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Huaroc Moquillaza E, Weiss K, Stelter J, Steinhelfer L, Lee YJ, Amthor T, Koken P, Makowski MR, Braren R, Doneva M, Karampinos DC. Accelerated liver water T 1 mapping using single-shot continuous inversion-recovery spiral imaging. NMR Biomed 2024; 37:e5097. [PMID: 38269568 DOI: 10.1002/nbm.5097] [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] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE Liver T1 mapping techniques typically require long breath holds or long scan time in free-breathing, need correction for B 1 + inhomogeneities and process composite (water and fat) signals. The purpose of this work is to accelerate the multi-slice acquisition of liver water selective T1 (wT1) mapping in a single breath hold, improving the k-space sampling efficiency. METHODS The proposed continuous inversion-recovery (IR) Look-Locker methodology combines a single-shot gradient echo spiral readout, Dixon processing and a dictionary-based analysis for liver wT1 mapping at 3 T. The sequence parameters were adapted to obtain short scan times. The influence of fat, B 1 + inhomogeneities and TE on the estimation of T1 was first assessed using simulations. The proposed method was then validated in a phantom and in 10 volunteers, comparing it with MRS and the modified Look-Locker inversion-recovery (MOLLI) method. Finally, the clinical feasibility was investigated by comparing wT1 maps with clinical scans in nine patients. RESULTS The phantom results are in good agreement with MRS. The proposed method encodes the IR-curve for the liver wT1 estimation, is minimally sensitive to B 1 + inhomogeneities and acquires one slice in 1.2 s. The volunteer results confirmed the multi-slice capability of the proposed method, acquiring nine slices in a breath hold of 11 s. The present work shows robustness to B 1 + inhomogeneities (wT 1 , No B 1 + = 1.07 wT 1 , B 1 + - 45.63 , R 2 = 0.99 ) , good repeatability (wT 1 , 2 ° = 1 . 0 wT 1 , 1 ° - 2.14 , R 2 = 0.96 ) and is in better agreement with MRS (wT 1 = 0.92 wT 1 MRS + 103.28 , R 2 = 0.38 ) than is MOLLI (wT 1 MOLLI = 0.76 wT 1 MRS + 254.43 , R 2 = 0.44 ) . The wT1 maps in patients captured diverse lesions, thus showing their clinical feasibility. CONCLUSION A single-shot spiral acquisition can be combined with a continuous IR Look-Locker method to perform rapid repeatable multi-slice liver water T1 mapping at a rate of 1.2 s per slice without a B 1 + map. The proposed method is suitable for nine-slice liver clinical applications acquired in a single breath hold of 11 s.
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Affiliation(s)
- Elizabeth Huaroc Moquillaza
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Jonathan Stelter
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lisa Steinhelfer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | | | | | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rickmer Braren
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Gassert FG, Kranz J, Gassert FT, Schwaiger BJ, Bogner C, Makowski MR, Glanz L, Stelter J, Baum T, Braren R, Karampinos DC, Gersing AS. Longitudinal MR-based proton-density fat fraction (PDFF) and T2* for the assessment of associations between bone marrow changes and myelotoxic chemotherapy. Eur Radiol 2024; 34:2437-2444. [PMID: 37691079 PMCID: PMC10957695 DOI: 10.1007/s00330-023-10189-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/14/2023] [Accepted: 07/07/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES MR imaging-based proton density fat fraction (PDFF) and T2* imaging has shown to be useful for the evaluation of degenerative changes in the spine. Therefore, the aim of this study was to investigate the influence of myelotoxic chemotherapy on the PDFF and T2* of the thoracolumbar spine in comparison to changes in bone mineral density (BMD). METHODS In this study, 19 patients were included who had received myelotoxic chemotherapy (MC) and had received a MR imaging scan of the thoracolumbar vertebrates before and after the MC. Every patient was matched for age, sex, and time between the MRI scans to two controls without MC. All patients underwent 3-T MR imaging including the thoracolumbar spine comprising chemical shift encoding-based water-fat imaging to extract PDFF and T2* maps. Moreover, trabecular BMD values were determined before and after chemotherapy. Longitudinal changes in PDFF and T2* were evaluated and compared to changes in BMD. RESULTS Absolute mean differences of PDFF values between scans before and after MC were at 8.7% (p = 0.01) and at -0.5% (p = 0.57) in the control group, resulting in significantly higher changes in PDFF in patients with MC (p = 0.008). BMD and T2* values neither showed significant changes in patients with nor in those without myelotoxic chemotherapy (p = 0.15 and p = 0.47). There was an inverse, yet non-significant correlation between changes in PDFF and BMD found in patients with myelotoxic chemotherapy (r = -0.41, p = 0.12). CONCLUSION Therefore, PDFF could be a useful non-invasive biomarker in order to detect changes in the bone marrow in patients receiving myelotoxic therapy. CLINICAL RELEVANCE STATEMENT Using PDFF as a non-invasive biomarker for early bone marrow changes in oncologic patients undergoing myelotoxic treatment may help enable more targeted countermeasures at commencing states of bone marrow degradation and reduce risks of possible fragility fractures. KEY POINTS Quantifying changes in bone marrow fat fraction, as well as T2* caused by myelotoxic pharmaceuticals using proton density fat fraction, is feasible. Proton density fat fraction could potentially be established as a non-invasive biomarker for early bone marrow changes in oncologic patients undergoing myelotoxic treatment.
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Affiliation(s)
- Felix G Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Julia Kranz
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Florian T Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Bogner
- Department of Oncology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Leander Glanz
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Jonathan Stelter
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Thomas Baum
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Rickmer Braren
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Department of Neuroradiology, University Hospital of Munich, Ludwig-Maximilians University Munich, Munich, Germany
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Steinhardt M, Marka AW, Ziegelmayer S, Makowski M, Braren R, Graf M, Gawlitza J. Comparison of Virtual Non-Contrast and True Non-Contrast CT Images Obtained by Dual-Layer Spectral CT in COPD Patients. Bioengineering (Basel) 2024; 11:301. [PMID: 38671723 PMCID: PMC11047621 DOI: 10.3390/bioengineering11040301] [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: 02/20/2024] [Revised: 03/10/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death. Recent studies have underlined the importance of non-contrast-enhanced chest CT scans not only for emphysema progression quantification, but for correlation with clinical outcomes as well. As about 40 percent of the 300 million CT scans per year are contrast-enhanced, no proper emphysema quantification is available in a one-stop-shop approach for patients with known or newly diagnosed COPD. Since the introduction of spectral imaging (e.g., dual-energy CT scanners), it has been possible to create virtual non-contrast-enhanced images (VNC) from contrast-enhanced images, making it theoretically possible to offer proper COPD imaging despite contrast enhancing. This study is aimed towards investigating whether these VNC images are comparable to true non-contrast-enhanced images (TNC), thereby reducing the radiation exposure of patients and usage of resources in hospitals. In total, 100 COPD patients with two scans, one with (VNC) and one without contrast media (TNC), within 8 weeks or less obtained by a spectral CT using dual-layer technology, were included in this retrospective study. TNC and VNC were compared according to their voxel-density histograms. While the comparison showed significant differences in the low attenuated volumes (LAVs) of TNC and VNC regarding the emphysema threshold of -950 Houndsfield Units (HU), the 15th and 10th percentiles of the LAVs used as a proxy for pre-emphysema were comparable. Upon further investigation, the threshold-based LAVs (-950 HU) of TNC and VNC were comparable in patients with a water equivalent diameter (DW) below 270 mm. The study concludes that VNC imaging may be a viable option for assessing emphysema progression in COPD patients, particularly those with a normal body mass index (BMI). Further, pre-emphysema was generally comparable between TNC and VNC. This approach could potentially reduce radiation exposure and hospital resources by making additional TNC scans obsolete.
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Affiliation(s)
- Manuel Steinhardt
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (A.W.M.); (S.Z.); (M.M.); (R.B.); (M.G.)
| | | | | | | | | | | | - Joshua Gawlitza
- Correspondence: (M.S.); (J.G.); Tel.: +49-176-24498226 (M.S.); +49-89-4140-8834 (J.G.)
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Tayebi Arasteh S, Ziller A, Kuhl C, Makowski M, Nebelung S, Braren R, Rueckert D, Truhn D, Kaissis G. Preserving fairness and diagnostic accuracy in private large-scale AI models for medical imaging. Commun Med (Lond) 2024; 4:46. [PMID: 38486100 PMCID: PMC10940659 DOI: 10.1038/s43856-024-00462-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 02/16/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI) models are increasingly used in the medical domain. However, as medical data is highly sensitive, special precautions to ensure its protection are required. The gold standard for privacy preservation is the introduction of differential privacy (DP) to model training. Prior work indicates that DP has negative implications on model accuracy and fairness, which are unacceptable in medicine and represent a main barrier to the widespread use of privacy-preserving techniques. In this work, we evaluated the effect of privacy-preserving training of AI models regarding accuracy and fairness compared to non-private training. METHODS We used two datasets: (1) A large dataset (N = 193,311) of high quality clinical chest radiographs, and (2) a dataset (N = 1625) of 3D abdominal computed tomography (CT) images, with the task of classifying the presence of pancreatic ductal adenocarcinoma (PDAC). Both were retrospectively collected and manually labeled by experienced radiologists. We then compared non-private deep convolutional neural networks (CNNs) and privacy-preserving (DP) models with respect to privacy-utility trade-offs measured as area under the receiver operating characteristic curve (AUROC), and privacy-fairness trade-offs, measured as Pearson's r or Statistical Parity Difference. RESULTS We find that, while the privacy-preserving training yields lower accuracy, it largely does not amplify discrimination against age, sex or co-morbidity. However, we find an indication that difficult diagnoses and subgroups suffer stronger performance hits in private training. CONCLUSIONS Our study shows that - under the challenging realistic circumstances of a real-life clinical dataset - the privacy-preserving training of diagnostic deep learning models is possible with excellent diagnostic accuracy and fairness.
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Affiliation(s)
- Soroosh Tayebi Arasteh
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
| | - Alexander Ziller
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany.
- Artificial Intelligence in Healthcare and Medicine, Technical University of Munich, Munich, Germany.
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcus Makowski
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Rickmer Braren
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Daniel Rueckert
- Artificial Intelligence in Healthcare and Medicine, Technical University of Munich, Munich, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
| | - Georgios Kaissis
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany.
- Artificial Intelligence in Healthcare and Medicine, Technical University of Munich, Munich, Germany.
- Department of Computing, Imperial College London, London, United Kingdom.
- Institute for Machine Learning in Biomedical Imaging, Helmholtz Munich, Neuherberg, Germany.
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Lippenberger F, Ziegelmayer S, Berlet M, Feussner H, Makowski M, Neumann PA, Graf M, Kaissis G, Wilhelm D, Braren R, Reischl S. Development of an image-based Random Forest classifier for prediction of surgery duration of laparoscopic sigmoid resections. Int J Colorectal Dis 2024; 39:21. [PMID: 38273097 PMCID: PMC10811180 DOI: 10.1007/s00384-024-04593-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE Sigmoid diverticulitis is a disease with a high socioeconomic burden, accounting for a high number of left-sided colonic resections worldwide. Modern surgical scheduling relies on accurate prediction of operation times to enhance patient care and optimize healthcare resources. This study aims to develop a predictive model for surgery duration in laparoscopic sigmoid resections, based on preoperative CT biometric and demographic patient data. METHODS This retrospective single-center cohort study included 85 patients who underwent laparoscopic sigmoid resection for diverticular disease. Potentially relevant procedure-specific anatomical parameters recommended by a surgical expert were measured in preoperative CT imaging. After random split into training and test set (75% / 25%) multiclass logistic regression was performed and a Random Forest classifier was trained on CT imaging parameters, patient age, and sex in the training cohort to predict categorized surgery duration. The models were evaluated in the test cohort using established performance metrics including receiver operating characteristics area under the curve (AUROC). RESULTS The Random Forest model achieved a good average AUROC of 0.78. It allowed a very good prediction of long (AUROC = 0.89; specificity 0.71; sensitivity 1.0) and short (AUROC = 0.81; specificity 0.77; sensitivity 0.56) procedures. It clearly outperformed the multiclass logistic regression model (AUROC: average = 0.33; short = 0.31; long = 0.22). CONCLUSION A Random Forest classifier trained on demographic and CT imaging biometric patient data could predict procedure duration outliers of laparoscopic sigmoid resections. Pending validation in a multicenter study, this approach could potentially improve procedure scheduling in visceral surgery and be scaled to other procedures.
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Affiliation(s)
- Florian Lippenberger
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Ziegelmayer
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maximilian Berlet
- Department of Surgery, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Hubertus Feussner
- Department of Surgery, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Marcus Makowski
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Philipp-Alexander Neumann
- Department of Surgery, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Markus Graf
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Georgios Kaissis
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Institute for Artificial Intelligence in Medicine and Healthcare, School of Medicine and Faculty of Informatics, Technical University of Munich, Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Rickmer Braren
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- German Cancer Consortium (DKTK, Partner Site Munich) and German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Stefan Reischl
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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Keyl J, Bucher A, Jungmann F, Hosch R, Ziller A, Armbruster R, Malkomes P, Reissig TM, Koitka S, Tzianopoulos I, Keyl P, Kostbade K, Albers D, Markus P, Treckmann J, Nassenstein K, Haubold J, Makowski M, Forsting M, Baba HA, Kasper S, Siveke JT, Nensa F, Schuler M, Kaissis G, Kleesiek J, Braren R. Prognostic value of deep learning-derived body composition in advanced pancreatic cancer-a retrospective multicenter study. ESMO Open 2024; 9:102219. [PMID: 38194881 PMCID: PMC10837775 DOI: 10.1016/j.esmoop.2023.102219] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Despite the prognostic relevance of cachexia in pancreatic cancer, individual body composition has not been routinely integrated into treatment planning. In this multicenter study, we investigated the prognostic value of sarcopenia and myosteatosis automatically extracted from routine computed tomography (CT) scans of patients with advanced pancreatic ductal adenocarcinoma (PDAC). PATIENTS AND METHODS We retrospectively analyzed clinical imaging data of 601 patients from three German cancer centers. We applied a deep learning approach to assess sarcopenia by the abdominal muscle-to-bone ratio (MBR) and myosteatosis by the ratio of abdominal inter- and intramuscular fat to muscle volume. In the pooled cohort, univariable and multivariable analyses were carried out to analyze the association between body composition markers and overall survival (OS). We analyzed the relationship between body composition markers and laboratory values during the first year of therapy in a subgroup using linear regression analysis adjusted for age, sex, and American Joint Committee on Cancer (AJCC) stage. RESULTS Deep learning-derived MBR [hazard ratio (HR) 0.60, 95% confidence interval (CI) 0.47-0.77, P < 0.005] and myosteatosis (HR 3.73, 95% CI 1.66-8.39, P < 0.005) were significantly associated with OS in univariable analysis. In multivariable analysis, MBR (P = 0.019) and myosteatosis (P = 0.02) were associated with OS independent of age, sex, and AJCC stage. In a subgroup, MBR and myosteatosis were associated with albumin and C-reactive protein levels after initiation of therapy. Additionally, MBR was also associated with hemoglobin and total protein levels. CONCLUSIONS Our work demonstrates that deep learning can be applied across cancer centers to automatically assess sarcopenia and myosteatosis from routine CT scans. We highlight the prognostic role of our proposed markers and show a strong relationship with protein levels, inflammation, and anemia. In clinical practice, automated body composition analysis holds the potential to further personalize cancer treatment.
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Affiliation(s)
- J Keyl
- Institute for Artificial Intelligence in Medicine, University Hospital Essen (AöR), Essen, Germany; Institute of Pathology, University Hospital Essen (AöR), Essen, Germany.
| | - A Bucher
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany; German Cancer Consortium (DKTK), Frankfurt partner site, Heidelberg, Germany
| | - F Jungmann
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany; Artificial Intelligence in Healthcare and Medicine, School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - R Hosch
- Institute for Artificial Intelligence in Medicine, University Hospital Essen (AöR), Essen, Germany
| | - A Ziller
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany; Artificial Intelligence in Healthcare and Medicine, School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - R Armbruster
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - P Malkomes
- Department of General, Visceral and Transplant Surgery, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - T M Reissig
- Department of Medical Oncology, University Hospital Essen (AöR), Essen, Germany; West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen (AöR), Essen, Germany; Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - S Koitka
- Institute for Artificial Intelligence in Medicine, University Hospital Essen (AöR), Essen, Germany; Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (AöR), Essen, Germany
| | - I Tzianopoulos
- Department of Medical Oncology, University Hospital Essen (AöR), Essen, Germany; West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - P Keyl
- Institute of Pathology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - K Kostbade
- Department of Medical Oncology, University Hospital Essen (AöR), Essen, Germany; West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - D Albers
- Department of Gastroenterology, Elisabeth Hospital Essen, Essen, Germany
| | - P Markus
- Department of General Surgery and Traumatology, Elisabeth Hospital Essen, Essen, Germany
| | - J Treckmann
- West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany; Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
| | - K Nassenstein
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - J Haubold
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - M Makowski
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - M Forsting
- German Cancer Consortium (DKTK), Partner site University Hospital Essen (AöR), Essen, Germany; Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - H A Baba
- Institute of Pathology, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - S Kasper
- Department of Medical Oncology, University Hospital Essen (AöR), Essen, Germany; West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - J T Siveke
- Department of Medical Oncology, University Hospital Essen (AöR), Essen, Germany; West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen (AöR), Essen, Germany; Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - F Nensa
- Institute for Artificial Intelligence in Medicine, University Hospital Essen (AöR), Essen, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen (AöR), Essen, Germany; Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - M Schuler
- Department of Medical Oncology, University Hospital Essen (AöR), Essen, Germany; West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany; National Center for Tumor Diseases (NCT), NCT West, Essen, Germany
| | - G Kaissis
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany; Artificial Intelligence in Healthcare and Medicine, School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - J Kleesiek
- Institute for Artificial Intelligence in Medicine, University Hospital Essen (AöR), Essen, Germany; West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - R Braren
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany; German Cancer Consortium (DKTK), Munich partner site, Heidelberg, Germany
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Schillmaier M, Kaika A, Topping GJ, Braren R, Schilling F. Repeatability and reproducibility of apparent exchange rate measurements in yeast cell phantoms using filter-exchange imaging. MAGMA 2023; 36:957-974. [PMID: 37436611 PMCID: PMC10667135 DOI: 10.1007/s10334-023-01107-w] [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] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Development of a protocol for validation and quality assurance of filter-exchange imaging (FEXI) pulse sequences with well-defined and reproducible phantoms. MATERIALS AND METHODS A FEXI pulse sequence was implemented on a 7 T preclinical MRI scanner. Six experiments in three different test categories were established for sequence validation, demonstration of the reproducibility of phantoms and the measurement of induced changes in the apparent exchange rate (AXR). First, an ice-water phantom was used to investigate the consistency of apparent diffusion coefficient (ADC) measurements with different diffusion filters. Second, yeast cell phantoms were utilized to validate the determination of the AXR in terms of repeatability (same phantom and session), reproducibility (separate but comparable phantoms in different sessions) and directionality of diffusion encodings. Third, the yeast cell phantoms were, furthermore, used to assess potential AXR bias because of altered cell density and temperature. In addition, a treatment experiment with aquaporin inhibitors was performed to evaluate the influence of these compounds on the cell membrane permeability in yeast cells. RESULTS FEXI-based ADC measurements of an ice-water phantom were performed for three different filter strengths, showed good agreement with the literature value of 1.099 × 10-3 mm2/s and had a maximum coefficient of variation (CV) of 0.55% within the individual filter strengths. AXR estimation in a single yeast cell phantom and imaging session with five repetitions resulted in an overall mean value of (1.49 ± 0.05) s-1 and a CV of 3.4% between the chosen regions of interest. For three separately prepared phantoms, AXR measurements resulted in a mean value of (1.50 ± 0.04) s-1 and a CV of 2.7% across the three phantoms, demonstrating high reproducibility. Across three orthogonal diffusion directions, a mean value of (1.57 ± 0.03) s-1 with a CV of 1.9% was detected, consistent with isotropy of AXR in yeast cells. Temperature and AXR were linearly correlated (R2 = 0.99) and an activation energy EA of 37.7 kJ/mol was determined by Arrhenius plot. Furthermore, a negative correlation was found between cell density (as determined by the reference ADC/fe) and AXR (R2 = 0.95). The treatment experiment resulted in significantly decreased AXR values at different temperatures in the treated sample compared to the untreated control indicating an inhibiting effect. CONCLUSIONS Using ice-water and yeast cell-based phantoms, a protocol for the validation of FEXI pulse sequences was established for the assessment of stability, repeatability, reproducibility and directionality. In addition, a strong dependence of AXR on cell density and temperature was shown. As AXR is an emerging novel imaging biomarker, the suggested protocol will be useful for quality assurance of AXR measurements within a study and potentially across multiple sites.
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Affiliation(s)
- Mathias Schillmaier
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
- Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Athanasia Kaika
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Geoffrey J Topping
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Rickmer Braren
- Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Franz Schilling
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Keicher M, Burwinkel H, Bani-Harouni D, Paschali M, Czempiel T, Burian E, Makowski MR, Braren R, Navab N, Wendler T. Multimodal graph attention network for COVID-19 outcome prediction. Sci Rep 2023; 13:19539. [PMID: 37945590 PMCID: PMC10636061 DOI: 10.1038/s41598-023-46625-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
When dealing with a newly emerging disease such as COVID-19, the impact of patient- and disease-specific factors (e.g., body weight or known co-morbidities) on the immediate course of the disease is largely unknown. An accurate prediction of the most likely individual disease progression can improve the planning of limited resources and finding the optimal treatment for patients. In the case of COVID-19, the need for intensive care unit (ICU) admission of pneumonia patients can often only be determined on short notice by acute indicators such as vital signs (e.g., breathing rate, blood oxygen levels), whereas statistical analysis and decision support systems that integrate all of the available data could enable an earlier prognosis. To this end, we propose a holistic, multimodal graph-based approach combining imaging and non-imaging information. Specifically, we introduce a multimodal similarity metric to build a population graph that shows a clustering of patients. For each patient in the graph, we extract radiomic features from a segmentation network that also serves as a latent image feature encoder. Together with clinical patient data like vital signs, demographics, and lab results, these modalities are combined into a multimodal representation of each patient. This feature extraction is trained end-to-end with an image-based Graph Attention Network to process the population graph and predict the COVID-19 patient outcomes: admission to ICU, need for ventilation, and mortality. To combine multiple modalities, radiomic features are extracted from chest CTs using a segmentation neural network. Results on a dataset collected in Klinikum rechts der Isar in Munich, Germany and the publicly available iCTCF dataset show that our approach outperforms single modality and non-graph baselines. Moreover, our clustering and graph attention increases understanding of the patient relationships within the population graph and provides insight into the network's decision-making process.
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Affiliation(s)
- Matthias Keicher
- Computer Aided Medical Procedures and Augmented Reality, School of Computation, Information and Technology, Technical University of Munich, Boltzmannstr. 3, 85748, Garching, Germany.
| | - Hendrik Burwinkel
- Computer Aided Medical Procedures and Augmented Reality, School of Computation, Information and Technology, Technical University of Munich, Boltzmannstr. 3, 85748, Garching, Germany
| | - David Bani-Harouni
- Computer Aided Medical Procedures and Augmented Reality, School of Computation, Information and Technology, Technical University of Munich, Boltzmannstr. 3, 85748, Garching, Germany
| | - Magdalini Paschali
- Computer Aided Medical Procedures and Augmented Reality, School of Computation, Information and Technology, Technical University of Munich, Boltzmannstr. 3, 85748, Garching, Germany
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - Tobias Czempiel
- Computer Aided Medical Procedures and Augmented Reality, School of Computation, Information and Technology, Technical University of Munich, Boltzmannstr. 3, 85748, Garching, Germany
| | - Egon Burian
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rickmer Braren
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Nassir Navab
- Computer Aided Medical Procedures and Augmented Reality, School of Computation, Information and Technology, Technical University of Munich, Boltzmannstr. 3, 85748, Garching, Germany
| | - Thomas Wendler
- Computer Aided Medical Procedures and Augmented Reality, School of Computation, Information and Technology, Technical University of Munich, Boltzmannstr. 3, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Clinical Computational Medical Imaging Research, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
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9
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Barner A, Burian E, Simon A, Castillo K, Waschulzik B, Braren R, Heemann U, Osterwalder J, Spiel A, Heim M, Stock KF. Pulmonary Findings in Hospitalized COVID-19 Patients Assessed by Lung Ultrasonography (LUS) - A Prospective Registry Study. Ultraschall Med 2023; 44:e248-e256. [PMID: 36646113 DOI: 10.1055/a-2013-8045] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE This prospective two-centre study investigated localisation-dependent lesion patterns in COVID-19 with standard lung ultrasonography (LUS) and their relationship with thoracic computed tomography (CT) and clinical parameters. MATERIALS AND METHODS Between April 2020 and April 2021, 52 SARS-CoV-2-positive patients in two hospitals were examined by means of LUS for "B-lines", fragmented pleura, consolidation and air bronchogram in 12 lung regions and for pleural effusions. A newly developed LUS score based on the number of features present was correlated with clinical parameters (respiration, laboratory parameters) and the CT and analysed with respect to the 30- and 60-day outcome. All patients were offered an outpatient LUS follow-up. RESULTS The LUS and CT showed a bilateral, partially posteriorly accentuated lesion distribution pattern. 294/323 (91%) of CT-detected lesions were pleural. The LUS score showed an association with respiratory status and C-reactive protein; the correlation with the CT score was weak (Spearman's rho = 0.339, p < 0.001). High LUS scores on admission were also observed in patients who were discharged within 30 days. LUS during follow-up showed predominantly declining LUS scores. CONCLUSION The LUS score reflected the clinical condition of the patients. No conclusion could be made on the prognostic value of the LUS, because of the low event rate. The LUS and CT score showed no sufficient correlation. This is probably due to different physical principles, which is why LUS could be of complementary value.
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Affiliation(s)
- Anna Barner
- Department of Nephrology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Egon Burian
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Simon
- Department of Emergency Medicine, Klinik Ottakring, Vienna, Austria
| | - Katty Castillo
- Institute for AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Birgit Waschulzik
- Institute for AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Rickmer Braren
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Joseph Osterwalder
- Emergency medicine and ultrasound diagnostics, Polipraxis, St. Gallen, Switzerland
| | - Alexander Spiel
- Department of Emergency Medicine, Klinik Ottakring, Vienna, Austria
| | - Markus Heim
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Konrad Friedrich Stock
- Department of Nephrology, School of Medicine, Technical University of Munich, Munich, Germany
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10
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Meiser P, Knolle MA, Hirschberger A, de Almeida GP, Bayerl F, Lacher S, Pedde AM, Flommersfeld S, Hönninger J, Stark L, Stögbauer F, Anton M, Wirth M, Wohlleber D, Steiger K, Buchholz VR, Wollenberg B, Zielinski CE, Braren R, Rueckert D, Knolle PA, Kaissis G, Böttcher JP. A distinct stimulatory cDC1 subpopulation amplifies CD8 + T cell responses in tumors for protective anti-cancer immunity. Cancer Cell 2023; 41:1498-1515.e10. [PMID: 37451271 DOI: 10.1016/j.ccell.2023.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 04/28/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
Type 1 conventional dendritic cells (cDC1) can support T cell responses within tumors but whether this determines protective versus ineffective anti-cancer immunity is poorly understood. Here, we use imaging-based deep learning to identify intratumoral cDC1-CD8+ T cell clustering as a unique feature of protective anti-cancer immunity. These clusters form selectively in stromal tumor regions and constitute niches in which cDC1 activate TCF1+ stem-like CD8+ T cells. We identify a distinct population of immunostimulatory CCR7neg cDC1 that produce CXCL9 to promote cluster formation and cross-present tumor antigens within these niches, which is required for intratumoral CD8+ T cell differentiation and expansion and promotes cancer immune control. Similarly, in human cancers, CCR7neg cDC1 interact with CD8+ T cells in clusters and are associated with patient survival. Our findings reveal an intratumoral phase of the anti-cancer T cell response orchestrated by tumor-residing cDC1 that determines protective versus ineffective immunity and could be exploited for cancer therapy.
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Affiliation(s)
- Philippa Meiser
- Institute of Molecular Immunology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Moritz A Knolle
- Institute for Artificial Intelligence in Medicine & Healthcare, School of Medicine, TUM, Munich, Germany; Institute for Diagnostic and Interventional Radiology, School of Medicine, TUM, Munich, Germany; Department of Computing, Imperial College London, London, UK
| | - Anna Hirschberger
- Institute of Molecular Immunology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Gustavo P de Almeida
- Institute of Animal Physiology and Immunology, School of Life Science, TUM, Freising, Germany; Institute of Virology, School of Medicine, TUM, Munich, Germany
| | - Felix Bayerl
- Institute of Molecular Immunology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Sebastian Lacher
- Institute of Molecular Immunology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Anna-Marie Pedde
- Institute of Molecular Immunology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Sophie Flommersfeld
- Institute for Medical Microbiology, Immunology and Hygiene, School of Medicine, TUM, Munich, Germany
| | - Julian Hönninger
- Institute of Molecular Immunology, School of Medicine, Technical University of Munich (TUM), Munich, Germany; Institute for Medical Microbiology, Immunology and Hygiene, School of Medicine, TUM, Munich, Germany
| | - Leonhard Stark
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, TUM, Munich, Germany
| | - Fabian Stögbauer
- Institute of Pathology, School of Medicine, TUM, Munich, Germany
| | - Martina Anton
- Institute of Molecular Immunology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Markus Wirth
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, TUM, Munich, Germany
| | - Dirk Wohlleber
- Institute of Molecular Immunology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Katja Steiger
- Institute of Pathology, School of Medicine, TUM, Munich, Germany; Comparative Experimental Pathology, School of Medicine, TUM, Munich, Germany; German Cancer Consortium, partner site Munich, Munich, Germany
| | - Veit R Buchholz
- Institute for Medical Microbiology, Immunology and Hygiene, School of Medicine, TUM, Munich, Germany
| | - Barbara Wollenberg
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, TUM, Munich, Germany
| | - Christina E Zielinski
- Department of Infection Immunology, Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute, Jena, Germany; Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University, Jena, Germany
| | - Rickmer Braren
- Institute for Diagnostic and Interventional Radiology, School of Medicine, TUM, Munich, Germany
| | - Daniel Rueckert
- Institute for Artificial Intelligence in Medicine & Healthcare, School of Medicine, TUM, Munich, Germany; Department of Computing, Imperial College London, London, UK; Chair for Artificial Intelligence in Medicine and Healthcare, School of Medicine and School of Computation, Information and Technology, Klinikum rechts der Isar, TUM, Munich, Germany
| | - Percy A Knolle
- Institute of Molecular Immunology, School of Medicine, Technical University of Munich (TUM), Munich, Germany; Institute of Molecular Immunology, School of Life Science, TUM, Freising, Germany; German Center for Infection Research, Munich site, Munich, Germany
| | - Georgios Kaissis
- Institute for Artificial Intelligence in Medicine & Healthcare, School of Medicine, TUM, Munich, Germany; Institute for Diagnostic and Interventional Radiology, School of Medicine, TUM, Munich, Germany; Department of Computing, Imperial College London, London, UK
| | - Jan P Böttcher
- Institute of Molecular Immunology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.
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11
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Hesse F, Ritter J, Hapfelmeier A, Braren R, Phillip V. Comparison of Magnetic Resonance Imaging and Endoscopic Ultrasound in the Sizing of Intraductal Papillary Mucinous Neoplasia of the Pancreas. Pancreas 2023; 52:e315-e320. [PMID: 37906550 DOI: 10.1097/mpa.0000000000002264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVES Because IPMNs are potentially malignant, surveillance of IPMN is recommended by magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). The aim of the study was the evaluation of the concordance between EUS and MRI regarding cyst size. METHODS Retrospective data analysis was done for patients with IPMN in whom EUS and MRI were performed simultaneously (≤60 days). The measured cyst size of both procedures was compared by Bland-Altman plots. Agreement of cyst localization and dilation of main pancreatic duct was assessed using kappa statistics. RESULTS Fifty-nine cases were evaluated (median age, 71 years; 65% female; median time interval between both investigations, 17 days). The mean difference of IPMN maximal diameter between EUS and MRI was 0.55 mm with a prediction interval of -9.20 to +10.29 mm for 95% of the expected differences. There was strong interobserver agreement regarding cyst localization ( κ = 0.669, P = 1.06e -13 ) and the width of main pancreatic duct (<5, 5-9, and ≥10 mm; κ = 0.676 caput, κ = 0.823 corpus). CONCLUSIONS We found a clinically relevant difference in cyst size comparing EUS and MRI. Therefore, alternating EUS and MRI for follow-up of the "worrisome feature" size growth is not reasonable.
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Affiliation(s)
| | - Jessica Ritter
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Health, Department Clinical Medicine, University Hospital rechts der Isar
| | | | - Rickmer Braren
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Health, Department Clinical Medicine, University Hospital rechts der Isar
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12
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Schulz D, Rasch S, Heilmaier M, Abbassi R, Poszler A, Ulrich J, Steinhardt M, Kaissis GA, Schmid RM, Braren R, Lahmer T. A deep learning model enables accurate prediction and quantification of pulmonary edema from chest X-rays. Crit Care 2023; 27:201. [PMID: 37237287 DOI: 10.1186/s13054-023-04426-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/02/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND A quantitative assessment of pulmonary edema is important because the clinical severity can range from mild impairment to life threatening. A quantitative surrogate measure, although invasive, for pulmonary edema is the extravascular lung water index (EVLWI) extracted from the transpulmonary thermodilution (TPTD). Severity of edema from chest X-rays, to date is based on the subjective classification of radiologists. In this work, we use machine learning to quantitatively predict the severity of pulmonary edema from chest radiography. METHODS We retrospectively included 471 X-rays from 431 patients who underwent chest radiography and TPTD measurement within 24 h at our intensive care unit. The EVLWI extracted from the TPTD was used as a quantitative measure for pulmonary edema. We used a deep learning approach and binned the data into two, three, four and five classes increasing the resolution of the EVLWI prediction from the X-rays. RESULTS The accuracy, area under the receiver operating characteristic curve (AUROC) and Mathews correlation coefficient (MCC) in the binary classification models (EVLWI < 15, ≥ 15) were 0.93 (accuracy), 0.98 (AUROC) and 0.86(MCC). In the three multiclass models, the accuracy ranged between 0.90 and 0.95, the AUROC between 0.97 and 0.99 and the MCC between 0.86 and 0.92. CONCLUSION Deep learning can quantify pulmonary edema as measured by EVLWI with high accuracy.
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Affiliation(s)
- Dominik Schulz
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Munich, Germany.
- III. Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany.
| | - Sebastian Rasch
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Munich, Germany
| | - Markus Heilmaier
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Munich, Germany
| | - Rami Abbassi
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Munich, Germany
| | - Alexander Poszler
- Innere Medizin - Gastroenterologie, Krankenhaus Agatharied, Hausham, Germany
| | - Jörg Ulrich
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Munich, Germany
| | - Manuel Steinhardt
- Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georgios A Kaissis
- Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Roland M Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Munich, Germany
| | - Rickmer Braren
- Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Tobias Lahmer
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Munich, Germany
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Skinner JG, Topping GJ, Nagel L, Heid I, Hundshammer C, Grashei M, van Heijster FHA, Braren R, Schilling F. Spectrally selective bSSFP using off-resonant RF excitations permits high spatiotemporal resolution 3D metabolic imaging of hyperpolarized [1- 13 C]Pyruvate-to-[1- 13 C]lactate conversion. Magn Reson Med 2023. [PMID: 37093981 DOI: 10.1002/mrm.29676] [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: 11/23/2022] [Revised: 02/24/2023] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE To develop a high spatiotemporal resolution 3D dynamic pulse sequence for preclinical imaging of hyperpolarized [1-13 C]pyruvate-to-[1-13 C]lactate metabolism at 7T. METHODS A standard 3D balanced SSFP (bSSFP) sequence was modified to enable alternating-frequency excitations. RF pulses with 2.33 ms duration and 900 Hz FWHM were placed off-resonance of the target metabolites, [1-13 C]pyruvate (by approximately -245 Hz) and [1-13 C]lactate (by approximately 735 Hz), to selectively excite those resonances. Relatively broad bandwidth (compared to those metabolites' chemical shift offset) permits a short TR of 6.29 ms, enabling higher spatiotemporal resolution. Bloch equation simulations of the bSSFP response profile guided the sequence parameter selection to minimize spectral contamination between metabolites and preserve magnetization over time. RESULTS Bloch equation simulations, phantom studies, and in vivo studies demonstrated that the two target resonances could be cleanly imaged without substantial bSSFP banding artifacts and with little spectral contamination between lactate and pyruvate and from pyruvate hydrate. High spatiotemporal resolution 3D images were acquired of in vivo pyruvate-lactate metabolism in healthy wild-type and endogenous pancreatic tumor-bearing mice, with 1.212 s acquisition time per single-metabolite image and (1.75 mm)3 isotropic voxels with full mouse abdomen 56 × 28 × 21 mm3 FOV and fully-sampled k-space. Kidney and tumor lactate/pyruvate ratios of two consecutive measurements in one animal, 1 h apart, were consistent. CONCLUSION Spectrally selective bSSFP using off-resonant RF excitations can provide high spatio-temporal resolution 3D dynamic images of pyruvate-lactate metabolic conversion.
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Affiliation(s)
- Jason G Skinner
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Geoffrey J Topping
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Luca Nagel
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Irina Heid
- Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Hundshammer
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martin Grashei
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Frits H A van Heijster
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rickmer Braren
- Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Franz Schilling
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, Munich, Germany
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14
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Maier D, Vehreschild JJ, Uhl B, Meyer S, Berger-Thürmel K, Boerries M, Braren R, Grünwald V, Hadaschik B, Palm S, Singer S, Stuschke M, Juárez D, Delpy P, Lambarki M, Hummel M, Engels C, Andreas S, Gökbuget N, Ihrig K, Burock S, Keune D, Eggert A, Keilholz U, Schulz H, Büttner D, Löck S, Krause M, Esins M, Ressing F, Schuler M, Brandts C, Brucker DP, Husmann G, Oellerich T, Metzger P, Voigt F, Illert AL, Theobald M, Kindler T, Sudhof U, Reckmann A, Schwinghammer F, Nasseh D, Weichert W, von Bergwelt-Baildon M, Bitzer M, Malek N, Öner Ö, Schulze-Osthoff K, Bartels S, Haier J, Ammann R, Schmidt AF, Guenther B, Janning M, Kasper B, Loges S, Stilgenbauer S, Kuhn P, Tausch E, Runow S, Kerscher A, Neumann M, Breu M, Lablans M, Serve H. Profile of the multicenter cohort of the German Cancer Consortium's Clinical Communication Platform. Eur J Epidemiol 2023; 38:573-586. [PMID: 37017830 PMCID: PMC10073785 DOI: 10.1007/s10654-023-00990-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/09/2023] [Indexed: 04/06/2023]
Abstract
Treatment concepts in oncology are becoming increasingly personalized and diverse. Successively, changes in standards of care mandate continuous monitoring of patient pathways and clinical outcomes based on large, representative real-world data. The German Cancer Consortium's (DKTK) Clinical Communication Platform (CCP) provides such opportunity. Connecting fourteen university hospital-based cancer centers, the CCP relies on a federated IT-infrastructure sourcing data from facility-based cancer registry units and biobanks. Federated analyses resulted in a cohort of 600,915 patients, out of which 232,991 were incident since 2013 and for which a comprehensive documentation is available. Next to demographic data (i.e., age at diagnosis: 2.0% 0-20 years, 8.3% 21-40 years, 30.9% 41-60 years, 50.1% 61-80 years, 8.8% 81+ years; and gender: 45.2% female, 54.7% male, 0.1% other) and diagnoses (five most frequent tumor origins: 22,523 prostate, 18,409 breast, 15,575 lung, 13,964 skin/malignant melanoma, 9005 brain), the cohort dataset contains information about therapeutic interventions and response assessments and is connected to 287,883 liquid and tissue biosamples. Focusing on diagnoses and therapy-sequences, showcase analyses of diagnosis-specific sub-cohorts (pancreas, larynx, kidney, thyroid gland) demonstrate the analytical opportunities offered by the cohort's data. Due to its data granularity and size, the cohort is a potential catalyst for translational cancer research. It provides rapid access to comprehensive patient groups and may improve the understanding of the clinical course of various (even rare) malignancies. Therefore, the cohort may serve as a decisions-making tool for clinical trial design and contributes to the evaluation of scientific findings under real-world conditions.
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Affiliation(s)
- Daniel Maier
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jörg Janne Vehreschild
- University Hospital Frankfurt, Frankfurt, Germany.
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany.
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
| | - Barbara Uhl
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sandra Meyer
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Karin Berger-Thürmel
- University Hospital Munich, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melanie Boerries
- Faculty of Medicine, Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rickmer Braren
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- School of Medicine, Technical University Munich, Munich, Germany
| | - Viktor Grünwald
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Boris Hadaschik
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan Palm
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Susanne Singer
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Cancer Consortium (DKTK), Partner Site Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Stuschke
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Juárez
- German Cancer Research Center (DKFZ), Federated Information Systems, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pierre Delpy
- German Cancer Research Center (DKFZ), Federated Information Systems, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mohamed Lambarki
- German Cancer Research Center (DKFZ), Federated Information Systems, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hummel
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Cäcilia Engels
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefanie Andreas
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicola Gökbuget
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kristina Ihrig
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Susen Burock
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dietmar Keune
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Angelika Eggert
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrich Keilholz
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hagen Schulz
- University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Büttner
- University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Steffen Löck
- University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mechthild Krause
- University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mirko Esins
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Frank Ressing
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martin Schuler
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Brandts
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel P Brucker
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gabriele Husmann
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Oellerich
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patrick Metzger
- Faculty of Medicine, Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frederik Voigt
- Faculty of Medicine, Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna L Illert
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Medicine I, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Matthias Theobald
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Cancer Consortium (DKTK), Partner Site Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Kindler
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Cancer Consortium (DKTK), Partner Site Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ursula Sudhof
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Achim Reckmann
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Cancer Consortium (DKTK), Partner Site Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Schwinghammer
- University Hospital Munich, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Nasseh
- University Hospital Munich, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wilko Weichert
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- School of Medicine, Technical University Munich, Munich, Germany
| | - Michael von Bergwelt-Baildon
- University Hospital Munich, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Bitzer
- Center for Personalized Medicine, Eberhard-Karls University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nisar Malek
- Center for Personalized Medicine, Eberhard-Karls University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Öznur Öner
- Center for Personalized Medicine, Eberhard-Karls University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Klaus Schulze-Osthoff
- Center for Personalized Medicine, Eberhard-Karls University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan Bartels
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Haier
- Comprehensive Cancer Center Hannover (Claudia von Schilling-Zentrum), Hannover Medical School, Hannover, Germany
| | - Raimund Ammann
- Comprehensive Cancer Center Hannover (Claudia von Schilling-Zentrum), Hannover Medical School, Hannover, Germany
| | - Anja Franziska Schmidt
- Comprehensive Cancer Center Hannover (Claudia von Schilling-Zentrum), Hannover Medical School, Hannover, Germany
| | - Bernd Guenther
- Comprehensive Cancer Center Hannover (Claudia von Schilling-Zentrum), Hannover Medical School, Hannover, Germany
| | - Melanie Janning
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
- Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
- Department of Personalized Medical Oncology (A420), DKFZ German Cancer Research Center, Heidelberg, Germany
| | - Bernd Kasper
- Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Sonja Loges
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
- Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
- Department of Personalized Medical Oncology (A420), DKFZ German Cancer Research Center, Heidelberg, Germany
| | | | - Peter Kuhn
- Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | | | | | | | | | - Martin Breu
- University Hospital of Würzburg, Würzburg, Germany
| | - Martin Lablans
- German Cancer Research Center (DKFZ), Federated Information Systems, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hubert Serve
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Frankfurt Cancer Institute, Frankfurt, Germany
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15
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Bilic P, Christ P, Li HB, Vorontsov E, Ben-Cohen A, Kaissis G, Szeskin A, Jacobs C, Mamani GEH, Chartrand G, Lohöfer F, Holch JW, Sommer W, Hofmann F, Hostettler A, Lev-Cohain N, Drozdzal M, Amitai MM, Vivanti R, Sosna J, Ezhov I, Sekuboyina A, Navarro F, Kofler F, Paetzold JC, Shit S, Hu X, Lipková J, Rempfler M, Piraud M, Kirschke J, Wiestler B, Zhang Z, Hülsemeyer C, Beetz M, Ettlinger F, Antonelli M, Bae W, Bellver M, Bi L, Chen H, Chlebus G, Dam EB, Dou Q, Fu CW, Georgescu B, Giró-I-Nieto X, Gruen F, Han X, Heng PA, Hesser J, Moltz JH, Igel C, Isensee F, Jäger P, Jia F, Kaluva KC, Khened M, Kim I, Kim JH, Kim S, Kohl S, Konopczynski T, Kori A, Krishnamurthi G, Li F, Li H, Li J, Li X, Lowengrub J, Ma J, Maier-Hein K, Maninis KK, Meine H, Merhof D, Pai A, Perslev M, Petersen J, Pont-Tuset J, Qi J, Qi X, Rippel O, Roth K, Sarasua I, Schenk A, Shen Z, Torres J, Wachinger C, Wang C, Weninger L, Wu J, Xu D, Yang X, Yu SCH, Yuan Y, Yue M, Zhang L, Cardoso J, Bakas S, Braren R, Heinemann V, Pal C, Tang A, Kadoury S, Soler L, van Ginneken B, Greenspan H, Joskowicz L, Menze B. The Liver Tumor Segmentation Benchmark (LiTS). Med Image Anal 2023; 84:102680. [PMID: 36481607 PMCID: PMC10631490 DOI: 10.1016/j.media.2022.102680] [Citation(s) in RCA: 61] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 09/27/2022] [Accepted: 10/29/2022] [Indexed: 11/18/2022]
Abstract
In this work, we report the set-up and results of the Liver Tumor Segmentation Benchmark (LiTS), which was organized in conjunction with the IEEE International Symposium on Biomedical Imaging (ISBI) 2017 and the International Conferences on Medical Image Computing and Computer-Assisted Intervention (MICCAI) 2017 and 2018. The image dataset is diverse and contains primary and secondary tumors with varied sizes and appearances with various lesion-to-background levels (hyper-/hypo-dense), created in collaboration with seven hospitals and research institutions. Seventy-five submitted liver and liver tumor segmentation algorithms were trained on a set of 131 computed tomography (CT) volumes and were tested on 70 unseen test images acquired from different patients. We found that not a single algorithm performed best for both liver and liver tumors in the three events. The best liver segmentation algorithm achieved a Dice score of 0.963, whereas, for tumor segmentation, the best algorithms achieved Dices scores of 0.674 (ISBI 2017), 0.702 (MICCAI 2017), and 0.739 (MICCAI 2018). Retrospectively, we performed additional analysis on liver tumor detection and revealed that not all top-performing segmentation algorithms worked well for tumor detection. The best liver tumor detection method achieved a lesion-wise recall of 0.458 (ISBI 2017), 0.515 (MICCAI 2017), and 0.554 (MICCAI 2018), indicating the need for further research. LiTS remains an active benchmark and resource for research, e.g., contributing the liver-related segmentation tasks in http://medicaldecathlon.com/. In addition, both data and online evaluation are accessible via https://competitions.codalab.org/competitions/17094.
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Affiliation(s)
- Patrick Bilic
- Department of Informatics, Technical University of Munich, Germany
| | - Patrick Christ
- Department of Informatics, Technical University of Munich, Germany
| | - Hongwei Bran Li
- Department of Informatics, Technical University of Munich, Germany; Department of Quantitative Biomedicine, University of Zurich, Switzerland.
| | | | - Avi Ben-Cohen
- Department of Biomedical Engineering, Tel-Aviv University, Israel
| | - Georgios Kaissis
- Institute for AI in Medicine, Technical University of Munich, Germany; Institute for diagnostic and interventional radiology, Klinikum rechts der Isar, Technical University of Munich, Germany; Department of Computing, Imperial College London, London, United Kingdom
| | - Adi Szeskin
- School of Computer Science and Engineering, the Hebrew University of Jerusalem, Israel
| | - Colin Jacobs
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Gabriel Chartrand
- The University of Montréal Hospital Research Centre (CRCHUM) Montréal, Québec, Canada
| | - Fabian Lohöfer
- Institute for diagnostic and interventional radiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Julian Walter Holch
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Comprehensive Cancer Center Munich, Munich, Germany; Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wieland Sommer
- Department of Radiology, University Hospital, LMU Munich, Germany
| | - Felix Hofmann
- Department of General, Visceral and Transplantation Surgery, University Hospital, LMU Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Germany
| | - Alexandre Hostettler
- Department of Surgical Data Science, Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), France
| | - Naama Lev-Cohain
- Department of Radiology, Hadassah University Medical Center, Jerusalem, Israel
| | | | | | | | - Jacob Sosna
- Department of Radiology, Hadassah University Medical Center, Jerusalem, Israel
| | - Ivan Ezhov
- Department of Informatics, Technical University of Munich, Germany
| | - Anjany Sekuboyina
- Department of Informatics, Technical University of Munich, Germany; Department of Quantitative Biomedicine, University of Zurich, Switzerland
| | - Fernando Navarro
- Department of Informatics, Technical University of Munich, Germany; Department of Radiation Oncology and Radiotherapy, Klinikum rechts der Isar, Technical University of Munich, Germany; TranslaTUM - Central Institute for Translational Cancer Research, Technical University of Munich, Germany
| | - Florian Kofler
- Department of Informatics, Technical University of Munich, Germany; Institute for diagnostic and interventional neuroradiology, Klinikum rechts der Isar,Technical University of Munich, Germany; Helmholtz AI, Helmholtz Zentrum München, Neuherberg, Germany; TranslaTUM - Central Institute for Translational Cancer Research, Technical University of Munich, Germany
| | - Johannes C Paetzold
- Department of Computing, Imperial College London, London, United Kingdom; Institute for Tissue Engineering and Regenerative Medicine, Helmholtz Zentrum München, Neuherberg, Germany
| | - Suprosanna Shit
- Department of Informatics, Technical University of Munich, Germany
| | - Xiaobin Hu
- Department of Informatics, Technical University of Munich, Germany
| | - Jana Lipková
- Brigham and Women's Hospital, Harvard Medical School, USA
| | - Markus Rempfler
- Department of Informatics, Technical University of Munich, Germany
| | - Marie Piraud
- Department of Informatics, Technical University of Munich, Germany; Helmholtz AI, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jan Kirschke
- Institute for diagnostic and interventional neuroradiology, Klinikum rechts der Isar,Technical University of Munich, Germany
| | - Benedikt Wiestler
- Institute for diagnostic and interventional neuroradiology, Klinikum rechts der Isar,Technical University of Munich, Germany
| | - Zhiheng Zhang
- Department of Hepatobiliary Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | | | - Marcel Beetz
- Department of Informatics, Technical University of Munich, Germany
| | | | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | | | - Lei Bi
- School of Computer Science, the University of Sydney, Australia
| | - Hao Chen
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, China
| | - Grzegorz Chlebus
- Fraunhofer MEVIS, Bremen, Germany; Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik B Dam
- Department of Computer Science, University of Copenhagen, Denmark
| | - Qi Dou
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Wing Fu
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Xavier Giró-I-Nieto
- Signal Theory and Communications Department, Universitat Politecnica de Catalunya, Catalonia, Spain
| | - Felix Gruen
- Institute of Control Engineering, Technische Universität Braunschweig, Germany
| | - Xu Han
- Department of computer science, UNC Chapel Hill, USA
| | - Pheng-Ann Heng
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Jürgen Hesser
- Mannheim Institute for Intelligent Systems in Medicine, department of Medicine Mannheim, Heidelberg University, Germany; Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, Germany; Central Institute for Computer Engineering (ZITI), Heidelberg University, Germany
| | | | - Christian Igel
- Department of Computer Science, University of Copenhagen, Denmark
| | - Fabian Isensee
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany; Helmholtz Imaging, Germany
| | - Paul Jäger
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany; Helmholtz Imaging, Germany
| | - Fucang Jia
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, China
| | - Krishna Chaitanya Kaluva
- Medical Imaging and Reconstruction Lab, Department of Engineering Design, Indian Institute of Technology Madras, India
| | - Mahendra Khened
- Medical Imaging and Reconstruction Lab, Department of Engineering Design, Indian Institute of Technology Madras, India
| | | | - Jae-Hun Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea
| | | | - Simon Kohl
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tomasz Konopczynski
- Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, Germany
| | - Avinash Kori
- Medical Imaging and Reconstruction Lab, Department of Engineering Design, Indian Institute of Technology Madras, India
| | - Ganapathy Krishnamurthi
- Medical Imaging and Reconstruction Lab, Department of Engineering Design, Indian Institute of Technology Madras, India
| | - Fan Li
- Sensetime, Shanghai, China
| | - Hongchao Li
- Department of Computer Science, Guangdong University of Foreign Studies, China
| | - Junbo Li
- Philips Research China, Philips China Innovation Campus, Shanghai, China
| | - Xiaomeng Li
- Department of Electrical and Electronic Engineering, The University of Hong Kong, China
| | - John Lowengrub
- Departments of Mathematics, Biomedical Engineering, University of California, Irvine, USA; Center for Complex Biological Systems, University of California, Irvine, USA; Chao Family Comprehensive Cancer Center, University of California, Irvine, USA
| | - Jun Ma
- Department of Mathematics, Nanjing University of Science and Technology, China
| | - Klaus Maier-Hein
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany; Helmholtz Imaging, Germany
| | | | - Hans Meine
- Fraunhofer MEVIS, Bremen, Germany; Medical Image Computing Group, FB3, University of Bremen, Germany
| | - Dorit Merhof
- Institute of Imaging & Computer Vision, RWTH Aachen University, Germany
| | - Akshay Pai
- Department of Computer Science, University of Copenhagen, Denmark
| | - Mathias Perslev
- Department of Computer Science, University of Copenhagen, Denmark
| | - Jens Petersen
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jordi Pont-Tuset
- Eidgenössische Technische Hochschule Zurich (ETHZ), Zurich, Switzerland
| | - Jin Qi
- School of Information and Communication Engineering, University of Electronic Science and Technology of China, China
| | - Xiaojuan Qi
- Department of Electrical and Electronic Engineering, The University of Hong Kong, China
| | - Oliver Rippel
- Institute of Imaging & Computer Vision, RWTH Aachen University, Germany
| | | | - Ignacio Sarasua
- Institute for diagnostic and interventional radiology, Klinikum rechts der Isar, Technical University of Munich, Germany; Department of Child and Adolescent Psychiatry, Ludwig-Maximilians-Universität, Munich, Germany
| | - Andrea Schenk
- Fraunhofer MEVIS, Bremen, Germany; Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Zengming Shen
- Beckman Institute, University of Illinois at Urbana-Champaign, USA; Siemens Healthineers, USA
| | - Jordi Torres
- Barcelona Supercomputing Center, Barcelona, Spain; Universitat Politecnica de Catalunya, Catalonia, Spain
| | - Christian Wachinger
- Department of Informatics, Technical University of Munich, Germany; Institute for diagnostic and interventional radiology, Klinikum rechts der Isar, Technical University of Munich, Germany; Department of Child and Adolescent Psychiatry, Ludwig-Maximilians-Universität, Munich, Germany
| | - Chunliang Wang
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Sweden
| | - Leon Weninger
- Institute of Imaging & Computer Vision, RWTH Aachen University, Germany
| | - Jianrong Wu
- Tencent Healthcare (Shenzhen) Co., Ltd, China
| | | | - Xiaoping Yang
- Department of Mathematics, Nanjing University, China
| | - Simon Chun-Ho Yu
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, China
| | - Yading Yuan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Miao Yue
- CGG Services (Singapore) Pte. Ltd., Singapore
| | - Liping Zhang
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, China
| | - Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, USA; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - Rickmer Braren
- German Cancer Consortium (DKTK), Germany; Institute for diagnostic and interventional radiology, Klinikum rechts der Isar, Technical University of Munich, Germany; Comprehensive Cancer Center Munich, Munich, Germany
| | - Volker Heinemann
- Department of Hematology/Oncology & Comprehensive Cancer Center Munich, LMU Klinikum Munich, Germany
| | | | - An Tang
- Department of Radiology, Radiation Oncology and Nuclear Medicine, University of Montréal, Canada
| | | | - Luc Soler
- Department of Surgical Data Science, Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), France
| | - Bram van Ginneken
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hayit Greenspan
- Department of Biomedical Engineering, Tel-Aviv University, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, the Hebrew University of Jerusalem, Israel
| | - Bjoern Menze
- Department of Informatics, Technical University of Munich, Germany; Department of Quantitative Biomedicine, University of Zurich, Switzerland
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16
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Ziegelmayer S, Reischl S, Havrda H, Gawlitza J, Graf M, Lenhart N, Nehls N, Lemke T, Wilhelm D, Lohöfer F, Burian E, Neumann PA, Makowski M, Braren R. Development and Validation of a Deep Learning Algorithm to Differentiate Colon Carcinoma From Acute Diverticulitis in Computed Tomography Images. JAMA Netw Open 2023; 6:e2253370. [PMID: 36705919 DOI: 10.1001/jamanetworkopen.2022.53370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Differentiating between malignant and benign etiology in large-bowel wall thickening on computed tomography (CT) images can be a challenging task. Artificial intelligence (AI) support systems can improve the diagnostic accuracy of radiologists, as shown for a variety of imaging tasks. Improvements in diagnostic performance, in particular the reduction of false-negative findings, may be useful in patient care. OBJECTIVE To develop and evaluate a deep learning algorithm able to differentiate colon carcinoma (CC) and acute diverticulitis (AD) on CT images and analyze the impact of the AI-support system in a reader study. DESIGN, SETTING, AND PARTICIPANTS In this diagnostic study, patients who underwent surgery between July 1, 2005, and October 1, 2020, for CC or AD were included. Three-dimensional (3-D) bounding boxes including the diseased bowel segment and surrounding mesentery were manually delineated and used to develop a 3-D convolutional neural network (CNN). A reader study with 10 observers of different experience levels was conducted. Readers were asked to classify the testing cohort under reading room conditions, first without and then with algorithmic support. MAIN OUTCOMES AND MEASURES To evaluate the diagnostic performance, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for all readers and reader groups with and without AI support. Metrics were compared using the McNemar test and relative and absolute predictive value comparisons. RESULTS A total of 585 patients (AD: n = 267, CC: n = 318; mean [SD] age, 63.2 [13.4] years; 341 men [58.3%]) were included. The 3-D CNN reached a sensitivity of 83.3% (95% CI, 70.0%-96.6%) and specificity of 86.6% (95% CI, 74.5%-98.8%) for the test set, compared with the mean reader sensitivity of 77.6% (95% CI, 72.9%-82.3%) and specificity of 81.6% (95% CI, 77.2%-86.1%). The combined group of readers improved significantly with AI support from a sensitivity of 77.6% to 85.6% (95% CI, 81.3%-89.3%; P < .001) and a specificity of 81.6% to 91.3% (95% CI, 88.1%-94.5%; P < .001). Artificial intelligence support significantly reduced the number of false-negative and false-positive findings (NPV from 78.5% to 86.4% and PPV from 80.9% to 90.8%; P < .001). CONCLUSIONS AND RELEVANCE The findings of this study suggest that a deep learning model able to distinguish CC and AD in CT images as a support system may significantly improve the diagnostic performance of radiologists, which may improve patient care.
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Affiliation(s)
- Sebastian Ziegelmayer
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Stefan Reischl
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Hannah Havrda
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Joshua Gawlitza
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Markus Graf
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Nicolas Lenhart
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Nadja Nehls
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Tristan Lemke
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, Technical University of Munich, School of Medicine, Munich, Germany
| | - Fabian Lohöfer
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Egon Burian
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | | | - Marcus Makowski
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Rickmer Braren
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
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17
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Heid I, Münch C, Karakaya S, Lueong SS, Winkelkotte AM, Liffers ST, Godfrey L, Cheung PFY, Savvatakis K, Topping GJ, Englert F, Kritzner L, Grashei M, Tannapfel A, Viebahn R, Wolters H, Uhl W, Vangala D, Smeets EMM, Aarntzen EHJG, Rauh D, Weichert W, Hoheisel JD, Hahn SA, Schilling F, Braren R, Trajkovic-Arsic M, Siveke JT. Functional noninvasive detection of glycolytic pancreatic ductal adenocarcinoma. Cancer Metab 2022; 10:24. [PMID: 36494842 PMCID: PMC9737747 DOI: 10.1186/s40170-022-00298-5] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) lacks effective treatment options beyond chemotherapy. Although molecular subtypes such as classical and QM (quasi-mesenchymal)/basal-like with transcriptome-based distinct signatures have been identified, deduced therapeutic strategies and targets remain elusive. Gene expression data show enrichment of glycolytic genes in the more aggressive and therapy-resistant QM subtype. However, whether the glycolytic transcripts are translated into functional glycolysis that could further be explored for metabolic targeting in QM subtype is still not known. METHODS We used different patient-derived PDAC model systems (conventional and primary patient-derived cells, patient-derived xenografts (PDX), and patient samples) and performed transcriptional and functional metabolic analysis. These included RNAseq and Illumina HT12 bead array, in vitro Seahorse metabolic flux assays and metabolic drug targeting, and in vivo hyperpolarized [1-13C]pyruvate and [1-13C]lactate magnetic resonance spectroscopy (HP-MRS) in PDAC xenografts. RESULTS We found that glycolytic metabolic dependencies are not unambiguously functionally exposed in all QM PDACs. Metabolic analysis demonstrated functional metabolic heterogeneity in patient-derived primary cells and less so in conventional cell lines independent of molecular subtype. Importantly, we observed that the glycolytic product lactate is actively imported into the PDAC cells and used in mitochondrial oxidation in both classical and QM PDAC cells, although more actively in the QM cell lines. By using HP-MRS, we were able to noninvasively identify highly glycolytic PDAC xenografts by detecting the last glycolytic enzymatic step and prominent intra-tumoral [1-13C]pyruvate and [1-13C]lactate interconversion in vivo. CONCLUSION Our study adds functional metabolic phenotyping to transcriptome-based analysis and proposes a functional approach to identify highly glycolytic PDACs as candidates for antimetabolic therapeutic avenues.
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Affiliation(s)
- Irina Heid
- grid.6936.a0000000123222966Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Corinna Münch
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Sinan Karakaya
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Smiths S. Lueong
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Alina M. Winkelkotte
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Sven T. Liffers
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Laura Godfrey
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Phyllis F. Y. Cheung
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Konstantinos Savvatakis
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Geoffrey J. Topping
- grid.6936.a0000000123222966Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Englert
- grid.6936.a0000000123222966Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lukas Kritzner
- grid.6936.a0000000123222966Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martin Grashei
- grid.6936.a0000000123222966Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andrea Tannapfel
- grid.5570.70000 0004 0490 981XInstitute of Pathology, Ruhr University of Bochum, Bochum, Germany
| | - Richard Viebahn
- grid.5570.70000 0004 0490 981XDepartment of Surgery, Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Heiner Wolters
- grid.416438.cDepartment of Visceral and General Surgery, St. Josef-Hospital, Dortmund, Germany
| | - Waldemar Uhl
- grid.416438.cClinic for General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Deepak Vangala
- grid.5570.70000 0004 0490 981XDepartment of Medicine, Ruhr University Bochum, University Hospital Knappschaftskrankenhaus Bochum GmbH, Bochum, Germany
| | - Esther M. M. Smeets
- grid.10417.330000 0004 0444 9382Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik H. J. G. Aarntzen
- grid.10417.330000 0004 0444 9382Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniel Rauh
- grid.5675.10000 0001 0416 9637Faculty of Chemistry and Chemical Biology, TU Dortmund University, Dortmund, Germany ,Drug Discovery Hub Dortmund (DDHD) Am Zentrum Für Integrierte Wirkstoffforschung (ZIW), Dortmund, Germany
| | - Wilko Weichert
- grid.6936.a0000000123222966Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany ,Comprehensive Cancer Center Munich (CCCM), Munich, Germany
| | - Jörg D. Hoheisel
- grid.7497.d0000 0004 0492 0584Division of Functional Genome Analysis, German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Stephan A. Hahn
- grid.5570.70000 0004 0490 981XDepartment of Molecular GI Oncology, Faculty of Medicine, Ruhr University Bochum, 44780 Bochum, Germany
| | - Franz Schilling
- grid.6936.a0000000123222966Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rickmer Braren
- grid.6936.a0000000123222966Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Marija Trajkovic-Arsic
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
| | - Jens T. Siveke
- grid.5718.b0000 0001 2187 5445West German Cancer Center, Bridge Institute of Experimental Tumor Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,grid.7497.d0000 0004 0492 0584Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany ,German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
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18
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Bohrer P, Lohöfer F, Werner J, Braren R, Kronenberg K, Paprottka P. Entwicklung eines präklinischen Tiermodells zur Evaluation von Bildgebung und interventioneller Tumortherapie im HCC. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- P Bohrer
- Klinikum rechts der Isar, Institut für diagnostische und interventionelle Radiologie, München
| | - F Lohöfer
- Institut für diagnostische und interventionelle Radiologie TU München, Klinikum rechts der isar der TU München, München
| | - J Werner
- Institut für diagnostische und interventionelle Radiologie TU München, Klinikum rechts der isar der TU München, München
| | - R Braren
- Institut für diagnostische und interventionelle Radiologie TU München, Klinikum rechts der isar der TU München, München
| | - K Kronenberg
- Institut für Analytische und anorganische Chemie Universität Münster, Münster
| | - P Paprottka
- Institut für diagnostische und interventionelle Rdiologie TU München, Klinikum rechts der Isar der TU München, München
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19
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Dou Q, So TY, Jiang M, Liu Q, Vardhanabhuti V, Kaissis G, Li Z, Si W, Lee HHC, Yu K, Feng Z, Dong L, Burian E, Jungmann F, Braren R, Makowski M, Kainz B, Rueckert D, Glocker B, Yu SCH, Heng PA. Author Correction: Federated deep learning for detecting COVID-19 lung abnormalities in CT: a privacy-preserving multinational validation study. NPJ Digit Med 2022; 5:56. [PMID: 35462562 PMCID: PMC9035308 DOI: 10.1038/s41746-022-00600-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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20
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Karabid NM, Wiedemann T, Gulde S, Mohr H, Segaran RC, Geppert J, Rohm M, Vitale G, Gaudenzi G, Dicitore A, Ankerst DP, Chen Y, Braren R, Kaissis G, Schilling F, Schillmaier M, Eisenhofer G, Herzig S, Roncaroli F, Honegger JB, Pellegata NS. Angpt2/Tie2 autostimulatory loop controls tumorigenesis. EMBO Mol Med 2022; 14:e14364. [PMID: 35266635 PMCID: PMC9081903 DOI: 10.15252/emmm.202114364] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 12/27/2022] Open
Abstract
Invasive nonfunctioning (NF) pituitary neuroendocrine tumors (PitNETs) are non‐resectable neoplasms associated with frequent relapses and significant comorbidities. As the current therapies of NF‐PitNETs often fail, new therapeutic targets are needed. The observation that circulating angiopoietin‐2 (ANGPT2) is elevated in patients with NF‐PitNET and correlates with tumor aggressiveness prompted us to investigate the ANGPT2/TIE2 axis in NF‐PitNETs in the GH3 PitNET cell line, primary human NF‐PitNET cells, xenografts in zebrafish and mice, and in MENX rats, the only autochthonous NF‐PitNET model. We show that PitNET cells express a functional TIE2 receptor and secrete bioactive ANGPT2, which promotes, besides angiogenesis, tumor cell growth in an autocrine and paracrine fashion. ANGPT2 stimulation of TIE2 in tumor cells activates downstream cell proliferation signals, as previously demonstrated in endothelial cells (ECs). Tie2 gene deletion blunts PitNETs growth in xenograft models, and pharmacological inhibition of Angpt2/Tie2 signaling antagonizes PitNETs in primary cell cultures, tumor xenografts in mice, and in MENX rats. Thus, the ANGPT2/TIE2 axis provides an exploitable therapeutic target in NF‐PitNETs and possibly in other tumors expressing ANGPT2/TIE2. The ability of tumor cells to coopt angiogenic signals classically viewed as EC‐specific expands our view on the microenvironmental cues that are essential for tumor progression.
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Affiliation(s)
- Ninelia Minaskan Karabid
- Institute for Diabetes and Cancer, Helmholtz Zentrum München, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Wiedemann
- Institute for Diabetes and Cancer, Helmholtz Zentrum München, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Gulde
- Institute for Diabetes and Cancer, Helmholtz Zentrum München, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Heidelberg University Hospital, Heidelberg, Germany
| | - Hermine Mohr
- Institute for Diabetes and Cancer, Helmholtz Zentrum München, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Heidelberg University Hospital, Heidelberg, Germany
| | - Renu Chandra Segaran
- Institute for Diabetes and Cancer, Helmholtz Zentrum München, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Heidelberg University Hospital, Heidelberg, Germany
| | - Julia Geppert
- Institute for Diabetes and Cancer, Helmholtz Zentrum München, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Heidelberg University Hospital, Heidelberg, Germany
| | - Maria Rohm
- Institute for Diabetes and Cancer, Helmholtz Zentrum München, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Heidelberg University Hospital, Heidelberg, Germany
| | - Giovanni Vitale
- Istituto Auxologico Italiano IRCCS, Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Cusano Milanino, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Germano Gaudenzi
- Istituto Auxologico Italiano IRCCS, Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Cusano Milanino, Milan, Italy
| | - Alessandra Dicitore
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | | | - Yiyao Chen
- Department of Mathematics, Technical University Munich, Garching, Germany
| | - Rickmer Braren
- Institute for Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Georg Kaissis
- Institute for Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Franz Schilling
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Mathias Schillmaier
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stephan Herzig
- Institute for Diabetes and Cancer, Helmholtz Zentrum München, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Heidelberg University Hospital, Heidelberg, Germany
| | - Federico Roncaroli
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jürgen B Honegger
- Department of Neurosurgery, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Natalia S Pellegata
- Institute for Diabetes and Cancer, Helmholtz Zentrum München, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Heidelberg University Hospital, Heidelberg, Germany
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21
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Ziegelmayer S, Reischl S, Harder F, Makowski M, Braren R, Gawlitza J. Feature Robustness and Diagnostic Capabilities of Convolutional Neural Networks Against Radiomics Features in Computed Tomography Imaging. Invest Radiol 2022; 57:171-177. [PMID: 34524173 DOI: 10.1097/rli.0000000000000827] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
MATERIALS AND METHODS Imaging phantoms were scanned twice on 3 computed tomography scanners from 2 different manufactures with varying tube voltages and currents. Phantoms were segmented, and features were extracted using PyRadiomics and a pretrained CNN. After standardization the concordance correlation coefficient (CCC), mean feature variance, feature range, and the coefficient of variant were calculated to assess feature robustness. In addition, the cosine similarity was calculated for the vectorized activation maps for an exemplary phantom. For the in vivo comparison, the radiomics and CNN features of 30 patients with hepatocellular carcinoma (HCC) and 30 patients with hepatic colon carcinoma metastasis were compared. RESULTS In total, 851 radiomics features and 256 CNN features were extracted for each phantom. For all phantoms, the global CCC of the CNN features was above 98%, whereas the highest CCC for the radiomics features was 36%. The mean feature variance and feature range was significantly lower for the CNN features. Using a coefficient of variant ≤0.2 as a threshold to define robust features and averaging across all phantoms 346 of 851 (41%) radiomics features and 196 of 256 (77%) CNN features were found to be robust. The cosine similarity was greater than 0.98 for all scanner and parameter variations. In the retrospective analysis, 122 of the 256 CNN (49%) features showed significant differences between HCC and hepatic colon metastasis. DISCUSSION Convolutional neural network features were more stable compared with radiomics features against technical variations. Moreover, the possibility of tumor entity differentiation based on CNN features was shown. Combined with visualization methods, CNN features are expected to increase reproducibility of quantitative image representations. Further studies are warranted to investigate the impact of feature stability on radiological image-based prediction of clinical outcomes.
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Affiliation(s)
- Sebastian Ziegelmayer
- From the Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University Munich
| | - Stefan Reischl
- From the Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University Munich
| | - Felix Harder
- From the Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University Munich
| | - Marcus Makowski
- From the Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University Munich
| | | | - Joshua Gawlitza
- From the Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University Munich
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22
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Peschke K, Jakubowski H, Schäfer A, Maurer C, Lange S, Orben F, Bernad R, Harder F, Eiber M, Öllinger R, Schlitter M, Weichert W, Phillip V, Schlag C, Schmid R, Braren R, Kong B, Demir E, Friess H, Rad R, Saur D, Schneider G, Reichert M. Abstract PO-070: Longitudinal precision oncology platform to identify chemotherapy-induced vulnerabilities in pancreatic cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.panca21-po-070] [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: 11/16/2022]
Abstract
Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains a devastating disease with poor survival rates as almost all patients develop resistance towards chemotherapy and molecular-informed targeted therapies are reserved to a few. Here, we aim to establish a longitudinal precision oncology platform with a multi-dimensional characterization of PDAC biopsies including genomic, transcriptomic as well as functional analyses to identify and exploit treatment-induced vulnerabilities. In order to investigate adaptive processes of tumors under treatment we aimed to generate PDAC patient-derived organoids (PDOs) and 2D cell lines before and after chemotherapy. Therefore, we enrolled a patient with borderline resectable PDAC who received neoadjuvant FOLFIRINOX. Endoscopic fine needle (pre-FFX) and surgical biopsies (post-FFX) were used to generate PDOs and 2D cells. Whole exome sequencing (WES) and RNA sequencing data of the pre-FFX and post-FFX organoids were compared in order to evaluate the genetic landscape and PDAC subtypes. 2D cells were subjected to an unbiased automated drug screening of 415 compounds to investigate FFX-induced vulnerabilities. Top targets were validated manually in the 2D cells and organoids. Although transcriptional subtyping classified both PDOs as classical PDAC, gene set enrichment analysis (GSEA) revealed a reduced pathway activation linked to the basal-like phenotype such as KRAS signaling in the post-FFX organoids. WES did not show major differences in the genetic landscape of the tumor pre- and post-FFX induction suggesting a plasticity process rather than a clonal selection during chemotherapy. Importantly, post-FFX cells exhibited an increased sensitivity in the unbiased drug screening towards MEK and EGFR inhibition compared to pre-FFX cells. 2D cells and organoids were treated with different MEK inhibitors (MEKi) for validation and post-FFX cells showed a highly increased response compared to the treatment-naïve cells, as well. Interestingly, when placed into the context of a panel of 15 primary PDAC cell lines the pre-FFX cells cluster with highly MEKi resistant PDAC cells whereas post-FFX cells belong to the most sensitive cell lines. In sum, integrating functional layers into personalized medicine allowed us to identify chemotherapy-induced vulnerabilities as potent targeted therapy options in PDAC. Thus, this longitudinal precision oncology platform harbors a unique opportunity to understand adaptive processes in tumor evolution and/or treatment-imposed pressure in PDAC patients.
Citation Format: Katja Peschke, Hannah Jakubowski, Arlett Schäfer, Carlo Maurer, Sebastian Lange, Felix Orben, Raquel Bernad, Felix Harder, Matthias Eiber, Rupert Öllinger, Melissa Schlitter, Wilko Weichert, Veit Phillip, Christoph Schlag, Roland Schmid, Rickmer Braren, Bo Kong, Ekin Demir, Helmut Friess, Roland Rad, Dieter Saur, Günter Schneider, Maximilian Reichert. Longitudinal precision oncology platform to identify chemotherapy-induced vulnerabilities in pancreatic cancer [abstract]. In: Proceedings of the AACR Virtual Special Conference on Pancreatic Cancer; 2021 Sep 29-30. Philadelphia (PA): AACR; Cancer Res 2021;81(22 Suppl):Abstract nr PO-070.
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Affiliation(s)
- Katja Peschke
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Hannah Jakubowski
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Arlett Schäfer
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Carlo Maurer
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Sebastian Lange
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Felix Orben
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Raquel Bernad
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Felix Harder
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Matthias Eiber
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Rupert Öllinger
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Melissa Schlitter
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Wilko Weichert
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Veit Phillip
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Christoph Schlag
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Roland Schmid
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Rickmer Braren
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Bo Kong
- 2University of Ulm, Ulm, Germany
| | - Ekin Demir
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Helmut Friess
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Roland Rad
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Dieter Saur
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Günter Schneider
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
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23
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Usynin D, Ziller A, Makowski M, Braren R, Rueckert D, Glocker B, Kaissis G, Passerat-Palmbach J. Adversarial interference and its mitigations in privacy-preserving collaborative machine learning. NAT MACH INTELL 2021. [DOI: 10.1038/s42256-021-00390-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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24
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Scherer J, Nolden M, Kleesiek J, Metzger J, Kades K, Schneider V, Bach M, Sedlaczek O, Bucher AM, Vogl TJ, Grünwald F, Kühn JP, Hoffmann RT, Kotzerke J, Bethge O, Schimmöller L, Antoch G, Müller HW, Daul A, Nikolaou K, la Fougère C, Kunz WG, Ingrisch M, Schachtner B, Ricke J, Bartenstein P, Nensa F, Radbruch A, Umutlu L, Forsting M, Seifert R, Herrmann K, Mayer P, Kauczor HU, Penzkofer T, Hamm B, Brenner W, Kloeckner R, Düber C, Schreckenberger M, Braren R, Kaissis G, Makowski M, Eiber M, Gafita A, Trager R, Weber WA, Neubauer J, Reisert M, Bock M, Bamberg F, Hennig J, Meyer PT, Ruf J, Haberkorn U, Schoenberg SO, Kuder T, Neher P, Floca R, Schlemmer HP, Maier-Hein K. Joint Imaging Platform for Federated Clinical Data Analytics. JCO Clin Cancer Inform 2021; 4:1027-1038. [PMID: 33166197 PMCID: PMC7713526 DOI: 10.1200/cci.20.00045] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Image analysis is one of the most promising applications of artificial intelligence (AI) in health care, potentially improving prediction, diagnosis, and treatment of diseases. Although scientific advances in this area critically depend on the accessibility of large-volume and high-quality data, sharing data between institutions faces various ethical and legal constraints as well as organizational and technical obstacles. METHODS The Joint Imaging Platform (JIP) of the German Cancer Consortium (DKTK) addresses these issues by providing federated data analysis technology in a secure and compliant way. Using the JIP, medical image data remain in the originator institutions, but analysis and AI algorithms are shared and jointly used. Common standards and interfaces to local systems ensure permanent data sovereignty of participating institutions. RESULTS The JIP is established in the radiology and nuclear medicine departments of 10 university hospitals in Germany (DKTK partner sites). In multiple complementary use cases, we show that the platform fulfills all relevant requirements to serve as a foundation for multicenter medical imaging trials and research on large cohorts, including the harmonization and integration of data, interactive analysis, automatic analysis, federated machine learning, and extensibility and maintenance processes, which are elementary for the sustainability of such a platform. CONCLUSION The results demonstrate the feasibility of using the JIP as a federated data analytics platform in heterogeneous clinical information technology and software landscapes, solving an important bottleneck for the application of AI to large-scale clinical imaging data.
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Affiliation(s)
- Jonas Scherer
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany
| | - Marco Nolden
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany.,Pattern Analysis and Learning Group, Radio-oncology and Clinical Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany
| | - Jens Kleesiek
- German Cancer Consortium, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Jasmin Metzger
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany
| | - Klaus Kades
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany
| | - Verena Schneider
- German Cancer Consortium, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Michael Bach
- German Cancer Consortium, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Oliver Sedlaczek
- German Cancer Consortium, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany.,Klinik Diagnostische und Interventionelle Radiologie der Universität Heidelberg, Heidelberg, Germany
| | - Andreas M Bucher
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Thomas J Vogl
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Frank Grünwald
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Jens-Peter Kühn
- German Cancer Consortium, Heidelberg, Germany.,Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Ralf-Thorsten Hoffmann
- German Cancer Consortium, Heidelberg, Germany.,Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Jörg Kotzerke
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Oliver Bethge
- German Cancer Consortium, Heidelberg, Germany.,Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Lars Schimmöller
- German Cancer Consortium, Heidelberg, Germany.,Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- German Cancer Consortium, Heidelberg, Germany.,Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Hans-Wilhelm Müller
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Andreas Daul
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Christian la Fougère
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin und Klinische Molekulare Bildgebung, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Wolfgang G Kunz
- German Cancer Consortium, Heidelberg, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Michael Ingrisch
- German Cancer Consortium, Heidelberg, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Balthasar Schachtner
- German Cancer Consortium, Heidelberg, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,German Center of Lung Research, Giessen, Germany
| | - Jens Ricke
- German Cancer Consortium, Heidelberg, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Peter Bartenstein
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Klinikum der Universität München, München, Germany
| | - Felix Nensa
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen AöR, Essen, Germany
| | - Alexander Radbruch
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen AöR, Essen, Germany
| | - Lale Umutlu
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen AöR, Essen, Germany
| | - Michael Forsting
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen AöR, Essen, Germany
| | - Robert Seifert
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Essen AöR, Essen, Germany
| | - Ken Herrmann
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Essen AöR, Essen, Germany
| | - Philipp Mayer
- German Cancer Consortium, Heidelberg, Germany.,Klinik Diagnostische und Interventionelle Radiologie der Universität Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- German Cancer Consortium, Heidelberg, Germany.,Klinik Diagnostische und Interventionelle Radiologie der Universität Heidelberg, Heidelberg, Germany.,German Center of Lung Research, Giessen, Germany
| | - Tobias Penzkofer
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Radiologie (mit dem Bereich Kinderradiologie), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Radiologie (mit dem Bereich Kinderradiologie), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Winfried Brenner
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Roman Kloeckner
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Mainz, Germany
| | - Christoph Düber
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Mainz, Germany
| | - Mathias Schreckenberger
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | - Rickmer Braren
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Georgios Kaissis
- German Cancer Consortium, Heidelberg, Germany.,Pattern Analysis and Learning Group, Radio-oncology and Clinical Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Computing, Imperial College London, London, United Kingdom
| | - Marcus Makowski
- German Cancer Consortium, Heidelberg, Germany.,Institut für Diagnostische und Interventionelle Radiologie, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andrei Gafita
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rupert Trager
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wolfgang A Weber
- German Cancer Consortium, Heidelberg, Germany.,Klinik und Poliklinik für Nuklearmedizin, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jakob Neubauer
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Marco Reisert
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Michael Bock
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Jürgen Hennig
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Philipp Tobias Meyer
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Juri Ruf
- German Cancer Consortium, Heidelberg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Uwe Haberkorn
- German Cancer Consortium, Heidelberg, Germany.,Klinische Kooperationseinheit Nuklearmedizin, Deutsches Krebsforschungszentrum Heidelberg, Heidelberg, Germany
| | - Stefan O Schoenberg
- German Cancer Consortium, Heidelberg, Germany.,Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Heidelberg, Germany
| | - Tristan Kuder
- German Cancer Consortium, Heidelberg, Germany.,Medizinische Physik in der Radiologie, Deutsches Krebsforschungszentrum Heidelberg, Heidelberg, Germany
| | - Peter Neher
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany
| | - Ralf Floca
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany.,Pattern Analysis and Learning Group, Radio-oncology and Clinical Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Klaus Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.,Pattern Analysis and Learning Group, Radio-oncology and Clinical Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany
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Ballke S, Heid I, Mogler C, Braren R, Schwaiger M, Weichert W, Steiger K. Correlation of in vivo imaging to morphomolecular pathology in translational research: challenge accepted. EJNMMI Res 2021; 11:83. [PMID: 34453623 PMCID: PMC8401369 DOI: 10.1186/s13550-021-00826-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/15/2021] [Indexed: 12/26/2022] Open
Abstract
Correlation of in vivo imaging to histomorphological pathology in animal models requires comparative interdisciplinary expertise of different fields of medicine. From the morphological point of view, there is an urgent need to improve histopathological evaluation in animal model-based research to expedite translation into clinical applications. While different other fields of translational science were standardized over the last years, little was done to improve the pipeline of experimental pathology to ensure reproducibility based on pathological expertise in experimental animal models with respect to defined guidelines and classifications. Additionally, longitudinal analyses of preclinical models often use a variety of imaging methods and much more attention should be drawn to enable for proper co-registration of in vivo imaging methods with the ex vivo morphological read-outs. Here we present the development of the Comparative Experimental Pathology (CEP) unit embedded in the Institute of Pathology of the Technical University of Munich during the Collaborative Research Center 824 (CRC824) funding period together with selected approaches of histomorphological techniques for correlation of in vivo imaging to morphomolecular pathology.
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Affiliation(s)
- Simone Ballke
- School of Medicine, Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Irina Heid
- School of Medicine, Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carolin Mogler
- School of Medicine, Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Rickmer Braren
- School of Medicine, Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Markus Schwaiger
- School of Medicine, Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wilko Weichert
- School of Medicine, Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Katja Steiger
- School of Medicine, Institute of Pathology, Technical University of Munich, Munich, Germany.
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26
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Knolle M, Kaissis G, Jungmann F, Ziegelmayer S, Sasse D, Makowski M, Rueckert D, Braren R. Efficient, high-performance semantic segmentation using multi-scale feature extraction. PLoS One 2021; 16:e0255397. [PMID: 34411138 PMCID: PMC8375977 DOI: 10.1371/journal.pone.0255397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/07/2021] [Accepted: 07/15/2021] [Indexed: 11/19/2022] Open
Abstract
The success of deep learning in recent years has arguably been driven by the availability of large datasets for training powerful predictive algorithms. In medical applications however, the sensitive nature of the data limits the collection and exchange of large-scale datasets. Privacy-preserving and collaborative learning systems can enable the successful application of machine learning in medicine. However, collaborative protocols such as federated learning require the frequent transfer of parameter updates over a network. To enable the deployment of such protocols to a wide range of systems with varying computational performance, efficient deep learning architectures for resource-constrained environments are required. Here we present MoNet, a small, highly optimized neural-network-based segmentation algorithm leveraging efficient multi-scale image features. MoNet is a shallow, U-Net-like architecture based on repeated, dilated convolutions with decreasing dilation rates. We apply and test our architecture on the challenging clinical tasks of pancreatic segmentation in computed tomography (CT) images as well as brain tumor segmentation in magnetic resonance imaging (MRI) data. We assess our model’s segmentation performance and demonstrate that it provides performance on par with compared architectures while providing superior out-of-sample generalization performance, outperforming larger architectures on an independent validation set, while utilizing significantly fewer parameters. We furthermore confirm the suitability of our architecture for federated learning applications by demonstrating a substantial reduction in serialized model storage requirement as a surrogate for network data transfer. Finally, we evaluate MoNet’s inference latency on the central processing unit (CPU) to determine its utility in environments without access to graphics processing units. Our implementation is publicly available as free and open-source software.
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Affiliation(s)
- Moritz Knolle
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Institute for Artificial Intelligence and Informatics in Medicine, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georgios Kaissis
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Institute for Artificial Intelligence and Informatics in Medicine, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- OpenMined
- Department of Computing, Imperial College London, London, United Kingdom
| | - Friederike Jungmann
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sebastian Ziegelmayer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniel Sasse
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus Makowski
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniel Rueckert
- Institute for Artificial Intelligence and Informatics in Medicine, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Computing, Imperial College London, London, United Kingdom
| | - Rickmer Braren
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- * E-mail:
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27
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Ai J, Wörmann SM, Görgülü K, Vallespinos M, Zagorac S, Alcala S, Wu N, Kabacaoglu D, Berninger A, Navarro D, Kaya-Aksoy E, Ruess DA, Ciecielski KJ, Kowalska M, Demir IE, Ceyhan GO, Heid I, Braren R, Riemann M, Schreiner S, Hofmann S, Kutschke M, Jastroch M, Slotta-Huspenina J, Muckenhuber A, Schlitter AM, Schmid RM, Steiger K, Diakopoulos KN, Lesina M, Sainz B, Algül H. Bcl3 Couples Cancer Stem Cell Enrichment With Pancreatic Cancer Molecular Subtypes. Gastroenterology 2021; 161:318-332.e9. [PMID: 33819482 DOI: 10.1053/j.gastro.2021.03.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The existence of different subtypes of pancreatic ductal adenocarcinoma (PDAC) and their correlation with patient outcome have shifted the emphasis on patient classification for better decision-making algorithms and personalized therapy. The contribution of mechanisms regulating the cancer stem cell (CSC) population in different subtypes remains unknown. METHODS Using RNA-seq, we identified B-cell CLL/lymphoma 3 (BCL3), an atypical nf-κb signaling member, as differing in pancreatic CSCs. To determine the biological consequences of BCL3 silencing in vivo and in vitro, we generated bcl3-deficient preclinical mouse models as well as murine cell lines and correlated our findings with human cell lines, PDX models, and 2 independent patient cohorts. We assessed the correlation of bcl3 expression pattern with clinical parameters and subtypes. RESULTS Bcl3 was significantly down-regulated in human CSCs. Recapitulating this phenotype in preclinical mouse models of PDAC via BCL3 genetic knockout enhanced tumor burden, metastasis, epithelial to mesenchymal transition, and reduced overall survival. Fluorescence-activated cell sorting analyses, together with oxygen consumption, sphere formation, and tumorigenicity assays, all indicated that BCL3 loss resulted in CSC compartment expansion promoting cellular dedifferentiation. Overexpression of BCL3 in human PDXs diminished tumor growth by significantly reducing the CSC population and promoting differentiation. Human PDACs with low BCL3 expression correlated with increased metastasis, and BCL3-negative tumors correlated with lower survival and nonclassical subtypes. CONCLUSIONS We demonstrate that bcl3 impacts pancreatic carcinogenesis by restraining CSC expansion and by curtailing an aggressive and metastatic tumor burden in PDAC across species. Levels of BCL3 expression are a useful stratification marker for predicting subtype characterization in PDAC, thereby allowing for personalized therapeutic approaches.
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Affiliation(s)
- Jiaoyu Ai
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sonja M Wörmann
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Ahmed Cancer Center for Pancreatic Cancer Research, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Kıvanç Görgülü
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Mireia Vallespinos
- Department of Biochemistry, Autónoma University of Madrid, School of Medicine, Instituto de Investigaciones Biomédicas "Alberto Sols" CSIC-UAM, Madrid, Spain; Enfermedades Crónicas y Cáncer Area, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Sladjana Zagorac
- Department of Biochemistry, Autónoma University of Madrid, School of Medicine, Instituto de Investigaciones Biomédicas "Alberto Sols" CSIC-UAM, Madrid, Spain; Department of Surgery and Cancer, Division of Cancer, Imperial College London, Imperial Centre for Translational and Experimental Medicine, London, United Kingdom
| | - Sonia Alcala
- Department of Biochemistry, Autónoma University of Madrid, School of Medicine, Instituto de Investigaciones Biomédicas "Alberto Sols" CSIC-UAM, Madrid, Spain; Enfermedades Crónicas y Cáncer Area, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Nan Wu
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Derya Kabacaoglu
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexandra Berninger
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Diego Navarro
- Department of Biochemistry, Autónoma University of Madrid, School of Medicine, Instituto de Investigaciones Biomédicas "Alberto Sols" CSIC-UAM, Madrid, Spain; Enfermedades Crónicas y Cáncer Area, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Ezgi Kaya-Aksoy
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Dietrich A Ruess
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of General and Visceral Surgery, Center for Surgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Katrin J Ciecielski
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marlena Kowalska
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ihsan Ekin Demir
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Güralp O Ceyhan
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Irina Heid
- Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar der, Technische Universität München, Munich, Germany
| | - Rickmer Braren
- Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar der, Technische Universität München, Munich, Germany
| | - Marc Riemann
- Leibniz Institute on Aging, Fritz Lipmann Institute, Jena, Germany
| | - Sabrina Schreiner
- Institute for Virology, Technical University of Munich, Neuherberg, Germany
| | - Samuel Hofmann
- Institute for Virology, Technical University of Munich, Neuherberg, Germany
| | - Maria Kutschke
- Department of Molecular Biosciences, The Wenner-Gren Institute, The Arrhenius Laboratories F3, Stockholm University, Stockholm, Sweden
| | - Martin Jastroch
- Department of Molecular Biosciences, The Wenner-Gren Institute, The Arrhenius Laboratories F3, Stockholm University, Stockholm, Sweden
| | - Julia Slotta-Huspenina
- Institute for Pathology, Technische Universität München, Munich, Germany; MTBio-Biobank of Technische Universität München and University Hospital Klinikum rechts der Isar, Munich, Germany
| | - Alexander Muckenhuber
- Institute for Pathology, Technische Universität München, Munich, Germany; MTBio-Biobank of Technische Universität München and University Hospital Klinikum rechts der Isar, Munich, Germany
| | | | - Roland M Schmid
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Katja Steiger
- Institute for Pathology, Technische Universität München, Munich, Germany
| | - Kalliope N Diakopoulos
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marina Lesina
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bruno Sainz
- Department of Biochemistry, Autónoma University of Madrid, School of Medicine, Instituto de Investigaciones Biomédicas "Alberto Sols" CSIC-UAM, Madrid, Spain; Enfermedades Crónicas y Cáncer Area, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
| | - Hana Algül
- Comprehensive Cancer Center Munich at Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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Kaissis G, Ziller A, Passerat-Palmbach J, Ryffel T, Usynin D, Trask A, Lima I, Mancuso J, Jungmann F, Steinborn MM, Saleh A, Makowski M, Rueckert D, Braren R. End-to-end privacy preserving deep learning on multi-institutional medical imaging. NAT MACH INTELL 2021. [DOI: 10.1038/s42256-021-00337-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Schneider J, Mijočević H, Ulm K, Ulm B, Weidlich S, Würstle S, Rothe K, Treiber M, Iakoubov R, Mayr U, Lahmer T, Rasch S, Herner A, Burian E, Lohöfer F, Braren R, Makowski MR, Schmid RM, Protzer U, Spinner C, Geisler F. SARS-CoV-2 serology increases diagnostic accuracy in CT-suspected, PCR-negative COVID-19 patients during pandemic. Respir Res 2021; 22:119. [PMID: 33892720 PMCID: PMC8062836 DOI: 10.1186/s12931-021-01717-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 04/14/2021] [Indexed: 12/28/2022] Open
Abstract
Background In the absence of PCR detection of SARS-CoV-2 RNA, accurate diagnosis of COVID-19 is challenging. Low-dose computed tomography (CT) detects pulmonary infiltrates with high sensitivity, but findings may be non-specific. This study assesses the diagnostic value of SARS-CoV-2 serology for patients with distinct CT features but negative PCR. Methods IgM/IgG chemiluminescent immunoassay was performed for 107 patients with confirmed (group A: PCR + ; CT ±) and 46 patients with suspected (group B: repetitive PCR-; CT +) COVID-19, admitted to a German university hospital during the pandemic’s first wave. A standardized, in-house CT classification of radiological signs of a viral pneumonia was used to assess the probability of COVID-19. Results Seroconversion rates (SR) determined on day 5, 10, 15, 20 and 25 after symptom onset (SO) were 8%, 25%, 65%, 76% and 91% for group A, and 0%, 10%, 19%, 37% and 46% for group B, respectively; (p < 0.01). Compared to hospitalized patients with a non-complicated course (non-ICU patients), seroconversion tended to occur at lower frequency and delayed in patients on intensive care units. SR of patients with CT findings classified as high certainty for COVID-19 were 8%, 22%, 68%, 79% and 93% in group A, compared with 0%, 15%, 28%, 50% and 50% in group B (p < 0.01). SARS-CoV-2 serology established a definite diagnosis in 12/46 group B patients. In 88% (8/9) of patients with negative serology > 14 days after symptom onset (group B), clinico-radiological consensus reassessment revealed probable diagnoses other than COVID-19. Sensitivity of SARS-CoV-2 serology was superior to PCR > 17d after symptom onset. Conclusions Approximately one-third of patients with distinct COVID-19 CT findings are tested negative for SARS-CoV-2 RNA by PCR rendering correct diagnosis difficult. Implementation of SARS-CoV-2 serology testing alongside current CT/PCR-based diagnostic algorithms improves discrimination between COVID-19-related and non-related pulmonary infiltrates in PCR negative patients. However, sensitivity of SARS-CoV-2 serology strongly depends on the time of testing and becomes superior to PCR after the 2nd week following symptom onset.
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Affiliation(s)
- Jochen Schneider
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany. .,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany.
| | - Hrvoje Mijočević
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany.,Institute for Virology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kurt Ulm
- Institute for Medical Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Ulm
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Simon Weidlich
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Silvia Würstle
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kathrin Rothe
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany.,Institute for Medical Microbiology, Immunology and Hygiene, School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Treiber
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Roman Iakoubov
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Ulrich Mayr
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Tobias Lahmer
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sebastian Rasch
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Herner
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Egon Burian
- Institute for Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Fabian Lohöfer
- Institute for Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Rickmer Braren
- Institute for Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Institute for Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Ulrike Protzer
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany.,Institute for Virology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christoph Spinner
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Fabian Geisler
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany.
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30
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Liotta L, Lange S, Maurer HC, Olive KP, Braren R, Pfarr N, Burger S, Muckenhuber A, Jesinghaus M, Steiger K, Weichert W, Friess H, Schmid R, Algül H, Jost PJ, Ramser J, Fischer C, Quante AS, Reichert M, Quante M. PALLD mutation in a European family conveys a stromal predisposition for familial pancreatic cancer. JCI Insight 2021; 6:141532. [PMID: 33764904 PMCID: PMC8119201 DOI: 10.1172/jci.insight.141532] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/17/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUNDPancreatic cancer is one of the deadliest cancers, with low long-term survival rates. Despite recent advances in treatment, it is important to identify and screen high-risk individuals for cancer prevention. Familial pancreatic cancer (FPC) accounts for 4%-10% of pancreatic cancers. Several germline mutations are related to an increased risk and might offer screening and therapy options. In this study, we aimed to identity of a susceptibility gene in a family with FPC.METHODSWhole exome sequencing and PCR confirmation was performed on the surgical specimen and peripheral blood of an index patient and her sister in a family with high incidence of pancreatic cancer, to identify somatic and germline mutations associated with familial pancreatic cancer. Compartment-specific gene expression data and immunohistochemistry were also queried.RESULTSThe identical germline mutation of the PALLD gene (NM_001166108.1:c.G154A:p.D52N) was detected in the index patient with pancreatic cancer and the tumor tissue of her sister. Whole genome sequencing showed similar somatic mutation patterns between the 2 sisters. Apart from the PALLD mutation, commonly mutated genes that characterize pancreatic ductal adenocarcinoma were found in both tumor samples. However, the 2 patients harbored different somatic KRAS mutations (G12D and G12V). Healthy siblings did not have the PALLD mutation, indicating a disease-specific impact. Compartment-specific gene expression data and IHC showed expression in cancer-associated fibroblasts (CAFs).CONCLUSIONWe identified a germline mutation of the palladin (PALLD) gene in 2 siblings in Europe, affected by familial pancreatic cancer, with a significant overexpression in CAFs, suggesting that stromal palladin could play a role in the development, maintenance, and/or progression of pancreatic cancer.FUNDINGDFG SFB 1321.
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Affiliation(s)
- Lucia Liotta
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sebastian Lange
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - H. Carlo Maurer
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Division of Digestive and Liver Diseases, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Kenneth P. Olive
- Division of Digestive and Liver Diseases, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Rickmer Braren
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Nicole Pfarr
- Institut für Pathologie und pathologische Anatomie, Technische Universität München, Munich, Germany
| | - Sebastian Burger
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Muckenhuber
- Institut für Pathologie und pathologische Anatomie, Technische Universität München, Munich, Germany
| | - Moritz Jesinghaus
- Institut für Pathologie und pathologische Anatomie, Technische Universität München, Munich, Germany
| | - Katja Steiger
- Institut für Pathologie und pathologische Anatomie, Technische Universität München, Munich, Germany
| | - Wilko Weichert
- Institut für Pathologie und pathologische Anatomie, Technische Universität München, Munich, Germany
- Deutschen Konsortium für Translationale Krebsforschung (DKTK), Partner site Munich, Technische Universität München, Munich, Germany
| | - Helmut Friess
- Chirurgische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Roland Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Hana Algül
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Philipp J. Jost
- Deutschen Konsortium für Translationale Krebsforschung (DKTK), Partner site Munich, Technische Universität München, Munich, Germany
- Innere Medizin III, Hämatologie und Onkologie, Technische Universität München, Munich, Germany
| | - Juliane Ramser
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christine Fischer
- Institut für Humangenetik, Ruprecht-Karls Universität, Heidelberg, Germany
| | - Anne S. Quante
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Maximilian Reichert
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Deutschen Konsortium für Translationale Krebsforschung (DKTK), Partner site Munich, Technische Universität München, Munich, Germany
| | - Michael Quante
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Deutschen Konsortium für Translationale Krebsforschung (DKTK), Partner site Munich, Technische Universität München, Munich, Germany
- Klinik für Innere Medizin II, Universität Freiburg, Germany
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31
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Topping GJ, Heid I, Trajkovic-Arsic M, Kritzner L, Grashei M, Hundshammer C, Aigner M, Skinner JG, Braren R, Schilling F. Hyperpolarized 13C Spectroscopy with Simple Slice-and-Frequency-Selective Excitation. Biomedicines 2021; 9:biomedicines9020121. [PMID: 33513763 PMCID: PMC7911979 DOI: 10.3390/biomedicines9020121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/16/2021] [Accepted: 01/23/2021] [Indexed: 01/01/2023] Open
Abstract
Hyperpolarized 13C nuclear magnetic resonance spectroscopy can characterize in vivo tissue metabolism, including preclinical models of cancer and inflammatory disease. Broad bandwidth radiofrequency excitation is often paired with free induction decay readout for spectral separation, but quantification of low-signal downstream metabolites using this method can be impeded by spectral peak overlap or when frequency separation of the detected peaks exceeds the excitation bandwidth. In this work, alternating frequency narrow bandwidth (250 Hz) slice-selective excitation was used for 13C spectroscopy at 7 T in a subcutaneous xenograft rat model of human pancreatic cancer (PSN1) to improve quantification while measuring the dynamics of injected hyperpolarized [1-13C]lactate and its metabolite [1-13C]pyruvate. This method does not require sophisticated pulse sequences or specialized radiofrequency and gradient pulses, but rather uses nominally spatially offset slices to produce alternating frequency excitation with simpler slice-selective radiofrequency pulses. Additionally, point-resolved spectroscopy was used to calibrate the 13C frequency from the thermal proton signal in the target region. This excitation scheme isolates the small [1-13C]pyruvate peak from the similar-magnitude tail of the much larger injected [1-13C]lactate peak, facilitates quantification of the [1-13C]pyruvate signal, simplifies data processing, and could be employed for other substrates and preclinical models.
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Affiliation(s)
- Geoffrey J. Topping
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (G.J.T.); (M.G.); (C.H.); (M.A.); (J.G.S.)
| | - Irina Heid
- Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.H.); (L.K.); (R.B.)
| | - Marija Trajkovic-Arsic
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen), 45147 Essen, Germany;
- German Cancer Research Center, DKFZ, 69120 Heidelberg, Germany
- Institute of Developmental Cancer Therapeutics, West German Cancer Center, University Hospital Essen, 45147 Essen, Germany
| | - Lukas Kritzner
- Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.H.); (L.K.); (R.B.)
| | - Martin Grashei
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (G.J.T.); (M.G.); (C.H.); (M.A.); (J.G.S.)
| | - Christian Hundshammer
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (G.J.T.); (M.G.); (C.H.); (M.A.); (J.G.S.)
| | - Maximilian Aigner
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (G.J.T.); (M.G.); (C.H.); (M.A.); (J.G.S.)
| | - Jason G. Skinner
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (G.J.T.); (M.G.); (C.H.); (M.A.); (J.G.S.)
| | - Rickmer Braren
- Institute of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.H.); (L.K.); (R.B.)
- German Cancer Consortium (DKTK, Partner Site Munich), 81675 Munich, Germany
| | - Franz Schilling
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (G.J.T.); (M.G.); (C.H.); (M.A.); (J.G.S.)
- Correspondence:
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32
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Ziegelmayer S, Kaissis G, Harder F, Jungmann F, Müller T, Makowski M, Braren R. Deep Convolutional Neural Network-Assisted Feature Extraction for Diagnostic Discrimination and Feature Visualization in Pancreatic Ductal Adenocarcinoma (PDAC) versus Autoimmune Pancreatitis (AIP). J Clin Med 2020; 9:jcm9124013. [PMID: 33322559 PMCID: PMC7764649 DOI: 10.3390/jcm9124013] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/25/2020] [Accepted: 12/08/2020] [Indexed: 12/12/2022] Open
Abstract
The differentiation of autoimmune pancreatitis (AIP) and pancreatic ductal adenocarcinoma (PDAC) poses a relevant diagnostic challenge and can lead to misdiagnosis and consequently poor patient outcome. Recent studies have shown that radiomics-based models can achieve high sensitivity and specificity in predicting both entities. However, radiomic features can only capture low level representations of the input image. In contrast, convolutional neural networks (CNNs) can learn and extract more complex representations which have been used for image classification to great success. In our retrospective observational study, we performed a deep learning-based feature extraction using CT-scans of both entities and compared the predictive value against traditional radiomic features. In total, 86 patients, 44 with AIP and 42 with PDACs, were analyzed. Whole pancreas segmentation was automatically performed on CT-scans during the portal venous phase. The segmentation masks were manually checked and corrected if necessary. In total, 1411 radiomic features were extracted using PyRadiomics and 256 features (deep features) were extracted using an intermediate layer of a convolutional neural network (CNN). After feature selection and normalization, an extremely randomized trees algorithm was trained and tested using a two-fold shuffle-split cross-validation with a test sample of 20% (n = 18) to discriminate between AIP or PDAC. Feature maps were plotted and visual difference was noted. The machine learning (ML) model achieved a sensitivity, specificity, and ROC-AUC of 0.89 ± 0.11, 0.83 ± 0.06, and 0.90 ± 0.02 for the deep features and 0.72 ± 0.11, 0.78 ± 0.06, and 0.80 ± 0.01 for the radiomic features. Visualization of feature maps indicated different activation patterns for AIP and PDAC. We successfully trained a machine learning model using deep feature extraction from CT-images to differentiate between AIP and PDAC. In comparison to traditional radiomic features, deep features achieved a higher sensitivity, specificity, and ROC-AUC. Visualization of deep features could further improve the diagnostic accuracy of non-invasive differentiation of AIP and PDAC.
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Affiliation(s)
- Sebastian Ziegelmayer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (S.Z.); (G.K.); (F.H.); (F.J.); (T.M.); (M.M.)
| | - Georgios Kaissis
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (S.Z.); (G.K.); (F.H.); (F.J.); (T.M.); (M.M.)
- Department of Computing, Faculty of Engineering, Technology and Medicine, Imperial College of Science, London SW7 2BU, UK
| | - Felix Harder
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (S.Z.); (G.K.); (F.H.); (F.J.); (T.M.); (M.M.)
| | - Friederike Jungmann
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (S.Z.); (G.K.); (F.H.); (F.J.); (T.M.); (M.M.)
| | - Tamara Müller
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (S.Z.); (G.K.); (F.H.); (F.J.); (T.M.); (M.M.)
| | - Marcus Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (S.Z.); (G.K.); (F.H.); (F.J.); (T.M.); (M.M.)
| | - Rickmer Braren
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (S.Z.); (G.K.); (F.H.); (F.J.); (T.M.); (M.M.)
- German Cancer Consortium, Partner Site Technical University of Munich, D-69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-89-4140-5627
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33
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Kleesiek J, Murray JM, Strack C, Prinz S, Kaissis G, Braren R. [Artificial intelligence and machine learning in oncologic imaging]. Pathologe 2020; 41:649-658. [PMID: 33052431 DOI: 10.1007/s00292-020-00827-3] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Machine learning (ML) is entering many areas of society, including medicine. This transformation has the potential to drastically change medicine and medical practice. These aspects become particularly clear when considering the different stages of oncologic patient care and the involved interdisciplinary and intermodality interactions. In recent publications, computers-in collaboration with humans or alone-have been outperforming humans regarding tumor identification, tumor classification, estimating prognoses, and evaluation of treatments. In addition, ML algorithms, e.g., artificial neural networks (ANNs), which constitute the drivers behind many of the latest achievements in ML, can deliver this level of performance in a reproducible, fast, and inexpensive manner. In the future, artificial intelligence applications will become an integral part of the medical profession and offer advantages for oncologic diagnostics and treatment.
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Affiliation(s)
- Jens Kleesiek
- AG Computational Radiology, Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Deutschland. .,German Cancer Consortium (DKTK), Heidelberg, Deutschland. .,Institut für Künstliche Intelligenz in der Medizin (IKIM), Universitätsklinikum Essen, Girardetstr. 6, 45131, Essen, Deutschland.
| | - Jacob M Murray
- AG Computational Radiology, Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Deutschland.,Heidelberg University, Heidelberg, Deutschland
| | - Christian Strack
- AG Computational Radiology, Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Deutschland.,Heidelberg University, Heidelberg, Deutschland
| | - Sebastian Prinz
- AG Computational Radiology, Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Deutschland.,Heidelberg University, Heidelberg, Deutschland
| | - Georgios Kaissis
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, München, Deutschland
| | - Rickmer Braren
- German Cancer Consortium (DKTK), Heidelberg, Deutschland.,Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, München, Deutschland
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Munkhbaatar E, Dietzen M, Agrawal D, Anton M, Jesinghaus M, Boxberg M, Pfarr N, Bidola P, Uhrig S, Höckendorf U, Meinhardt AL, Wahida A, Heid I, Braren R, Mishra R, Warth A, Muley T, Poh PSP, Wang X, Fröhling S, Steiger K, Slotta-Huspenina J, van Griensven M, Pfeiffer F, Lange S, Rad R, Spella M, Stathopoulos GT, Ruland J, Bassermann F, Weichert W, Strasser A, Branca C, Heikenwalder M, Swanton C, McGranahan N, Jost PJ. MCL-1 gains occur with high frequency in lung adenocarcinoma and can be targeted therapeutically. Nat Commun 2020; 11:4527. [PMID: 32913197 PMCID: PMC7484793 DOI: 10.1038/s41467-020-18372-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 11/01/2019] [Accepted: 08/20/2020] [Indexed: 12/25/2022] Open
Abstract
Evasion of programmed cell death represents a critical form of oncogene addiction in cancer cells. Understanding the molecular mechanisms underpinning cancer cell survival despite the oncogenic stress could provide a molecular basis for potential therapeutic interventions. Here we explore the role of pro-survival genes in cancer cell integrity during clonal evolution in non-small cell lung cancer (NSCLC). We identify gains of MCL-1 at high frequency in multiple independent NSCLC cohorts, occurring both clonally and subclonally. Clonal loss of functional TP53 is significantly associated with subclonal gains of MCL-1. In mice, tumour progression is delayed upon pharmacologic or genetic inhibition of MCL-1. These findings reveal that MCL-1 gains occur with high frequency in lung adenocarcinoma and can be targeted therapeutically.
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Affiliation(s)
- Enkhtsetseg Munkhbaatar
- Department of Medicine III, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Michelle Dietzen
- Cancer Research UK Lung Cancer Center of Excellence, University College London Cancer Institute, Paul O'Gorman Building, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Genome Evolution Research Group, University College London Cancer Institute, University College London, London, UK
| | - Deepti Agrawal
- Department of Medicine III, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Martina Anton
- Institute of Molecular Immunology and Experimental Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Moritz Jesinghaus
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Melanie Boxberg
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Nicole Pfarr
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Pidassa Bidola
- Chair of Biomedical Physics, Department of Physics & Munich School of Bioengineering, Technical University of Munich, Garching, Germany
| | - Sebastian Uhrig
- Division of Applied Bioinformatics, German Cancer Research Center, Heidelberg, Germany
- Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Ulrike Höckendorf
- Department of Medicine III, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Anna-Lena Meinhardt
- Department of Medicine III, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Adam Wahida
- Department of Medicine III, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Irina Heid
- Department of diagnostic and interventional radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rickmer Braren
- Department of diagnostic and interventional radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ritu Mishra
- Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
| | - Arne Warth
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Institute of Pathology, Cytopathology and Molecular Pathology UEGP MVZ, Giessen, Wetzlar, Limburg, Germany
| | - Thomas Muley
- Translational Research Unit, Thoraxklinik at Heidelberg University, Heidelberg, Germany
- Translational Lung Research Centre (TLRC) Heidelberg, member of the German Centre for lung Research (DZL), Heidelberg, Germany
| | - Patrina S P Poh
- Experimental Trauma Surgery, Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Xin Wang
- Department of Medicine III, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Fröhling
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katja Steiger
- Institute of Pathology, Technical University of Munich, Munich, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Julia Slotta-Huspenina
- Institute of Pathology, Technical University of Munich, Munich, Germany
- Gewebebank des Klinikums rechts der Isar und der Technischen Universität München Am Institut für Pathologie der TU München, München, Germany
| | - Martijn van Griensven
- Department cBITE, MERLN Institute, Maastricht University, Maastricht, The Netherlands
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics & Munich School of Bioengineering, Technical University of Munich, Garching, Germany
| | - Sebastian Lange
- Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Institute of Molecular Oncology and Functional Genomics, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Department of Medicine II, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Roland Rad
- Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Molecular Oncology and Functional Genomics, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Department of Medicine II, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Magda Spella
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Greece
| | - Georgios T Stathopoulos
- Comprehensive Pneumology Center (CPC) and Institute for Lung Biology and Disease (iLBD), Helmholtz Center Munich for Environmental Health, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Ruland
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian Bassermann
- Department of Medicine III, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University of Munich, Munich, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas Strasser
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Australia
| | - Caterina Branca
- Department of Medicine III, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Mathias Heikenwalder
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Charles Swanton
- Cancer Research UK Lung Cancer Center of Excellence, University College London Cancer Institute, Paul O'Gorman Building, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Nicholas McGranahan
- Cancer Research UK Lung Cancer Center of Excellence, University College London Cancer Institute, Paul O'Gorman Building, London, UK
- Cancer Genome Evolution Research Group, University College London Cancer Institute, University College London, London, UK
| | - Philipp J Jost
- Department of Medicine III, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany.
- Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany.
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria.
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Dantes Z, Yen HY, Pfarr N, Winter C, Steiger K, Muckenhuber A, Hennig A, Lange S, Engleitner T, Öllinger R, Maresch R, Orben F, Heid I, Kaissis G, Shi K, Topping G, Stögbauer F, Wirth M, Peschke K, Papargyriou A, Rezaee-Oghazi M, Feldmann K, Schäfer AP, Ranjan R, Lubeseder-Martellato C, Stange DE, Welsch T, Martignoni M, Ceyhan GO, Friess H, Herner A, Liotta L, Treiber M, von Figura G, Abdelhafez M, Klare P, Schlag C, Algül H, Siveke J, Braren R, Weirich G, Weichert W, Saur D, Rad R, Schmid RM, Schneider G, Reichert M. Implementing cell-free DNA of pancreatic cancer patient-derived organoids for personalized oncology. JCI Insight 2020; 5:137809. [PMID: 32614802 DOI: 10.1172/jci.insight.137809] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 03/06/2020] [Accepted: 06/24/2020] [Indexed: 01/05/2023] Open
Abstract
One of the major challenges in using pancreatic cancer patient-derived organoids (PDOs) in precision oncology is the time from biopsy to functional characterization. This is particularly true for endoscopic ultrasound-guided fine-needle aspiration biopsies, typically resulting in specimens with limited tumor cell yield. Here, we tested conditioned media of individual PDOs for cell-free DNA to detect driver mutations already early on during the expansion process to accelerate the genetic characterization of PDOs as well as subsequent functional testing. Importantly, genetic alterations detected in the PDO supernatant, collected as early as 72 hours after biopsy, recapitulate the mutational profile of the primary tumor, indicating suitability of this approach to subject PDOs to drug testing in a reduced time frame. In addition, we demonstrated that this workflow was practicable, even in patients for whom the amount of tumor material was not sufficient for molecular characterization by established means. Together, our findings demonstrate that generating PDOs from very limited biopsy material permits molecular profiling and drug testing. With our approach, this can be achieved in a rapid and feasible fashion with broad implications in clinical practice.
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Affiliation(s)
- Zahra Dantes
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | - Hsi-Yu Yen
- Institute of Pathology.,Comparative Experimental Pathology, and
| | | | - Christof Winter
- Institute of Clinical Chemistry and Pathobiochemistry, Technical University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), partner site Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katja Steiger
- Institute of Pathology.,Comparative Experimental Pathology, and
| | | | - Alexander Hennig
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Medical Faculty, Technical University of Dresden, Dresden, Germany
| | - Sebastian Lange
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | - Thomas Engleitner
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | - Rupert Öllinger
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | - Roman Maresch
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | - Felix Orben
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | | | | | - Kuangyu Shi
- Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
| | - Geoffrey Topping
- Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
| | | | - Matthias Wirth
- Medical Department, Division of Hematology and Oncology at Campus Benjamin Franklin, Charité, Berlin, Germany
| | - Katja Peschke
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | | | | | - Karin Feldmann
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | - Arlett Pg Schäfer
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | - Raphela Ranjan
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | | | - Daniel E Stange
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Medical Faculty, Technical University of Dresden, Dresden, Germany.,DKTK, partner site Dresden, Germany
| | - Thilo Welsch
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Medical Faculty, Technical University of Dresden, Dresden, Germany.,DKTK, partner site Dresden, Germany
| | - Marc Martignoni
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Güralp O Ceyhan
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Herner
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | - Lucia Liotta
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | - Matthias Treiber
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | - Guido von Figura
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | | | - Peter Klare
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | - Christoph Schlag
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | - Hana Algül
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | - Jens Siveke
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute for Developmental Cancer Therapeutics, West German Cancer Center, University Hospital Essen, Essen, Germany.,Division of Solid Tumor Translational Oncology, DKTK, partner site Essen, Germany
| | - Rickmer Braren
- German Cancer Consortium (DKTK), partner site Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Medical Faculty, Technical University of Dresden, Dresden, Germany
| | | | - Wilko Weichert
- Institute of Pathology.,German Cancer Consortium (DKTK), partner site Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dieter Saur
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar.,German Cancer Consortium (DKTK), partner site Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Roland Rad
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar.,German Cancer Consortium (DKTK), partner site Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Roland M Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar
| | - Günter Schneider
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar.,German Cancer Consortium (DKTK), partner site Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maximilian Reichert
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar.,German Cancer Consortium (DKTK), partner site Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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Dommasch M, Gebhardt F, Protzer U, Werner A, Schuster E, Brakemeier C, Mayer J, Feihl S, Querbach C, Braren R, Treiber M, Geisler F, Spinner CD. [Strategy for university emergency room management at the beginning of an epidemic using COVID-19 as an example]. Notf Rett Med 2020; 23:578-586. [PMID: 32837305 PMCID: PMC7362327 DOI: 10.1007/s10049-020-00759-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Durch die weltweit steigenden Zahlen an „coronavirus disease 2019“(COVID-19)-Infektionen besteht für sämtliche Kliniken die Aufgabe, sich der Herausforderung einer Pandemie zu stellen. Es gilt insbesondere auch für die Notaufnahmen, sich auf vollständig veränderte Arbeitsabläufe vorzubereiten und sie umzusetzen. Dies betrifft insbesondere den Bereich Patientenscreening und -selektion (Triage). Auch mit anderen Fachbereichen wie der Hygiene, Infektiologie oder Virologie muss Hand in Hand zusammengearbeitet werden, um vor, während und nach Abschluss der Diagnostik entsprechende Behandlungskonzepte zu realisieren. Darüber hinaus sind Kommunikation und Qualitäts- und Risikomanagement nebst den klinischen Bereichen von hoher Relevanz. Dieser Artikel beschreibt an einem Beispiel, wie sich Notaufnahmen hier am Beispiel COVID-19 (coronavirus disease 2019) konkret und praxisnah auf eine Pandemie vorbereiten können.
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Affiliation(s)
- Michael Dommasch
- Fakultät für Medizin, Zentrale Interdisziplinäre Notaufnahme, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Deutschland
| | - Friedemann Gebhardt
- Fakultät für Medizin, Krankenhaushygiene, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Ulrike Protzer
- Fakultät für Medizin, Institut für Virologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Angelika Werner
- Fakultät für Medizin, Stabsstelle für Qualitäts- und Risikomanagement, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Eva Schuster
- Fakultät für Medizin, Unternehmenskommunikation, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Christoph Brakemeier
- Fakultät für Medizin, Pflegedirektion, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Julia Mayer
- Fakultät für Medizin, Pflegedirektion, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Susanne Feihl
- Fakultät für Medizin, Institut für medizinische Mikrobiologie, Immunologie und Hygiene, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Christine Querbach
- Fakultät für Medizin, Krankenhausapotheke, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Rickmer Braren
- Fakultät für Medizin, Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Matthias Treiber
- Fakultät für Medizin, Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Fabian Geisler
- Fakultät für Medizin, Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Christoph D Spinner
- Fakultät für Medizin, Klinik und Poliklinik für Innere Medizin II (Infektiologie), Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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Rothe K, Katchanov J, Schneider J, Spinner CD, Phillip V, Busch DH, Tappe D, Braren R, Schmid RM, Slotta-Huspenina J. Strongyloides stercoralis hyperinfection syndrome presenting as mechanical ileus after short-course oral steroids for chronic obstructive pulmonary disease (COPD) exacerbation. Parasitol Int 2020; 76:102087. [PMID: 32087332 DOI: 10.1016/j.parint.2020.102087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/12/2020] [Revised: 02/06/2020] [Accepted: 02/16/2020] [Indexed: 12/14/2022]
Abstract
We report a case of a fatal Strongyloides stercoralis hyperinfection syndrome (SHS) in a migrant from Kenya, who had been living in Germany for three decades. A short-course oral steroid treatment for Chronic Obstructive Pulmonary Disease (COPD) exacerbation had been administered four weeks prior to the presentation. The initial clinical and radiological findings suggested a mechanical small bowel obstruction as a cause of ileus. Our case highlights the importance of maintaining a high index of suspicion for strongyloidiasis in patients from endemic areas even years after they left the country of origin. It demonstrates that even a five-day course of prednisolone is able to trigger SHS in patients with underlying strongyloidiasis. History of frequent previous administration of oral prednisolone for COPD exacerbations in our case raises the question why and how the last steroid regimen provoked SHS. SHS can present with multiple gastrointestinal symptoms including ileus and the absence of eosinophilia during the whole course of the disease should not lower the level of suspicion in the appropriate clinical setting.
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Affiliation(s)
- Kathrin Rothe
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University Munich, Munich, Germany.
| | - Juri Katchanov
- Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Jochen Schneider
- Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Christoph D Spinner
- Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Veit Phillip
- Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Dirk H Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University Munich, Munich, Germany; German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Dennis Tappe
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Rickmer Braren
- Department of Radiology, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
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Münch S, Marr L, Feuerecker B, Dapper H, Braren R, Combs SE, Duma MN. Impact of 18F-FDG-PET/CT on the identification of regional lymph node metastases and delineation of the primary tumor in esophageal squamous cell carcinoma patients. Strahlenther Onkol 2020; 196:787-794. [PMID: 32430661 PMCID: PMC7449992 DOI: 10.1007/s00066-020-01630-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/28/2020] [Indexed: 12/27/2022]
Abstract
Purpose In patients undergoing chemoradiation for esophageal squamous cell carcinoma (ESCC), the extent of elective nodal irradiation (ENI) is still discussed controversially. This study aimed to analyze patterns of lymph node metastases and their correlation with the primary tumor using 18F‑fludeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans. Methods 102 ESCC patients with pre-treatment FDG-PET/CT scans were evaluated retrospectively. After exclusion of patients with low FDG uptake and patients without FDG-PET-positive lymph node metastases (LNM), 76 patients were included in the final analysis. All LNM were assigned to 16 pre-defined anatomical regions and classified according to their position relative to the primary tumor (above, at the same height, or below the primary tumor). In addition, the longitudinal distance to the primary tumor was measured for all LNM above or below the primary tumor. The craniocaudal extent (i.e., length) of the primary tumor was measured using FDG-PET imaging (LPET) and also based on all other available clinical and imaging data (endoscopy, computed tomography, biopsy results) except FDG-PET (LCT/EUS). Results Significantly more LNM were identified with 18F‑FDG-PET/CT (177 LNM) compared to CT alone (131 LNM, p < 0.001). The most common sites of LNM were paraesophageal (63% of patients, 37% of LNM) and paratracheal (33% of patients, 20% of LNM), while less than 5% of patients had supraclavicular, subaortic, diaphragmatic, or hilar LNM. With regard to the primary tumor, 51% of LNM were at the same height, while 25% and 24% of lymph node metastases were above and below the primary tumor, respectively. For thirty-three LNM (19%), the distance to the primary tumor was larger than 4 cm. No significant difference was seen between LCT/EUS (median 6 cm) and LPET (median 6 cm, p = 0.846) Conclusion 18F‑FDG-PET can help to identify subclinical lymph node metastases which are located outside of recommended radiation fields. PET-based involved-field irradiation might be the ideal compromise between small treatment volumes and decreasing the risk of undertreatment of subclinical metastatic lymph nodes and should be further evaluated.
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Affiliation(s)
- Stefan Münch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany. .,Partner Site Munich, German Cancer Consortium (DKTK), Munich, Germany.
| | - Lisa Marr
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benedikt Feuerecker
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Hendrik Dapper
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rickmer Braren
- Institute of Radiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Partner Site Munich, German Cancer Consortium (DKTK), Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany
| | - Marciana-Nona Duma
- Department of Radiation Oncology, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Bachstraße 18, 07743, Jena, Germany
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Li H, Shi K, Reichert M, Lin K, Tselousov N, Braren R, Fu D, Schmid R, Li J, Menze B. Differential Diagnosis for Pancreatic Cysts in CT Scans Using Densely-Connected Convolutional Networks. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:2095-2098. [PMID: 31946314 DOI: 10.1109/embc.2019.8856745] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The lethal nature of pancreatic ductal adenocarcinoma (PDAC) calls for early differential diagnosis of pancreatic cysts, which are identified in up to 16% of normal subjects, and some of them may develop into PDAC. Pancreatic cysts have a large variation in size and shape, and the precise segmentation of them remains rather challenging, which restricts the computer-aided interpretation of CT images acquired for differential diagnosis. We propose a computer-aided framework for early differential diagnosis of pancreatic cysts without pre-segmenting the lesions using densely-connected convolutional networks (Dense-Net). The Dense-Net learns high-level features from whole abnormal pancreas and builds mappings between medical imaging appearance to different pathological types of pancreatic cysts. To enhance the clinical applicability, we integrate saliency maps in the framework to assist the physicians to understand the decision of the deep learning method. The test on a cohort of 206 patients with 4 pathologically confirmed subtypes of pancreatic cysts has achieved an overall accuracy of 72.8%, which is significantly higher than the baseline accuracy of 48.1%. The superior performance on this challenging dataset strongly supports the clinical potential of our developed method.
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Abstract
BACKGROUND The methods of machine learning and artificial intelligence are slowly but surely being introduced in everyday medical practice. In the future, they will support us in diagnosis and therapy and thus improve treatment for the benefit of the individual patient. It is therefore important to deal with this topic and to develop a basic understanding of it. OBJECTIVES This article gives an overview of the exciting and dynamic field of machine learning and serves as an introduction to some methods primarily from the realm of supervised learning. In addition to definitions and simple examples, limitations are discussed. CONCLUSIONS The basic principles behind the methods are simple. Nevertheless, due to their high dimensional nature, the factors influencing the results are often difficult or impossible to understand by humans. In order to build confidence in the new technologies and to guarantee their safe application, we need explainable algorithms and prospective effectiveness studies.
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Affiliation(s)
- Jens Kleesiek
- AG Computational Radiology, Abteilung Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland.
- German Cancer Consortium (DKTK), Heidelberg, Deutschland.
| | - Jacob M Murray
- AG Computational Radiology, Abteilung Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
- Universität Heidelberg, Heidelberg, Deutschland
| | - Christian Strack
- AG Computational Radiology, Abteilung Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
- Universität Heidelberg, Heidelberg, Deutschland
| | - Georgios Kaissis
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, München, Deutschland
| | - Rickmer Braren
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, München, Deutschland
- German Cancer Consortium (DKTK), Heidelberg, Deutschland
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Abstract
CLINICAL ISSUE The reproducible and exhaustive extraction of information from radiological images is a central task in the practice of radiology. Dynamic developments in the fields of artificial intelligence (AI) and machine learning are introducing new methods for this task. Radiomics is one such method and offers new opportunities and challenges for the future of radiology. METHODOLOGICAL INNOVATIONS Radiomics describes the quantitative evaluation, interpretation, and clinical assessment of imaging markers in radiological data. Components of a radiomics analysis are data acquisition, data preprocessing, data management, segmentation of regions of interest, computation and selection of imaging markers, as well as the development of a radiomics model used for diagnosis and prognosis. This article explains these components and aims at providing an introduction to the field of radiomics while highlighting existing limitations. MATERIALS AND METHODS This article is based on a selective literature search with the PubMed search engine. ASSESSMENT Even though radiomics applications have yet to arrive in routine clinical practice, the quantification of radiological data in terms of radiomics is underway and will increase in the future. This holds the potential for lasting change in the discipline of radiology. Through the successful extraction and interpretation of all the information encoded in radiological images the next step in the direction of a more personalized, future-oriented form of medicine can be taken.
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Affiliation(s)
- Jacob M Murray
- AG Computational Radiology, Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland.,Heidelberg University, Heidelberg, Deutschland
| | - Georgios Kaissis
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, München, Deutschland
| | - Rickmer Braren
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, München, Deutschland
| | - Jens Kleesiek
- AG Computational Radiology, Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland. .,German Cancer Consortium (DKTK), Heidelberg, Deutschland.
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Kaissis GA, Lohöfer FK, Hörl M, Heid I, Steiger K, Munoz-Alvarez KA, Schwaiger M, Rummeny EJ, Weichert W, Paprottka P, Braren R. Combined DCE-MRI- and FDG-PET enable histopathological grading prediction in a rat model of hepatocellular carcinoma. Eur J Radiol 2020; 124:108848. [PMID: 32006931 DOI: 10.1016/j.ejrad.2020.108848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/10/2019] [Revised: 12/10/2019] [Accepted: 01/19/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To test combined dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and 18F-FDG positron emission tomography (FDG-PET)-derived parameters for prediction of histopathological grading in a rat Diethyl Nitrosamine (DEN)-induced hepatocellular carcinoma (HCC) model. METHODS 15 male Wistar rats, aged 10 weeks were treated with oral DEN 0.01 % in drinking water and monitored until HCCs were detectable. DCE-MRI and PET were performed consecutively on small animal scanners. 38 tumors were identified and manually segmented based on HCC-specific contrast enhancement patterns. Grading (G2/3: 24 tumors, G1:14 tumors) alongside other histopathological parameters, tumor volume, contrast agent and 18F-FDG uptake metrics were noted. Class imbalance was addressed using SMOTE and collinearity was removed using hierarchical clustering and principal component analysis. A logistic regression model was fit separately to the individual parameter groups (DCE-MRI-derived, PET-derived, tumor volume) and the combined parameters. RESULTS The combined model using all imaging-derived parameters achieved a mean ± STD sensitivity of 0.88 ± 0.16, specificity of 0.70 ± 0.20 and AUC of 0.90 ± 0.03. No correlation was found between tumor grading and tumor volume, morphology, necrosis, extracellular matrix, immune cell infiltration or underlying liver fibrosis. CONCLUSION A combination of DCE-MRI- and 18F-FDG-PET-derived parameters provides high accuracy for histopathological grading of hepatocellular carcinoma in a relevant translational model system.
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Affiliation(s)
- Georgios A Kaissis
- Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Fabian K Lohöfer
- Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Marie Hörl
- Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Irina Heid
- Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Katja Steiger
- Institute of Pathology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Kim Agnes Munoz-Alvarez
- Clinic and Policlinic for Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Markus Schwaiger
- Clinic and Policlinic for Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Ernst J Rummeny
- Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Wilko Weichert
- Institute of Pathology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Philipp Paprottka
- Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Rickmer Braren
- Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany.
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Kaissis G, Ziegelmayer S, Lohöfer F, Algül H, Eiber M, Weichert W, Schmid R, Friess H, Rummeny E, Ankerst D, Siveke J, Braren R. A machine learning model for the prediction of survival and tumor subtype in pancreatic ductal adenocarcinoma from preoperative diffusion-weighted imaging. Eur Radiol Exp 2019; 3:41. [PMID: 31624935 PMCID: PMC6797674 DOI: 10.1186/s41747-019-0119-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/21/2019] [Indexed: 12/11/2022] Open
Abstract
Background To develop a supervised machine learning (ML) algorithm predicting above- versus below-median overall survival (OS) from diffusion-weighted imaging-derived radiomic features in patients with pancreatic ductal adenocarcinoma (PDAC). Methods One hundred two patients with histopathologically proven PDAC were retrospectively assessed as training cohort, and 30 prospectively accrued and retrospectively enrolled patients served as independent validation cohort (IVC). Tumors were segmented on preoperative apparent diffusion coefficient (ADC) maps, and radiomic features were extracted. A random forest ML algorithm was fit to the training cohort and tested in the IVC. Histopathological subtype of tumor samples was assessed by immunohistochemistry in 21 IVC patients. Individual radiomic feature importance was evaluated by assessment of tree node Gini impurity decrease and recursive feature elimination. Fisher’s exact test, 95% confidence intervals (CI), and receiver operating characteristic area under the curve (ROC-AUC) were used. Results The ML algorithm achieved 87% sensitivity (95% IC 67.3–92.7), 80% specificity (95% CI 74.0–86.7), and ROC-AUC 90% for the prediction of above- versus below-median OS in the IVC. Heterogeneity-related features were highly ranked by the model. Of the 21 patients with determined histopathological subtype, 8/9 patients predicted to experience below-median OS exhibited the quasi-mesenchymal subtype, whilst 11/12 patients predicted to experience above-median OS exhibited a non-quasi-mesenchymal subtype (p < 0.001). Conclusion ML application to ADC radiomics allowed OS prediction with a high diagnostic accuracy in an IVC. The high overlap of clinically relevant histopathological subtypes with model predictions underlines the potential of quantitative imaging in PDAC pre-operative subtyping and prognosis. Electronic supplementary material The online version of this article (10.1186/s41747-019-0119-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Georgios Kaissis
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, DE-81675, Munich, Germany
| | - Sebastian Ziegelmayer
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, DE-81675, Munich, Germany
| | - Fabian Lohöfer
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, DE-81675, Munich, Germany
| | - Hana Algül
- Department of Internal Medicine II, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Wilko Weichert
- Department of Pathology, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Roland Schmid
- Department of Internal Medicine II, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Ernst Rummeny
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, DE-81675, Munich, Germany
| | - Donna Ankerst
- Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Jens Siveke
- West German Cancer Center, University of Essen, Essen, Germany
| | - Rickmer Braren
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, DE-81675, Munich, Germany.
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Kaissis G, Ziegelmayer S, Lohöfer F, Steiger K, Algül H, Muckenhuber A, Yen HY, Rummeny E, Friess H, Schmid R, Weichert W, Siveke JT, Braren R. A machine learning algorithm predicts molecular subtypes in pancreatic ductal adenocarcinoma with differential response to gemcitabine-based versus FOLFIRINOX chemotherapy. PLoS One 2019; 14:e0218642. [PMID: 31577805 PMCID: PMC6774515 DOI: 10.1371/journal.pone.0218642] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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: 06/03/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Development of a supervised machine-learning model capable of predicting clinically relevant molecular subtypes of pancreatic ductal adenocarcinoma (PDAC) from diffusion-weighted-imaging-derived radiomic features. METHODS The retrospective observational study assessed 55 surgical PDAC patients. Molecular subtypes were defined by immunohistochemical staining of KRT81. Tumors were manually segmented and 1606 radiomic features were extracted with PyRadiomics. A gradient-boosted-tree algorithm was trained on 70% of the patients (N = 28) and tested on 30% (N = 17) to predict KRT81+ vs. KRT81- tumor subtypes. A gradient-boosted survival regression model was fit to the disease-free and overall survival data. Chemotherapy response and survival were assessed stratified by subtype and radiomic signature. Radiomic feature importance was ranked. RESULTS The mean±STDEV sensitivity, specificity and ROC-AUC were 0.90±0.07, 0.92±0.11, and 0.93±0.07, respectively. The mean±STDEV concordance indices between the disease-free and overall survival predicted by the model based on the radiomic parameters and actual patient survival were 0.76±0.05 and 0.71±0.06, respectively. Patients with a KRT81+ subtype experienced significantly diminished median overall survival compared to KRT81- patients (7.0 vs. 22.6 months, HR 4.03, log-rank-test P = <0.001) and a significantly improved response to gemcitabine-based chemotherapy over FOLFIRINOX (10.14 vs. 3.8 months median overall survival, HR 2.33, P = 0.037) compared to KRT81- patients, who responded significantly better to FOLFIRINOX over gemcitabine-based treatment (30.8 vs. 13.4 months median overall survival, HR 2.41, P = 0.027). Entropy was ranked as the most important radiomic feature. CONCLUSIONS The machine-learning based analysis of radiomic features enables the prediction of subtypes of PDAC, which are highly relevant for disease-free and overall patient survival and response to chemotherapy.
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Affiliation(s)
- Georgios Kaissis
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sebastian Ziegelmayer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Fabian Lohöfer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Katja Steiger
- Department of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Hana Algül
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Muckenhuber
- Department of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Hsi-Yu Yen
- Department of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Ernst Rummeny
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Roland Schmid
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Wilko Weichert
- Department of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jens T. Siveke
- Division of Solid Tumor Translational Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rickmer Braren
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
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Lu M, Hartmann D, Braren R, Gupta A, Wang B, Wang Y, Mogler C, Cheng Z, Wirth T, Friess H, Kleeff J, Hüser N, Sunami Y. Oncogenic Akt-FOXO3 loop favors tumor-promoting modes and enhances oxidative damage-associated hepatocellular carcinogenesis. BMC Cancer 2019; 19:887. [PMID: 31488102 PMCID: PMC6728971 DOI: 10.1186/s12885-019-6110-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 08/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the most prevalent primary liver cancer, accounting for 80-90% of cases. Mutations are commonly found in the signaling regulating the PI3K/Akt pathway, leading to oncogenic cell proliferation and survival. Key transcription factors that are negatively regulated downstream of PI3K/Akt are members of the forkhead box O family (FOXO). FOXOs were initially considered as tumor suppressors by inducing cell cycle arrest and apoptosis. However, there is increasing evidence showing that FOXOs, especially FOXO3, can support tumorigenesis. METHODS To understand the roles of FOXO3 in liver tumorigenesis and hepatocarcinogenesis, we analyzed HCC patient specimens and also established a doxycycline-regulated transgenic mouse model with hepatocyte-specific FOXO3 expression in a constitutively active form. RESULTS We found that FOXO3 protein is significantly overexpressed and activated in livers of HCC patients. Hepatic activation of FOXO3 induced extensive hepatic damage and elevated gene expression of several HCC-associated factors. Furthermore, FOXO3 expression enhanced hepatotoxicin-induced tumorigenesis. Mechanistically, FOXO3 activation caused oxidative stress and DNA damage and triggered positive feedback-loop for Akt activation as well as mTORC2 activation. Interestingly, FOXO3 activated not only reactive oxygen species (ROS)-promoting pathways, but also ROS-eliminating systems, which can be associated with the activation of the pentose phosphate pathway. CONCLUSIONS FOXO3 is a master regulator of ROS in a 'carrot and stick' manner; on one side avoiding cellular crisis while also supporting hepatocellular carcinogenesis. Clinically, we suggest analyzing FOXO3 activation status in patients with liver diseases, in addition to PI3K/Akt signaling. Personalized therapy of FOXO3 inhibition may be a reasonable, depending on the activation status of FOXO3.
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Affiliation(s)
- Miao Lu
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Munich, Germany.,Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Daniel Hartmann
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Munich, Germany
| | - Rickmer Braren
- School of Medicine, Klinikum rechts der Isar, Institute for diagnostic and interventional Radiology, Technical University of Munich, Munich, Germany
| | - Aayush Gupta
- School of Medicine, Klinikum rechts der Isar, Institute for diagnostic and interventional Radiology, Technical University of Munich, Munich, Germany
| | - Baocai Wang
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Munich, Germany
| | - Yang Wang
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Munich, Germany
| | - Carolin Mogler
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Zhangjun Cheng
- Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Thomas Wirth
- Institute of Physiological Chemistry, University of Ulm, Ulm, Germany
| | - Helmut Friess
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Munich, Germany
| | - Jörg Kleeff
- Department of Visceral, Vascular and Endocrine Surgery, University Medical Center Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Norbert Hüser
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Munich, Germany.
| | - Yoshiaki Sunami
- Department of Visceral, Vascular and Endocrine Surgery, University Medical Center Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
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Hesse F, Braren R, Schmid RM, Phillip V. Autoimmune Pancreatitis Type 1 Associated with a Pancreatic Pseudocyst. Case Rep Gastroenterol 2019; 13:195-199. [PMID: 31123446 PMCID: PMC6514526 DOI: 10.1159/000499444] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/05/2019] [Indexed: 11/19/2022] Open
Abstract
Pancreatic cystic lesions comprise diverse entities with different histopathological characteristics. Differential diagnosis is often challenging. Autoimmune pancreatitis (AIP) is usually not considered an underlying pathology in the differential diagnosis of peri-/pancreatic pseudo-/cystic lesions. We report the case of a 73-year-old male with diffuse pancreatic enlargement and an adjacent cystic lesion (60 × 80 mm) on computed tomography scan. Based on these imaging findings and an elevated serum IgG4 concentration, AIP complicated by a pancreatic pseudocyst was diagnosed, and treatment with glucocorticoids was started. Regular follow-ups showed a good response to treatment with regression of the pancreatic pseudocyst and remittent pancreatic swelling.
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Affiliation(s)
- Felix Hesse
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Rickmer Braren
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Roland M Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Veit Phillip
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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47
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Kaissis G, Braren R. Pancreatic cancer detection and characterization-state of the art cross-sectional imaging and imaging data analysis. Transl Gastroenterol Hepatol 2019; 4:35. [PMID: 31231702 DOI: 10.21037/tgh.2019.05.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) represents a deadly disease, prognosticated to become the 2nd most common cause of cancer related death in the western world by 2030. State of the art radiologic high-resolution cross-sectional imaging by computed tomography (CT) and magnetic resonance imaging (MRI) represent advanced techniques for early lesion detection, pre-therapeutic patient staging and therapy response monitoring. In light of molecular taxonomies currently under development, the implementation of advanced imaging data post-processing pipelines and the integration of imaging and clinical data for the development of risk assessment and clinical decision support tools are required. This review will present the current state of cross-sectional radiologic imaging and image post-processing related to PDAC.
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Affiliation(s)
- Georgios Kaissis
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Translational Oncology and Quantitative Imaging/Data Science Laboratory, Munich, Germany
| | - Rickmer Braren
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Translational Oncology and Quantitative Imaging/Data Science Laboratory, Munich, Germany
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48
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Münch S, Pigorsch SU, Devečka M, Dapper H, Feith M, Friess H, Weichert W, Jesinghaus M, Braren R, Combs SE, Habermehl D. Neoadjuvant versus definitive chemoradiation in patients with squamous cell carcinoma of the esophagus. Radiat Oncol 2019; 14:66. [PMID: 30992022 PMCID: PMC6469104 DOI: 10.1186/s13014-019-1270-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/05/2019] [Indexed: 01/24/2023] Open
Abstract
Background Multimodal treatment with neoadjuvant chemoradiation followed by surgery (nCRT + S) is the treatment of choice for patients with locally advanced or node-positive esophageal squamous cell carcinoma (E-SCC). Those who are unsuitable or who decline surgery can be treated with definitive chemoradiation (dCRT). This study compares the oncologic outcome of nCRT + S and dCRT in E-SCC patients. Methods Between 2011 and 2017, 95 patients with E-SCC were scheduled for dCRT or nCRT+ S with IMRT at our department. Patients undergoing dCRT received at least 50 Gy and those undergoing nCRT + S received at least 41.4 Gy. All patients received simultaneous chemotherapy with either carboplatin and paclitaxel or cisplatin and 5-fluoruracil. We retrospectively compared baseline characteristics and oncologic outcome including overall survival (OS), progression-free survival (PFS) and site of failure between both treatment groups. Results Patients undergoing dCRT were less likely to have clinically suspected lymph node metastases (85% vs. 100%, p = 0.019) than patients undergoing nCRT + S and had more proximally located tumors (median distance from dental arch to cranial tumor border 20 cm vs. 26 cm, p < 0.001). After a median follow up of 25.6 months for surviving patients, no significant differences for OS and PFS were noticed comparing nCRT + S and dCRT. However, the rate of local tumor recurrence was significantly higher in patients treated with dCRT than in those treated with nCRT + S (38% vs. 10%, p = 0.002). Within a multivariate Cox regression model, age, tumor location, and tumor grading were the only independent parameters affecting OS and PFS. In addition to that, proximal tumor location was the only parameter independently associated with an increased risk for local treatment failure. Conclusion In E-SCC patients treated with either dCRT or nCRT + S, a higher rate of local tumor recurrence was seen in patients treated with dCRT than in patients treated with nCRT + S. There was at least a trend towards an improved OS and PFS in patients undergoing nCRT + S. However, this should be interpreted with caution, because proximal tumor location was the only parameter independently affecting the risk of local tumor recurrence.
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Affiliation(s)
- Stefan Münch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany. .,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
| | - Steffi U Pigorsch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Michal Devečka
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Hendrik Dapper
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marcus Feith
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Wilko Weichert
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Institute of Pathology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Moritz Jesinghaus
- Institute of Pathology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rickmer Braren
- Institute of Radiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Helmholtz Zentrum München, Institute of Radiation Medicine (IRM), Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany
| | - Daniel Habermehl
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Münch S, Pigorsch SU, Devečka M, Dapper H, Weichert W, Friess H, Braren R, Combs SE, Habermehl D. Comparison of definite chemoradiation therapy with carboplatin/paclitaxel or cisplatin/5-fluoruracil in patients with squamous cell carcinoma of the esophagus. Radiat Oncol 2018; 13:139. [PMID: 30068371 PMCID: PMC6090949 DOI: 10.1186/s13014-018-1085-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/24/2018] [Indexed: 11/15/2022] Open
Abstract
Background While neoadjuvant chemoradiation therapy (nCRT) with subsequent surgery is the treatment of choice for patients with locally advanced or node-positive squamous cell carcinoma of the esophagus (SCC) suitable for surgery, patients who are unsuitable for surgery or who refuse surgery should be treated with definite chemoradiation therapy (dCRT). Purpose of this study was to compare toxicity and oncologic outcome of dCRT with either cisplatin and 5-fluoruracil (CDDP/5FU) or carboplatin and paclitaxel (Carb/TAX) in patients with SCC. Methods Twenty-two patients who received dCRT with carboplatin (AUC2, weekly) and paclitaxel (50 mg per square meter of body-surface area, weekly) were retrospectively compared to 25 patients who were scheduled for dCRT with cisplatin (20 mg/m2/d) and 5-fluoruracil (500 mg/m2/d) on day 1–5 and day 29–33. For the per-protocol (PP) analysis, PP treatment was defined as complete radiation therapy with at least 54Gy and at least three complete cycles of Carb/TAX or complete radiation therapy with at least 54Gy and at least one complete cycle of CDDP/5FU. While patients who were scheduled for dCRT with Carb/TAX received a significantly higher total radiation dose (median dose 59.4Gy vs. 54Gy, p < 0.001) than patients who were scheduled for dCRT with CDDP/5FU, no significant differences were seen for other parameters (age, sex, TNM-stage, grading and tumor extension). Results Forty-seven patients (25 patients treated with CDDP/5FU and 22 patients treated with Carb/TAX) were evaluated for the intention-to-treat (ITT) analysis and 41 of 47 patients (23 patients treated with CDDP/5FU and 18 patients treated with Carb/TAX) were evaluated for the PP analysis. Severe myelotoxicity (≥ III°) was seen in 52% (CDDP/5FU) and 55% of patients (Carb/TAX), respectively (p = 1.000). In the univariate binary logistic regression analysis, patients age was the only factor associated with an increased risk of ≥ III° myelotoxicity (hazard ratio 1.145, 95% CI 1.035; 1.266; p = 0.009). Regarding treatment efficiency, no significant differences were seen for overall survival (OS) and freedom from relapse (FFR) between both treatment groups. Conclusion Myelotoxicity and oncologic outcome under dCRT were not different for patients with SCC of the esophagus treated with either CDDP/5FU or Carb/TAX. The putative equivalence of dCRT with Carb/TAX in this setting should be further investigated in prospective trials. However, our data reveal that the risk of significant myelotoxicity increases with patient age and therefore other chemotherapy regimens might be evaluated in elderly patients.
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Affiliation(s)
- Stefan Münch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany. .,German Cancer Consortium (DKTK) Partner Site Munich, Munich, Germany.
| | - Steffi U Pigorsch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany.,German Cancer Consortium (DKTK) Partner Site Munich, Munich, Germany
| | - Michal Devečka
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany
| | - Hendrik Dapper
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany
| | - Wilko Weichert
- German Cancer Consortium (DKTK) Partner Site Munich, Munich, Germany.,Institute of Pathology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany
| | - Rickmer Braren
- Institute of Radiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany.,German Cancer Consortium (DKTK) Partner Site Munich, Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, D-85764, Munich, Germany
| | - Daniel Habermehl
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany
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50
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Dangelmaier J, Schwaiger BJ, Gersing AS, Kopp FF, Sauter A, Renz M, Riederer I, Braren R, Pfeiffer D, Fingerle A, Rummeny EJ, Noël PB. Dual layer computed tomography: Reduction of metal artefacts from posterior spinal fusion using virtual monoenergetic imaging. Eur J Radiol 2018; 105:195-203. [PMID: 30017279 DOI: 10.1016/j.ejrad.2018.05.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 09/25/2017] [Revised: 05/07/2018] [Accepted: 05/31/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION To evaluate the clinical potential of dual layer computed tomography (DLCT) for posterior fusions of the thoracic and lumbar spine and determine the optimal keV-settings for an improved overall image quality and effective reduction of metal artefacts affecting the implant inheriting vertebral body, the spinal canal, the paravertebral muscle and aorta. METHODS AND MATERIALS Twenty patients with posterior thoracic and lumbar spinal fusion, who underwent a 120kVp- DLCT scan were included in this study. Two independent readers evaluated axial 0.9 mm slides with soft tissue and bone window settings. Image quality of the conventional scan was compared to virtual monoenergetic images (VMI) at 40, 60, 80, 100,120, 140, 160, 180 and 200 keV. Diagnostic image quality was assessed on a four point Likert-scale overall, as well as specifically for the implant inheriting bone, paravertebral muscle, spinal canal or aorta. The Hounsfield Units (HU) of the area with the most pronounced streak artefact as well as HU of a reference area containing fat and muscle were documented for each keV-setting and compared to the conventional image. SNR and CNR were calculated for each of the four anatomic areas. Statistical analysis was conducted for the total collective and separately for the thoracic and lumbar spine level. RESULTS Starting from 80 keV qualitative analysis revealed significant improvement of overall image quality and benefit for each tissue separately compared to the conventional images (CI) (p-values in the range from <0.001 to 0.005). 180 keV was considered the optimal monoenergetic setting regarding the overall image quality. For the assessment of the implant inheriting bone, the spinal canal, paravertebral muscle and aorta 200, 180, 160 and 180 keV were rated to be the most sufficient. Our results reveal high inter-reader agreement for qualitative evaluations (intra-class correlation coefficients >0.927; p < 0.05). HU values within the most pronounced streak artefact increased significantly with higher keV (p < 0.001), while there was no significant alteration of HU within the reference area. A decrease in SNR and CNR for higher VMI was revealed by our results. CONCLUSION VMIs of higher energies provide significant reduction of metallic artefacts from posterior spinal fusions. Dedicated keV settings to evaluate either the implant inheriting bone, the spinal canal,adjacent muscle or aorta - structures, which are frequently of particular interest after posterior spinal fusion - are recommended. In addition, an optimal keV for an improved overall image quality is proposed.
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Affiliation(s)
- Julia Dangelmaier
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Benedikt J Schwaiger
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Alexandra S Gersing
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Felix F Kopp
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Andreas Sauter
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Martin Renz
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Isabelle Riederer
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Rickmer Braren
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany; Department of Physics & Munich School of BioEngineering, Technical University of Munich, James-Franck-Straße 1 85748, Garching, Germany
| | - Alexander Fingerle
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany; Department of Physics & Munich School of BioEngineering, Technical University of Munich, James-Franck-Straße 1 85748, Garching, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany; Department of Physics & Munich School of BioEngineering, Technical University of Munich, James-Franck-Straße 1 85748, Garching, Germany
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