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Zhou W, Wen J, Huang Q, Zeng Y, Zhou Z, Zhu Y, Chen L, Guan Y, Xie F, Zhuang D, Hua T. Development and validation of clinical-radiomics analysis for preoperative prediction of IDH mutation status and WHO grade in diffuse gliomas: a consecutive L-[methyl-11C] methionine cohort study with two PET scanners. Eur J Nucl Med Mol Imaging 2024; 51:1423-1435. [PMID: 38110710 DOI: 10.1007/s00259-023-06562-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE Determination of isocitrate dehydrogenase (IDH) genotype is crucial in the stratification of diagnosis and prognostication in diffuse gliomas. We sought to build and validate radiomics models and clinical features incorporated nomogram for preoperative prediction of IDH mutation status and WHO grade of diffuse gliomas with L-[methyl-11C] methionine ([11C]MET) PET/CT imaging according to the 2016 WHO classification of tumors of the central nervous system. METHODS Consecutive 178 preoperative [11C]MET PET/CT images were retrospectively studied for radiomics analysis. One hundred six patients from PET scanner 1 were used as training dataset, and 72 patients from PET scanner 2 were used for validation dataset. [11C]MET PET and integrated CT radiomics features were extracted, respectively; three independent predictive models were built based on PET features, CT features, and combined PET/CT features, respectively. The SelectKBest method, Spearman correlation analysis, Least Absolute Shrinkage and Selection Operator (LASSO) regression, and machine learning algorithms were applied for feature selection and model building. After filtering the satisfactory predictive model, key clinical features were incorporated for the nomogram establishment. RESULTS The combined [11C]MET PET/CT radiomics model, which consisted of four PET features and eight integrated CT features, was significantly associated with IDH genotype (p < 0.0001 for both training and validation datasets). Nomogram based on the [11C]MET PET/CT radiomics score, patients' age, and dichotomous tumor location status showed satisfactory discrimination capacity, and the AUC was 0.880 (95% CI, 0.726-0.998) in the training dataset and 0.866 (95% CI, 0.777-0.956) in the validation dataset. In IDH stratified WHO grade prediction, the final radiomics model consists of four PET features and two CT features had reasonable and stable differential efficacy of WHO grade II and III patients from grade IV patients in IDH-wildtype patients, and the AUC was 0.820 (95% CI, 0.541-1.000) in the training dataset and 0.766 (95% CI, 0.612-0.921) in the validation dataset. CONCLUSION [11C]MET PET radiomics features could benefit non-invasive IDH genotype prediction, and integrated CT radiomics features could enhance the efficacy. Radiomics and clinical features incorporation could establish satisfactory nomogram for clinical application. This non-invasive predictive investigation based on our consecutive cohort from two PET scanners could provide the perspective to observe the differential efficacy and the stability of radiomics-based investigation in untreated diffuse gliomas.
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Affiliation(s)
- Weiyan Zhou
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianbo Wen
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qi Huang
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Zeng
- Department of Research Center, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Zhirui Zhou
- Radiation Oncology Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuhua Zhu
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Lei Chen
- Department of Research Center, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Yihui Guan
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Fang Xie
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China.
| | - Dongxiao Zhuang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
- National Center for Neurological Disorders, Shanghai, China.
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.
- Neurosurgical Institute of Fudan University, Shanghai, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.
| | - Tao Hua
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China.
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Eisazadeh R, Shahbazi-Akbari M, Mirshahvalad SA, Pirich C, Beheshti M. Application of Artificial Intelligence in Oncologic Molecular PET-Imaging: A Narrative Review on Beyond [ 18F]F-FDG Tracers Part II. [ 18F]F-FLT, [ 18F]F-FET, [ 11C]C-MET and Other Less-Commonly Used Radiotracers. Semin Nucl Med 2024; 54:293-301. [PMID: 38331629 DOI: 10.1053/j.semnuclmed.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
Following the previous part of the narrative review on artificial intelligence (AI) applications in positron emission tomography (PET) using tracers rather than 18F-fluorodeoxyglucose ([18F]F-FDG), in this part we review the impact of PET-derived radiomics data on the diagnostic performance of other PET radiotracers, 18F-O-(2-fluoroethyl)-L-tyrosine ([18F]F-FET), 18F-Fluorothymidine ([18F]F-FLT) and 11C-Methionine ([11C]C-MET). [18F]F-FET-PET, using an artificial amino acid taken up into upregulated tumoral cells, showed potential in lesion detection and tumor characterization, especially with its ability to reflect glioma heterogeneity. [18F]F-FET-PET-derived textural features appeared to have the potential to reveal considerable information for accurate delineation for guiding biopsy and treatment, differentiate between low-grade and high-grade glioma and related wild-type genotypes, and distinguish pseudoprogression from true progression. In addition, models built using clinical parameters and [18F]F-FET-PET-derived radiomics features showed acceptable results for survival stratification of glioblastoma patients. [18F]F-FLT-PET-based characteristics also showed potential in evaluating glioma patients, correlating with Ki-67 and patient prognosis. AI-based PET-volumetry using this radiotracer as a proliferation marker also revealed promising preliminary results in terms of guide-targeting bone marrow-preserving adaptive radiation therapy. Similar to [18F]F-FET, the other amino acid tracer which reflects cellular proliferation, [11C]C-MET, has also shown acceptable performance in predicting tumor grade, distinguishing brain tumor recurrence from radiation necrosis, and treatment monitoring by PET-derived radiomics models. In addition, PET-derived radiomics features of various radiotracers such as [18F]F-DOPA, [18F]F-FACBC, [18F]F-NaF, [68Ga]Ga-CXCR-4 and [18F]F-FMISO may also provide useful information for tumor characterization and predict of disease outcome. In conclusion, AI using tracers beyond [18F]F-FDG could improve the diagnostic performance of PET-imaging for specific indications and help clinicians in their daily routine by providing features that are often not detectable by the naked eye.
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Affiliation(s)
- Roya Eisazadeh
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Malihe Shahbazi-Akbari
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria; Research center for Nuclear Medicine, Department of Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria; Research center for Nuclear Medicine, Department of Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran; Joint Department of Medical Imaging, University Medical Imaging Toronto (UMIT), University Health Network, Mount Sinai Hospital & Women's College Hospital; University of Toronto, Toronto, Ontario, Canada
| | - Christian Pirich
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria.
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Kaiser L, Quach S, Zounek AJ, Wiestler B, Zatcepin A, Holzgreve A, Bollenbacher A, Bartos LM, Ruf VC, Böning G, Thon N, Herms J, Riemenschneider MJ, Stöcklein S, Brendel M, Rupprecht R, Tonn JC, Bartenstein P, von Baumgarten L, Ziegler S, Albert NL. Enhancing predictability of IDH mutation status in glioma patients at initial diagnosis: a comparative analysis of radiomics from MRI, [ 18F]FET PET, and TSPO PET. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06654-5. [PMID: 38396261 DOI: 10.1007/s00259-024-06654-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE According to the World Health Organization classification for tumors of the central nervous system, mutation status of the isocitrate dehydrogenase (IDH) genes has become a major diagnostic discriminator for gliomas. Therefore, imaging-based prediction of IDH mutation status is of high interest for individual patient management. We compared and evaluated the diagnostic value of radiomics derived from dual positron emission tomography (PET) and magnetic resonance imaging (MRI) data to predict the IDH mutation status non-invasively. METHODS Eighty-seven glioma patients at initial diagnosis who underwent PET targeting the translocator protein (TSPO) using [18F]GE-180, dynamic amino acid PET using [18F]FET, and T1-/T2-weighted MRI scans were examined. In addition to calculating tumor-to-background ratio (TBR) images for all modalities, parametric images quantifying dynamic [18F]FET PET information were generated. Radiomic features were extracted from TBR and parametric images. The area under the receiver operating characteristic curve (AUC) was employed to assess the performance of logistic regression (LR) classifiers. To report robust estimates, nested cross-validation with five folds and 50 repeats was applied. RESULTS TBRGE-180 features extracted from TSPO-positive volumes had the highest predictive power among TBR images (AUC 0.88, with age as co-factor 0.94). Dynamic [18F]FET PET reached a similarly high performance (0.94, with age 0.96). The highest LR coefficients in multimodal analyses included TBRGE-180 features, parameters from kinetic and early static [18F]FET PET images, age, and the features from TBRT2 images such as the kurtosis (0.97). CONCLUSION The findings suggest that incorporating TBRGE-180 features along with kinetic information from dynamic [18F]FET PET, kurtosis from TBRT2, and age can yield very high predictability of IDH mutation status, thus potentially improving early patient management.
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Affiliation(s)
- Lena Kaiser
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - S Quach
- Department of Neurosurgery, University Hospital, LMU Munich, 81377, Munich, Germany
| | - A J Zounek
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - B Wiestler
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), 91054, Erlangen, Germany
| | - A Zatcepin
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 81377, Munich, Germany
| | - A Holzgreve
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - A Bollenbacher
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - L M Bartos
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - V C Ruf
- Center for Neuropathology and Prion Research, Faculty of Medicine, LMU Munich, Munich, Germany
| | - G Böning
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - N Thon
- Department of Neurosurgery, University Hospital, LMU Munich, 81377, Munich, Germany
| | - J Herms
- Center for Neuropathology and Prion Research, Faculty of Medicine, LMU Munich, Munich, Germany
| | - M J Riemenschneider
- Department of Neuropathology, University Hospital Regensburg, 93053, Regensburg, Germany
- Bavarian Cancer Research Center (BZKF), 91054, Erlangen, Germany
| | - S Stöcklein
- Department of Radiology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - M Brendel
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 81377, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377, Munich, Germany
| | - R Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053, Regensburg, Germany
| | - J C Tonn
- Department of Neurosurgery, University Hospital, LMU Munich, 81377, Munich, Germany
- Bavarian Cancer Research Center (BZKF), 91054, Erlangen, Germany
| | - P Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - L von Baumgarten
- Department of Neurosurgery, University Hospital, LMU Munich, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
- Bavarian Cancer Research Center (BZKF), 91054, Erlangen, Germany
| | - S Ziegler
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - N L Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
- Bavarian Cancer Research Center (BZKF), 91054, Erlangen, Germany
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Ahrari S, Zaragori T, Zinsz A, Oster J, Imbert L, Verger A. Application of PET imaging delta radiomics for predicting progression-free survival in rare high-grade glioma. Sci Rep 2024; 14:3256. [PMID: 38332004 PMCID: PMC10853227 DOI: 10.1038/s41598-024-53693-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/03/2024] [Indexed: 02/10/2024] Open
Abstract
This study assesses the feasibility of using a sample-efficient model to investigate radiomics changes over time for predicting progression-free survival in rare diseases. Eighteen high-grade glioma patients underwent two L-3,4-dihydroxy-6-[18F]-fluoro-phenylalanine positron emission tomography (PET) dynamic scans: the first during treatment and the second at temozolomide chemotherapy discontinuation. Radiomics features from static/dynamic parametric images, alongside conventional features, were extracted. After excluding highly correlated features, 16 different models were trained by combining various feature selection methods and time-to-event survival algorithms. Performance was assessed using cross-validation. To evaluate model robustness, an additional dataset including 35 patients with a single PET scan at therapy discontinuation was used. Model performance was compared with a strategy extracting informative features from the set of 35 patients and applying them to the 18 patients with 2 PET scans. Delta-absolute radiomics achieved the highest performance when the pipeline was directly applied to the 18-patient subset (support vector machine (SVM) and recursive feature elimination (RFE): C-index = 0.783 [0.744-0.818]). This result remained consistent when transferring informative features from 35 patients (SVM + RFE: C-index = 0.751 [0.716-0.784], p = 0.06). In addition, it significantly outperformed delta-absolute conventional (C-index = 0.584 [0.548-0.620], p < 0.001) and single-time-point radiomics features (C-index = 0.546 [0.512-0.580], p < 0.001), highlighting the considerable potential of delta radiomics in rare cancer cohorts.
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Affiliation(s)
- Shamimeh Ahrari
- Imagerie Adaptative Diagnostique et Interventionnelle, Institut National de la Santé et de la Recherche Médicale U1254, Université de Lorraine, 54000, Nancy, France
- Nancyclotep Imaging Platform, Université de Lorraine, 54000, Nancy, France
| | - Timothée Zaragori
- Imagerie Adaptative Diagnostique et Interventionnelle, Institut National de la Santé et de la Recherche Médicale U1254, Université de Lorraine, 54000, Nancy, France
- Nancyclotep Imaging Platform, Université de Lorraine, 54000, Nancy, France
| | - Adeline Zinsz
- Department of Nuclear Medicine, Centre Hospitalier Régional Universitaire de Nancy, 54000, Nancy, France
| | - Julien Oster
- Imagerie Adaptative Diagnostique et Interventionnelle, Institut National de la Santé et de la Recherche Médicale U1254, Université de Lorraine, 54000, Nancy, France
| | - Laetitia Imbert
- Imagerie Adaptative Diagnostique et Interventionnelle, Institut National de la Santé et de la Recherche Médicale U1254, Université de Lorraine, 54000, Nancy, France
- Nancyclotep Imaging Platform, Université de Lorraine, 54000, Nancy, France
- Department of Nuclear Medicine, Centre Hospitalier Régional Universitaire de Nancy, 54000, Nancy, France
| | - Antoine Verger
- Imagerie Adaptative Diagnostique et Interventionnelle, Institut National de la Santé et de la Recherche Médicale U1254, Université de Lorraine, 54000, Nancy, France.
- Nancyclotep Imaging Platform, Université de Lorraine, 54000, Nancy, France.
- Department of Nuclear Medicine, Centre Hospitalier Régional Universitaire de Nancy, 54000, Nancy, France.
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5
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Di Salle G, Tumminello L, Laino ME, Shalaby S, Aghakhanyan G, Fanni SC, Febi M, Shortrede JE, Miccoli M, Faggioni L, Cosottini M, Neri E. Accuracy of Radiomics in Predicting IDH Mutation Status in Diffuse Gliomas: A Bivariate Meta-Analysis. Radiol Artif Intell 2024; 6:e220257. [PMID: 38231039 PMCID: PMC10831518 DOI: 10.1148/ryai.220257] [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: 11/22/2022] [Revised: 09/12/2023] [Accepted: 10/24/2023] [Indexed: 01/18/2024]
Abstract
Purpose To perform a systematic review and meta-analysis assessing the predictive accuracy of radiomics in the noninvasive determination of isocitrate dehydrogenase (IDH) status in grade 4 and lower-grade diffuse gliomas. Materials and Methods A systematic search was performed in the PubMed, Scopus, Embase, Web of Science, and Cochrane Library databases for relevant articles published between January 1, 2010, and July 7, 2021. Pooled sensitivity and specificity across studies were estimated. Risk of bias was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2, and methods were evaluated using the radiomics quality score (RQS). Additional subgroup analyses were performed according to tumor grade, RQS, and number of sequences used (PROSPERO ID: CRD42021268958). Results Twenty-six studies that included 3280 patients were included for analysis. The pooled sensitivity and specificity of radiomics for the detection of IDH mutation were 79% (95% CI: 76, 83) and 80% (95% CI: 76, 83), respectively. Low RQS scores were found overall for the included works. Subgroup analyses showed lower false-positive rates in very low RQS studies (RQS < 6) (meta-regression, z = -1.9; P = .02) compared with adequate RQS studies. No substantial differences were found in pooled sensitivity and specificity for the pure grade 4 gliomas group compared with the all-grade gliomas group (81% and 86% vs 79% and 79%, respectively) and for studies using single versus multiple sequences (80% and 77% vs 79% and 82%, respectively). Conclusion The pooled data showed that radiomics achieved good accuracy performance in distinguishing IDH mutation status in patients with grade 4 and lower-grade diffuse gliomas. The overall methodologic quality (RQS) was low and introduced potential bias. Keywords: Neuro-Oncology, Radiomics, Integration, Application Domain, Glioblastoma, IDH Mutation, Radiomics Quality Scoring Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Gianfranco Di Salle
- From Academic Radiology, Department of Translational Research on New
Technologies in Medicine and Surgery (G.D.S., L.T., G.A., S.C.F., M.F., J.E.S.,
L.F., E.N.), Department of Clinical and Experimental Medicine (M.M.), and
Neuroradiology Unit, Department of Translational Research on New Technologies in
Medicine and Surgery (M.C.), University of Pisa, Via Roma 67, 56126 Pisa, Italy;
Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano,
Milan, Italy (M.E.L.); The Shrewsbury and Telford Hospital NHS Trust,
Shrewsbury, England (S.S.); and Italian Society of Medical and Interventional
Radiology, SIRM Foundation, Milan, Italy (E.N.)
| | - Lorenzo Tumminello
- From Academic Radiology, Department of Translational Research on New
Technologies in Medicine and Surgery (G.D.S., L.T., G.A., S.C.F., M.F., J.E.S.,
L.F., E.N.), Department of Clinical and Experimental Medicine (M.M.), and
Neuroradiology Unit, Department of Translational Research on New Technologies in
Medicine and Surgery (M.C.), University of Pisa, Via Roma 67, 56126 Pisa, Italy;
Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano,
Milan, Italy (M.E.L.); The Shrewsbury and Telford Hospital NHS Trust,
Shrewsbury, England (S.S.); and Italian Society of Medical and Interventional
Radiology, SIRM Foundation, Milan, Italy (E.N.)
| | - Maria Elena Laino
- From Academic Radiology, Department of Translational Research on New
Technologies in Medicine and Surgery (G.D.S., L.T., G.A., S.C.F., M.F., J.E.S.,
L.F., E.N.), Department of Clinical and Experimental Medicine (M.M.), and
Neuroradiology Unit, Department of Translational Research on New Technologies in
Medicine and Surgery (M.C.), University of Pisa, Via Roma 67, 56126 Pisa, Italy;
Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano,
Milan, Italy (M.E.L.); The Shrewsbury and Telford Hospital NHS Trust,
Shrewsbury, England (S.S.); and Italian Society of Medical and Interventional
Radiology, SIRM Foundation, Milan, Italy (E.N.)
| | - Sherif Shalaby
- From Academic Radiology, Department of Translational Research on New
Technologies in Medicine and Surgery (G.D.S., L.T., G.A., S.C.F., M.F., J.E.S.,
L.F., E.N.), Department of Clinical and Experimental Medicine (M.M.), and
Neuroradiology Unit, Department of Translational Research on New Technologies in
Medicine and Surgery (M.C.), University of Pisa, Via Roma 67, 56126 Pisa, Italy;
Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano,
Milan, Italy (M.E.L.); The Shrewsbury and Telford Hospital NHS Trust,
Shrewsbury, England (S.S.); and Italian Society of Medical and Interventional
Radiology, SIRM Foundation, Milan, Italy (E.N.)
| | - Gayane Aghakhanyan
- From Academic Radiology, Department of Translational Research on New
Technologies in Medicine and Surgery (G.D.S., L.T., G.A., S.C.F., M.F., J.E.S.,
L.F., E.N.), Department of Clinical and Experimental Medicine (M.M.), and
Neuroradiology Unit, Department of Translational Research on New Technologies in
Medicine and Surgery (M.C.), University of Pisa, Via Roma 67, 56126 Pisa, Italy;
Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano,
Milan, Italy (M.E.L.); The Shrewsbury and Telford Hospital NHS Trust,
Shrewsbury, England (S.S.); and Italian Society of Medical and Interventional
Radiology, SIRM Foundation, Milan, Italy (E.N.)
| | - Salvatore Claudio Fanni
- From Academic Radiology, Department of Translational Research on New
Technologies in Medicine and Surgery (G.D.S., L.T., G.A., S.C.F., M.F., J.E.S.,
L.F., E.N.), Department of Clinical and Experimental Medicine (M.M.), and
Neuroradiology Unit, Department of Translational Research on New Technologies in
Medicine and Surgery (M.C.), University of Pisa, Via Roma 67, 56126 Pisa, Italy;
Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano,
Milan, Italy (M.E.L.); The Shrewsbury and Telford Hospital NHS Trust,
Shrewsbury, England (S.S.); and Italian Society of Medical and Interventional
Radiology, SIRM Foundation, Milan, Italy (E.N.)
| | - Maria Febi
- From Academic Radiology, Department of Translational Research on New
Technologies in Medicine and Surgery (G.D.S., L.T., G.A., S.C.F., M.F., J.E.S.,
L.F., E.N.), Department of Clinical and Experimental Medicine (M.M.), and
Neuroradiology Unit, Department of Translational Research on New Technologies in
Medicine and Surgery (M.C.), University of Pisa, Via Roma 67, 56126 Pisa, Italy;
Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano,
Milan, Italy (M.E.L.); The Shrewsbury and Telford Hospital NHS Trust,
Shrewsbury, England (S.S.); and Italian Society of Medical and Interventional
Radiology, SIRM Foundation, Milan, Italy (E.N.)
| | - Jorge Eduardo Shortrede
- From Academic Radiology, Department of Translational Research on New
Technologies in Medicine and Surgery (G.D.S., L.T., G.A., S.C.F., M.F., J.E.S.,
L.F., E.N.), Department of Clinical and Experimental Medicine (M.M.), and
Neuroradiology Unit, Department of Translational Research on New Technologies in
Medicine and Surgery (M.C.), University of Pisa, Via Roma 67, 56126 Pisa, Italy;
Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano,
Milan, Italy (M.E.L.); The Shrewsbury and Telford Hospital NHS Trust,
Shrewsbury, England (S.S.); and Italian Society of Medical and Interventional
Radiology, SIRM Foundation, Milan, Italy (E.N.)
| | - Mario Miccoli
- From Academic Radiology, Department of Translational Research on New
Technologies in Medicine and Surgery (G.D.S., L.T., G.A., S.C.F., M.F., J.E.S.,
L.F., E.N.), Department of Clinical and Experimental Medicine (M.M.), and
Neuroradiology Unit, Department of Translational Research on New Technologies in
Medicine and Surgery (M.C.), University of Pisa, Via Roma 67, 56126 Pisa, Italy;
Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano,
Milan, Italy (M.E.L.); The Shrewsbury and Telford Hospital NHS Trust,
Shrewsbury, England (S.S.); and Italian Society of Medical and Interventional
Radiology, SIRM Foundation, Milan, Italy (E.N.)
| | - Lorenzo Faggioni
- From Academic Radiology, Department of Translational Research on New
Technologies in Medicine and Surgery (G.D.S., L.T., G.A., S.C.F., M.F., J.E.S.,
L.F., E.N.), Department of Clinical and Experimental Medicine (M.M.), and
Neuroradiology Unit, Department of Translational Research on New Technologies in
Medicine and Surgery (M.C.), University of Pisa, Via Roma 67, 56126 Pisa, Italy;
Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano,
Milan, Italy (M.E.L.); The Shrewsbury and Telford Hospital NHS Trust,
Shrewsbury, England (S.S.); and Italian Society of Medical and Interventional
Radiology, SIRM Foundation, Milan, Italy (E.N.)
| | - Mirco Cosottini
- From Academic Radiology, Department of Translational Research on New
Technologies in Medicine and Surgery (G.D.S., L.T., G.A., S.C.F., M.F., J.E.S.,
L.F., E.N.), Department of Clinical and Experimental Medicine (M.M.), and
Neuroradiology Unit, Department of Translational Research on New Technologies in
Medicine and Surgery (M.C.), University of Pisa, Via Roma 67, 56126 Pisa, Italy;
Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano,
Milan, Italy (M.E.L.); The Shrewsbury and Telford Hospital NHS Trust,
Shrewsbury, England (S.S.); and Italian Society of Medical and Interventional
Radiology, SIRM Foundation, Milan, Italy (E.N.)
| | - Emanuele Neri
- From Academic Radiology, Department of Translational Research on New
Technologies in Medicine and Surgery (G.D.S., L.T., G.A., S.C.F., M.F., J.E.S.,
L.F., E.N.), Department of Clinical and Experimental Medicine (M.M.), and
Neuroradiology Unit, Department of Translational Research on New Technologies in
Medicine and Surgery (M.C.), University of Pisa, Via Roma 67, 56126 Pisa, Italy;
Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano,
Milan, Italy (M.E.L.); The Shrewsbury and Telford Hospital NHS Trust,
Shrewsbury, England (S.S.); and Italian Society of Medical and Interventional
Radiology, SIRM Foundation, Milan, Italy (E.N.)
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6
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Karlberg A, Pedersen LK, Vindstad BE, Skjulsvik AJ, Johansen H, Solheim O, Skogen K, Kvistad KA, Bogsrud TV, Myrmel KS, Giskeødegård GF, Ingebrigtsen T, Berntsen EM, Eikenes L. Diagnostic accuracy of anti-3-[ 18F]-FACBC PET/MRI in gliomas. Eur J Nucl Med Mol Imaging 2024; 51:496-509. [PMID: 37776502 PMCID: PMC10774221 DOI: 10.1007/s00259-023-06437-4] [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: 06/22/2023] [Accepted: 09/06/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE The primary aim was to evaluate whether anti-3-[18F]FACBC PET combined with conventional MRI correlated better with histomolecular diagnosis (reference standard) than MRI alone in glioma diagnostics. The ability of anti-3-[18F]FACBC to differentiate between molecular and histopathological entities in gliomas was also evaluated. METHODS In this prospective study, patients with suspected primary or recurrent gliomas were recruited from two sites in Norway and examined with PET/MRI prior to surgery. Anti-3-[18F]FACBC uptake (TBRpeak) was compared to histomolecular features in 36 patients. PET results were then added to clinical MRI readings (performed by two neuroradiologists, blinded for histomolecular results and PET data) to assess the predicted tumor characteristics with and without PET. RESULTS Histomolecular analyses revealed two CNS WHO grade 1, nine grade 2, eight grade 3, and 17 grade 4 gliomas. All tumors were visible on MRI FLAIR. The sensitivity of contrast-enhanced MRI and anti-3-[18F]FACBC PET was 61% (95%CI [45, 77]) and 72% (95%CI [58, 87]), respectively, in the detection of gliomas. Median TBRpeak was 7.1 (range: 1.4-19.2) for PET positive tumors. All CNS WHO grade 1 pilocytic astrocytomas/gangliogliomas, grade 3 oligodendrogliomas, and grade 4 glioblastomas/astrocytomas were PET positive, while 25% of grade 2-3 astrocytomas and 56% of grade 2-3 oligodendrogliomas were PET positive. Generally, TBRpeak increased with malignancy grade for diffuse gliomas. A significant difference in PET uptake between CNS WHO grade 2 and 4 gliomas (p < 0.001) and between grade 3 and 4 gliomas (p = 0.002) was observed. Diffuse IDH wildtype gliomas had significantly higher TBRpeak compared to IDH1/2 mutated gliomas (p < 0.001). Adding anti-3-[18F]FACBC PET to MRI improved the accuracy of predicted glioma grades, types, and IDH status, and yielded 13.9 and 16.7 percentage point improvement in the overall diagnoses for both readers, respectively. CONCLUSION Anti-3-[18F]FACBC PET demonstrated high uptake in the majority of gliomas, especially in IDH wildtype gliomas, and improved the accuracy of preoperatively predicted glioma diagnoses. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov ID: NCT04111588, URL: https://clinicaltrials.gov/study/NCT04111588.
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Affiliation(s)
- Anna Karlberg
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, N-7030, Trondheim, Norway.
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | - Benedikte Emilie Vindstad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Jarstein Skjulsvik
- Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medical and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håkon Johansen
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, N-7030, Trondheim, Norway
| | - Ole Solheim
- Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karoline Skogen
- Department of Radiology and Nuclear Medicine, Oslo University Hospitals, Oslo, Norway
| | - Kjell Arne Kvistad
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, N-7030, Trondheim, Norway
| | - Trond Velde Bogsrud
- PET-Centre, University Hospital of North Norway, Tromsø, Norway
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | | | - Guro F Giskeødegård
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tor Ingebrigtsen
- Department of Neurosurgery, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Erik Magnus Berntsen
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, N-7030, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Live Eikenes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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7
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Manzarbeitia-Arroba B, Hodolic M, Pichler R, Osipova O, Soriano-Castrejón ÁM, García-Vicente AM. 18F-Fluoroethyl-L Tyrosine Positron Emission Tomography Radiomics in the Differentiation of Treatment-Related Changes from Disease Progression in Patients with Glioblastoma. Cancers (Basel) 2023; 16:195. [PMID: 38201621 PMCID: PMC10778283 DOI: 10.3390/cancers16010195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/10/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
The follow-up of glioma patients after therapeutic intervention remains a challenging topic, as therapy-related changes can emulate true progression in contrast-enhanced magnetic resonance imaging. 18F-fluoroethyl-tyrosine (18F-FET) is a radiopharmaceutical that accumulates in glioma cells due to an increased expression of L-amino acid transporters and, contrary to gadolinium, does not depend on blood-brain barrier disruption to reach tumoral cells. It has demonstrated a high diagnostic value in the differentiation of tumoral viability and pseudoprogression or any other therapy-related changes, especially when combining traditional visual analysis with modern radiomics. In this review, we aim to cover the potential role of 18F-FET positron emission tomography in everyday clinical practice when applied to the follow-up of patients after the first therapeutical intervention, early response evaluation, and the differential diagnosis between therapy-related changes and progression.
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Affiliation(s)
| | - Marina Hodolic
- Nuclear Medicine Department, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic;
| | - Robert Pichler
- Institute of Nuclear Medicine Kepler University Hospital—Neuromed Campus, 4020 Linz, Austria; (R.P.); (O.O.)
| | - Olga Osipova
- Institute of Nuclear Medicine Kepler University Hospital—Neuromed Campus, 4020 Linz, Austria; (R.P.); (O.O.)
| | | | - Ana María García-Vicente
- Nuclear Medicine Department, University Hospital of Toledo, 45007 Toledo, Spain; (B.M.-A.); (Á.M.S.-C.)
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8
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McAfee D, Moyer M, Queen J, Mortazavi A, Boddeti U, Bachani M, Zaghloul K, Ksendzovsky A. Differential metabolic alterations in IDH1 mutant vs. wildtype glioma cells promote epileptogenesis through distinctive mechanisms. Front Cell Neurosci 2023; 17:1288918. [PMID: 38026690 PMCID: PMC10680369 DOI: 10.3389/fncel.2023.1288918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Glioma-related epilepsy (GRE) is a hallmark clinical presentation of gliomas with significant impacts on patient quality of life. The current standard of care for seizure management is comprised of anti-seizure medications (ASMs) and surgical resection. Seizures in glioma patients are often drug-resistant and can often recur after surgery despite total tumor resection. Therefore, current research is focused on the pro-epileptic pathological changes occurring in tumor cells and the peritumoral environment. One important contribution to seizures in GRE patients is metabolic reprogramming in tumor and surrounding cells. This is most evident by the significantly heightened seizure rate in patients with isocitrate dehydrogenase mutated (IDHmut) tumors compared to patients with IDH wildtype (IDHwt) gliomas. To gain further insight into glioma metabolism in epileptogenesis, this review compares the metabolic changes inherent to IDHmut vs. IDHwt tumors and describes the pro-epileptic effects these changes have on both the tumor cells and the peritumoral environment. Understanding alterations in glioma metabolism can help to uncover novel therapeutic interventions for seizure management in GRE patients.
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Affiliation(s)
- Darrian McAfee
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Mitchell Moyer
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jaden Queen
- The College of Arts and Sciences, Cornell University, Ithaca, NY, United States
| | - Armin Mortazavi
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States
| | - Ujwal Boddeti
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Muzna Bachani
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kareem Zaghloul
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, MD, United States
| | - Alexander Ksendzovsky
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
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9
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Kas A, Rozenblum L, Pyatigorskaya N. Clinical Value of Hybrid PET/MR Imaging: Brain Imaging Using PET/MR Imaging. Magn Reson Imaging Clin N Am 2023; 31:591-604. [PMID: 37741643 DOI: 10.1016/j.mric.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Hybrid PET/MR imaging offers a unique opportunity to acquire MR imaging and PET information during a single imaging session. PET/MR imaging has numerous advantages, including enhanced diagnostic accuracy, improved disease characterization, and better treatment planning and monitoring. It enables the immediate integration of anatomic, functional, and metabolic imaging information, allowing for personalized characterization and monitoring of neurologic diseases. This review presents recent advances in PET/MR imaging and highlights advantages in clinical practice for neuro-oncology, epilepsy, and neurodegenerative disorders. PET/MR imaging provides valuable information about brain tumor metabolism, perfusion, and anatomic features, aiding in accurate delineation, treatment response assessment, and prognostication.
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Affiliation(s)
- Aurélie Kas
- Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, APHP Sorbonne Université, Paris, France; Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris F-75006, France.
| | - Laura Rozenblum
- Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, APHP Sorbonne Université, Paris, France; Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris F-75006, France
| | - Nadya Pyatigorskaya
- Neuroradiology Department, Pitié-Salpêtrière Hospital, APHP Sorbonne Université, Paris, France; Sorbonne Université, UMR S 1127, CNRS UMR 722, Institut du Cerveau, Paris, France
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10
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Lohmeier J, Radbruch H, Brenner W, Hamm B, Tietze A, Makowski MR. Predictive IDH Genotyping Based on the Evaluation of Spatial Metabolic Heterogeneity by Compartmental Uptake Characteristics in Preoperative Glioma Using 18F-FET PET. J Nucl Med 2023; 64:1683-1689. [PMID: 37652542 PMCID: PMC10626372 DOI: 10.2967/jnumed.123.265642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/13/2023] [Indexed: 09/02/2023] Open
Abstract
Molecular markers are of increasing importance for classifying, treating, and determining the prognosis for central nervous system tumors. Isocitrate dehydrogenase (IDH) is a critical regulator of glucose and amino acid metabolism. Our objective was to investigate metabolic reprogramming of glioma using compartmental uptake (CU) characteristics in O-(2-18F-fluoroethyl)-l-tyrosine (FET) PET and to evaluate its diagnostic potential for IDH genotyping. Methods: Between 2017 and 2022, patients with confirmed glioma were preoperatively investigated using static 18F-FET PET. Metabolic tumor volume (MTV), MTV for 60%-100% uptake (MTV60), and T2-weighted and contrast-enhancing lesion volumes were automatically segmented using U-Net neural architecture and isocontouring. Volume intersections were determined using the Dice coefficient. Uptake characteristics were determined for metabolically defined compartments (central [80%-100%] and peripheral [60%-75%] areas of 18F-FET uptake). CU ratio was defined as the fraction between the peripheral and central compartments. Mean target-to-background ratio was calculated. Comparisons were performed using parametric and nonparametric tests. Receiver-operating-characteristic curves, regression, and correlation were used for statistical analysis. Results: In total, 52 participants (male, 27, female, 25; mean age ± SD, 51 ± 16 y) were evaluated. MTV60 was greater and distinct from contrast-enhancing lesion volume (P = 0.046). IDH-mutated tumors presented a greater volumetric CU ratio and SUV CU ratio than IDH wild-type tumors (P < 0.05). Volumetric CU ratio determined IDH genotype with excellent diagnostic performance (area under the curve [AUC], 0.88; P < 0.001) at more than 5.49 (sensitivity, 86%, specificity, 90%), because IDH-mutated tumors presented a greater peripheral metabolic compartment than IDH wild-type tumors (P = 0.045). MTV60 and MTV were not suitable for IDH classification (P > 0.05). SUV CU ratio (AUC, 0.72; P = 0.005) and target-to-background ratio (AUC, 0.68; P = 0.016) achieved modest diagnostic performance-inferior to the volumetric CU ratio. Furthermore, the classification of loss of heterozygosity of chromosomes 1p and 19q (AUC, 0.75; P = 0.019), MGMT promoter methylation (AUC, 0.70; P = 0.011), and ATRX loss (AUC, 0.73; P = 0.004) by amino acid PET was evaluated. Conclusion: We proposed parametric 18F-FET PET as a noninvasive metabolic biomarker for the evaluation of CU characteristics, which differentiated IDH genotype with excellent diagnostic performance, establishing a critical association between spatial metabolic heterogeneity, mitochondrial tricarboxylic acid cycle, and genomic features with critical implications for clinical management and the diagnostic workup of patients with central nervous system cancer.
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Affiliation(s)
- Johannes Lohmeier
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany;
| | - Helena Radbruch
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Tietze
- Institute of Neuroradiology, Charité-Universitätsmedizin Berlin, Berlin, Germany; and
| | - Marcus R Makowski
- Department of Radiology, Technical University Munich, Munich, Germany
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11
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Hajri R, Nicod-Lalonde M, Hottinger AF, Prior JO, Dunet V. Prediction of Glioma Grade and IDH Status Using 18F-FET PET/CT Dynamic and Multiparametric Texture Analysis. Diagnostics (Basel) 2023; 13:2604. [PMID: 37568967 PMCID: PMC10417545 DOI: 10.3390/diagnostics13152604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Mutations in isocitrate dehydrogenase (IDH) represent an independent predictor of better survival in patients with gliomas. We aimed to assess grade and IDH mutation status in patients with untreated gliomas, by evaluating the respective value of 18F-FET PET/CT via dynamic and texture analyses. A total of 73 patients (male: 48, median age: 47) who underwent an 18F-FET PET/CT for initial glioma evaluation were retrospectively included. IDH status was available in 61 patients (20 patients with WHO grade 2 gliomas, 41 with grade 3-4 gliomas). Time-activity curve type and 20 parameters obtained from static analysis using LIFEx© v6.30 software were recorded. Respective performance was assessed using receiver operating characteristic curve analysis and stepwise multivariate regression analysis adjusted for patients' age and sex. The time-activity curve type and texture parameters derived from the static parameters showed satisfactory-to-good performance in predicting glioma grade and IDH status. Both time-activity curve type (stepwise OR: 101.6 (95% CI: 5.76-1791), p = 0.002) and NGLDM coarseness (stepwise OR: 2.08 × 1043 (95% CI: 2.76 × 1012-1.57 × 1074), p = 0.006) were independent predictors of glioma grade. No independent predictor of IDH status was found. Dynamic and texture analyses of 18F-FET PET/CT have limited predictive value for IDH status when adjusted for confounding factors. However, they both help predict glioma grade.
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Affiliation(s)
- Rami Hajri
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland;
| | - Marie Nicod-Lalonde
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; (M.N.-L.); (J.O.P.)
| | - Andreas F. Hottinger
- Department of Neurology, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland;
- Lukas Lundin & Family Brain Tumor Research Center, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
| | - John O. Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; (M.N.-L.); (J.O.P.)
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland;
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12
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Dao Trong P, Kilian S, Jesser J, Reuss D, Aras FK, Von Deimling A, Herold-Mende C, Unterberg A, Jungk C. Risk Estimation in Non-Enhancing Glioma: Introducing a Clinical Score. Cancers (Basel) 2023; 15:cancers15092503. [PMID: 37173969 PMCID: PMC10177456 DOI: 10.3390/cancers15092503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
The preoperative grading of non-enhancing glioma (NEG) remains challenging. Herein, we analyzed clinical and magnetic resonance imaging (MRI) features to predict malignancy in NEG according to the 2021 WHO classification and developed a clinical score, facilitating risk estimation. A discovery cohort (2012-2017, n = 72) was analyzed for MRI and clinical features (T2/FLAIR mismatch sign, subventricular zone (SVZ) involvement, tumor volume, growth rate, age, Pignatti score, and symptoms). Despite a "low-grade" appearance on MRI, 81% of patients were classified as WHO grade 3 or 4. Malignancy was then stratified by: (1) WHO grade (WHO grade 2 vs. WHO grade 3 + 4) and (2) molecular criteria (IDHmut WHO grade 2 + 3 vs. IDHwt glioblastoma + IDHmut astrocytoma WHO grade 4). Age, Pignatti score, SVZ involvement, and T2/FLAIR mismatch sign predicted malignancy only when considering molecular criteria, including IDH mutation and CDKN2A/B deletion status. A multivariate regression confirmed age and T2/FLAIR mismatch sign as independent predictors (p = 0.0009; p = 0.011). A "risk estimation in non-enhancing glioma" (RENEG) score was derived and tested in a validation cohort (2018-2019, n = 40), yielding a higher predictive value than the Pignatti score or the T2/FLAIR mismatch sign (AUC of receiver operating characteristics = 0.89). The prevalence of malignant glioma was high in this series of NEGs, supporting an upfront diagnosis and treatment approach. A clinical score with robust test performance was developed that identifies patients at risk for malignancy.
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Affiliation(s)
- Philip Dao Trong
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Samuel Kilian
- Institute of Medical Biometry, Heidelberg University, 69120 Heidelberg, Germany
| | - Jessica Jesser
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - David Reuss
- Division of Neuropathology, Institute of Pathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), CCU Neuropathology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Fuat Kaan Aras
- Division of Neuropathology, Institute of Pathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Andreas Von Deimling
- Division of Neuropathology, Institute of Pathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), CCU Neuropathology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Christel Herold-Mende
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Christine Jungk
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
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13
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Neumaier F, Zlatopolskiy BD, Neumaier B. Mutated Isocitrate Dehydrogenase (mIDH) as Target for PET Imaging in Gliomas. Molecules 2023; 28:molecules28072890. [PMID: 37049661 PMCID: PMC10096429 DOI: 10.3390/molecules28072890] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Gliomas are the most common primary brain tumors in adults. A diffuse infiltrative growth pattern and high resistance to therapy make them largely incurable, but there are significant differences in the prognosis of patients with different subtypes of glioma. Mutations in isocitrate dehydrogenase (IDH) have been recognized as an important biomarker for glioma classification and a potential therapeutic target. However, current clinical methods for detecting mutated IDH (mIDH) require invasive tissue sampling and cannot be used for follow-up examinations or longitudinal studies. PET imaging could be a promising approach for non-invasive assessment of the IDH status in gliomas, owing to the availability of various mIDH-selective inhibitors as potential leads for the development of PET tracers. In the present review, we summarize the rationale for the development of mIDH-selective PET probes, describe their potential applications beyond the assessment of the IDH status and highlight potential challenges that may complicate tracer development. In addition, we compile the major chemical classes of mIDH-selective inhibitors that have been described to date and briefly consider possible strategies for radiolabeling of the most promising candidates. Where available, we also summarize previous studies with radiolabeled analogs of mIDH inhibitors and assess their suitability for PET imaging in gliomas.
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Affiliation(s)
- Felix Neumaier
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, Nuclear Chemistry (INM-5), Wilhelm-Johnen-Str., 52428 Jülich, Germany
- Institute of Radiochemistry and Experimental Molecular Imaging, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Boris D Zlatopolskiy
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, Nuclear Chemistry (INM-5), Wilhelm-Johnen-Str., 52428 Jülich, Germany
- Institute of Radiochemistry and Experimental Molecular Imaging, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Bernd Neumaier
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, Nuclear Chemistry (INM-5), Wilhelm-Johnen-Str., 52428 Jülich, Germany
- Institute of Radiochemistry and Experimental Molecular Imaging, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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14
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Soni N, Ora M, Jena A, Rana P, Mangla R, Ellika S, Almast J, Puri S, Meyers SP. Amino Acid Tracer PET MRI in Glioma Management: What a Neuroradiologist Needs to Know. AJNR Am J Neuroradiol 2023; 44:236-246. [PMID: 36657945 PMCID: PMC10187808 DOI: 10.3174/ajnr.a7762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/21/2022] [Indexed: 01/21/2023]
Abstract
PET with amino acid tracers provides additional insight beyond MR imaging into the biology of gliomas that can be used for initial diagnosis, delineation of tumor margins, planning of surgical and radiation therapy, assessment of residual tumor, and evaluation of posttreatment response. Hybrid PET MR imaging allows the simultaneous acquisition of various PET and MR imaging parameters in a single investigation with reduced scanning time and improved anatomic localization. This review aimed to provide neuroradiologists with a concise overview of the various amino acid tracers and a practical understanding of the clinical applications of amino acid PET MR imaging in glioma management. Future perspectives in newer advances, novel radiotracers, radiomics, and cost-effectiveness are also outlined.
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Affiliation(s)
- N Soni
- From the University of Rochester Medical Center (N.S., S.E., J.A., S.P., S.M.), Rochester, New York
| | - M Ora
- Sanjay Gandhi Postgraduate Institute of Medical Sciences (M.O.), Lucknow, Uttar Pradesh, India
| | - A Jena
- Indraprastha Apollo Hospital (A.J., P.R.), New Delhi, India
| | - P Rana
- Indraprastha Apollo Hospital (A.J., P.R.), New Delhi, India
| | - R Mangla
- Upstate University Hospital (R.M.), Syracuse, New York
| | - S Ellika
- From the University of Rochester Medical Center (N.S., S.E., J.A., S.P., S.M.), Rochester, New York
| | - J Almast
- From the University of Rochester Medical Center (N.S., S.E., J.A., S.P., S.M.), Rochester, New York
| | - S Puri
- From the University of Rochester Medical Center (N.S., S.E., J.A., S.P., S.M.), Rochester, New York
| | - S P Meyers
- From the University of Rochester Medical Center (N.S., S.E., J.A., S.P., S.M.), Rochester, New York
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15
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Predicting gene mutation status via artificial intelligence technologies based on multimodal integration (MMI) to advance precision oncology. Semin Cancer Biol 2023; 91:1-15. [PMID: 36801447 DOI: 10.1016/j.semcancer.2023.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/30/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023]
Abstract
Personalized treatment strategies for cancer frequently rely on the detection of genetic alterations which are determined by molecular biology assays. Historically, these processes typically required single-gene sequencing, next-generation sequencing, or visual inspection of histopathology slides by experienced pathologists in a clinical context. In the past decade, advances in artificial intelligence (AI) technologies have demonstrated remarkable potential in assisting physicians with accurate diagnosis of oncology image-recognition tasks. Meanwhile, AI techniques make it possible to integrate multimodal data such as radiology, histology, and genomics, providing critical guidance for the stratification of patients in the context of precision therapy. Given that the mutation detection is unaffordable and time-consuming for a considerable number of patients, predicting gene mutations based on routine clinical radiological scans or whole-slide images of tissue with AI-based methods has become a hot issue in actual clinical practice. In this review, we synthesized the general framework of multimodal integration (MMI) for molecular intelligent diagnostics beyond standard techniques. Then we summarized the emerging applications of AI in the prediction of mutational and molecular profiles of common cancers (lung, brain, breast, and other tumor types) pertaining to radiology and histology imaging. Furthermore, we concluded that there truly exist multiple challenges of AI techniques in the way of its real-world application in the medical field, including data curation, feature fusion, model interpretability, and practice regulations. Despite these challenges, we still prospect the clinical implementation of AI as a highly potential decision-support tool to aid oncologists in future cancer treatment management.
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Papp L, Rasul S, Spielvogel CP, Krajnc D, Poetsch N, Woehrer A, Patronas EM, Ecsedi B, Furtner J, Mitterhauser M, Rausch I, Widhalm G, Beyer T, Hacker M, Traub-Weidinger T. Sex-specific radiomic features of L-[S-methyl- 11C] methionine PET in patients with newly-diagnosed gliomas in relation to IDH1 predictability. Front Oncol 2023; 13:986788. [PMID: 36816966 PMCID: PMC9936222 DOI: 10.3389/fonc.2023.986788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Amino-acid positron emission tomography (PET) is a validated metabolic imaging approach for the diagnostic work-up of gliomas. This study aimed to evaluate sex-specific radiomic characteristics of L-[S-methyl-11Cmethionine (MET)-PET images of glioma patients in consideration of the prognostically relevant biomarker isocitrate dehydrogenase (IDH) mutation status. Methods MET-PET of 35 astrocytic gliomas (13 females, mean age 41 ± 13 yrs. and 22 males, mean age 46 ± 17 yrs.) and known IDH mutation status were included. All patients underwent radiomic analysis following imaging biomarker standardization initiative (IBSI)-conform guidelines both from standardized uptake value (SUV) and tumor-to-background ratio (TBR) PET values. Aligned Monte Carlo (MC) 100-fold split was utilized for SUV and TBR dataset pairs for both sex and IDH-specific analysis. Borderline and outlier scores were calculated for both sex and IDH-specific MC folds. Feature ranking was performed by R-squared ranking and Mann-Whitney U-test together with Bonferroni correction. Correlation of SUV and TBR radiomics in relation to IDH mutational status in male and female patients were also investigated. Results There were no significant features in either SUV or TBR radiomics to distinguish female and male patients. In contrast, intensity histogram coefficient of variation (ih.cov) and intensity skewness (stat.skew) were identified as significant to predict IDH +/-. In addition, IDH+ females had significant ih.cov deviation (0.031) and mean stat.skew (-0.327) differences compared to IDH+ male patients (0.068 and -0.123, respectively) with two-times higher standard deviations of the normal brain background MET uptake as well. Discussion We demonstrated that female and male glioma patients have significantly different radiomic profiles in MET PET imaging data. Future IDH prediction models shall not be built on mixed female-male cohorts, but shall rely on sex-specific cohorts and radiomic imaging biomarkers.
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Affiliation(s)
- Laszlo Papp
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Sazan Rasul
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Clemens P. Spielvogel
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria,Christian Doppler Laboratory for Applied Metabolomics , Medical University of Vienna, Vienna, Austria
| | - Denis Krajnc
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Nina Poetsch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Adelheid Woehrer
- Clinical Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Eva-Maria Patronas
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria,Division of Pharmaceutical Technology and Biopharmaceutics, Department of Pharmaceutical Sciences, University of Vienna, Vienna, Austria
| | - Boglarka Ecsedi
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Julia Furtner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Markus Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute Applied Diagnostics, Medical University of Vienna, Vienna, Austria
| | - Ivo Rausch
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Clinical University of Neuro-Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Beyer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Tatjana Traub-Weidinger
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria,*Correspondence: Tatjana Traub-Weidinger,
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Zounek AJ, Albert NL, Holzgreve A, Unterrainer M, Brosch-Lenz J, Lindner S, Bollenbacher A, Boening G, Rupprecht R, Brendel M, von Baumgarten L, Tonn JC, Bartenstein P, Ziegler S, Kaiser L. Feasibility of radiomic feature harmonization for pooling of [ 18F]FET or [ 18F]GE-180 PET images of gliomas. Z Med Phys 2023; 33:91-102. [PMID: 36710156 PMCID: PMC10068577 DOI: 10.1016/j.zemedi.2022.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Large datasets are required to ensure reliable non-invasive glioma assessment with radiomics-based machine learning methods. This can often only be achieved by pooling images from different centers. Moreover, trained models should perform with high accuracy when applied to data from different centers. In this study, the impact of reconstruction settings and segmentation methods on radiomic features derived from amino acid and TSPO PET images of glioma patients was examined. Additionally, the ability to model and thus reduce feature differences was investigated. METHODS [18F]FET and [18F]GE-180 PET data were acquired from 19 glioma patients. For each acquisition, 10 reconstruction settings and 9 segmentation methods were included to emulate multicentric data. Statistical robustness measures were calculated before and after ComBat harmonization. Differences between features due to setting variations were assessed using Friedman test, coefficient of variation (CV) and inter-rater reliability measures, including intraclass and Spearman's rank correlation coefficients and Fleiss' Kappa. RESULTS According to Friedman analyses, most features (>60%) showed significant differences. Yet, CV and inter-rater reliability measures indicated higher robustness. ComBat resulted in almost complete harmonization (>87%) according to Friedman test and little to no improvement according to CV and inter-rater reliability measures. [18F]GE-180 features were more sensitive to reconstruction settings than [18F]FET features. CONCLUSIONS According to Friedman test, feature distributions could be successfully aligned using ComBat. However, depending on settings, changes in patient ranks were observed for some features and could not be eliminated by harmonization. Thus, for clinical utilization it is recommended to exclude affected features.
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Affiliation(s)
- Adrian Jun Zounek
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Nathalie Lisa Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Bavarian Cancer Research Center (BZKF), 91054 Erlangen, Germany.
| | - Adrien Holzgreve
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Marcus Unterrainer
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Julia Brosch-Lenz
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Simon Lindner
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Andreas Bollenbacher
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Guido Boening
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany.
| | - Matthias Brendel
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany.
| | - Louisa von Baumgarten
- Bavarian Cancer Research Center (BZKF), 91054 Erlangen, Germany; Department of Neurosurgery, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Joerg-Christian Tonn
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Department of Neurosurgery, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany.
| | - Sibylle Ziegler
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Lena Kaiser
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany.
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Lohmann P, Franceschi E, Vollmuth P, Dhermain F, Weller M, Preusser M, Smits M, Galldiks N. Radiomics in neuro-oncological clinical trials. Lancet Digit Health 2022; 4:e841-e849. [PMID: 36182633 DOI: 10.1016/s2589-7500(22)00144-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 06/16/2023]
Abstract
The development of clinical trials has led to substantial improvements in the prevention and treatment of many diseases, including brain cancer. Advances in medicine, such as improved surgical techniques, the development of new drugs and devices, the use of statistical methods in research, and the development of codes of ethics, have considerably influenced the way clinical trials are conducted today. In addition, methods from the broad field of artificial intelligence, such as radiomics, have the potential to considerably affect clinical trials and clinical practice in the future. Radiomics is a method to extract undiscovered features from routinely acquired imaging data that can neither be captured by means of human perception nor conventional image analysis. In patients with brain cancer, radiomics has shown its potential for the non-invasive identification of prognostic biomarkers, automated response assessment, and differentiation between treatment-related changes from tumour progression. Despite promising results, radiomics is not yet established in routine clinical practice nor in clinical trials. In this Viewpoint, the European Organization for Research and Treatment of Cancer Brain Tumour Group summarises the current status of radiomics, discusses its potential and limitations, envisions its future role in clinical trials in neuro-oncology, and provides guidance on how to address the challenges in radiomics.
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Affiliation(s)
- Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, INM-4), Research Center Juelich (FZJ), Juelich, Germany; Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Brain Tumour Group, European Organization for Research and Treatment of Cancer, Brussels, Belgium.
| | - Enrico Franceschi
- Brain Tumour Group, European Organization for Research and Treatment of Cancer, Brussels, Belgium; IRCCS Istituto Scienze Neurologiche di Bologna, Nervous System Medical Oncology Department, Bologna, Italy
| | - Philipp Vollmuth
- Brain Tumour Group, European Organization for Research and Treatment of Cancer, Brussels, Belgium; Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Frédéric Dhermain
- Brain Tumour Group, European Organization for Research and Treatment of Cancer, Brussels, Belgium; Radiation Oncology Department, Gustave Roussy University Hospital, Cancer Campus Grand Paris, Villejuif, France
| | - Michael Weller
- Brain Tumour Group, European Organization for Research and Treatment of Cancer, Brussels, Belgium; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Matthias Preusser
- Brain Tumour Group, European Organization for Research and Treatment of Cancer, Brussels, Belgium; Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Marion Smits
- Brain Tumour Group, European Organization for Research and Treatment of Cancer, Brussels, Belgium; Department of Radiology and Nuclear Medicine and Brain Tumour Center, Erasmus Medical Center, Rotterdam, Netherlands
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-3, INM-4), Research Center Juelich (FZJ), Juelich, Germany; Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Brain Tumour Group, European Organization for Research and Treatment of Cancer, Brussels, Belgium; Center for Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany
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von Rohr K, Unterrainer M, Holzgreve A, Kirchner MA, Li Z, Unterrainer LM, Suchorska B, Brendel M, Tonn JC, Bartenstein P, Ziegler S, Albert NL, Kaiser L. Can Radiomics Provide Additional Information in [18F]FET-Negative Gliomas? Cancers (Basel) 2022; 14:cancers14194860. [PMID: 36230783 PMCID: PMC9612387 DOI: 10.3390/cancers14194860] [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: 09/08/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Amino acid positron emission tomography (PET) complements standard magnetic resonance imaging (MRI) since it directly visualizes the increased amino acid transport into tumor cells. Amino acid PET using O-(2-[18F]fluoroethyl)-L-tyrosine ([18F]FET) has proven to be relevant, for example, for glioma classification, identification of tumor progression or recurrence, or for the delineation of tumor extent. Nevertheless, a relevant proportion of low-grade gliomas (30%) and few high-grade gliomas (5%) were found to show no or even decreased amino acid uptake by conventional visual analysis of PET images. Advanced image analysis with the extraction of radiomic features is known to provide more detailed information on tumor characteristics than conventional analyses. Hence, this study aimed to investigate whether radiomic features derived from dynamic [18F]FET PET data differ between [18F]FET-negative glioma and healthy background and thus provide information that cannot be extracted by visual read. Abstract The purpose of this study was to evaluate the possibility of extracting relevant information from radiomic features even in apparently [18F]FET-negative gliomas. A total of 46 patients with a newly diagnosed, histologically verified glioma that was visually classified as [18F]FET-negative were included. Tumor volumes were defined using routine T2/FLAIR MRI data and applied to extract information from dynamic [18F]FET PET data, i.e., early and late tumor-to-background (TBR5–15, TBR20–40) and time-to-peak (TTP) images. Radiomic features of healthy background were calculated from the tumor volume of interest mirrored in the contralateral hemisphere. The ability to distinguish tumors from healthy tissue was assessed using the Wilcoxon test and logistic regression. A total of 5, 15, and 69% of features derived from TBR20–40, TBR5–15, and TTP images, respectively, were significantly different. A high number of significantly different TTP features was even found in isometabolic gliomas (after exclusion of photopenic gliomas) with visually normal [18F]FET uptake in static images. However, the differences did not reach satisfactory predictability for machine-learning-based identification of tumor tissue. In conclusion, radiomic features derived from dynamic [18F]FET PET data may extract additional information even in [18F]FET-negative gliomas, which should be investigated in larger cohorts and correlated with histological and outcome features in future studies.
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Affiliation(s)
- Katharina von Rohr
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Marcus Unterrainer
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Adrien Holzgreve
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany
| | | | - Zhicong Li
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Lena M. Unterrainer
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany
| | | | - Matthias Brendel
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, University Hospital, LMU Munich, 81377 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Sibylle Ziegler
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Nathalie L. Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Bavarian Cancer Research Center (BZKF), 91054 Erlangen, Germany
- Correspondence: (N.L.A.); (L.K.)
| | - Lena Kaiser
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany
- Correspondence: (N.L.A.); (L.K.)
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Pre-operative MRI radiomics model non-invasively predicts key genomic markers and survival in glioblastoma patients. J Neurooncol 2022; 160:253-263. [DOI: 10.1007/s11060-022-04150-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
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Two Decades of Brain Tumour Imaging with O-(2-[18F]fluoroethyl)-L-tyrosine PET: The Forschungszentrum Jülich Experience. Cancers (Basel) 2022; 14:cancers14143336. [PMID: 35884396 PMCID: PMC9319157 DOI: 10.3390/cancers14143336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary PET using radiolabelled amino acids has become an essential tool for diagnosing brain tumours in addition to MRI. O-(2-[18F]fluoroethyl)-L-tyrosine (FET) is one of the most successful tracers in the field. We analysed our database of 6534 FET PET examinations regarding the diagnostic needs and preferences of the referring physicians for FET PET in the clinical decision-making process. The demand for FET PET increased considerably in the last decade, especially for differentiating tumour progress from treatment-related changes in gliomas. Accordingly, referring physicians rated the diagnostics of recurrent glioma and recurrent brain metastases as the most relevant indication for FET PET. The analysis and survey results confirm the high relevance of FET PET in the clinical diagnosis of brain tumours and support the need for approval for routine use. Abstract O-(2-[18F]fluoroethyl)-L-tyrosine (FET) is a widely used amino acid tracer for positron emission tomography (PET) imaging of brain tumours. This retrospective study and survey aimed to analyse our extensive database regarding the development of FET PET investigations, indications, and the referring physicians’ rating concerning the role of FET PET in the clinical decision-making process. Between 2006 and 2019, we performed 6534 FET PET scans on 3928 different patients against a backdrop of growing demand for FET PET. In 2019, indications for the use of FET PET were as follows: suspected recurrent glioma (46%), unclear brain lesions (20%), treatment monitoring (19%), and suspected recurrent brain metastasis (13%). The referring physicians were neurosurgeons (60%), neurologists (19%), radiation oncologists (11%), general oncologists (3%), and other physicians (7%). Most patients travelled 50 to 75 km, but 9% travelled more than 200 km. The role of FET PET in decision-making in clinical practice was evaluated by a questionnaire consisting of 30 questions, which was filled out by 23 referring physicians with long experience in FET PET. Fifty to seventy per cent rated FET PET as being important for different aspects of the assessment of newly diagnosed gliomas, including differential diagnosis, delineation of tumour extent for biopsy guidance, and treatment planning such as surgery or radiotherapy, 95% for the diagnosis of recurrent glioma, and 68% for the diagnosis of recurrent brain metastases. Approximately 50% of the referring physicians rated FET PET as necessary for treatment monitoring in patients with glioma or brain metastases. All referring physicians stated that the availability of FET PET is essential and that it should be approved for routine use. Although the present analysis is limited by the fact that only physicians who frequently referred patients for FET PET participated in the survey, the results confirm the high relevance of FET PET in the clinical diagnosis of brain tumours and support the need for its approval for routine use.
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A Survey of Radiomics in Precision Diagnosis and Treatment of Adult Gliomas. J Clin Med 2022; 11:jcm11133802. [PMID: 35807084 PMCID: PMC9267404 DOI: 10.3390/jcm11133802] [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: 06/06/2022] [Revised: 06/18/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023] Open
Abstract
Glioma is the most common primary malignant tumor of the adult central nervous system (CNS), which mostly shows invasive growth. In most cases, surgery is often difficult to completely remove, and the recurrence rate and mortality of patients are high. With the continuous development of molecular genetics and the great progress of molecular biology technology, more and more molecular biomarkers have been proved to have important guiding significance in the individualized diagnosis, treatment, and prognosis evaluation of glioma. With the updates of the World Health Organization (WHO) classification of tumors of the CNS in 2021, the diagnosis and treatment of glioma has entered the era of precision medicine in the true sense. Due to its ability to non-invasively achieve accurate identification of glioma from other intracranial tumors, and to predict the grade, genotyping, treatment response, and prognosis of glioma, which provides a scientific basis for the clinical application of individualized diagnosis and treatment model of glioma, radiomics has become a research hotspot in the field of precision medicine. This paper reviewed the research related to radiomics of adult gliomas published in recent years and summarized the research proceedings of radiomics in differential diagnosis, preoperative grading and genotyping, treatment and efficacy evaluation, and survival prediction of adult gliomas.
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Morland D, Triumbari EKA, Boldrini L, Gatta R, Pizzuto D, Annunziata S. Radiomics in Oncological PET Imaging: A Systematic Review—Part 1, Supradiaphragmatic Cancers. Diagnostics (Basel) 2022; 12:diagnostics12061329. [PMID: 35741138 PMCID: PMC9221970 DOI: 10.3390/diagnostics12061329] [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: 05/04/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 12/10/2022] Open
Abstract
Radiomics is an upcoming field in nuclear oncology, both promising and technically challenging. To summarize the already undertaken work on supradiaphragmatic neoplasia and assess its quality, we performed a literature search in the PubMed database up to 18 February 2022. Inclusion criteria were: studies based on human data; at least one specified tumor type; supradiaphragmatic malignancy; performing radiomics on PET imaging. Exclusion criteria were: studies only based on phantom or animal data; technical articles without a clinically oriented question; fewer than 30 patients in the training cohort. A review database containing PMID, year of publication, cancer type, and quality criteria (number of patients, retrospective or prospective nature, independent validation cohort) was constructed. A total of 220 studies met the inclusion criteria. Among them, 119 (54.1%) studies included more than 100 patients, 21 studies (9.5%) were based on prospectively acquired data, and 91 (41.4%) used an independent validation set. Most studies focused on prognostic and treatment response objectives. Because the textural parameters and methods employed are very different from one article to another, it is complicated to aggregate and compare articles. New contributions and radiomics guidelines tend to help improving quality of the reported studies over the years.
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Affiliation(s)
- David Morland
- Nuclear Medicine Unit, TracerGLab, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (E.K.A.T.); (D.P.); (S.A.)
- Service de Médecine Nucléaire, Institut Godinot, 51100 Reims, France
- Laboratoire de Biophysique, UFR de Médecine, Université de Reims Champagne-Ardenne, 51100 Reims, France
- CReSTIC (Centre de Recherche en Sciences et Technologies de l’Information et de la Communication), EA 3804, Université de Reims Champagne-Ardenne, 51100 Reims, France
- Correspondence:
| | - Elizabeth Katherine Anna Triumbari
- Nuclear Medicine Unit, TracerGLab, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (E.K.A.T.); (D.P.); (S.A.)
| | - Luca Boldrini
- Radiotherapy Unit, Radiomics, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (L.B.); (R.G.)
| | - Roberto Gatta
- Radiotherapy Unit, Radiomics, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (L.B.); (R.G.)
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
- Department of Oncology, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Daniele Pizzuto
- Nuclear Medicine Unit, TracerGLab, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (E.K.A.T.); (D.P.); (S.A.)
| | - Salvatore Annunziata
- Nuclear Medicine Unit, TracerGLab, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (E.K.A.T.); (D.P.); (S.A.)
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Probing individual-level structural atrophy in frontal glioma patients. Neurosurg Rev 2022; 45:2845-2855. [PMID: 35508819 DOI: 10.1007/s10143-022-01800-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
Although every glioma patient varies in tumor size, location, histological grade and molecular biomarkers, non-tumoral morphological abnormalities are commonly detected by a statistical comparison among patient groups, missing the information of individual morphological alterations. In this study, we introduced an individual-level structural abnormality detection method for glioma patients and proposed several abnormality indexes to depict individual atrophy patterns. Forty-five patients with a glioma in the frontal lobe and fifty-one age-matched healthy controls participated in the study. Individual structural abnormality maps (SAM) were generated using patients' preoperative T1 images, by calculating the degree of deviation of voxel volume in each patient with the normative model built from healthy controls. Based on SAM, a series of individual abnormality indexes were computed, and their relationship with glioma characteristics was explored. The results demonstrated that glioma patients showed unique non-tumoral atrophy patterns with overlapping atrophy regions mainly located at hippocampus, parahippocampus, amygdala, insula, middle temporal gyrus and inferior temporal gyrus, which are closely related to the human cognitive functions. The abnormality indexes were associated with several molecular biomarkers including isocitrate dehydrogenase (IDH) mutation, 1p/19q co-deletion and telomerase reverse transcriptase (TERT) promoter mutation. Our study provides an effective way to access the individual-level non-tumoral structural abnormalities in glioma patients, which has the potential to significantly improve individualized precision medicine.
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Afridi M, Jain A, Aboian M, Payabvash S. Brain Tumor Imaging: Applications of Artificial Intelligence. Semin Ultrasound CT MR 2022; 43:153-169. [PMID: 35339256 PMCID: PMC8961005 DOI: 10.1053/j.sult.2022.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Artificial intelligence has become a popular field of research with goals of integrating it into the clinical decision-making process. A growing number of predictive models are being employed utilizing machine learning that includes quantitative, computer-extracted imaging features known as radiomic features, and deep learning systems. This is especially true in brain-tumor imaging where artificial intelligence has been proposed to characterize, differentiate, and prognostication. We reviewed current literature regarding the potential uses of machine learning-based, and deep learning-based artificial intelligence in neuro-oncology as it pertains to brain tumor molecular classification, differentiation, and treatment response. While there is promising evidence supporting the use of artificial intelligence in neuro-oncology, there are still more investigations needed on a larger, multicenter scale along with a streamlined and standardized image processing workflow prior to its introduction in routine clinical decision-making protocol.
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Affiliation(s)
- Muhammad Afridi
- School of Osteopathic Medicine, Rowan University, Stratford, NJ
| | - Abhi Jain
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Mariam Aboian
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT.
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PET Imaging in Neuro-Oncology: An Update and Overview of a Rapidly Growing Area. Cancers (Basel) 2022; 14:cancers14051103. [PMID: 35267411 PMCID: PMC8909369 DOI: 10.3390/cancers14051103] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/08/2022] [Accepted: 02/19/2022] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Positron emission tomography (PET) is a functional imaging technique which plays an increasingly important role in the management of brain tumors. Owing different radiotracers, PET allows to image different metabolic aspects of the brain tumors. This review outlines currently available PET radiotracers and their respective indications in neuro-oncology. It specifically focuses on the investigation of gliomas, meningiomas, primary central nervous system lymphomas as well as brain metastases. Recent advances in the production of PET radiotracers, image analyses and translational applications to peptide radionuclide receptor therapy, which allow to treat brain tumors with radiotracers, are also discussed. The objective of this review is to provide a comprehensive overview of PET imaging’s potential in neuro-oncology as an adjunct to brain magnetic resonance imaging (MRI). Abstract PET plays an increasingly important role in the management of brain tumors. This review outlines currently available PET radiotracers and their respective indications. It specifically focuses on 18F-FDG, amino acid and somatostatin receptor radiotracers, for imaging gliomas, meningiomas, primary central nervous system lymphomas as well as brain metastases. Recent advances in radiopharmaceuticals, image analyses and translational applications to therapy are also discussed. The objective of this review is to provide a comprehensive overview of PET imaging’s potential in neuro-oncology as an adjunct to brain MRI for all medical professionals implicated in brain tumor diagnosis and care.
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The application of radiomics in predicting gene mutations in cancer. Eur Radiol 2022; 32:4014-4024. [DOI: 10.1007/s00330-021-08520-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 12/24/2022]
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Müller M, Winz O, Gutsche R, Leijenaar RTH, Kocher M, Lerche C, Filss CP, Stoffels G, Steidl E, Hattingen E, Steinbach JP, Maurer GD, Heinzel A, Galldiks N, Mottaghy FM, Langen KJ, Lohmann P. Static FET PET radiomics for the differentiation of treatment-related changes from glioma progression. J Neurooncol 2022; 159:519-529. [PMID: 35852737 PMCID: PMC9477932 DOI: 10.1007/s11060-022-04089-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/04/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the potential of radiomics applied to static clinical PET data using the tracer O-(2-[18F]fluoroethyl)-L-tyrosine (FET) to differentiate treatment-related changes (TRC) from tumor progression (TP) in patients with gliomas. PATIENTS AND METHODS One hundred fifty-one (151) patients with histologically confirmed gliomas and post-therapeutic progressive MRI findings according to the response assessment in neuro-oncology criteria underwent a dynamic amino acid PET scan using the tracer O-(2-[18F]fluoroethyl)-L-tyrosine (FET). Thereof, 124 patients were investigated on a stand-alone PET scanner (data used for model development and validation), and 27 patients on a hybrid PET/MRI scanner (data used for model testing). Mean and maximum tumor to brain ratios (TBRmean, TBRmax) were calculated using the PET data from 20 to 40 min after tracer injection. Logistic regression models were evaluated for the FET PET parameters TBRmean, TBRmax, and for radiomics features of the tumor areas as well as combinations thereof to differentiate between TP and TRC. The best performing models in the validation dataset were finally applied to the test dataset. The diagnostic performance was assessed by receiver operating characteristic analysis. RESULTS Thirty-seven patients (25%) were diagnosed with TRC, and 114 (75%) with TP. The logistic regression model comprising the conventional FET PET parameters TBRmean and TBRmax resulted in an AUC of 0.78 in both the validation (sensitivity, 64%; specificity, 80%) and the test dataset (sensitivity, 64%; specificity, 80%). The model combining the conventional FET PET parameters and two radiomics features yielded the best diagnostic performance in the validation dataset (AUC, 0.92; sensitivity, 91%; specificity, 80%) and demonstrated its generalizability in the independent test dataset (AUC, 0.85; sensitivity, 81%; specificity, 70%). CONCLUSION The developed radiomics classifier allows the differentiation between TRC and TP in pretreated gliomas based on routinely acquired static FET PET scans with a high diagnostic accuracy.
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Affiliation(s)
- Marguerite Müller
- Department of Nuclear Medicine and Comprehensive Diagnostic Center Aachen (CDCA), RWTH Aachen University, Aachen, Germany ,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Oliver Winz
- Department of Nuclear Medicine and Comprehensive Diagnostic Center Aachen (CDCA), RWTH Aachen University, Aachen, Germany ,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Robin Gutsche
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich (FZJ), Juelich, Germany ,RWTH Aachen University, Aachen, Germany
| | - Ralph T. H. Leijenaar
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Martin Kocher
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich (FZJ), Juelich, Germany ,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christoph Lerche
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich (FZJ), Juelich, Germany
| | - Christian P. Filss
- Department of Nuclear Medicine and Comprehensive Diagnostic Center Aachen (CDCA), RWTH Aachen University, Aachen, Germany ,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany ,Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich (FZJ), Juelich, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich (FZJ), Juelich, Germany
| | - Eike Steidl
- Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany ,University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany ,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany ,University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany ,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joachim P. Steinbach
- University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany ,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), Heidelberg, Germany ,Dr. Senckenberg Institute of Neurooncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Gabriele D. Maurer
- University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany ,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), Heidelberg, Germany ,Dr. Senckenberg Institute of Neurooncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Alexander Heinzel
- Department of Nuclear Medicine and Comprehensive Diagnostic Center Aachen (CDCA), RWTH Aachen University, Aachen, Germany ,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Norbert Galldiks
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany ,Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich (FZJ), Juelich, Germany ,Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Felix M. Mottaghy
- Department of Nuclear Medicine and Comprehensive Diagnostic Center Aachen (CDCA), RWTH Aachen University, Aachen, Germany ,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany ,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Karl-Josef Langen
- Department of Nuclear Medicine and Comprehensive Diagnostic Center Aachen (CDCA), RWTH Aachen University, Aachen, Germany ,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany ,Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich (FZJ), Juelich, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich (FZJ), Juelich, Germany ,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Seifert R, Kersting D, Rischpler C, Opitz M, Kirchner J, Pabst KM, Mavroeidi IA, Laschinsky C, Grueneisen J, Schaarschmidt B, Catalano OA, Herrmann K, Umutlu L. Clinical Use of PET/MR in Oncology: An Update. Semin Nucl Med 2021; 52:356-364. [PMID: 34980479 DOI: 10.1053/j.semnuclmed.2021.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 12/30/2022]
Abstract
The combination of PET and MRI is one of the recent advances of hybrid imaging. Yet to date, the adoption rate of PET/MRI systems has been rather slow. This seems to be partially caused by the high costs of PET/MRI systems and the need to verify an incremental benefit over PET/CT or sequential PET/CT and MRI. In analogy to PET/CT, the MRI part of PET/MRI was primarily used for anatomical imaging. Though this can be advantageous, for example in diseases where the superior soft tissue contrast of MRI is highly appreciated, the sole use of MRI for anatomical orientation lessens the potential of PET/MRI. Consequently, more recent studies focused on its multiparametric potential and employed diffusion weighted sequences and other functional imaging sequences in PET/MRI. This integration puts the focus on a more wholesome approach to PET/MR imaging, in terms of releasing its full potential for local primary staging based on multiparametric imaging and an included one-stop shop approach for whole-body staging. This approach as well as the implementation of computational analysis, in terms of radiomics analysis, has been shown valuable in several oncological diseases, as will be discussed in this review article.
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Affiliation(s)
- Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; Department of Nuclear Medicine, University Hospital Münster, Münster, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany.
| | - David Kersting
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Marcel Opitz
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Kim M Pabst
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Ilektra-Antonia Mavroeidi
- West German Cancer Center, University Hospital Essen, Essen, Germany.; Clinic for Internal Medicine (Tumor Research), University Hospital Essen, Essen, Germany
| | - Christina Laschinsky
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Johannes Grueneisen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Benedikt Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Onofrio Antonio Catalano
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA; Abdominal Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Zhou W, Huang Q, Wen J, Li M, Zhu Y, Liu Y, Dai Y, Guan Y, Zhou Z, Hua T. Integrated CT Radiomics Features Could Enhance the Efficacy of 18F-FET PET for Non-Invasive Isocitrate Dehydrogenase Genotype Prediction in Adult Untreated Gliomas: A Retrospective Cohort Study. Front Oncol 2021; 11:772703. [PMID: 34869011 PMCID: PMC8640504 DOI: 10.3389/fonc.2021.772703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/01/2021] [Indexed: 01/03/2023] Open
Abstract
Purpose We aimed to investigate the predictive models based on O-[2-(18F)fluoroethyl]-l-tyrosine positron emission tomography/computed tomography (18F-FET PET/CT) radiomics features for the isocitrate dehydrogenase (IDH) genotype identification in adult gliomas. Methods Fifty-eight consecutive pathologically confirmed adult glioma patients with pretreatment 18F-FET PET/CT were retrospectively enrolled. One hundred and five radiomics features were extracted for analysis in each modality. Three independent radiomics models (PET-Rad Model, CT-Rad Model and PET/CT-Rad Model) predicting IDH mutation status were generated using the least absolute shrinkage and selection operator (LASSO) regression analysis based on machine learning algorithms. All-subsets regression and cross validation were applied for the filter and calibration of the predictive radiomics models. Besides, semi-quantitative parameters including maximum, peak and mean tumor to background ratio (TBRmax, TBRpeak, TBRmean), standard deviation of glioma lesion standardized uptake value (SUVSD), metabolic tumor volume (MTV) and total lesion tracer uptake (TLU) were obtained and filtered for the simple model construction with clinical feature of brain midline involvement status. The area under the receiver operating characteristic curve (AUC) was applied for the evaluation of the predictive models. Results The AUC of the simple predictive model consists of semi-quantitative parameter SUVSD and dichotomized brain midline involvement status was 0.786 (95% CI 0.659-0.883). The AUC of PET-Rad Model building with three 18F-FET PET radiomics parameters was 0.812 (95% CI 0.688-0.902). The AUC of CT-Rad Model building with three co-registered CT radiomics parameters was 0.883 (95% CI 0.771-0.952). While the AUC of the combined 18F-FET PET/CT-Rad Model building with three CT and one PET radiomics features was 0.912 (95% CI 0.808-0.970). DeLong test results indicated the PET/CT-Rad Model outperformed the PET-Rad Model (p = 0.048) and simple predictive model (p = 0.034). Further combination of the PET/CT-Rad Model with the clinical feature of dichotomized tumor location status could slightly enhance the AUC to 0.917 (95% CI 0.814-0.973). Conclusion The predictive model combining 18F-FET PET and integrated CT radiomics features could significantly enhance and well balance the non-invasive IDH genotype prediction in untreated gliomas, which is important in clinical decision making for personalized treatment.
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Affiliation(s)
- Weiyan Zhou
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Qi Huang
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianbo Wen
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ming Li
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuhua Zhu
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Liu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.,Jinan Guoke Medical Engineering Technology Development Co., LTD, Jinan, China
| | - Yakang Dai
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.,Jinan Guoke Medical Engineering Technology Development Co., LTD, Jinan, China
| | - Yihui Guan
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhirui Zhou
- Radiation Oncology Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Tao Hua
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
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Machine Learning-Based Radiomics in Neuro-Oncology. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 134:139-151. [PMID: 34862538 DOI: 10.1007/978-3-030-85292-4_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In the last decades, modern medicine has evolved into a data-centered discipline, generating massive amounts of granular high-dimensional data exceeding human comprehension. With improved computational methods, machine learning and artificial intelligence (AI) as tools for data processing and analysis are becoming more and more important. At the forefront of neuro-oncology and AI-research, the field of radiomics has emerged. Non-invasive assessments of quantitative radiological biomarkers mined from complex imaging characteristics across various applications are used to predict survival, discriminate between primary and secondary tumors, as well as between progression and pseudo-progression. In particular, the application of molecular phenotyping, envisioned in the field of radiogenomics, has gained popularity for both primary and secondary brain tumors. Although promising results have been obtained thus far, the lack of workflow standardization and availability of multicenter data remains challenging. The objective of this review is to provide an overview of novel applications of machine learning- and deep learning-based radiomics in primary and secondary brain tumors and their implications for future research in the field.
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Zaragori T, Doyen M, Rech F, Blonski M, Taillandier L, Imbert L, Verger A. Dynamic 18F-FDopa PET Imaging for Newly Diagnosed Gliomas: Is a Semiquantitative Model Sufficient? Front Oncol 2021; 11:735257. [PMID: 34676168 PMCID: PMC8523996 DOI: 10.3389/fonc.2021.735257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose Dynamic amino acid positron emission tomography (PET) has become essential in neuro-oncology, most notably for its prognostic value in the noninvasive prediction of isocitrate dehydrogenase (IDH) mutations in newly diagnosed gliomas. The 6-[18F]fluoro-l-DOPA (18F-FDOPA) kinetic model has an underlying complexity, while previous studies have predominantly used a semiquantitative dynamic analysis. Our study addresses whether a semiquantitative analysis can capture all the relevant information contained in time–activity curves for predicting the presence of IDH mutations compared to the more sophisticated graphical and compartmental models. Methods Thirty-seven tumour time–activity curves from 18F-FDOPA PET dynamic acquisitions of newly diagnosed gliomas (median age = 58.3 years, range = 20.3–79.9 years, 16 women, 16 IDH-wild type) were analyzed with a semiquantitative model based on classical parameters, with (SQ) or without (Ref SQ) a reference region, or on parameters of a fit function (SQ Fit), a graphical Logan model with input function (Logan) or reference region (Ref Logan), and a two-tissue compartmental model previously reported for 18F-FDOPA PET imaging of gliomas (2TCM). The overall predictive performance of each model was assessed with an area under the curve (AUC) comparison using multivariate analysis of all the parameters included in the model. Moreover, each extracted parameter was assessed in a univariate analysis by a receiver operating characteristic curve analysis. Results The SQ model with an AUC of 0.733 for predicting IDH mutations showed comparable performance to the other models with AUCs of 0.752, 0.814, 0.693, 0.786, and 0.863, respectively corresponding to SQ Fit, Ref SQ, Logan, Ref Logan, and 2TCM (p ≥ 0.10 for the pairwise comparisons with other models). In the univariate analysis, the SQ time-to-peak parameter had the best diagnostic performance (75.7% accuracy) compared to all other individual parameters considered. Conclusions The SQ model circumvents the complexities of the 18F-FDOPA kinetic model and yields similar performance in predicting IDH mutations when compared to the other models, most notably the compartmental model. Our study provides supportive evidence for the routine clinical application of the SQ model for the dynamic analysis of 18F-FDOPA PET images in newly diagnosed gliomas.
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Affiliation(s)
- Timothée Zaragori
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Université de Lorraine, Nancy, France.,IADI UMR 1254, INSERM, Université de Lorraine, Nancy, France
| | - Matthieu Doyen
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Université de Lorraine, Nancy, France.,IADI UMR 1254, INSERM, Université de Lorraine, Nancy, France
| | - Fabien Rech
- Department of Neurosurgery, CHRU-Nancy, Université de Lorraine, Nancy, France.,Centre de Recherche en Automatique de Nancy CRAN UMR 7039, CNRS, Université de Lorraine, Nancy, France
| | - Marie Blonski
- Centre de Recherche en Automatique de Nancy CRAN UMR 7039, CNRS, Université de Lorraine, Nancy, France.,Department of Neuro-Oncology, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Luc Taillandier
- Centre de Recherche en Automatique de Nancy CRAN UMR 7039, CNRS, Université de Lorraine, Nancy, France.,Department of Neuro-Oncology, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Laëtitia Imbert
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Université de Lorraine, Nancy, France.,IADI UMR 1254, INSERM, Université de Lorraine, Nancy, France
| | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Université de Lorraine, Nancy, France.,IADI UMR 1254, INSERM, Université de Lorraine, Nancy, France
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Ak M, Toll SA, Hein KZ, Colen RR, Khatua S. Evolving Role and Translation of Radiomics and Radiogenomics in Adult and Pediatric Neuro-Oncology. AJNR Am J Neuroradiol 2021; 43:792-801. [PMID: 34649914 DOI: 10.3174/ajnr.a7297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/19/2021] [Indexed: 12/24/2022]
Abstract
Exponential technologic advancements in imaging, high-performance computing, and artificial intelligence, in addition to increasing access to vast amounts of diverse data, have revolutionized the role of imaging in medicine. Radiomics is defined as a high-throughput feature-extraction method that unlocks microscale quantitative data hidden within standard-of-care medical imaging. Radiogenomics is defined as the linkage between imaging and genomics information. Multiple radiomics and radiogenomics studies performed on conventional and advanced neuro-oncology image modalities show that they have the potential to differentiate pseudoprogression from true progression, classify tumor subgroups, and predict recurrence, survival, and mutation status with high accuracy. In this article, we outline the technical steps involved in radiomics and radiogenomics analyses with the use of artificial intelligence methods and review current applications in adult and pediatric neuro-oncology.
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Affiliation(s)
- M Ak
- From the Department of Radiology (M.A., R.R.C.), University of Pittsburgh, Pittsburgh, Pennsylvania.,Hillman Cancer Center (M.A., R.R.C.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - S A Toll
- Department of Hematology-Oncology (S.A.T.), Children's Hospital of Michigan, Detroit, Michigan
| | - K Z Hein
- Department of Leukemia (K.Z.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - R R Colen
- From the Department of Radiology (M.A., R.R.C.), University of Pittsburgh, Pittsburgh, Pennsylvania.,Hillman Cancer Center (M.A., R.R.C.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - S Khatua
- Department of Pediatric Hematology-Oncology (S.K.), Mayo Clinic, Rochester, Minnesota.
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Ort J, Hamou HA, Kernbach JM, Hakvoort K, Blume C, Lohmann P, Galldiks N, Heiland DH, Mottaghy FM, Clusmann H, Neuloh G, Langen KJ, Delev D. 18F-FET-PET-guided gross total resection improves overall survival in patients with WHO grade III/IV glioma: moving towards a multimodal imaging-guided resection. J Neurooncol 2021; 155:71-80. [PMID: 34599479 PMCID: PMC8545732 DOI: 10.1007/s11060-021-03844-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/08/2021] [Indexed: 11/15/2022]
Abstract
Purpose PET using radiolabeled amino acid [18F]-fluoro-ethyl-L-tyrosine (FET-PET) is a well-established imaging modality for glioma diagnostics. The biological tumor volume (BTV) as depicted by FET-PET often differs in volume and location from tumor volume of contrast enhancement (CE) in MRI. Our aim was to investigate whether a gross total resection of BTVs defined as < 1 cm3 of residual BTV (PET GTR) correlates with better oncological outcome. Methods We retrospectively analyzed imaging and survival data from patients with primary and recurrent WHO grade III or IV gliomas who underwent FET-PET before surgical resection. Tumor overlap between FET-PET and CE was evaluated. Completeness of FET-PET resection (PET GTR) was calculated after superimposition and semi-automated segmentation of pre-operative FET-PET and postoperative MRI imaging. Survival analysis was performed using the Kaplan–Meier method and the log-rank test. Results From 30 included patients, PET GTR was achieved in 20 patients. Patients with PET GTR showed improved median OS with 19.3 compared to 13.7 months for patients with residual FET uptake (p = 0.007; HR 0.3; 95% CI 0.12–0.76). This finding remained as independent prognostic factor after performing multivariate analysis (HR 0.19, 95% CI 0.06–0.62, p = 0.006). Other survival influencing factors such as age, IDH-mutation, MGMT promotor status, and adjuvant treatment modalities were equally distributed between both groups. Conclusion Our results suggest that PET GTR improves the OS in patients with WHO grade III or IV gliomas. A multimodal imaging approach including FET-PET for surgical planning in newly diagnosed and recurrent tumors may improve the oncological outcome in glioma patients. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-021-03844-1.
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Affiliation(s)
- Jonas Ort
- Department of Neurosurgery, Medical Faculty, RWTH Aachen University, 52074, Aachen, Germany. .,NAILA-Neurosurgical Artificial Intelligence Laboratory Aachen, Aachen, Germany. .,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany.
| | - Hussam Aldin Hamou
- Department of Neurosurgery, Medical Faculty, RWTH Aachen University, 52074, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Julius M Kernbach
- Department of Neurosurgery, Medical Faculty, RWTH Aachen University, 52074, Aachen, Germany.,NAILA-Neurosurgical Artificial Intelligence Laboratory Aachen, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Karlijn Hakvoort
- Department of Neurosurgery, Medical Faculty, RWTH Aachen University, 52074, Aachen, Germany.,NAILA-Neurosurgical Artificial Intelligence Laboratory Aachen, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Christian Blume
- Department of Neurosurgery, Medical Faculty, RWTH Aachen University, 52074, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, INM-4), Research Center Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-3, INM-4), Research Center Juelich, Juelich, Germany.,Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Dieter Henrik Heiland
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Freiburg University, Freiburg, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, Medical Faculty, RWTH Aachen University, 52074, Aachen, Germany.,JARA-Juelich Aachen Research Alliance, Juelich, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, Medical Faculty, RWTH Aachen University, 52074, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Georg Neuloh
- Department of Neurosurgery, Medical Faculty, RWTH Aachen University, 52074, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, INM-4), Research Center Juelich, Juelich, Germany.,Department of Nuclear Medicine, Medical Faculty, RWTH Aachen University, 52074, Aachen, Germany.,JARA-Juelich Aachen Research Alliance, Juelich, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Daniel Delev
- Department of Neurosurgery, Medical Faculty, RWTH Aachen University, 52074, Aachen, Germany.,NAILA-Neurosurgical Artificial Intelligence Laboratory Aachen, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
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Laudicella R, Bauckneht M, Cuppari L, Donegani MI, Arnone A, Baldari S, Burger IA, Quartuccio N. Emerging applications of imaging in glioma: focus on PET/MRI and radiomics. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00464-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Li Z, Kaiser L, Holzgreve A, Ruf VC, Suchorska B, Wenter V, Quach S, Herms J, Bartenstein P, Tonn JC, Unterrainer M, Albert NL. Prediction of TERTp-mutation status in IDH-wildtype high-grade gliomas using pre-treatment dynamic [ 18F]FET PET radiomics. Eur J Nucl Med Mol Imaging 2021; 48:4415-4425. [PMID: 34490493 PMCID: PMC8566644 DOI: 10.1007/s00259-021-05526-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/05/2021] [Indexed: 12/22/2022]
Abstract
Purpose To evaluate radiomic features extracted from standard static images (20–40 min p.i.), early summation images (5–15 min p.i.), and dynamic [18F]FET PET images for the prediction of TERTp-mutation status in patients with IDH-wildtype high-grade glioma. Methods A total of 159 patients (median age 60.2 years, range 19–82 years) with newly diagnosed IDH-wildtype diffuse astrocytic glioma (WHO grade III or IV) and dynamic [18F]FET PET prior to surgical intervention were enrolled and divided into a training (n = 112) and a testing cohort (n = 47) randomly. First-order, shape, and texture radiomic features were extracted from standard static (20–40 min summation images; TBR20–40), early static (5–15 min summation images; TBR5–15), and dynamic (time-to-peak; TTP) images, respectively. Recursive feature elimination was used for feature selection by 10-fold cross-validation in the training cohort after normalization, and logistic regression models were generated using the radiomic features extracted from each image to differentiate TERTp-mutation status. The areas under the ROC curve (AUC), accuracy, sensitivity, specificity, and positive and negative predictive value were calculated to illustrate diagnostic power in both the training and testing cohort. Results The TTP model comprised nine selected features and achieved highest predictability of TERTp-mutation with an AUC of 0.82 (95% confidence interval 0.71–0.92) and sensitivity of 92.1% in the independent testing cohort. Weak predictive capability was obtained in the TBR5–15 model, with an AUC of 0.61 (95% CI 0.42–0.80) in the testing cohort, while no predictive power was observed in the TBR20–40 model. Conclusions Radiomics based on TTP images extracted from dynamic [18F]FET PET can predict the TERTp-mutation status of IDH-wildtype diffuse astrocytic high-grade gliomas with high accuracy preoperatively. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05526-6.
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Affiliation(s)
- Zhicong Li
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Lena Kaiser
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Adrien Holzgreve
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Viktoria C Ruf
- Center for Neuropathology and Prion Research, LMU Munich, Munich, Germany
| | - Bogdana Suchorska
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
- Department of Neurosurgery, Sana Hospital, Duisburg, Germany
| | - Vera Wenter
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Stefanie Quach
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Jochen Herms
- Center for Neuropathology and Prion Research, LMU Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcus Unterrainer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Repeatability of image features extracted from FET PET in application to post-surgical glioblastoma assessment. Phys Eng Sci Med 2021; 44:1131-1140. [PMID: 34436751 DOI: 10.1007/s13246-021-01049-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022]
Abstract
Positron emission tomography (PET) imaging using the amino acid tracer O-[2-(18F)fluoroethyl]-L-tyrosine (FET) has gained increased popularity within the past decade in the management of glioblastoma (GBM). Radiomics features extracted from FET PET images may be sensitive to variations when imaging at multiple time points. It is therefore necessary to assess feature robustness to test-retest imaging. Eight patients with histologically confirmed GBM that had undergone post-surgical test-retest FET PET imaging were recruited. In total, 1578 radiomic features were extracted from biological tumour volumes (BTVs) delineated using a semi-automatic contouring method. Feature repeatability was assessed using the intraclass correlation coefficient (ICC). The effect of both bin width and filter choice on feature repeatability was also investigated. 59/106 (55.7%) features from the original image and 843/1472 (57.3%) features from filtered images had an ICC ≥ 0.85. Shape and first order features were most stable. Choice of bin width showed minimal impact on features defined as stable. The Laplacian of Gaussian (LoG, σ = 5 mm) and Wavelet filters (HLL and LHL) significantly improved feature repeatability (p ≪ 0.0001, p = 0.003, p = 0.002, respectively). Correlation of textural features with tumour volume was reported for transparency. FET PET radiomic features extracted from post-surgical images of GBM patients that are robust to test-retest imaging were identified. An investigation with a larger dataset is warranted to validate the findings in this study.
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Ahn SS, Cha S. Pre- and Post-Treatment Imaging of Primary Central Nervous System Tumors in the Molecular and Genetic Era. Korean J Radiol 2021; 22:1858-1874. [PMID: 34402244 PMCID: PMC8546137 DOI: 10.3348/kjr.2020.1450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/15/2022] Open
Abstract
Recent advances in the molecular and genetic characterization of central nervous system (CNS) tumors have ushered in a new era of tumor classification, diagnosis, and prognostic assessment. In this emerging and rapidly evolving molecular genetic era, imaging plays a critical role in the preoperative diagnosis and surgical planning, molecular marker prediction, targeted treatment planning, and post-therapy assessment of CNS tumors. This review provides an overview of the current imaging methods relevant to the molecular genetic classification of CNS tumors. Specifically, we focused on 1) the correlates between imaging features and specific molecular genetic markers and 2) the post-therapy imaging used for therapeutic assessment.
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Affiliation(s)
- Sung Soo Ahn
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea.,Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
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La Greca Saint-Esteven A, Vuong D, Tschanz F, van Timmeren JE, Dal Bello R, Waller V, Pruschy M, Guckenberger M, Tanadini-Lang S. Systematic Review on the Association of Radiomics with Tumor Biological Endpoints. Cancers (Basel) 2021; 13:cancers13123015. [PMID: 34208595 PMCID: PMC8234501 DOI: 10.3390/cancers13123015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 12/23/2022] Open
Abstract
Radiomics supposes an alternative non-invasive tumor characterization tool, which has experienced increased interest with the advent of more powerful computers and more sophisticated machine learning algorithms. Nonetheless, the incorporation of radiomics in cancer clinical-decision support systems still necessitates a thorough analysis of its relationship with tumor biology. Herein, we present a systematic review focusing on the clinical evidence of radiomics as a surrogate method for tumor molecular profile characterization. An extensive literature review was conducted in PubMed, including papers on radiomics and a selected set of clinically relevant and commonly used tumor molecular markers. We summarized our findings based on different cancer entities, additionally evaluating the effect of different modalities for the prediction of biomarkers at each tumor site. Results suggest the existence of an association between the studied biomarkers and radiomics from different modalities and different tumor sites, even though a larger number of multi-center studies are required to further validate the reported outcomes.
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Affiliation(s)
- Agustina La Greca Saint-Esteven
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland; (D.V.); (J.E.v.T.); (R.D.B.); (M.G.); (S.T.-L.)
- Correspondence:
| | - Diem Vuong
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland; (D.V.); (J.E.v.T.); (R.D.B.); (M.G.); (S.T.-L.)
| | - Fabienne Tschanz
- Laboratory of Applied Radiobiology, Department of Radiation Oncology, University of Zurich, 8091 Zurich, Switzerland; (F.T.); (V.W.); (M.P.)
| | - Janita E. van Timmeren
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland; (D.V.); (J.E.v.T.); (R.D.B.); (M.G.); (S.T.-L.)
| | - Riccardo Dal Bello
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland; (D.V.); (J.E.v.T.); (R.D.B.); (M.G.); (S.T.-L.)
| | - Verena Waller
- Laboratory of Applied Radiobiology, Department of Radiation Oncology, University of Zurich, 8091 Zurich, Switzerland; (F.T.); (V.W.); (M.P.)
| | - Martin Pruschy
- Laboratory of Applied Radiobiology, Department of Radiation Oncology, University of Zurich, 8091 Zurich, Switzerland; (F.T.); (V.W.); (M.P.)
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland; (D.V.); (J.E.v.T.); (R.D.B.); (M.G.); (S.T.-L.)
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland; (D.V.); (J.E.v.T.); (R.D.B.); (M.G.); (S.T.-L.)
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Zaragori T, Oster J, Roch V, Hossu G, Chawki MB, Grignon R, Pouget C, Gauchotte G, Rech F, Blonski M, Taillandier L, Imbert L, Verger A. 18F-FDOPA PET for the non-invasive prediction of glioma molecular parameters: a radiomics study. J Nucl Med 2021; 63:147-157. [PMID: 34016731 DOI: 10.2967/jnumed.120.261545] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: The assessment of gliomas by 18F-FDOPA PET imaging in adjunct to MRI showed high performance by combining static and dynamic features to non-invasively predict the isocitrate dehydrogenase (IDH) mutations and the 1p/19q co-deletion, which the World Health Organization classified as significant parameters in 2016. The current study evaluates whether other 18F-FDOPA PET radiomics features further improve performance and the contributions of each of these features to performance. Methods: Our study included seventy-two, retrospectively selected, newly diagnosed, glioma patients with 18F-FDOPA PET dynamic acquisitions. A set of 114 features, including conventional static features and dynamic features as well as other radiomics features were extracted and machine-learning models trained to predict IDH mutations and the 1p/19q co-deletion. Models were based on a machine-learning algorithm built from stable, relevant, and uncorrelated features selected by hierarchical clustering followed by a bootstrapped feature selection process. Models were assessed by comparing area under the curve (AUC) using a nested cross-validation approach. Feature importance was assessed using SHapley Additive exPlanations (SHAP) values. Results: The best models were able to predict IDH mutations (logistic regression with L2 regularization) and the 1p/19q co-deletion (support vector machine with radial basis function kernel) with an AUC of 0.831[0.790;0.873] and 0.724[0.669;0.782] respectively. For the prediction of IDH mutations, dynamic features were the most important features in the model (TTP: 35.5%). In contrast, other radiomics features were the most useful for predicting the 1p/19q co-deletion (up to 14.5% of importance for the small zone low grey level emphasis) . Conclusion: 18F-FDOPA PET is an effective tool for the non-invasive prediction of glioma molecular parameters using a full set of amino-acid PET radiomics features. The contribution of each feature set shows the importance of systematically integrating dynamic acquisition for the prediction of the IDH mutations as well as developing the use of radiomics features in routine practice for the prediction the 1p/19q co-deletion.
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Affiliation(s)
- Timothée Zaragori
- CHRU-Nancy, Department of Nuclear Medicine & Nancyclotep Imaging platform and INSERM, IADI, UMR 1254
| | | | - Veronique Roch
- CHRU-Nancy, Department of Nuclear Medicine & Nancyclotep Imaging platform
| | - Gabriela Hossu
- INSERM, IADI, UMR 1254 and CHRU Nancy, CIC 1433 Innovation Technologique
| | | | - Rachel Grignon
- CHRU-Nancy, Department of Nuclear Medicine & Nancyclotep Imaging platform
| | - Celso Pouget
- CHRU-Nancy, Department of Pathology and INSERM U1256
| | | | - Fabien Rech
- CHRU-Nancy, Department of Neurosurgery and CRAN, CNRS UMR 7039
| | - Marie Blonski
- CHRU-Nancy, Department of Neuro-oncology and CRAN, CNRS UMR 7039
| | - Luc Taillandier
- CHRU-Nancy, Department of Neuro-oncology and CRAN, CNRS UMR 7039
| | - Laëtitia Imbert
- CHRU-Nancy, Department of Nuclear Medicine & Nancyclotep Imaging platform and INSERM, IADI, UMR 1254
| | - Antoine Verger
- CHRU-Nancy, Department of Nuclear Medicine & Nancyclotep Imaging platform and INSERM, IADI, UMR 1254
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Taha B, Boley D, Sun J, Chen CC. State of Radiomics in Glioblastoma. Neurosurgery 2021; 89:177-184. [PMID: 33913492 DOI: 10.1093/neuros/nyab124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 02/13/2021] [Indexed: 12/30/2022] Open
Abstract
Radiomics is an emerging discipline that aims to make intelligent predictions and derive medical insights based on quantitative features extracted from medical images as a means to improve clinical diagnosis or outcome. Pertaining to glioblastoma, radiomics has provided powerful, noninvasive tools for gaining insights into pathogenesis and therapeutic responses. Radiomic studies have yielded meaningful biological understandings of imaging features that are often taken for granted in clinical medicine, including contrast enhancement on glioblastoma magnetic resonance imaging, the distance of a tumor from the subventricular zone, and the extent of mass effect. They have also laid the groundwork for noninvasive detection of mutations and epigenetic events that influence clinical outcomes such as isocitrate dehydrogenase (IDH) and O6-methylguanine-DNA methyltransferase (MGMT). In this article, we review advances in the field of glioblastoma radiomics as they pertain to prediction of IDH mutation status and MGMT promoter methylation status, as well as the development of novel, higher order radiomic parameters.
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Affiliation(s)
- Birra Taha
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel Boley
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ju Sun
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, Minnesota, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
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Unterrainer M, Ruf V, von Rohr K, Suchorska B, Mittlmeier LM, Beyer L, Brendel M, Wenter V, Kunz WG, Bartenstein P, Herms J, Niyazi M, Tonn JC, Albert NL. TERT-Promoter Mutational Status in Glioblastoma - Is There an Association With Amino Acid Uptake on Dynamic 18F-FET PET? Front Oncol 2021; 11:645316. [PMID: 33996563 PMCID: PMC8121001 DOI: 10.3389/fonc.2021.645316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/26/2021] [Indexed: 12/19/2022] Open
Abstract
Objective The mutation of the ‘telomerase reverse transcriptase gene promoter’ (TERTp) has been identified as an important factor for individual prognostication and tumorigenesis and will be implemented in upcoming glioma classifications. Uptake characteristics on dynamic 18F-FET PET have been shown to serve as additional imaging biomarker for prognosis. However, data on the correlation of TERTp-mutational status and amino acid uptake on dynamic 18F-FET PET are missing. Therefore, we aimed to analyze whether static and dynamic 18F-FET PET parameters are associated with the TERTp-mutational status in de-novo IDH-wildtype glioblastoma and whether a TERTp-mutation can be predicted by dynamic 18F-FET PET. Methods Patients with de-novo IDH-wildtype glioblastoma, WHO grade IV, available TERTp-mutational status and dynamic 18F-FET PET scan prior to any therapy were included. Here, established clinical parameters maximal and mean tumor-to-background-ratios (TBRmax/TBRmean), the biological-tumor-volume (BTV) and minimal-time-to-peak (TTPmin) on dynamic PET were analyzed and correlated with the TERTp-mutational status. Results One hundred IDH-wildtype glioblastoma patients were evaluated; 85/100 of the analyzed tumors showed a TERTp-mutation (C228T or C250T), 15/100 were classified as TERTp-wildtype. None of the static PET parameters was associated with the TERTp-mutational status (median TBRmax 3.41 vs. 3.32 (p=0.362), TBRmean 2.09 vs. 2.02 (p=0.349) and BTV 26.1 vs. 22.4 ml (p=0.377)). Also, the dynamic PET parameter TTPmin did not differ in both groups (12.5 vs. 12.5 min, p=0.411). Within the TERTp-mutant subgroups (i.e., C228T (n=23) & C250T (n=62)), the median TBRmax (3.33 vs. 3.69, p=0.095), TBRmean (2.08 vs. 2.09, p=0.352), BTV (25.4 vs. 30.0 ml, p=0.130) and TTPmin (12.5 vs. 12.5 min, p=0.190) were comparable, too. Conclusion Uptake characteristics on dynamic 18F-FET PET are not associated with the TERTp-mutational status in glioblastoma However, as both, dynamic 18F-FET PET parameters as well as the TERTp-mutation status are well-known prognostic biomarkers, future studies should investigate the complementary and independent prognostic value of both factors in order to further stratify patients into risk groups.
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Affiliation(s)
- Marcus Unterrainer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.,Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Viktoria Ruf
- Department of Neuropathology and Prion Research, LMU Munich, Munich, Germany
| | - Katharina von Rohr
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Bogdana Suchorska
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Leonie Beyer
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Brendel
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Vera Wenter
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jochen Herms
- Department of Neuropathology and Prion Research, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Jörg C Tonn
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Nathalie Lisa Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Holzgreve A, Albert NL, Galldiks N, Suchorska B. Use of PET Imaging in Neuro-Oncological Surgery. Cancers (Basel) 2021; 13:cancers13092093. [PMID: 33926002 PMCID: PMC8123649 DOI: 10.3390/cancers13092093] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The use of positron emission tomography (PET) imaging in neuro-oncological surgery is an exciting field with thriving perspectives. Increasing evidence exists for amino acid-based PET to facilitate interpretation of imaging findings following therapeutic interventions in patients with glioma and brain metastases. In meningioma patients, radiolabeled somatostatin receptor ligands provide an improved tumor tissue visualization in lesions located in the vicinity of the skull base and differentiate between scar tissue and tumor recurrence. Moreover, they can be applied as an individual treatment option in recurrent atypical and anaplastic meningioma not eligible for further surgery and radiotherapy. With a focus on its clinical application, this review provides an overview of the emerging field of PET imaging in neuro-oncological surgery. Abstract This review provides an overview of current applications and perspectives of PET imaging in neuro-oncological surgery. The past and future of PET imaging in the management of patients with glioma and brain metastases are elucidated with an emphasis on amino acid tracers, such as O-(2-[18F]fluoroethyl)-L-tyrosine (18F-FET). The thematic scope includes surgical resection planning, prognostication, non-invasive prediction of molecular tumor characteristics, depiction of intratumoral heterogeneity, response assessment, differentiation between tumor progression and treatment-related changes, and emerging new tracers. Furthermore, the role of PET using specific somatostatin receptor ligands for the management of patients with meningioma is discussed. Further advances in neuro-oncological imaging can be expected from promising new techniques, such as hybrid PET/MR scanners and the implementation of artificial intelligence methods, such as radiomics.
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Affiliation(s)
- Adrien Holzgreve
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (A.H.); (N.L.A.)
| | - Nathalie L. Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (A.H.); (N.L.A.)
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
- Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, 52425 Juelich, Germany
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, 50937 Cologne, Germany
| | - Bogdana Suchorska
- Department of Neurosurgery, Sana Kliniken Duisburg, 47055 Duisburg, Germany
- Correspondence: ; Tel.: +49-203-733-2401
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Morimoto M, Kudomi N, Maeda Y, Kobata T, Oishi A, Matsumoto K, Monden T, Iwasaki T, Mitamura K, Norikane T, Yamamoto Y, Nishiyama Y. Effect of quantitative values on shortened acquisition duration in brain tumor 11C-methionine PET/CT. EJNMMI Phys 2021; 8:34. [PMID: 33788057 PMCID: PMC8012475 DOI: 10.1186/s40658-021-00379-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/18/2021] [Indexed: 01/15/2023] Open
Abstract
Background The amount of signal decreases when the acquisition duration is shortened. However, it is not clear how this affects the quantitative values. This study aims to clarify the effect of acquisition time shortening in brain tumor PET/CT using 11C-methionine on the quantitative values. Method This study was a retrospective analysis of 30 patients who underwent clinical 11C-methionine PET/CT examination. PET images were acquired in list mode for 10 min. PET images of acquisition duration from 1 to 10 min with 1-min step were reconstructed. We examined the effect on the quantitative values of acquisition duration. We placed a volume of interest to include the entire tumor and regions of interest in the shape of a large crescent in the contralateral hemisphere in 5 contiguous axial slices as normal tissue. Quantitative values examined were maximum, peak, and mean standardized uptake values (SUVmax, SUVpeak, SUVmean), metabolic tumor volume (MTV), and maximum tumor to normal tissue ratio (TNRmax), with each duration compared to that with 10 min. Results SUVmax, MTV, and TNRmax showed the highest values due to the effects of statistical noise when the acquisition time was 1 min. These values were stable when the acquisition duration was > 6 min. SUVpeak and SUVmean showed mostly consistent values regardless of duration. Conclusions SUVmax, MTV, and TNRmax are affected by acquisition time. If the acquisition duration was > 6 min, the fluctuation could be suppressed within 5% in these quantitative values. However, SUVpeak was suggested to be a robust index regardless of the acquisition duration. Supplementary Information The online version contains supplementary material available at 10.1186/s40658-021-00379-2.
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Affiliation(s)
- Masatoshi Morimoto
- Division of Social and Environmental Medicine, Graduate School of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan. .,Department of Clinical Radiology, Kagawa University Hospital, Kita-gun, Kagawa, 761-0793, Japan.
| | - Nobuyuki Kudomi
- Department of Medical Physics, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, 761-0793, Japan
| | - Yukito Maeda
- Department of Clinical Radiology, Kagawa University Hospital, Kita-gun, Kagawa, 761-0793, Japan
| | - Takuya Kobata
- Department of Clinical Radiology, Kagawa University Hospital, Kita-gun, Kagawa, 761-0793, Japan
| | - Akihiro Oishi
- Department of Clinical Radiology, Kagawa University Hospital, Kita-gun, Kagawa, 761-0793, Japan
| | - Keisuke Matsumoto
- Department of Clinical Radiology, Kagawa University Hospital, Kita-gun, Kagawa, 761-0793, Japan
| | - Toshihide Monden
- Department of Clinical Radiology, Kagawa University Hospital, Kita-gun, Kagawa, 761-0793, Japan
| | - Takanobu Iwasaki
- Faculty of Health and Welfare, Tokushima Bunri University, 1314-1 Shido, Sanuki-city, Kagawa, 769-2193, Japan
| | - Katsuya Mitamura
- Department of Radiology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, 761-0793, Japan
| | - Takashi Norikane
- Department of Radiology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, 761-0793, Japan
| | - Yuka Yamamoto
- Department of Radiology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, 761-0793, Japan
| | - Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, 761-0793, Japan
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Tatekawa H, Hagiwara A, Uetani H, Bahri S, Raymond C, Lai A, Cloughesy TF, Nghiemphu PL, Liau LM, Pope WB, Salamon N, Ellingson BM. Differentiating IDH status in human gliomas using machine learning and multiparametric MR/PET. Cancer Imaging 2021; 21:27. [PMID: 33691798 PMCID: PMC7944911 DOI: 10.1186/s40644-021-00396-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/02/2021] [Indexed: 12/21/2022] Open
Abstract
Background The purpose of this study was to develop a voxel-wise clustering method of multiparametric magnetic resonance imaging (MRI) and 3,4-dihydroxy-6-[18F]-fluoro-L-phenylalanine (FDOPA) positron emission tomography (PET) images using an unsupervised, two-level clustering approach followed by support vector machine in order to classify the isocitrate dehydrogenase (IDH) status of gliomas. Methods Sixty-two treatment-naïve glioma patients who underwent FDOPA PET and MRI were retrospectively included. Contrast enhanced T1-weighted images, T2-weighted images, fluid-attenuated inversion recovery images, apparent diffusion coefficient maps, and relative cerebral blood volume maps, and FDOPA PET images were used for voxel-wise feature extraction. An unsupervised two-level clustering approach, including a self-organizing map followed by the K-means algorithm was used, and each class label was applied to the original images. The logarithmic ratio of labels in each class within tumor regions was applied to a support vector machine to differentiate IDH mutation status. The area under the curve (AUC) of receiver operating characteristic curves, accuracy, and F1-socore were calculated and used as metrics for performance. Results The associations of multiparametric imaging values in each cluster were successfully visualized. Multiparametric images with 16-class clustering revealed the highest classification performance to differentiate IDH status with the AUC, accuracy, and F1-score of 0.81, 0.76, and 0.76, respectively. Conclusions Machine learning using an unsupervised two-level clustering approach followed by a support vector machine classified the IDH mutation status of gliomas, and visualized voxel-wise features from multiparametric MRI and FDOPA PET images. Unsupervised clustered features may improve the understanding of prioritizing multiparametric imaging for classifying IDH status. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-021-00396-5.
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Affiliation(s)
- Hiroyuki Tatekawa
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akifumi Hagiwara
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Uetani
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shadfar Bahri
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Albert Lai
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Phioanh L Nghiemphu
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Linda M Liau
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Whitney B Pope
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Noriko Salamon
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA. .,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA. .,UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
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Le NQK, Hung TNK, Do DT, Lam LHT, Dang LH, Huynh TT. Radiomics-based machine learning model for efficiently classifying transcriptome subtypes in glioblastoma patients from MRI. Comput Biol Med 2021; 132:104320. [PMID: 33735760 DOI: 10.1016/j.compbiomed.2021.104320] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the field of glioma, transcriptome subtypes have been considered as an important diagnostic and prognostic biomarker that may help improve the treatment efficacy. However, existing identification methods of transcriptome subtypes are limited due to the relatively long detection period, the unattainability of tumor specimens via biopsy or surgery, and the fleeting nature of intralesional heterogeneity. In search of a superior model over previous ones, this study evaluated the efficiency of eXtreme Gradient Boosting (XGBoost)-based radiomics model to classify transcriptome subtypes in glioblastoma patients. METHODS This retrospective study retrieved patients from TCGA-GBM and IvyGAP cohorts with pathologically diagnosed glioblastoma, and separated them into different transcriptome subtypes groups. GBM patients were then segmented into three different regions of MRI: enhancement of the tumor core (ET), non-enhancing portion of the tumor core (NET), and peritumoral edema (ED). We subsequently used handcrafted radiomics features (n = 704) from multimodality MRI and two-level feature selection techniques (Spearman correlation and F-score tests) in order to find the features that could be relevant. RESULTS After the feature selection approach, we identified 13 radiomics features that were the most meaningful ones that can be used to reach the optimal results. With these features, our XGBoost model reached the predictive accuracies of 70.9%, 73.3%, 88.4%, and 88.4% for classical, mesenchymal, neural, and proneural subtypes, respectively. Our model performance has been improved in comparison with the other models as well as previous works on the same dataset. CONCLUSION The use of XGBoost and two-level feature selection analysis (Spearman correlation and F-score) could be expected as a potential combination for classifying transcriptome subtypes with high performance and might raise public attention for further research on radiomics-based GBM models.
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Affiliation(s)
- Nguyen Quoc Khanh Le
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, 106, Taiwan; Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, 106, Taiwan; Translational Imaging Research Center, Taipei Medical University Hospital, Taipei, 110, Taiwan.
| | - Truong Nguyen Khanh Hung
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan; Orthopedic and Trauma Department, Cho Ray Hospital, Ho Chi Minh City, 70000, Viet Nam
| | - Duyen Thi Do
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, 106, Taiwan
| | - Luu Ho Thanh Lam
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan; Children's Hospital 2, Ho Chi Minh City, 70000, Viet Nam
| | - Luong Huu Dang
- Department of Otolaryngology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 70000, Viet Nam
| | - Tuan-Tu Huynh
- Department of Electrical Engineering, Yuan Ze University, No. 135, Yuandong Road, Zhongli, 320, Taoyuan, Taiwan; Department of Electrical Electronic and Mechanical Engineering, Lac Hong University, No. 10, Huynh Van Nghe Road, Bien Hoa, Dong Nai, 76120, Viet Nam
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Carles M, Popp I, Starke MM, Mix M, Urbach H, Schimek-Jasch T, Eckert F, Niyazi M, Baltas D, Grosu AL. FET-PET radiomics in recurrent glioblastoma: prognostic value for outcome after re-irradiation? Radiat Oncol 2021; 16:46. [PMID: 33658069 PMCID: PMC7931514 DOI: 10.1186/s13014-020-01744-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/29/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose The value of O-(2-[18F]fluoroethyl)-L-tyrosine (FET)-positron emission tomography (PET)-radiomics in the outcome assessment of patients with recurrent glioblastoma (rGBM) has not been evaluated until now.
The aim of this study was to evaluate whether a prognostic model based on FET-PET radiomics features (RF) is feasible and can identify rGBM patients that would most benefit from re-irradiation.
Methods We prospectively recruited rGBM patients who underwent FET-PET before re-irradiation (GLIAA-Pilot trial, DRKS00000633). Tumor volume was delineated using a semi-automatic method with a threshold of 1.8 times the standardized-uptake-value of the background. 135 FET-RF (histogram parameters, shape and texture features) were extracted. The analysis involved the characterization of tumor and non-tumor tissue with FET-RF and the evaluation of the prognostic value of FET-RF for time-to-progression (TTP), overall survival (OS) and recurrence location (RL). Results Thirty-two rGBM patients constituted our cohort. FET-RF discriminated significantly between tumor and non-tumor. The texture feature Small-Zone-Low-Gray-Level-Emphasis (SZLGE) showed the best performance for the prediction of TTP (p = 0.001, satisfying Bonferroni-multiple-test significance level). Additionally, two radiomics signatures could predict TTP (TTP-radiomics-signature, p = 0.001) and OS (OS-radiomics-signature, p = 0.038). SZLGE and the TTP-radiomics-signature additionally predicted RL. Specifically, high values for TTP-radiomics-signature and for SZLGE indicated not only earlier progression, but also a RL within the initial FET-PET active volume. Conclusion Our findings suggest that FET-PET radiomics could contribute to the prognostic assessment and selection of rGBM-patients benefiting from re-irradiation. Trial registration DRKS00000633. Registered on 8th of December in 2010. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00000633.
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Affiliation(s)
- Montserrat Carles
- Division of Medical Physics, Department of Radiation Oncology, Medical Center, University of Freiburg, Robert-Koch Str. 3, 79106, Freiburg, Germany. .,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Freiburg, Heidelberg, Germany. .,Biomedical Imaging Research Group (GIBI230-PREBI), Imaging La Fe Node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS), La Fe Health Research Institute, Valencia, Spain.
| | - Ilinca Popp
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Freiburg, Heidelberg, Germany.,Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Maximilian Starke
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Mix
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Freiburg, Heidelberg, Germany.,Department of Nuclear Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tanja Schimek-Jasch
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Franziska Eckert
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Tübingen, Tübingen, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,Cerman Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Munich, Munich, Germany
| | - Dimos Baltas
- Division of Medical Physics, Department of Radiation Oncology, Medical Center, University of Freiburg, Robert-Koch Str. 3, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Freiburg, Heidelberg, Germany
| | - Anca L Grosu
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Freiburg, Heidelberg, Germany.,Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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A Systematic Review of PET Textural Analysis and Radiomics in Cancer. Diagnostics (Basel) 2021; 11:diagnostics11020380. [PMID: 33672285 PMCID: PMC7926413 DOI: 10.3390/diagnostics11020380] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Although many works have supported the utility of PET radiomics, several authors have raised concerns over the robustness and replicability of the results. This study aimed to perform a systematic review on the topic of PET radiomics and the used methodologies. Methods: PubMed was searched up to 15 October 2020. Original research articles based on human data specifying at least one tumor type and PET image were included, excluding those that apply only first-order statistics and those including fewer than 20 patients. Each publication, cancer type, objective and several methodological parameters (number of patients and features, validation approach, among other things) were extracted. Results: A total of 290 studies were included. Lung (28%) and head and neck (24%) were the most studied cancers. The most common objective was prognosis/treatment response (46%), followed by diagnosis/staging (21%), tumor characterization (18%) and technical evaluations (15%). The average number of patients included was 114 (median = 71; range 20–1419), and the average number of high-order features calculated per study was 31 (median = 26, range 1–286). Conclusions: PET radiomics is a promising field, but the number of patients in most publications is insufficient, and very few papers perform in-depth validations. The role of standardization initiatives will be crucial in the upcoming years.
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Overcast WB, Davis KM, Ho CY, Hutchins GD, Green MA, Graner BD, Veronesi MC. Advanced imaging techniques for neuro-oncologic tumor diagnosis, with an emphasis on PET-MRI imaging of malignant brain tumors. Curr Oncol Rep 2021; 23:34. [PMID: 33599882 PMCID: PMC7892735 DOI: 10.1007/s11912-021-01020-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review will explore the latest in advanced imaging techniques, with a focus on the complementary nature of multiparametric, multimodality imaging using magnetic resonance imaging (MRI) and positron emission tomography (PET). RECENT FINDINGS Advanced MRI techniques including perfusion-weighted imaging (PWI), MR spectroscopy (MRS), diffusion-weighted imaging (DWI), and MR chemical exchange saturation transfer (CEST) offer significant advantages over conventional MR imaging when evaluating tumor extent, predicting grade, and assessing treatment response. PET performed in addition to advanced MRI provides complementary information regarding tumor metabolic properties, particularly when performed simultaneously. 18F-fluoroethyltyrosine (FET) PET improves the specificity of tumor diagnosis and evaluation of post-treatment changes. Incorporation of radiogenomics and machine learning methods further improve advanced imaging. The complementary nature of combining advanced imaging techniques across modalities for brain tumor imaging and incorporating technologies such as radiogenomics has the potential to reshape the landscape in neuro-oncology.
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Affiliation(s)
- Wynton B. Overcast
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd. Room 0663, Indianapolis, IN 46202 USA
| | - Korbin M. Davis
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd. Room 0663, Indianapolis, IN 46202 USA
| | - Chang Y. Ho
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Goodman Hall, 355 West 16th Street, Suite 4100, Indianapolis, IN 46202 USA
| | - Gary D. Hutchins
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Research 2 Building (R2), Room E124, 920 W. Walnut Street, Indianapolis, IN 46202-5181 USA
| | - Mark A. Green
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Research 2 Building (R2), Room E124, 920 W. Walnut Street, Indianapolis, IN 46202-5181 USA
| | - Brian D. Graner
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Goodman Hall, 355 West 16th Street, Suite 4100, Indianapolis, IN 46202 USA
| | - Michael C. Veronesi
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Research 2 Building (R2), Room E174, 920 W. Walnut Street, Indianapolis, IN 46202-5181 USA
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Grosse F, Wedel F, Thomale UW, Steffen I, Koch A, Brenner W, Plotkin M, Driever PH. Benefit of Static FET PET in Pretreated Pediatric Brain Tumor Patients with Equivocal Conventional MRI Results. KLINISCHE PADIATRIE 2021; 233:127-134. [PMID: 33598897 DOI: 10.1055/a-1335-4844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND MRI has shortcomings in differentiation between tumor tissue and post-therapeutic changes in pretreated brain tumor patients. PATIENTS We assessed 22 static FET-PET/CT-scans of 17 pediatric patients (median age 12 years, range 2-16 years, ependymoma n=4, medulloblastoma n=4, low-grade glioma n=6, high-grade glioma n=3, germ cell tumor n=1, choroid plexus tumor n=1, median follow-up: 112 months) with multimodal treatment. METHOD FET-PET/CT-scans were analyzed visually by 3 independent nuclear medicine physicians. Additionally quantitative FET-Uptake for each lesion was determined by calculating standardized uptake values (SUVmaxT/SUVmeanB, SUVmeanT/SUVmeanB). Histology or clinical follow-up served as reference. RESULTS Static FET-PET/CT reliably distinguished between tumor tissue and post-therapeutic changes in 16 out of 17 patients. It identified correctly vital tumor tissue in 13 patients and post-therapeutic changes in 3 patients. SUV-based analyses were less sensitive than visual analyses. Except from a choroid plexus carcinoma, all tumor entities showed increased FET-uptake. DISCUSSION Our study comprises a limited number of patients but results corroborate the ability of FET to detect different brain tumor entities in pediatric patients and discriminate between residual/recurrent tumor and post-therapeutic changes. CONCLUSIONS We observed a clear benefit from additional static FET-PET/CT-scans when conventional MRI identified equivocal lesions in pretreated pediatric brain tumor patients. These results warrant prospective studies that should include dynamic scans.
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Affiliation(s)
- Frederik Grosse
- Department of Pediatric Oncology and Hematology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Gastroenterology and Diabetology, Städtisches Klinikum Brandenburg GmbH, Brandenburg an der Havel, Germany
| | - Florian Wedel
- Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich-Wilhelm Thomale
- Department of Neurosurgery, Section of pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Steffen
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Arend Koch
- Institute of Neuropathology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Michail Plotkin
- Institut für Nuklearmedizin, Vivantes-Netzwerk fur Gesundheit GmbH, Berlin, Germany
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology and Hematology, Charité Universitätsmedizin Berlin, Berlin, Germany
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