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Li S, Wei X, Wang L, Zhang G, Jiang L, Zhou X, Huang Q. Dual-source dual-energy CT and deep learning for equivocal lymph nodes on CT images for thyroid cancer. Eur Radiol 2024:10.1007/s00330-024-10854-w. [PMID: 38904758 DOI: 10.1007/s00330-024-10854-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 04/08/2024] [Accepted: 04/23/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVES This study investigated the diagnostic performance of dual-energy computed tomography (CT) and deep learning for the preoperative classification of equivocal lymph nodes (LNs) on CT images in thyroid cancer patients. METHODS In this prospective study, from October 2020 to March 2021, 375 patients with thyroid disease underwent thin-section dual-energy thyroid CT at a small field of view (FOV) and thyroid surgery. The data of 183 patients with 281 LNs were analyzed. The targeted LNs were negative or equivocal on small FOV CT images. Six deep-learning models were used to classify the LNs on conventional CT images. The performance of all models was compared with pathology reports. RESULTS Of the 281 LNs, 65.5% had a short diameter of less than 4 mm. Multiple quantitative dual-energy CT parameters significantly differed between benign and malignant LNs. Multivariable logistic regression analyses showed that the best combination of parameters had an area under the curve (AUC) of 0.857, with excellent consistency and discrimination, and its diagnostic accuracy and sensitivity were 74.4% and 84.2%, respectively (p < 0.001). The visual geometry group 16 (VGG16) based model achieved the best accuracy (86%) and sensitivity (88%) in differentiating between benign and malignant LNs, with an AUC of 0.89. CONCLUSIONS The VGG16 model based on small FOV CT images showed better diagnostic accuracy and sensitivity than the spectral parameter model. Our study presents a noninvasive and convenient imaging biomarker to predict malignant LNs without suspicious CT features in thyroid cancer patients. CLINICAL RELEVANCE STATEMENT Our study presents a deep-learning-based model to predict malignant lymph nodes in thyroid cancer without suspicious features on conventional CT images, which shows better diagnostic accuracy and sensitivity than the regression model based on spectral parameters. KEY POINTS Many cervical lymph nodes (LNs) do not express suspicious features on conventional computed tomography (CT). Dual-energy CT parameters can distinguish between benign and malignant LNs. Visual geometry group 16 model shows superior diagnostic accuracy and sensitivity for malignant LNs.
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Affiliation(s)
- Sheng Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
- Guangdong Esophageal Cancer Institute, Guangzhou, 510060, China
| | - Xiaoting Wei
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518036, China
| | - Li Wang
- School of Artificial Intelligence, Optics and Electronics (iOPEN), Northwestern Polytechnical University, Xi'an, 710072, China
| | - Guizhi Zhang
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518036, China
| | - Linling Jiang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Xuhui Zhou
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518036, China.
| | - Qinghua Huang
- School of Artificial Intelligence, Optics and Electronics (iOPEN), Northwestern Polytechnical University, Xi'an, 710072, China.
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Ren X, Zhang J, Song Z, Li Q, Zhang D, Li X, Yu J, Li Z, Wen Y, Zeng D, Zhang X, Tang Z. Detection of malignant lesions in cytologically indeterminate thyroid nodules using a dual-layer spectral detector CT-clinical nomogram. Front Oncol 2024; 14:1357419. [PMID: 38863637 PMCID: PMC11165073 DOI: 10.3389/fonc.2024.1357419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/02/2024] [Indexed: 06/13/2024] Open
Abstract
Purpose To evaluate the capability of dual-layer detector spectral CT (DLCT) quantitative parameters in conjunction with clinical variables to detect malignant lesions in cytologically indeterminate thyroid nodules (TNs). Materials and methods Data from 107 patients with cytologically indeterminate TNs who underwent DLCT scans were retrospectively reviewed and randomly divided into training and validation sets (7:3 ratio). DLCT quantitative parameters (iodine concentration (IC), NICP (IC nodule/IC thyroid parenchyma), NICA (IC nodule/IC ipsilateral carotid artery), attenuation on the slope of spectral HU curve and effective atomic number), along with clinical variables, were compared between benign and malignant cohorts through univariate analysis. Multivariable logistic regression analysis was employed to identify independent predictors which were used to construct the clinical model, DLCT model, and combined model. A nomogram was formulated based on optimal performing model, and its performance was assessed using receiver operating characteristic curve, calibration curve, and decision curve analysis. The nomogram was subsequently tested in the validation set. Results Independent predictors associated with malignant TNs with indeterminate cytology included NICP in the arterial phase, Hashimoto's Thyroiditis (HT), and BRAF V600E (all p < 0.05). The DLCT-clinical nomogram, incorporating the aforementioned variables, exhibited superior performance than the clinical model or DLCT model in both training set (AUC: 0.875 vs 0.792 vs 0.824) and validation set (AUC: 0.874 vs 0.792 vs 0.779). The DLCT-clinical nomogram demonstrated satisfactory calibration and clinical utility in both training set and validation set. Conclusion The DLCT-clinical nomogram emerges as an effective tool to detect malignant lesions in cytologically indeterminate TNs.
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Affiliation(s)
- Xiaofang Ren
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Jiayan Zhang
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Zuhua Song
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Qian Li
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Dan Zhang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Xiaojiao Li
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Jiayi Yu
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Zongwen Li
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Youjia Wen
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Dan Zeng
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Xiaodi Zhang
- Department of Clinical and Technical Support, Philips Healthcare, Chengdu, China
| | - Zhuoyue Tang
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Radiology, Chongqing General Hospital, Chongqing, China
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Li S, Jiang D, Jiang L, Yan S, Liu L, Ruan G, Zhou X, Zhuo S. Dual-energy computed tomography in a multiparametric regression model for diagnosing lymph node metastases in pancreatic ductal adenocarcinoma. Cancer Imaging 2024; 24:38. [PMID: 38504330 PMCID: PMC10953218 DOI: 10.1186/s40644-024-00687-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/10/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE To investigate the diagnostic value of dual-energy computed tomography (DECT) quantitative parameters in the identification of regional lymph node metastasis in pancreatic ductal adenocarcinoma (PDAC). METHODS This retrospective diagnostic study assessed 145 patients with pathologically confirmed pancreatic ductal adenocarcinoma from August 2016-October 2020. Quantitative parameters for targeted lymph nodes were measured using DECT, and all parameters were compared between benign and metastatic lymph nodes to determine their diagnostic value. A logistic regression model was constructed; the receiver operator characteristics curve was plotted; the area under the curve (AUC) was calculated to evaluate the diagnostic efficacy of each energy DECT parameter; and the DeLong test was used to compare AUC differences. Model evaluation was used for correlation analysis of each DECT parameter. RESULTS Statistical differences in benign and metastatic lymph nodes were found for several parameters. Venous phase iodine density had the highest diagnostic efficacy as a single parameter, with AUC 0.949 [95% confidence interval (CI):0.915-0.972, threshold: 3.95], sensitivity 79.80%, specificity 96.00%, and accuracy 87.44%. Regression models with multiple parameters had the highest diagnostic efficacy, with AUC 0.992 (95% CI: 0.967-0.999), sensitivity 95.96%, specificity 96%, and accuracy 94.97%, which was higher than that for a single DECT parameter, and the difference was statistically significant. CONCLUSION Among all DECT parameters for regional lymph node metastasis in PDAC, venous phase iodine density has the highest diagnostic efficacy as a single parameter, which is convenient for use in clinical settings, whereas a multiparametric regression model has higher diagnostic value compared with the single-parameter model.
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Affiliation(s)
- Sheng Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
| | - Dongping Jiang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
| | - Linling Jiang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
| | - Shumei Yan
- Department of pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
| | - Lizhi Liu
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
| | - Guangying Ruan
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
| | - Xuhui Zhou
- Department of Radiology, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518036, China.
| | - Shuiqing Zhuo
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China.
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Chen M, Jiang Y, Zhou X, Wu D, Xie Q. Dual-Energy Computed Tomography in Detecting and Predicting Lymph Node Metastasis in Malignant Tumor Patients: A Comprehensive Review. Diagnostics (Basel) 2024; 14:377. [PMID: 38396416 PMCID: PMC10888055 DOI: 10.3390/diagnostics14040377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
The accurate and timely assessment of lymph node involvement is paramount in the management of patients with malignant tumors, owing to its direct correlation with cancer staging, therapeutic strategy formulation, and prognostication. Dual-energy computed tomography (DECT), as a burgeoning imaging modality, has shown promising results in the diagnosis and prediction of preoperative metastatic lymph nodes in recent years. This article aims to explore the application of DECT in identifying metastatic lymph nodes (LNs) across various cancer types, including but not limited to thyroid carcinoma (focusing on papillary thyroid carcinoma), lung cancer, and colorectal cancer. Through this narrative review, we aim to elucidate the clinical relevance and utility of DECT in the detection and predictive assessment of lymph node metastasis in malignant tumors, thereby contributing to the broader academic discourse in oncologic radiology and diagnostic precision.
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Affiliation(s)
| | | | | | - Di Wu
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518036, China; (M.C.); (Y.J.); (X.Z.)
| | - Qiuxia Xie
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518036, China; (M.C.); (Y.J.); (X.Z.)
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Geng D, Zhou Y, Shang T, Su GY, Lin SS, Si Y, Wu FY, Xu XQ. Effect of Hashimoto's thyroiditis on the dual-energy CT quantitative parameters and performance in diagnosing metastatic cervical lymph nodes in patients with papillary thyroid cancer. Cancer Imaging 2024; 24:10. [PMID: 38238870 PMCID: PMC10797959 DOI: 10.1186/s40644-024-00655-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND To evaluate the effect of Hashimoto's thyroiditis (HT) on dual-energy computed tomography (DECT) quantitative parameters of cervical lymph nodes (LNs) in patients with papillary thyroid cancer (PTC), and its effect on the diagnostic performance and threshold of DECT in preoperatively identifying metastatic cervical LNs. METHODS A total of 479 LNs from 233 PTC patients were classified into four groups: HT+/LN+, HT+/LN-, HT-/LN + and HT-/LN - group. DECT quantitative parameters including iodine concentration (IC), normalized IC (NIC), effective atomic number (Zeff), and slope of the spectral Hounsfield unit curve (λHU) in the arterial phase (AP) and venous phase were compared. Receiver operating characteristic curve analyses were performed to evaluate DECT parameters' diagnostic performance in differentiating metastatic from nonmetastatic LNs in the HT - and HT + groups. RESULTS The HT+/LN + group exhibited lower values of DECT parameters than the HT-/LN + group (all p < 0.05). Conversely, the HT+/LN - group exhibited higher values of DECT parameters than the HT-/LN - group (all p < 0.05). In the HT + group, if an AP-IC of 1.850 mg/mL was used as the threshold value, then the optimal diagnostic performance (area under the curve, 0.757; sensitivity, 69.4%; specificity, 71.0%) could be obtained. The optimal threshold value of AP-IC in the HT - group was 2.050 mg/mL. In contrast, in the HT - group, AP-NIC demonstrated the highest area under the curve of 0.988, when an optimal threshold of 0.243 was used. The optimal threshold value of AP-NIC was 0.188 in the HT + group. CONCLUSIONS HT affected DECT quantitative parameters of LNs and subsequent the diagnostic thresholds. When using DECT to diagnose metastatic LNs in patients with PTC, whether HT is coexistent should be clarified considering the different diagnostic thresholds.
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Affiliation(s)
- Di Geng
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, PR China
| | - Yan Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, PR China
| | - Ting Shang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, PR China
- Department of Radiology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine, Nanjing, China
| | - Guo-Yi Su
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, PR China
| | | | - Yan Si
- Department of Thyroid Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, PR China.
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, PR China.
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Wei L, Wu Y, Bo J, Fu B, Sun M, Zhang Y, Xiong B, Dong J. Dual-Energy Computed Tomography Parameters Combined With Inflammatory Indicators Predict Cervical Lymph Node Metastasis in Papillary Thyroid Cancer. Cancer Control 2024; 31:10732748241262177. [PMID: 38881040 PMCID: PMC11181884 DOI: 10.1177/10732748241262177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 05/26/2024] [Accepted: 05/30/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Cervical lymph node metastasis (CLNM) is considered a marker of papillar Fethicy thyroid cancer (PTC) progression and has a potential impact on the prognosis of PTC. The purpose of this study was to screen for predictors of CLNM in PTC and to construct a predictive model to guide the surgical approach in patients with PTC. METHODS This is a retrospective study. Preoperative dual-energy computed tomography images of 114 patients with pathologically confirmed PTC between July 2019 and April 2023 were retrospectively analyzed. The dual-energy computed tomography parameters [iodine concentration (IC), normalized iodine concentration (NIC), the slope of energy spectrum curve (λHU)] of the venous stage cancer foci were measured and calculated. The independent influencing factors for predicting CLNM were determined by univariate and multivariate logistic regression analysis, and the prediction models were constructed. The clinical benefits of the model were evaluated using decision curves, calibration curves, and receiver operating characteristic curves. RESULTS The statistical results show that NIC, derived neutrophil-to-lymphocyte ratio (dNLR), prognostic nutritional index (PNI), gender, and tumor diameter were independent predictors of CLNM in PTC. The AUC of the nomogram was .898 (95% CI: .829-.966), and the calibration curve and decision curve showed that the prediction model had good predictive effect and clinical benefit, respectively. CONCLUSION The nomogram constructed based on dual-energy CT parameters and inflammatory prognostic indicators has high clinical value in predicting CLNM in PTC patients.
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Affiliation(s)
- Longyu Wei
- Department of Graduate, Bengbu Medical University, Bengbu, China
| | - Yaoyuan Wu
- Department of Radiology, Anhui Provincial Cancer Hospital, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Juan Bo
- Department of Radiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Baoyue Fu
- Department of Graduate, Bengbu Medical University, Bengbu, China
| | - Mingjie Sun
- Department of Radiology, Wannan Medical College, Wuhu, China
| | - Yu Zhang
- Department of Radiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Baizhu Xiong
- Department of Graduate, Bengbu Medical University, Bengbu, China
| | - Jiangning Dong
- Department of Graduate, Bengbu Medical University, Bengbu, China
- Department of Radiology, Anhui Provincial Cancer Hospital, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
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Chen W, Lin G, Cheng F, Kong C, Li X, Zhong Y, Hu Y, Su Y, Weng Q, Chen M, Xia S, Lu C, Xu M, Ji J. Development and Validation of a Dual-Energy CT-Based Model for Predicting the Number of Central Lymph Node Metastases in Clinically Node-Negative Papillary Thyroid Carcinoma. Acad Radiol 2024; 31:142-156. [PMID: 37280128 DOI: 10.1016/j.acra.2023.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 06/08/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to develop and validate a dual-energy CT (DECT)-based model for preoperative prediction of the number of central lymph node metastases (CLNMs) in clinically node-negative (cN0) papillary thyroid carcinoma (PTC) patients. MATERIALS AND METHODS Between January 2016 and January 2021, 490 patients who underwent lobectomy or thyroidectomy, CLN dissection, and preoperative DECT examinations were enrolled and randomly allocated into the training (N = 345) and validation cohorts (N = 145). The patients' clinical characteristics and quantitative DECT parameters obtained on primary tumors were collected. Independent predictors of> 5 CLNMs were identified and integrated to construct a DECT-based prediction model, for which the area under the curve (AUC), calibration, and clinical usefulness were assessed. Risk group stratification was performed to distinguish patients with different recurrence risks. RESULTS More than 5 CLNMs were found in 75 (15.3%) cN0 PTC patients. Age, tumor size, normalized iodine concentration (NIC), normalized effective atomic number (nZeff) and the slope of the spectral Hounsfield unit curve (λHu) in the arterial phase were independently associated with> 5 CLNMs. The DECT-based nomogram that incorporated predictors demonstrated favorable performance in both cohorts (AUC: 0.842 and 0.848) and significantly outperformed the clinical model (AUC: 0.688 and 0.694). The nomogram showed good calibration and added clinical benefit for predicting> 5 CLNMs. The KaplanMeier curves for recurrence-free survival showed that the high- and low-risk groups stratified by the nomogram were significantly different. CONCLUSION The nomogram based on DECT parameters and clinical factors could facilitate preoperative prediction of the number of CLNMs in cN0 PTC patients.
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Affiliation(s)
- Weiyue Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, School of Medcine, Lishui University, Lishui 323000, China; Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China
| | - Guihan Lin
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, School of Medcine, Lishui University, Lishui 323000, China; Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China
| | - Feng Cheng
- Department of Head and Neck Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China
| | - Chunli Kong
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, School of Medcine, Lishui University, Lishui 323000, China; Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China
| | - Xia Li
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, School of Medcine, Lishui University, Lishui 323000, China; Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China
| | - Yi Zhong
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, School of Medcine, Lishui University, Lishui 323000, China; Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China
| | - Yumin Hu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, School of Medcine, Lishui University, Lishui 323000, China; Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China
| | - Yanping Su
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, School of Medcine, Lishui University, Lishui 323000, China; Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China
| | - Qiaoyou Weng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, School of Medcine, Lishui University, Lishui 323000, China; Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China
| | - Minjiang Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, School of Medcine, Lishui University, Lishui 323000, China; Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China
| | - Shuiwei Xia
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, School of Medcine, Lishui University, Lishui 323000, China; Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China
| | - Chenying Lu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, School of Medcine, Lishui University, Lishui 323000, China; Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China
| | - Min Xu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, School of Medcine, Lishui University, Lishui 323000, China; Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China
| | - Jiansong Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, School of Medcine, Lishui University, Lishui 323000, China; Institute of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China.
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Xu H, Wu W, Zhao Y, Liu Z, Bao D, Li L, Lin M, Zhang Y, Zhao X, Luo D. Analysis of preoperative computed tomography radiomics and clinical factors for predicting postsurgical recurrence of papillary thyroid carcinoma. Cancer Imaging 2023; 23:118. [PMID: 38098119 PMCID: PMC10722708 DOI: 10.1186/s40644-023-00629-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/19/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Postsurgical recurrence is of great concern for papillary thyroid carcinoma (PTC). We aim to investigate the value of computed tomography (CT)-based radiomics features and conventional clinical factors in predicting the recurrence of PTC. METHODS Two-hundred and eighty patients with PTC were retrospectively enrolled and divided into training and validation cohorts at a 6:4 ratio. Recurrence was defined as cytology/pathology-proven disease or morphological evidence of lesions on imaging examinations within 5 years after surgery. Radiomics features were extracted from manually segmented tumor on CT images and were then selected using four different feature selection methods sequentially. Multivariate logistic regression analysis was conducted to identify clinical features associated with recurrence. Radiomics, clinical, and combined models were constructed separately using logistic regression (LR), support vector machine (SVM), k-nearest neighbor (KNN), and neural network (NN), respectively. Receiver operating characteristic analysis was performed to evaluate the model performance in predicting recurrence. A nomogram was established based on all relevant features, with its reliability and reproducibility verified using calibration curves and decision curve analysis (DCA). RESULTS Eighty-nine patients with PTC experienced recurrence. A total of 1218 radiomics features were extracted from each segmentation. Five radiomics and six clinical features were related to recurrence. Among the 4 radiomics models, the LR-based and SVM-based radiomics models outperformed the NN-based radiomics model (P = 0.032 and 0.026, respectively). Among the 4 clinical models, only the difference between the area under the curve (AUC) of the LR-based and NN-based clinical model was statistically significant (P = 0.035). The combined models had higher AUCs than the corresponding radiomics and clinical models based on the same classifier, although most differences were not statistically significant. In the validation cohort, the combined models based on the LR, SVM, KNN, and NN classifiers had AUCs of 0.746, 0.754, 0.669, and 0.711, respectively. However, the AUCs of these combined models had no significant differences (all P > 0.05). Calibration curves and DCA indicated that the nomogram have potential clinical utility. CONCLUSIONS The combined model may have potential for better prediction of PTC recurrence than radiomics and clinical models alone. Further testing with larger cohort may help reach statistical significance.
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Affiliation(s)
- Haijun Xu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wenli Wu
- Medical Imaging Center, Liaocheng Tumor Hospital, Liaocheng, 252000, China
| | - Yanfeng Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Zhou Liu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Dan Bao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lin Li
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Meng Lin
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ya Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Xinming Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dehong Luo
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
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9
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Roh YH, Chung SR, Baek JH, Choi YJ, Sung TY, Song DE, Kim TY, Lee JH. Validation of CT-Based Risk Stratification System for Lymph Node Metastasis in Patients With Thyroid Cancer. Korean J Radiol 2023; 24:1028-1037. [PMID: 37793671 PMCID: PMC10550739 DOI: 10.3348/kjr.2023.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE To evaluate the computed tomography (CT) features for diagnosing metastatic cervical lymph nodes (LNs) in patients with differentiated thyroid cancer (DTC) and validate the CT-based risk stratification system suggested by the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) guidelines. MATERIALS AND METHODS A total of 463 LNs from 399 patients with DTC who underwent preoperative CT staging and ultrasound-guided fine-needle aspiration were included. The following CT features for each LN were evaluated: absence of hilum, cystic changes, calcification, strong enhancement, and heterogeneous enhancement. Multivariable logistic regression analysis was performed to identify independent CT features associated with metastatic LNs, and their diagnostic performances were evaluated. LNs were classified into probably benign, indeterminate, and suspicious categories according to the K-TIRADS and the modified LN classification proposed in our study. The diagnostic performance of both classification systems was compared using the exact McNemar and Kosinski tests. RESULTS The absence of hilum (odds ratio [OR], 4.859; 95% confidence interval [CI], 1.593-14.823; P = 0.005), strong enhancement (OR, 28.755; 95% CI, 12.719-65.007; P < 0.001), and cystic changes (OR, 46.157; 95% CI, 5.07-420.234; P = 0.001) were independently associated with metastatic LNs. All LNs showing calcification were diagnosed as metastases. Heterogeneous enhancement did not show a significant independent association with metastatic LNs. Strong enhancement, calcification, and cystic changes showed moderate to high specificity (70.1%-100%) and positive predictive value (PPV) (91.8%-100%). The absence of the hilum showed high sensitivity (97.8%) but low specificity (34.0%). The modified LN classification, which excluded heterogeneous enhancement from the K-TIRADS, demonstrated higher specificity (70.1% vs. 62.9%, P = 0.016) and PPV (92.5% vs. 90.9%, P = 0.011) than the K-TIRADS. CONCLUSION Excluding heterogeneous enhancement as a suspicious feature resulted in a higher specificity and PPV for diagnosing metastatic LNs than the K-TIRADS. Our research results may provide a basis for revising the LN classification in future guidelines.
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Affiliation(s)
- Yun Hwa Roh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae Yong Kim
- Department of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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10
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Toshima F, Yoneda N, Terada K, Inoue D, Gabata T. DECT Numbers in Upper Abdominal Organs for Differential Diagnosis: A Feasibility Study. Tomography 2022; 8:2698-2708. [PMID: 36412684 PMCID: PMC9680450 DOI: 10.3390/tomography8060225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
Abstract
Evaluating the similarity between two entities such as primary and suspected metastatic lesions using quantitative dual-energy computed tomography (DECT) numbers may be useful. However, the criteria for the similarity between two entities based on DECT numbers remain unclear. We therefore considered the possibility that a similarity in DECT numbers within the same organ could provide suitable standards. Thus, we assumed that the variation in DECT numbers within a single organ is sufficiently minimal to be considered clinically equivalent. Therefore, the purpose of this preliminary study is to investigate the differences in DECT numbers within upper abdominal organs. This retrospective study included 30 patients with data from hepatic protocol DECT scans. DECT numbers of the following parameters were collected: (a, b) 70 and 40 keV CT values, (c) slope, (d) effective Z, and (e, f) iodine and water concentration. The agreement of DECT numbers obtained from two regions of interest in the same organ (liver, spleen, and kidney) were assessed using Bland-Altman analysis. The diagnostic ability of each DECT parameter to distinguish between the same or different organs was also assessed using receiver operating characteristic analysis. The 95% limits of agreement within the same organ exhibited the narrowest value range on delayed phase (DP) CT [(c) -11.2-8.3%, (d) -2.0-1.5%, (e) -11.3-8.4%, and (f) -0.59-0.62%]. The diagnostic ability was notably high when using differences in DECT numbers on portal venous (PVP) and DP images (the area under the curve of DP: 0.987-0.999 in (c)-(f)). Using the variability in DECT numbers in the same organ as a criterion for defining similarity may be helpful in making a differential diagnosis by comparing the DECT numbers of two entities.
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11
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Diagnosing cervical lymph node metastasis in oral squamous cell carcinoma based on third-generation dual-source, dual-energy computed tomography. Eur Radiol 2022; 33:162-171. [PMID: 36070090 DOI: 10.1007/s00330-022-09033-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/12/2022] [Accepted: 07/14/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the potential of dual-energy computed tomography (DECT) parameters in identifying metastatic cervical lymph nodes in oral squamous cell carcinoma (OSCC) patients and to explore the relationships between DECT and pathological features. METHODS Clinical and DECT data were collected from patients who underwent radical resection of OSCC and cervical lymph node dissection between November 2019 and June 2021. Microvascular density was assessed using the Weidner counting method. The electron density (ED) and effective atomic number (Zeff) in non - contrast phase and iodine concentration (IC), normalized IC, slope of the energy spectrum curve (λHU), and dual-energy index (DEI) in parenchymal phase were compared between metastatic and non - metastatic lymph nodes. Student's t-test, Pearson's rank correlation, and receiver operating characteristic curves were performed. RESULTS The inclusion criteria were met in 399 lymph nodes from 103 patients. Metastatic nodes (n = 158) displayed significantly decreased ED, IC, normalized IC, λHU, and DEI values compared with non-metastatic nodes (n = 241) (all p < 0.01). Strong correlations were found between IC (r = 0.776), normalized IC (r = 0.779), λHU (r = 0.738), DEI (r = 0.734), and microvascular density. Area under the curve (AUC) for normalized IC performed the highest (0.875) in diagnosing metastatic nodes. When combined with the width of nodes, AUC increased to 0.918. CONCLUSION DECT parameters IC, normalized IC, λHU, and DEI reflect pathologic changes in lymph nodes to a certain extent, and aid for detection of metastatic cervical lymph nodes from OSCC. KEY POINTS • Electron density, iodine concentration, normalized iodine concentration, λHU, and dual-energy index values showed significant differences between metastatic and non-metastatic nodes. • Strong correlations were found between iodine concentration, normalized iodine concentration, slope of the spectral Hounsfield unit curve, dual-energy index, and microvascular density. • DECT qualitative parameters reflect the pathologic changes in lymph nodes to a certain extent, and aid for the detection of metastatic cervical lymph nodes from oral squamous cell carcinoma.
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Jin D, Ni X, Zhang X, Yin H, Zhang H, Xu L, Wang R, Fan G. Multiphase Dual-Energy Spectral CT-Based Deep Learning Method for the Noninvasive Prediction of Head and Neck Lymph Nodes Metastasis in Patients With Papillary Thyroid Cancer. Front Oncol 2022; 12:869895. [PMID: 35515110 PMCID: PMC9065438 DOI: 10.3389/fonc.2022.869895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/21/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose To develop deep learning (DL) models based on multiphase dual-energy spectral CT for predicting lymph nodes metastasis preoperatively and noninvasively in papillary thyroid cancer patients. Methods A total of 293 lymph nodes from 78 papillary thyroid cancer patients who underwent dual-energy spectral CT before lymphadenectomy were enrolled in this retrospective study. The lymph nodes were randomly divided into a development set and an independent testing set following a 4:1 ratio. Four single-modality DL models based on CT-A model, CT-V model, Iodine-A model and Iodine-V model and a multichannel DL model incorporating all modalities (Combined model) were proposed for the prediction of lymph nodes metastasis. A CT-feature model was also built on the selected CT image features. The model performance was evaluated with respect to discrimination, calibration and clinical usefulness. In addition, the diagnostic performance of the Combined model was also compared with four radiologists in the independent test set. Results The AUCs of the CT-A, CT-V, Iodine-A, Iodine-V and CT-feature models were 0.865, 0.849, 0.791, 0.785 and 0.746 in the development set and 0.830, 0.822, 0.744, 0.739 and 0.732 in the testing set. The Combined model had outperformed the other models and achieved the best performance with AUCs yielding 0.890 in the development set and 0.865 in the independent testing set. The Combined model showed good calibration, and the decision curve analysis demonstrated that the net benefit of the Combined model was higher than that of the other models across the majority of threshold probabilities. The Combined model also showed noninferior diagnostic capability compared with the senior radiologists and significantly outperformed the junior radiologists, and the interobserver agreement of junior radiologists was also improved after artificial intelligence assistance. Conclusion The Combined model integrating both CT images and iodine maps of the arterial and venous phases showed good performance in predicting lymph nodes metastasis in papillary thyroid cancer patients, which could facilitate clinical decision-making.
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Affiliation(s)
- Dan Jin
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoqiong Ni
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaodong Zhang
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongkun Yin
- Department of Advanced Research, Infervision Medical Technology Co., Ltd, Beijing, China
| | - Huiling Zhang
- Department of Advanced Research, Infervision Medical Technology Co., Ltd, Beijing, China
| | - Liang Xu
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rui Wang
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Guohua Fan
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China
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