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Bizzarri N, Russo L, Dolciami M, Zormpas-Petridis K, Boldrini L, Querleu D, Ferrandina G, Pedone Anchora L, Gui B, Sala E, Scambia G. Radiomics systematic review in cervical cancer: gynecological oncologists' perspective. Int J Gynecol Cancer 2023; 33:1522-1541. [PMID: 37714669 DOI: 10.1136/ijgc-2023-004589] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE Radiomics is the process of extracting quantitative features from radiological images, and represents a relatively new field in gynecological cancers. Cervical cancer has been the most studied gynecological tumor for what concerns radiomics analysis. The aim of this study was to report on the clinical applications of radiomics combined and/or compared with clinical-pathological variables in patients with cervical cancer. METHODS A systematic review of the literature from inception to February 2023 was performed, including studies on cervical cancer analysing a predictive/prognostic radiomics model, which was combined and/or compared with a radiological or a clinical-pathological model. RESULTS A total of 57 of 334 (17.1%) screened studies met inclusion criteria. The majority of studies used magnetic resonance imaging (MRI), but positron emission tomography (PET)/computed tomography (CT) scan, CT scan, and ultrasound scan also underwent radiomics analysis. In apparent early-stage disease, the majority of studies (16/27, 59.3%) analysed the role of radiomics signature in predicting lymph node metastasis; six (22.2%) investigated the prediction of radiomics to detect lymphovascular space involvement, one (3.7%) investigated depth of stromal infiltration, and one investigated (3.7%) parametrial infiltration. Survival prediction was evaluated both in early-stage and locally advanced settings. No study focused on the application of radiomics in metastatic or recurrent disease. CONCLUSION Radiomics signatures were predictive of pathological and oncological outcomes, particularly if combined with clinical variables. These may be integrated in a model using different clinical-pathological and translational characteristics, with the aim to tailor and personalize the treatment of each patient with cervical cancer.
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Affiliation(s)
- Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Russo
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Miriam Dolciami
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Konstantinos Zormpas-Petridis
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Boldrini
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Denis Querleu
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Pedone Anchora
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Benedetta Gui
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Evis Sala
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Jackson A, Pathak R, deSouza NM, Liu Y, Jacobs BKM, Litiere S, Urbanowicz-Nijaki M, Julie C, Chiti A, Theysohn J, Ayuso JR, Stroobants S, Waterton JC. MRI Apparent Diffusion Coefficient (ADC) as a Biomarker of Tumour Response: Imaging-Pathology Correlation in Patients with Hepatic Metastases from Colorectal Cancer (EORTC 1423). Cancers (Basel) 2023; 15:3580. [PMID: 37509240 PMCID: PMC10377224 DOI: 10.3390/cancers15143580] [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: 05/13/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
Background: Tumour apparent diffusion coefficient (ADC) from diffusion-weighted magnetic resonance imaging (MRI) is a putative pharmacodynamic/response biomarker but the relationship between drug-induced effects on the ADC and on the underlying pathology has not been adequately defined. Hypothesis: Changes in ADC during early chemotherapy reflect underlying histological markers of tumour response as measured by tumour regression grade (TRG). Methods: Twenty-six patients were enrolled in the study. Baseline, 14 days, and pre-surgery MRI were performed per study protocol. Surgical resection was performed in 23 of the enrolled patients; imaging-pathological correlation was obtained from 39 lesions from 21 patients. Results: There was no evidence of correlation between TRG and ADC changes at day 14 (study primary endpoint), and no significant correlation with other ADC metrics. In scans acquired one week prior to surgery, there was no significant correlation between ADC metrics and percentage of viable tumour, percentage necrosis, percentage fibrosis, or Ki67 index. Conclusions: Our hypothesis was not supported by the data. The lack of meaningful correlation between change in ADC and TRG is a robust finding which is not explained by variability or small sample size. Change in ADC is not a proxy for TRG in metastatic colorectal cancer.
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Affiliation(s)
- Alan Jackson
- Centre for Imaging Sciences, University of Manchester, Manchester M20 4GJ, UK
| | - Ryan Pathak
- Centre for Imaging Sciences, University of Manchester, Manchester M20 4GJ, UK
| | - Nandita M deSouza
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, London SW7 3RP, UK
| | - Yan Liu
- European Organisation for Research and Treatment of Cancer, 1200 Brussels, Belgium
| | - Bart K M Jacobs
- European Organisation for Research and Treatment of Cancer, 1200 Brussels, Belgium
| | - Saskia Litiere
- European Organisation for Research and Treatment of Cancer, 1200 Brussels, Belgium
| | | | - Catherine Julie
- EA 4340 BECCOH, UVSQ, Universite Paris-Saclay, 92104 Boulogne-Billancourt, France
- Department of Pathology, APHP-Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France
| | - Arturo Chiti
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Bio-Medical Sciences, Humanitas University, 20072 Milan, Italy
| | - Jens Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany
| | - Juan R Ayuso
- Radiology Department-CDI, Hospital Clinic Universitari de Barcelona, 08036 Barcelona, Spain
| | - Sigrid Stroobants
- Molecular Imaging and Radiology, University of Antwerp, 2000 Antwerp, Belgium
| | - John C Waterton
- Centre for Imaging Sciences, University of Manchester, Manchester M20 4GJ, UK
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3
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Reijers SJM, Gennaro N, Bruining A, van Boven H, Snaebjornsson P, Bekers EM, van Coevorden F, Scholten AN, Schrage Y, van der Graaf WTA, Haas RLM, van Houdt WJ. Correlation of radiological and histopathological response after neoadjuvant radiotherapy in soft tissue sarcoma. Acta Oncol 2023; 62:25-32. [PMID: 36637511 DOI: 10.1080/0284186x.2023.2166427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The aim of this study was to assess the association between radiological and histopathological response after neoadjuvant radiotherapy (nRT) in soft tissue sarcoma (STS), as well as the prognostic value of the different response evaluation methods on the oncological outcome. METHODS A retrospective cohort of patients with localized STS of the extremity and trunk wall, treated with nRT followed by resection were included. The radiological response was assessed by RECIST 1.1 (RECIST) and MR-adapted Choi (Choi), histopathologic response was evaluated according to the EORTC-STBSG recommendations. Oncological outcome parameters of interest were local recurrence-free survival (LRFS), disease metastases-free survival (DMFS), and overall survival (OS). RESULTS For 107 patients, complete pre- and postoperative pathology and imaging datasets were available. Most tumors were high-grade (77%) and the most common histological subtypes were undifferentiated pleomorphic sarcoma/not otherwise specified (UPS/NOS, 40%), myxoid liposarcoma (MLS, 21%) and myxofibrosarcoma (MFS, 16%). When comparing RECIST to Choi, the response was differently categorized in 58%, with a higher response rate (CR + PR) with Choi. Radiological responders showed a significant lower median percentage of viable cells (RECIST p = .050, Choi p = .015) and necrosis (RECIST p < .001), and a higher median percentage of fibrosis (RECIST p = .005, Choi p = .008), compared to radiological non-responders (SD + PD). RECIST, Choi, fibrosis, and viable cells were not significantly associated with altered oncological outcome, more necrosis was associated with poorer OS (p = .038). CONCLUSION RECIST, Choi and the EORTC-STBSG response score show incongruent results in response evaluation. The radiological response was significantly correlated with a lower percentage of viable cells and necrosis, but a higher percentage of fibrosis. Apart from necrosis, radiological nor other histopathological parameters were associated with oncologic outcomes.
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Affiliation(s)
- Sophie J M Reijers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nicolò Gennaro
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annemarie Bruining
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hester van Boven
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elise M Bekers
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frits van Coevorden
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Astrid N Scholten
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Yvonne Schrage
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Rick L M Haas
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Zormpas-Petridis K, Tunariu N, Collins DJ, Messiou C, Koh DM, Blackledge MD. Deep-learned estimation of uncertainty in measurements of apparent diffusion coefficient from whole-body diffusion-weighted MRI. Comput Biol Med 2022; 149:106091. [PMID: 36115298 DOI: 10.1016/j.compbiomed.2022.106091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/01/2022] [Accepted: 09/03/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To use deep learning to calculate the uncertainty in apparent diffusion coefficient (σADC) voxel-wise measurements to clinically impact the monitoring of treatment response and improve the quality of ADC maps. MATERIALS AND METHODS We use a uniquely designed diffusion-weighted imaging (DWI) acquisition protocol that provides gold-standard measurements of σADC to train a deep learning model on two separate cohorts: 16 patients with prostate cancer and 28 patients with mesothelioma. Our network was trained with a novel cost function, which incorporates a perception metric and a b-value regularisation term, on ADC maps calculated by combinations of 2 or 3 b-values (e.g. 50/600/900, 50/900, 50/600, 600/900 s/mm2). We compare the accuracy of the deep-learning based approach for estimation of σADC with gold-standard measurements. RESULTS The model accurately predicted the σADC for every b-value combination in both cohorts. Mean values of σADC within areas of active disease deviated from those measured by the gold-standard by 4.3% (range, 2.87-6.13%) for the prostate and 3.7% (range, 3.06-4.54%) for the mesothelioma cohort. We also showed that the model can easily be adapted for a different DWI protocol and field-of-view with only a few images (as little as a single patient) using transfer learning. CONCLUSION Deep learning produces maps of σADC from standard clinical diffusion-weighted images (DWI) when 2 or more b-values are available.
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Affiliation(s)
| | - Nina Tunariu
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, United Kingdom
| | - David J Collins
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Christina Messiou
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, United Kingdom
| | - Dow-Mu Koh
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, United Kingdom
| | - Matthew D Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.
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5
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Hubbard Cristinacce PL, Keaveney S, Aboagye EO, Hall MG, Little RA, O'Connor JPB, Parker GJM, Waterton JC, Winfield JM, Jauregui-Osoro M. Clinical translation of quantitative magnetic resonance imaging biomarkers - An overview and gap analysis of current practice. Phys Med 2022; 101:165-182. [PMID: 36055125 DOI: 10.1016/j.ejmp.2022.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/05/2022] [Accepted: 08/17/2022] [Indexed: 10/14/2022] Open
Abstract
PURPOSE This overview of the current landscape of quantitative magnetic resonance imaging biomarkers (qMR IBs) aims to support the standardisation of academic IBs to assist their translation to clinical practice. METHODS We used three complementary approaches to investigate qMR IB use and quality management practices within the UK: 1) a literature search of qMR and quality management terms during 2011-2015 and 2016-2020; 2) a database search for clinical research studies using qMR IBs during 2016-2020; and 3) a survey to ascertain the current availability and quality management practices for clinical MRI scanners and associated equipment at research institutions across the UK. RESULTS The analysis showed increased use of all qMR methods between the periods 2011-2015 and 2016-2020 and diffusion-tensor MRI and volumetry to be popular methods. However, the "translation ratio" of journal articles to clinical research studies was higher for qMR methods that have evidence of clinical translation via a commercial route, such as fat fraction and T2 mapping. The number of journal articles citing quality management terms doubled between the periods 2011-2015 and 2016-2020; although, its proportion relative to all journal articles only increased by 3.0%. The survey suggested that quality assurance (QA) and quality control (QC) of data acquisition procedures are under-reported in the literature and that QA/QC of acquired data/data analysis are under-developed and lack consistency between institutions. CONCLUSIONS We summarise current attempts to standardise and translate qMR IBs, and conclude by outlining the ideal quality management practices and providing a gap analysis between current practice and a metrological standard.
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Affiliation(s)
| | - Sam Keaveney
- MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Eric O Aboagye
- Department of Surgery & Cancer, Division of Cancer, Imperial College London, W12 0NN London, UK
| | - Matt G Hall
- National Physical Laboratory, Hampton Road, Teddington TW11 0LW, UK
| | - Ross A Little
- Division of Cancer Sciences, The University of Manchester, Manchester M13 9PT, UK
| | - James P B O'Connor
- Division of Cancer Sciences, The University of Manchester, Manchester M13 9PT, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Geoff J M Parker
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, 90 High Holborn, London WC1V 6LJ, UK; Bioxydyn Ltd, Manchester M15 6SZ, UK
| | - John C Waterton
- Bioxydyn Ltd, Manchester M15 6SZ, UK; Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester M13 9PT, UK
| | - Jessica M Winfield
- MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Maite Jauregui-Osoro
- Department of Surgery & Cancer, Division of Cancer, Imperial College London, W12 0NN London, UK
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6
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Ye S, Lim JY, Huang W. Statistical considerations for repeatability and reproducibility of quantitative imaging biomarkers. BJR Open 2022; 4:20210083. [PMID: 36452056 PMCID: PMC9667479 DOI: 10.1259/bjro.20210083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/05/2022] Open
Abstract
Quantitative imaging biomarkers (QIBs) are increasingly used in clinical studies. Because many QIBs are derived through multiple steps in image data acquisition and data analysis, QIB measurements can produce large variabilities, posing a significant challenge in translating QIBs into clinical trials, and ultimately, clinical practice. Both repeatability and reproducibility constitute the reliability of a QIB measurement. In this article, we review the statistical aspects of repeatability and reproducibility of QIB measurements by introducing methods and metrics for assessments of QIB repeatability and reproducibility and illustrating the impact of QIB measurement error on sample size and statistical power calculations, as well as predictive performance with a QIB as a predictive biomarker.
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Affiliation(s)
- Shangyuan Ye
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, United States
| | - Jeong Youn Lim
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, United States
| | - Wei Huang
- Advanced Imaging Research Center, Oregon Health and Science University, Portland, OR, United States
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7
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Egnell L, Jerome NP, Andreassen MMS, Bathen TF, Goa PE. Effects of echo time on IVIM quantifications of locally advanced breast cancer in clinical diffusion-weighted MRI at 3 T. NMR IN BIOMEDICINE 2022; 35:e4654. [PMID: 34967468 DOI: 10.1002/nbm.4654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE The purpose of this study was to investigate the effects of echo time dependence in IVIM quantification of the pseudo-diffusion fraction in breast cancer and whether correcting for the echo time dependence offers added clinical value. MATERIALS AND METHODS Fifteen patients with biopsy-proven breast cancer underwent a 3 T MRI examination with an extended DWI protocol at two different echo times (TE = 53 ms, b = 0, 50 s/mm2 ; TE = 77 ms, b = 0, 50, 120, 200, 400, 700 s/mm2 ). Volumes of interest were delineated around the tumors. In addition, simulated MRI data were generated for different levels of signal-to-noise ratio and two values for the blood T2 relaxation time (T2p = 100 ms and 150 ms). The pseudo-diffusion signal fraction was estimated from the simulated and in vivo tumor data using both the standard IVIM model and an extended IVIM model that accounts for the echo time dependence arising from distinct transverse relaxation times. RESULTS Simulations showed that the standard IVIM model overestimated the pseudo-diffusion fraction by 25% (T2p = 100 ms) and 60 % (T2p = 150 ms) (p < 0.0001 at SNR = 50). In vivo, the estimated apparent T2 value at b = 50 s/mm2 was around 8% lower than at b = 0 s/mm2 (p = 0.01) demonstrating a removal of the signal contribution from blood with long T2 associated with pseudo-diffusion. Using two different fixed values for T2p = 100, 150 ms, the pseudo-diffusion fraction was 15% and 46% higher in the standard model compared with the echo-time-corrected model (p < 0.01). CONCLUSION The standard IVIM model was found to overestimate the pseudo-diffusion fraction by 15% to 46% compared with the echo-time-corrected model in breast tumor DWI data acquired at 3 T. Our results suggest that a corrected model may give more accurate results in terms of signal fractions, but may not justify the added time needed to acquire the additional data in terms of clinical value.
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Affiliation(s)
- Liv Egnell
- Department of Physics, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Radiology and Nuclear Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Neil P Jerome
- Clinic of Radiology and Nuclear Medicine, St. Olav's University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Maren M S Andreassen
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Tone F Bathen
- Clinic of Radiology and Nuclear Medicine, St. Olav's University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Erik Goa
- Department of Physics, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Radiology and Nuclear Medicine, St. Olav's University Hospital, Trondheim, Norway
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8
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Keenan KE, Delfino JG, Jordanova KV, Poorman ME, Chirra P, Chaudhari AS, Baessler B, Winfield J, Viswanath SE, deSouza NM. Challenges in ensuring the generalizability of image quantitation methods for MRI. Med Phys 2022; 49:2820-2835. [PMID: 34455593 PMCID: PMC8882689 DOI: 10.1002/mp.15195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 01/31/2023] Open
Abstract
Image quantitation methods including quantitative MRI, multiparametric MRI, and radiomics offer great promise for clinical use. However, many of these methods have limited clinical adoption, in part due to issues of generalizability, that is, the ability to translate methods and models across institutions. Researchers can assess generalizability through measurement of repeatability and reproducibility, thus quantifying different aspects of measurement variance. In this article, we review the challenges to ensuring repeatability and reproducibility of image quantitation methods as well as present strategies to minimize their variance to enable wider clinical implementation. We present possible solutions for achieving clinically acceptable performance of image quantitation methods and briefly discuss the impact of minimizing variance and achieving generalizability towards clinical implementation and adoption.
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Affiliation(s)
- Kathryn E. Keenan
- Physical Measurement Laboratory, National Institute of Standards and Technology, 325 Broadway, Boulder, CO 80305, USA
| | - Jana G. Delfino
- Center for Devices and Radiological Health, US Food and Drug Administration, 10993 New Hampshire Ave, Silver Spring, MD 20993, USA
| | - Kalina V. Jordanova
- Physical Measurement Laboratory, National Institute of Standards and Technology, 325 Broadway, Boulder, CO 80305, USA
| | - Megan E. Poorman
- Physical Measurement Laboratory, National Institute of Standards and Technology, 325 Broadway, Boulder, CO 80305, USA
| | - Prathyush Chirra
- Dept of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Akshay S. Chaudhari
- Department of Radiology, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA
- Department of Biomedical Data Science, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA
| | - Bettina Baessler
- University Hospital of Zurich and University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Jessica Winfield
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Satish E. Viswanath
- Dept of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Nandita M. deSouza
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
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9
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Fournier L, de Geus-Oei LF, Regge D, Oprea-Lager DE, D’Anastasi M, Bidaut L, Bäuerle T, Lopci E, Cappello G, Lecouvet F, Mayerhoefer M, Kunz WG, Verhoeff JJC, Caruso D, Smits M, Hoffmann RT, Gourtsoyianni S, Beets-Tan R, Neri E, deSouza NM, Deroose CM, Caramella C. Twenty Years On: RECIST as a Biomarker of Response in Solid Tumours an EORTC Imaging Group - ESOI Joint Paper. Front Oncol 2022; 11:800547. [PMID: 35083155 PMCID: PMC8784734 DOI: 10.3389/fonc.2021.800547] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/30/2021] [Indexed: 12/15/2022] Open
Abstract
Response evaluation criteria in solid tumours (RECIST) v1.1 are currently the reference standard for evaluating efficacy of therapies in patients with solid tumours who are included in clinical trials, and they are widely used and accepted by regulatory agencies. This expert statement discusses the principles underlying RECIST, as well as their reproducibility and limitations. While the RECIST framework may not be perfect, the scientific bases for the anticancer drugs that have been approved using a RECIST-based surrogate endpoint remain valid. Importantly, changes in measurement have to meet thresholds defined by RECIST for response classification within thus partly circumventing the problems of measurement variability. The RECIST framework also applies to clinical patients in individual settings even though the relationship between tumour size changes and outcome from cohort studies is not necessarily translatable to individual cases. As reproducibility of RECIST measurements is impacted by reader experience, choice of target lesions and detection/interpretation of new lesions, it can result in patients changing response categories when measurements are near threshold values or if new lesions are missed or incorrectly interpreted. There are several situations where RECIST will fail to evaluate treatment-induced changes correctly; knowledge and understanding of these is crucial for correct interpretation. Also, some patterns of response/progression cannot be correctly documented by RECIST, particularly in relation to organ-site (e.g. bone without associated soft-tissue lesion) and treatment type (e.g. focal therapies). These require specialist reader experience and communication with oncologists to determine the actual impact of the therapy and best evaluation strategy. In such situations, alternative imaging markers for tumour response may be used but the sources of variability of individual imaging techniques need to be known and accounted for. Communication between imaging experts and oncologists regarding the level of confidence in a biomarker is essential for the correct interpretation of a biomarker and its application to clinical decision-making. Though measurement automation is desirable and potentially reduces the variability of results, associated technical difficulties must be overcome, and human adjudications may be required.
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Affiliation(s)
- Laure Fournier
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Université de Paris, Assistance Publique–Hôpitaux de Paris (AP-HP), Hopital europeen Georges Pompidou, Department of Radiology, Paris Cardiovascular Research Center (PARCC) Unité Mixte de Recherche (UMRS) 970, Institut national de la santé et de la recherche médicale (INSERM), Paris, France
| | - Lioe-Fee de Geus-Oei
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, Netherlands
| | - Daniele Regge
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Radiology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per l’Oncologia-Istituto Di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Turin, Italy
| | - Daniela-Elena Oprea-Lager
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology & Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centers [Vrije Universiteit (VU) University], Amsterdam, Netherlands
| | - Melvin D’Anastasi
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Medical Imaging Department, Mater Dei Hospital, University of Malta, Msida, Malta
| | - Luc Bidaut
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- College of Science, University of Lincoln, Lincoln, United Kingdom
| | - Tobias Bäuerle
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Egesta Lopci
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Nuclear Medicine Unit, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) – Humanitas Research Hospital, Milan, Italy
| | - Giovanni Cappello
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Radiology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per l’Oncologia-Istituto Di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Turin, Italy
| | - Frederic Lecouvet
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Marius Mayerhoefer
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Wolfgang G. Kunz
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Radiology, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany
| | - Joost J. C. Verhoeff
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Damiano Caruso
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Marion Smits
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Brain Tumour Centre, Erasmus Medical Centre (MC) Cancer Institute, Rotterdam, Netherlands
| | - Ralf-Thorsten Hoffmann
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital, Carl-Gustav-Carus Technical University Dresden, Dresden, Germany
| | - Sofia Gourtsoyianni
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Regina Beets-Tan
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- School For Oncology and Developmental Biology (GROW) School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Emanuele Neri
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Diagnostic and Interventional Radiology, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Nandita M. deSouza
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, IL, United States
| | - Christophe M. Deroose
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
- Nuclear Medicine & Molecular Imaging, Department of Imaging and Pathology, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Caroline Caramella
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Radiology Department, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph Centre International des Cancers Thoraciques, Université Paris-Saclay, Le Plessis-Robinson, France
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10
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Review of imaging techniques for evaluating morphological and functional responses to the treatment of bone metastases in prostate and breast cancer. Clin Transl Oncol 2022; 24:1290-1310. [PMID: 35152355 PMCID: PMC9192443 DOI: 10.1007/s12094-022-02784-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/20/2022] [Indexed: 12/27/2022]
Abstract
Bone metastases are very common complications associated with certain types of cancers that frequently negatively impact the quality of life and functional status of patients; thus, early detection is necessary for the implementation of immediate therapeutic measures to reduce the risk of skeletal complications and improve survival and quality of life. There is no consensus or universal standard approach for the detection of bone metastases in cancer patients based on imaging. Endorsed by the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) a group of experts met to discuss and provide an up-to-date review of our current understanding of the biological mechanisms through which tumors spread to the bone and describe the imaging methods available to diagnose bone metastasis and monitor their response to oncological treatment, focusing on patients with breast and prostate cancer. According to current available data, the use of next-generation imaging techniques, including whole-body diffusion-weighted MRI, PET/CT, and PET/MRI with novel radiopharmaceuticals, is recommended instead of the classical combination of CT and bone scan in detection, staging and response assessment of bone metastases from prostate and breast cancer.Clinical trial registration: Not applicable.
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11
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Zormpas-Petridis K, Tunariu N, Curcean A, Messiou C, Curcean S, Collins DJ, Hughes JC, Jamin Y, Koh DM, Blackledge MD. Accelerating Whole-Body Diffusion-weighted MRI with Deep Learning-based Denoising Image Filters. Radiol Artif Intell 2021; 3:e200279. [PMID: 34617028 PMCID: PMC8489468 DOI: 10.1148/ryai.2021200279] [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: 11/19/2020] [Revised: 05/11/2021] [Accepted: 06/04/2021] [Indexed: 11/23/2022]
Abstract
Purpose To use deep learning to improve the image quality of subsampled images (number of acquisitions = 1 [NOA1]) to reduce whole-body diffusion-weighted MRI (WBDWI) acquisition times. Materials and Methods Both retrospective and prospective patient groups were used to develop a deep learning–based denoising image filter (DNIF) model. For initial model training and validation, 17 patients with metastatic prostate cancer with acquired WBDWI NOA1 and NOA9 images (acquisition period, 2015–2017) were retrospectively included. An additional 22 prospective patients with advanced prostate cancer, myeloma, and advanced breast cancer were used for model testing (2019), and the radiologic quality of DNIF-processed NOA1 (NOA1-DNIF) images were compared with NOA1 images and clinical NOA16 images by using a three-point Likert scale (good, average, or poor; statistical significance was calculated by using a Wilcoxon signed ranked test). The model was also retrained and tested in 28 patients with malignant pleural mesothelioma (MPM) who underwent lung MRI (2015–2017) to demonstrate feasibility in other body regions. Results The model visually improved the quality of NOA1 images in all test patients, with the majority of NOA1-DNIF and NOA16 images being graded as either “average” or “good” across all image-quality criteria. From validation data, the mean apparent diffusion coefficient (ADC) values within NOA1-DNIF images of bone disease deviated from those within NOA9 images by an average of 1.9% (range, 1.1%–2.6%). The model was also successfully applied in the context of MPM; the mean ADCs from NOA1-DNIF images of MPM deviated from those measured by using clinical-standard images (NOA12) by 3.7% (range, 0.2%–10.6%). Conclusion Clinical-standard images were generated from subsampled images by using a DNIF. Keywords: Image Postprocessing, MR-Diffusion-weighted Imaging, Neural Networks, Oncology, Whole-Body Imaging, Supervised Learning, MR-Functional Imaging, Metastases, Prostate, Lung Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Konstantinos Zormpas-Petridis
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Nina Tunariu
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Andra Curcean
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Christina Messiou
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Sebastian Curcean
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - David J Collins
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Julie C Hughes
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Yann Jamin
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Dow-Mu Koh
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Matthew D Blackledge
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
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12
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Jerome NP, Vidić I, Egnell L, Sjøbakk TE, Østlie A, Fjøsne HE, Goa PE, Bathen TF. Understanding diffusion-weighted MRI analysis: Repeatability and performance of diffusion models in a benign breast lesion cohort. NMR IN BIOMEDICINE 2021; 34:e4508. [PMID: 33738878 DOI: 10.1002/nbm.4508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 06/12/2023]
Abstract
Diffusion-weighted MRI (DWI) is an important tool for oncology research, with great clinical potential for the classification and monitoring of breast lesions. The utility of parameters derived from DWI, however, is influenced by specific analysis choices. The purpose of this study was to critically evaluate repeatability and curve-fitting performance of common DWI signal representations, for a prospective cohort of patients with benign breast lesions. Twenty informed, consented patients with confirmed benign breast lesions underwent repeated DWI (3 T) using: sagittal single-shot spin-echo echo planar imaging, bipolar encoding, TR/TE: 11,600/86 ms, FOV: 180 x 180 mm, matrix: 90 x 90, slices: 60 x 2.5 mm, iPAT: GRAPPA 2, fat suppression, and 13 b-values: 0-700 s/mm2 . A phase-reversed scan (b = 0 s/mm2 ) was acquired for distortion correction. Voxel-wise repeat-measures coefficients of variation (CoVs) were derived for monoexponential (apparent diffusion coefficient [ADC]), biexponential (intravoxel incoherent motion: f, D, D*) and stretched exponential (α, DDC) across the parameter histograms for lesion regions of interest (ROIs). Goodness-of-fit for each representation was assessed by Bayesian information criterion. The volume of interest (VOI) definition was repeatable (CoV 13.9%). Within lesions, and across both visits and the cohort, there was no dominant best-fit model, with all representations giving the best fit for a fraction of the voxels. Diffusivity measures from the signal representations (ADC, D, DDC) all showed good repeatability (CoV < 10%), whereas parameters associated with pseudodiffusion (f, D*) performed poorly (CoV > 50%). The stretching exponent α was repeatable (CoV < 12%). This pattern of repeatability was consistent over the central part of the parameter percentiles. Assumptions often made in diffusion studies about analysis choices will influence the detectability of changes, potentially obscuring useful information. No single signal representation prevails within or across lesions, or across repeated visits; parameter robustness is therefore a critical consideration. Our results suggest that stretched exponential representation is more repeatable than biexponential, with pseudodiffusion parameters unlikely to provide clinically useful biomarkers.
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Affiliation(s)
- Neil Peter Jerome
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Igor Vidić
- Department of Physics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Liv Egnell
- Clinic of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim, Norway
- Department of Physics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Torill E Sjøbakk
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Agnes Østlie
- Department of Radiology, St. Olavs Hospital, Trondheim, Norway
| | - Hans E Fjøsne
- Department of Radiology, St. Olavs Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Pål Erik Goa
- Department of Physics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tone F Bathen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim, Norway
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13
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Hajjo R, Sabbah DA, Bardaweel SK, Tropsha A. Identification of Tumor-Specific MRI Biomarkers Using Machine Learning (ML). Diagnostics (Basel) 2021; 11:742. [PMID: 33919342 PMCID: PMC8143297 DOI: 10.3390/diagnostics11050742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023] Open
Abstract
The identification of reliable and non-invasive oncology biomarkers remains a main priority in healthcare. There are only a few biomarkers that have been approved as diagnostic for cancer. The most frequently used cancer biomarkers are derived from either biological materials or imaging data. Most cancer biomarkers suffer from a lack of high specificity. However, the latest advancements in machine learning (ML) and artificial intelligence (AI) have enabled the identification of highly predictive, disease-specific biomarkers. Such biomarkers can be used to diagnose cancer patients, to predict cancer prognosis, or even to predict treatment efficacy. Herein, we provide a summary of the current status of developing and applying Magnetic resonance imaging (MRI) biomarkers in cancer care. We focus on all aspects of MRI biomarkers, starting from MRI data collection, preprocessing and machine learning methods, and ending with summarizing the types of existing biomarkers and their clinical applications in different cancer types.
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Affiliation(s)
- Rima Hajjo
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P.O. Box 130, Amman 11733, Jordan;
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, Eshelman School of Pharmacy, The University of North Carlina at Chapel Hill, Chapel Hill, NC 27599, USA;
- National Center for Epidemics and Communicable Disease Control, Amman 11118, Jordan
| | - Dima A. Sabbah
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P.O. Box 130, Amman 11733, Jordan;
| | - Sanaa K. Bardaweel
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Jordan, Amman 11942, Jordan;
| | - Alexander Tropsha
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, Eshelman School of Pharmacy, The University of North Carlina at Chapel Hill, Chapel Hill, NC 27599, USA;
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14
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Colombo A, Saia G, Azzena AA, Rossi A, Zugni F, Pricolo P, Summers PE, Marvaso G, Grimm R, Bellomi M, Jereczek-Fossa BA, Padhani AR, Petralia G. Semi-Automated Segmentation of Bone Metastases from Whole-Body MRI: Reproducibility of Apparent Diffusion Coefficient Measurements. Diagnostics (Basel) 2021; 11:diagnostics11030499. [PMID: 33799913 PMCID: PMC7998160 DOI: 10.3390/diagnostics11030499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 01/15/2023] Open
Abstract
Using semi-automated software simplifies quantitative analysis of the visible burden of disease on whole-body MRI diffusion-weighted images. To establish the intra- and inter-observer reproducibility of apparent diffusion coefficient (ADC) measures, we retrospectively analyzed data from 20 patients with bone metastases from breast (BCa; n = 10; aged 62.3 ± 14.8) or prostate cancer (PCa; n = 10; aged 67.4 ± 9.0) who had undergone examinations at two timepoints, before and after hormone-therapy. Four independent observers processed all images twice, first segmenting the entire skeleton on diffusion-weighted images, and then isolating bone metastases via ADC histogram thresholding (ADC: 650–1400 µm2/s). Dice Similarity, Bland-Altman method, and Intraclass Correlation Coefficient were used to assess reproducibility. Inter-observer Dice similarity was moderate (0.71) for women with BCa and poor (0.40) for men with PCa. Nonetheless, the limits of agreement of the mean ADC were just ±6% for women with BCa and ±10% for men with PCa (mean ADCs: 941 and 999 µm2/s, respectively). Inter-observer Intraclass Correlation Coefficients of the ADC histogram parameters were consistently greater in women with BCa than in men with PCa. While scope remains for improving consistency of the volume segmented, the observer-dependent variability measured in this study was appropriate to distinguish the clinically meaningful changes of ADC observed in patients responding to therapy, as changes of at least 25% are of interest.
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Affiliation(s)
- Alberto Colombo
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.S.); (F.Z.); (P.P.); (P.E.S.); (M.B.)
- Correspondence:
| | - Giulia Saia
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.S.); (F.Z.); (P.P.); (P.E.S.); (M.B.)
| | - Alcide A. Azzena
- Postgraduate School in Radiodiagnostics, University of Milan, 20122 Milan, Italy;
| | - Alice Rossi
- Radiology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
| | - Fabio Zugni
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.S.); (F.Z.); (P.P.); (P.E.S.); (M.B.)
| | - Paola Pricolo
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.S.); (F.Z.); (P.P.); (P.E.S.); (M.B.)
| | - Paul E. Summers
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.S.); (F.Z.); (P.P.); (P.E.S.); (M.B.)
| | - Giulia Marvaso
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Robert Grimm
- MR Applications Pre-Development, Siemens Healthcare, 91052 Erlangen, Germany;
| | - Massimo Bellomi
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.S.); (F.Z.); (P.P.); (P.E.S.); (M.B.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Barbara A. Jereczek-Fossa
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Anwar R. Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood HA6 2RN, UK;
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
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15
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Tomaszewski MR, Dominguez-Viqueira W, Ortiz A, Shi Y, Costello JR, Enderling H, Rosenberg SA, Gillies RJ. Heterogeneity analysis of MRI T2 maps for measurement of early tumor response to radiotherapy. NMR IN BIOMEDICINE 2021; 34:e4454. [PMID: 33325086 DOI: 10.1002/nbm.4454] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/09/2020] [Indexed: 06/12/2023]
Abstract
External beam radiotherapy (XRT) is a widely used cancer treatment, yet responses vary dramatically among patients. These differences are not accounted for in clinical practice, partly due to a lack of sensitive early response biomarkers. We hypothesize that quantitative magnetic resonance imaging (MRI) measures reflecting tumor heterogeneity can provide a sensitive and robust biomarker of early XRT response. MRI T2 mapping was performed every 72 hours following 10 Gy dose XRT in two models of pancreatic cancer propagated in the hind limb of mice. Interquartile range (IQR) of tumor T2 was presented as a potential biomarker of radiotherapy response compared with tumor growth kinetics, and biological validation was performed through quantitative histology analysis. Quantification of tumor T2 IQR showed sensitivity for detection of XRT-induced tumor changes 72 hours after treatment, outperforming T2-weighted and diffusion-weighted MRI, with very good robustness. Histological comparison revealed that T2 IQR provides a measure of spatial heterogeneity in tumor cell density, related to radiation-induced necrosis. Early IQR changes were found to correlate to subsequent tumor volume changes, indicating promise for treatment response prediction. Our preclinical findings indicate that spatial heterogeneity analysis of T2 MRI can provide a translatable method for early radiotherapy response assessment. We propose that the method may in future be applied for personalization of radiotherapy through adaptive treatment paradigms.
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Affiliation(s)
- Michal R Tomaszewski
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - William Dominguez-Viqueira
- Small Imaging Laboratory Core Facility, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Antonio Ortiz
- Analytical Microscopy Core Facility, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Yu Shi
- Department of Radiology, ShengJing Hospital of China Medical University, Shenyang, China
| | - James R Costello
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Heiko Enderling
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Stephen A Rosenberg
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Robert J Gillies
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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16
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Jerome NP, Periquito JS. Analysis of Renal Diffusion-Weighted Imaging (DWI) Using Apparent Diffusion Coefficient (ADC) and Intravoxel Incoherent Motion (IVIM) Models. Methods Mol Biol 2021; 2216:611-635. [PMID: 33476027 DOI: 10.1007/978-1-0716-0978-1_37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Analysis of renal diffusion-weighted imaging (DWI) data to derive markers of tissue properties requires careful consideration of the type, extent, and limitations of the acquired data. Alongside data quality and general suitability for quantitative analysis, choice of diffusion model, fitting algorithm, and processing steps can have consequences for the precision, accuracy, and reliability of derived diffusion parameters. Here we introduce and discuss important steps for diffusion-weighted image processing, and in particular give example analysis protocols and pseudo-code for analysis using the apparent diffusion coefficient (ADC) and intravoxel incoherent motion (IVIM) models. Following an overview of general principles, we provide details of optional steps, and steps for validation of results. Illustrative examples are provided, together with extensive notes discussing wider context of individual steps, and notes on potential pitfalls.This publication is based upon work from the COST Action PARENCHIMA, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers. This analysis protocol chapter is complemented by two separate chapters describing the basic concepts and experimental procedure.
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Affiliation(s)
- Neil Peter Jerome
- Institute for Circulation and Diagnostic Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- Department of Radiology and Nuclear Medicine, St. Olav's University Hospital, Trondheim, Norway.
| | - João S Periquito
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine (MDC) in the Helmholtz Association, Berlin, Germany
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Michoux NF, Ceranka JW, Vandemeulebroucke J, Peeters F, Lu P, Absil J, Triqueneaux P, Liu Y, Collette L, Willekens I, Brussaard C, Debeir O, Hahn S, Raeymaekers H, de Mey J, Metens T, Lecouvet FE. Repeatability and reproducibility of ADC measurements: a prospective multicenter whole-body-MRI study. Eur Radiol 2021; 31:4514-4527. [PMID: 33409773 DOI: 10.1007/s00330-020-07522-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/31/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Multicenter oncology trials increasingly include MRI examinations with apparent diffusion coefficient (ADC) quantification for lesion characterization and follow-up. However, the repeatability and reproducibility (R&R) limits above which a true change in ADC can be considered relevant are poorly defined. This study assessed these limits in a standardized whole-body (WB)-MRI protocol. METHODS A prospective, multicenter study was performed at three centers equipped with the same 3.0-T scanners to test a WB-MRI protocol including diffusion-weighted imaging (DWI). Eight healthy volunteers per center were enrolled to undergo test and retest examinations in the same center and a third examination in another center. ADC variability was assessed in multiple organs by two readers using two-way mixed ANOVA, Bland-Altman plots, coefficient of variation (CoV), and the upper limit of the 95% CI on repeatability (RC) and reproducibility (RDC) coefficients. RESULTS CoV of ADC was not influenced by other factors (center, reader) than the organ. Based on the upper limit of the 95% CI on RC and RDC (from both readers), a change in ADC in an individual patient must be superior to 12% (cerebrum white matter), 16% (paraspinal muscle), 22% (renal cortex), 26% (central and peripheral zones of the prostate), 29% (renal medulla), 35% (liver), 45% (spleen), 50% (posterior iliac crest), 66% (L5 vertebra), 68% (femur), and 94% (acetabulum) to be significant. CONCLUSIONS This study proposes R&R limits above which ADC changes can be considered as a reliable quantitative endpoint to assess disease or treatment-related changes in the tissue microstructure in the setting of multicenter WB-MRI trials. KEY POINTS • The present study showed the range of R&R of ADC in WB-MRI that may be achieved in a multicenter framework when a standardized protocol is deployed. • R&R was not influenced by the site of acquisition of DW images. • Clinically significant changes in ADC measured in a multicenter WB-MRI protocol performed with the same type of MRI scanner must be superior to 12% (cerebrum white matter), 16% (paraspinal muscle), 22% (renal cortex), 26% (central zone and peripheral zone of prostate), 29% (renal medulla), 35% (liver), 45% (spleen), 50% (posterior iliac crest), 66% (L5 vertebra), 68% (femur), and 94% (acetabulum) to be detected with a 95% confidence level.
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Affiliation(s)
- Nicolas F Michoux
- Institut de Recherche Expérimentale & Clinique (IREC) - Radiology Department, Université Catholique de Louvain (UCLouvain) - Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium.
| | - Jakub W Ceranka
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jef Vandemeulebroucke
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Frank Peeters
- Institut de Recherche Expérimentale & Clinique (IREC) - Radiology Department, Université Catholique de Louvain (UCLouvain) - Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium
| | - Pierre Lu
- Institut de Recherche Expérimentale & Clinique (IREC) - Radiology Department, Université Catholique de Louvain (UCLouvain) - Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium
| | - Julie Absil
- Radiology Department, Université libre de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Perrine Triqueneaux
- Institut de Recherche Expérimentale & Clinique (IREC) - Radiology Department, Université Catholique de Louvain (UCLouvain) - Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium
| | - Yan Liu
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Laurence Collette
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | | | | | - Olivier Debeir
- LISA (Laboratories of Image Synthesis and Analysis), Ecole Polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Stephan Hahn
- LISA (Laboratories of Image Synthesis and Analysis), Ecole Polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | | | | | - Thierry Metens
- Radiology Department, Université libre de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Frédéric E Lecouvet
- Institut de Recherche Expérimentale & Clinique (IREC) - Radiology Department, Université Catholique de Louvain (UCLouvain) - Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium
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18
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Renal Diffusion-Weighted Imaging (DWI) for Apparent Diffusion Coefficient (ADC), Intravoxel Incoherent Motion (IVIM), and Diffusion Tensor Imaging (DTI): Basic Concepts. Methods Mol Biol 2021; 2216:187-204. [PMID: 33476001 PMCID: PMC9703200 DOI: 10.1007/978-1-0716-0978-1_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The specialized function of the kidney is reflected in its unique structure, characterized by juxtaposition of disorganized and ordered elements, including renal glomerula, capillaries, and tubules. The key role of the kidney in blood filtration, and changes in filtration rate and blood flow associated with pathological conditions, make it possible to investigate kidney function using the motion of water molecules in renal tissue. Diffusion-weighted imaging (DWI) is a versatile modality that sensitizes observable signal to water motion, and can inform on the complexity of the tissue microstructure. Several DWI acquisition strategies are available, as are different analysis strategies, and models that attempt to capture not only simple diffusion effects, but also perfusion, compartmentalization, and anisotropy. This chapter introduces the basic concepts of DWI alongside common acquisition schemes and models, and gives an overview of specific DWI applications for animal models of renal disease.This chapter is based upon work from the COST Action PARENCHIMA, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers. This introduction chapter is complemented by two separate chapters describing the experimental procedure and data analysis.
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19
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Kunigelis KE, Hosokawa P, Arnone G, Raban D, Starr A, Gurau A, Sunshine A, Bunn J, Thaker AA, Youssef AS. The predictive value of preoperative apparent diffusion coefficient (ADC) for facial nerve outcomes after vestibular schwannoma resection: clinical study. Acta Neurochir (Wien) 2020; 162:1995-2005. [PMID: 32440924 DOI: 10.1007/s00701-020-04338-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/07/2020] [Indexed: 02/07/2023]
Abstract
OBJECT Diffusion MRI has been used to predict intraoperative consistency of tumors. Apparent diffusion coefficient (ADC) has shown predictive value as an imaging biomarker in many CNS tumors but has not been studied in a large cohort of patients with vestibular schwannoma. In this study, we examine the utility of ADC as a predictive biomarker for intraoperative tumor characteristics and postoperative facial nerve outcome. METHODS A retrospective review of patients who underwent vestibular schwannoma resection at our institution from 2008 to 2018 yielded 87 patients, of which 72 met inclusion criteria. Operative reports and clinical records were reviewed for clinical data; MRI data were interpreted in a blinded fashion for qualitative and quantitative biomarkers, including tumor ADC. RESULTS Mean tumor ADC values did not predict intraoperative consistency or adherence (p = 0.63). Adherent tumors were associated with worse facial nerve outcomes (p = 0.003). Regression tree analysis identified 3 ADC categories with statistically different facial nerve outcomes. The categories identified were ADC < 1006.04 × 10-6 mm2/s; ADC 1006.04-1563.93 × 10-6 mm2/s and ADC ≥ 1563.94 × 10-6 mm2/s. Postoperative and final House-Brackmann (HB) scores were significantly higher in the intermediate ADC group (2.3, p = 0.0038). HB outcomes were similar between the group with ADC < 1006.04 × 10-6 mm2/s and ≥ 1563.94 × 10-6 mm2/s (1.3 vs 1.3). CONCLUSIONS Middle-range preoperative ADC in vestibular schwannoma suggests a less favorable postoperative HB score. Preoperative measurement of ADC in vestibular schwannoma may provide additional information regarding prognostication of facial nerve outcomes.
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Affiliation(s)
- Katherine E Kunigelis
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Patrick Hosokawa
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, USA
| | - Gregory Arnone
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - David Raban
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Adam Starr
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Andrei Gurau
- University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Alexis Sunshine
- University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Jason Bunn
- University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Ashesh A Thaker
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - A Samy Youssef
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
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20
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Mallon D, Dixon L, Campion T, Dawe G, Bhatia K, Kachramanoglou C, Kirmi O. Beyond the brain: Extra-axial pathology on diffusion weighted imaging in neuroimaging. J Neurol Sci 2020; 415:116900. [PMID: 32464349 DOI: 10.1016/j.jns.2020.116900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/30/2020] [Accepted: 05/09/2020] [Indexed: 01/10/2023]
Abstract
Diffusion-weighted imaging (DWI) has a central role in the assessment of the brain parenchyma, particularly in the context of acute stroke. However, the applications of DWI extend far beyond the brain parenchyma and include the assessment of the extra-axial structures of the head and neck that are included in routine brain imaging. In this pictorial review, the added-value of DWI over other conventional sequences is illustrated through discussion of a broad range of disorders affecting the vasculature, skull, orbits, nasal cavity and salivary glands. This article highlights the requirement for all structures, both intra- and extra-axial, to be carefully reviewed on DWI.
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Affiliation(s)
- Dermot Mallon
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
| | - Luke Dixon
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Tom Campion
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Gemma Dawe
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Kunwar Bhatia
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Carolina Kachramanoglou
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Olga Kirmi
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
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21
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Baltzer P, Mann RM, Iima M, Sigmund EE, Clauser P, Gilbert FJ, Martincich L, Partridge SC, Patterson A, Pinker K, Thibault F, Camps-Herrero J, Le Bihan D. Diffusion-weighted imaging of the breast-a consensus and mission statement from the EUSOBI International Breast Diffusion-Weighted Imaging working group. Eur Radiol 2019; 30:1436-1450. [PMID: 31786616 PMCID: PMC7033067 DOI: 10.1007/s00330-019-06510-3] [Citation(s) in RCA: 229] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/03/2019] [Accepted: 10/10/2019] [Indexed: 01/03/2023]
Abstract
The European Society of Breast Radiology (EUSOBI) established an International Breast DWI working group. The working group consists of clinical breast MRI experts, MRI physicists, and representatives from large vendors of MRI equipment, invited based upon proven expertise in breast MRI and/or in particular breast DWI, representing 25 sites from 16 countries. The aims of the working group are (a) to promote the use of breast DWI into clinical practice by issuing consensus statements and initiate collaborative research where appropriate; (b) to define necessary standards and provide practical guidance for clinical application of breast DWI; (c) to develop a standardized and translatable multisite multivendor quality assurance protocol, especially for multisite research studies; (d) to find consensus on optimal methods for image processing/analysis, visualization, and interpretation; and (e) to work collaboratively with system vendors to improve breast DWI sequences. First consensus recommendations, presented in this paper, include acquisition parameters for standard breast DWI sequences including specifications of b values, fat saturation, spatial resolution, and repetition and echo times. To describe lesions in an objective way, levels of diffusion restriction/hindrance in the breast have been defined based on the published literature on breast DWI. The use of a small ROI placed on the darkest part of the lesion on the ADC map, avoiding necrotic, noisy or non-enhancing lesion voxels is currently recommended. The working group emphasizes the need for standardization and quality assurance before ADC thresholds are applied. The working group encourages further research in advanced diffusion techniques and tailored DWI strategies for specific indications. Key Points • The working group considers breast DWI an essential part of a multiparametric breast MRI protocol and encourages its use. • Basic requirements for routine clinical application of breast DWI are provided, including recommendations on b values, fat saturation, spatial resolution, and other sequence parameters. • Diffusion levels in breast lesions are defined based on meta-analysis data and methods to obtain a reliable ADC value are detailed.
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Affiliation(s)
- Pascal Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna/Vienna General Hospital, Wien, Austria
| | - Ritse M Mann
- Department of Radiology, Radboud University Medical Centre, Nijmegen, Netherlands. .,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
| | - Mami Iima
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eric E Sigmund
- Department of Radiology, New York University School of Medicine, NYU Langone Health, Ney York, NY, 10016, USA
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna/Vienna General Hospital, Wien, Austria
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | | | - Savannah C Partridge
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Andrew Patterson
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna/Vienna General Hospital, Wien, Austria.,MSKCC, New York, NY, 10065, USA
| | | | | | - Denis Le Bihan
- NeuroSpin, Frédéric Joliot Institute, Gif Sur Yvette, France
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Brancato V, Cavaliere C, Salvatore M, Monti S. Non-Gaussian models of diffusion weighted imaging for detection and characterization of prostate cancer: a systematic review and meta-analysis. Sci Rep 2019; 9:16837. [PMID: 31728007 PMCID: PMC6856159 DOI: 10.1038/s41598-019-53350-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/28/2019] [Indexed: 12/24/2022] Open
Abstract
The importance of Diffusion Weighted Imaging (DWI) in prostate cancer (PCa) diagnosis have been widely handled in literature. In the last decade, due to the mono-exponential model limitations, several studies investigated non-Gaussian DWI models and their utility in PCa diagnosis. Since their results were often inconsistent and conflicting, we performed a systematic review of studies from 2012 examining the most commonly used Non-Gaussian DWI models for PCa detection and characterization. A meta-analysis was conducted to assess the ability of each Non-Gaussian model to detect PCa lesions and distinguish between low and intermediate/high grade lesions. Weighted mean differences and 95% confidence intervals were calculated and the heterogeneity was estimated using the I2 statistic. 29 studies were selected for the systematic review, whose results showed inconsistence and an unclear idea about the actual usefulness and the added value of the Non-Gaussian model parameters. 12 studies were considered in the meta-analyses, which showed statistical significance for several non-Gaussian parameters for PCa detection, and to a lesser extent for PCa characterization. Our findings showed that Non-Gaussian model parameters may potentially play a role in the detection and characterization of PCa but further studies are required to identify a standardized DWI acquisition protocol for PCa diagnosis.
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23
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Winfield JM, Wakefield JC, Dolling D, Hall M, Freeman S, Brenton JD, Lutchman-Singh K, Pace E, Priest AN, Quest RA, Taylor NJ, Gabra H, McKnight L, Collins DJ, Banerjee S, Hall E, deSouza NM. Diffusion-weighted MRI in Advanced Epithelial Ovarian Cancer: Apparent Diffusion Coefficient as a Response Marker. Radiology 2019; 293:374-383. [PMID: 31573402 DOI: 10.1148/radiol.2019190545] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Treatment of advanced epithelial ovarian cancer results in a relapse rate of 75%. Early markers of response would enable optimization of management and improved outcome in both primary and recurrent disease. Purpose To assess the apparent diffusion coefficient (ADC), derived from diffusion-weighted MRI, as an indicator of response, progression-free survival (PFS), and overall survival. Materials and Methods This prospective multicenter trial (from 2012-2016) recruited participants with stage III or IV ovarian, primary peritoneal, or fallopian tube cancer (newly diagnosed, cohort one; relapsed, cohort two) scheduled for platinum-based chemotherapy, with interval debulking surgery in cohort one. Cohort one underwent two baseline MRI examinations separated by 0-7 days to assess ADC repeatability; an additional MRI was performed after three treatment cycles. Cohort two underwent imaging at baseline and after one and three treatment cycles. ADC changes in responders and nonresponders were compared (Wilcoxon rank sum tests). PFS and overall survival were assessed by using a multivariable Cox model. Results A total of 125 participants (median age, 63.3 years [interquartile range, 57.0-70.7 years]; 125 women; cohort one, n = 47; cohort two, n = 78) were included. Baseline ADC (range, 77-258 × 10-5mm2s-1) was repeatable (upper and lower 95% limits of agreement of 12 × 10-5mm2s-1 [95% confidence interval {CI}: 6 × 10-5mm2s-1 to 18 × 10-5mm2s-1] and -15 × 10-5mm2s-1 [95% CI: -21 × 10-5mm2s-1 to -9 × 10-5mm2s-1]). ADC increased in 47% of cohort two after one treatment cycle, and in 58% and 53% of cohorts one and two, respectively, after three cycles. Percentage change from baseline differed between responders and nonresponders after three cycles (16.6% vs 3.9%; P = .02 [biochemical response definition]; 19.0% vs 6.2%; P = .04 [radiologic definition]). ADC increase after one cycle was associated with longer PFS in cohort two (adjusted hazard ratio, 0.86; 95% CI: 0.75, 0.98; P = .03). ADC change was not indicative of overall survival for either cohort. Conclusion After three cycles of platinum-based chemotherapy, apparent diffusion coefficient (ADC) changes are indicative of response. After one treatment cycle, increased ADC is indicative of improved progression-free survival in relapsed disease. Published under a CC BY 4.0 license. Online supplemental material is available for this article.
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Affiliation(s)
- Jessica M Winfield
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - Jennifer C Wakefield
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - David Dolling
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - Marcia Hall
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - Susan Freeman
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - James D Brenton
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - Kerryn Lutchman-Singh
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - Erika Pace
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - Andrew N Priest
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - Rebecca A Quest
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - N Jane Taylor
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - Hani Gabra
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - Liam McKnight
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - David J Collins
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - Susana Banerjee
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - Emma Hall
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
| | - Nandita M deSouza
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.)
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24
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Blackledge MD, Winfield JM, Miah A, Strauss D, Thway K, Morgan VA, Collins DJ, Koh DM, Leach MO, Messiou C. Supervised Machine-Learning Enables Segmentation and Evaluation of Heterogeneous Post-treatment Changes in Multi-Parametric MRI of Soft-Tissue Sarcoma. Front Oncol 2019; 9:941. [PMID: 31649872 PMCID: PMC6795696 DOI: 10.3389/fonc.2019.00941] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/06/2019] [Indexed: 01/12/2023] Open
Abstract
Background: Multi-parametric MRI provides non-invasive methods for response assessment of soft-tissue sarcoma (STS) from non-surgical treatments. However, evaluation of MRI parameters over the whole tumor volume may not reveal the full extent of post-treatment changes as STS tumors are often highly heterogeneous, including cellular tumor, fat, necrosis, and cystic tissue compartments. In this pilot study, we investigate the use of machine-learning approaches to automatically delineate tissue compartments in STS, and use this approach to monitor post-radiotherapy changes. Methods: Eighteen patients with retroperitoneal sarcoma were imaged using multi-parametric MRI; 8/18 received a follow-up imaging study 2-4 weeks after pre-operative radiotherapy. Eight commonly-used supervised machine-learning techniques were optimized for classifying pixels into one of five tissue sub-types using an exhaustive cross-validation approach and expert-defined regions of interest as a gold standard. Final pixel classification was smoothed using a Markov Random Field (MRF) prior distribution on the final machine-learning models. Findings: 5/8 machine-learning techniques demonstrated high median cross-validation accuracies (82.2%, range 80.5-82.5%) with no significant difference between these five methods. One technique was selected (Naïve-Bayes) due to its relatively short training and class-prediction times (median 0.73 and 0.69 ms, respectively on a 3.5 GHz personal machine). When combined with the MRF-prior, this approach was successfully applied in all eight post-radiotherapy imaging studies and provided visualization and quantification of changes to independent STS sub-regions following radiotherapy for heterogeneous response assessment. Interpretation: Supervised machine-learning approaches to tissue classification in multi-parametric MRI of soft-tissue sarcomas provide quantitative evaluation of heterogeneous tissue changes following radiotherapy.
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Affiliation(s)
- Matthew D. Blackledge
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Jessica M. Winfield
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Aisha Miah
- Sarcoma Unit, Department of Radiotherapy and Physics, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Dirk Strauss
- Department of Surgery, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Khin Thway
- Sarcoma Unit, Department of Radiotherapy and Physics, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Veronica A. Morgan
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - David J. Collins
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Dow-Mu Koh
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Martin O. Leach
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Christina Messiou
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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25
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deSouza NM, Achten E, Alberich-Bayarri A, Bamberg F, Boellaard R, Clément O, Fournier L, Gallagher F, Golay X, Heussel CP, Jackson EF, Manniesing R, Mayerhofer ME, Neri E, O'Connor J, Oguz KK, Persson A, Smits M, van Beek EJR, Zech CJ. Validated imaging biomarkers as decision-making tools in clinical trials and routine practice: current status and recommendations from the EIBALL* subcommittee of the European Society of Radiology (ESR). Insights Imaging 2019; 10:87. [PMID: 31468205 PMCID: PMC6715762 DOI: 10.1186/s13244-019-0764-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/28/2019] [Indexed: 12/12/2022] Open
Abstract
Observer-driven pattern recognition is the standard for interpretation of medical images. To achieve global parity in interpretation, semi-quantitative scoring systems have been developed based on observer assessments; these are widely used in scoring coronary artery disease, the arthritides and neurological conditions and for indicating the likelihood of malignancy. However, in an era of machine learning and artificial intelligence, it is increasingly desirable that we extract quantitative biomarkers from medical images that inform on disease detection, characterisation, monitoring and assessment of response to treatment. Quantitation has the potential to provide objective decision-support tools in the management pathway of patients. Despite this, the quantitative potential of imaging remains under-exploited because of variability of the measurement, lack of harmonised systems for data acquisition and analysis, and crucially, a paucity of evidence on how such quantitation potentially affects clinical decision-making and patient outcome. This article reviews the current evidence for the use of semi-quantitative and quantitative biomarkers in clinical settings at various stages of the disease pathway including diagnosis, staging and prognosis, as well as predicting and detecting treatment response. It critically appraises current practice and sets out recommendations for using imaging objectively to drive patient management decisions.
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Affiliation(s)
- Nandita M deSouza
- Cancer Research UK Imaging Centre, The Institute of Cancer Research and The Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | | | | | - Fabian Bamberg
- Department of Radiology, University of Freiburg, Freiburg im Breisgau, Germany
| | | | | | | | | | | | - Claus Peter Heussel
- Universitätsklinik Heidelberg, Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
| | - Edward F Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rashindra Manniesing
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands
| | | | - Emanuele Neri
- Department of Translational Research, University of Pisa, Pisa, Italy
| | - James O'Connor
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | | | | | - Marion Smits
- Department of Radiology and Nuclear Medicine (Ne-515), Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Edwin J R van Beek
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh Bioquarter, 47 Little France Crescent, Edinburgh, UK
| | - Christoph J Zech
- University Hospital Basel, Radiology and Nuclear Medicine, University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland
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Winfield JM, Miah AB, Strauss D, Thway K, Collins DJ, deSouza NM, Leach MO, Morgan VA, Giles SL, Moskovic E, Hayes A, Smith M, Zaidi SH, Henderson D, Messiou C. Utility of Multi-Parametric Quantitative Magnetic Resonance Imaging for Characterization and Radiotherapy Response Assessment in Soft-Tissue Sarcomas and Correlation With Histopathology. Front Oncol 2019; 9:280. [PMID: 31106141 PMCID: PMC6494941 DOI: 10.3389/fonc.2019.00280] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/27/2019] [Indexed: 02/05/2023] Open
Abstract
Purpose: To evaluate repeatability of quantitative multi-parametric MRI in retroperitoneal sarcomas, assess parameter changes with radiotherapy, and correlate pre-operative values with histopathological findings in the surgical specimens. Materials and Methods: Thirty patients with retroperitoneal sarcoma were imaged at baseline, of whom 27 also underwent a second baseline examination for repeatability assessment. 14/30 patients were treated with pre-operative radiotherapy and were imaged again after completing radiotherapy (50.4 Gy in 28 daily fractions, over 5.5 weeks). The following parameter estimates were assessed in the whole tumor volume at baseline and following radiotherapy: apparent diffusion coefficient (ADC), parameters of the intra-voxel incoherent motion model of diffusion-weighted MRI (D, f, D*), transverse relaxation rate, fat fraction, and enhancing fraction after gadolinium-based contrast injection. Correlation was evaluated between pre-operative quantitative parameters and histopathological assessments of cellularity and fat fraction in post-surgical specimens (ClinicalTrials.gov, registration number NCT01902667). Results: Upper and lower 95% limits of agreement were 7.1 and -6.6%, respectively for median ADC at baseline. Median ADC increased significantly post-radiotherapy. Pre-operative ADC and D were negatively correlated with cellularity (r = -0.42, p = 0.01, 95% confidence interval (CI) -0.22 to -0.59 for ADC; r = -0.45, p = 0.005, 95% CI -0.25 to -0.62 for D), and fat fraction from Dixon MRI showed strong correlation with histopathological assessment of fat fraction (r = 0.79, p = 10-7, 95% CI 0.69-0.86). Conclusion: Fat fraction on MRI corresponded to fat content on histology and therefore contributes to lesion characterization. Measurement repeatability was excellent for ADC; this parameter increased significantly post-radiotherapy even in disease categorized as stable by size criteria, and corresponded to cellularity on histology. ADC can be utilized for characterizing and assessing response in heterogeneous retroperitoneal sarcomas.
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Affiliation(s)
- Jessica M. Winfield
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Aisha B. Miah
- Sarcoma Unit, Department of Radiotherapy and Physics, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Dirk Strauss
- Department of Surgery, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Khin Thway
- Sarcoma Unit, Department of Radiotherapy and Physics, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David J. Collins
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Nandita M. deSouza
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Martin O. Leach
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Veronica A. Morgan
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Sharon L. Giles
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Eleanor Moskovic
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Andrew Hayes
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Surgery, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Myles Smith
- Department of Surgery, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Shane H. Zaidi
- Sarcoma Unit, Department of Radiotherapy and Physics, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Daniel Henderson
- Sarcoma Unit, Department of Radiotherapy and Physics, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Christina Messiou
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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27
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Onodera K, Hatakenaka M, Yama N, Onodera M, Saito T, Kwee TC, Takahara T. Repeatability analysis of ADC histogram metrics of the uterus. Acta Radiol 2019; 60:526-534. [PMID: 29969050 DOI: 10.1177/0284185118786062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recently, histogram analysis based on voxel-wise apparent diffusion coefficient (ADC) value distribution has been increasingly performed. However, few studies have been reported regarding its repeatability. PURPOSE To evaluate the repeatability of ADC histogram metrics of the uterus in clinical magnetic resonance imaging (MRI). MATERIAL AND METHODS Thirty-three female patients who underwent pelvic MRI including diffusion-weighted imaging (DWI) were prospectively included after providing informed consent. Two sequential DWI acquisitions with identical parameters and position were obtained. Regions of interest (ROIs) for histologically confirmed uterine lesions (five cervical and three endometrial cancers, and one endometrial hyperplasia) and normal appearing tissues (21 endometrium and 33 myometrium) were assigned on the first DWI dataset and then pasted onto the second DWI dataset. ADC histogram metrics within the ROIs were calculated and repeatability was evaluated by calculating within-subject coefficient of variance (%) (wCV (%)) and Bland-Altman plot (%). RESULTS ADC 10%, 25%, median, 75%, 90%, maximum, mean, and entropy showed high repeatability (wCV (%) < 7, 95% limit of agreement in Bland-Altman plot (%) < ±20), followed by ADC minimum (wCV (%) = 8.12, 95% limit of agreement in Bland-Altman plot (%) < ±30). However, ADC skewness and kurtosis showed very low repeatability in all evaluations. CONCLUSION ADC histogram metrics like ADC 10%, 25%, median, 75%, 90%, maximum, mean, and entropy are robust biomarkers and could be applicable to clinical use. However, ADC skewness and kurtosis lack robustness. Radiologists should keep these characteristics and limitations in mind when interpreting quantitative DWI.
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Affiliation(s)
- Koichi Onodera
- Department of Diagnostic Radiology, Sapporo Medical University, Sapporo, Japan
| | | | - Naoya Yama
- Department of Diagnostic Radiology, Sapporo Medical University, Sapporo, Japan
| | - Maki Onodera
- Department of Diagnostic Radiology, Sapporo Medical University, Sapporo, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Thomas Christian Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Taro Takahara
- Department of Biomedical Engineering, School of Engineering, Tokai University, Hiratsuka, Japan
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28
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Peerlings J, Woodruff HC, Winfield JM, Ibrahim A, Van Beers BE, Heerschap A, Jackson A, Wildberger JE, Mottaghy FM, DeSouza NM, Lambin P. Stability of radiomics features in apparent diffusion coefficient maps from a multi-centre test-retest trial. Sci Rep 2019; 9:4800. [PMID: 30886309 PMCID: PMC6423042 DOI: 10.1038/s41598-019-41344-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 03/05/2019] [Indexed: 12/16/2022] Open
Abstract
Quantitative radiomics features, extracted from medical images, characterize tumour-phenotypes and have been shown to provide prognostic value in predicting clinical outcomes. Stability of radiomics features extracted from apparent diffusion coefficient (ADC)-maps is essential for reliable correlation with the underlying pathology and its clinical applications. Within a multicentre, multi-vendor trial we established a method to analyse radiomics features from ADC-maps of ovarian (n = 12), lung (n = 19), and colorectal liver metastasis (n = 30) cancer patients who underwent repeated (<7 days) diffusion-weighted imaging at 1.5 T and 3 T. From these ADC-maps, 1322 features describing tumour shape, texture and intensity were retrospectively extracted and stable features were selected using the concordance correlation coefficient (CCC > 0.85). Although some features were tissue- and/or respiratory motion-specific, 122 features were stable for all tumour-entities. A large proportion of features were stable across different vendors and field strengths. By extracting stable phenotypic features, fitting-dimensionality is reduced and reliable prognostic models can be created, paving the way for clinical implementation of ADC-based radiomics.
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Affiliation(s)
- Jurgen Peerlings
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Henry C Woodruff
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
- Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - Jessica M Winfield
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden Hospital, Sutton, UK
| | - Abdalla Ibrahim
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Bernard E Van Beers
- Laboratory of Imaging Biomarkers, UMR 1149 Inserm - University Paris Diderot, Paris; Department of Radiology, Beaujon University Hospital Paris Nord, Clichy, France
| | - Arend Heerschap
- Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Alan Jackson
- Wolfson Imaging Centre, Wolfson Molecular Imaging Centre, University of Manchester, 23 Palatine Rd, Withington, Greater Manchester, UK
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Felix M Mottaghy
- Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Nuclear Medicine, University Hospital RWTH Aachen University, Aachen, Germany
| | - Nandita M DeSouza
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden Hospital, Sutton, UK
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Considering tumour volume for motion corrected DWI of colorectal liver metastases increases sensitivity of ADC to detect treatment-induced changes. Sci Rep 2019; 9:3828. [PMID: 30846790 PMCID: PMC6405765 DOI: 10.1038/s41598-019-40565-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/12/2019] [Indexed: 01/20/2023] Open
Abstract
ADC is a potential post treatment imaging biomarker in colorectal liver metastasis however measurements are affected by respiratory motion. This is compounded by increased statistical uncertainty in ADC measurement with decreasing tumour volume. In this prospective study we applied a retrospective motion correction method to improve the image quality of 15 tumour data sets from 11 patients. We compared repeatability of ADC measurements corrected for motion artefact against non-motion corrected acquisition of the same data set. We then applied an error model that estimated the uncertainty in ADC repeatability measurements therefore taking into consideration tumour volume. Test-retest differences in ADC for each tumour, was scaled to their estimated measurement uncertainty, and 95% confidence limits were calculated, with a null hypothesis that there is no difference between the model distribution and the data. An early post treatment scan (within 7 days of starting treatment) was acquired for 12 tumours from 8 patients. When accounting for both motion artefact and statistical uncertainty due to tumour volumes, the threshold for detecting significant post treatment changes for an individual tumour in this data set, reduced from 30.3% to 1.7% (95% limits of agreement). Applying these constraints, a significant change in ADC (5th and 20th percentiles of the ADC histogram) was observed in 5 patients post treatment. For smaller studies, motion correcting data for small tumour volumes increased statistical efficiency to detect post treatment changes in ADC. Lower percentiles may be more sensitive than mean ADC for colorectal metastases.
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30
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Fraum TJ, Fowler KJ, Crandall JP, Laforest RA, Salter A, An H, Jacobs MA, Grigsby PW, Dehdashti F, Wahl RL. Measurement Repeatability of 18F-FDG PET/CT Versus 18F-FDG PET/MRI in Solid Tumors of the Pelvis. J Nucl Med 2019; 60:1080-1086. [PMID: 30733325 PMCID: PMC6681694 DOI: 10.2967/jnumed.118.218735] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/09/2019] [Indexed: 12/20/2022] Open
Abstract
Knowledge of the within-subject variability of 18F-FDG PET/MRI measurements is necessary for proper interpretation of quantitative PET or MRI metrics in the context of therapeutic efficacy assessments with integrated PET/MRI scanners. The goal of this study was to determine the test–retest repeatability of these metrics on PET/MRI, with comparison to similar metrics acquired by PET/CT. Methods: This prospective study enrolled subjects with pathology-proven pelvic malignancies. Baseline imaging consisted of PET/CT immediately followed by PET/MRI, using a single 370-MBq 18F-FDG dose. Repeat imaging was performed within 7 d using an identical imaging protocol, with no oncologic therapy between sessions. PET imaging on both scanners consisted of a list-mode acquisition at a single pelvic station. The MRI consisted of 2-point Dixon imaging for attenuation correction, standard sequences for anatomic correlation, and diffusion-weighted imaging. PET data were statically reconstructed using various frame durations and minimizing uptake time differences between sessions. SUV metrics were extracted for both PET/CT and PET/MRI in each imaging session. Apparent diffusion coefficient (ADC) metrics were extracted for both PET/MRI sessions. Results: The study cohort consisted of 14 subjects (13 female, 1 male) with various pelvic cancers (11 cervical, 2 rectal, 1 endometrial). For SUVmax, the within-subject coefficient of variation (wCV) appeared higher for PET/CT (8.5%–12.8%) than PET/MRI (6.6%–8.7%) across all PET reconstructions, though with no significant repeatability differences (all P values ≥ 0.08) between modalities. For lean body mass-adjusted SUVpeak, the wCVs appeared similar for PET/CT (9.9%–11.5%) and PET/MRI (9.2%–11.3%) across all PET reconstructions, again with no significant repeatability differences (all P values ≥ 0.14) between modalities. For PET/MRI, the wCV for ADCmedian of 3.5% appeared lower than the wCVs for SUVmax (6.6%–8.7%) and SULpeak (9.2%–11.3%), though without significant repeatability differences (all P values ≥ 0.23). Conclusion: For solid tumors of the pelvis, the repeatability of the evaluated SUV and ADC metrics on 18F-FDG PET/MRI is both acceptably high and similar to previously published values for 18F-FDG PET/CT and MRI, supporting the use of 18F-FDG PET/MRI for quantitative oncologic treatment response assessments.
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Affiliation(s)
- Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - John P Crandall
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Richard A Laforest
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Amber Salter
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Michael A Jacobs
- Russell H. Morgan Department of Radiology and Radiological Science and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri; and.,Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Farrokh Dehdashti
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.,Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.,Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
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deSouza NM. Diffusion-weighted MRI in Multicenter Trials of Breast Cancer: A Useful Measure of Tumor Response? Radiology 2018; 289:628-629. [PMID: 30179102 DOI: 10.1148/radiol.2018181717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Nandita M deSouza
- From the MRI Unit, Cancer Research UK Imaging Centre, The Institute of Cancer Research and Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, England
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32
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Obuchowski NA. Interpreting Change in Quantitative Imaging Biomarkers. Acad Radiol 2018; 25:372-379. [PMID: 29191687 DOI: 10.1016/j.acra.2017.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
Abstract
RATIONALE AND OBJECTIVES Quantitative imaging biomarkers (QIBs) are becoming increasingly adopted into clinical practice to monitor changes in patients' conditions. The repeatability coefficient (RC) is the clinical cut-point used to discern between changes in a biomarker's measurements due to measurement error and changes that exceed measurement error, thus indicating real change in the patient. Imaging biomarkers have characteristics that make them difficult for estimating the repeatability coefficient, including nonconstant error, non-Gaussian distributions, and measurement error that must be estimated from small studies. METHODS We conducted a Monte Carlo simulation study to investigate how well three statistical methods for estimating the repeatability coefficient perform under five settings common for QIBs. RESULTS When the measurement error is constant and replicates are normally distributed, all of the statistical methods perform well. When the measurement error is proportional to the true value, approaches that use the log transformation or coefficient of variation perform similarly. For other common settings, none of the methods for estimating the repeatability coefficient perform adequately. CONCLUSION Many of the common approaches to estimating the repeatability coefficient perform well for only limited scenarios. The optimal approach depends strongly on the pattern of the within-subject variability; thus, a precision profile is critical in evaluating the technical performance of QIBs. Asymmetric bounds for detecting regression vs progression can be implemented and should be used when clinically appropriate.
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Haas RL, Gronchi A, van de Sande MA, Baldini EH, Gelderblom H, Messiou C, Wardelmann E, Le Cesne A. Perioperative Management of Extremity Soft Tissue Sarcomas. J Clin Oncol 2018; 36:118-124. [DOI: 10.1200/jco.2017.74.7527] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Surgery is potentially curative for primary nonmetastatic extremity soft tissue sarcomas. After surgery alone, patients may remain at risk for local recurrences and/or metastatic disease. To reduce the likelihood of a local relapse, the addition of radiotherapy (RT) to limb-sparing surgery may result in higher local control rates of at least 85%. Generally, it can be stated that local control after both preoperative and postoperative RT is comparable, but that preoperative RT comes with a more favorable toxicity profile after prolonged follow-up, albeit at the cost of a higher wound complication rate. Furthermore, recent data suggest that preoperative RT is more cost effective. To reduce the risk of subsequent metastatic disease, systemic chemotherapy can be introduced early during the primary management of these patients. These systemic chemotherapy regimens can also be applied both preoperatively and postoperatively. Finally, with the aim of increasing the antitumor response of perioperative RT, these agents may even be combined with RT, concurrently and sequentially. While designing new preoperative combination regimens, responses should be carefully monitored by both sophisticated radiologic and pathologic evaluations. This article reviews all these aspects, in addition to limb-sparing surgery.
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Affiliation(s)
- Rick L. Haas
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
| | - Alessandro Gronchi
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
| | - Michiel A.J. van de Sande
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
| | - Elizabeth H. Baldini
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
| | - Hans Gelderblom
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
| | - Christina Messiou
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
| | - Eva Wardelmann
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
| | - Axel Le Cesne
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
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Apparent Diffusion Coefficient Values of Prostate Cancer: Comparison of 2D and 3D ROIs. AJR Am J Roentgenol 2018; 210:113-117. [DOI: 10.2214/ajr.17.18495] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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