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Artificial Intelligence Increases the Agreement among Physicians Classifying Focal Skeleton/Bone Marrow Uptake in Hodgkin’s Lymphoma Patients Staged with [18F]FDG PET/CT—a Retrospective Study. Nucl Med Mol Imaging 2022; 57:110-116. [PMID: 36998589 PMCID: PMC10043120 DOI: 10.1007/s13139-022-00765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/23/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022] Open
Abstract
Abstract
Purpose
Classification of focal skeleton/bone marrow uptake (BMU) can be challenging. The aim is to investigate whether an artificial intelligence–based method (AI), which highlights suspicious focal BMU, increases interobserver agreement among a group of physicians from different hospitals classifying Hodgkin’s lymphoma (HL) patients staged with [18F]FDG PET/CT.
Methods
Forty-eight patients staged with [18F]FDG PET/CT at Sahlgenska University Hospital between 2017 and 2018 were reviewed twice, 6 months apart, regarding focal BMU. During the second time review, the 10 physicians also had access to AI-based advice regarding focal BMU.
Results
Each physician’s classifications were pairwise compared with the classifications made by all the other physicians, resulting in 45 unique pairs of comparisons both without and with AI advice. The agreement between the physicians increased significantly when AI advice was available, which was measured as an increase in mean Kappa values from 0.51 (range 0.25–0.80) without AI advice to 0.61 (range 0.19–0.94) with AI advice (p = 0.005). The majority of the physicians agreed with the AI-based method in 40 (83%) of the 48 cases.
Conclusion
An AI-based method significantly increases interobserver agreement among physicians working at different hospitals by highlighting suspicious focal BMU in HL patients staged with [18F]FDG PET/CT.
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Kreissl S, Voltin CA, Kaul H, Bühnen I, Mettler J, Pabst T, Eichenauer DA, Fuchs M, Diehl V, Dietlein M, Engert A, Borchmann P, Kobe C. Impact of bone marrow involvement on early positron emission tomography response and progression-free survival in the HD18 trial for patients with advanced-stage Hodgkin lymphoma. Br J Haematol 2021; 197:e5-e8. [PMID: 34929056 DOI: 10.1111/bjh.17997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Stefanie Kreissl
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Centre for Integrated Oncology Aachen - Bonn - Cologne - Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Conrad-Amadeus Voltin
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Helen Kaul
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Centre for Integrated Oncology Aachen - Bonn - Cologne - Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Bühnen
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Centre for Integrated Oncology Aachen - Bonn - Cologne - Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jasmin Mettler
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thomas Pabst
- Department of Medical Oncology, Bern University Hospital, University of Bern, Bern, Switzerland.,Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Dennis A Eichenauer
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Centre for Integrated Oncology Aachen - Bonn - Cologne - Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Fuchs
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Centre for Integrated Oncology Aachen - Bonn - Cologne - Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Volker Diehl
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Centre for Integrated Oncology Aachen - Bonn - Cologne - Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andreas Engert
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Centre for Integrated Oncology Aachen - Bonn - Cologne - Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Peter Borchmann
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Centre for Integrated Oncology Aachen - Bonn - Cologne - Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Carsten Kobe
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Sadik M, López-Urdaneta J, Ulén J, Enqvist O, Krupic A, Kumar R, Andersson PO, Trägårdh E. Artificial intelligence could alert for focal skeleton/bone marrow uptake in Hodgkin's lymphoma patients staged with FDG-PET/CT. Sci Rep 2021; 11:10382. [PMID: 34001922 PMCID: PMC8128858 DOI: 10.1038/s41598-021-89656-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/23/2021] [Indexed: 11/09/2022] Open
Abstract
To develop an artificial intelligence (AI)-based method for the detection of focal skeleton/bone marrow uptake (BMU) in patients with Hodgkin’s lymphoma (HL) undergoing staging with FDG-PET/CT. The results of the AI in a separate test group were compared to the interpretations of independent physicians. The skeleton and bone marrow were segmented using a convolutional neural network. The training of AI was based on 153 un-treated patients. Bone uptake significantly higher than the mean BMU was marked as abnormal, and an index, based on the total squared abnormal uptake, was computed to identify the focal uptake. Patients with an index above a predefined threshold were interpreted as having focal uptake. As the test group, 48 un-treated patients who had undergone a staging FDG-PET/CT between 2017–2018 with biopsy-proven HL were retrospectively included. Ten physicians classified the 48 cases regarding focal skeleton/BMU. The majority of the physicians agreed with the AI in 39/48 cases (81%) regarding focal skeleton/bone marrow involvement. Inter-observer agreement between the physicians was moderate, Kappa 0.51 (range 0.25–0.80). An AI-based method can be developed to highlight suspicious focal skeleton/BMU in HL patients staged with FDG-PET/CT. Inter-observer agreement regarding focal BMU is moderate among nuclear medicine physicians.
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Affiliation(s)
- May Sadik
- Department of Molecular and Clinical Medicine, Clinical Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, 413 45, Gothenburg, Sweden.
| | - Jesús López-Urdaneta
- Department of Molecular and Clinical Medicine, Clinical Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, 413 45, Gothenburg, Sweden
| | | | - Olof Enqvist
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Armin Krupic
- Department of Molecular and Clinical Medicine, Clinical Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Rajender Kumar
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Elin Trägårdh
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Malmö, Sweden
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Voltin CA, Mettler J, Grosse J, Dietlein M, Baues C, Schmitz C, Borchmann P, Kobe C, Hellwig D. FDG-PET Imaging for Hodgkin and Diffuse Large B-Cell Lymphoma-An Updated Overview. Cancers (Basel) 2020; 12:cancers12030601. [PMID: 32150986 PMCID: PMC7139791 DOI: 10.3390/cancers12030601] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 01/07/2023] Open
Abstract
Since the mid-1990s, 18F-fluorodeoxglucose (FDG)-positron emission tomography (PET) in combination with computed tomography has come to play a prominent role in the management of malignant lymphomas. One of the first PET applications in oncology was the detection of lymphoma manifestations at staging, where it has shown high sensitivity. Nowadays, this imaging modality is also used during treatment to evaluate the individual chemosensitivity and adapt further therapy accordingly. If the end-of-treatment PET is negative, irradiation in advanced-stage Hodgkin lymphoma patients can be safely omitted after highly effective chemotherapy. Thus far, lymphoma response assessment has mainly been performed using visual criteria, such as the Deauville five-point scale, which became the international standard in 2014. However, novel measures such as metabolic tumor volume or total lesion glycolysis have recently been recognized by several working groups and may further increase the diagnostic and prognostic value of FDG-PET in the future.
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Affiliation(s)
- Conrad-Amadeus Voltin
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (M.D.); (C.K.)
- Correspondence: ; Tel.: +49-221-478-7534
| | - Jasmin Mettler
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (M.D.); (C.K.)
| | - Jirka Grosse
- Department of Nuclear Medicine, University Hospital Regensburg, 93053 Regensburg, Germany; (J.G.); (D.H.)
| | - Markus Dietlein
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (M.D.); (C.K.)
| | - Christian Baues
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Christine Schmitz
- Department of Hematology, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany;
| | - Peter Borchmann
- Department of Internal Medicine I, Center for Integrated Oncology Aachen-Bonn-Cologne-Dusseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Carsten Kobe
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (M.D.); (C.K.)
| | - Dirk Hellwig
- Department of Nuclear Medicine, University Hospital Regensburg, 93053 Regensburg, Germany; (J.G.); (D.H.)
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Adams HJA, Kwee TC. Value of detecting bone marrow involvement in Hodgkin lymphoma. Br J Haematol 2019; 187:397-399. [PMID: 31524948 DOI: 10.1111/bjh.16181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Pedersen MA, Gormsen LC, d'Amore F. Value of detecting bone marrow involvement in Hodgkin lymphoma ‐ Response to Adams and Kwee. Br J Haematol 2019; 187:396-397. [DOI: 10.1111/bjh.16180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mette A. Pedersen
- Department of Nuclear Medicine and PET‐Centre Aarhus University Hospital Aarhus N Denmark
| | - Lars C. Gormsen
- Department of Nuclear Medicine and PET‐Centre Aarhus University Hospital Aarhus N Denmark
| | - Francesco d'Amore
- Department of Haematology Aarhus University Hospital Aarhus N Denmark
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