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Keaveney S, Hopkinson G, Markus JE, Priest AN, Scurr E, Hughes J, Robertson S, Doran SJ, Collins DJ, Messiou C, Koh DM, Winfield JM. A scan-specific quality control acquisition for clinical whole-body (WB) MRI protocols. Phys Med Biol 2024. [PMID: 38648786 DOI: 10.1088/1361-6560/ad4195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Image quality in whole-body MRI (WB-MRI) may be degraded by faulty radiofrequency (RF) coil elements or mispositioning of the coil arrays. Phantom-based quality control (QC) is used to identify broken RF coil elements but the frequency of these acquisitions is limited by scanner and staff availability. This work aimed to develop a scan-specific QC acquisition and processing pipeline to detect broken RF coil elements, which is sufficiently rapid to be added to the clinical WB-MRI protocol. The purpose of this is to improve the quality of WB-MRI by reducing the number of patient examinations conducted with suboptimal equipment.
Approach: A rapid acquisition (14 seconds additional acquisition time per imaging station) was developed that identifies broken RF coil elements by acquiring images from each individual coil element and using the integral body coil. This acquisition was added to one centre's clinical WB-MRI protocol for one year (892 examinations) to evaluate the effect of this scan-specific QC. To demonstrate applicability in multi-centre imaging trials, the technique was also implemented on scanners from three manufacturers.
Main Results: Over the course of the study RF coil elements were flagged as potentially broken on five occasions, with the faults confirmed in four of those cases. The method had a precision of 80 % and a recall of 100 % for detecting faulty RF coil elements. The coil array positioning measurements were consistent across scanners and have been used to define the expected variation in signal.
Significance: The technique demonstrated here can identify faulty RF coil elements and positioning errors and is a practical addition to the clinical WB-MRI protocol. This approach was fully implemented on systems from three manufacturers and partially implemented on a third. It has potential to reduce the number of clinical examinations conducted with suboptimal hardware and improve image quality across multi-centre studies.
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Affiliation(s)
- Sam Keaveney
- MRI Unit, Royal Marsden Hospital NHS Trust, Royal Marsden Hospital, Sutton, SM2 5PT, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Georgina Hopkinson
- MRI Unit, Royal Marsden Hospital NHS Trust, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Julia E Markus
- Centre for Medical Imaging, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Andrew N Priest
- Department of Imaging, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, CB2 0QQ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Erica Scurr
- MRI Physics, Royal Marsden Hospital NHS Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Julie Hughes
- MRI Unit, Royal Marsden Hospital NHS Trust, Royal Marsden Hospital, Sutton, SM2 5PT, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Scott Robertson
- MRI Unit, Royal Marsden Hospital NHS Trust, Royal Marsden Hospital, Sutton, SM2 5PT, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Simon J Doran
- Institute of Cancer Research Division of Radiotherapy and Imaging, Institute of Cancer Research, London, London, SW7 3RP, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - David J Collins
- Institute of Cancer Research Division of Radiotherapy and Imaging, Institute of Cancer Research, London, London, SW7 3RP, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Christina Messiou
- MRI Unit, Royal Marsden Hospital NHS Trust, Royal Marsden Hospital, Sutton, London, SM2 5PT, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Dow-Mu Koh
- MRI Unit, Royal Marsden Hospital NHS Trust, Royal Marsden Hospital, Sutton, SM2 5PT, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Jessica M Winfield
- MRI Unit, Royal Marsden Hospital NHS Trust, Royal Marsden Hospital, Sutton, SM2 5PT, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
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2
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Rata M, De Paepe KN, Orton MR, Castagnoli F, d'Arcy J, Winfield JM, Hughes J, Stemmer A, Nickel MD, Koh DM. Evaluation of simultaneous multi-slice acquisition with advanced processing for free-breathing diffusion-weighted imaging in patients with liver metastasis. Eur Radiol 2024; 34:2457-2467. [PMID: 37776361 PMCID: PMC10957610 DOI: 10.1007/s00330-023-10234-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES Diffusion-weighted imaging (DWI) with simultaneous multi-slice (SMS) acquisition and advanced processing can accelerate acquisition time and improve MR image quality. This study evaluated the image quality and apparent diffusion coefficient (ADC) measurements of free-breathing DWI acquired from patients with liver metastases using a prototype SMS-DWI acquisition (with/without an advanced processing option) and conventional DWI. METHODS Four DWI schemes were compared in a pilot 5-patient cohort; three DWI schemes were further assessed in a 24-patient cohort. Two readers scored image quality of all b-value images and ADC maps across the three methods. ADC measurements were performed, for all three methods, in left and right liver parenchyma, spleen, and liver metastases. The Friedman non-parametric test (post-hoc Wilcoxon test with Bonferroni correction) was used to compare image quality scoring; t-test was used for ADC comparisons. RESULTS SMS-DWI was faster (by 24%) than conventional DWI. Both readers scored the SMS-DWI with advanced processing as having the best image quality for highest b-value images (b750) and ADC maps; Cohen's kappa inter-reader agreement was 0.6 for b750 image and 0.56 for ADC maps. The prototype SMS-DWI sequence with advanced processing allowed a better visualization of the left lobe of the liver. ADC measured in liver parenchyma, spleen, and liver metastases using the SMS-DWI with advanced processing option showed lower values than those derived from the SMS-DWI method alone (t-test, p < 0.0001; p < 0.0001; p = 0.002). CONCLUSIONS Free-breathing SMS-DWI with advanced processing was faster and demonstrated better image quality versus a conventional DWI protocol in liver patients. CLINICAL RELEVANCE STATEMENT Free-breathing simultaneous multi-slice- diffusion-weighted imaging (DWI) with advanced processing was faster and demonstrated better image quality versus a conventional DWI protocol in liver patients. KEY POINTS • Diffusion-weighted imaging (DWI) with simultaneous multi-slice (SMS) can accelerate acquisition time and improve image quality. • Apparent diffusion coefficients (ADC) measured in liver parenchyma, spleen, and liver metastases using the simultaneous multi-slice DWI with advanced processing were significantly lower than those derived from the simultaneous multi-slice DWI method alone. • Simultaneous multi-slice DWI sequence with inline advanced processing was faster and demonstrated better image quality in liver patients.
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Affiliation(s)
- Mihaela Rata
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK.
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
| | - Katja N De Paepe
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Matthew R Orton
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Francesca Castagnoli
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - James d'Arcy
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Jessica M Winfield
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Julie Hughes
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Alto Stemmer
- Siemens Healthcare GmbH, MR Application Predevelopment, Erlangen, Germany
| | | | - Dow-Mu Koh
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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Doran SJ, Barfoot T, Wedlake L, Winfield JM, Petts J, Glocker B, Li X, Leach M, Kaiser M, Barwick TD, Chaidos A, Satchwell L, Soneji N, Elgendy K, Sheeka A, Wallitt K, Koh DM, Messiou C, Rockall A. Curation of myeloma observational study MALIMAR using XNAT: solving the challenges posed by real-world data. Insights Imaging 2024; 15:47. [PMID: 38361108 PMCID: PMC10869673 DOI: 10.1186/s13244-023-01591-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/06/2023] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVES MAchine Learning In MyelomA Response (MALIMAR) is an observational clinical study combining "real-world" and clinical trial data, both retrospective and prospective. Images were acquired on three MRI scanners over a 10-year window at two institutions, leading to a need for extensive curation. METHODS Curation involved image aggregation, pseudonymisation, allocation between project phases, data cleaning, upload to an XNAT repository visible from multiple sites, annotation, incorporation of machine learning research outputs and quality assurance using programmatic methods. RESULTS A total of 796 whole-body MR imaging sessions from 462 subjects were curated. A major change in scan protocol part way through the retrospective window meant that approximately 30% of available imaging sessions had properties that differed significantly from the remainder of the data. Issues were found with a vendor-supplied clinical algorithm for "composing" whole-body images from multiple imaging stations. Historic weaknesses in a digital video disk (DVD) research archive (already addressed by the mid-2010s) were highlighted by incomplete datasets, some of which could not be completely recovered. The final dataset contained 736 imaging sessions for 432 subjects. Software was written to clean and harmonise data. Implications for the subsequent machine learning activity are considered. CONCLUSIONS MALIMAR exemplifies the vital role that curation plays in machine learning studies that use real-world data. A research repository such as XNAT facilitates day-to-day management, ensures robustness and consistency and enhances the value of the final dataset. The types of process described here will be vital for future large-scale multi-institutional and multi-national imaging projects. CRITICAL RELEVANCE STATEMENT This article showcases innovative data curation methods using a state-of-the-art image repository platform; such tools will be vital for managing the large multi-institutional datasets required to train and validate generalisable ML algorithms and future foundation models in medical imaging. KEY POINTS • Heterogeneous data in the MALIMAR study required the development of novel curation strategies. • Correction of multiple problems affecting the real-world data was successful, but implications for machine learning are still being evaluated. • Modern image repositories have rich application programming interfaces enabling data enrichment and programmatic QA, making them much more than simple "image marts".
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Affiliation(s)
- Simon J Doran
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
- National Cancer Imaging Translational Accelerator, London, UK.
| | - Theo Barfoot
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Jessica M Winfield
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust, London, UK
| | - James Petts
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Ben Glocker
- Department of Computing, Imperial College London, London, UK
| | - Xingfeng Li
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Martin Leach
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust, London, UK
| | - Martin Kaiser
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Haemato-Oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Tara D Barwick
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Aristeidis Chaidos
- Department of Haematology, Imperial College Healthcare NHS Trust, London, UK
| | - Laura Satchwell
- Research and Development Statistics Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Neil Soneji
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Khalil Elgendy
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Alexander Sheeka
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Kathryn Wallitt
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Dow-Mu Koh
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- National Cancer Imaging Translational Accelerator, London, UK
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Christina Messiou
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Andrea Rockall
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
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Kalantar R, Curcean S, Winfield JM, Lin G, Messiou C, Blackledge MD, Koh DM. Deep Learning Framework with Multi-Head Dilated Encoders for Enhanced Segmentation of Cervical Cancer on Multiparametric Magnetic Resonance Imaging. Diagnostics (Basel) 2023; 13:3381. [PMID: 37958277 PMCID: PMC10647438 DOI: 10.3390/diagnostics13213381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
T2-weighted magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) are essential components of cervical cancer diagnosis. However, combining these channels for the training of deep learning models is challenging due to image misalignment. Here, we propose a novel multi-head framework that uses dilated convolutions and shared residual connections for the separate encoding of multiparametric MRI images. We employ a residual U-Net model as a baseline, and perform a series of architectural experiments to evaluate the tumor segmentation performance based on multiparametric input channels and different feature encoding configurations. All experiments were performed on a cohort of 207 patients with locally advanced cervical cancer. Our proposed multi-head model using separate dilated encoding for T2W MRI and combined b1000 DWI and apparent diffusion coefficient (ADC) maps achieved the best median Dice similarity coefficient (DSC) score, 0.823 (confidence interval (CI), 0.595-0.797), outperforming the conventional multi-channel model, DSC 0.788 (95% CI, 0.568-0.776), although the difference was not statistically significant (p > 0.05). We investigated channel sensitivity using 3D GRAD-CAM and channel dropout, and highlighted the critical importance of T2W and ADC channels for accurate tumor segmentation. However, our results showed that b1000 DWI had a minor impact on the overall segmentation performance. We demonstrated that the use of separate dilated feature extractors and independent contextual learning improved the model's ability to reduce the boundary effects and distortion of DWI, leading to improved segmentation performance. Our findings could have significant implications for the development of robust and generalizable models that can extend to other multi-modal segmentation applications.
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Affiliation(s)
- Reza Kalantar
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK; (R.K.); (J.M.W.); (C.M.); (D.-M.K.)
- Department of Radiology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Sebastian Curcean
- Department of Radiation Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania;
| | - Jessica M. Winfield
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK; (R.K.); (J.M.W.); (C.M.); (D.-M.K.)
- Department of Radiology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Guishan, Taoyuan 333, Taiwan;
| | - Christina Messiou
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK; (R.K.); (J.M.W.); (C.M.); (D.-M.K.)
- Department of Radiology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Matthew D. Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK; (R.K.); (J.M.W.); (C.M.); (D.-M.K.)
- Department of Radiology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Dow-Mu Koh
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK; (R.K.); (J.M.W.); (C.M.); (D.-M.K.)
- Department of Radiology, The Royal Marsden Hospital, London SW3 6JJ, UK
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5
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Keaveney S, Dragan A, Rata M, Blackledge M, Scurr E, Winfield JM, Shur J, Koh DM, Porta N, Candito A, King A, Rennie W, Gaba S, Suresh P, Malcolm P, Davis A, Nilak A, Shah A, Gandhi S, Albrizio M, Drury A, Pratt G, Cook G, Roberts S, Jenner M, Brown S, Kaiser M, Messiou C. Image quality in whole-body MRI using the MY-RADS protocol in a prospective multi-centre multiple myeloma study. Insights Imaging 2023; 14:170. [PMID: 37840055 PMCID: PMC10577121 DOI: 10.1186/s13244-023-01498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/08/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND The Myeloma Response Assessment and Diagnosis System (MY-RADS) guidelines establish a standardised acquisition and analysis pipeline for whole-body MRI (WB-MRI) in patients with myeloma. This is the first study to assess image quality in a multi-centre prospective trial using MY-RADS. METHODS The cohort consisted of 121 examinations acquired across ten sites with a range of prior WB-MRI experience, three scanner manufacturers and two field strengths. Image quality was evaluated qualitatively by a radiologist and quantitatively using a semi-automated pipeline to quantify common artefacts and image quality issues. The intra- and inter-rater repeatability of qualitative and quantitative scoring was also assessed. RESULTS Qualitative radiological scoring found that the image quality was generally good, with 94% of examinations rated as good or excellent and only one examination rated as non-diagnostic. There was a significant correlation between radiological and quantitative scoring for most measures, and intra- and inter-rater repeatability were generally good. When the quality of an overall examination was low, this was often due to low quality diffusion-weighted imaging (DWI), where signal to noise ratio (SNR), anterior thoracic signal loss and brain geometric distortion were found as significant predictors of examination quality. CONCLUSIONS It is possible to successfully deliver a multi-centre WB-MRI study using the MY-RADS protocol involving scanners with a range of manufacturers, models and field strengths. Quantitative measures of image quality were developed and shown to be significantly correlated with radiological assessment. The SNR of DW images was identified as a significant factor affecting overall examination quality. TRIAL REGISTRATION ClinicalTrials.gov, NCT03188172 , Registered on 15 June 2017. CRITICAL RELEVANCE STATEMENT Good overall image quality, assessed both qualitatively and quantitatively, can be achieved in a multi-centre whole-body MRI study using the MY-RADS guidelines. KEY POINTS • A prospective multi-centre WB-MRI study using MY-RADS can be successfully delivered. • Quantitative image quality metrics were developed and correlated with radiological assessment. • SNR in DWI was identified as a significant predictor of quality, allowing for rapid quality adjustment.
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Affiliation(s)
- Sam Keaveney
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK.
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
| | - Alina Dragan
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Mihaela Rata
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Matthew Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Erica Scurr
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Jessica M Winfield
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Joshua Shur
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Dow-Mu Koh
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Nuria Porta
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Antonio Candito
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Alexander King
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Winston Rennie
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Suchi Gaba
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Priya Suresh
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Paul Malcolm
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Amy Davis
- Epsom & St. Helier University Hospitals NHS Trust, Epsom, UK
| | | | - Aarti Shah
- Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | | | - Mauro Albrizio
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Arnold Drury
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gordon Cook
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sadie Roberts
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Matthew Jenner
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Martin Kaiser
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Christina Messiou
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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6
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Kalantar R, Ingle M, Winfield JM, Messiou C, Lalondrelle S, Koh DM, Blackledge M. Synthetic MRI-Assisted and Self-Supervised Adaptive Segmentation of Organs-at-Risk (OARs) in MRI-Based Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:S116. [PMID: 37784302 DOI: 10.1016/j.ijrobp.2023.06.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) This study proposes a self-supervised solution for OAR segmentation, combining patch-based adaptation and unsupervised synthesis of T2-weighted MRI data to finetune the segmentation model. The aim is to improve adaptation to patient anatomy, overcome limited annotated MRI data, and enhance the generalizability of automatic segmentation models for gynecological cancers. MATERIALS/METHODS The study used a patch-based cycle consistent generative adversarial network (cycle-GAN) for unsupervised MRI synthesis from CT scans of 20 patients, and a residual U-Net model for OARs segmentation. The segmentation model was trained and validated on synthetic MRI (sMRI) of 103 and 25 patient scans respectively, then finetuned on 78 MRI scans from radiation therapy fractions of 15 additional patients through three-fold cross validation. Self-supervised adaptation was applied, incorporating affine and elastic deformations, intensity shifting, and scaling. The model was trained on 96 × 96 × 96 sub-volumes and validated on entire pelvic sections of the same images. A combination of Dice and weighted cross entropy (CE) losses, with weights assigned for bladder (1), small bowel (1), rectum (2), sigmoid (2), left femoral head (0), and right femoral head (0), was used for OAR segmentation. The performance was evaluated against the model trained only on a limited number of acquired MRI data, as well as sMRI pretrained models with encoder weight freezing and either equal weighting or soft-tissue adjusted weighting. RESULTS Our sMRI-assisted approach showed improved performance for challenging pelvic OARs compared to the method using only the acquired MRI data. The self-supervised fraction-adaptive segmentation results indicated better performance in target soft-tissues when using at least one treatment fraction for organ-specific adaptation. CONCLUSION Our framework leverages pre-existing CT planning data for gynecological cancers to enhance the segmentation performance of OARs during MR-guided adaptive treatments. This approach offers substantial benefits for the radiation therapy workflow, including reduced variability in per-fraction segmentation and clinical burden. Further studies that involve human expert evaluations will be conducted to assess the practicality of this approach in radiation therapy.
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Affiliation(s)
- R Kalantar
- The Institute of Cancer Research, London, United Kingdom
| | - M Ingle
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - J M Winfield
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - C Messiou
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - S Lalondrelle
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - D M Koh
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - M Blackledge
- The Institute of Cancer Research, London, United Kingdom
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7
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Knill AK, Blackledge MD, Curcean A, Larkin J, Turajlic S, Riddell A, Koh DM, Messiou C, Winfield JM. Optimisation of b-values for the accurate estimation of the apparent diffusion coefficient (ADC) in whole-body diffusion-weighted MRI in patients with metastatic melanoma. Eur Radiol 2023; 33:863-871. [PMID: 36169688 PMCID: PMC9889461 DOI: 10.1007/s00330-022-09088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/12/2022] [Accepted: 08/04/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To establish optimised diffusion weightings ('b-values') for acquisition of whole-body diffusion-weighted MRI (WB-DWI) for estimation of the apparent diffusion coefficient (ADC) in patients with metastatic melanoma (MM). Existing recommendations for WB-DWI have not been optimised for the tumour properties in MM; therefore, evaluation of acquisition parameters is essential before embarking on larger studies. METHODS Retrospective clinical data and phantom experiments were used. Clinical data comprised 125 lesions from 14 examinations in 11 patients with multifocal MM, imaged before and/or after treatment with immunotherapy at a single institution. ADC estimates from these data were applied to a model to estimate the optimum b-value. A large non-diffusing phantom was used to assess eddy current-induced geometric distortion. RESULTS Considering all tumour sites from pre- and post-treatment examinations together, metastases exhibited a large range of mean ADC values, [0.67-1.49] × 10-3 mm2/s, and the optimum high b-value (bhigh) for ADC estimation was 1100 (10th-90th percentile: 740-1790) s/mm2. At higher b-values, geometric distortion increased, and longer echo times were required, leading to reduced signal. CONCLUSIONS Theoretical optimisation gave an optimum bhigh of 1100 (10th-90th percentile: 740-1790) s/mm2 for ADC estimation in MM, with the large range of optimum b-values reflecting the wide range of ADC values in these tumours. Geometric distortion and minimum echo time increase at higher b-values and are not included in the theoretical optimisation; bhigh in the range 750-1100 s/mm2 should be adopted to maintain acceptable image quality but performance should be evaluated for a specific scanner. KEY POINTS • Theoretical optimisation gave an optimum high b-value of 1100 (10th-90th percentile: 740-1790) s/mm2 for ADC estimation in metastatic melanoma. • Considering geometric distortion and minimum echo time (TE), a b-value in the range 750-1100 s/mm2 is recommended. • Sites should evaluate the performance of specific scanners to assess the effect of geometric distortion and minimum TE.
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Affiliation(s)
- Annemarie K Knill
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Andra Curcean
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - James Larkin
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Samra Turajlic
- The Royal Marsden NHS Foundation Trust, London, UK
- The Francis Crick Institute, London, UK
| | | | - Dow Mu Koh
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Christina Messiou
- The Institute of Cancer Research, London, UK.
- The Royal Marsden NHS Foundation Trust, London, UK.
| | - Jessica M Winfield
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
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8
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Johnston EW, Fotiadis N, Cummings C, Basso J, Tyne T, Lameijer J, Messiou C, Koh DM, Winfield JM. Developing and testing a robotic MRI/CT fusion biopsy technique using a purpose-built interventional phantom. Eur Radiol Exp 2022; 6:55. [PMID: 36411379 PMCID: PMC9679095 DOI: 10.1186/s41747-022-00308-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/28/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) can be used to target tumour components in biopsy procedures, while the ability to precisely correlate histology and MRI signal is crucial for imaging biomarker validation. Robotic MRI/computed tomography (CT) fusion biopsy offers the potential for this without in-gantry biopsy, although requires development. METHODS Test-retest T1 and T2 relaxation times, attenuation (Hounsfield units, HU), and biopsy core quality were prospectively assessed (January-December 2021) in a range of gelatin, agar, and mixed gelatin/agar solutions of differing concentrations on days 1 and 8 after manufacture. Suitable materials were chosen, and four biopsy phantoms were constructed with twelve spherical 1-3-cm diameter targets visible on MRI, but not on CT. A technical pipeline was developed, and intraoperator and interoperator reliability was tested in four operators performing a total of 96 biopsies. Statistical analysis included T1, T2, and HU repeatability using Bland-Altman analysis, Dice similarity coefficient (DSC), and intraoperator and interoperator reliability. RESULTS T1, T2, and HU repeatability had 95% limits-of-agreement of 8.3%, 3.4%, and 17.9%, respectively. The phantom was highly reproducible, with DSC of 0.93 versus 0.92 for scanning the same or two different phantoms, respectively. Hit rate was 100% (96/96 targets), and all operators performed robotic biopsies using a single volumetric acquisition. The fastest procedure time was 32 min for all 12 targets. CONCLUSIONS A reproducible biopsy phantom was developed, validated, and used to test robotic MRI/CT-fusion biopsy. The technique was highly accurate, reliable, and achievable in clinically acceptable timescales meaning it is suitable for clinical application.
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Affiliation(s)
- Edward W. Johnston
- grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ UK ,grid.18886.3fInstitute of Cancer Research, 123 Old Brompton Road, London, SW73RP UK
| | - Nicos Fotiadis
- grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ UK ,grid.18886.3fInstitute of Cancer Research, 123 Old Brompton Road, London, SW73RP UK
| | - Craig Cummings
- grid.18886.3fInstitute of Cancer Research, 123 Old Brompton Road, London, SW73RP UK
| | - Jodie Basso
- grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ UK
| | - Toby Tyne
- grid.18886.3fInstitute of Cancer Research, 123 Old Brompton Road, London, SW73RP UK
| | - Joost Lameijer
- grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ UK
| | - Christina Messiou
- grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ UK ,grid.18886.3fInstitute of Cancer Research, 123 Old Brompton Road, London, SW73RP UK
| | - Dow-Mu Koh
- grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ UK ,grid.18886.3fInstitute of Cancer Research, 123 Old Brompton Road, London, SW73RP UK
| | - Jessica M. Winfield
- grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ UK ,grid.18886.3fInstitute of Cancer Research, 123 Old Brompton Road, London, SW73RP UK
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Thrussell I, Winfield JM, Orton MR, Miah AB, Zaidi SH, Arthur A, Thway K, Strauss DC, Collins DJ, Koh DM, Oelfke U, Huang PH, O’Connor JPB, Messiou C, Blackledge MD. Radiomic Features From Diffusion-Weighted MRI of Retroperitoneal Soft-Tissue Sarcomas Are Repeatable and Exhibit Change After Radiotherapy. Front Oncol 2022; 12:899180. [PMID: 35924167 PMCID: PMC9343063 DOI: 10.3389/fonc.2022.899180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Size-based assessments are inaccurate indicators of tumor response in soft-tissue sarcoma (STS), motivating the requirement for new response imaging biomarkers for this rare and heterogeneous disease. In this study, we assess the test-retest repeatability of radiomic features from MR diffusion-weighted imaging (DWI) and derived maps of apparent diffusion coefficient (ADC) in retroperitoneal STS and compare baseline repeatability with changes in radiomic features following radiotherapy (RT). Materials and Methods Thirty patients with retroperitoneal STS received an MR examination prior to treatment, of whom 23/30 were investigated in our repeatability analysis having received repeat baseline examinations and 14/30 patients were investigated in our post-treatment analysis having received an MR examination after completing pre-operative RT. One hundred and seven radiomic features were extracted from the full manually delineated tumor region using PyRadiomics. Test-retest repeatability was assessed using an intraclass correlation coefficient (baseline ICC), and post-radiotherapy variance analysis (post-RT-IMS) was used to compare the change in radiomic feature value to baseline repeatability. Results For the ADC maps and DWI images, 101 and 102 features demonstrated good baseline repeatability (baseline ICC > 0.85), respectively. Forty-three and 2 features demonstrated both good baseline repeatability and a high post-RT-IMS (>0.85), respectively. Pearson correlation between the baseline ICC and post-RT-IMS was weak (0.432 and 0.133, respectively). Conclusions The ADC-based radiomic analysis shows better test-retest repeatability compared with features derived from DWI images in STS, and some of these features are sensitive to post-treatment change. However, good repeatability at baseline does not imply sensitivity to post-treatment change.
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Affiliation(s)
- Imogen Thrussell
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
| | - Jessica M. Winfield
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
| | - Matthew R. Orton
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
| | - Aisha B. Miah
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Shane H. Zaidi
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Amani Arthur
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
| | - Khin Thway
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Department of Histopathology, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Dirk C. Strauss
- Department of Surgery, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - David J. Collins
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, 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 (NHS) Foundation Trust, Sutton, United Kingdom
| | - Uwe Oelfke
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Paul H. Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - James P. B. O’Connor
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Radiology, The Christie Hospital, Manchester, 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 (NHS) Foundation Trust, Sutton, United Kingdom
| | - Matthew D. Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
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11
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Arthur A, Johnston EW, Winfield JM, Blackledge MD, Jones RL, Huang PH, Messiou C. Virtual Biopsy in Soft Tissue Sarcoma. How Close Are We? Front Oncol 2022; 12:892620. [PMID: 35847882 PMCID: PMC9286756 DOI: 10.3389/fonc.2022.892620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/31/2022] [Indexed: 12/13/2022] Open
Abstract
A shift in radiology to a data-driven specialty has been unlocked by synergistic developments in imaging biomarkers (IB) and computational science. This is advancing the capability to deliver “virtual biopsies” within oncology. The ability to non-invasively probe tumour biology both spatially and temporally would fulfil the potential of imaging to inform management of complex tumours; improving diagnostic accuracy, providing new insights into inter- and intra-tumoral heterogeneity and individualised treatment planning and monitoring. Soft tissue sarcomas (STS) are rare tumours of mesenchymal origin with over 150 histological subtypes and notorious heterogeneity. The combination of inter- and intra-tumoural heterogeneity and the rarity of the disease remain major barriers to effective treatments. We provide an overview of the process of successful IB development, the key imaging and computational advancements in STS including quantitative magnetic resonance imaging, radiomics and artificial intelligence, and the studies to date that have explored the potential biological surrogates to imaging metrics. We discuss the promising future directions of IBs in STS and illustrate how the routine clinical implementation of a virtual biopsy has the potential to revolutionise the management of this group of complex cancers and improve clinical outcomes.
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Affiliation(s)
- Amani Arthur
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
| | - Edward W. Johnston
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Jessica M. Winfield
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Matthew D. Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
| | - Robin L. Jones
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Paul H. Huang
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton, United Kingdom
- *Correspondence: Paul H. Huang, ; Christina Messiou,
| | - Christina Messiou
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- *Correspondence: Paul H. Huang, ; Christina Messiou,
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12
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Rata M, Khan K, Collins DJ, Koh DM, Tunariu N, Bali MA, d'Arcy J, Winfield JM, Picchia S, Valeri N, Chau I, Cunningham D, Fassan M, Leach MO, Orton MR. DCE-MRI is more sensitive than IVIM-DWI for assessing anti-angiogenic treatment-induced changes in colorectal liver metastases. Cancer Imaging 2021; 21:67. [PMID: 34924031 PMCID: PMC8684660 DOI: 10.1186/s40644-021-00436-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/24/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diffusion weighted imaging (DWI) with intravoxel incoherent motion (IVIM) modelling can inform on tissue perfusion without exogenous contrast administration. Dynamic-contrast-enhanced (DCE) MRI can also characterise tissue perfusion, but requires a bolus injection of a Gadolinium-based contrast agent. This study compares the use of DCE-MRI and IVIM-DWI methods in assessing response to anti-angiogenic treatment in patients with colorectal liver metastases in a cohort with confirmed treatment response. METHODS This prospective imaging study enrolled 25 participants with colorectal liver metastases to receive Regorafenib treatment. A target metastasis > 2 cm in each patient was imaged before and at 15 days after treatment on a 1.5T MR scanner using slice-matched IVIM-DWI and DCE-MRI protocols. MRI data were motion-corrected and tumour volumes of interest drawn on b=900 s/mm2 diffusion-weighted images were transferred to DCE-MRI data for further analysis. The median value of four IVIM-DWI parameters [diffusion coefficient D (10-3 mm2/s), perfusion fraction f (ml/ml), pseudodiffusion coefficient D* (10-3 mm2/s), and their product fD* (mm2/s)] and three DCE-MRI parameters [volume transfer constant Ktrans (min-1), enhancement fraction EF (%), and their product KEF (min-1)] were recorded at each visit, before and after treatment. Changes in pre- and post-treatment measurements of all MR parameters were assessed using Wilcoxon signed-rank tests (P<0.05 was considered significant). DCE-MRI and IVIM-DWI parameter correlations were evaluated with Spearman rank tests. Functional MR parameters were also compared against Response Evaluation Criteria In Solid Tumours v.1.1 (RECIST) evaluations. RESULTS Significant treatment-induced reductions of DCE-MRI parameters across the cohort were observed for EF (91.2 to 50.8%, P<0.001), KEF (0.095 to 0.045 min-1, P<0.001) and Ktrans (0.109 to 0.078 min-1, P=0.002). For IVIM-DWI, only D (a non-perfusion parameter) increased significantly post treatment (0.83 to 0.97 × 10-3 mm2/s, P<0.001), while perfusion-related parameters showed no change. No strong correlations were found between DCE-MRI and IVIM-DWI parameters. A moderate correlation was found, after treatment, between Ktrans and D* (r=0.60; P=0.002) and fD* (r=0.67; P<0.001). When compared to RECIST v.1.1 evaluations, KEF and D correctly identified most clinical responders, whilst non-responders were incorrectly identified. CONCLUSION IVIM-DWI perfusion-related parameters showed limited sensitivity to the anti-angiogenic effects of Regorafenib treatment in colorectal liver metastases and showed low correlation with DCE-MRI parameters, despite profound and significant post-treatment reductions in DCE-MRI measurements. TRIAL REGISTRATION NCT03010722 clinicaltrials.gov; registration date 6th January 2015.
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Affiliation(s)
- Mihaela Rata
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom.
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.
- Royal Marsden NHS Foundation Trust & Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK.
| | - Khurum Khan
- Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - David J Collins
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Dow-Mu Koh
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Nina Tunariu
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Maria Antonietta Bali
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - James d'Arcy
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Cancer Research UK National Cancer Imaging Translational Accelerator (NCITA), London, United Kingdom
| | - Jessica M Winfield
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Simona Picchia
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nicola Valeri
- Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
- Centre for Evolution and Cancer, The Institute of Cancer Research, London and Sutton, United Kingdom
- Division of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Ian Chau
- Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - David Cunningham
- Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, Italy
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Martin O Leach
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Matthew R Orton
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
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13
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Kalantar R, Lin G, Winfield JM, Messiou C, Lalondrelle S, Blackledge MD, Koh DM. Automatic Segmentation of Pelvic Cancers Using Deep Learning: State-of-the-Art Approaches and Challenges. Diagnostics (Basel) 2021; 11:1964. [PMID: 34829310 PMCID: PMC8625809 DOI: 10.3390/diagnostics11111964] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 12/18/2022] Open
Abstract
The recent rise of deep learning (DL) and its promising capabilities in capturing non-explicit detail from large datasets have attracted substantial research attention in the field of medical image processing. DL provides grounds for technological development of computer-aided diagnosis and segmentation in radiology and radiation oncology. Amongst the anatomical locations where recent auto-segmentation algorithms have been employed, the pelvis remains one of the most challenging due to large intra- and inter-patient soft-tissue variabilities. This review provides a comprehensive, non-systematic and clinically-oriented overview of 74 DL-based segmentation studies, published between January 2016 and December 2020, for bladder, prostate, cervical and rectal cancers on computed tomography (CT) and magnetic resonance imaging (MRI), highlighting the key findings, challenges and limitations.
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Affiliation(s)
- Reza Kalantar
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SM2 5NG, UK; (R.K.); (J.M.W.); (C.M.); (S.L.); (D.-M.K.)
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan;
| | - Jessica M. Winfield
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SM2 5NG, UK; (R.K.); (J.M.W.); (C.M.); (S.L.); (D.-M.K.)
- Department of Radiology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Christina Messiou
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SM2 5NG, UK; (R.K.); (J.M.W.); (C.M.); (S.L.); (D.-M.K.)
- Department of Radiology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Susan Lalondrelle
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SM2 5NG, UK; (R.K.); (J.M.W.); (C.M.); (S.L.); (D.-M.K.)
- Department of Radiology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Matthew D. Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SM2 5NG, UK; (R.K.); (J.M.W.); (C.M.); (S.L.); (D.-M.K.)
| | - Dow-Mu Koh
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SM2 5NG, UK; (R.K.); (J.M.W.); (C.M.); (S.L.); (D.-M.K.)
- Department of Radiology, The Royal Marsden Hospital, London SW3 6JJ, UK
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14
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Kalantar R, Messiou C, Winfield JM, Renn A, Latifoltojar A, Downey K, Sohaib A, Lalondrelle S, Koh DM, Blackledge MD. CT-Based Pelvic T 1-Weighted MR Image Synthesis Using UNet, UNet++ and Cycle-Consistent Generative Adversarial Network (Cycle-GAN). Front Oncol 2021; 11:665807. [PMID: 34395244 PMCID: PMC8363308 DOI: 10.3389/fonc.2021.665807] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Computed tomography (CT) and magnetic resonance imaging (MRI) are the mainstay imaging modalities in radiotherapy planning. In MR-Linac treatment, manual annotation of organs-at-risk (OARs) and clinical volumes requires a significant clinician interaction and is a major challenge. Currently, there is a lack of available pre-annotated MRI data for training supervised segmentation algorithms. This study aimed to develop a deep learning (DL)-based framework to synthesize pelvic T1-weighted MRI from a pre-existing repository of clinical planning CTs. METHODS MRI synthesis was performed using UNet++ and cycle-consistent generative adversarial network (Cycle-GAN), and the predictions were compared qualitatively and quantitatively against a baseline UNet model using pixel-wise and perceptual loss functions. Additionally, the Cycle-GAN predictions were evaluated through qualitative expert testing (4 radiologists), and a pelvic bone segmentation routine based on a UNet architecture was trained on synthetic MRI using CT-propagated contours and subsequently tested on real pelvic T1 weighted MRI scans. RESULTS In our experiments, Cycle-GAN generated sharp images for all pelvic slices whilst UNet and UNet++ predictions suffered from poorer spatial resolution within deformable soft-tissues (e.g. bladder, bowel). Qualitative radiologist assessment showed inter-expert variabilities in the test scores; each of the four radiologists correctly identified images as acquired/synthetic with 67%, 100%, 86% and 94% accuracy. Unsupervised segmentation of pelvic bone on T1-weighted images was successful in a number of test cases. CONCLUSION Pelvic MRI synthesis is a challenging task due to the absence of soft-tissue contrast on CT. Our study showed the potential of deep learning models for synthesizing realistic MR images from CT, and transferring cross-domain knowledge which may help to expand training datasets for 21 development of MR-only segmentation models.
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Affiliation(s)
- Reza Kalantar
- 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 Hospital, London, United Kingdom
| | - Jessica M. Winfield
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden Hospital, London, United Kingdom
| | - Alexandra Renn
- Department of Radiology, The Royal Marsden Hospital, London, United Kingdom
| | - Arash Latifoltojar
- Department of Radiology, The Royal Marsden Hospital, London, United Kingdom
| | - Kate Downey
- Department of Radiology, The Royal Marsden Hospital, London, United Kingdom
| | - Aslam Sohaib
- Department of Radiology, The Royal Marsden Hospital, London, United Kingdom
| | - Susan Lalondrelle
- Gynaecological Unit, The Royal Marsden Hospital, London, United Kingdom
| | - Dow-Mu Koh
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden Hospital, London, United Kingdom
| | - Matthew D. Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
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15
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Winfield JM, Blackledge MD, Tunariu N, Koh DM, Messiou C. Whole-body MRI: a practical guide for imaging patients with malignant bone disease. Clin Radiol 2021; 76:715-727. [PMID: 33934876 DOI: 10.1016/j.crad.2021.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/08/2021] [Indexed: 01/09/2023]
Abstract
Whole-body magnetic resonance imaging (MRI) is now a crucial tool for the assessment of the extent of systemic malignant bone disease and response to treatment, and forms part of national and international recommendations for imaging patients with myeloma or metastatic prostate cancer. Recent developments in scanners have enabled acquisition of good-quality whole-body MRI data within 45 minutes on modern MRI systems from all main manufacturers. This provides complimentary morphological and functional whole-body imaging; however, lack of prior experience and acquisition times required can act as a barrier to adoption in busy radiology departments. This article aims to tackle the former by reviewing the indications and providing guidance for technical delivery and clinical interpretation of whole-body MRI for patients with malignant bone disease.
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Affiliation(s)
- J M Winfield
- 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
| | - M D Blackledge
- 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
| | - N Tunariu
- 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
| | - D-M Koh
- 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
| | - C Messiou
- 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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16
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Winfield JM, Wakefield JC, Brenton JD, AbdulJabbar K, Savio A, Freeman S, Pace E, Lutchman-Singh K, Vroobel KM, Yuan Y, Banerjee S, Porta N, Ahmed Raza SE, deSouza NM. Biomarkers for site-specific response to neoadjuvant chemotherapy in epithelial ovarian cancer: relating MRI changes to tumour cell load and necrosis. Br J Cancer 2021; 124:1130-1137. [PMID: 33398064 PMCID: PMC7961011 DOI: 10.1038/s41416-020-01217-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/11/2020] [Accepted: 11/25/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Diffusion-weighted magnetic resonance imaging (DW-MRI) potentially interrogates site-specific response to neoadjuvant chemotherapy (NAC) in epithelial ovarian cancer (EOC). METHODS Participants with newly diagnosed EOC due for platinum-based chemotherapy and interval debulking surgery were recruited prospectively in a multicentre study (n = 47 participants). Apparent diffusion coefficient (ADC) and solid tumour volume (up to 10 lesions per participant) were obtained from DW-MRI before and after NAC (including double-baseline for repeatability assessment in n = 19). Anatomically matched lesions were analysed after surgical excision (65 lesions obtained from 25 participants). A trained algorithm determined tumour cell fraction, percentage tumour and percentage necrosis on histology. Whole-lesion post-NAC ADC and pre/post-NAC ADC changes were compared with histological metrics (residual tumour/necrosis) for each tumour site (ovarian, omental, peritoneal, lymph node). RESULTS Tumour volume reduced at all sites after NAC. ADC increased between pre- and post-NAC measurements. Post-NAC ADC correlated negatively with tumour cell fraction. Pre/post-NAC changes in ADC correlated positively with percentage necrosis. Significant correlations were driven by peritoneal lesions. CONCLUSIONS Following NAC in EOC, the ADC (measured using DW-MRI) increases differentially at disease sites despite similar tumour shrinkage, making its utility site-specific. After NAC, ADC correlates negatively with tumour cell fraction; change in ADC correlates positively with percentage necrosis. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01505829.
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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, 123 Old Brompton Road, London, SW7 3RP, UK
- MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Jennifer C Wakefield
- 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
| | - James D Brenton
- Cancer Research UK Cambridge Institute, Cambridge, CB2 0RE, UK
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
- Department of Oncology, University of Cambridge, Cambridge, CB2 0XZ, UK
| | - Khalid AbdulJabbar
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Antonella Savio
- Department of Pathology, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Susan Freeman
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Erika Pace
- 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
| | - Kerryn Lutchman-Singh
- Swansea Gynaecological Oncology Centre, Swansea Bay University Health Board, Singleton Hospital, Swansea, SA2 8QA, UK
| | - Katherine M Vroobel
- Department of Pathology, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Yinyin Yuan
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Susana Banerjee
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Nuria Porta
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Shan E Ahmed Raza
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
- Department of Computer Science, University of Warwick, Coventry, UK
| | - 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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17
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McElroy S, Winfield JM, Westerland O, Charles-Edwards G, Bell J, Neji R, Stemmer A, Kiefer B, Streetly M, Goh V. Integrated slice-specific dynamic shimming for whole-body diffusion-weighted MR imaging at 1.5 T. MAGMA 2020; 34:513-521. [PMID: 33355719 PMCID: PMC8338872 DOI: 10.1007/s10334-020-00898-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 01/11/2023]
Abstract
Objective To compare integrated slice-specific dynamic shim (iShim) with distortion correction post-processing to conventional 3D volume shim for the reduction of artefacts and signal loss in 1.5 T whole-body diffusion-weighted imaging (WB-DWI). Methods Ten volunteers underwent WB-DWI using conventional 3D volume shim and iShim. Forty-eight consecutive patients underwent WB-DWI with either volume shim (n = 24) or iShim (n = 24) only. For all subjects, displacement of the spinal cord at imaging station interfaces was measured on composed b = 900 s/mm2 images. The signal intensity ratios, computed as the average signal intensity in a region of high susceptibility gradient (sternum) divided by the average signal intensity in a region of low susceptibility gradient (vertebral body), were compared in volunteers. For patients, image quality was graded from 1 to 5 (1 = Poor, 5 = Excellent). Signal intensity discontinuity scores were recorded from 1 to 4 (1 = 2 + steps, 4 = 0 steps). A p value of < 0.05 was considered significant. Results Spinal cord displacement artefacts were lower with iShim (p < 0.05) at the thoracic junction in volunteers and at the cervical and thoracic junctions in patients (p < 0.05). The sternum/vertebra signal intensity ratio in healthy volunteers was higher with iShim compared with the volume shim sequence (p < 0.05). There were no significant differences between the volume shim and iShim patient groups in terms of image quality and signal intensity discontinuity scores. Conclusion iShim reduced the degree of spinal cord displacement artefact between imaging stations and susceptibility-gradient-induced signal loss. Supplementary Information The online version contains supplementary material available at 10.1007/s10334-020-00898-6.
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Affiliation(s)
- Sarah McElroy
- Clinical Imaging and Medical Physics, Guy's and St Thomas' Hospital, London, UK.
| | - Jessica M Winfield
- Clinical Imaging and Medical Physics, Guy's and St Thomas' Hospital, London, UK
| | - Olwen Westerland
- Clinical Imaging and Medical Physics, Guy's and St Thomas' Hospital, London, UK
| | | | - Joanna Bell
- Clinical Imaging and Medical Physics, Guy's and St Thomas' Hospital, London, UK
| | - Radhouene Neji
- MR Research Collaborations, Siemens Healthcare, Frimley, UK
| | - Alto Stemmer
- MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany
| | - Berthold Kiefer
- MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany
| | - Matthew Streetly
- Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vicky Goh
- Clinical Imaging and Medical Physics, Guy's and St Thomas' Hospital, London, UK.,Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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18
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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: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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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: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Westerland O, Sivarasan N, Natas S, Verma H, McElroy S, Winfield JM, Neji R, El-Najjar I, Kazmi M, Streetly M, Goh V. Added Value of Contrast-Enhanced T1-Weighted and Diffusion-Weighted Sequences for Characterization of Incidental Findings on Whole Body Magnetic Resonance Imaging in Plasma-Cell Disorders. Clinical Lymphoma Myeloma and Leukemia 2018; 18:822-828. [DOI: 10.1016/j.clml.2018.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/24/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
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Giles SL, Winfield JM, Collins DJ, Rivens I, Civale J, ter Haar GR, deSouza NM. Value of diffusion-weighted imaging for monitoring tissue change during magnetic resonance-guided high-intensity focused ultrasound therapy in bone applications: an ex-vivo study. Eur Radiol Exp 2018; 2:10. [PMID: 29774894 PMCID: PMC5945713 DOI: 10.1186/s41747-018-0041-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Magnetic resonance (MR)-guided high-intensity focused ultrasound (HIFU) can palliate metastatic bone pain by periosteal neurolysis. We investigated the value of diffusion-weighted imaging (DWI) for monitoring soft tissue changes adjacent to bone during MR-guided HIFU. We evaluated the repeatability of the apparent diffusion coefficient (ADC) measurement, the temporal evolution of ADC change after sonication, and its relationship with thermal parameters. METHODS Ex-vivo experiments in lamb legs (n = 8) were performed on a Sonalleve MR-guided HIFU system. Baseline proton resonance frequency shift (PRFS) thermometry evaluated the accuracy of temperature measurements and tissue cooling times after exposure. PRFS acquired during sonication (n = 27) was used to estimate thermal dose volume and temperature. After repeat baseline measurements, DWI was assessed longitudinally and relative ADC changes were derived for heated regions. RESULTS Baseline PRFS was accurate to 1 °C and showed that tissues regained baseline temperatures within 5 min. Before sonication, coefficient of variation for repeat ADC measurements was 0.8%. After sonication, ADC increased in the muscle adjacent to the exposed periosteum, it was maximal 1-5 min after sonication, and it significantly differed between samples with persistent versus non-persistent ADC changes beyond 20 min. ADC increases at 20 min were stable for 2 h and correlated significantly with thermal parameters (ADC versus applied acoustic energy at 16-20 min: r = 0.77, p < 0.001). A 20% ADC increase resulted in clear macroscopic tissue damage. CONCLUSIONS Our preliminary results suggest that DWI can detect intra-procedural changes in ex-vivo muscle overlying the periosteum. This could be useful for studying the safety and efficacy of clinical MR-guided HIFU bone treatments.
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Affiliation(s)
- Sharon L. Giles
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Cancer Research UK Cancer Imaging Centre, Division of Imaging and Radiotherapy, The Institute of Cancer Research, London, UK
| | - Jessica M. Winfield
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Cancer Research UK Cancer Imaging Centre, Division of Imaging and Radiotherapy, The Institute of Cancer Research, London, UK
| | - David J. Collins
- Cancer Research UK Cancer Imaging Centre, Division of Imaging and Radiotherapy, The Institute of Cancer Research, London, UK
| | - Ian Rivens
- Therapeutic Ultrasound, Division of Imaging and Radiotherapy, The Institute of Cancer Research, London, UK
| | - John Civale
- Therapeutic Ultrasound, Division of Imaging and Radiotherapy, The Institute of Cancer Research, London, UK
| | - Gail R. ter Haar
- Therapeutic Ultrasound, Division of Imaging and Radiotherapy, The Institute of Cancer Research, London, UK
| | - Nandita M. deSouza
- Cancer Research UK Cancer Imaging Centre, Division of Imaging and Radiotherapy, The Institute of Cancer Research, London, UK
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Winfield JM, Poillucci G, Blackledge MD, Collins DJ, Shah V, Tunariu N, Kaiser MF, Messiou C. Apparent diffusion coefficient of vertebral haemangiomas allows differentiation from malignant focal deposits in whole-body diffusion-weighted MRI. Eur Radiol 2018; 28:1687-1691. [PMID: 29134357 PMCID: PMC5834553 DOI: 10.1007/s00330-017-5079-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/31/2017] [Accepted: 09/13/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The aim of this study was to identify apparent diffusion coefficient (ADC) values for typical haemangiomas in the spine and to compare them with active malignant focal deposits. METHODS This was a retrospective single-institution study. Whole-body magnetic resonance imaging (MRI) scans of 106 successive patients with active multiple myeloma, metastatic prostate or breast cancer were analysed. ADC values of typical vertebral haemangiomas and malignant focal deposits were recorded. RESULTS The ADC of haemangiomas (72 ROIs, median ADC 1,085×10-6mm2s-1, interquartile range 927-1,295×10-6mm2s-1) was significantly higher than the ADC of malignant focal deposits (97 ROIs, median ADC 682×10-6mm2s-1, interquartile range 583-781×10-6mm2s-1) with a p-value < 10-6. Receiver operating characteristic (ROC) analysis produced an area under the curve of 0.93. An ADC threshold of 872×10-6mm2s-1 separated haemangiomas from malignant focal deposits with a sensitivity of 84.7 % and specificity of 91.8 %. CONCLUSIONS ADC values of classical vertebral haemangiomas are significantly higher than malignant focal deposits. The high ADC of vertebral haemangiomas allows them to be distinguished visually and quantitatively from active sites of disease, which show restricted diffusion. KEY POINTS • Whole-body diffusion-weighted MRI is becoming widely used in myeloma and bone metastases. • ADC values of vertebral haemangiomas are significantly higher than malignant focal deposits. • High ADCs of haemangiomas allows them to be distinguished from active disease.
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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, 123 Old Brompton Road, London, SW7 3RP, UK.
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Gabriele Poillucci
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Matthew D Blackledge
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - David J Collins
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Vallari Shah
- Haemato-Oncology Research Unit, Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Nina Tunariu
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Martin F Kaiser
- Haemato-Oncology Research Unit, Division of Molecular Pathology, The Institute of Cancer Research, London, UK
- Department of Haematology, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Christina Messiou
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
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Winfield JM, Tunariu N, Rata M, Miyazaki K, Jerome NP, Germuska M, Blackledge MD, Collins DJ, de Bono JS, Yap TA, deSouza NM, Doran SJ, Koh DM, Leach MO, Messiou C, Orton MR. Extracranial Soft-Tissue Tumors: Repeatability of Apparent Diffusion Coefficient Estimates from Diffusion-weighted MR Imaging. Radiology 2017; 284:88-99. [PMID: 28301311 PMCID: PMC6063352 DOI: 10.1148/radiol.2017161965] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose To assess the repeatability of apparent diffusion coefficient (ADC) estimates in extracranial soft-tissue diffusion-weighted magnetic resonance imaging across a wide range of imaging protocols and patient populations. Materials and Methods Nine prospective patient studies and one prospective volunteer study, performed between 2006 and 2016 with research ethics committee approval and written informed consent from each subject, were included in this single-institution study. A total of 141 tumors and healthy organs were imaged twice (interval between repeated examinations, 45 minutes to 10 days, depending the on study) to assess the repeatability of median and mean ADC estimates. The Levene test was used to determine whether ADC repeatability differed between studies. The Pearson linear correlation coefficient was used to assess correlation between coefficient of variation (CoV) and the year the study started, study size, and volumes of tumors and healthy organs. The repeatability of ADC estimates from small, medium, and large tumors and healthy organs was assessed irrespective of study, and the Levene test was used to determine whether ADC repeatability differed between these groups. Results CoV aggregated across all studies was 4.1% (range for each study, 1.7%-6.5%). No correlation was observed between CoV and the year the study started or study size. CoV was weakly correlated with volume (r = -0.5, P = .1). Repeatability was significantly different between small, medium, and large tumors (P < .05), with the lowest CoV (2.6%) for large tumors. There was a significant difference in repeatability between studies-a difference that did not persist after the study with the largest tumors was excluded. Conclusion ADC is a robust imaging metric with excellent repeatability in extracranial soft tissues across a wide range of tumor sites, sizes, patient populations, and imaging protocol variations. 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 Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Nina Tunariu
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Mihaela Rata
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Keiko Miyazaki
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Neil P Jerome
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Michael Germuska
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Matthew D Blackledge
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - David J Collins
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Johann S de Bono
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Timothy A Yap
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Nandita M deSouza
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Simon J Doran
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Dow-Mu Koh
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Martin O Leach
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Christina Messiou
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Matthew R Orton
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
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Winfield JM, Orton MR, Collins DJ, Ind TEJ, Attygalle A, Hazell S, Morgan VA, deSouza NM. Separation of type and grade in cervical tumours using non-mono-exponential models of diffusion-weighted MRI. Eur Radiol 2017; 27:627-636. [PMID: 27221560 PMCID: PMC5209433 DOI: 10.1007/s00330-016-4417-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/15/2016] [Accepted: 05/13/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Assessment of empirical diffusion-weighted MRI (DW-MRI) models in cervical tumours to investigate whether fitted parameters distinguish between types and grades of tumours. METHODS Forty-two patients (24 squamous cell carcinomas, 14 well/moderately differentiated, 10 poorly differentiated; 15 adenocarcinomas, 13 well/moderately differentiated, two poorly differentiated; three rare types) were imaged at 3 T using nine b-values (0 to 800 s mm-2). Mono-exponential, stretched exponential, kurtosis, statistical, and bi-exponential models were fitted. Model preference was assessed using Bayesian Information Criterion analysis. Differences in fitted parameters between tumour types/grades and correlation between fitted parameters were assessed using two-way analysis of variance and Pearson's linear correlation coefficient, respectively. RESULTS Non-mono-exponential models were preferred by 83 % of tumours with bi-exponential and stretched exponential models preferred by the largest numbers of tumours. Apparent diffusion coefficient (ADC) and diffusion coefficients from non-mono-exponential models were significantly lower in poorly differentiated tumours than well/moderately differentiated tumours. α (stretched exponential), K (kurtosis), f and D* (bi-exponential) were significantly different between tumour types. Strong correlation was observed between ADC and diffusion coefficients from other models. CONCLUSIONS Non-mono-exponential models were preferred to the mono-exponential model in DW-MRI data from cervical tumours. Parameters of non-mono-exponential models showed significant differences between types and grades of tumours. KEY POINTS • Non-mono-exponential DW-MRI models are preferred in the majority of cervical tumours. • Poorly differentiated cervical tumours exhibit lower diffusion coefficients than well/moderately differentiated tumours. • Non-mono-exponential model parameters α, K, f, and D* differ between tumour types. • Micro-structural features are likely to affect parameters in non-mono-exponential models differently.
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Affiliation(s)
- Jessica M Winfield
- MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK.
| | - Matthew R Orton
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - David J Collins
- MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Thomas E J Ind
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Ayoma Attygalle
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Steve Hazell
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Veronica A Morgan
- MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Nandita M deSouza
- MRI Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
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Jerome NP, Papoutsaki MV, Orton MR, Parkes HG, Winfield JM, Boss MA, Leach MO, deSouza NM, Collins DJ. Development of a temperature-controlled phantom for magnetic resonance quality assurance of diffusion, dynamic, and relaxometry measurements. Med Phys 2016; 43:2998-3007. [PMID: 27277048 DOI: 10.1118/1.4948997] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 04/20/2016] [Accepted: 04/28/2016] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Diffusion-weighted (DW) and dynamic contrast-enhanced magnetic resonance imaging (MRI) are increasingly applied for the assessment of functional tissue biomarkers for diagnosis, lesion characterization, or for monitoring of treatment response. However, these techniques are vulnerable to the influence of various factors, so there is a necessity for a standardized MR quality assurance procedure utilizing a phantom to facilitate the reliable estimation of repeatability of these quantitative biomarkers arising from technical factors (e.g., B1 variation) affecting acquisition on scanners of different vendors and field strengths. The purpose of this study is to present a novel phantom designed for use in quality assurance for multicenter trials, and the associated repeatability measurements of functional and quantitative imaging protocols across different MR vendors and field strengths. METHODS A cylindrical acrylic phantom was manufactured containing 7 vials of polyvinylpyrrolidone (PVP) solutions of different concentrations, ranging from 0% (distilled water) to 25% w/w, to create a range of different MR contrast parameters. Temperature control was achieved by equilibration with ice-water. Repeated MR imaging measurements of the phantom were performed on four clinical scanners (two at 1.5 T, two at 3.0 T; two vendors) using the same scanning protocol to assess the long-term and short-term repeatability. The scanning protocol consisted of DW measurements, inversion recovery (IR) T1 measurements, multiecho T2 measurement, and dynamic T1-weighted sequence allowing multiple variable flip angle (VFA) estimation of T1 values over time. For each measurement, the corresponding calculated parameter maps were produced. On each calculated map, regions of interest (ROIs) were drawn within each vial and the median value of these voxels was assessed. For the dynamic data, the autocorrelation function and their variance were calculated; for the assessment of the repeatability, the coefficients of variation (CoV) were calculated. RESULTS For both field strengths across the available vendors, the apparent diffusion coefficient (ADC) at 0 °C ranged from (1.12 ± 0.01) × 10(-3) mm(2)/s for pure water to (0.48 ± 0.02) × 10(-3) mm(2)/s for the 25% w/w PVP concentration, presenting a minor variability between the vendors and the field strengths. T2 and IR-T1 relaxation time results demonstrated variability between the field strengths and the vendors across the different acquisitions. Moreover, the T1 values derived from the VFA method exhibited a large variation compared with the IR-T1 values across all the scanners for all repeated measurements, although the calculation of the standard deviation of the VFA-T1 estimate across each ROI and the autocorrelation showed a stability of the signal for three scanners, with autocorrelation of the signal over the dynamic series revealing a periodic variation in one scanner. Finally, the ADC, the T2, and the IR-T1 values exhibited an excellent repeatability across the scanners, whereas for the dynamic data, the CoVs were higher. CONCLUSIONS The combination of a novel PVP phantom, with multiple compartments to give a physiologically relevant range of ADC and T1 values, together with ice-water as a temperature-controlled medium, allows reliable quality assurance measurements that can be used to measure agreement between MRI scanners, critical in multicenter functional and quantitative imaging studies.
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Affiliation(s)
- Neil P Jerome
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, 123 Old Brompton Road, London SM2 5NG, United Kingdom
| | - Marianthi-Vasiliki Papoutsaki
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, 123 Old Brompton Road, London SM2 5NG, United Kingdom
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, 123 Old Brompton Road, London SM2 5NG, United Kingdom and Members of the Quantitative Imaging in Cancer: Connecting Cellular Processes with Therapy (QuiC-ConCePT) Consortium
| | - Matthew R Orton
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, 123 Old Brompton Road, London SM2 5NG, United Kingdom
| | - Harold G Parkes
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, 123 Old Brompton Road, London SM2 5NG, United Kingdom
| | - Jessica M Winfield
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, 123 Old Brompton Road, London SM2 5NG, United Kingdom
| | - Michael A Boss
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305
| | - Martin O Leach
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, 123 Old Brompton Road, London SM2 5NG, United Kingdom
| | - Nandita M deSouza
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, 123 Old Brompton Road, London SM2 5NG, United Kingdom and Members of the Quantitative Imaging in Cancer: Connecting Cellular Processes with Therapy (QuiC-ConCePT) Consortium
| | - David J Collins
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, 123 Old Brompton Road, London SM2 5NG, United Kingdom
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Winfield JM, Collins DJ, Priest AN, Quest RA, Glover A, Hunter S, Morgan VA, Freeman S, Rockall A, deSouza NM. A framework for optimization of diffusion-weighted MRI protocols for large field-of-view abdominal-pelvic imaging in multicenter studies. Med Phys 2016; 43:95. [PMID: 26745903 DOI: 10.1118/1.4937789] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/22/2015] [Accepted: 11/16/2015] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To develop methods for optimization of diffusion-weighted MRI (DW-MRI) in the abdomen and pelvis on 1.5 T MR scanners from three manufacturers and assess repeatability of apparent diffusion coefficient (ADC) estimates in a temperature-controlled phantom and abdominal and pelvic organs in healthy volunteers. METHODS Geometric distortion, ghosting, fat suppression, and repeatability and homogeneity of ADC estimates were assessed using phantoms and volunteers. Healthy volunteers (ten per scanner) were each scanned twice on the same scanner. One volunteer traveled to all three institutions in order to provide images for qualitative comparison. The common volunteer was excluded from quantitative analysis of the data from scanners 2 and 3 in order to ensure statistical independence, giving n = 10 on scanner 1 and n = 9 on scanners 2 and 3 for quantitative analysis. Repeatability and interscanner variation of ADC estimates in kidneys, liver, spleen, and uterus were assessed using within-patient coefficient of variation (wCV) and Kruskal-Wallis tests, respectively. RESULTS The coefficient of variation of ADC estimates in the temperature-controlled phantom was 1%-4% for all scanners. Images of healthy volunteers from all scanners showed homogeneous fat suppression and no marked ghosting or geometric distortion. The wCV of ADC estimates was 2%-4% for kidneys, 3%-7% for liver, 6%-9% for spleen, and 7%-10% for uterus. ADC estimates in kidneys, spleen, and uterus showed no significant difference between scanners but a significant difference was observed in liver (p < 0.05). CONCLUSIONS DW-MRI protocols can be optimized using simple phantom measurements to produce good quality images in the abdomen and pelvis at 1.5 T with repeatable quantitative measurements in a multicenter study.
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Affiliation(s)
- Jessica M Winfield
- MRI Unit, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom and Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom
| | - David J Collins
- MRI Unit, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom and Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom
| | - Andrew N Priest
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, United Kingdom
| | - Rebecca A Quest
- Imperial College Healthcare NHS Trust, Imaging Department, Hammersmith Hospital, Du Cane Road, London W12 0HS, United Kingdom
| | - Alan Glover
- Imperial College Healthcare NHS Trust, Imaging Department, Hammersmith Hospital, Du Cane Road, London W12 0HS, United Kingdom
| | - Sally Hunter
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, United Kingdom
| | - Veronica A Morgan
- MRI Unit, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom and Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom
| | - Susan Freeman
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, United Kingdom
| | - Andrea Rockall
- Imperial College Healthcare NHS Trust, Imaging Department, Hammersmith Hospital, Du Cane Road, London W12 0HS, United Kingdom
| | - Nandita M deSouza
- MRI Unit, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom and Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom
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Winfield JM, deSouza NM, Priest AN, Wakefield JC, Hodgkin C, Freeman S, Orton MR, Collins DJ. Modelling DW-MRI data from primary and metastatic ovarian tumours. Eur Radiol 2015; 25:2033-40. [PMID: 25605133 PMCID: PMC4457919 DOI: 10.1007/s00330-014-3573-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/13/2014] [Accepted: 12/16/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess goodness-of-fit and repeatability of mono-exponential, stretched exponential and bi-exponential models of diffusion-weighted MRI (DW-MRI) data in primary and metastatic ovarian cancer. METHODS Thirty-nine primary and metastatic lesions from thirty-one patients with stage III or IV ovarian cancer were examined before and after chemotherapy using DW-MRI with ten diffusion-weightings. The data were fitted with (a) a mono-exponential model to give the apparent diffusion coefficient (ADC), (b) a stretched exponential model to give the distributed diffusion coefficient (DDC) and stretching parameter (α), and (c) a bi-exponential model to give the diffusion coefficient (D), perfusion fraction (f) and pseudodiffusion coefficient (D*). RESULTS Coefficients of variation, established from repeated baseline measurements, were: ADC 3.1%, DDC 4.3%, α 7.0%, D 13.2%, f 44.0%, D* 165.1%. The bi-exponential model was unsuitable in these data owing to poor repeatability. After excluding the bi-exponential model, analysis using Akaike Information Criteria showed that the stretched exponential model provided the better fit to the majority of pixels in 64% of lesions. CONCLUSIONS The stretched exponential model provides the optimal fit to DW-MRI data from ovarian, omental and peritoneal lesions and lymph nodes in pre-treatment and post-treatment measurements with good repeatability. KEY POINTS • DW-MRI data in ovarian cancer show deviation from mono-exponential behaviour • Parameters derived from the stretched exponential model showed good repeatability (CV 7%) • The bi-exponential model was unsuitable because of poor parameter repeatability • The stretched exponential model showed comparable repeatability to the mono-exponential model • The extra parameter (α) provides scope for investigation of heterogeneity or response.
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Affiliation(s)
- Jessica M Winfield
- CRUK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK,
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Winfield JM, Papoutsaki MV, Ragheb H, Morris DM, Heerschap A, ter Voert EGW, Kuijer JPA, Pieters IC, Douglas NHM, Orton M, de souza NM. Development of a diffusion-weighted MRI protocol for multicentre abdominal imaging and evaluation of the effects of fasting on measurement of apparent diffusion coefficients (ADCs) in healthy liver. Br J Radiol 2015; 88:20140717. [PMID: 25790061 PMCID: PMC4628478 DOI: 10.1259/bjr.20140717] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/04/2015] [Accepted: 03/18/2015] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess the effect of fasting and eating on estimates of apparent diffusion coefficient (ADC) in the livers of healthy volunteers using a diffusion-weighted MRI protocol with b-values of 100, 500 and 900 s mm(-2) in a multicentre study at 1.5 T. METHODS 20 volunteers were scanned using 4 clinical 1.5-T MR scanners. Volunteers were scanned after fasting for at least 4 h and after eating a meal; the scans were repeated on a subsequent day. Median ADC estimates were calculated from all pixels in three slices near the centre of the liver. Analysis of variance (ANOVA) was used to assess the difference between ADC estimates in fasted and non-fasted states and between ADC estimates on different days. RESULTS ANOVA showed no difference between ADC estimates in fasted and non-fasted states (p = 0.8) nor between ADC estimates on different days (p = 0.8). The repeatability of the measurements was good, with coefficients of variation of 5.1% and 4.6% in fasted and non-fasted states, respectively. CONCLUSION There was no significant difference in ADC estimates between fasted and non-fasted measurements, indicating that the perfusion sensitivity of ADC estimates obtained from b-values of 100, 500 and 900 s mm(-2) is sufficiently low that changes in blood flow in the liver after eating are undetectable beyond the variability in the measurements. ADVANCES IN KNOWLEDGE Assessment of the effect of prandial state on ADC estimates is critical, in order to determine the appropriate patient preparation for biological validation in clinical trials.
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Affiliation(s)
- J M Winfield
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
- MRI Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - M-V Papoutsaki
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - H Ragheb
- Centre for Imaging Sciences, University of Manchester, Manchester, UK
| | - D M Morris
- Centre for Imaging Sciences, University of Manchester, Manchester, UK
| | - A Heerschap
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - E G W ter Voert
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - J P A Kuijer
- Department Physics and Medical Technology, VU University Medical Center, Amsterdam, Netherlands
| | - I C Pieters
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - N H M Douglas
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - M Orton
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - N M de souza
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
- MRI Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - on behalf of the QuIC-ConCePT Consortium
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
- MRI Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
- Centre for Imaging Sciences, University of Manchester, Manchester, UK
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
- Department Physics and Medical Technology, VU University Medical Center, Amsterdam, Netherlands
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands
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Abstract
Imaging biomarkers derived from MRI or CT describe functional properties of tumours and normal tissues. They are finding increasing numbers of applications in diagnosis, monitoring of response to treatment and assessment of progression or recurrence. Imaging biomarkers also provide scope for assessment of heterogeneity within and between lesions. A wide variety of functional parameters have been investigated for use as biomarkers in oncology. Some imaging techniques are used routinely in clinical applications while others are currently restricted to clinical trials or preclinical studies. Apparent diffusion coefficient, magnetization transfer ratio and native T1 relaxation time provide information about structure and organization of tissues. Vascular properties may be described using parameters derived from dynamic contrast-enhanced MRI, dynamic contrast-enhanced CT, transverse relaxation rate (R2*), vessel size index and relative blood volume, while magnetic resonance spectroscopy may be used to probe the metabolic profile of tumours. This review describes the mechanisms of contrast underpinning each technique and the technical requirements for robust and reproducible imaging. The current status of each biomarker is described in terms of its validation, qualification and clinical applications, followed by a discussion of the current limitations and future perspectives.
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Affiliation(s)
- J M Winfield
- CRUK Imaging Centre at the Institute of Cancer Research, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK,
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Winfield JM, Douglas NHM, deSouza NM, Collins DJ. Phantom for assessment of fat suppression in large field-of-view diffusion-weighted magnetic resonance imaging. Phys Med Biol 2014; 59:2235-48. [PMID: 24710825 DOI: 10.1088/0031-9155/59/9/2235] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We present the development and application of a phantom for assessment and optimization of fat suppression over a large field-of-view in diffusion-weighted magnetic resonance imaging at 1.5 T and 3 T. A Perspex cylinder (inner diameter 185 mm, height 300 mm) which contains a second cylinder (inner diameter 140 mm) was constructed. The inner cylinder was filled with water doped with copper sulphate and sodium chloride and the annulus was filled with corn oil, which closely matches the spectrum and longitudinal relaxation times of subcutaneous abdominal fat. Placement of the phantom on the couch at 45° to the z-axis presented an elliptical cross-section, which was of a similar size and shape to axial abdominal images. The use of a phantom for optimization of fat suppression allowed quantitative comparison between studies without the differences introduced by variability between human subjects. We have demonstrated that the phantom is suitable for selection of inversion delay times, spectral adiabatic inversion recovery delays and assessment of combinatorial methods of fat suppression. The phantom is valuable in protocol development and the assessment of new techniques, particularly in multi-centre trials.
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Affiliation(s)
- J M Winfield
- CRUK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
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Winfield JM, Van Vooren A, Park MJ, Hwang DH, Cornil J, Kim JS, Friend RH. Charge-transfer character of excitons in poly[2,7-(9,9-di-n-octylfluorene)(1−x)-co-4,7-(2,1,3-benzothiadiazole)(x)]. J Chem Phys 2009; 131:035104. [PMID: 19624236 DOI: 10.1063/1.3177327] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jessica M Winfield
- Cavendish Laboratory, JJ Thomson Avenue, Cambridge CB3 0HE, United Kingdom
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Abstract
Myocardial infarction is rarely recognized in the newborn. We report two cases in which the infant had a normal heart with normal coronary arteries. A review of previously described cases suggests that the most frequent cause of neonatal myocardial infarction is coronary artery occlusion secondary to paradoxical thromboembolization. It is speculated that infarction also can result from coronary hypoperfusion in asphyxiated infants. This report serves to remind the clinician that myocardial infarction can occur in the neonatal period and that an ECG should be obtained when evaluating a newborn with acute onset of shock.
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Miller H, Winfield JM. THE PROPHYLAXIS OF HUMAN BITE INFECTIONS. Ann Surg 1941; 113:1112-3. [PMID: 17857830 PMCID: PMC1385911 DOI: 10.1097/00000658-194106000-00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Winfield JM. The Medical Library as a Factor in Medical Education. Med Library Hist J 1904; 2:183-187. [PMID: 18340845 PMCID: PMC1692089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Winfield JM. Presentation of the Library of the Physicians to the German Hospital and Dispensary of the City of New York to the Library of the Medical Society of the County of Kings. Med Library Hist J 1904; 2:46-48. [PMID: 18340822 PMCID: PMC1692161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Winfield JM. A Brief Account of the Library of the Medical Society of the County of Kings. Med Library Hist J 1903; 1:1-32. [PMID: 18340785 PMCID: PMC1692042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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