IMR on precontrast scans) than on liver parenchyma or cysts. The mean attenuation and standard deviation were not affected by the reconstruction algorithm (p > .05). Most parameters showed good or excellent intra- and interobserver agreement, with intraclass correlation coefficients ranging from 0.634 to 0.972. CONCLUSIONS Different reconstruction algorithms affect histogram and texture features. Reconstruction algorithms showed stronger effects in focal liver lesions than in liver parenchyma or renal cysts. KEY POINTS • Imaging heterogeneities influenced the quantification of image features. • Different reconstruction algorithms had a significant effect on histogram and texture features. • Solid liver lesions were more affected than liver parenchyma or cysts.
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Affiliation(s)
- Su Joa Ahn
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea. .,Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehang-no, Chongno-gu, Seoul, 110-744, Korea.
| | - Sang Min Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Anyang-si, 431-796, Korea
| | - Sang Joon Park
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea.,Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehang-no, Chongno-gu, Seoul, 110-744, Korea
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Wang Y, Huang K, Chen J, Luo Y, Zhang Y, Jia Y, Xu L, Chen M, Huang B, Ni D, Li ZP, Feng ST. Combined Volumetric and Density Analyses of Contrast-Enhanced CT Imaging to Assess Drug Therapy Response in Gastroenteropancreatic Neuroendocrine Diffuse Liver Metastasis. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:6037273. [PMID: 30510495 PMCID: PMC6230417 DOI: 10.1155/2018/6037273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 08/09/2018] [Accepted: 09/25/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE We propose a computer-aided method to assess response to drug treatment, using CT imaging-based volumetric and density measures in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and diffuse liver metastases. METHODS Twenty-five patients with GEP-NETs with diffuse liver metastases were enrolled. Pre- and posttreatment CT examinations were retrospectively analyzed. Total tumor volume (volume) and mean volumetric tumor density (density) were calculated based on tumor segmentation on CT images. The maximum axial diameter (tumor size) for each target tumor was measured on pre- and posttreatment CT images according to Response Evaluation Criteria In Solid Tumors (RECIST). Progression-free survival (PFS) for each patient was measured and recorded. RESULTS Correlation analysis showed inverse correlation between change of volume and density (Δ(V + D)), change of volume (ΔV), and change of tumor size (ΔS) with PFS (r = -0.653, P=0.001; r = -0.617, P=0.003; r = -0.548, P=0.01, respectively). There was no linear correlation between ΔD and PFS (r = -0.226, P=0.325). CONCLUSION The changes of volume and density derived from CT images of all lesions showed a good correlation with PFS and may help assess treatment response.
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Affiliation(s)
- Yi Wang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Kun Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jie Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yu Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yingmei Jia
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ling Xu
- Faculty of Medicine and Dentistry, University of Western Australia, Perth 6009, Australia
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Bingsheng Huang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Dong Ni
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Mulé S, Hoeffel C. Evaluation of measurement variability in quantitative analyses: Application to dynamic contrast-enhanced MRI histogram analysis in rectal cancer. Diagn Interv Imaging 2018; 99:421-422. [DOI: 10.1016/j.diii.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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7
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Towards volumetric thresholds in RECIST 1.1: Therapeutic response assessment in hepatic metastases. Eur Radiol 2018; 28:4839-4848. [DOI: 10.1007/s00330-018-5424-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/24/2018] [Accepted: 03/09/2018] [Indexed: 10/17/2022]
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Imaging of Hepatocellular Carcinoma Response After 90Y Radioembolization. AJR Am J Roentgenol 2017; 209:W263-W276. [DOI: 10.2214/ajr.17.17993] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Li Q, Liang Y, Huang Q, Zong M, Berman B, Gavrielides MA, Schwartz LH, Zhao B, Petrick N. Volumetry of low-contrast liver lesions with CT: Investigation of estimation uncertainties in a phantom study. Med Phys 2017; 43:6608. [PMID: 27908157 DOI: 10.1118/1.4967776] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the performance of lesion volumetry in hepatic CT as a function of various imaging acquisition parameters. METHODS An anthropomorphic abdominal phantom with removable liver inserts was designed for this study. Two liver inserts, each containing 19 synthetic lesions with varying diameter (6-40 mm), shape, contrast (10-65 HU), and both homogenous and mixed-density were designed to have background and lesion CT values corresponding to arterial and portal-venous phase imaging, respectively. The two phantoms were scanned using two commercial CT scanners (GE 750 HD and Siemens Biograph mCT) across a set of imaging protocols (four slice thicknesses, three effective mAs, two convolution kernels, two pitches). Two repeated scans were collected for each imaging protocol. All scans were analyzed using a matched-filter estimator for volume estimation, resulting in 6080 volume measurements across all of the synthetic lesions in the two liver phantoms. A subset of portal venous phase scans was also analyzed using a semi-automatic segmentation algorithm, resulting in about 900 additional volume measurements. Lesions associated with large measurement error (quantified by root mean square error) for most imaging protocols were considered not measurable by the volume estimation tools and excluded for the statistical analyses. Imaging protocols were grouped into distinct imaging conditions based on ANOVA analysis of factors for repeatability testing. Statistical analyses, including overall linearity analysis, grouped bias analysis with standard deviation evaluation, and repeatability analysis, were performed to assess the accuracy and precision of the liver lesion volume biomarker. RESULTS Lesions with lower contrast and size ≤10 mm were associated with higher measurement error and were excluded from further analysis. Lesion size, contrast, imaging slice thickness, dose, and scanner were found to be factors substantially influencing volume estimation. Twenty-four distinct repeatable imaging conditions were determined as protocols for each scanner with a fixed slice thickness and dose. For the matched-filter estimation approach, strong linearity was observed for all imaging data for lesions ≥20 mm. For the Siemens scanner with 50 mAs effective dose at 0.6 mm slice thickness, grouped bias was about -10%. For all other repeatable imaging conditions with both scanners, grouped biases were low (-3%-3%). There was a trend of increasing standard deviation with decreasing dose. For each fixed dose, the standard deviations were similar among the three larger slice thicknesses (1.25, 2.5, 5 mm for GE, 1.5, 3, 5 mm for Siemens). Repeatability coefficients ranged from about 8% to 75% and showed similar trend to grouped standard deviation. For the segmentation approach, the results led to similar conclusions for both lesion characteristic factors and imaging factors but with increasing magnitude in all the error metrics assessed. CONCLUSIONS Results showed that liver lesion volumetry was strongly dependent on lesion size, contrast, acquisition dose, and their interactions. The overall performances were similar for images reconstructed with larger slice thicknesses, clinically used pitches, kernels, and doses. Conditions that yielded repeatable measurements were identified and they agreed with the Quantitative Imaging Biomarker Alliance's (QIBA) profile requirements in general. The authors' findings also suggest potential refinements to these guidelines for the tumor volume biomarker, especially for soft-tissue lesions.
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Affiliation(s)
- Qin Li
- Division of Imaging, Diagnostics and Software Reliability, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland 20993
| | - Yongguang Liang
- Department of Radiology, Columbia University Medical Center, New York, New York 10032
| | - Qiao Huang
- Department of Radiology, Columbia University Medical Center, New York, New York 10032
| | - Min Zong
- Department of Radiology, Columbia University Medical Center, New York, New York 10032
| | - Benjamin Berman
- Division of Imaging, Diagnostics and Software Reliability, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland 20993
| | - Marios A Gavrielides
- Division of Imaging, Diagnostics and Software Reliability, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland 20993
| | - Lawrence H Schwartz
- Department of Radiology, Columbia University Medical Center, New York, New York 10032
| | - Binsheng Zhao
- Department of Radiology, Columbia University Medical Center, New York, New York 10032
| | - Nicholas Petrick
- Division of Imaging, Diagnostics and Software Reliability, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland 20993
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Surrogate Imaging Biomarkers of Response of Colorectal Liver Metastases After Salvage Radioembolization Using 90Y-Loaded Resin Microspheres. AJR Am J Roentgenol 2016; 207:661-70. [PMID: 27384594 DOI: 10.2214/ajr.15.15202] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of the present study is to evaluate Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, tumor attenuation criteria, Choi criteria, and European Organization for Research and Treatment of Cancer (EORTC) PET criteria as measures of response and subsequent predictors of liver progression-free survival (PFS) after radioembolization (RE) of colorectal liver metastases (CLM). The study also assesses interobserver variability for measuring tumor attenuation using a single 2D ROI on a simple PACS workstation. MATERIALS AND METHODS We performed a retrospective review of the clinical RE database at our institution, to identify patients treated in the salvage setting for CLM between December 2009 and March 2013. Response was evaluated on FDG PET scans, with the use of EORTC PET criteria, and on portal venous phase CT scans, with the use of RECIST 1.1, tumor attenuation criteria, and Choi criteria. Two independent blinded observers measured tumor attenuation using a single 2D ROI. The intraclass correlation coefficient (ICC) for interobserver variability was assessed. Kaplan-Meier methodology was used to calculate liver PFS, and the log-rank test was used to assess the response criteria as predictors of liver PFS. RESULTS A total of 25 patients with 46 target tumors were enrolled in the study. The ICC was 0.95 at baseline and 0.98 at response evaluation. Among the 25 patients, more responders (i.e., partial response) were identified on the basis of EORTC PET criteria (n = 14), Choi criteria (n = 15), and tumor attenuation criteria (n = 13) than on the basis of RECIST 1.1 (n = 2). The median liver PFS was 3.0 months (95% CI, 2.1-4.0 months). Response identified on the basis of EORTC PET criteria (p < 0.001), Choi criteria (p < 0.001), or tumor attenuation criteria (p = 0.01) predicted liver PFS; however, response identified by RECIST 1.1 did not (p = 0.1). CONCLUSION RECIST 1.1 has poor sensitivity for detecting metabolic responses classified by EORTC PET criteria. EORTC PET criteria, Choi criteria, and tumor attenuation criteria appear to be equally reliable surrogate imaging biomarkers of liver PFS after RE in patients with CLM.
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Lundsgaard Hansen M, Fallentin E, Axelsen T, Lauridsen C, Norling R, Svendsen LB, Nielsen MB. Interobserver and Intraobserver Reproducibility with Volume Dynamic Contrast Enhanced Computed Tomography (DCE-CT) in Gastroesophageal Junction Cancer. Diagnostics (Basel) 2016; 6:diagnostics6010008. [PMID: 26838804 PMCID: PMC4808823 DOI: 10.3390/diagnostics6010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/20/2016] [Accepted: 01/26/2016] [Indexed: 01/05/2023] Open
Abstract
The purpose of this study was to assess inter- and intra-observer reproducibility of three different analytic methods to evaluate quantitative dynamic contrast-enhanced computed tomography (DCE-CT) measures from gastroesophageal junctional cancer. Twenty-five DCE-CT studies with gastroesophageal junction cancer were selected from a previous longitudinal study. Three radiologists independently reviewed all scans, and one repeated the analysis eight months later for intraobserver analysis. Review of the scans consisted of three analysis methods: (I) Four, fixed small sized regions of interest (2-dimensional (2D) fixed ROIs) placed in the tumor periphery, (II) 2-dimensional regions of interest (2D-ROI) along the tumor border in the tumor center, and (III) 3-dimensional volumes of interest (3D-VOI) containing the entire tumor volume. Arterial flow, blood volume and permeability (ktrans) were recorded for each observation. Inter- and intra-observer variability were assessed by Intraclass Correlation Coefficient (ICC) and Bland-Altman statistics. Interobserver ICC was excellent for arterial flow (0.88), for blood volume (0.89) and for permeability (0.91) with 3D-VOI analysis. The 95% limits of agreement were narrower for 3D analysis compared to 2D analysis. Three-dimensional volume DCE-CT analysis of gastroesophageal junction cancer provides higher inter- and intra-observer reproducibility with narrower limits of agreement between readers compared to 2D analysis.
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Affiliation(s)
- Martin Lundsgaard Hansen
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
- Department of Radiology, Koege and Roskilde Hospital, DK-4000 Roskilde, Denmark.
| | - Eva Fallentin
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
| | - Thomas Axelsen
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
| | - Carsten Lauridsen
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
- Metropolitan University College, Radiography Education, Copenhagen, DK-2200 Copenhagen, Denmark.
| | - Rikke Norling
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
| | - Lars Bo Svendsen
- Department of Surgery, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
| | - Michael Bachmann Nielsen
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
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Performance of tumor growth kinetics as an imaging biomarker for response assessment in colorectal liver metastases: correlation with FDG PET. ACTA ACUST UNITED AC 2015; 40:3043-51. [DOI: 10.1007/s00261-015-0546-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Bajpai S, Kambadakone A, Guimaraes AR, Arellano RS, Gervais DA, Sahani D. Image-guided Treatment in the Hepatobiliary System: Role of Imaging in Treatment Planning and Posttreatment Evaluation. Radiographics 2015; 35:1393-418. [DOI: 10.1148/rg.2015140281] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Histogram Analysis of CT Perfusion of Hepatocellular Carcinoma for Predicting Response to Transarterial Radioembolization: Value of Tumor Heterogeneity Assessment. Cardiovasc Intervent Radiol 2015. [PMID: 26216725 DOI: 10.1007/s00270-015-1185-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate in patients with hepatocellular carcinoma (HCC), whether assessment of tumor heterogeneity by histogram analysis of computed tomography (CT) perfusion helps predicting response to transarterial radioembolization (TARE). MATERIALS AND METHODS Sixteen patients (15 male; mean age 65 years; age range 47-80 years) with HCC underwent CT liver perfusion for treatment planning prior to TARE with Yttrium-90 microspheres. Arterial perfusion (AP) derived from CT perfusion was measured in the entire tumor volume, and heterogeneity was analyzed voxel-wise by histogram analysis. Response to TARE was evaluated on follow-up imaging (median follow-up, 129 days) based on modified Response Evaluation Criteria in Solid Tumors (mRECIST). Results of histogram analysis and mean AP values of the tumor were compared between responders and non-responders. Receiver operating characteristics were calculated to determine the parameters' ability to discriminate responders from non-responders. RESULTS According to mRECIST, 8 patients (50%) were responders and 8 (50%) non-responders. Comparing responders and non-responders, the 50th and 75th percentile of AP derived from histogram analysis was significantly different [AP 43.8/54.3 vs. 27.6/34.3 mL min(-1) 100 mL(-1)); p < 0.05], while the mean AP of HCCs (43.5 vs. 27.9 mL min(-1) 100 mL(-1); p > 0.05) was not. Further heterogeneity parameters from histogram analysis (skewness, coefficient of variation, and 25th percentile) did not differ between responders and non-responders (p > 0.05). If the cut-off for the 75th percentile was set to an AP of 37.5 mL min(-1) 100 mL(-1), therapy response could be predicted with a sensitivity of 88% (7/8) and specificity of 75% (6/8). CONCLUSION Voxel-wise histogram analysis of pretreatment CT perfusion indicating tumor heterogeneity of HCC improves the pretreatment prediction of response to TARE.
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Mukuda N, Fujii S, Inoue C, Fukunaga T, Tanabe Y, Itamochi H, Ogawa T. Apparent diffusion coefficient (ADC) measurement in ovarian tumor: Effect of region-of-interest methods on ADC values and diagnostic ability. J Magn Reson Imaging 2015. [DOI: 10.1002/jmri.25011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Naoko Mukuda
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine; Tottori University; Yonago Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine; Tottori University; Yonago Japan
| | - Chie Inoue
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine; Tottori University; Yonago Japan
| | - Takeru Fukunaga
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine; Tottori University; Yonago Japan
| | - Yoshio Tanabe
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine; Tottori University; Yonago Japan
| | - Hiroaki Itamochi
- Division of Reproductive-Perinatal Medicine and Gynecological Oncology, Department of Surgery, Faculty of Medicine; Tottori University; Yonago Japan
| | - Toshihide Ogawa
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine; Tottori University; Yonago Japan
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Folio LR, Turkbey EB, Steinberg SM, Apolo AB. Viable tumor volume: Volume of interest within segmented metastatic lesions, a pilot study of proposed computed tomography response criteria for urothelial cancer. Eur J Radiol 2015; 84:1708-14. [PMID: 26149529 DOI: 10.1016/j.ejrad.2015.05.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 05/16/2015] [Accepted: 05/18/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate the ability of new computed tomography (CT) response criteria for solid tumors such as urothelial cancer (VTV; viable tumor volume) to predict overall survival (OS) in patients with metastatic bladder cancer treated with cabozantinib. MATERIALS AND METHODS We compared the relative capabilities of VTV, RECIST, MASS (morphology, attenuation, size, and structure), and Choi criteria, as well as volume measurements, to predict OS using serial follow-up contrast-enhanced CT exams in patients with metastatic urothelial carcinoma. Kaplan-Meier curves and 2-tailed log-rank tests compared OS based on early RECIST 1.1 response against each of the other criteria. A Cox proportional hazards model assessed response at follow-up exams as a time-varying covariate for OS. RESULTS We assessed 141 lesions in 55CT scans from 17 patients with urothelial metastasis, comparing VTV, RECIST, MASS, and Choi criteria, and volumetric measurements, for response assessment. Median follow-up was 4.5 months, range was 2-14 months. Only the VTV criteria demonstrated a statistical association with OS (p=0.019; median OS 9.7 vs. 3.5 months). CONCLUSION This pilot study suggests that VTV is a promising tool for assessing tumor response and predicting OS, using criteria that incorporate tumor volume and density in patients receiving antiangiogenic therapy for urothelial cancer. Larger studies are warranted to further validate these findings.
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Affiliation(s)
- Les Roger Folio
- Lead Radiologist for CT, NIH Radiology and Imaging Sciences, 10 Center Drive, Bethesda, MD 20892, USA.
| | | | - Seth M Steinberg
- Head, Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, 9609 Medical Center Drive, Room 2W334, MSC 9716, Bethesda, MD 20892, USA.
| | - Andrea B Apolo
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
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Ahn SJ, Shin HJ, Chang JH, Lee SK. Differentiation between primary cerebral lymphoma and glioblastoma using the apparent diffusion coefficient: comparison of three different ROI methods. PLoS One 2014; 9:e112948. [PMID: 25393543 PMCID: PMC4231099 DOI: 10.1371/journal.pone.0112948] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/17/2014] [Indexed: 01/12/2023] Open
Abstract
Objective Apparent diffusion coefficients (ADC) can help differentiate between central nervous system (CNS) lymphoma and Glioblastoma (GBM). However, overlap between ADCs for GBM and lymphoma have been reported because of various region of interest (ROI) methods. Our aim is to explore ROI method to provide the most reproducible results for differentiation. Materials and Methods We studied 25 CNS lymphomas and 62 GBMs with three ROI methods: (1) ROI1, whole tumor volume; (2) ROI2, multiple ROIs; and (3) ROI3, a single ROI. Interobserver variability of two readers for each method was analyzed by intraclass correlation(ICC). ADCs were compared between GBM and lymphoma, using two-sample t-test. The discriminative ability was determined by ROC analysis. Results ADCs from ROI1 showed most reproducible results (ICC >0.9). For ROI1, ADCmean for lymphoma showed significantly lower values than GBM (p = 0.03). The optimal cut-off value was 0.98×10−3 mm2/s with 85% sensitivity and 90% specificity. For ROI2, ADCmin for lymphoma was significantly lower than GBM (p = 0.02). The cut-off value was 0.69×10−3 mm2/s with 87% sensitivity and 88% specificity. Conclusion ADC values were significantly dependent on ROI method. ADCs from the whole tumor volume had the most reproducible results. ADCmean from the whole tumor volume may aid in differentiating between lymphoma and GBM. However, multi-modal imaging approaches are recommended than ADC alone for differentiation.
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Affiliation(s)
- Sung Jun Ahn
- From the Department of Radiology, Severance Hospital, Yonsei University College of medicine, Seoul 120-752, Korea
| | - Hyun Joo Shin
- From the Department of Radiology, Severance Hospital, Yonsei University College of medicine, Seoul 120-752, Korea
| | - Jong-Hee Chang
- From the Department of Neurosurgery, Yonsei University College of medicine, Seoul 120-752, Korea
| | - Seung-Koo Lee
- From the Department of Radiology, Severance Hospital, Yonsei University College of medicine, Seoul 120-752, Korea
- * E-mail:
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Early treatment response evaluation after yttrium-90 radioembolization of liver malignancy with CT perfusion. J Vasc Interv Radiol 2014; 25:747-59. [PMID: 24630751 DOI: 10.1016/j.jvir.2014.01.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/30/2013] [Accepted: 01/01/2014] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate computed tomography (CT) perfusion for assessment of early treatment response after transarterial radioembolization of patients with liver malignancy. MATERIALS AND METHODS Dynamic contrast-enhanced CT liver perfusion was performed before and 4 weeks after transarterial radioembolization in 40 patients (25 men and 15 women; mean age, 64 y ± 11; range, 35-80 y) with liver metastases (n = 27) or hepatocellular carcinoma (HCC) (n = 13). Arterial perfusion (AP) of tumors derived from CT perfusion and tumor diameters were measured on CT perfusion before and after transarterial radioembolization. Success of transarterial radioembolization was evaluated on morphologic follow-up imaging (median follow-up time, 4 mo) based on Response Evaluation Criteria in Solid Tumors (Version 1.1). CT perfusion parameters before and after transarterial radioembolization for different response groups were compared. Kaplan-Meier curves were plotted to illustrate overall 1-year survival rates. RESULTS Liver metastases showed significant differences in AP before and after transarterial radioembolization in responders (P < .05) but not in nonresponders (P = .164). In HCC, AP values before and after transarterial radioembolization were not significantly different in responders and nonresponders (P = .180 and P = .052). Tumor diameters were not significantly different on CT perfusion before and after transarterial radioembolization in responders and nonresponders with liver metastases and HCC (P = .654, P = .968, P = .148, P = .164). In patients with significant decrease of AP in liver metastases after transarterial radioembolization, 1-year overall survival was significantly higher than in patients showing no reduction of AP. CONCLUSIONS CT perfusion showed early reduction of AP in liver metastases responding to transarterial radioembolization; tumor diameter remained unchanged early after treatment. No significant early treatment response to transarterial radioembolization was found in patients with HCC. In patients with liver metastases, a decrease of AP after transarterial radioembolization was associated with a higher 1-year overall survival rate.
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Bonekamp D, Bonekamp S, Halappa VG, Geschwind JFH, Eng J, Corona-Villalobos CP, Pawlik TM, Kamel IR. Interobserver agreement of semi-automated and manual measurements of functional MRI metrics of treatment response in hepatocellular carcinoma. Eur J Radiol 2013; 83:487-96. [PMID: 24387824 DOI: 10.1016/j.ejrad.2013.11.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 11/11/2013] [Accepted: 11/17/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the interobserver agreement in 50 patients with hepatocellular carcinoma (HCC) before and 1 month after intra-arterial therapy (IAT) using two semi-automated methods and a manual approach for the following functional, volumetric and morphologic parameters: (1) apparent diffusion coefficient (ADC), (2) arterial phase enhancement (AE), (3) portal venous phase enhancement (VE), (4) tumor volume, and assessment according to (5) the Response Evaluation Criteria in Solid Tumors (RECIST), and (6) the European Association for the Study of the Liver (EASL). MATERIALS AND METHODS This HIPAA-compliant retrospective study had institutional review board approval. The requirement for patient informed consent was waived. Tumor ADC, AE, VE, volume, RECIST, and EASL in 50 index lesions was measured by three observers. Interobserver reproducibility was evaluated using intraclass correlation coefficients (ICC). P<0.05 was considered to indicate a significant difference. RESULTS Semi-automated volumetric measurements of functional parameters (ADC, AE, and VE) before and after IAT as well as change in tumor ADC, AE, or VE had better interobserver agreement (ICC=0.830-0.974) compared with manual ROI-based axial measurements (ICC=0.157-0.799). Semi-automated measurements of tumor volume and size in the axial plane before and after IAT had better interobserver agreement (ICC=0.854-0.996) compared with manual size measurements (ICC=0.543-0.596), and interobserver agreement for change in tumor RECIST size was also higher using semi-automated measurements (ICC=0.655) compared with manual measurements (ICC=0.169). EASL measurements of tumor enhancement in the axial plane before and after IAT ((ICC=0.758-0.809), and changes in EASL after IAT (ICC=0.653) had good interobserver agreement. CONCLUSION Semi-automated measurements of functional changes assessed by ADC and VE based on whole-lesion segmentation demonstrated better reproducibility than ROI-based axial measurements, or RECIST or EASL measurements.
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Affiliation(s)
- David Bonekamp
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | - Susanne Bonekamp
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | - Vivek Gowdra Halappa
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | | | - John Eng
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | | | - Timothy M Pawlik
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; The Johns Hopkins School of Medicine, Department of Surgery, Oncology, Baltimore, MD, United States
| | - Ihab R Kamel
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States.
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Rao SX, Meng T, Zhang LJ, Zeng MS. Impact of slice thickness on semi-automated measurements for volume and whole-tumor attenuation of colorectal hepatic metastases in multislice computed tomography. Acta Radiol 2013; 54:863-8. [PMID: 23761557 DOI: 10.1177/0284185113488579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Volumetric and whole-tumor attenuation assessment of tumor are of value in assessment of treatment. PURPOSE To assess the impact of slice thickness on semi-automatic analyses (volume, whole-tumor attenuation) for small colorectal hepatic metastases. MATERIAL AND METHODS Computed tomography (CT) data of patients with colorectal hepatic metastases at 1.5-, 3-, and 5-mm slice thickness were semi-automatically evaluated for volume and whole-tumor attenuation by two radiologists independently. Statistical analysis included paired samples t-test and concordance correlation coefficient (CCC) analysis according to the longest axial tumor diameter (10-20 mm, 20-30 mm, 30-40 mm). RESULTS A total of 62 patients (32 men and 30 women) with 62 target tumors were included. The mean volume was significantly higher at 3- and 5-mm slice thicknesses in comparison with the reference (1.5 mm) for the target tumors between 10 mm and 20 mm (P = 0.0295, CCC = 0.9394 for 3 mm; P = 0.0029, CCC = 0.5129 for 5 mm, respectively) and at 5 mm slice thickness for the target tumors between 20 mm and 30 mm (P = 0.0071, CCC = 0.9102). For whole-tumor attenuation measurements, the significant difference was only seen at 5-mm slice thicknesses in comparison with the reference (1.5 mm) for the target tumors between 10 and 20 mm (P = 0.0015, CCC = 0.9389). CONCLUSION Slice thickness of 1.5 mm might be suggested for semi-automated volumetric measurements, and slice thickness of no more than 3 mm for whole-tumor CT attenuation in hepatic metastasis between 10 mm and 20 mm.
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Affiliation(s)
- Sheng-Xiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University; and Shanghai Medical Imaging Institute, Shanghai, People's Republic of China
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Gonzalez-Guindalini FD, Botelho MPF, Harmath CB, Sandrasegaran K, Miller FH, Salem R, Yaghmai V. Assessment of Liver Tumor Response to Therapy: Role of Quantitative Imaging. Radiographics 2013; 33:1781-800. [DOI: 10.1148/rg.336135511] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Imaging Assessment of Hepatocellular Carcinoma Response to Locoregional and Systemic Therapy. AJR Am J Roentgenol 2013; 201:80-96. [DOI: 10.2214/ajr.13.10706] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Wulff AM, Fabel M, Freitag-Wolf S, Tepper M, Knabe HM, Schäfer JP, Jansen O, Bolte H. Volumetric response classification in metastatic solid tumors on MSCT: initial results in a whole-body setting. Eur J Radiol 2013; 82:e567-73. [PMID: 23827800 DOI: 10.1016/j.ejrad.2013.05.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/28/2013] [Accepted: 05/27/2013] [Indexed: 01/16/2023]
Abstract
PURPOSE To examine technical parameters of measurement accuracy and differences in tumor response classification using RECIST 1.1 and volumetric assessment in three common metastasis types (lung nodules, liver lesions, lymph node metastasis) simultaneously. MATERIALS AND METHODS 56 consecutive patients (32 female) aged 41-82 years with a wide range of metastatic solid tumors were examined with MSCT for baseline and follow up. Images were evaluated by three experienced radiologists using manual measurements and semi-automatic lesion segmentation. Institutional ethics review was obtained and all patients gave written informed consent. Data analysis comprised interobserver variability operationalized as coefficient of variation and categorical response classification according to RECIST 1.1 for both manual and volumetric measures. Continuous data were assessed for statistical significance with Wilcoxon signed-rank test and categorical data with Fleiss kappa. RESULTS Interobserver variability was 6.3% (IQR 4.6%) for manual and 4.1% (IQR 4.4%) for volumetrically obtained sum of relevant diameters (p<0.05, corrected). 4-8 patients' response to therapy was classified differently across observers by using volumetry compared to standard manual measurements. Fleiss kappa revealed no significant difference in categorical agreement of response classification between manual (0.7558) and volumetric (0.7623) measurements. CONCLUSION Under standard RECIST thresholds there was no advantage of volumetric compared to manual response evaluation. However volumetric assessment yielded significantly lower interobserver variability. This may allow narrower thresholds for volumetric response classification in the future.
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Affiliation(s)
- A M Wulff
- Klinik für Diagnostische Radiologie, Arnold-Heller-Straße 3, Haus 23, 24105 Kiel, Germany.
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Bonekamp S, Li Z, Geschwind JFH, Halappa VG, Corona-Villalobos CP, Reyes D, Pawlik TM, Bonekamp D, Eng J, Kamel IR. Unresectable hepatocellular carcinoma: MR imaging after intraarterial therapy. Part I. Identification and validation of volumetric functional response criteria. Radiology 2013; 268:420-30. [PMID: 23616631 DOI: 10.1148/radiol.13122307] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To identify and validate the optimal thresholds for volumetric functional MR imaging response criteria to predict overall survival after intraarterial treatment (IAT) in patients with unresectable hepatocellular carcinoma (HCC). MATERIALS AND METHODS Institutional review board approval and waiver of informed consent were obtained. A total of 143 patients who had undergone MR imaging before and 3-4 weeks after the first cycle of IAT were included. MR imaging analysis of one representative HCC index lesion was performed with proprietary software after initial treatment. Subjects were randomly divided into training (n = 114 [79.7%]) and validation (n = 29 [20.3%]) data sets. Uni- and multivariate Cox models were used to determine the best cutoffs, as well as survival differences, between response groups in the validation data set. RESULTS Optimal cutoffs in the training data set were 23% increase in apparent diffusion coefficient (ADC) and 65% decrease in volumetric enhancement in the portal venous phase (VE). Subsequently, 25% increase in ADC and 65% decrease in VE were used to stratify patients in the validation data set. Comparison of ADC responders (n = 12 [58.6%]) with nonresponders (n = 17 [34.5%]) showed significant differences in survival (25th percentile survival, 11.2 vs 4.9 months, respectively; P = .008), as did VE responders (n = 9 [31.0%]) compared with nonresponders (n = 20 [69.0%]; 25th percentile survival, 11.5 vs 5.1 months, respectively; P = .01). Stratification of patients with a combination of the criteria resulted in significant differences in survival between patients with lesions that fulfilled both criteria (n = 6 [20.7%]; too few cases to determine 25th percentile), one criterion (n = 9 [31.0%]; 25th percentile survival, 6.0 months), and neither criterion (n = 14 [48.3%]; 25th percentile survival, 5.1 months; P = .01). The association between the two criteria and overall survival remained significant in a multivariate analysis that included age, sex, Barcelona Clinic for Liver Cancer stage, and number of follow-up treatments. CONCLUSION After IAT for unresectable HCC, patients can be stratified into significantly different survival categories based on responder versus nonresponder status according to MR imaging ADC and VE cutoffs.
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Affiliation(s)
- Susanne Bonekamp
- Russell H. Morgan Department of Radiology and Radiological Science and Department of Surgery and Oncology, The Johns Hopkins Hospital, 600 N Wolfe St, MRI 143, Baltimore, MD 21287, USA
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