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Yu Y, Wu J, Wu H, Qiu J, Wu S, Hong L, Xu B, Shao L. Prediction of liver metastasis and recommended optimal follow-up nursing in rectal cancer. Nurs Health Sci 2024; 26:e13102. [PMID: 38402869 DOI: 10.1111/nhs.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/16/2024] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
We aimed to analyze and investigate the clinical factors that influence the occurrence of liver metastasis in locally advanced rectal cancer patients, with an attempt to assist patients in devising the optimal imaging-based follow-up nursing. Between June 2011 and May 2021, patients with rectal cancer at our hospital were retrospectively analyzed. A random survival forest model was developed to predict the probability of liver metastasis and provide a practical risk-based approach to surveillance. The results indicated that age, perineural invasion, and tumor deposit were significant factors associated with the liver metastasis and survival. The liver metastasis risk of the low-risk group was higher at 6-21 months, with a peak occurrence time in the 15th month. The liver metastasis risk of the high-risk group was higher at 0-24 months, with a peak occurrence time in the 8th month. In general, our clinical model could predict liver metastasis in rectal cancer patients. It provides a visualization tool that can aid physicians and nurses in making clinical decisions, by detecting the probability of liver metastasis.
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Affiliation(s)
- Yilin Yu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Junxin Wu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Haixia Wu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Jianjian Qiu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Shiji Wu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Liang Hong
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Benhua Xu
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Lingdong Shao
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
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Avella P, Cappuccio M, Cappuccio T, Rotondo M, Fumarulo D, Guerra G, Sciaudone G, Santone A, Cammilleri F, Bianco P, Brunese MC. Artificial Intelligence to Early Predict Liver Metastases in Patients with Colorectal Cancer: Current Status and Future Prospectives. Life (Basel) 2023; 13:2027. [PMID: 37895409 PMCID: PMC10608483 DOI: 10.3390/life13102027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Artificial Intelligence (AI)-based analysis represents an evolving medical field. In the last few decades, several studies have reported the diagnostic efficiency of AI applied to Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) to early detect liver metastases (LM), mainly from colorectal cancer. Despite the increase in information and the development of different procedures in several radiological fields, an accurate method of predicting LM has not yet been found. This review aims to compare the diagnostic efficiency of different AI methods in the literature according to accuracy, sensibility, precision, and recall to identify early LM. METHODS A narrative review of the literature was conducted on PubMed. A total of 336 studies were screened. RESULTS We selected 17 studies from 2012 to 2022. In total, 14,475 patients were included, and more than 95% were affected by colorectal cancer. The most frequently used imaging tool to early detect LM was found to be CT (58%), while MRI was used in three cases. Four different AI analyses were used: deep learning, radiomics, machine learning, and fuzzy systems in seven (41.18%), five (29.41%), four (23.53%), and one (5.88%) cases, respectively. Four studies achieved an accuracy of more than 90% after MRI and CT scan acquisition, while just two reported a recall rate ≥90% (one method using MRI and CT and one CT). CONCLUSIONS Routinely acquired radiological images could be used for AI-based analysis to early detect LM. Simultaneous use of radiomics and machine learning analysis applied to MRI or CT images should be an effective method considering the better results achieved in the clinical scenario.
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Affiliation(s)
- Pasquale Avella
- HPB Surgery Unit, Pineta Grande Hospital, Castel Volturno, 81030 Caserta, Italy;
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
| | - Micaela Cappuccio
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
| | - Teresa Cappuccio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (T.C.); (M.R.); (D.F.); (G.G.); (G.S.); (A.S.); (M.C.B.)
| | - Marco Rotondo
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (T.C.); (M.R.); (D.F.); (G.G.); (G.S.); (A.S.); (M.C.B.)
| | - Daniela Fumarulo
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (T.C.); (M.R.); (D.F.); (G.G.); (G.S.); (A.S.); (M.C.B.)
| | - Germano Guerra
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (T.C.); (M.R.); (D.F.); (G.G.); (G.S.); (A.S.); (M.C.B.)
| | - Guido Sciaudone
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (T.C.); (M.R.); (D.F.); (G.G.); (G.S.); (A.S.); (M.C.B.)
| | - Antonella Santone
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (T.C.); (M.R.); (D.F.); (G.G.); (G.S.); (A.S.); (M.C.B.)
| | | | - Paolo Bianco
- HPB Surgery Unit, Pineta Grande Hospital, Castel Volturno, 81030 Caserta, Italy;
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (T.C.); (M.R.); (D.F.); (G.G.); (G.S.); (A.S.); (M.C.B.)
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Marmorino F, Faggioni L, Rossini D, Gabelloni M, Goddi A, Ferrer L, Conca V, Vargas J, Biagiarelli F, Daniel F, Carullo M, Vetere G, Granetto C, Boccaccio C, Cioni D, Antonuzzo L, Bergamo F, Pietrantonio F, Cremolini C, Neri E. The prognostic value of radiomic features in liver-limited metastatic colorectal cancer patients from the TRIBE2 study. Future Oncol 2023; 19:1601-1611. [PMID: 37577810 DOI: 10.2217/fon-2023-0406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Aims: Evaluating the prognostic role of radiomic features in liver-limited metastatic colorectal cancer treated with first-line therapy at baseline and best response among patients undergoing resection. Patients & methods: Among patients enrolled in TRIBE2 (NCT02339116), the association of clinical and radiomic data, extracted by SOPHiA-DDM™ with progression-free and overall survival (OS) in the overall population and with disease-free survival/postresection OS in those undergoing resection was investigated. Results: Among 98 patients, radiomic parameters improved the prediction accuracy of our model for OS (area under the curve: 0.83; sensitivity: 0.85; specificity: 0.73; accuracy: 0.78), but not progression-free survival. Of 46 resected patients, small-distance high gray-level emphasis was associated with shorter disease-free survival and high gray-level zone emphasis/higher kurtosis with shorter postresection OS. Conclusion: Radiomic features should be implemented as tools of outcome prediction for liver-limited metastatic colorectal cancer.
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Affiliation(s)
- Federica Marmorino
- Unit of Oncology, University Hospital of Pisa, Pisa, Italy & Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Lorenzo Faggioni
- Academic Radiology, Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Daniele Rossini
- Unit of Oncology, University Hospital of Pisa, Pisa, Italy & Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Michela Gabelloni
- Academic Radiology, Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Antonio Goddi
- Academic Radiology, Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Loïc Ferrer
- SOPHiA GENETICS, Multimodal Research team, Cité de la Photonique, 11 avenue de Canteranne, 33600, PESSAC, France
| | - Veronica Conca
- Unit of Oncology, University Hospital of Pisa, Pisa, Italy & Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Jennifer Vargas
- SOPHiA GENETICS, Multimodal Research team, Cité de la Photonique, 11 avenue de Canteranne, 33600, PESSAC, France
| | | | - Francesca Daniel
- Oncology Unit 1, Veneto Institute of Oncology IOV - IRCCS, 35128, Padova, Italy
| | - Martina Carullo
- Unit of Oncology, University Hospital of Pisa, Pisa, Italy & Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Guglielmo Vetere
- Unit of Oncology, University Hospital of Pisa, Pisa, Italy & Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Cristina Granetto
- SC Oncologia AO S. Croce & Carle, University Teaching Hospital, Via A. Carle 25, 12100, Cuneo, Italy
| | - Chiara Boccaccio
- Unit of Oncology, University Hospital of Pisa, Pisa, Italy & Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Dania Cioni
- Academic Radiology, Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Department of Experimental & Clinical Medicine, University of Florence, Viale Pieraccini 6, 50139, Firenze, Italy
| | - Francesca Bergamo
- Oncology Unit 1, Veneto Institute of Oncology IOV - IRCCS, 35128, Padova, Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133, Milano, Italy
| | - Chiara Cremolini
- Unit of Oncology, University Hospital of Pisa, Pisa, Italy & Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Emanuele Neri
- Academic Radiology, Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Roma 67, 56126, Pisa, Italy
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Li ZF, Kang LQ, Liu FH, Zhao M, Guo SY, Lu S, Quan S. Radiomics based on preoperative rectal cancer MRI to predict the metachronous liver metastasis. Abdom Radiol (NY) 2023; 48:833-843. [PMID: 36529807 DOI: 10.1007/s00261-022-03773-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE At present, there are few effective method to predict metachronous liver metastasis (MLM) from rectal cancer. We aim to investigate the efficacy of radiomics based on multiparametric MRI of first diagnosed rectal cancer in predicting MLM from rectal cancer. METHODS From 301 consecutive histopathologically confirmed rectal cancer patients, 130 patients who have no distant metastasis detected at the time of diagnosis were enrolled and divided into MLM group (n = 49) and non-MLM group (n = 81) according to whether liver metastasis be detected later than 6 month after the first diagnosis of rectal cancer within 3 years' follow-up. The 130 patients were divided into a training set (n = 91) and a testing set (n = 39) at a ratio of 7:3 by stratified sampling using SPSS 24.0 software. The DWI model, HD T2WI model, and DWI + HD T2WI model were constructed respectively. The best performing model was selected and combined with the screened clinical features (including non-radiomics MRI features) to construct a fusion model. The testing set was used to evaluate the performance of the models, and the area under the curve (AUC) of receiver operating characteristics (ROC) was calculated for both the training set and the testing set. RESULTS The AUC of the DWI + HD T2WI model in the testing set was higher than that of the DWI or the HD T2 model alone with statistically significance (P < 0.05). The screened clinical features were extramural vascular invasion (EMVI), T and N stages in MRI (mrT, mrN), and the distance from the lower edge of the tumor to the anal verge. The AUC of the fusion model in the testing set was 0.911. Decision curves and nomogram also showed that the fusion model had excellent clinical performance. CONCLUSION The fusion model of primary rectal cancer MRI based radiomics combing clinical features can effectively predict MLM from rectal cancer, which may assist clinicians in formulating individualized monitoring and treatment plans.
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Affiliation(s)
- Zhuo-Fu Li
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, No. 16 Xinhua Western Road, Yunhe District, Cangzhou, 061000, China
| | - Li-Qing Kang
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, No. 16 Xinhua Western Road, Yunhe District, Cangzhou, 061000, China.
| | - Feng-Hai Liu
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, No. 16 Xinhua Western Road, Yunhe District, Cangzhou, 061000, China
| | - Meng Zhao
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, No. 16 Xinhua Western Road, Yunhe District, Cangzhou, 061000, China
| | - Su-Yin Guo
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, No. 16 Xinhua Western Road, Yunhe District, Cangzhou, 061000, China
| | - Shan Lu
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, No. 16 Xinhua Western Road, Yunhe District, Cangzhou, 061000, China
| | - Shuai Quan
- GE HealthCare China (Shanghai), Shanghai, 210000, China
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Keyl J, Hosch R, Berger A, Ester O, Greiner T, Bogner S, Treckmann J, Ting S, Schumacher B, Albers D, Markus P, Wiesweg M, Forsting M, Nensa F, Schuler M, Kasper S, Kleesiek J. Deep learning-based assessment of body composition and liver tumour burden for survival modelling in advanced colorectal cancer. J Cachexia Sarcopenia Muscle 2023; 14:545-552. [PMID: 36544260 PMCID: PMC9891942 DOI: 10.1002/jcsm.13158] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Personalized therapy planning remains a significant challenge in advanced colorectal cancer care, despite extensive research on prognostic and predictive markers. A strong correlation of sarcopenia or overall body composition and survival has been described. Here, we explore whether automated assessment of body composition and liver metastases from standard of care CT images can add to clinical parameters in personalized survival risk prognostication. METHODS We retrospectively analysed clinical imaging data from 85 patients (50.6% female, mean age 58.9 SD 12.2 years) with colorectal cancer and synchronous liver metastases. Pretrained deep learning models were used to assess body composition and liver metastasis geometry from abdominal CT images before the initiation of systemic treatment. Abdominal muscle-to-bone ratio (MBR) was calculated by dividing abdominal muscle volume by abdominal bone volume. MBR was compared with body mass index (BMI), abdominal muscle volume, and abdominal muscle volume divided by height squared. Differences in overall survival based on body composition and liver metastasis parameters were compared using Kaplan-Meier survival curves. Results were correlated with clinical and biomarker data to develop a machine learning model for survival risk prognostication. RESULTS The MBR, unlike abdominal muscle volume or BMI, was significantly associated with overall survival (HR 0.39, 95% CI: 0.19-0.80, P = 0.009). The MBR (P = 0.022), liver metastasis surface area (P = 0.01) and primary tumour sidedness (P = 0.007) were independently associated with overall survival in multivariate analysis. Body composition parameters did not correlate with KRAS mutational status or primary tumour sidedness. A prediction model based on MBR, liver metastasis surface area and primary tumour sidedness achieved a concordance index of 0.69. CONCLUSIONS Automated segmentation enables to extract prognostic parameters from routine imaging data for personalized survival modelling in advanced colorectal cancer patients.
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Affiliation(s)
- Julius Keyl
- Department of Medical Oncology, West German Cancer CenterUniversity Hospital Essen (AöR)EssenGermany
- Institute for Artificial Intelligence in MedicineUniversity Hospital Essen (AöR)EssenGermany
- German Cancer Consortium (DKTK)Partner site University Hospital Essen (AöR)EssenGermany
| | - René Hosch
- Institute for Artificial Intelligence in MedicineUniversity Hospital Essen (AöR)EssenGermany
- Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital Essen (AöR)EssenGermany
| | - Aaron Berger
- Institute for Artificial Intelligence in MedicineUniversity Hospital Essen (AöR)EssenGermany
| | - Oliver Ester
- Institute for Artificial Intelligence in MedicineUniversity Hospital Essen (AöR)EssenGermany
| | | | - Simon Bogner
- Department of Medical Oncology, West German Cancer CenterUniversity Hospital Essen (AöR)EssenGermany
| | - Jürgen Treckmann
- Department of General, Visceral and Transplant Surgery, West German Cancer CenterUniversity Hospital Essen (AöR)EssenGermany
| | - Saskia Ting
- Institute of Pathology EssenWest German Cancer Center, University Hospital Essen (AöR)EssenGermany
| | | | - David Albers
- Department of GastroenterologyElisabeth Hospital EssenEssenGermany
| | - Peter Markus
- Department of General Surgery and TraumatologyElisabeth Hospital EssenEssenGermany
| | - Marcel Wiesweg
- Department of Medical Oncology, West German Cancer CenterUniversity Hospital Essen (AöR)EssenGermany
- Medical FacultyUniversity of Duisburg‐EssenEssenGermany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital Essen (AöR)EssenGermany
| | - Felix Nensa
- Institute for Artificial Intelligence in MedicineUniversity Hospital Essen (AöR)EssenGermany
- Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital Essen (AöR)EssenGermany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer CenterUniversity Hospital Essen (AöR)EssenGermany
- German Cancer Consortium (DKTK)Partner site University Hospital Essen (AöR)EssenGermany
- Medical FacultyUniversity of Duisburg‐EssenEssenGermany
| | - Stefan Kasper
- Department of Medical Oncology, West German Cancer CenterUniversity Hospital Essen (AöR)EssenGermany
- German Cancer Consortium (DKTK)Partner site University Hospital Essen (AöR)EssenGermany
- Medical FacultyUniversity of Duisburg‐EssenEssenGermany
| | - Jens Kleesiek
- Institute for Artificial Intelligence in MedicineUniversity Hospital Essen (AöR)EssenGermany
- Medical FacultyUniversity of Duisburg‐EssenEssenGermany
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Mao Q, Zhou MT, Zhao ZP, Liu N, Yang L, Zhang XM. Role of radiomics in the diagnosis and treatment of gastrointestinal cancer. World J Gastroenterol 2022; 28:6002-6016. [PMID: 36405385 PMCID: PMC9669820 DOI: 10.3748/wjg.v28.i42.6002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/24/2022] [Accepted: 10/27/2022] [Indexed: 11/10/2022] Open
Abstract
Gastrointestinal cancer (GIC) has high morbidity and mortality as one of the main causes of cancer death. Preoperative risk stratification is critical to guide patient management, but traditional imaging studies have difficulty predicting its biological behavior. The emerging field of radiomics allows the conversion of potential pathophysiological information in existing medical images that cannot be visually recognized into high-dimensional quantitative image features. Tumor lesion characterization, therapeutic response evaluation, and survival prediction can be achieved by analyzing the relationships between these features and clinical and genetic data. In recent years, the clinical application of radiomics to GIC has increased dramatically. In this editorial, we describe the latest progress in the application of radiomics to GIC and discuss the value of its potential clinical applications, as well as its limitations and future directions.
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Affiliation(s)
- Qi Mao
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Mao-Ting Zhou
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Zhang-Ping Zhao
- Department of Radiology, Panzhihua Central Hospital, Panzhihua 617000, Sichuan Province, China
| | - Ning Liu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Lin Yang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xiao-Ming Zhang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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Liang M, Ma X, Wang L, Li D, Wang S, Zhang H, Zhao X. Whole-liver enhanced CT radiomics analysis to predict metachronous liver metastases after rectal cancer surgery. Cancer Imaging 2022; 22:50. [PMID: 36089623 PMCID: PMC9465956 DOI: 10.1186/s40644-022-00485-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background To develop a radiomics model based on pretreatment whole-liver portal venous phase (PVP) contrast-enhanced CT (CE-CT) images for predicting metachronous liver metastases (MLM) within 24 months after rectal cancer (RC) surgery. Methods This study retrospectively analyzed 112 RC patients without preoperative liver metastases who underwent rectal surgery between January 2015 and December 2017 at our institution. Volume of interest (VOI) segmentation of the whole-liver was performed on the PVP CE-CT images. All 1316 radiomics features were extracted automatically. The maximum-relevance and minimum-redundancy and least absolute shrinkage and selection operator methods were used for features selection and radiomics signature constructing. Three models based on radiomics features (radiomics model), clinical features (clinical model), and radiomics combined with clinical features (combined model) were built by multivariable logistic regression analysis. Receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of models, and calibration curve and the decision curve analysis were performed to evaluate the clinical application value. Results In total, 52 patients in the MLM group and 60 patients in the non-MLM group were enrolled in this study. The radscore was built using 16 selected features and the corresponding coefficients. Both the radiomics model and the combined model showed higher diagnostic performance than clinical model (AUCs of training set: radiomics model 0.84 (95% CI, 0.76–0.93), clinical model 0.65 (95% CI, 0.55–0.75), combined model 0.85 (95% CI, 0.77–0.94); AUCs of validation set: radiomics model 0.84 (95% CI, 0.70–0.98), clinical model 0.58 (95% CI, 0.40–0.76), combined model 0.85 (95% CI, 0.71–0.99)). The calibration curves showed great consistency between the predicted value and actual event probability. The DCA showed that both the radiomics and combined models could add a net benefit on a large scale. Conclusions The radiomics model based on preoperative whole-liver PVP CE-CT could predict MLM within 24 months after RC surgery. Clinical features could not significantly improve the prediction efficiency of the radiomics model. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00485-z.
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Ye S, Han Y, Pan X, Niu K, Liao Y, Meng X. Association of CT-Based Delta Radiomics Biomarker With Progression-Free Survival in Patients With Colorectal Liver Metastases Undergo Chemotherapy. Front Oncol 2022; 12:843991. [PMID: 35692757 PMCID: PMC9184515 DOI: 10.3389/fonc.2022.843991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
Predicting the prognosis of patients in advance is conducive to providing personalized treatment for patients. Our aim was to predict the therapeutic efficacy and progression free survival (PFS) of patients with liver metastasis of colorectal cancer according to the changes of computed tomography (CT) radiomics before and after chemotherapy. Methods This retrospective study included 139 patients (397 lesions) with colorectal liver metastases who underwent neoadjuvant chemotherapy from April 2015 to April 2020. We divided the lesions into training cohort and testing cohort with a ratio of 7:3. Two - dimensional region of interest (ROI) was obtained by manually delineating the largest layers of each metastasis lesion. The expanded ROI (3 mm and 5 mm) were also included in the study to characterize microenvironment around tumor. For each of the ROI, 1,316 radiomics features were extracted from delineated plain scan, arterial, and venous phase CT images before and after neoadjuvant chemotherapy. Delta radiomics features were constructed by subtracting the radiomics features after treatment from the radiomics features before treatment. Univariate Cox regression and the Least Absolute Shrinkage and Selection Operator (LASSO) Cox regression were applied in the training cohort to select the valuable features. Based on clinical characteristics and radiomics features, 7 Cox proportional-hazards model were constructed to predict the PFS of patients. C-index value and Kaplan Meier (KM) analysis were used to evaluate the efficacy of predicting PFS of these models. Moreover, the prediction performance of one-year PFS was also evaluated by area under the curve (AUC). Results Compared with the PreRad (Radiomics form pre-treatment CT images; C-index [95% confidence interval (CI)] in testing cohort: 0.614(0.552-0.675) and PostRad models (Radiomics form post-treatment CT images; 0.642(0.578-0.707), the delta model has better PFS prediction performance (Delta radiomics; 0.688(0.627-0.749). By incorporating clinical characteristics, CombDeltaRad obtains the best performance in both training cohort [C-index (95% CI): 0.802(0.772-0.832)] and the testing cohort (0.744(0.686-0.803). For 1-year PFS prediction, CombDeltaRad model obtained the best performance with AUC (95% CI) of 0.871(0.828-0.914) and 0.745 (0.651-0.838) in training cohort and testing cohort, respectively. Conclusion CT radiomics features have the potential to predict PFS in patients with colorectal cancer and liver metastasis who undergo neoadjuvant chemotherapy. By combining pre-treatment radiomics features, post-treatment radiomics features, and clinical characteristics better prediction results can be achieved.
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Affiliation(s)
- Shuai Ye
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu Han
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - XiMin Pan
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - KeXin Niu
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - YuTing Liao
- GE Healthcare Pharmaceutical Diagnostics, Guangzhou, China
| | - XiaoChun Meng
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Li Y, Gong J, Shen X, Li M, Zhang H, Feng F, Tong T. Assessment of Primary Colorectal Cancer CT Radiomics to Predict Metachronous Liver Metastasis. Front Oncol 2022; 12:861892. [PMID: 35296011 PMCID: PMC8919043 DOI: 10.3389/fonc.2022.861892] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 12/18/2022] Open
Abstract
ObjectivesTo establish and validate a machine learning-based CT radiomics model to predict metachronous liver metastasis (MLM) in patients with colorectal cancer.MethodsIn total, 323 patients were retrospectively recruited from two independent institutions to develop and evaluate the CT radiomics model. Then, 1288 radiomics features were extracted to decode the imaging phenotypes of colorectal cancer on CT images. The optimal radiomics features were selected using a recursive feature elimination selector configured by a support vector machine. To reduce the bias caused by an unbalanced dataset, the synthetic minority oversampling technique was applied to resample the minority samples in the datasets. Then, both radiomics and clinical features were used to train the multilayer perceptron classifier to develop two classification models. Finally, a score-level fusion model was developed to further improve the model performance.ResultsThe area under the curve (AUC) was 0.78 ± 0.07 for the tumour feature model and 0.79 ± 0.08 for the clinical feature model. The fusion model achieved the best performance, with AUCs of 0.79 ± 0.08 and 0.72 ± 0.07 in the internal and external validation cohorts.ConclusionsRadiomics models based on baseline colorectal contrast-enhanced CT have high potential for MLM prediction. The fusion model combining radiomics and clinical features can provide valuable biomarkers to identify patients with a high risk of colorectal liver metastases.
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Affiliation(s)
- Yue Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing Gong
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xigang Shen
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Menglei Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Huan Zhang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Feng Feng
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, China
- *Correspondence: Feng Feng, ; Tong Tong,
| | - Tong Tong
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- *Correspondence: Feng Feng, ; Tong Tong,
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Rocca A, Brunese MC, Santone A, Avella P, Bianco P, Scacchi A, Scaglione M, Bellifemine F, Danzi R, Varriano G, Vallone G, Calise F, Brunese L. Early Diagnosis of Liver Metastases from Colorectal Cancer through CT Radiomics and Formal Methods: A Pilot Study. J Clin Med 2021; 11:31. [PMID: 35011771 DOI: 10.3390/jcm11010031] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver metastases are a leading cause of cancer-associated deaths in patients affected by colorectal cancer (CRC). The multidisciplinary strategy to treat CRC is more effective when the radiological diagnosis is accurate and early. Despite the evolving technologies in radiological accuracy, the radiological diagnosis of Colorectal Cancer Liver Metastases (CRCLM) is still a key point. The aim of our study was to define a new patient representation different by Artificial Intelligence models, using Formal Methods (FMs), to help clinicians to predict the presence of liver metastasis when still undetectable using the standard protocols. METHODS We retrospectively reviewed from 2013 to 2020 the CT scan of nine patients affected by CRC who would develop liver lesions within 4 months and 8 years. Seven patients developed liver metastases after primary staging before any liver surgery, and two patients were enrolled after R0 liver resection. Twenty-one patients were enrolled as the case control group (CCG). Regions of Interest (ROIs) were identified through manual segmentation on the medical images including only liver parenchyma and eventual benign lesions, avoiding major vessels and biliary ducts. Our predictive model was built based on formally verified radiomic features. RESULTS The precision of our methods is 100%, scheduling patients as positive only if they will be affected by CRCLM, showing a 93.3% overall accuracy. Recall was 77.8%. CONCLUSION FMs can provide an effective early detection of CRCLM before clinical diagnosis only through non-invasive radiomic features even in very heterogeneous and small clinical samples.
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Taghavi M, Staal FCR, Simões R, Hong EK, Lambregts DMJ, van der Heide UA, Beets-Tan RGH, Maas M. CT radiomics models are unable to predict new liver metastasis after successful thermal ablation of colorectal liver metastases. Acta Radiol 2021; 64:5-12. [PMID: 34918955 DOI: 10.1177/02841851211060437] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with colorectal liver metastases (CRLM) who undergo thermal ablation are at risk of developing new CRLM after ablation. Identification of these patients might enable individualized treatment. PURPOSE To investigate whether an existing machine-learning model with radiomics features based on pre-ablation computed tomography (CT) images of patients with colorectal cancer can predict development of new CRLM. MATERIAL AND METHODS In total, 94 patients with CRLM who were treated with thermal ablation were analyzed. Radiomics features were extracted from the healthy liver parenchyma of CT images in the portal venous phase, before thermal ablation. First, a previously developed radiomics model (Original model) was applied to the entire cohort to predict new CRLM after 6 and 24 months of follow-up. Next, new machine-learning models were developed (Radiomics, Clinical, and Combined), based on radiomics features, clinical features, or a combination of both. RESULTS The external validation of the Original model reached an area under the curve (AUC) of 0.57 (95% confidence interval [CI]=0.56-0.58) and 0.52 (95% CI=0.51-0.53) for 6 and 24 months of follow-up. The new predictive radiomics models yielded a higher performance at 6 months compared to 24 months. For the prediction of CRLM at 6 months, the Combined model had slightly better performance (AUC=0.60; 95% CI=0.59-0.61) compared to the Radiomics and Clinical models (AUC=0.55-0.57), while all three models had a low performance for the prediction at 24 months (AUC=0.52-0.53). CONCLUSION Both the Original and newly developed radiomics models were unable to predict new CLRM based on healthy liver parenchyma in patients who will undergo ablation for CRLM.
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Affiliation(s)
- Marjaneh Taghavi
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Femke CR Staal
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rita Simões
- Department of Radiotherapy, Netherland Cancer Institute, Amsterdam, The Netherlands
| | - Eun K Hong
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Doenja MJ Lambregts
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Regina GH Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Starmans MPA, Buisman FE, Renckens M, Willemssen FEJA, van der Voort SR, Groot Koerkamp B, Grünhagen DJ, Niessen WJ, Vermeulen PB, Verhoef C, Visser JJ, Klein S. Distinguishing pure histopathological growth patterns of colorectal liver metastases on CT using deep learning and radiomics: a pilot study. Clin Exp Metastasis 2021; 38:483-494. [PMID: 34533669 PMCID: PMC8510954 DOI: 10.1007/s10585-021-10119-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/23/2021] [Indexed: 02/05/2023]
Abstract
Histopathological growth patterns (HGPs) are independent prognosticators for colorectal liver metastases (CRLM). Currently, HGPs are determined postoperatively. In this study, we evaluated radiomics for preoperative prediction of HGPs on computed tomography (CT), and its robustness to segmentation and acquisition variations. Patients with pure HGPs [i.e. 100% desmoplastic (dHGP) or 100% replacement (rHGP)] and a CT-scan who were surgically treated at the Erasmus MC between 2003-2015 were included retrospectively. Each lesion was segmented by three clinicians and a convolutional neural network (CNN). A prediction model was created using 564 radiomics features and a combination of machine learning approaches by training on the clinician's and testing on the unseen CNN segmentations. The intra-class correlation coefficient (ICC) was used to select features robust to segmentation variations; ComBat was used to harmonize for acquisition variations. Evaluation was performed through a 100 × random-split cross-validation. The study included 93 CRLM in 76 patients (48% dHGP; 52% rHGP). Despite substantial differences between the segmentations of the three clinicians and the CNN, the radiomics model had a mean area under the curve of 0.69. ICC-based feature selection or ComBat yielded no improvement. Concluding, the combination of a CNN for segmentation and radiomics for classification has potential for automatically distinguishing dHGPs from rHGP, and is robust to segmentation and acquisition variations. Pending further optimization, including extension to mixed HGPs, our model may serve as a preoperative addition to postoperative HGP assessment, enabling further exploitation of HGPs as a biomarker.
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Affiliation(s)
- Martijn P A Starmans
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Florian E Buisman
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Michel Renckens
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | | | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Wiro J Niessen
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - Peter B Vermeulen
- Translational Cancer Research Unit, Department of Oncological Research, Oncology Center, GZA Hospitals Campus Sint-Augustinus and University of Antwerp, Antwerp, Belgium
| | - Cornelis Verhoef
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jacob J Visser
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Stefan Klein
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
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Zhang T, Dong X, Zhou Y, Liu M, Hang J, Wu L. Development and validation of a radiomics nomogram to discriminate advanced pancreatic cancer with liver metastases or other metastatic patterns. Cancer Biomark 2021; 32:541-550. [PMID: 34334383 DOI: 10.3233/cbm-210190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with advanced pancreatic cancer (APC) and liver metastases have much poorer prognoses than patients with other metastatic patterns. OBJECTIVE This study aimed to develop and validate a radiomics model to discriminate patients with pancreatic cancer and liver metastases from those with other metastatic patterns. METHODS We evaluated 77 patients who had APC and performed texture analysis on the region of interest. 58 patients and 19 patients were allocated randomly into the training and validation cohorts with almost the same proportion of liver metastases. An independentsamples t-test was used for feature selection in the training cohort. Random forest classifier was used to construct models based on these features and a radiomics signature (RS) was derived. A nomogram was constructed based on RS and CA19-9, and was validated with calibration plot and decision curve. The prognostic value of RS was evaluated by Kaplan-Meier methods. RESULTS The constructed nomogram demonstrated good discrimination in the training (AUC = 0.93) and validation (AUC = 0.81) cohorts. In both cohorts, patients with RS > 0.61 had much poorer overall survival than patients with RS < 0.61. CONCLUSIONS This study presents a radiomics nomogram incorporating RS and CA19-9 to discriminate patients who have APC with liver metastases from patients with other metastatic patterns.
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Affiliation(s)
- Tianliang Zhang
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China.,School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Xiao Dong
- Department of Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Yang Zhou
- Changzhou No. 2 People's Hospital, Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Muhan Liu
- Changzhou No. 2 People's Hospital, Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Junjie Hang
- Changzhou No. 2 People's Hospital, Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Lixia Wu
- Department of Oncology, Shanghai JingAn District ZhaBei Central Hospital, Shanghai, China
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Hou M, Sun JH. Emerging applications of radiomics in rectal cancer: State of the art and future perspectives. World J Gastroenterol 2021; 27:3802-3814. [PMID: 34321845 PMCID: PMC8291019 DOI: 10.3748/wjg.v27.i25.3802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/06/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023] Open
Abstract
Rectal cancer (RC) is the third most commonly diagnosed cancer and has a high risk of mortality, although overall survival rates have improved. Preoperative assessments and predictions, including risk stratification, responses to therapy, long-term clinical outcomes, and gene mutation status, are crucial to guide the optimization of personalized treatment strategies. Radiomics is a novel approach that enables the evaluation of the heterogeneity and biological behavior of tumors by quantitative extraction of features from medical imaging. As these extracted features cannot be captured by visual inspection, the field holds significant promise. Recent studies have proved the rapid development of radiomics and validated its diagnostic and predictive efficacy. Nonetheless, existing radiomics research on RC is highly heterogeneous due to challenges in workflow standardization and limitations of objective cohort conditions. Here, we present a summary of existing research based on computed tomography and magnetic resonance imaging. We highlight the most salient issues in the field of radiomics and analyze the most urgent problems that require resolution. Our review provides a cutting-edge view of the use of radiomics to detect and evaluate RC, and will benefit researchers dedicated to using this state-of-the-art technology in the era of precision medicine.
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Affiliation(s)
- Min Hou
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Ji-Hong Sun
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
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15
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Taghavi M, Trebeschi S, Simões R, Meek DB, Beckers RCJ, Lambregts DMJ, Verhoef C, Houwers JB, van der Heide UA, Beets-Tan RGH, Maas M. Machine learning-based analysis of CT radiomics model for prediction of colorectal metachronous liver metastases. Abdom Radiol (NY) 2021; 46:249-256. [PMID: 32583138 DOI: 10.1007/s00261-020-02624-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Early identification of patients at risk of developing colorectal liver metastases can help personalizing treatment and improve oncological outcome. The aim of this study was to investigate in patients with colorectal cancer (CRC) whether a machine learning-based radiomics model can predict the occurrence of metachronous metastases. METHODS In this multicentre study, the primary staging portal venous phase CT of 91 CRC patients were retrospectively analysed. Two groups were assessed: patients without liver metastases at primary staging, or during follow-up of ≥ 24 months (n = 67) and patients without liver metastases at primary staging but developed metachronous liver metastases < 24 months after primary staging (n = 24). After liver parenchyma segmentation, 1767 radiomics features were extracted for each patient. Three predictive models were constructed based on (1) radiomics features, (2) clinical features and (3) a combination of clinical and radiomics features. Stability of features across hospitals was assessed by the Kruskal-Wallis test and inter-correlated features were removed if their correlation coefficient was higher than 0.9. Bayesian-optimized random forest with wrapper feature selection was used for prediction models. RESULTS The three predictive models that included radiomics features, clinical features and a combination of radiomics with clinical features resulted in an AUC in the validation cohort of 86% (95%CI 85-87%), 71% (95%CI 69-72%) and 86% (95% CI 85-87%), respectively. CONCLUSION A machine learning-based radiomics analysis of routine clinical CT imaging at primary staging can provide valuable biomarkers to identify patients at high risk for developing colorectal liver metastases.
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Staal FCR, van der Reijd DJ, Taghavi M, Lambregts DMJ, Beets-Tan RGH, Maas M. Radiomics for the Prediction of Treatment Outcome and Survival in Patients With Colorectal Cancer: A Systematic Review. Clin Colorectal Cancer 2020; 20:52-71. [PMID: 33349519 DOI: 10.1016/j.clcc.2020.11.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 09/03/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Prediction of outcome in patients with colorectal cancer (CRC) is challenging as a result of lack of a robust biomarker and heterogeneity between and within tumors. The aim of this review was to assess the current possibilities and limitations of radiomics (on computed tomography [CT], magnetic resonance imaging [MRI], and positron emission tomography [PET]) for the prediction of treatment outcome and long-term outcome in CRC. Medline/PubMed was searched up to August 2020 for studies that used radiomics for the prediction of response to treatment and survival in patients with CRC (based on pretreatment imaging). The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool and Radiomics Quality Score (RQS) were used for quality assessment. A total of 76 studies met the inclusion criteria and were included for further analysis. Radiomics analyses were performed on MRI in 41 studies, on CT in 30 studies, and on 18F-FDG-PET/CT in 10 studies. Heterogeneous results were reported regarding radiomics methods and included features. High-quality studies (n = 13), consisting mainly of MRI-based radiomics to predict response in rectal cancer, were able to predict response with good performance. Radiomics literature in CRC is highly heterogeneous, but it nonetheless holds promise for the prediction of outcome. The most evidence is available for MRI-based radiomics in rectal cancer. Future radiomics research in CRC should focus on independent validation of existing models rather than on developing new models.
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Affiliation(s)
- Femke C R Staal
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Denise J van der Reijd
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marjaneh Taghavi
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Monique Maas
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Zhao Y, Yang J, Luo M, Yang Y, Guo X, Zhang T, Hao J, Yao Y, Ma X. Contrast-Enhanced CT-based Textural Parameters as Potential Prognostic Factors of Survival for Colorectal Cancer Patients Receiving Targeted Therapy. Mol Imaging Biol 2021; 23:427-35. [PMID: 33108800 DOI: 10.1007/s11307-020-01552-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 09/07/2020] [Accepted: 10/05/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to estimate the clinical significance of the contrast-enhanced computed tomography (CT) textural features for prediction of survival in colorectal cancer (CRC) patients receiving targeted therapy (bevacizumab and cetuximab). PROCEDURES The LifeX software was used to extract the textural parameters of the tumor lesions in the contrast-enhanced CT. We used the least absolute shrinkage and selection operator (LASSO) Cox regression and random forest method to screen the non-redundant radiomic features and constructed the CT imaging score. Univariate and multivariate analyses through the Cox proportional hazards model were performed to assess the prognostic clinical factor. Based on the result of multivariate analysis and CT imaging score, combined nomogram model was constructed to predict the overall survival (OS) of patients. Decision curves analysis was employed to evaluate the performance of the combined model and clinical model. RESULTS After comparative analysis of the area under curve of the receiver operating characteristic (ROC) curve, we chose the result of random forest model as CT imaging score. Considering the clinical practice and the result of analysis, age, surgery, and lactate dehydrogenase (LDH) level have been introduced into clinical model. Based on the result of analysis and the CT imaging score, we constructed the nomogram combined model. C-index and calibration curve verified the goodness of fit and discrimination of the combined model. Decision curve analysis (DCA) demonstrated that the combined model showed the better net benefit for a 3-year OS than clinical model. CONCLUSIONS In conclusion, the study provides preliminary evidences that several radiomic parameters of tumor lesions derived from CT images were prognostic factors and predictive markers for CRC patients who are candidates for targeted therapy (bevacizumab and cetuximab).
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Martini K, Baessler B, Bogowicz M, Blüthgen C, Mannil M, Tanadini-Lang S, Schniering J, Maurer B, Frauenfelder T. Applicability of radiomics in interstitial lung disease associated with systemic sclerosis: proof of concept. Eur Radiol 2021; 31:1987-98. [PMID: 33025174 DOI: 10.1007/s00330-020-07293-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/30/2020] [Accepted: 09/14/2020] [Indexed: 01/04/2023]
Abstract
Objective To retrospectively evaluate if texture-based radiomics features are able to detect interstitial lung disease (ILD) and to distinguish between the different disease stages in patients with systemic sclerosis (SSc) in comparison with mere visual analysis of high-resolution computed tomography (HRCT). Methods Sixty patients (46 females, median age 56 years) with SSc who underwent HRCT of the thorax were retrospectively analyzed. Visual analysis was performed by two radiologists for the presence of ILD features. Gender, age, and pulmonary function (GAP) stage was calculated from clinical data (gender, age, pulmonary function test). Data augmentation was performed and the balanced dataset was split into a training (70%) and a testing dataset (30%). For selecting variables that allow classification of the GAP stage, single and multiple logistic regression models were fitted and compared by using the Akaike information criterion (AIC). Diagnostic accuracy was evaluated from the area under the curve (AUC) from receiver operating characteristic (ROC) analyses, and diagnostic sensitivity and specificity were calculated. Results Values for some radiomics features were significantly lower (p < 0.05) and those of other radiomics features were significantly higher (p = 0.001) in patients with GAP2 compared with those in patients with GAP1. The combination of two specific radiomics features in a multivariable model resulted in the lowest AIC of 10.73 with an AUC of 0.96, 84% sensitivity, and 99% specificity. Visual assessment of fibrosis was inferior in predicting individual GAP stages (AUC 0.86; 83% sensitivity; 74% specificity). Conclusion The correlation of radiomics with GAP stage, but not with the visually defined features of ILD-HRCT, implies that radiomics might capture features indicating severity of SSc-ILD on HRCT, which are not recognized by visual analysis. Key Points • Radiomics features can predict GAP stage with a sensitivity of 84% and a specificity of almost 100%. • Extent of fibrosis on HRCT and a combined model of different visual HRCT-ILD features perform worse in predicting GAP stage. • The correlation of radiomics with GAP stage, but not with the visually defined features of ILD-HRCT, implies that radiomics might capture features on HRCT, which are not recognized by visual analysis. Electronic supplementary material The online version of this article (10.1007/s00330-020-07293-8) contains supplementary material, which is available to authorized users.
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Mühlberg A, Holch JW, Heinemann V, Huber T, Moltz J, Maurus S, Jäger N, Liu L, Froelich MF, Katzmann A, Gresser E, Taubmann O, Sühling M, Nörenberg D. The relevance of CT-based geometric and radiomics analysis of whole liver tumor burden to predict survival of patients with metastatic colorectal cancer. Eur Radiol 2020; 31:834-846. [PMID: 32851450 DOI: 10.1007/s00330-020-07192-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/02/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate the prediction of 1-year survival (1-YS) in patients with metastatic colorectal cancer with use of a systematic comparative analysis of quantitative imaging biomarkers (QIBs) based on the geometric and radiomics analysis of whole liver tumor burden (WLTB) in comparison to predictions based on the tumor burden score (TBS), WLTB volume alone, and a clinical model. METHODS A total of 103 patients (mean age: 61.0 ± 11.2 years) with colorectal liver metastases were analyzed in this retrospective study. Automatic segmentations of WLTB from baseline contrast-enhanced CT images were used. Established biomarkers as well as a standard radiomics model building were used to derive 3 prognostic models. The benefits of a geometric metastatic spread (GMS) model, the Aerts radiomics prior model of the WLTB, and the performance of TBS and WLTB volume alone were assessed. All models were analyzed in both statistical and predictive machine learning settings in terms of AUC. RESULTS TBS showed the best discriminative performance in a statistical setting to discriminate 1-YS (AUC = 0.70, CI: [0.56, 0.90]). For the machine learning-based prediction for unseen patients, both a model of the GMS of WLTB (0.73, CI: [0.60, 0.84]) and the Aerts radiomics prior model (0.76, CI: [0.65, 0.86]) applied on the WLTB showed a numerically higher predictive performance than TBS (0.68, CI: [0.54, 0.79]), radiomics (0.65, CI: [0.55, 0.78]), WLTB volume alone (0.53, CI: [0.40. 0.66]), or the clinical model (0.56, CI: [0.43, 0.67]). CONCLUSIONS The imaging-based GMS model may be a first step towards a more fine-grained machine learning extension of the TBS concept for risk stratification in mCRC patients without the vulnerability to technical variance of radiomics. KEY POINTS • CT-based geometric distribution and radiomics analysis of whole liver tumor burden in metastatic colorectal cancer patients yield prognostic information. • Differences in survival are possibly attributable to the spatial distribution of metastatic lesions and the geometric metastatic spread analysis of all liver metastases may serve as robust imaging biomarker invariant to technical variation. • Imaging-based prediction models outperform clinical models for 1-year survival prediction in metastatic colorectal cancer patients with liver metastases.
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Affiliation(s)
| | - Julian W Holch
- Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Munich, Germany
| | - Volker Heinemann
- Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Huber
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Radiology, Munich University Hospitals, Munich, Germany
| | - Jan Moltz
- Fraunhofer Institute for Medical Image Computing MEVIS, Bremen, Germany
| | - Stefan Maurus
- Department of Radiology, Munich University Hospitals, Munich, Germany
| | - Nils Jäger
- Department of Radiology, Munich University Hospitals, Munich, Germany
| | - Lian Liu
- Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Munich, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Radiology, Munich University Hospitals, Munich, Germany
| | | | - Eva Gresser
- Department of Radiology, Munich University Hospitals, Munich, Germany
| | - Oliver Taubmann
- CT R&D Image Analytics, Siemens Healthineers, Forchheim, Germany
| | - Michael Sühling
- CT R&D Image Analytics, Siemens Healthineers, Forchheim, Germany
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. .,Department of Radiology, Munich University Hospitals, Munich, Germany.
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Chen BB. Will novel imaging approaches predict oligometastases or early liver metastasis in patients with colorectal cancer? Hepatobiliary Surg Nutr 2020; 9:391-393. [PMID: 32509839 PMCID: PMC7262606 DOI: 10.21037/hbsn.2019.10.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 10/24/2019] [Indexed: 08/29/2023]
Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei
- Department of Medical Imaging, College of Medicine, National Taiwan University, Taipei
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Hazhirkarzar B, Khoshpouri P, Shaghaghi M, Ghasabeh MA, Pawlik TM, Kamel IR. Current state of the art imaging approaches for colorectal liver metastasis. Hepatobiliary Surg Nutr 2020; 9:35-48. [PMID: 32140477 DOI: 10.21037/hbsn.2019.05.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
One of the most common cancers worldwide, colorectal cancer (CRC) has been associated with significant morbidity and mortality and therefore represents an enormous burden to the health care system. Recent advances in CRC treatments have provided patients with primary and metastatic CRC a better long-term prognosis. The presence of synchronous or metachronous metastasis has been associated, however, with worse survival. The most common site of metastatic disease is the liver. A variety of treatment modalities aimed at targeting colorectal liver metastases (CRLM) has been demonstrated to improve the prognosis of these patients. Loco-regional approaches such as surgical resection and tumor ablation (operative and percutaneous) can provide patients with a chance at long-term disease control and even cure in select populations. Patient selection is important in defining the most suitable treatment option for CRLM in order to provide the best possible survival benefit while avoiding unnecessary interventions and adverse events. Medical imaging plays a crucial role in evaluating the characteristics of CRLMs and disease resectability. Size of tumors, proximity to adjacent anatomical structures, and volume of the unaffected liver are among the most important imaging parameters to determine the suitability of patients for surgical management or other appropriate treatment approaches. We herein provide a comprehensive overview of current-state-of-the-art imaging in the management of CRLM, including staging, treatment planning, response and survival assessment, and post-treatment surveillance. Computed tomography (CT) scan and magnetic resonance imaging (MRI) are two most commonly used techniques, which can be used solely or in combination with functional imaging modalities such as positron emission tomography (PET) and diffusion weighted imaging (DWI). Providing up-to-date evidence on advantages and disadvantages of imaging modalities and tumor assessment criteria, the current review offers a practice guide to assist providers in choosing the most suitable imaging approach for patients with CRLM.
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Affiliation(s)
- Bita Hazhirkarzar
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pegah Khoshpouri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohammadreza Shaghaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mounes Aliyari Ghasabeh
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Shur J, Orton M, Connor A, Fischer S, Moulton CA, Gallinger S, Koh DM, Jhaveri KS. A clinical-radiomic model for improved prognostication of surgical candidates with colorectal liver metastases. J Surg Oncol 2020; 121:357-364. [PMID: 31797378 DOI: 10.1002/jso.25783] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/17/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Colorectal cancer with liver metastases is potentially curable with surgical resection however clinical prognostic factors can insufficiently stratify patients. This study aims to assess whether radiomic features are prognostic and can inform clinical decision making. METHODS This single-site retrospective study included 102 patients who underwent colorectal liver metastases resection with preoperative computed tomography (CT), magnetic resonance imaging (MRI) with gadoxetic acid (EOB) and clinical covariates. A lasso-regularized multivariate Cox proportional hazards model was applied to 114 features (10 clinical, 104 radiomic) to determine association with disease-free survival (DFS). A prognostic index was derived using the significant Cox regression coefficients and their corresponding input features and a threshold was determined to classify patients into high- and low-risk groups, and DFS compared using log-rank tests. RESULTS Four covariates were significantly associated with DFS; bilobar disease (hazard ratio [HR]= 1.56; P = .0043), complete pathological response (HR= 0.67; P = .025), minimum pixel value (HR= 1.66; P = .00016), and small area emphasis (HR= 0.62; P = .0013) from the EOB-MRI data. Radiomic CT features were not prognostic. The prognostic index strongly stratified high- and low-risk prognostic groups (HR = 0.31; P = .00068). CONCLUSION Radiomic MRI features provided meaningful prognostic information above clinical covariates alone. This merits further validation for potential clinical implementation to inform management.
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Affiliation(s)
- Joshua Shur
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - Matthew Orton
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - Ashton Connor
- Department of Surgery, Duke University Hospital, Durham, North Carolina
| | - Sandra Fischer
- Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Carol-Anne Moulton
- Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Steven Gallinger
- Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - Kartik S Jhaveri
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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Jang S, Kim JH, Choi SY, Park SJ, Han JK. Application of computerized 3D-CT texture analysis of pancreas for the assessment of patients with diabetes. PLoS One 2020; 15:e0227492. [PMID: 31929591 PMCID: PMC6957148 DOI: 10.1371/journal.pone.0227492] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 12/19/2019] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate the role of computerized 3D CT texture analysis of the pancreas as quantitative parameters for assessing diabetes. Methods Among 2,493 patients with diabetes, 39 with type 2 diabetes (T2D) and 12 with type 1 diabetes (T1D) who underwent CT using two selected CT scanners, were enrolled. We compared these patients with age-, body mass index- (BMI), and CT scanner-matched normal subjects. Computerized texture analysis for entire pancreas was performed by extracting 17 variable features. A multivariate logistic regression analysis was performed to identify the predictive factors for diabetes. A receiver operator characteristic (ROC) curve was constructed to determine the optimal cut off values for statistically significant variables. Results In diabetes, mean attenuation, standard deviation, variance, entropy, homogeneity, surface area, sphericity, discrete compactness, gray-level co-occurrence matrix (GLCM) contrast, and GLCM entropy showed significant differences (P < .05). Multivariate analysis revealed that a higher variance (adjusted OR, 1.002; P = .005), sphericity (adjusted OR, 1.649×104; P = .048), GLCM entropy (adjusted OR, 1.057×105; P = .032), and lower GLCM contrast (adjusted OR, 0.997; P < .001) were significant variables. The mean AUCs for each feature were 0.654, 0.689, 0.620, and 0.613, respectively (P < .05). In subgroup analysis, only larger surface area (adjusted OR, 1.000; P = .025) was a significant predictor for T2D. Conclusions Computerized 3D CT texture analysis of the pancreas could be helpful for predicting diabetes. A higher variance, sphericity, GLCM entropy, and a lower GLCM contrast were the significant predictors for diabetes.
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Affiliation(s)
- Siwon Jang
- Department of Radiology, SMG—SNU Boramae Medical Center, Seoul, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
| | - Seo-Youn Choi
- Department of Radiology, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sang Joon Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Liang M, Cai Z, Zhang H, Huang C, Meng Y, Zhao L, Li D, Ma X, Zhao X. Machine Learning-based Analysis of Rectal Cancer MRI Radiomics for Prediction of Metachronous Liver Metastasis. Acad Radiol 2019; 26:1495-1504. [PMID: 30711405 DOI: 10.1016/j.acra.2018.12.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES To use machine learning-based magnetic resonance imaging radiomics to predict metachronous liver metastases (MLM) in patients with rectal cancer. MATERIALS AND METHODS This study retrospectively analyzed 108 patients with rectal cancer (54 in MLM group and 54 in nonmetastases group). Feature selection were performed in the radiomic feature sets extracted from images of T2-weighted image (T2WI) and venous phase (VP) sequence respectively, and the combining feature set with 2058 radiomic features incorporating two sequences with the least absolute shrinkage and selection operator method. Five-fold cross-validation and two machine learning algorithms (support vector machine [SVM]; logistic regression [LR]) were utilized for predictive model constructing. The diagnostic performance of the models was evaluated by receiver operating characteristic curves with indicators of accuracy, sensitivity, specificity and area under the curve, and compared by DeLong test. RESULTS Five, 8, and 22 optimal features were selected from 1029 T2WI, 1029 VP, and 2058 combining features, respectively. Four-group models were constructed using the five T2WI features (ModelT2), the 8 VP features (ModelVP), the combined 13 optimal features (Modelcombined), and the 22 optimal features selected from 2058 features (Modeloptimal). In ModelVP, the LR was superior to the SVM algorithm (P = 0.0303). The Modeloptimal using LR algorithm showed the best prediction performance (P = 0.0019-0.0081) with accuracy, sensitivity, specificity, and area under the curve of 0.80, 0.83, 0.76, and 0.87, respectively. CONCLUSION Radiomics models based on baseline rectal magnetic resonance imaging has high potential for MLM prediction, especially the Modeloptimal using LR algorithm. Moreover, except for ModelVP, the LR was not superior to the SVM algorithm for model construction.
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Affiliation(s)
- Meng Liang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Zhengting Cai
- Huiying Medical Technology Co., Ltd., HaiDian District, Beijing City, 100192, People's Republic of China
| | - Hongmei Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Chencui Huang
- Huiying Medical Technology Co., Ltd., HaiDian District, Beijing City, 100192, People's Republic of China
| | - Yankai Meng
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China; Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, People's Republic of China
| | - Li Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Dengfeng Li
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Xiaohong Ma
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China.
| | - Xinming Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China.
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Pöhler GH, Ringe KI. [Computed tomography and/or magnetic resonance imaging of the liver : How, why, what for?]. Radiologe 2019; 59:804-811. [PMID: 31414150 DOI: 10.1007/s00117-019-00583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
CLINICAL PROBLEM Colorectal metastases are the most common malignant liver lesions. Imaging of the liver in patients with colorectal carcinoma is performed for early detection of liver metastases (CRLM) at the time of initial tumor diagnosis, for monitoring and follow-up in order to exclude or diagnose metachronous metastases. STANDARD RADIOLOGICAL METHODS Radiological imaging includes primarily multislice computed tomography (CT) and magnetic resonance imaging (MRI), which play an important role regarding therapeutic management and assessment of prognosis. PERFORMANCE, ACHIEVEMENTS Contrast-enhanced CT is broadly available and allows for rapid image acquisition including the possibility for complete tumor staging. MRI, on the other hand, is characterized by very good soft tissue contrast and has-especially with the use of diffusion-weighted imaging and administration of liver-specific contrast agents-the highest sensitivity for detection of metastases smaller than 1 cm. PRACTICAL RECOMMENDATIONS The choice of imaging in daily routine is often dependent on availability and clinical question. Frequently, e.g. for assessment of resectability (extent of metastases, anatomic relation of lesions to critical structures), both modalities may be implemented in combination.
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Affiliation(s)
- G H Pöhler
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - K I Ringe
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Hannover, Deutschland.
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Ravanelli M, Agazzi GM, Tononcelli E, Roca E, Cabassa P, Baiocchi G, Berruti A, Maroldi R, Farina D. Texture features of colorectal liver metastases on pretreatment contrast-enhanced CT may predict response and prognosis in patients treated with bevacizumab-containing chemotherapy: a pilot study including comparison with standard chemotherapy. Radiol Med 2019; 124:877-86. [DOI: 10.1007/s11547-019-01046-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/13/2019] [Indexed: 02/06/2023]
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Cannella R, Borhani AA, Minervini MI, Tsung A, Furlan A. Evaluation of texture analysis for the differential diagnosis of focal nodular hyperplasia from hepatocellular adenoma on contrast-enhanced CT images. Abdom Radiol (NY) 2019; 44:1323-30. [PMID: 30267107 DOI: 10.1007/s00261-018-1788-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To explore the value of CT texture analysis (CTTA) for differentiation of focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA) on contrast-enhanced CT (CECT). METHODS This is a retrospective, IRB-approved study conducted in a single institution. A search of the medical records between 2008 and 2017 revealed 48 patients with 70 HCA and 50 patients with 62 FNH. All lesions were histologically proven and with available pre-operative CECT imaging. Hepatic arterial phase (HAP) and portal venous phase (PVP) were used for CTTA. Textural features were extracted using a commercially available research software (TexRAD). The differences between textural parameters of FNH and HCA were assessed using the Mann-Whitney U test and the AUROC were calculated. CTTA parameters showing significant difference in rank sum test were used for binary logistic regression analysis. A p value < 0.05 was considered statistically significant. RESULTS On HAP images, mean, mpp, and skewness were significantly higher in FNH than in HCA on unfiltered images (p ≤ 0.007); SD, entropy, and mpp on filtered analysis (p ≤ 0.006). On PVP, mean, mpp, and skewness in FNH were significantly different from HCA (p ≤ 0.001) on unfiltered images, while entropy and kurtosis were significantly higher in FNH on filtered images (p ≤ 0.018). The multivariate logistic regression analysis indicated that the mean, mpp, and entropy of medium-level and coarse-level filtered images on HAP were independent predictors for the diagnosis of HCA and a model based on all these parameters showed the largest AUROC (0.824). CONCLUSIONS Multiple explored CTTA parameters are significantly different between FNH and HCA on CECT.
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Mannil M, von Spiczak J, Muehlematter UJ, Thanabalasingam A, Keller DI, Manka R, Alkadhi H. Texture analysis of myocardial infarction in CT: Comparison with visual analysis and impact of iterative reconstruction. Eur J Radiol 2019; 113:245-250. [PMID: 30927955 DOI: 10.1016/j.ejrad.2019.02.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To compare texture analysis (TA) with subjective visual diagnosis of myocardial infarction (MI) in cardiac computed tomography (CT) and to evaluate the impact of iterative reconstruction (IR). METHODS Ten patients (4 women, mean age 68 ± 11 years) with confirmed chronic MI and 20 controls (8 women, mean age 52 ± 11 years) with no cardiac abnormality underwent contrast-enhanced cardiac CT with the same protocol. Images were reconstructed with filtered back projection (FBP) and with advanced modeled IR at strength levels 3-5. Subjective diagnosis of MI was made by three independent, blinded readers with different experience levels. Classification of MI was performed using machine learning-based decision tree models for the entire data set and after splitting into training and test data to avoid overfitting. RESULTS Subjective visual analysis for diagnosis of MI showed excellent intrareader (kappa: 0.93) but poor interreader agreement (kappa: 0.3), with variable performance at different image reconstructions. TA showed high performance for all image reconstructions (correct classifications: 94%-97%, areas under the curve: 0.94-0.99). After splitting into training and test data, overall lower performances were observed, with best results for IR at level 5 (correct classifications: 73%, area under the curve: 0.65). CONCLUSIONS As compared with subjective, nonreliable visual analysis of inexperienced readers, TA enables objective and reproducible diagnosis of chronic MI in cardiac CT with higher accuracy. IR has a considerable impact on both subjective and objective image analysis.
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Affiliation(s)
- Manoj Mannil
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr. 100, CH-8091 Zurich, Switzerland.
| | - Jochen von Spiczak
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr. 100, CH-8091 Zurich, Switzerland
| | - Urs J Muehlematter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr. 100, CH-8091 Zurich, Switzerland
| | - Arjun Thanabalasingam
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr. 100, CH-8091 Zurich, Switzerland
| | - Dagmar I Keller
- Institute for Emergency Medicine, University Hospital Zurich, University of Zurich, Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr. 100, CH-8091 Zurich, Switzerland; Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Raemistr. 100, 8091 Zurich, Switzerland; Institute for Biomedical Engineering, University and ETH Zurich Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr. 100, CH-8091 Zurich, Switzerland
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Beckers R, Trebeschi S, Maas M, Schnerr R, Sijmons J, Beets G, Houwers J, Beets-Tan R, Lambregts D. CT texture analysis in colorectal liver metastases and the surrounding liver parenchyma and its potential as an imaging biomarker of disease aggressiveness, response and survival. Eur J Radiol 2018; 102:15-21. [DOI: 10.1016/j.ejrad.2018.02.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/10/2018] [Accepted: 02/26/2018] [Indexed: 12/20/2022]
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Beckers RCJ, Beets-Tan RGH, Schnerr RS, Maas M, da Costa Andrade LA, Beets GL, Dejong CH, Houwers JB, Lambregts DMJ. Whole-volume vs. segmental CT texture analysis of the liver to assess metachronous colorectal liver metastases. Abdom Radiol (NY) 2017; 42:2639-2645. [PMID: 28555265 DOI: 10.1007/s00261-017-1190-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE It is unclear whether changes in liver texture in patients with colorectal cancer are caused by diffuse (e.g., perfusional) changes throughout the liver or rather based on focal changes (e.g., presence of occult metastases). The aim of this study is to compare a whole-liver approach to a segmental (Couinaud) approach for measuring the CT texture at the time of primary staging in patients who later develop metachronous metastases and evaluate whether assessing CT texture on a segmental level is of added benefit. METHODS 46 Patients were included: 27 patients without metastases (follow-up >2 years) and 19 patients who developed metachronous metastases within 24 months after diagnosis. Volumes of interest covering the whole liver were drawn on primary staging portal-phase CT. In addition, each liver segment was delineated separately. Mean gray-level intensity, entropy (E), and uniformity (U) were derived with different filters (σ0.5-2.5). Patients/segments without metastases and patients/segments that later developed metachronous metastases were compared using independent samples t tests. RESULTS Absolute differences in entropy and uniformity between the group without metastases and the group with metachronous metastases group were consistently smaller for the segmental approach compared to the whole-liver approach. No statistically significant differences were found in the texture measurements between both groups. CONCLUSIONS In this small patient cohort, we could not demonstrate a clear predictive value to identify patients at risk of developing metachronous metastases within 2 years. Segmental CT texture analysis of the liver probably has no additional benefit over whole-liver texture analysis.
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Affiliation(s)
- R C J Beckers
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R G H Beets-Tan
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R S Schnerr
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L A da Costa Andrade
- Medical Imaging Department and Faculty of Medicine, University Hospital of Coimbra, Coimbra, Portugal
| | - G L Beets
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C H Dejong
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, RWTH Universitätsklinikum Aachen, Aachen, Germany
| | - J B Houwers
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - D M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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