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Triggiani S, Contaldo MT, Mastellone G, Cè M, Ierardi AM, Carrafiello G, Cellina M. The Role of Artificial Intelligence and Texture Analysis in Interventional Radiological Treatments of Liver Masses: A Narrative Review. Crit Rev Oncog 2024; 29:37-52. [PMID: 38505880 DOI: 10.1615/critrevoncog.2023049855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Liver lesions, including both benign and malignant tumors, pose significant challenges in interventional radiological treatment planning and prognostication. The emerging field of artificial intelligence (AI) and its integration with texture analysis techniques have shown promising potential in predicting treatment outcomes, enhancing precision, and aiding clinical decision-making. This comprehensive review aims to summarize the current state-of-the-art research on the application of AI and texture analysis in determining treatment response, recurrence rates, and overall survival outcomes for patients undergoing interventional radiological treatment for liver lesions. Furthermore, the review addresses the challenges associated with the implementation of AI and texture analysis in clinical practice, including data acquisition, standardization of imaging protocols, and model validation. Future directions and potential advancements in this field are discussed. Integration of multi-modal imaging data, incorporation of genomics and clinical data, and the development of predictive models with enhanced interpretability are proposed as potential avenues for further research. In conclusion, the application of AI and texture analysis in predicting outcomes of interventional radiological treatment for liver lesions shows great promise in augmenting clinical decision-making and improving patient care. By leveraging these technologies, clinicians can potentially enhance treatment planning, optimize intervention strategies, and ultimately improve patient outcomes in the management of liver lesions.
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Affiliation(s)
- Sonia Triggiani
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Maria T Contaldo
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy
| | - Giulia Mastellone
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy
| | - Maurizio Cè
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Anna M Ierardi
- Radiology Department, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, 20122 Milan, Italy
| | - Gianpaolo Carrafiello
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy; Radiology Department, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Università di Milano, 20122 Milan, Italy
| | - Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Piazza Principessa Clotilde 3, 20121, Milan, Italy
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Zhuo M, Tang Y, Guo J, Qian Q, Xue E, Chen Z. Predicting the risk stratification of gastrointestinal stromal tumors using machine learning-based ultrasound radiomics. J Med Ultrason (2001) 2024; 51:71-82. [PMID: 37798591 DOI: 10.1007/s10396-023-01373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/21/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE This study aimed to use conventional ultrasound features, ultrasound radiomics, and machine learning algorithms to establish a predictive model to assess the risk of post-surgical recurrence of gastrointestinal stromal tumors (GISTs). METHODS This retrospective analysis included 230 patients with pathologically diagnosed GISTs. Radiomic features were extracted from manually annotated images. Radiomic features plus conventional ultrasound features were selected using the SelectKbest analysis of variance and stratified tenfold cross-validation recursive elimination methods. Finally, five different machine learning algorithms (logistic regression [LR], support vector machine [SVM], random forest [RF], extreme gradient boosting [XGBoost], and multilayer perceptron [MLP]) were established to predict risk stratification of GISTs. The predictive performance of the established model was mainly evaluated based on the area under the receiver operating characteristic (ROC) curve (AUC) and accuracy, whereas the predictive performance of the optimal machine learning algorithm and a radiologist's subjective assessment were compared using McNemar's test. RESULTS Seven radiomics features and one conventional ultrasound feature were selected to construct the machine learning models for GIST risk classification. The mentioned five machine learning models were able to predict the malignant potential of GISTs. LR and SVM outperformed other classifiers on the test set, with LR achieving an accuracy of 0.852 (AUC, 0.881; sensitivity, 0.871; specificity, 0.826) and SVM achieving an accuracy of 0.852 (AUC, 0.879; sensitivity, 0.839; specificity, 0.870), and proved significantly better than the radiologist (accuracy, 0.691; sensitivity, 0.645; specificity, 0.813). CONCLUSION Machine learning-based ultrasound radiomics features are able to noninvasively predict the biological risk of GISTs.
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Affiliation(s)
- Minling Zhuo
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Yi Tang
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Jingjing Guo
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Qingfu Qian
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Ensheng Xue
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Zhikui Chen
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China.
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Ricci Lara MA, Esposito MI, Aineseder M, López Grove R, Cerini MA, Verzura MA, Luna DR, Benítez SE, Spina JC. Radiomics and Machine Learning for prediction of two-year disease-specific mortality and KRAS mutation status in metastatic colorectal cancer. Surg Oncol 2023; 51:101986. [PMID: 37729816 DOI: 10.1016/j.suronc.2023.101986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE Colorectal cancer is usually accompanied by liver metastases. The prediction of patient evolution is essential for the choice of the appropriate therapy. The aim of this study is to develop and evaluate machine learning models to predict KRAS gene mutations and 2-year disease-specific mortality from medical images. METHODS Clinical and follow-up information was collected from patients with metastatic colorectal cancer who had undergone computed tomography prior to liver resection. The dominant liver lesion was segmented in each scan and radiomic features were extracted from the volumes of interest. The 65% of the cases were employed to perform feature selection and to train machine learning algorithms through cross-validation. The best performing models were assembled and evaluated in the remaining cases of the cohort. RESULTS For the mortality model development, 101 cases were used as training set (64 alive, 37 deceased) and 35 as test set (22 alive, 13 deceased); while for KRAS mutation models, 55 cases were used for training (31 wild-type, 24 mutated) and 30 for testing (17 wild-type, 13 mutated). The ensemble of top performing models resulted in an area under the receiver operating characteristic curve of 0.878 for mortality and 0.905 for KRAS prediction. CONCLUSIONS Predicting the prognosis of patients with metastatic colorectal cancer is useful for making timely decisions about the best treatment options. This study presents a noninvasive method based on quantitative analysis of baseline images to identify factors influencing patient outcomes, with the aim of incorporating these tools as support systems.
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Affiliation(s)
- María Agustina Ricci Lara
- Health Informatics Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, 1199, Ciudad Autónoma de Buenos Aires, Argentina; Universidad Tecnológica Nacional, Av. Medrano 951, 1179, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Marco Iván Esposito
- Health Informatics Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, 1199, Ciudad Autónoma de Buenos Aires, Argentina; Instituto Tecnológico de Buenos Aires, Iguazú 341, 1437, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Martina Aineseder
- Radiology Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, 1199, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Roy López Grove
- Radiology Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, 1199, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Matías Alejandro Cerini
- Oncology Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, 1199, Ciudad Autónoma de Buenos Aires, Argentina.
| | - María Alicia Verzura
- Oncology Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, 1199, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Daniel Roberto Luna
- Health Informatics Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, 1199, Ciudad Autónoma de Buenos Aires, Argentina; Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de triple dependencia CONICET- Instituto Universitario del Hospital Italiano (IUHI) - Hospital ITaliano (HIBA), Tte. Gral. Juan Domingo Perón 4190, 1199, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Sonia Elizabeth Benítez
- Health Informatics Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, 1199, Ciudad Autónoma de Buenos Aires, Argentina; Instituto Universitario del Hospital Italiano, Potosí 4265, 1199, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Juan Carlos Spina
- Radiology Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, 1199, Ciudad Autónoma de Buenos Aires, Argentina.
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Liang M, Ma X, Wang L, Li D, Wang S, Zhang H, Zhao X. Whole-liver enhanced CT radiomics analysis to predict metachronous liver metastases after rectal cancer surgery. Cancer Imaging 2022; 22:50. [PMID: 36089623 PMCID: PMC9465956 DOI: 10.1186/s40644-022-00485-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background To develop a radiomics model based on pretreatment whole-liver portal venous phase (PVP) contrast-enhanced CT (CE-CT) images for predicting metachronous liver metastases (MLM) within 24 months after rectal cancer (RC) surgery. Methods This study retrospectively analyzed 112 RC patients without preoperative liver metastases who underwent rectal surgery between January 2015 and December 2017 at our institution. Volume of interest (VOI) segmentation of the whole-liver was performed on the PVP CE-CT images. All 1316 radiomics features were extracted automatically. The maximum-relevance and minimum-redundancy and least absolute shrinkage and selection operator methods were used for features selection and radiomics signature constructing. Three models based on radiomics features (radiomics model), clinical features (clinical model), and radiomics combined with clinical features (combined model) were built by multivariable logistic regression analysis. Receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of models, and calibration curve and the decision curve analysis were performed to evaluate the clinical application value. Results In total, 52 patients in the MLM group and 60 patients in the non-MLM group were enrolled in this study. The radscore was built using 16 selected features and the corresponding coefficients. Both the radiomics model and the combined model showed higher diagnostic performance than clinical model (AUCs of training set: radiomics model 0.84 (95% CI, 0.76–0.93), clinical model 0.65 (95% CI, 0.55–0.75), combined model 0.85 (95% CI, 0.77–0.94); AUCs of validation set: radiomics model 0.84 (95% CI, 0.70–0.98), clinical model 0.58 (95% CI, 0.40–0.76), combined model 0.85 (95% CI, 0.71–0.99)). The calibration curves showed great consistency between the predicted value and actual event probability. The DCA showed that both the radiomics and combined models could add a net benefit on a large scale. Conclusions The radiomics model based on preoperative whole-liver PVP CE-CT could predict MLM within 24 months after RC surgery. Clinical features could not significantly improve the prediction efficiency of the radiomics model. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00485-z.
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Granata V, Fusco R, De Muzio F, Cutolo C, Setola SV, Dell'Aversana F, Grassi F, Belli A, Silvestro L, Ottaiano A, Nasti G, Avallone A, Flammia F, Miele V, Tatangelo F, Izzo F, Petrillo A. Radiomics and machine learning analysis based on magnetic resonance imaging in the assessment of liver mucinous colorectal metastases. Radiol Med 2022; 127:763-772. [PMID: 35653011 DOI: 10.1007/s11547-022-01501-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/27/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the Radiomics and Machine Learning Analysis based on MRI in the assessment of Liver Mucinous Colorectal Metastases.Query METHODS: The cohort of patients included a training set (121 cases) and an external validation set (30 cases) with colorectal liver metastases with pathological proof and MRI study enrolled in this approved study retrospectively. About 851 radiomics features were extracted as median values by means of the PyRadiomics tool on volume on interest segmented manually by two expert radiologists. Univariate analysis, linear regression modelling and pattern recognition methods were used as statistical and classification procedures. RESULTS The best results at univariate analysis were reached by the wavelet_LLH_glcm_JointEntropy extracted by T2W SPACE sequence with accuracy of 92%. Linear regression model increased the performance obtained respect to the univariate analysis. The best results were obtained by a linear regression model of 15 significant features extracted by the T2W SPACE sequence with accuracy of 94%, a sensitivity of 92% and a specificity of 95%. The best classifier among the tested pattern recognition approaches was k-nearest neighbours (KNN); however, KNN achieved lower precision than the best linear regression model. CONCLUSIONS Radiomics metrics allow the mucinous subtype lesion characterization, in order to obtain a more personalized approach. We demonstrated that the best performance was obtained by T2-W extracted textural metrics.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS Di Napoli, Naples, Italy
| | | | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100, Campobasso, Italy
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084, Fisciano, Italy
| | - Sergio Venanzio Setola
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS Di Napoli, Naples, Italy
| | - Federica Dell'Aversana
- Division of Radiology, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Grassi
- Division of Radiology, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Andrea Belli
- Division of Hepatobiliary Surgery, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS Di Napoli, Naples, Italy
| | - Lucrezia Silvestro
- Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Alessandro Ottaiano
- Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Guglielmo Nasti
- Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Antonio Avallone
- Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Federica Flammia
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134, Florence, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, via della Signora 2, 20122, Milan, Italy.,Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134, Florence, Italy
| | - Fabiana Tatangelo
- Division of Pathology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS Di Napoli, 80131, Naples, Italy
| | - Francesco Izzo
- Division of Hepatobiliary Surgery, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS Di Napoli, Naples, Italy
| | - Antonella Petrillo
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS Di Napoli, Naples, Italy
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Radiomics and Machine Learning Analysis Based on Magnetic Resonance Imaging in the Assessment of Colorectal Liver Metastases Growth Pattern. Diagnostics (Basel) 2022; 12:diagnostics12051115. [PMID: 35626271 PMCID: PMC9140199 DOI: 10.3390/diagnostics12051115] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/11/2022] [Accepted: 04/27/2022] [Indexed: 02/07/2023] Open
Abstract
To assess Radiomics and Machine Learning Analysis in Liver Colon and Rectal Cancer Metastases (CRLM) Growth Pattern, we evaluated, retrospectively, a training set of 51 patients with 121 liver metastases and an external validation set of 30 patients with a single lesion. All patients were subjected to MRI studies in pre-surgical setting. For each segmented volume of interest (VOI), 851 radiomics features were extracted using PyRadiomics package. Nonparametric test, univariate, linear regression analysis and patter recognition approaches were performed. The best results to discriminate expansive versus infiltrative front of tumor growth with the highest accuracy and AUC at univariate analysis were obtained by the wavelet_LHH_glrlm_ShortRunLowGray Level Emphasis from portal phase of contrast study. With regard to linear regression model, this increased the performance obtained respect to the univariate analysis for each sequence except that for EOB-phase sequence. The best results were obtained by a linear regression model of 15 significant features extracted by the T2-W SPACE sequence. Furthermore, using pattern recognition approaches, the diagnostic performance to discriminate the expansive versus infiltrative front of tumor growth increased again and the best classifier was a weighted KNN trained with the 9 significant metrics extracted from the portal phase of contrast study, with an accuracy of 92% on training set and of 91% on validation set. In the present study, we have demonstrated as Radiomics and Machine Learning Analysis, based on EOB-MRI study, allow to identify several biomarkers that permit to recognise the different Growth Patterns in CRLM.
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Granata V, Fusco R, De Muzio F, Cutolo C, Setola SV, Grassi R, Grassi F, Ottaiano A, Nasti G, Tatangelo F, Pilone V, Miele V, Brunese MC, Izzo F, Petrillo A. Radiomics textural features by MR imaging to assess clinical outcomes following liver resection in colorectal liver metastases. Radiol Med 2022; 127:461-470. [PMID: 35347583 DOI: 10.1007/s11547-022-01477-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/25/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To assess the efficacy of radiomics features obtained by T2-weighted sequences to predict clinical outcomes following liver resection in colorectal liver metastases patients. METHODS This retrospective analysis was approved by the local Ethical Committee board and radiological databases were interrogated, from January 2018 to May 2021, to select patients with liver metastases with pathological proof and MRI study in pre-surgical setting. The cohort of patients included a training set and an external validation set. The internal training set included 51 patients with 61 years of median age and 121 liver metastases. The validation cohort consisted a total of 30 patients with single lesion with 60 years of median age. For each volume of interest, 851 radiomics features were extracted as median values using PyRadiomics. Nonparametric test, intraclass correlation, receiver operating characteristic (ROC) analysis, linear regression modelling and pattern recognition methods (support vector machine (SVM), k-nearest neighbours (KNN), artificial neural network (NNET) and decision tree (DT)) were considered. RESULTS The best predictor to discriminate expansive versus infiltrative front of tumour growth was obtained by wavelet_LHL_gldm_DependenceNonUniformityNormalized with an accuracy of 82%; to discriminate high grade versus low grade or absent was the wavelet_LLH_glcm_Imc1 with accuracy of 88%; to differentiate the mucinous type of tumour was the wavelet_LLH_glcm_JointEntropy with accuracy of 92% while to identify tumour recurrence was the wavelet_LLL_glcm_Correlation with accuracy of 85%. Linear regression model increased the performance obtained with respect to the univariate analysis exclusively in the discrimination of expansive versus infiltrative front of tumour growth reaching an accuracy of 90%, a sensitivity of 95% and a specificity of 80%. Considering significant texture metrics tested with pattern recognition approaches, the best performance was reached by the KNN in the discrimination of the tumour budding considering the four textural predictors obtaining an accuracy of 93%, a sensitivity of 81% and a specificity of 97%. CONCLUSIONS Ours results confirmed the capacity of radiomics to identify as biomarkers, several prognostic features that could affect the treatment choice in patients with liver metastases, in order to obtain a more personalized approach.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.
| | | | - Federica De Muzio
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Sergio Venanzio Setola
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Roberta Grassi
- Division of Radiology, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Grassi
- Division of Radiology, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Alessandro Ottaiano
- Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Guglielmo Nasti
- Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Fabiana Tatangelo
- Division of Pathology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Vincenzo Pilone
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Vittorio Miele
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.,Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, via della Signora 2, 20122, Milan, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Francesco Izzo
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Antonella Petrillo
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
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CT-Based Radiomics Analysis to Predict Histopathological Outcomes Following Liver Resection in Colorectal Liver Metastases. Cancers (Basel) 2022; 14:cancers14071648. [PMID: 35406419 PMCID: PMC8996874 DOI: 10.3390/cancers14071648] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The objective of the study was to assess the radiomic features obtained by computed tomography (CT) examination as prognostic biomarkers in patients with colorectal liver metastases, in order to predict histopathological outcomes following liver resection. We obtained good performance considering the single significant textural metric in the identification of the front of tumor growth (expansive versus infiltrative) and tumor budding (high grade versus low grade or absent), in the recognition of mucinous type, and in the detection of recurrences. Abstract Purpose: We aimed to assess the efficacy of radiomic features extracted by computed tomography (CT) in predicting histopathological outcomes following liver resection in colorectal liver metastases patients, evaluating recurrence, mutational status, histopathological characteristics (mucinous), and surgical resection margin. Methods: This retrospectively approved study included a training set and an external validation set. The internal training set included 49 patients with a median age of 60 years and 119 liver colorectal metastases. The validation cohort consisted of 28 patients with single liver colorectal metastasis and a median age of 61 years. Radiomic features were extracted using PyRadiomics on CT portal phase. Nonparametric Kruskal–Wallis tests, intraclass correlation, receiver operating characteristic (ROC) analyses, linear regression modeling, and pattern recognition methods (support vector machine (SVM), k-nearest neighbors (KNN), artificial neural network (NNET), and decision tree (DT)) were considered. Results: The median value of intraclass correlation coefficients for the features was 0.92 (range 0.87–0.96). The best performance in discriminating expansive versus infiltrative front of tumor growth was wavelet_HHL_glcm_Imc2, with an accuracy of 79%, a sensitivity of 84%, and a specificity of 67%. The best performance in discriminating expansive versus tumor budding was wavelet_LLL_firstorder_Mean, with an accuracy of 86%, a sensitivity of 91%, and a specificity of 65%. The best performance in differentiating the mucinous type of tumor was original_firstorder_RobustMeanAbsoluteDeviation, with an accuracy of 88%, a sensitivity of 42%, and a specificity of 100%. The best performance in identifying tumor recurrence was the wavelet_HLH_glcm_Idmn, with an accuracy of 85%, a sensitivity of 81%, and a specificity of 88%. The best linear regression model was obtained with the identification of recurrence considering the linear combination of the 16 significant textural metrics (accuracy of 97%, sensitivity of 94%, and specificity of 98%). The best performance for each outcome was reached using KNN as a classifier with an accuracy greater than 86% in the training and validation sets for each classification problem; the best results were obtained with the identification of tumor front growth considering the seven significant textural features (accuracy of 97%, sensitivity of 90%, and specificity of 100%). Conclusions: This study confirmed the capacity of radiomics data to identify several prognostic features that may affect the treatment choice in patients with liver metastases, in order to obtain a more personalized approach.
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EOB-MR Based Radiomics Analysis to Assess Clinical Outcomes following Liver Resection in Colorectal Liver Metastases. Cancers (Basel) 2022; 14:cancers14051239. [PMID: 35267544 PMCID: PMC8909637 DOI: 10.3390/cancers14051239] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The aim of this study was to assess the efficacy of radiomics features obtained by EOB-MRI phase in order to predict clinical outcomes following liver resection in Colorectal Liver Metastases Patients, and evaluate recurrence, mutational status, pathological characteristic (mucinous) and surgical resection margin. Ours results confirmed the capacity of radiomics to identify, as biomarkers, several prognostic features that could affect the treatment choice in patients with liver metastases, in order to obtain a more personalized approach. These results were confirmed by external validation dataset. We obtained a good performance considering the single textural significant metric in the identification of front of tumor growth (expansive versus infiltrative) and tumor budding (high grade versus low grade or absent), in the recognition of mucinous type and in the detection of recurrences. Abstract The aim of this study was to assess the efficacy of radiomics features obtained by EOB-MRI phase in order to predict clinical outcomes following liver resection in Colorectal Liver Metastases Patients, and evaluate recurrence, mutational status, pathological characteristic (mucinous) and surgical resection margin. This retrospective analysis was approved by the local Ethical Committee board of National Cancer of Naples, IRCCS “Fondazione Pascale”. Radiological databases were interrogated from January 2018 to May 2021 in order to select patients with liver metastases with pathological proof and EOB-MRI study in pre-surgical setting. The cohort of patients included a training set (51 patients with 61 years of median age and 121 liver metastases) and an external validation set (30 patients with single lesion with 60 years of median age). For each segmented volume of interest by 2 expert radiologists, 851 radiomics features were extracted as median values using PyRadiomics. non-parametric test, intraclass correlation, receiver operating characteristic (ROC) analysis, linear regression modelling and pattern recognition methods (support vector machine (SVM), k-nearest neighbors (KNN), artificial neural network (NNET), and decision tree (DT)) were considered. The best predictor to discriminate expansive versus infiltrative front of tumor growth was HLH_glcm_MaximumProbability extraxted on VIBE_FA30 with an accuracy of 84%, a sensitivity of 83%, and a specificity of 82%. The best predictor to discriminate tumor budding was Inverse Variance obtained by the original GLCM matrix extraxted on VIBE_FA30 with an accuracy of 89%, a sensitivity of 96% and a specificity of 65%. The best predictor to differentiate the mucinous type of tumor was the HHL_glszm_ZoneVariance extraxted on VIBE_FA30 with an accuracy of 85%, a sensitivity of 46% and a specificity of 95%. The best predictor to identify tumor recurrence was the LHL_glcm_Correlation extraxted on VIBE_FA30 with an accuracy of 86%, a sensitivity of 52% and a specificity of 97%. The best linear regression model was obtained in the identification of the tumor growth front considering the height textural significant metrics by VIBE_FA10 (an accuracy of 89%; sensitivity of 93% and a specificity of 82%). Considering significant texture metrics tested with pattern recognition approaches, the best performance for each outcome was reached by a KNN in the identification of recurrence with the 3 textural significant features extracted by VIBE_FA10 (AUC of 91%, an accuracy of 93%; sensitivity of 99% and a specificity of 77%). Ours results confirmed the capacity of radiomics to identify as biomarkers, several prognostic features that could affect the treatment choice in patients with liver metastases, in order to obtain a more personalized approach.
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10
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Granata V, Fusco R, De Muzio F, Cutolo C, Setola SV, dell’ Aversana F, Ottaiano A, Avallone A, Nasti G, Grassi F, Pilone V, Miele V, Brunese L, Izzo F, Petrillo A. Contrast MR-Based Radiomics and Machine Learning Analysis to Assess Clinical Outcomes following Liver Resection in Colorectal Liver Metastases: A Preliminary Study. Cancers (Basel) 2022; 14:cancers14051110. [PMID: 35267418 PMCID: PMC8909569 DOI: 10.3390/cancers14051110] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary The objective of the study was to evaluate the radiomics features obtained by contrast MRI studies as prognostic biomarkers in colorectal liver metastases patients to predict clinical outcomes following liver resection. We demonstrated a good performance considering the single textural significant metric in the identification of front of tumor growth (expansive versus infiltrative) and tumor budding (high grade versus low grade or absent), in the recognition of mucinous type and in the detection of recurrences. Moreover, considering linear regression models or neural network classifiers in a multivariate approach was possible to increase the performance in terms of accuracy, sensitivity, and specificity. Abstract Purpose: To assess radiomics features efficacy obtained by arterial and portal MRI phase in the prediction of clinical outcomes in the colorectal liver metastases patients, evaluating recurrence, mutational status, pathological characteristic (mucinous and tumor budding) and surgical resection margin. Methods: This retrospective analysis was approved by the local Ethical Committee board, and radiological databases were used to select patients with colorectal liver metastases with pathological proof and MRI study in a pre-surgical setting after neoadjuvant chemotherapy. The cohort of patients included a training set (51 patients with 61 years of median age and 121 liver metastases) and an external validation set (30 patients with single lesion with 60 years of median age). For each segmented volume of interest on MRI by two expert radiologists, 851 radiomics features were extracted as median values using the PyRadiomics tool. Non-parametric Kruskal-Wallis test, intraclass correlation, receiver operating characteristic (ROC) analysis, linear regression modelling and pattern recognition methods (support vector machine (SVM), k-nearest neighbors (KNN), artificial neural network (NNET), and decision tree (DT)) were considered. Results: The best predictor to discriminate expansive versus infiltrative tumor growth front was wavelet_LHH_glrlm_ShortRunLowGrayLevelEmphasis extracted on portal phase with accuracy of 82%, sensitivity of 84%, and specificity of 77%. The best predictor to discriminate tumor budding was wavelet_LLH_firstorder_10Percentile extracted on portal phase with accuracy of 92%, a sensitivity of 96%, and a specificity of 81%. The best predictor to differentiate the mucinous type of tumor was the wavelet_LLL_glcm_ClusterTendency extracted on portal phase with accuracy of 88%, a sensitivity of 38%, and a specificity of 100%. The best predictor to identify the recurrence was the wavelet_HLH_ngtdm_Complexity extracted on arterial phase with accuracy of 90%, a sensitivity of 71%, and a specificity of 95%. The best linear regression model was obtained in the identification of mucinous type considering the 13 textural significant metrics extracted by arterial phase (accuracy of 94%, sensitivity of 77% and a specificity of 99%). The best results were obtained in the identification of tumor budding with the eleven textural significant features extracted by arterial phase using a KNN (accuracy of 95%, sensitivity of 84%, and a specificity of 99%). Conclusions: Our results confirmed the capacity of radiomics to identify as biomarkers and several prognostic features that could affect the treatment choice in patients with liver metastases in order to obtain a more personalized approach.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale–IRCCS di Napoli, 80131 Naples, Italy; (S.V.S.); (A.P.)
- Correspondence:
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Napoli, Italy;
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (F.D.M.); (L.B.)
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy; (C.C.); (V.P.)
| | - Sergio Venanzio Setola
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale–IRCCS di Napoli, 80131 Naples, Italy; (S.V.S.); (A.P.)
| | - Federica dell’ Aversana
- Division of Radiology, Università Degli Studi Della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.d.A.); (F.G.)
| | - Alessandro Ottaiano
- Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale–IRCCS di Napoli, 80131 Naples, Italy; (A.O.); (A.A.); (G.N.)
| | - Antonio Avallone
- Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale–IRCCS di Napoli, 80131 Naples, Italy; (A.O.); (A.A.); (G.N.)
| | - Guglielmo Nasti
- Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale–IRCCS di Napoli, 80131 Naples, Italy; (A.O.); (A.A.); (G.N.)
| | - Francesca Grassi
- Division of Radiology, Università Degli Studi Della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.d.A.); (F.G.)
| | - Vincenzo Pilone
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy; (C.C.); (V.P.)
| | - Vittorio Miele
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy;
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (F.D.M.); (L.B.)
| | - Francesco Izzo
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale–IRCCS di Napoli, 80131 Naples, Italy;
| | - Antonella Petrillo
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale–IRCCS di Napoli, 80131 Naples, Italy; (S.V.S.); (A.P.)
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Dercle L, Zhao B, Gönen M, Moskowitz CS, Connors DE, Yang H, Lu L, Reidy-Lagunes D, Fojo T, Karovic S, Maitland ML, Oxnard GR, Schwartz LH. An imaging signature to predict outcome in metastatic colorectal cancer using routine computed tomography scans. Eur J Cancer 2022; 161:138-147. [PMID: 34916122 PMCID: PMC10018811 DOI: 10.1016/j.ejca.2021.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/10/2021] [Accepted: 10/24/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS Quantitative analysis of computed tomography (CT) scans of patients with metastatic colorectal cancer (mCRC) can identify imaging signatures that predict overall survival (OS). METHODS We retrospectively analysed CT images from 1584 mCRC patients on two phase III trials evaluating FOLFOX ± panitumumab (n = 331, 350) and FOLFIRI ± aflibercept (n = 437, 466). In the training set (n = 720), an algorithm was trained to predict OS landmarked from month 2; the output was a signature value on a scale from 0 to 1 (most to least favourable predicted OS). In the validation set (n = 864), hazard ratios (HRs) evaluated the association of the signature with OS using RECIST1.1 as a benchmark of comparison. RESULTS In the training set, the selected signature combined three features - change in tumour volume, change in tumour spatial heterogeneity, and tumour volume - to predict OS. In the validation set, RECIST1.1 classified patients in three categories: response (n = 166, 19.2%), stable disease (n = 636, 73.6%), and progression (n = 62, 7.2%). The HR was 3.93 (2.79-5.54). Using the same distribution for the signature, the HR was 21.04 (14.88-30.58), showing an incremental prognostic separation. Stable disease by RECIST1.1 was reclassified by the signature along a continuum where patients belonging to the most and least favourable signature quartiles had a median OS of 40.73 (28.49 to NA) months (n = 94) and 7.03 (5.66-7.89) months (n = 166), respectively. CONCLUSIONS A signature combining three imaging features provides early prognostic information that can improve treatment decisions for individual patients and clinical trial analyses.
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Affiliation(s)
- Laurent Dercle
- Department of Radiology, Columbia University Medical Center and New York Presbyterian Hospital, 710 West 168th St., New York, NY 10032, USA.
| | - Binsheng Zhao
- Department of Radiology, Columbia University Medical Center and New York Presbyterian Hospital, 710 West 168th St., New York, NY 10032, USA
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Chaya S Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Dana E Connors
- Foundation for the National Institutes of Health (FNIH), 11400 Rockville Pike, Suite 600, North Bethesda, MD 20852, USA
| | - Hao Yang
- Department of Radiology, Columbia University Medical Center and New York Presbyterian Hospital, 710 West 168th St., New York, NY 10032, USA
| | - Lin Lu
- Department of Radiology, Columbia University Medical Center and New York Presbyterian Hospital, 710 West 168th St., New York, NY 10032, USA
| | - Diane Reidy-Lagunes
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Tito Fojo
- Columbia University Herbert Irving Comprehensive Cancer Center, 161 Fort Washington Ave., New York, NY 10032, USA
| | - Sanja Karovic
- Inova Center for Personalized Health and Schar Cancer Institute, 8100 Innovation Park Dr, Fairfax, VA 22031, USA
| | - Michael L Maitland
- Inova Center for Personalized Health and Schar Cancer Institute, 8100 Innovation Park Dr, Fairfax, VA 22031, USA; University of Virginia Cancer Center, 1240 Lee St., Charlottesville, VA 22903, USA
| | - Geoffrey R Oxnard
- Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave., Boston, MA 02215, USA
| | - Lawrence H Schwartz
- Department of Radiology, Columbia University Medical Center and New York Presbyterian Hospital, 710 West 168th St., New York, NY 10032, USA
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Devoto L, Ganeshan B, Keller D, Groves A, Endozo R, Arulampalam T, Chand M. Using texture analysis in the development of a potential radiomic signature for early identification of hepatic metastasis in colorectal cancer. Eur J Radiol Open 2022; 9:100415. [PMID: 35340828 PMCID: PMC8942820 DOI: 10.1016/j.ejro.2022.100415] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 12/24/2022] Open
Abstract
Background Aim Methods Results Conclusion
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Affiliation(s)
- Laurence Devoto
- Wellcome / EPSRC Centre, for Interventional and Surgical Sciences, University College London, 1st Floor, Charles Bell House, 43-45 Foley Street, London W1W 7TS, United Kingdom
- Correspondence to: Wellcome / EPSRC Centre for Interventional and Surgical Sciences, Charles Bell House, 43-45 Foley Street, London W1W 7TS, United Kingdom.
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, 5th floor, Tower, University College London Hospital, 235 Euston Road, London NW1 2BU, United Kingdom
| | - Deborah Keller
- Wellcome / EPSRC Centre, for Interventional and Surgical Sciences, University College London, 1st Floor, Charles Bell House, 43-45 Foley Street, London W1W 7TS, United Kingdom
| | - Ashley Groves
- Institute of Nuclear Medicine, 5th floor, Tower, University College London Hospital, 235 Euston Road, London NW1 2BU, United Kingdom
| | - Raymond Endozo
- Institute of Nuclear Medicine, 5th floor, Tower, University College London Hospital, 235 Euston Road, London NW1 2BU, United Kingdom
| | - Tan Arulampalam
- ICENI Centre, Colchester Hospital, Turner Rd, Mile End, Colchester CO4 5JL, United Kingdom
| | - Manish Chand
- Wellcome / EPSRC Centre, for Interventional and Surgical Sciences, University College London, 1st Floor, Charles Bell House, 43-45 Foley Street, London W1W 7TS, United Kingdom
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Radiogenomics: Hunting Down Liver Metastasis in Colorectal Cancer Patients. Cancers (Basel) 2021; 13:cancers13215547. [PMID: 34771709 PMCID: PMC8582778 DOI: 10.3390/cancers13215547] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Colorectal cancer (CRC) is the third leading cause of cancer and the second most deadly tumor type in the world. The liver is the most common site of metastasis in CRC patients. The conversion of new imaging biomarkers into diagnostic, prognostic and predictive signatures, by the development of radiomics and radiogenomics, is an important potential new tool for the clinical management of cancer patients. In this review, we assess the knowledge gained from radiomics and radiogenomics studies in liver metastatic colorectal cancer patients and their possible use for early diagnosis, response assessment and treatment decisions. Abstract Radiomics is a developing new discipline that analyzes conventional medical images to extract quantifiable data that can be mined for new biomarkers that show the biology of pathological processes at microscopic levels. These data can be converted into image-based signatures to improve diagnostic, prognostic and predictive accuracy in cancer patients. The combination of radiomics and molecular data, called radiogenomics, has clear implications for cancer patients’ management. Though some studies have focused on radiogenomics signatures in hepatocellular carcinoma patients, only a few have examined colorectal cancer metastatic lesions in the liver. Moreover, the need to differentiate between liver lesions is fundamental for accurate diagnosis and treatment. In this review, we summarize the knowledge gained from radiomics and radiogenomics studies in hepatic metastatic colorectal cancer patients and their use in early diagnosis, response assessment and treatment decisions. We also investigate their value as possible prognostic biomarkers. In addition, the great potential of image mining to provide a comprehensive view of liver niche formation is examined thoroughly. Finally, new challenges and current limitations for the early detection of the liver premetastatic niche, based on radiomics and radiogenomics, are also discussed.
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Zhang YH, Brehmer K, Svensson A, Herlin G, Stål P, Brismar TB. Variation in textural parameters of hepatic lesions during contrast medium injection. Acta Radiol 2021; 62:1317-1323. [PMID: 33108894 DOI: 10.1177/0284185120964904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Textural parameters extracted using quantitative imaging techniques have been shown to have prognostic value for hepatocellular carcinoma (HCC). PURPOSE To evaluate whether the contrast medium timing of the image acquisition affects the reproducibility of textural parameters in HCC and hepatic tissue. MATERIAL AND METHODS This retrospective study included 17 patients with 37 HCC lesions. Perfusion computed tomography (CT) was obtained after 50 mL contrast medium injection. HCC lesions were segmented for analysis. The gray-level co-occurrence (GLCM) textural analysis parameters, homogeneity, energy, entropy, inertia, and correlation were calculated. Variation was quantified by calculating the SD of each parameter during respective perfusion series and the inter lesion variation as the SD among the lesions. RESULTS The average change in texture parameters in both HCC and hepatic tissue per second after injection was 0.01% to 0.3% of the respective texture parameter. In HCC, the average variation in homogeneity, energy, and entropy within each lesion after contrast medium injection was significantly less than the variation observed among the lesions (23% to 74%, P < 0.001). Significant differences in energy, entropy, inertia, and correlation between hepatic tissue and HCC were observed. However, when considering the intra-individual variation of hepatic tissue over time, only the HCC parameter energy was significantly outside that 95% confidence interval (P < 0.02). CONCLUSION The contrast medium timing does not affect the reproducibility of textural parameters in HCC and hepatic tissue. Thus, contrast medium timing should not be an issue at CT texture analysis of HCC.
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Affiliation(s)
- Yi-Hua Zhang
- Division of Medical Imaging and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Katharina Brehmer
- Division of Medical Imaging and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Svensson
- Division of Medical Imaging and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Herlin
- Division of Medical Imaging and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Per Stål
- Division of Hepatology, Karolinska University Hospital, Stockholm, Sweden
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Staal FCR, Taghavi M, van der Reijd DJ, Gomez FM, Imani F, Klompenhouwer EG, Meek D, Roberti S, de Boer M, Lambregts DMJ, Beets-Tan RGH, Maas M. Predicting local tumour progression after ablation for colorectal liver metastases: CT-based radiomics of the ablation zone. Eur J Radiol 2021; 141:109773. [PMID: 34022475 DOI: 10.1016/j.ejrad.2021.109773] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/23/2021] [Accepted: 05/10/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To assess whether CT-based radiomics of the ablation zone (AZ) can predict local tumour progression (LTP) after thermal ablation for colorectal liver metastases (CRLM). MATERIALS AND METHODS Eighty-two patients with 127 CRLM were included. Radiomics features (with different filters) were extracted from the AZ and a 10 mm periablational rim (PAR)on portal-venous-phase CT up to 8 weeks after ablation. Multivariable stepwise Cox regression analyses were used to predict LTP based on clinical and radiomics features. Performance (concordance [c]-statistics) of the different models was compared and performance in an 'independent' dataset was approximated with bootstrapped leave-one-out-cross-validation (LOOCV). RESULTS Thirty-three lesions (26 %) developed LTP. Median follow-up was 21 months (range 6-115). The combined model, a combination of clinical and radiomics features, included chemotherapy (HR 0.50, p = 0.024), cT-stage (HR 10.13, p = 0.016), lesion size (HR 1.11, p = <0.001), AZ_Skewness (HR 1.58, p = 0.016), AZ_Uniformity (HR 0.45, p = 0.002), PAR_Mean (HR 0.52, p = 0.008), PAR_Skewness (HR 1.67, p = 0.019) and PAR_Uniformity (HR 3.35, p < 0.001) as relevant predictors for LTP. The predictive performance of the combined model (after LOOCV) yielded a c-statistic of 0.78 (95 %CI 0.65-0.87), compared to the clinical or radiomics models only (c-statistic 0.74 (95 %CI 0.58-0.84) and 0.65 (95 %CI 0.52-0.83), respectively). CONCLUSION Combining radiomics features with clinical features yielded a better performing prediction of LTP than radiomics only. CT-based radiomics of the AZ and PAR may have potential to aid in the prediction of LTP during follow-up in patients with CRLM.
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Affiliation(s)
- F C R Staal
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
| | - M Taghavi
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - D J van der Reijd
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - F M Gomez
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Radiology, Hospital Clinic de Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - F Imani
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - E G Klompenhouwer
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - D Meek
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - S Roberti
- Department of Epidemiology and Biostatistics, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - M de Boer
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - D M J Lambregts
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - R G H Beets-Tan
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - M Maas
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
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Dercle L, Lu L, Schwartz LH, Qian M, Tejpar S, Eggleton P, Zhao B, Piessevaux H. Radiomics Response Signature for Identification of Metastatic Colorectal Cancer Sensitive to Therapies Targeting EGFR Pathway. J Natl Cancer Inst 2021; 112:902-912. [PMID: 32016387 DOI: 10.1093/jnci/djaa017] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/05/2019] [Accepted: 01/24/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The authors sought to forecast survival and enhance treatment decisions for patients with liver metastatic colorectal cancer by using on-treatment radiomics signature to predict tumor sensitiveness to irinotecan, 5-fluorouracil, and leucovorin (FOLFIRI) alone (F) or in combination with cetuximab (FC). METHODS We retrospectively analyzed 667 metastatic colorectal cancer patients treated with F or FC. Computed tomography quality was classified as high (HQ) or standard (SD). Four datasets were created using the nomenclature (treatment) - (quality). Patients were randomly assigned (2:1) to training or validation sets: FCHQ: 78:38, FCSD: 124:62, FHQ: 78:51, FSD: 158:78. Four tumor-imaging biomarkers measured quantitative radiomics changes between standard of care computed tomography scans at baseline and 8 weeks. Using machine learning, the performance of the signature to classify tumors as treatment sensitive or treatment insensitive was trained and validated using receiver operating characteristic (ROC) curves. Hazard ratio and Cox regression models evaluated association with overall survival (OS). RESULTS The signature (area under the ROC curve [95% confidence interval (CI)]) used temporal decrease in tumor spatial heterogeneity plus boundary infiltration to successfully predict sensitivity to antiepidermal growth factor receptor therapy (FCHQ: 0.80 [95% CI = 0.69 to 0.94], FCSD: 0.72 [95% CI = 0.59 to 0.83]) but failed with chemotherapy (FHQ: 0.59 [95% CI = 0.44 to 0.72], FSD: 0.55 [95% CI = 0.43 to 0.66]). In cetuximab-containing sets, radiomics signature outperformed existing biomarkers (KRAS-mutational status, and tumor shrinkage by RECIST 1.1) for detection of treatment sensitivity and was strongly associated with OS (two-sided P < .005). CONCLUSIONS Radiomics response signature can serve as an intermediate surrogate marker of OS. The signature outperformed known biomarkers in providing an early prediction of treatment sensitivity and could be used to guide cetuximab treatment continuation decisions.
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Affiliation(s)
- Laurent Dercle
- Department of Radiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.,Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Lin Lu
- Department of Radiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Lawrence H Schwartz
- Department of Radiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Min Qian
- Department of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - Sabine Tejpar
- Molecular Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | | | - Binsheng Zhao
- Department of Radiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Hubert Piessevaux
- Department of Hepato-Gastroenterology, Cliniques Universitaires Saint-Luc, UCLouvain Brussels, Brussels, Belgium
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Chang JR, Lee CY, Chen CC, Reischl J, Qaiser T, Yeh CY. Hybrid Aggregation Network for Survival Analysis from Whole Slide Histopathological Images. MEDICAL IMAGE COMPUTING AND COMPUTER ASSISTED INTERVENTION – MICCAI 2021 2021:731-740. [DOI: 10.1007/978-3-030-87240-3_70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Staal FCR, van der Reijd DJ, Taghavi M, Lambregts DMJ, Beets-Tan RGH, Maas M. Radiomics for the Prediction of Treatment Outcome and Survival in Patients With Colorectal Cancer: A Systematic Review. Clin Colorectal Cancer 2020; 20:52-71. [PMID: 33349519 DOI: 10.1016/j.clcc.2020.11.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 09/03/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Prediction of outcome in patients with colorectal cancer (CRC) is challenging as a result of lack of a robust biomarker and heterogeneity between and within tumors. The aim of this review was to assess the current possibilities and limitations of radiomics (on computed tomography [CT], magnetic resonance imaging [MRI], and positron emission tomography [PET]) for the prediction of treatment outcome and long-term outcome in CRC. Medline/PubMed was searched up to August 2020 for studies that used radiomics for the prediction of response to treatment and survival in patients with CRC (based on pretreatment imaging). The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool and Radiomics Quality Score (RQS) were used for quality assessment. A total of 76 studies met the inclusion criteria and were included for further analysis. Radiomics analyses were performed on MRI in 41 studies, on CT in 30 studies, and on 18F-FDG-PET/CT in 10 studies. Heterogeneous results were reported regarding radiomics methods and included features. High-quality studies (n = 13), consisting mainly of MRI-based radiomics to predict response in rectal cancer, were able to predict response with good performance. Radiomics literature in CRC is highly heterogeneous, but it nonetheless holds promise for the prediction of outcome. The most evidence is available for MRI-based radiomics in rectal cancer. Future radiomics research in CRC should focus on independent validation of existing models rather than on developing new models.
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Affiliation(s)
- Femke C R Staal
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Denise J van der Reijd
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marjaneh Taghavi
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Monique Maas
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Contrast-Enhanced CT-based Textural Parameters as Potential Prognostic Factors of Survival for Colorectal Cancer Patients Receiving Targeted Therapy. Mol Imaging Biol 2020; 23:427-435. [PMID: 33108800 DOI: 10.1007/s11307-020-01552-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 09/07/2020] [Accepted: 10/05/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to estimate the clinical significance of the contrast-enhanced computed tomography (CT) textural features for prediction of survival in colorectal cancer (CRC) patients receiving targeted therapy (bevacizumab and cetuximab). PROCEDURES The LifeX software was used to extract the textural parameters of the tumor lesions in the contrast-enhanced CT. We used the least absolute shrinkage and selection operator (LASSO) Cox regression and random forest method to screen the non-redundant radiomic features and constructed the CT imaging score. Univariate and multivariate analyses through the Cox proportional hazards model were performed to assess the prognostic clinical factor. Based on the result of multivariate analysis and CT imaging score, combined nomogram model was constructed to predict the overall survival (OS) of patients. Decision curves analysis was employed to evaluate the performance of the combined model and clinical model. RESULTS After comparative analysis of the area under curve of the receiver operating characteristic (ROC) curve, we chose the result of random forest model as CT imaging score. Considering the clinical practice and the result of analysis, age, surgery, and lactate dehydrogenase (LDH) level have been introduced into clinical model. Based on the result of analysis and the CT imaging score, we constructed the nomogram combined model. C-index and calibration curve verified the goodness of fit and discrimination of the combined model. Decision curve analysis (DCA) demonstrated that the combined model showed the better net benefit for a 3-year OS than clinical model. CONCLUSIONS In conclusion, the study provides preliminary evidences that several radiomic parameters of tumor lesions derived from CT images were prognostic factors and predictive markers for CRC patients who are candidates for targeted therapy (bevacizumab and cetuximab).
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Enhancing the differentiation of pulmonary lymphoma and fungal pneumonia in hematological patients using texture analysis in 3-T MRI. Eur Radiol 2020; 31:695-705. [PMID: 32822054 PMCID: PMC7813714 DOI: 10.1007/s00330-020-07137-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/08/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022]
Abstract
Objectives To evaluate texture analysis in nonenhanced 3-T MRI for differentiating pulmonary fungal infiltrates and lymphoma manifestations in hematological patients and to compare the diagnostic performance with that of signal intensity quotients (“nonenhanced imaging characterization quotients,” NICQs). Methods MR scans were performed using a speed-optimized imaging protocol without an intravenous contrast medium including axial T2-weighted (T2w) single-shot fast spin-echo and T1-weighted (T1w) gradient-echo sequences. ROIs were drawn within the lesions to extract first-order statistics from original images using HeterogeneityCAD and PyRadiomics. NICQs were calculated using signal intensities of the lesions, muscle, and fat. The standard of reference was histology or clinical diagnosis in follow-up. Statistical testing included ROC analysis, clustered ROC analysis, and DeLong test. Intra- and interrater reliability was tested using intraclass correlation coefficients (ICC). Results Thirty-three fungal infiltrates in 16 patients and 38 pulmonary lymphoma manifestations in 19 patients were included. Considering the leading lesion in each patient, diagnostic performance was excellent for T1w entropy (AUC 80.2%; p < 0.005) and slightly inferior for T2w energy (79.9%; p < 0.005), T1w uniformity (79.6%; p < 0.005), and T1w energy (77.0%; p < 0.01); the best AUC for NICQs was 72.0% for T2NICQmean (p < 0.05). Intra- and interrater reliability was good to excellent (ICC > 0.81) for these parameters except for moderate intrarater reliability of T1w energy (ICC = 0.64). Conclusions T1w entropy, uniformity, and energy and T2w energy showed the best performances for differentiating pulmonary lymphoma and fungal pneumonia and outperformed NICQs. Results of the texture analysis should be checked for their intrinsic consistency to identify possible incongruities of single parameters. Key Points • Texture analysis in nonenhanced pulmonary MRI improves the differentiation of pulmonary lymphoma and fungal pneumonia compared with signal intensity quotients. • T1w entropy, uniformity, and energy along with T2w energy show the best performances for differentiating pulmonary lymphoma from fungal pneumonia. • The results of the texture analysis should be checked for their intrinsic consistency to identify possible incongruities of single parameters.
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Choi B, Choi IY, Cha SH, Yeom SK, Chung HH, Lee SH, Cha J, Lee JH. Feasibility of computed tomography texture analysis of hepatic fibrosis using dual-energy spectral detector computed tomography. Jpn J Radiol 2020; 38:1179-1189. [PMID: 32666182 DOI: 10.1007/s11604-020-01020-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/06/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate feasibility of computer tomography texture analysis (CTTA) at different energy level using dual-energy spectral detector CT for liver fibrosis. MATERIALS AND METHODS Eighty-seven patients who underwent a spectral CT examination and had a reference standard of liver fibrosis (histopathologic findings, n = 61, or clinical findings for normal, n = 26) were included. Mean gray-level intensity, mean number of positive pixels (MPP), entropy, skewness, and kurtosis using commercially available software (TexRAD) were compared at different energy levels. Optimal CTTA parameter cutoffs to diagnose liver fibrosis were evaluated. CTTA parameters at different energy levels correlated with liver fibrosis. The association of CTTA parameters with energy level was evaluated. RESULTS Mean gray-level intensity, skewness, kurtosis, and entropy showed significant differences between patients with and without clinically significant hepatic fibrosis (P < 0.05). Mean gray-level intensity at 50 keV was significantly positively correlated with liver fibrosis (ρ = 0.502, P < 0.001). To diagnose stages F2-F4, entropy and mean gray-level intensity at low keV level showed the largest area under the curve (AUC; 0.79 and 0.79). Estimated marginal means (EMMs) of mean gray-level intensity showed prominent differences at low energy levels. CONCLUSION CTTA parameters from different keV levels demonstrated meaningful accuracy for diagnosis of liver fibrosis or clinically significant hepatic fibrosis.
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Affiliation(s)
- ByukGyung Choi
- Department of Radiology, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea
| | - In Young Choi
- Department of Radiology, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea.
| | - Sang Hoon Cha
- Department of Radiology, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea
| | - Suk Keu Yeom
- Department of Radiology, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea
| | - Hwan Hoon Chung
- Department of Radiology, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea
| | - Seung Hwa Lee
- Department of Radiology, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea
| | - Jaehyung Cha
- Department of Biostatistics, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea
| | - Ju-Han Lee
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea
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King MJ, Hectors S, Lee KM, Omidele O, Babb JS, Schwartz M, Tabrizian P, Taouli B, Lewis S. Outcomes assessment in intrahepatic cholangiocarcinoma using qualitative and quantitative imaging features. Cancer Imaging 2020; 20:43. [PMID: 32620153 PMCID: PMC7333305 DOI: 10.1186/s40644-020-00323-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To assess the performance of imaging features, including radiomics texture features, in predicting histopathologic tumor grade, AJCC stage, and outcomes [time to recurrence (TTR) and overall survival (OS)] in patients with intrahepatic cholangiocarcinoma (ICC). METHODS Seventy-three patients (26 M/47F, mean age 63y) with pre-operative imaging (CT, n = 37; MRI, n = 21; CT and MRI, n = 15] within 6 months of resection were included in this retrospective study. Qualitative imaging traits were assessed by 2 observers. A 3rd observer measured tumor apparent diffusion coefficient (ADC), enhancement ratios (ERs), and Haralick texture features. Blood biomarkers and imaging features were compared with histopathology (tumor grade and AJCC stage) and outcomes (TTR and OS) using log-rank, generalized Wilcoxon, Cox proportional hazards regression, and Fisher exact tests. RESULTS Median TTR and OS were 53.9 and 79.7 months. ICC recurred in 64.4% (47/73) of patients and 46.6% (34/73) of patients died. There was fair accuracy for some qualitative imaging features in the prediction of worse tumor grade (maximal AUC of 0.68 for biliary obstruction on MRI, p = 0.032, observer 1) and higher AJCC stage (maximal AUC of 0.73 for biliary obstruction on CT, p = 0.002, observer 2; and AUC of 0.73 for vascular involvement on MRI, p = 0.01, observer 2). Cox proportional hazards regression analysis showed that CA 19-9 [hazard ratio (HR) 2.44/95% confidence interval (CI) 1.31-4.57/p = 0.005)] and tumor size on imaging (HR 1.13/95% CI 1.04-1.22/p = 0.003) were significant predictors of TTR, while CA 19-9 (HR 4.08/95% CI 1.75-9.56, p = 0.001) and presence of metastatic lymph nodes at histopathology (HR 2.86/95% CI 1.35-6.07/p = 0.006) were significant predictors of OS. On multivariable analysis, satellite lesions on CT (HR 2.79/95%CI 1.01-7.15/p = 0.032, observer 2), vascular involvement on MRI (HR 0.10/95% CI 0.01-0.85/p = 0.032, observer 1), and texture feature MRI variance (HR 0.55/95% CI 0.31-0.97, p = 0.040) predicted TTR once adjusted for the independent predictors CA 19-9 and tumor size on imaging. Several qualitative and quantitative features demonstrated associations with TTR, OS, and AJCC stage at univariable analysis (range: HR 0.35-19; p < 0.001-0.045), however none were predictive of OS at multivariable analysis when adjusted for CA 19-9 and metastatic lymph nodes (p > 0.088). CONCLUSIONS There was reasonable accuracy in predicting tumor grade and higher AJCC stage in ICC utilizing certain qualitative and quantitative imaging traits. Serum CA 19-9, tumor size, presence of metastatic lymph nodes, and qualitative imaging traits of satellite lesions and vascular involvement are predictors of patient outcomes, along with a promising predictive ability of certain quantitative texture features.
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Affiliation(s)
- Michael J King
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA
| | - Stefanie Hectors
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA.,BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Karen M Lee
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA
| | - Olamide Omidele
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA
| | - James S Babb
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Myron Schwartz
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parissa Tabrizian
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA.,BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA. .,BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Delta-radiomics increases multicentre reproducibility: a phantom study. Med Oncol 2020; 37:38. [PMID: 32236847 DOI: 10.1007/s12032-020-01359-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/06/2020] [Indexed: 12/19/2022]
Abstract
Texture analysis (TA) can provide quantitative features from medical imaging that can be correlated to clinical endpoints. The challenges relevant to robustness of radiomics features have been analyzed by many researchers, as it seems to be influenced by acquisition and reconstruction protocols. Delta-texture analysis (D-TA), conversely, consist in the analysis of TA feature variations at different acquisition times, usually before and after a therapy. Aim of this study was to investigate the influence of different CT scanners and acquisition parameters in the robustness of TA and D-TA. We scanned a commercial phantom (CIRS model 467, Gammex, Middleton, WI, USA), that is used for the calibration of electron density, two times by varying the disposition of plugs, using three different scanners. After the segmentation, we extracted TA features with LifeX and calculated TA features and D-TA features, defined as the variation of each TA parameters extracted from the same position by varying the plugs with the formula (Y-X)/X. The robustness of TA and D-TA features were then tested with intraclass coefficient correlation (ICC) analysis. The reliability of TA parameters across different scans, with different acquisition parameters and ROI positions has shown poor reliability in 12/37 and moderate reliability in the remaining 25/37, with no parameters showing good reliability. The reliability of D-TA, conversely, showed poor reliability in 10/37 parameters, moderate reliability in 10/37 parameters, and good reliability in 17/37 parameters. The comparison between TA and D-TA ICCs showed a significant difference for the whole group of parameters (p:0.004) and for the subclasses of GLCM parameters (p:0.033), whereas for the other subclasses of matrices (GLRLM, NGLDM, GLZLM, Histogram), the difference was not significant. D-TA features seem to be more robust than TA features. These findings reinforce the potentiality for using D-TA features for early assessment of treatment response and for developing tailored therapies. More work is needed in a clinical setting to confirm the results of the present study.
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Ma J, Dercle L, Lichtenstein P, Wang D, Chen A, Zhu J, Piessevaux H, Zhao J, Schwartz LH, Lu L, Zhao B. Automated Identification of Optimal Portal Venous Phase Timing with Convolutional Neural Networks. Acad Radiol 2020; 27:e10-e18. [PMID: 31151901 DOI: 10.1016/j.acra.2019.02.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To develop a deep learning-based algorithm to automatically identify optimal portal venous phase timing (PVP-timing) so that image analysis techniques can be accurately performed on post contrast studies. METHODS 681 CT-scans (training: 479 CT-scans; validation: 202 CT-scans) from a multicenter clinical trial in patients with liver metastases from colorectal cancer were retrospectively analyzed for algorithm development and validation. An additional external validation was performed on a cohort of 228 CT-scans from gastroenteropancreatic neuroendocrine cancer patients. Image acquisition was performed according to each centers' standard CT protocol for single portal venous phase, portal venous acquisition. The reference gold standard for the classification of PVP-timing as either optimal or nonoptimal was based on experienced radiologists' consensus opinion. The algorithm performed automated localization (on axial slices) of the portal vein and aorta upon which a novel dual input Convolutional Neural Network calculated a probability of the optimal PVP-timing. RESULTS The algorithm automatically computed a PVP-timing score in 3 seconds and reached area under the curve of 0.837 (95% CI: 0.765, 0.890) in validation set and 0.844 (95% CI: 0.786, 0.889) in external validation set. CONCLUSION A fully automated, deep-learning derived PVP-timing algorithm was developed to classify scans' contrast-enhancement timing and identify scans with optimal PVP-timing. The rapid identification of such scans will aid in the analysis of quantitative (radiomics) features used to characterize tumors and changes in enhancement with treatment in a multitude of settings including quantitative response criteria such as Choi and MASS which rely on reproducible measurement of enhancement.
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Affiliation(s)
- Jingchen Ma
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Department of Radiology, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032
| | - Laurent Dercle
- Department of Radiology, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032; Gustave Roussy, Université Paris-Saclay, Université Paris-Saclay, Département D'imagerie Médicale, Villejuif, France
| | - Philip Lichtenstein
- Department of Radiology, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032
| | - Deling Wang
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Aiping Chen
- Department of Radiology, First Affiliated Hospital of NanJing Medical University, Nanjing, China
| | - Jianguo Zhu
- Department of Radiology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | - Jun Zhao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Lawrence H Schwartz
- Department of Radiology, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032
| | - Lin Lu
- Department of Radiology, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032.
| | - Binsheng Zhao
- Department of Radiology, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032
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Nardone V, Tini P, Pastina P, Botta C, Reginelli A, Carbone SF, Giannicola R, Calabrese G, Tebala C, Guida C, Giudice A, Barbieri V, Tassone P, Tagliaferri P, Cappabianca S, Capasso R, Luce A, Caraglia M, Mazzei MA, Pirtoli L, Correale P. Radiomics predicts survival of patients with advanced non-small cell lung cancer undergoing PD-1 blockade using Nivolumab. Oncol Lett 2019; 19:1559-1566. [PMID: 31966081 DOI: 10.3892/ol.2019.11220] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/13/2019] [Indexed: 12/27/2022] Open
Abstract
Immune checkpoint blockade is an emerging anticancer strategy, and Nivolumab is a human mAb to PD-1 that is used in the treatment of a number of different malignancies, including non-small cell lung cancer (NSCLC), kidney cancer, urothelial carcinoma and melanoma. Although the use of Nivolumab prolongs survival in a number of patients, this treatment is hampered by high cost. Therefore, the identification of predictive markers of response to treatment in patients is required. In this context, PD-1/PDL1 blockade antitumor effects occur through the reactivation of a pre-existing immune response, and the efficacy of these effects is strictly associated with the presence of necrosis, hypoxia and inflammation at the tumour sites. It has been indicated that these events can be evaluated by specific assessments using a computed tomography (CT) texture analysis (TA) or radiomics. Therefore, a retrospective study was performed, which aimed to evaluate the potential use of this analysis in the identification of patients with NSCLC who may benefit from Nivolumab treatment. A retrospective analysis was performed of 59 patients with metastatic NSCLC who received Nivolumab treatment between January 2015 and July 2017 at Siena University Hospital (35 patients, training dataset), Catanzaro University Hospital and Reggio Calabria Grand Metropolitan Hospital, Italy (24 patients, validation dataset). Pre- and post-contrast CT sequences were used to contour the gross tumour volume (GTV) of the target lesions prior to Nivolumab treatment. The impact of variations on contouring was analysed using two delineations, which were performed on each patient, and the TA parameters were tested for reliability using the Intraclass Coefficient Correlation method (ICC). All analyses for the current study were performed using LifeX Software©. Imaging, clinical and pathological parameters were correlated with progression free survival and overall survival (OS) using Kaplan Meier analysis. An external validation testing was performed for the TA Score using the validation dataset. A total of 59 patients were included in the analysis of the present study. The reliability ICC analysis of 14 TA parameters indicated a highly reproducibility (ICC >0.70, single measure) in 12 (85%) pre- contrast and 13 (93%) post-contrast exams. A specific cut-off was detected for each of the following parameters: volume (score 1 >36 ml), histogram entropy (score 1 > 1.30), compacity (score 1 <3), gray level co-occurrence matrix (GLCM)-entropy (score 1 >1.80), GLCM-Dissimilarity (score 1 >5) and GLCM-Correlation (score 1<0.54). The global texture score allowed the classification of two subgroups of Low (Score 0-1; 36 patients; 61%) and High Risk patients (Score >1; 23 patients; 39%) that respectively, showed a median OS of 26 (mean +/- SD: 18 +/- 1.98 months; 95% CI 14-21 months) and 5 months (mean +/- SD: 6 +/- 0.99 months; 95% CI: 4-8 months; P=0.002). The current study indicated that TA parameters can identify patients that will benefit from PD-1 blockage by defining the radiological settings that are potentially suggestive of an active immune response. These results require further confirmation in prospective trials.
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Affiliation(s)
- Valerio Nardone
- Unit of Radiation Oncology, Integrated Department of Diagnostic Radiology and Radiotherapy, Ospedale del Mare, I-80147 Naples, Italy
| | - Paolo Tini
- Unit of Radiation Oncology, Oncology Department, University Hospital of Siena, I-53100 Siena, Italy
| | - Pierpaolo Pastina
- Unit of Radiation Oncology, Oncology Department, University Hospital of Siena, I-53100 Siena, Italy
| | - Cirino Botta
- Integrated Area of Medical Oncology, AOU Mater Domini and Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, I-88100 Catanzaro, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', I-80138 Naples, Italy
| | - Salvatore Francesco Carbone
- Unit of Medical Imaging, Emergency Department and Diagnostic Services, University Hospital of Siena, I-53100 Siena, Italy
| | - Rocco Giannicola
- Unit of Medical Oncology, Oncology Department, Grand Metropolitan Hospital 'Bianchi Melacrino Morelli' Reggio Calabria I-89124, Italy
| | - Grazia Calabrese
- Unit of Radiology, Department of Diagnostic Services, Grand Metropolitan Hospital 'Bianchi Melacrino Morelli' Reggio Calabria I-89124, Italy
| | - Carmela Tebala
- Unit of Radiology, Department of Diagnostic Services, Grand Metropolitan Hospital 'Bianchi Melacrino Morelli' Reggio Calabria I-89124, Italy
| | - Cesare Guida
- Unit of Radiation Oncology, Integrated Department of Diagnostic Radiology and Radiotherapy, Ospedale del Mare, I-80147 Naples, Italy
| | - Aldo Giudice
- Epidemiology Unit, IRCCS Istituto Nazionale Tumori 'Fondazione G. Pascale', I-80131 Naples, Italy
| | - Vito Barbieri
- Integrated Area of Medical Oncology, AOU Mater Domini and Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, I-88100 Catanzaro, Italy
| | - Pierfrancesco Tassone
- Integrated Area of Medical Oncology, AOU Mater Domini and Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, I-88100 Catanzaro, Italy
| | - Pierosandro Tagliaferri
- Integrated Area of Medical Oncology, AOU Mater Domini and Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, I-88100 Catanzaro, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', I-80138 Naples, Italy
| | - Rosanna Capasso
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', I-80138 Naples, Italy
| | - Amalia Luce
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', I-80138 Naples, Italy
| | - Michele Caraglia
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', I-80138 Naples, Italy
| | - Maria Antonietta Mazzei
- Unit of Medical Imaging, Emergency Department and Diagnostic Services, University Hospital of Siena, I-53100 Siena, Italy
| | - Luigi Pirtoli
- Unit of Radiation Oncology, Oncology Department, University Hospital of Siena, I-53100 Siena, Italy
| | - Pierpaolo Correale
- Unit of Medical Oncology, Oncology Department, Grand Metropolitan Hospital 'Bianchi Melacrino Morelli' Reggio Calabria I-89124, Italy
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Gordon GSD, Joseph J, Alcolea MP, Sawyer T, Williams C, Fitzpatrick CRM, Jones PH, di Pietro M, Fitzgerald RC, Wilkinson TD, Bohndiek SE. Quantitative phase and polarization imaging through an optical fiber applied to detection of early esophageal tumorigenesis. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-13. [PMID: 31840442 PMCID: PMC7006047 DOI: 10.1117/1.jbo.24.12.126004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/18/2019] [Indexed: 05/30/2023]
Abstract
Phase and polarization of coherent light are highly perturbed by interaction with microstructural changes in premalignant tissue, holding promise for label-free detection of early tumors in endoscopically accessible tissues such as the gastrointestinal tract. Flexible optical multicore fiber (MCF) bundles used in conventional diagnostic endoscopy and endomicroscopy scramble phase and polarization, restricting clinicians instead to low-contrast amplitude-only imaging. We apply a transmission matrix characterization approach to produce full-field en-face images of amplitude, quantitative phase, and resolved polarimetric properties through an MCF. We first demonstrate imaging and quantification of biologically relevant amounts of optical scattering and birefringence in tissue-mimicking phantoms. We present an entropy metric that enables imaging of phase heterogeneity, indicative of disordered tissue microstructure associated with early tumors. Finally, we demonstrate that the spatial distribution of phase and polarization information enables label-free visualization of early tumors in esophageal mouse tissues, which are not identifiable using conventional amplitude-only information.
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Affiliation(s)
- George S. D. Gordon
- University of Cambridge, Department of Engineering, Cambridge, United Kingdom
| | - James Joseph
- University of Cambridge, Department of Physics, Cavendish Laboratory, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Maria P. Alcolea
- University of Cambridge, Wellcome Trust MRC Stem Cell Institute, Cambridge, United Kingdom
| | - Travis Sawyer
- University of Cambridge, Department of Physics, Cavendish Laboratory, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Calum Williams
- University of Cambridge, Department of Engineering, Cambridge, United Kingdom
- University of Cambridge, Department of Physics, Cavendish Laboratory, Cambridge, United Kingdom
| | | | - Philip H. Jones
- University of Cambridge, MRC Cancer Unit, Hutchison/MRC Research Centre, Cambridge, United Kingdom
| | - Massimiliano di Pietro
- University of Cambridge, MRC Cancer Unit, Hutchison/MRC Research Centre, Cambridge, United Kingdom
| | - Rebecca C. Fitzgerald
- University of Cambridge, MRC Cancer Unit, Hutchison/MRC Research Centre, Cambridge, United Kingdom
| | | | - Sarah E. Bohndiek
- University of Cambridge, Department of Physics, Cavendish Laboratory, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, United Kingdom
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27
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Schick U, Lucia F, Dissaux G, Visvikis D, Badic B, Masson I, Pradier O, Bourbonne V, Hatt M. MRI-derived radiomics: methodology and clinical applications in the field of pelvic oncology. Br J Radiol 2019; 92:20190105. [PMID: 31538516 DOI: 10.1259/bjr.20190105] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Personalized medicine aims at offering optimized treatment options and improved survival for cancer patients based on individual variability. The success of precision medicine depends on robust biomarkers. Recently, the requirement for improved non-biologic biomarkers that reflect tumor biology has emerged and there has been a growing interest in the automatic extraction of quantitative features from medical images, denoted as radiomics. Radiomics as a methodological approach can be applied to any image and most studies have focused on PET, CT, ultrasound, and MRI. Here, we aim to present an overview of the radiomics workflow as well as the major challenges with special emphasis on the use of multiparametric MRI datasets. We then reviewed recent studies on radiomics in the field of pelvic oncology including prostate, cervical, and colorectal cancer.
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Affiliation(s)
- Ulrike Schick
- Radiation Oncology department, University Hospital, Brest, France.,LaTIM, INSERM, UMR 1101, University of Brest, ISBAM, UBO, UBL, Brest, France.,Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France
| | - François Lucia
- Radiation Oncology department, University Hospital, Brest, France.,LaTIM, INSERM, UMR 1101, University of Brest, ISBAM, UBO, UBL, Brest, France
| | - Gurvan Dissaux
- Radiation Oncology department, University Hospital, Brest, France.,LaTIM, INSERM, UMR 1101, University of Brest, ISBAM, UBO, UBL, Brest, France.,Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France
| | - Dimitris Visvikis
- LaTIM, INSERM, UMR 1101, University of Brest, ISBAM, UBO, UBL, Brest, France
| | - Bogdan Badic
- LaTIM, INSERM, UMR 1101, University of Brest, ISBAM, UBO, UBL, Brest, France.,Department of General and Digestive Surgery, University Hospital, Brest, France
| | - Ingrid Masson
- LaTIM, INSERM, UMR 1101, University of Brest, ISBAM, UBO, UBL, Brest, France
| | - Olivier Pradier
- Radiation Oncology department, University Hospital, Brest, France.,LaTIM, INSERM, UMR 1101, University of Brest, ISBAM, UBO, UBL, Brest, France.,Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France
| | - Vincent Bourbonne
- Radiation Oncology department, University Hospital, Brest, France.,LaTIM, INSERM, UMR 1101, University of Brest, ISBAM, UBO, UBL, Brest, France
| | - Mathieu Hatt
- LaTIM, INSERM, UMR 1101, University of Brest, ISBAM, UBO, UBL, Brest, France
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28
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Andersen IR, Thorup K, Andersen MB, Olesen R, Mortensen FV, Nielsen DT, Rasmussen F. Texture in the monitoring of regorafenib therapy in patients with colorectal liver metastases. Acta Radiol 2019; 60:1084-1093. [PMID: 30612433 DOI: 10.1177/0284185118817940] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Iben R Andersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kennet Thorup
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Rene Olesen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Dennis T Nielsen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Rasmussen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
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29
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Dercle L, Lu L, Lichtenstein P, Yang H, Wang D, Zhu J, Wu F, Piessevaux H, Schwartz LH, Zhao B. Impact of Variability in Portal Venous Phase Acquisition Timing in Tumor Density Measurement and Treatment Response Assessment: Metastatic Colorectal Cancer as a Paradigm. JCO Clin Cancer Inform 2019; 1:1-8. [PMID: 30657405 DOI: 10.1200/cci.17.00108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE New response patterns to anticancer drugs have led tumor size-based response criteria to shift to also include density measurements. Choi criteria, for instance, categorize antiangiogenic therapy response as a decrease in tumor density > 15% at the portal venous phase (PVP). We studied the effect that PVP timing has on measurement of the density of liver metastases (LM) from colorectal cancer (CRC). METHODS Pretreatment PVP computed tomography images from 291 patients with LM-CRC from the CRYSTAL trial (Cetuximab Combined With Irinotecan in First-Line Therapy for Metastatic Colorectal Cancer; ClinicalTrials.gov identifier: NCT00154102) were included. Four radiologists independently scored the scans' timing according to a three-point scoring system: early, optimal, late PVP. Using this, we developed, by machine learning, a proprietary computer-aided quality-control algorithm to grade PVP timing. The reference standard was a computer-refined consensus. For each patient, we contoured target liver lesions and calculated their mean density. RESULTS Contrast-product administration data were not recorded in the digital imaging and communications in medicine headers for injection volume (94%), type (93%), and route (76%). The PVP timing was early, optimal, and late in 52, 194, and 45 patients, respectively. The mean (95% CI) accuracy of the radiologists for detection of optimal PVP timing was 81.7% (78.3 to 85.2) and was outperformed by the 88.6% (84.8 to 92.4) computer accuracy. The mean ± standard deviation of LM-CRC density was 68 ± 15 Hounsfield units (HU) overall and 59.5 ± 14.9 HU, 71.4 ± 14.1 HU, 62.4 ± 12.5 HU at early, optimal, and late PVP timing, respectively. LM-CRC density was thus decreased at nonoptimal PVP timing by 14.8%: 16.7% at early PVP ( P < .001) and 12.6% at late PVP ( P < .001). CONCLUSION Nonoptimal PVP timing should be identified because it significantly decreased tumor density by 14.8%. Our computer-aided quality-control system outperformed the accuracy, reproducibility, and speed of radiologists' visual scoring. PVP-timing scoring could improve the extraction of tumor quantitative imaging biomarkers and the monitoring of anticancer therapy efficacy at the patient and clinical trial levels.
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Affiliation(s)
- Laurent Dercle
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Lin Lu
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Philip Lichtenstein
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Hao Yang
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Deling Wang
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jianguo Zhu
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Feiyun Wu
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Hubert Piessevaux
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Lawrence H Schwartz
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Binsheng Zhao
- Laurent Dercle, Lin Lu, Philip Lichtenstein, Hao Yang, Jianguo Zhu, Feiyun Wu, Lawrence H. Schwartz, and Binsheng Zhao, Columbia University Medical Center, and Presbyterian Hospital, New York, NY; Laurent Dercle, Gustave Roussy, Université Paris-Saclay, UMR1015, Villejuif, France; Deling Wang, Sun Yat-sen University Cancer Center; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong; State Key Laboratory of Oncology in South China, Hong Kong, Special Administrative Region, People's Republic of China; and Hubert Piessevaux, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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30
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Badic B, Desseroit MC, Hatt M, Visvikis D. Potential Complementary Value of Noncontrast and Contrast Enhanced CT Radiomics in Colorectal Cancers. Acad Radiol 2019; 26:469-479. [PMID: 30072293 DOI: 10.1016/j.acra.2018.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/31/2018] [Accepted: 06/02/2018] [Indexed: 01/08/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of our study was to assess the relationships between textural features extracted from contrast enhanced (CE) and noncontrast enhanced (NCE) computed tomography (CT) images of primary colorectal cancer, in order to identify radiomics features more likely to provide potential complementary information regarding outcome. MATERIALS AND METHODS Sixty-one patients with primary colorectal cancer underwent both CE-CT and NCE-CT scans within the same acquisition. First-order and textural features (with three different methods for grey-level discretization) were extracted from the tumor volume in both modalities and their correlation was assessed with Spearman's rank correlation (rs). Significance was assessed at p < 0.05 with correction for multiple comparisons. Kaplan-Meier estimation and log-rank tests were used to identify features associated with long term patient survival. RESULTS Moderate positive correlations were observed between CE-CT and NCE-CT histogram-derived entropy (EntropyHist) and area under the curve (CHAUC) (rs = 0.49, p < 0.001 and rs= 0.45, p < 0.001, respectively). Some second and third order textural features were found highly correlated between CE-CT and NCE-CT, such as small zone-size emphasis SZSE (rs = 0.729, p < 0.001) and zone-size percentage (rs = 0.770, p < 0.001). Grey-levels discretization methods influenced these correlations. A few of the third order NCE-CT and CE-CT features were significantly associated with survival. CONCLUSION Some radiomics features with moderate correlations between nonenhanced and enhanced CT images were found to be associated with survival, thus suggesting that complementary prognostic value may be extracted from both modalities when available.
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31
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Digumarthy SR, Padole AM, Gullo RL, Sequist LV, Kalra MK. Can CT radiomic analysis in NSCLC predict histology and EGFR mutation status? Medicine (Baltimore) 2019; 98:e13963. [PMID: 30608433 PMCID: PMC6344142 DOI: 10.1097/md.0000000000013963] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
To assess the role of radiomic features in distinguishing squamous and adenocarcinoma subtypes of nonsmall cell lung cancers (NSCLC) and predict EGFR mutations.Institution Review Board-approved study included chest CT scans of 93 consecutive patients (43 men, 50 women, mean age 60 ± 11 years) with biopsy-proven squamous and adenocarcinoma lung cancers greater than 1 cm. All cancers were evaluated for epidermal growth factor receptor (EGFR) mutation. The clinical parameters such as age, sex, and smoking history and standard morphology-based CT imaging features such as target lesion longest diameter (LD), longest perpendicular diameter (LPD), density, and presence of cavity were recorded. The radiomics data was obtained using commercial CT texture analysis (CTTA) software. The CTTA was performed on a single image of the dominant lung lesion. The predictive value of clinical history, standard imaging features, and radiomics was assessed with multivariable logistic regression and receiver operating characteristic (ROC) analyses.Between adenocarcinoma and squamous cell carcinomas, ROC analysis showed significant difference in 3/11 radiomic features (entropy, normalized SD, total) [AUC 0.686-0.744, P = .006 to <.0001], 1/3 clinical features (smoking) [AUC 0.732, P = .001], and 2/3 imaging features (LD and LPD) [AUC 0.646-0658, P = .020 to .032]. ROC analysis for probability variables showed higher values for radiomics (AUC 0.800, P < .0001) than clinical (AUC 0.676, P = .017) and standard imaging (AUC 0.708, P < .0001). Between EGFR mutant and wild-type adenocarcinoma, ROC analysis showed significant difference in 2/11 radiomic features (kurtosis, K2) [AUC 0.656-0.713, P = .03 to .003], 1/3 clinical features (smoking) [AUC 0.758, P < .0001]. The combined probability variable for radiomics, clinical and imaging features was higher (AUC 0.890, P < .0001) than independent probability variables.The radiomics evaluation adds incremental value to clinical history and standard imaging features in predicting histology and EGFR mutations.
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Affiliation(s)
| | | | | | - Lecia V. Sequist
- Department of Medicine, Massachusetts General Hospital, Boston, MA
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32
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Beckers R, Trebeschi S, Maas M, Schnerr R, Sijmons J, Beets G, Houwers J, Beets-Tan R, Lambregts D. CT texture analysis in colorectal liver metastases and the surrounding liver parenchyma and its potential as an imaging biomarker of disease aggressiveness, response and survival. Eur J Radiol 2018; 102:15-21. [DOI: 10.1016/j.ejrad.2018.02.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/10/2018] [Accepted: 02/26/2018] [Indexed: 12/20/2022]
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33
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Lee SJ, Zea R, Kim DH, Lubner MG, Deming DA, Pickhardt PJ. CT texture features of liver parenchyma for predicting development of metastatic disease and overall survival in patients with colorectal cancer. Eur Radiol 2018; 28:1520-1528. [PMID: 29164382 PMCID: PMC7713793 DOI: 10.1007/s00330-017-5111-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/15/2017] [Accepted: 09/29/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine if identifiable hepatic textural features are present at abdominal CT in patients with colorectal cancer (CRC) prior to the development of CT-detectable hepatic metastases. METHODS Four filtration-histogram texture features (standard deviation, skewness, entropy and kurtosis) were extracted from the liver parenchyma on portal venous phase CT images at staging and post-treatment surveillance. Surveillance scans corresponded to the last scan prior to the development of CT-detectable CRC liver metastases in 29 patients (median time interval, 6 months), and these were compared with interval-matched surveillance scans in 60 CRC patients who did not develop liver metastases. Predictive models of liver metastasis-free survival and overall survival were built using regularised Cox proportional hazards regression. RESULTS Texture features did not significantly differ between cases and controls. For Cox models using all features as predictors, all coefficients were shrunk to zero, suggesting no association between any CT texture features and outcomes. Prognostic indices derived from entropy features at surveillance CT incorrectly classified patients into risk groups for future liver metastases (p < 0.001). CONCLUSIONS On surveillance CT scans immediately prior to the development of CRC liver metastases, we found no evidence suggesting that changes in identifiable hepatic texture features were predictive of their development. KEY POINTS • No correlation between liver texture features and metastasis-free survival was observed. • Liver texture features incorrectly classified patients into risk groups for liver metastases. • Standardised texture analysis workflows need to be developed to improve research reproducibility.
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Affiliation(s)
- Scott J Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
| | - Ryan Zea
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - David H Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Dustin A Deming
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
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Shaikh F, Franc B, Allen E, Sala E, Awan O, Hendrata K, Halabi S, Mohiuddin S, Malik S, Hadley D, Shrestha R. Translational Radiomics: Defining the Strategy Pipeline and Considerations for Application-Part 2: From Clinical Implementation to Enterprise. J Am Coll Radiol 2018; 15:543-549. [PMID: 29366598 DOI: 10.1016/j.jacr.2017.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/07/2017] [Indexed: 12/18/2022]
Abstract
Enterprise imaging has channeled various technological innovations to the field of clinical radiology, ranging from advanced imaging equipment and postacquisition iterative reconstruction tools to image analysis and computer-aided detection tools. More recently, the advancement in the field of quantitative image analysis coupled with machine learning-based data analytics, classification, and integration has ushered in the era of radiomics, a paradigm shift that holds tremendous potential in clinical decision support as well as drug discovery. However, there are important issues to consider to incorporate radiomics into a clinically applicable system and a commercially viable solution. In this two-part series, we offer insights into the development of the translational pipeline for radiomics from methodology to clinical implementation (Part 1) and from that point to enterprise development (Part 2). In Part 2 of this two-part series, we study the components of the strategy pipeline, from clinical implementation to building enterprise solutions.
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Affiliation(s)
- Faiq Shaikh
- Institute of Computational Health Sciences, UCSF, San Francisco, California.
| | - Benjamin Franc
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California
| | | | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Omer Awan
- Department of Radiology, Temple University, Philadelphia, Pennsylvania
| | | | - Safwan Halabi
- Department of Radiology, Stanford University, Palo Alto, California
| | - Sohaib Mohiuddin
- Department of Radiology, Division of Nuclear Medicine, University of Miami, Miami, Florida
| | - Sana Malik
- School of Social Welfare, Stony Brook University, New York, New York
| | - Dexter Hadley
- Institute of Computational Health Sciences, UCSF, San Francisco, California
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35
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Lubner MG, Smith AD, Sandrasegaran K, Sahani DV, Pickhardt PJ. CT Texture Analysis: Definitions, Applications, Biologic Correlates, and Challenges. Radiographics 2017; 37:1483-1503. [PMID: 28898189 DOI: 10.1148/rg.2017170056] [Citation(s) in RCA: 520] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review discusses potential oncologic and nononcologic applications of CT texture analysis ( CTTA CT texture analysis ), an emerging area of "radiomics" that extracts, analyzes, and interprets quantitative imaging features. CTTA CT texture analysis allows objective assessment of lesion and organ heterogeneity beyond what is possible with subjective visual interpretation and may reflect information about the tissue microenvironment. CTTA CT texture analysis has shown promise in lesion characterization, such as differentiating benign from malignant or more biologically aggressive lesions. Pretreatment CT texture features are associated with histopathologic correlates such as tumor grade, tumor cellular processes such as hypoxia or angiogenesis, and genetic features such as KRAS or epidermal growth factor receptor (EGFR) mutation status. In addition, and likely as a result, these CT texture features have been linked to prognosis and clinical outcomes in some tumor types. CTTA CT texture analysis has also been used to assess response to therapy, with decreases in tumor heterogeneity generally associated with pathologic response and improved outcomes. A variety of nononcologic applications of CTTA CT texture analysis are emerging, particularly quantifying fibrosis in the liver and lung. Although CTTA CT texture analysis seems to be a promising imaging biomarker, there is marked variability in methods, parameters reported, and strength of associations with biologic correlates. Before CTTA CT texture analysis can be considered for widespread clinical implementation, standardization of tumor segmentation and measurement techniques, image filtration and postprocessing techniques, and methods for mathematically handling multiple tumors and time points is needed, in addition to identification of key texture parameters among hundreds of potential candidates, continued investigation and external validation of histopathologic correlates, and structured reporting of findings. ©RSNA, 2017.
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Affiliation(s)
- Meghan G Lubner
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 35792 (M.G.L., P.J.P.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (A.D.S.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Department of Radiology, Harvard Medical School, Boston, Mass (D.V.S.)
| | - Andrew D Smith
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 35792 (M.G.L., P.J.P.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (A.D.S.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Department of Radiology, Harvard Medical School, Boston, Mass (D.V.S.)
| | - Kumar Sandrasegaran
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 35792 (M.G.L., P.J.P.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (A.D.S.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Department of Radiology, Harvard Medical School, Boston, Mass (D.V.S.)
| | - Dushyant V Sahani
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 35792 (M.G.L., P.J.P.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (A.D.S.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Department of Radiology, Harvard Medical School, Boston, Mass (D.V.S.)
| | - Perry J Pickhardt
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 35792 (M.G.L., P.J.P.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (A.D.S.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Department of Radiology, Harvard Medical School, Boston, Mass (D.V.S.)
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Colgan N, Ganeshan B, Harrison IF, Ismail O, Holmes HE, Wells JA, Powell NM, O'Callaghan JM, O'Neill MJ, Murray TK, Ahmed Z, Collins EC, Johnson RA, Groves A, Lythgoe MF. In Vivo Imaging of Tau Pathology Using Magnetic Resonance Imaging Textural Analysis. Front Neurosci 2017; 11:599. [PMID: 29163005 PMCID: PMC5681716 DOI: 10.3389/fnins.2017.00599] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/11/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Non-invasive characterization of the pathological features of Alzheimer's disease (AD) could enhance patient management and the development of therapeutic strategies. Magnetic resonance imaging texture analysis (MRTA) has been used previously to extract texture descriptors from structural clinical scans in AD to determine cerebral tissue heterogeneity. In this study, we examined the potential of MRTA to specifically identify tau pathology in an AD mouse model and compared the MRTA metrics to histological measures of tau burden. Methods: MRTA was applied to T2 weighted high-resolution MR images of nine 8.5-month-old rTg4510 tau pathology (TG) mice and 16 litter matched wild-type (WT) mice. MRTA comprised of the filtration-histogram technique, where the filtration step extracted and enhanced features of different sizes (fine, medium, and coarse texture scales), followed by quantification of texture using histogram analysis (mean gray level intensity, mean intensity, entropy, uniformity, skewness, standard-deviation, and kurtosis). MRTA was applied to manually segmented regions of interest (ROI) drawn within the cortex, hippocampus, and thalamus regions and the level of tau burden was assessed in equivalent regions using histology. Results: Texture parameters were markedly different between WT and TG in the cortex (E, p < 0.01, K, p < 0.01), the hippocampus (K, p < 0.05) and in the thalamus (K, p < 0.01). In addition, we observed significant correlations between histological measurements of tau burden and kurtosis in the cortex, hippocampus and thalamus. Conclusions: MRTA successfully differentiated WT and TG in brain regions with varying degrees of tau pathology (cortex, hippocampus, and thalamus) based on T2 weighted MR images. Furthermore, the kurtosis measurement correlated with histological measures of tau burden. This initial study indicates that MRTA may have a role in the early diagnosis of AD and the assessment of tau pathology using routinely acquired structural MR images.
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Affiliation(s)
- Niall Colgan
- Division of Medicine, UCL Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
- School of Physics, National University of Ireland Galway, Galway, Ireland
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Ian F. Harrison
- Division of Medicine, UCL Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
| | - Ozama Ismail
- Division of Medicine, UCL Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
| | - Holly E. Holmes
- Division of Medicine, UCL Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
| | - Jack A. Wells
- Division of Medicine, UCL Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
| | - Nick M. Powell
- Division of Medicine, UCL Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
| | - James M. O'Callaghan
- Division of Medicine, UCL Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
| | | | | | - Zeshan Ahmed
- Eli Lilly & Co. Ltd., Windlesham, United Kingdom
| | - Emily C. Collins
- Eli Lilly & Co. Ltd., Lilly Corporate Center, Indianapolis, IN, United States
| | - Ross A. Johnson
- Eli Lilly & Co. Ltd., Lilly Corporate Center, Indianapolis, IN, United States
| | - Ashley Groves
- Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Mark F. Lythgoe
- Division of Medicine, UCL Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
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Kloth C, Thaiss WM, Kärgel R, Grimmer R, Fritz J, Ioanoviciu SD, Ketelsen D, Nikolaou K, Horger M. Evaluation of Texture Analysis Parameter for Response Prediction in Patients with Hepatocellular Carcinoma Undergoing Drug-eluting Bead Transarterial Chemoembolization (DEB-TACE) Using Biphasic Contrast-enhanced CT Image Data: Correlation with Liver Perfusion CT. Acad Radiol 2017; 24:1352-1363. [PMID: 28652049 DOI: 10.1016/j.acra.2017.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to evaluate the potential role of computed tomography texture analysis (CTTA) of arterial and portal-venous enhancement phase image data for prediction and accurate assessment of response of hepatocellular carcinoma undergoing drug-eluting bead transarterial chemoembolization (TACE) by comparison to liver perfusion CT (PCT). MATERIALS AND METHODS Twenty-eight patients (27 male; mean age 67.2 ± 10.4) with 56 hepatocellular carcinoma-typical liver lesions were included. Arterial and portal-venous phase CT data obtained before and after TACE with a mean time of 39.93 ± 62.21 days between examinations were analyzed. TACE was performed within 48 hours after first contrast-enhanced CT. CTTA software was a prototype. CTTA analysis was performed blinded (for results) by two observers separately. Combined results of modified Response Evaluation Criteria In Solid Tumors (mRECIST) and PCT of the liver were used as the standard of reference. Time to progression was additionally assessed for all patients. CTTA parameters included heterogeneity, intensity, average, deviation, skewness, and entropy of co-occurrence. Each parameter was compared to those of PCT (blood flow [BF], blood volume, arterial liver perfusion [ALP], portal-venous perfusion, and hepatic perfusion index) measured before and after TACE. RESULTS mRECIST + PCT yielded 28.6% complete response (CR), 42.8% partial response, and 28.6% stable disease. Significant correlations were registered in the arterial phase in CR between changes in mean heterogeneity and BF (P = .004, r = -0.815), blood volume (P = .002, r = -0.851), and ALP (P = .002, r = -0.851), respectively. In the partial response group, changes in mean heterogeneity correlated with changes in ALP (P = .003) and to a lesser degree with hepatic perfusion index (P = .027) in the arterial phase. In the stable disease group, BF correlated with entropy of nonuniformity (P = .010). In the portal-venous phase, no statistically significant correlations were registered in all groups. Receiver operating characteristic analysis of CTTA parameters yielded predictive cutoff values for CR in the arterial contrast-enhanced CT phase for uniformity of skewness (sensitivity: 90.0%; specificity: 45.8%), and in the portal-venous phase for uniformity of heterogeneity (sensitivity: 92.3%; specificity: 81.8%). CONCLUSIONS Significant correlations exist between CTTA parameters and those derived from PCT both in the pre- and the post-TACE settings, and some of them have predictive value for TACE midterm outcome.
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Beckers RCJ, Beets-Tan RGH, Schnerr RS, Maas M, da Costa Andrade LA, Beets GL, Dejong CH, Houwers JB, Lambregts DMJ. Whole-volume vs. segmental CT texture analysis of the liver to assess metachronous colorectal liver metastases. Abdom Radiol (NY) 2017; 42:2639-2645. [PMID: 28555265 DOI: 10.1007/s00261-017-1190-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE It is unclear whether changes in liver texture in patients with colorectal cancer are caused by diffuse (e.g., perfusional) changes throughout the liver or rather based on focal changes (e.g., presence of occult metastases). The aim of this study is to compare a whole-liver approach to a segmental (Couinaud) approach for measuring the CT texture at the time of primary staging in patients who later develop metachronous metastases and evaluate whether assessing CT texture on a segmental level is of added benefit. METHODS 46 Patients were included: 27 patients without metastases (follow-up >2 years) and 19 patients who developed metachronous metastases within 24 months after diagnosis. Volumes of interest covering the whole liver were drawn on primary staging portal-phase CT. In addition, each liver segment was delineated separately. Mean gray-level intensity, entropy (E), and uniformity (U) were derived with different filters (σ0.5-2.5). Patients/segments without metastases and patients/segments that later developed metachronous metastases were compared using independent samples t tests. RESULTS Absolute differences in entropy and uniformity between the group without metastases and the group with metachronous metastases group were consistently smaller for the segmental approach compared to the whole-liver approach. No statistically significant differences were found in the texture measurements between both groups. CONCLUSIONS In this small patient cohort, we could not demonstrate a clear predictive value to identify patients at risk of developing metachronous metastases within 2 years. Segmental CT texture analysis of the liver probably has no additional benefit over whole-liver texture analysis.
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Affiliation(s)
- R C J Beckers
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R G H Beets-Tan
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R S Schnerr
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L A da Costa Andrade
- Medical Imaging Department and Faculty of Medicine, University Hospital of Coimbra, Coimbra, Portugal
| | - G L Beets
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C H Dejong
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, RWTH Universitätsklinikum Aachen, Aachen, Germany
| | - J B Houwers
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - D M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Abstract
PURPOSE To evaluate CT texture analysis (CTTA) for staging of hepatic fibrosis (stages F0-F4) METHODS: Quantitative texture analysis (QTA) of the liver was performed on abdominal MDCT scans using commercially available software (TexRAD), which uses a filtration-histogram statistic-based technique. Single-slice ROI measurements of the total liver, Couinaud segments IV-VIII, and segments I-III were obtained. CTTA parameters were correlated against fibrosis stage (F0-F4), with biopsy performed within one year for all cases with intermediate fibrosis (F1-F3). RESULTS The study cohort consisted of 289 adults (158M/131W; mean age, 51 years), including healthy controls (F0, n = 77), and patients with increasing stages of fibrosis (F1, n = 42; F2 n = 37; F3 n = 53; F4 n = 80). Mean gray-level intensity increased with fibrosis stage, demonstrating an ROC AUC of 0.78 at medium filtration for F0 vs F1-4, with sensitivity and specificity of 74% and 74% at cutoff 0.18. For significant fibrosis (≥F2), mean showed AUCs ranging from 0.71-0.73 across medium- and coarse- filtered textures with sensitivity and specificity of 71% and 68% at cutoff of 0.3, with similar performance also observed for advanced fibrosis (≥F3). Entropy showed a similar trend. Conversely, kurtosis and skewness decreased with increasing fibrosis, particularly in cirrhotic patients. For cirrhosis (≥F4), kurtosis and skewness showed AUCs of 0.86 and 0.87, respectively, at coarse-filtered scale, with skewness showing a sensitivity and specificity of 84% and 75% at cutoff of 1.3. CONCLUSION CTTA may be helpful in detecting the presence of hepatic fibrosis and discriminating between stages of fibrosis, particularly at advanced levels.
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Cui HW, Devlies W, Ravenscroft S, Heers H, Freidin AJ, Cleveland RO, Ganeshan B, Turney BW. CT Texture Analysis of Ex Vivo Renal Stones Predicts Ease of Fragmentation with Shockwave Lithotripsy. J Endourol 2017; 31:694-700. [DOI: 10.1089/end.2017.0084] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Helen W. Cui
- Oxford Stone Group, University of Oxford, Oxford, United Kingdom
| | | | - Samuel Ravenscroft
- Division of Medical Sciences, University of Oxford, Oxford, United Kingdom
| | - Hendrik Heers
- Oxford Stone Group, University of Oxford, Oxford, United Kingdom
- Department of Urology and Paediatric Urology, Philipps-Universität Marburg, Marburg, Germany
| | - Andrew J. Freidin
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | - Robin O. Cleveland
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Balaji Ganeshan
- Division of Medicine, Institute of Nuclear Medicine, University College London, London, United Kingdom
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Beckers RCJ, Lambregts DMJ, Schnerr RS, Maas M, Rao SX, Kessels AGH, Thywissen T, Beets GL, Trebeschi S, Houwers JB, Dejong CH, Verhoef C, Beets-Tan RGH. Whole liver CT texture analysis to predict the development of colorectal liver metastases-A multicentre study. Eur J Radiol 2017. [PMID: 28624022 DOI: 10.1016/j.ejrad.2017.04.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES CT texture analysis has shown promise to differentiate colorectal cancer patients with/without hepatic metastases. AIM To investigate whether whole-liver CT texture analysis can also predict the development of colorectal liver metastases. MATERIAL AND METHODS Retrospective multicentre study (n=165). Three subgroups were assessed: patients [A] without metastases (n=57), [B] with synchronous metastases (n=54) and [C] who developed metastases within ≤24 months (n=54). Whole-liver texture analysis was performed on primary staging CT. Mean grey-level intensity, entropy and uniformity were derived with different filters (σ0.5-2.5). Univariable logistic regression (group A vs. B) identified potentially predictive parameters, which were tested in multivariable analyses to predict development of metastases (group A vs. C), including subgroup analyses for early (≤6 months), intermediate (7-12 months) and late (13-24 months) metastases. RESULTS Univariable analysis identified uniformity (σ0.5), sex, tumour site, nodal stage and carcinoembryonic antigen as potential predictors. Uniformity remained a significant predictor in multivariable analysis to predict early metastases (OR 0.56). None of the parameters could predict intermediate/late metastases. CONCLUSIONS Whole-liver CT-texture analysis has potential to predict patients at risk of developing early liver metastases ≤6 months, but is not robust enough to identify patients at risk of developing metastases at later stage.
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Affiliation(s)
- Rianne C J Beckers
- GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, The Netherlands; Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands; Department of Radiology, Maastricht University Medical Center, P.O. Box 6200, 6202 AZ Maastricht, The Netherlands; Department of Surgery, Maastricht University Medical Center, P.O. Box 6200, 6202 AZ Maastricht, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands.
| | - Roald S Schnerr
- Department of Radiology, Maastricht University Medical Center, P.O. Box 6200, 6202 AZ Maastricht, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
| | - Sheng-Xiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University,180 Fenglin Road Shangai 200032, China
| | - Alfons G H Kessels
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University, P.O. Box 6200, 6202 AZ Maastricht, , The Netherlands
| | - Thomas Thywissen
- Department of Radiology, Maastricht University Medical Center, P.O. Box 6200, 6202 AZ Maastricht, The Netherlands
| | - Geerard L Beets
- GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, The Netherlands; Department of Surgery, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
| | - Stefano Trebeschi
- GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, The Netherlands; Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
| | - Janneke B Houwers
- GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, The Netherlands; Department of Radiology, Maastricht University Medical Center, P.O. Box 6200, 6202 AZ Maastricht, The Netherlands
| | - Cornelis H Dejong
- Department of Surgery, Maastricht University Medical Center, P.O. Box 6200, 6202 AZ Maastricht, The Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD, The Netherlands; Department of Surgery, RWTH Universitätsklinikum Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands
| | - Regina G H Beets-Tan
- GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, The Netherlands; Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
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Chen S, Zhu Y, Liu Z, Liang C. Texture analysis of baseline multiphasic hepatic computed tomography images for the prognosis of single hepatocellular carcinoma after hepatectomy: A retrospective pilot study. Eur J Radiol 2017; 90:198-204. [PMID: 28583634 DOI: 10.1016/j.ejrad.2017.02.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/15/2017] [Accepted: 02/21/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the prognostic value of texture analysis for single hepatocellular carcinomas (HCCs) after hepatectomy. MATERIALS AND METHODS A total of 61 HCC patients were enrolled in this retrospective study. Textural characteristics of the computed tomography (CT) images were quantified. The differences between the hepatic arterial phase and the portal venous phase were obtained (the Dif.). The receiver operating characteristic (ROC) curves were used for data screening. Cox regression analyses were performed to determine independent factors adjusted with the derived clinical and radiological variables. Model identifications were based on Akaike information criteria. Kaplan-Meier and log-rank tests were performed for overall survival (OS) and disease-free survival (DFS). RESULTS ROC and Cox regression analyses identified five parameters. Filter 1.0 achieved the best performance, in which the Dif.Scale 1.2 was a superior indicative independent marker for OS (p=0.05). Kaplan-Meier analyses further demonstrated that the Dif.Scale2.2 at filter 0 (p=0.001), Dif.Scale1.2 (p=0.006), Dif.Scale3.2 (p=0.005) at filter 1.0, Dif.Wavelet 8 at filter 1.5 (p<0.001), and corona (p=0.032) were associated with OS. Moreover, Dif.Scale 2.2 at filter 0 (p=0.039), Dif.Scale1.2 at filter 1.0 (p=0.001), and Dif.Wavelet 8 at filter 1.5 (p=0.007) were associated with DFS, while the Barcelona-Clínic Liver Cancer (BCLC) parameters showed no statistical correlation with OS (p=0.057). CONCLUSIONS For patients with a single HCC treated by hepatectomy, the textural features for Gabor and Wavelet, especially the varying Dif., potentially provided prognostic information beyond traditional indicators such as those of the BCLC.
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Affiliation(s)
- Shuting Chen
- Southern Medical University, Guangzhou, 510080, China; Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yanjie Zhu
- Shenzhen Institutes of Advanced Technology, Shenzhen, 518055, China
| | - Zaiyi Liu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Changhong Liang
- Southern Medical University, Guangzhou, 510080, China; Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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Wagner F, Hakami YA, Warnock G, Fischer G, Huellner MW, Veit-Haibach P. Comparison of Contrast-Enhanced CT and [18F]FDG PET/CT Analysis Using Kurtosis and Skewness in Patients with Primary Colorectal Cancer. Mol Imaging Biol 2017; 19:795-803. [DOI: 10.1007/s11307-017-1066-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Multislice Analysis of Blood Flow Values in CT Perfusion Studies of Lung Cancer. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3236893. [PMID: 28164118 PMCID: PMC5259676 DOI: 10.1155/2017/3236893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/07/2016] [Accepted: 12/12/2016] [Indexed: 12/20/2022]
Abstract
Objectives. Tumour heterogeneity represents a key issue in CT perfusion (CTp), where all studies are usually based on global mean or median values of perfusion maps, often computed on whole tumour. We sought to determine whether, and to what extent, such global values can be representative of tumour heterogeneity, with respect to single slices, and could be used for therapy assessment. Materials and Methods. Twelve patients with one primary non-small cell lung cancer lesion were enrolled in this study, for a total amount of 26 CTp examinations and 118 slices. Mean and median blood flow (BF) values, calculated voxel-based, were computed on each slice and the whole tumour. To measure functional heterogeneity, entropy was calculated on BF values as well. Results. Most of the slices were not represented by the global BF values computed on the whole tumour. In addition, there are a number of lesions having equivalent global BF values, but they are composed of slices having very different heterogeneity distributions, that is, entropy values. Conclusions. Global mean/median BF values of the single slices separately should be considered for clinical assessment, only if interpreted through entropy computed on BF values. The numerical equivalence between global BF values of different lesions may correspond to different clinical status, thus inducing possible errors in choice of therapy when considering global values only.
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Kim JH, Ko ES, Lim Y, Lee KS, Han BK, Ko EY, Hahn SY, Nam SJ. Breast Cancer Heterogeneity: MR Imaging Texture Analysis and Survival Outcomes. Radiology 2016; 282:665-675. [PMID: 27700229 DOI: 10.1148/radiol.2016160261] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose To determine the relationship between tumor heterogeneity assessed by means of magnetic resonance (MR) imaging texture analysis and survival outcomes in patients with primary breast cancer. Materials and Methods Between January and August 2010, texture analysis of the entire primary breast tumor in 203 patients was performed with T2-weighted and contrast material-enhanced T1-weighted subtraction MR imaging for preoperative staging. Histogram-based uniformity and entropy were calculated. To dichotomize texture parameters for survival analysis, the 10-fold cross-validation method was used to determine cutoff points in the receiver operating characteristic curve analysis. The Cox proportional hazards model and Kaplan-Meier analysis were used to determine the association of texture parameters and morphologic or volumetric information obtained at MR imaging or clinical-pathologic variables with recurrence-free survival (RFS). Results There were 26 events, including 22 recurrences (10 local-regional and 12 distant) and four deaths, with a mean follow-up time of 56.2 months. In multivariate analysis, a higher N stage (RFS hazard ratio, 11.15 [N3 stage]; P = .002, Bonferroni-adjusted α = .0167), triple-negative subtype (RFS hazard ratio, 16.91; P < .001, Bonferroni-adjusted α = .0167), high risk of T1 entropy (less than the cutoff values [mean, 5.057; range, 5.022-5.167], RFS hazard ratio, 4.55; P = .018), and T2 entropy (equal to or higher than the cutoff values [mean, 6.013; range, 6.004-6.035], RFS hazard ratio = 9.84; P = .001) were associated with worse outcomes. Conclusion Patients with breast cancers that appeared more heterogeneous on T2-weighted images (higher entropy) and those that appeared less heterogeneous on contrast-enhanced T1-weighted subtraction images (lower entropy) exhibited poorer RFS. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Jae-Hun Kim
- From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.)
| | - Eun Sook Ko
- From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.)
| | - Yaeji Lim
- From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.)
| | - Kyung Soo Lee
- From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.)
| | - Boo-Kyung Han
- From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.)
| | - Eun Young Ko
- From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.)
| | - Soo Yeon Hahn
- From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.)
| | - Seok Jin Nam
- From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.)
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Ahn SJ, Kim JH, Park SJ, Han JK. Prediction of the therapeutic response after FOLFOX and FOLFIRI treatment for patients with liver metastasis from colorectal cancer using computerized CT texture analysis. Eur J Radiol 2016; 85:1867-1874. [PMID: 27666629 DOI: 10.1016/j.ejrad.2016.08.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine whether baseline CT texture analysis of hepatic metastasis from colorectal cancer (CRC) is predictive of therapeutic response after cytotoxic chemotherapy. MATERIALS AND METHODS 235 patients with liver metastasis from CRC who underwent CT and cytotoxic chemotherapy using FOLFOX and FOLFIRI were divided into derivation cohort (n=145) and validation cohort (n=90). The CT texture of the hepatic metastasis was quantified using baseline CT. We analyzed the independent predictor for the response from derivation cohort and validated it using validation cohort. We also compared texture features between included four CT scanners. RESULTS 89 responding and 146 non-responding patients were evaluated. In the derivation cohort, lower skewness (OR, 6.739) in 2D, higher mean attenuation (OR, 2.587), and narrower standard deviation (SD) (OR, 3.163) in 3D were independently associated with response to chemotherapy. However, only lower skewness (P=0.213) on 2D and narrower SD on 3D analysis (P=0.097) did not show a significant difference on either CT scanner. When applied to the validation set, the lower skewness on 2D (AUC=0.797) and narrower SD on 3D (AUC=0.785) showed good performance. CONCLUSION CT texture analysis is useful for prediction of therapeutic response after cytotoxic chemotherapy in patients with liver metastasis from colorectal cancer.
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Affiliation(s)
- Su Joa Ahn
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Sang Joon Park
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Cancer Research Institute, Seoul National University, Seoul, South Korea.
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, South Korea.
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Preliminary data using computed tomography texture analysis for the classification of hypervascular liver lesions: generation of a predictive model on the basis of quantitative spatial frequency measurements--a work in progress. J Comput Assist Tomogr 2015; 39:383-95. [PMID: 25700222 DOI: 10.1097/rct.0000000000000217] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Computed tomography texture analysis (CTTA) is a method of quantifying lesion heterogeneity based on distribution of pixel intensities within a region of interest. This study investigates the ability of CTTA to distinguish different hypervascular liver lesions and compares CTTA parameters by creating a proof-of-concept model to distinguish between different lesions. METHODS Following institutional review board approval, CTTA software (TexRAD Ltd) was used to retrospectively analyze 17 cases of focal nodular hyperplasia, 19 hepatic adenomas, 25 hepatocellular carcinomas, and 19 cases of normal liver parenchyma using arterial phase scans. Two radiologists read the same image series used by the CTTA software and reported their best guess diagnosis. Computed tomography texture analysis parameters were computed from regions of interest using spatial band-pass filters to quantify heterogeneity. Random-forest method was used to construct a predictive model from these parameters, and a separate regression model was created using a subset of parameters. RESULTS The random-forest model successfully distinguished the 3 lesion types and normal liver with predicted classification performance accuracy for 91.2% for adenoma, 94.4% for focal nodular hyperplasia, and 98.6% for hepatocellular carcinoma. This error prediction was generated using a subset of data points not used in generation of the model, but not on discrete prospective cases. In contrast, the 2 human readers using the same image series data analyzed by the CTTA software had lower accuracies, of 72.2% and 65.6%, respectively. The explicit regression model with a subset of image parameters had intermediate overall accuracy of 84.9%. CONCLUSIONS Computed tomography texture analysis may prove valuable in lesion characterization. Differentiation between common hypervascular lesion types could be aided by the judicious incorporation of texture parameters into clinical analysis.
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Kinetic Textural Biomarker for Predicting Survival of Patients with Advanced Hepatocellular Carcinoma After Antiangiogenic Therapy by Use of Baseline First-Pass Perfusion CT. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/978-3-319-13692-9_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Rao SX, Lambregts DM, Schnerr RS, van Ommen W, van Nijnatten TJ, Martens MH, Heijnen LA, Backes WH, Verhoef C, Zeng MS, Beets GL, Beets-Tan RG. Whole-liver CT texture analysis in colorectal cancer: Does the presence of liver metastases affect the texture of the remaining liver? United European Gastroenterol J 2014; 2:530-8. [PMID: 25452849 DOI: 10.1177/2050640614552463] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/25/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Liver metastases limit survival in colorectal cancer. Earlier detection of (occult) metastatic disease may benefit treatment and survival. OBJECTIVE The objective of this article is to evaluate the potential of whole-liver CT texture analysis of apparently disease-free liver parenchyma for discriminating between colorectal cancer (CRC) patients with and without hepatic metastases. METHODS The primary staging CT examinations of 29 CRC patients were retrospectively analysed. Patients were divided into three groups: patients without liver metastases (n = 15), with synchronous liver metastases (n = 10) and metachronous liver metastases within 18 months following primary staging (n = 4). Whole-liver texture analysis was performed by delineation of the apparently non-diseased liver parenchyma (excluding metastases or other focal liver lesions) on portal phase images. Mean grey-level intensity (M), entropy (E) and uniformity (U) were derived with no filtration and different filter widths (0.5 = fine, 1.5 = medium, 2.5 = coarse). RESULTS Mean E1.5 and E2.5 for the whole liver in patients with synchronous metastases were significantly higher compared with the non-metastatic patients (p = 0.02 and p = 0.01). Mean U1.5 and U2.5 were significantly lower in the synchronous metastases group compared with the non-metastatic group (p = 0.04 and p = 0.02). Texture parameters for the metachronous metastases group were not significantly different from the non-metastatic group or synchronous metastases group (p > 0.05), although - similar to the synchronous metastases group - there was a subtle trend towards increased E1.5, E2.5 and decreased U1.5, U2.5 values. Areas under the ROC curve for the diagnosis of synchronous metastatic disease based on the texture parameters E1.5,2.5 and U1.5,2.5 ranged between 0.73 and 0.78. CONCLUSION Texture analysis of the apparently non-diseased liver holds promise to differentiate between CRC patients with and without metastatic liver disease. Further research is required to determine whether these findings may be used to benefit the prediction of metachronous liver disease.
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Affiliation(s)
- Sheng-Xiang Rao
- Department of Radiology, Maastricht University Medical Center, The Netherlands ; Department of Radiology, Zhongshan Hospital, Fudan University, China
| | - Doenja Mj Lambregts
- Department of Radiology, Maastricht University Medical Center, The Netherlands
| | - Roald S Schnerr
- Department of Radiology, Maastricht University Medical Center, The Netherlands
| | - Wenzel van Ommen
- Department of Radiology, Maastricht University Medical Center, The Netherlands ; Department of Radiology, Catharina Hospital Eindhoven, The Netherlands
| | | | - Milou H Martens
- Department of Radiology, Maastricht University Medical Center, The Netherlands ; Department of Surgery, Maastricht University Medical Center, The Netherlands
| | - Luc A Heijnen
- Department of Radiology, Maastricht University Medical Center, The Netherlands ; Department of Surgery, Maastricht University Medical Center, The Netherlands
| | - Walter H Backes
- Department of Radiology, Maastricht University Medical Center, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, The Netherlands
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, China
| | - Geerard L Beets
- Department of Surgery, Maastricht University Medical Center, The Netherlands ; GROW School for Oncology and Developmental Biology, The Netherlands
| | - Regina Gh Beets-Tan
- Department of Radiology, Maastricht University Medical Center, The Netherlands ; GROW School for Oncology and Developmental Biology, The Netherlands
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Raman SP, Chen Y, Schroeder JL, Huang P, Fishman EK. CT texture analysis of renal masses: pilot study using random forest classification for prediction of pathology. Acad Radiol 2014; 21:1587-96. [PMID: 25239842 DOI: 10.1016/j.acra.2014.07.023] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/16/2014] [Accepted: 07/26/2014] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES Computed tomography texture analysis (CTTA) allows quantification of heterogeneity within a region of interest. This study investigates the possibility of distinguishing between several common renal masses using CTTA-derived parameters by developing and validating a predictive model. MATERIALS AND METHODS CTTA software was used to analyze 20 clear cell renal cell carcinomas (RCCs), 20 papillary RCCs, 20 oncocytomas, and 20 renal cysts. Regions of interest were drawn around each mass on multiple slices in the arterial, venous, and delayed phases on renal mass protocol CT scans. Unfiltered images and spatial band-pass filtered images were analyzed to quantify heterogeneity. Random forest method was used to construct a predictive model to classify lesions using quantitative parameters. The model was externally validated on a separate set of 19 unknown cases. RESULTS The random forest model correctly categorized oncocytomas in 89% of cases (sensitivity = 89%, specificity = 99%), clear cell RCCs in 91% of cases (sensitivity = 91%, specificity = 97%), cysts in 100% of cases (sensitivity = 100%, specificity = 100%), and papillary RCCs in 100% of cases (sensitivity = 100%, specificity = 98%). CONCLUSIONS CTTA, in conjunction with random forest modeling, demonstrates promise as a tool to characterize lesions. Various renal masses were accurately classified using quantitative information derived from routine scans.
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Affiliation(s)
- Siva P Raman
- Department of Radiology, JHOC 3251, Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287.
| | - Yifei Chen
- Department of Radiology, JHOC 3251, Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287
| | - James L Schroeder
- Department of Radiology, JHOC 3251, Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287
| | - Peng Huang
- Biostatistics and Bioinformatics Division, Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Elliot K Fishman
- Department of Radiology, JHOC 3251, Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287
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