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Barbe R, Belkouchi Y, Menu Y, Cohen R, David C, Kind M, Harguem S, Dawi L, Hadchiti J, Selhane F, Billet N, Ammari S, Bertin A, Lawrance L, Cervantes B, Hollebecque A, Balleyguier C, Cournede PH, Talbot H, Lassau N, Andre T. Imaging-guided prognostic score-based approach to assess the benefits of combotherapy versus monotherapy with immune checkpoint inhibitors in metastatic MSI-H colorectal cancer patients. Eur J Cancer 2024; 202:114020. [PMID: 38502988 DOI: 10.1016/j.ejca.2024.114020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND This retrospective study determined survival responses to immune checkpoint inhibitors (ICIs), comparing mono- (mono) and combo-immunotherapy (combo) in patients with microsatellite instability-high (MSI-H) metastatic colorectal cancer (mCRC) by analyzing quantitative imaging data and clinical factors. METHODS One hundred fifty patients were included from two centers and divided into training (n = 105) and validation (n = 45) cohorts. Radiologists manually annotated chest-abdomen-pelvis computed tomography and calculated tumor burden. Progression-free survival (PFS) was assessed, and variables were selected through Recursive Feature Elimination. Cutoff values were determined using maximally selected rank statistics to binarize features, forming a risk score with hazard ratio-derived weights. RESULTS In total, 2258 lesions were annotated with excellent reproducibility. Key variables in the training cohort included: total tumor volume (cutoff: 73 cm3), lesion count (cutoff: 20), age (cutoff: 60) and the presence of peritoneal carcinomatosis. Their respective weights were 1.13, 0.96, 0.91, and 0.38, resulting in a risk score cutoff of 1.36. Low-score patients showed similar overall survival and PFS regardless of treatment, while those with a high-score had significantly worse survivals with mono vs combo (P = 0.004 and P = 0.0001). In the validation set, low-score patients exhibited no significant difference in overall survival and PFS with mono or combo. However, patients with a high-score had worse PFS with mono (P = 0.046). CONCLUSIONS A score based on total tumor volume, lesion count, the presence of peritoneal carcinomatosis, and age can guide MSI-H mCRC treatment decisions, allowing oncologists to identify suitable candidates for mono and combo ICI therapies.
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Affiliation(s)
- Rémy Barbe
- Département d'imagerie, Gustave Roussy, Villejuif, France
| | - Younes Belkouchi
- Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France; Université Paris-Saclay, Centrale-Supelec, Centre de vision numérique, Gif-Sur-Yvette, France
| | - Yves Menu
- Département d'imagerie, Gustave Roussy, Villejuif, France; SIRIC CURAMUS, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France; Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France
| | - Romain Cohen
- SIRIC CURAMUS, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France; Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France
| | - Clemence David
- Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France
| | - Michele Kind
- Département d'imagerie, Institut Bergonié, Bordeaux, France
| | - Sana Harguem
- Département d'imagerie, Gustave Roussy, Villejuif, France
| | - Lama Dawi
- Département d'imagerie, Gustave Roussy, Villejuif, France
| | - Joya Hadchiti
- Département d'imagerie, Gustave Roussy, Villejuif, France
| | - Fatine Selhane
- Département d'imagerie, Gustave Roussy, Villejuif, France
| | - Nicolas Billet
- Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France
| | - Samy Ammari
- Département d'imagerie, Gustave Roussy, Villejuif, France; Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France
| | - Ambroise Bertin
- Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France
| | - Littisha Lawrance
- Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France
| | - Baptiste Cervantes
- SIRIC CURAMUS, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France; Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France
| | - Antoine Hollebecque
- Département d'Innovation Thérapeutique et Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Corinne Balleyguier
- Département d'imagerie, Gustave Roussy, Villejuif, France; Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France
| | - Paul-Henry Cournede
- Université Paris-Saclay, Centrale-Supelec, Lab of Mathematics and Informatics, Gif-Sur-Yvette, France
| | - Hugues Talbot
- Université Paris-Saclay, Centrale-Supelec, Centre de vision numérique, Gif-Sur-Yvette, France
| | - Nathalie Lassau
- Département d'imagerie, Gustave Roussy, Villejuif, France; Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France
| | - Thierry Andre
- SIRIC CURAMUS, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France; Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France.
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Djahnine A, Lazarus C, Lederlin M, Mulé S, Wiemker R, Si-Mohamed S, Jupin-Delevaux E, Nempont O, Skandarani Y, De Craene M, Goubalan S, Raynaud C, Belkouchi Y, Afia AB, Fabre C, Ferretti G, De Margerie C, Berge P, Liberge R, Elbaz N, Blain M, Brillet PY, Chassagnon G, Cadour F, Caramella C, Hajjam ME, Boussouar S, Hadchiti J, Fablet X, Khalil A, Talbot H, Luciani A, Lassau N, Boussel L. Detection and severity quantification of pulmonary embolism with 3D CT data using an automated deep learning-based artificial solution. Diagn Interv Imaging 2024; 105:97-103. [PMID: 38261553 DOI: 10.1016/j.diii.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE The purpose of this study was to propose a deep learning-based approach to detect pulmonary embolism and quantify its severity using the Qanadli score and the right-to-left ventricle diameter (RV/LV) ratio on three-dimensional (3D) computed tomography pulmonary angiography (CTPA) examinations with limited annotations. MATERIALS AND METHODS Using a database of 3D CTPA examinations of 1268 patients with image-level annotations, and two other public datasets of CTPA examinations from 91 (CAD-PE) and 35 (FUME-PE) patients with pixel-level annotations, a pipeline consisting of: (i), detecting blood clots; (ii), performing PE-positive versus negative classification; (iii), estimating the Qanadli score; and (iv), predicting RV/LV diameter ratio was followed. The method was evaluated on a test set including 378 patients. The performance of PE classification and severity quantification was quantitatively assessed using an area under the curve (AUC) analysis for PE classification and a coefficient of determination (R²) for the Qanadli score and the RV/LV diameter ratio. RESULTS Quantitative evaluation led to an overall AUC of 0.870 (95% confidence interval [CI]: 0.850-0.900) for PE classification task on the training set and an AUC of 0.852 (95% CI: 0.810-0.890) on the test set. Regression analysis yielded R² value of 0.717 (95% CI: 0.668-0.760) and of 0.723 (95% CI: 0.668-0.766) for the Qanadli score and the RV/LV diameter ratio estimation, respectively on the test set. CONCLUSION This study shows the feasibility of utilizing AI-based assistance tools in detecting blood clots and estimating PE severity scores with 3D CTPA examinations. This is achieved by leveraging blood clots and cardiac segmentations. Further studies are needed to assess the effectiveness of these tools in clinical practice.
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Affiliation(s)
- Aissam Djahnine
- Philips Research France, 92150 Suresnes, France; CREATIS, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, Lyon, France.
| | | | | | - Sébastien Mulé
- Medical Imaging Department, Henri Mondor University Hospital, AP-HP, Créteil, France, Inserm, U955, Team 18, 94000 Créteil, France
| | | | - Salim Si-Mohamed
- Department of Radiology, Hospices Civils de Lyon, 69500 Lyon, France
| | | | | | | | | | | | | | - Younes Belkouchi
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; OPIS - Optimisation Imagerie et Santé, Université Paris-Saclay, Inria, CentraleSupélec, CVN - Centre de vision numérique, 91190 Gif-Sur-Yvette, France
| | - Amira Ben Afia
- Department of Radiology, APHP Nord, Hôpital Bichat, 75018 Paris, France
| | - Clement Fabre
- Department of Radiology, Centre Hospitalier de Laval, 53000 Laval, France
| | - Gilbert Ferretti
- Universite Grenobles Alpes, Service de Radiologie et Imagerie Médicale, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - Constance De Margerie
- Université Paris Cité, 75006 Paris, France, Department of Radiology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
| | - Pierre Berge
- Department of Radiology, CHU Angers, 49000 Angers, France
| | - Renan Liberge
- Department of Radiology, CHU Nantes, 44000 Nantes, France
| | - Nicolas Elbaz
- Department of Radiology, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Maxime Blain
- Department of Radiology, Hopital Henri Mondor, AP-HP, 94000 Créteil, France
| | - Pierre-Yves Brillet
- Department of Radiology, Hôpital Avicenne, Paris 13 University, 93000 Bobigny, France
| | - Guillaume Chassagnon
- Department of Radiology, Hopital Cochin, APHP, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Farah Cadour
- APHM, Hôpital Universitaire Timone, CEMEREM, 13005 Marseille, France
| | - Caroline Caramella
- Department of Radiology, Groupe Hospitalier Paris Saint-Joseph, 75015 Paris, France
| | - Mostafa El Hajjam
- Department of Radiology, Hôpital Ambroise Paré Hospital, UMR 1179 INSERM/UVSQ, Team 3, 92100 Boulogne-Billancourt, France
| | - Samia Boussouar
- Sorbonne Université, Hôpital La Pitié-Salpêtrière, APHP, Unité d'Imagerie Cardiovasculaire et Thoracique (ICT), 75013 Paris, France
| | - Joya Hadchiti
- Department of Imaging, Institut Gustave Roussy, Université Paris-Saclay. 94800 Villejuif, France
| | - Xavier Fablet
- Department of Radiology, CHU Rennes, 35000 Rennes, France
| | - Antoine Khalil
- Department of Radiology, APHP Nord, Hôpital Bichat, 75018 Paris, France
| | - Hugues Talbot
- OPIS - Optimisation Imagerie et Santé, Université Paris-Saclay, Inria, CentraleSupélec, CVN - Centre de vision numérique, 91190 Gif-Sur-Yvette, France
| | - Alain Luciani
- Medical Imaging Department, Henri Mondor University Hospital, AP-HP, Créteil, France, Inserm, U955, Team 18, 94000 Créteil, France
| | - Nathalie Lassau
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, Université Paris-Saclay. 94800 Villejuif, France
| | - Loic Boussel
- CREATIS, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, Lyon, France; Department of Radiology, Hospices Civils de Lyon, 69500 Lyon, France
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Dietrich CF, Correas JM, Cui XW, Dong Y, Havre RF, Jenssen C, Jung EM, Krix M, Lim A, Lassau N, Piscaglia F. EFSUMB Technical Review - Update 2023: Dynamic Contrast-Enhanced Ultrasound (DCE-CEUS) for the Quantification of Tumor Perfusion. Ultraschall Med 2024; 45:36-46. [PMID: 37748503 DOI: 10.1055/a-2157-2587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Dynamic contrast-enhanced ultrasound (DCE-US) is a technique to quantify tissue perfusion based on phase-specific enhancement after the injection of microbubble contrast agents for diagnostic ultrasound. The guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) published in 2004 and updated in 2008, 2011, and 2020 focused on the use of contrast-enhanced ultrasound (CEUS), including essential technical requirements, training, investigational procedures and steps, guidance regarding image interpretation, established and recommended clinical indications, and safety considerations. However, the quantification of phase-specific enhancement patterns acquired with ultrasound contrast agents (UCAs) is not discussed here. The purpose of this EFSUMB Technical Review is to further establish a basis for the standardization of DCE-US focusing on treatment monitoring in oncology. It provides some recommendations and descriptions as to how to quantify dynamic ultrasound contrast enhancement, and technical explanations for the analysis of time-intensity curves (TICs). This update of the 2012 EFSUMB introduction to DCE-US includes clinical aspects for data collection, analysis, and interpretation that have emerged from recent studies. The current study not only aims to support future work in this research field but also to facilitate a transition to clinical routine use of DCE-US.
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Affiliation(s)
- Christoph F Dietrich
- Department General Internal Medicine, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- Zentrum der Inneren Medizin, Johann Wolfgang Goethe Universitätsklinik Frankfurt, Frankfurt, Germany
| | - Jean-Michel Correas
- Department of Adult Radiology, Assistance Publique Hôpitaux de Paris, Necker University Hospital, Paris, France
- Paris Cité University, Paris, France
- CNRS, INSERM Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Roald Flesland Havre
- Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Wriezen, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS), Medical University Brandenburg, Neuruppin, Brandenburg, Germany
| | - Ernst Michael Jung
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - Martin Krix
- Global Medical & Regulatory Affairs, Bracco Imaging, Konstanz, Germany
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London, United Kingdom of Great Britain and Northern Ireland
| | - Nathalie Lassau
- Imaging Department. Gustave Roussy cancer Campus. Villejuif, France. BIOMAPS. UMR 1281. CEA. CNRS. INSERM, Université Paris-Saclay, France
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Dept of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Courcier J, Leguerney I, Benatsou B, Pochon S, Tardy I, Albiges L, Cournède PH, De La Taille A, Lassau N, Ingels A. BR55 Ultrasound Molecular Imaging of Clear Cell Renal Cell Carcinoma Reflects Tumor Vascular Expression of VEGFR-2 in a Patient-Derived Xenograft Model. Int J Mol Sci 2023; 24:16211. [PMID: 38003400 PMCID: PMC10671137 DOI: 10.3390/ijms242216211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Standard imaging cannot reliably predict the nature of renal tumors. Among malignant renal tumors, clear cell renal cell carcinoma (ccRCC) is the most common histological subtype, in which the vascular endothelial growth factor 2 (VEGFR-2) is highly expressed in the vascular endothelium. BR55, a contrast agent for ultrasound imaging, consists of gas-core lipid microbubbles that specifically target and bind to the extracellular portion of the VEGFR-2. The specific information provided by ultrasound molecular imaging (USMI) using BR55 was compared with the vascular tumor expression of the VEGFR-2 by immunohistochemical (IHC) staining in a preclinical model of ccRCC. Patients' ccRCCs were orthotopically grafted onto Nod-Scid-Gamma (NSG) mice to generate patient-derived xenografts (PdX). Mice were divided into four groups to receive either vehicle or axitinib an amount of 2, 7.5 or 15 mg/kg twice daily. Perfusion parameters and the BR55 ultrasound contrast signal on PdX renal tumors were analyzed at D0, D1, D3, D7 and D11, and compared with IHC staining for the VEGFR-2 and CD34. Significant Pearson correlation coefficients were observed between the area under the curve (AUC) and the CD34 (0.84, p < 10-4), and between the VEGFR-2-specific signal obtained by USMI and IHC (0.72, p < 10-4). USMI with BR55 could provide instant, quantitative information on tumor VEGFR-2 expression to characterize renal masses non-invasively.
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Affiliation(s)
- Jean Courcier
- Department of Urology, Henri Mondor Hospital, University of Paris Est Créteil (UPEC), 94000 Créteil, France
- Biomaps, UMR1281, INSERM, Centre National de la Recherche Scientifique (CNRS), Commissariat à l’Energie Atomique (CEA), Université Paris Saclay, 94800 Villejuif, France
| | - Ingrid Leguerney
- Biomaps, UMR1281, INSERM, Centre National de la Recherche Scientifique (CNRS), Commissariat à l’Energie Atomique (CEA), Université Paris Saclay, 94800 Villejuif, France
- Department of Imaging, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | - Baya Benatsou
- Biomaps, UMR1281, INSERM, Centre National de la Recherche Scientifique (CNRS), Commissariat à l’Energie Atomique (CEA), Université Paris Saclay, 94800 Villejuif, France
- Department of Imaging, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | | | | | - Laurence Albiges
- Department of Urological Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Paul-Henry Cournède
- Laboratory of Mathematics and Computer Science (MICS), CentraleSupélec, Université Paris-Saclay, 91190 Gif-Sur-Yvette, France
| | - Alexandre De La Taille
- Department of Urology, Henri Mondor Hospital, University of Paris Est Créteil (UPEC), 94000 Créteil, France
| | - Nathalie Lassau
- Biomaps, UMR1281, INSERM, Centre National de la Recherche Scientifique (CNRS), Commissariat à l’Energie Atomique (CEA), Université Paris Saclay, 94800 Villejuif, France
- Department of Imaging, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | - Alexandre Ingels
- Department of Urology, Henri Mondor Hospital, University of Paris Est Créteil (UPEC), 94000 Créteil, France
- Biomaps, UMR1281, INSERM, Centre National de la Recherche Scientifique (CNRS), Commissariat à l’Energie Atomique (CEA), Université Paris Saclay, 94800 Villejuif, France
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5
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Belkouchi Y, Lederlin M, Ben Afia A, Fabre C, Ferretti G, De Margerie C, Berge P, Liberge R, Elbaz N, Blain M, Brillet PY, Chassagnon G, Cadour F, Caramella C, Hajjam ME, Boussouar S, Hadchiti J, Fablet X, Khalil A, Luciani A, Cotten A, Meder JF, Talbot H, Lassau N. Detection and quantification of pulmonary embolism with artificial intelligence: The SFR 2022 artificial intelligence data challenge. Diagn Interv Imaging 2023; 104:485-489. [PMID: 37321875 DOI: 10.1016/j.diii.2023.05.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE In 2022, the French Society of Radiology together with the French Society of Thoracic Imaging and CentraleSupelec organized their 13th data challenge. The aim was to aid in the diagnosis of pulmonary embolism, by identifying the presence of pulmonary embolism and by estimating the ratio between right and left ventricular (RV/LV) diameters, and an arterial obstruction index (Qanadli's score) using artificial intelligence. MATERIALS AND METHODS The data challenge was composed of three tasks: the detection of pulmonary embolism, the RV/LV diameter ratio, and Qanadli's score. Sixteen centers all over France participated in the inclusion of the cases. A health data hosting certified web platform was established to facilitate the inclusion process of the anonymized CT examinations in compliance with general data protection regulation. CT pulmonary angiography images were collected. Each center provided the CT examinations with their annotations. A randomization process was established to pool the scans from different centers. Each team was required to have at least a radiologist, a data scientist, and an engineer. Data were provided in three batches to the teams, two for training and one for evaluation. The evaluation of the results was determined to rank the participants on the three tasks. RESULTS A total of 1268 CT examinations were collected from the 16 centers following the inclusion criteria. The dataset was split into three batches of 310, 580 and 378 C T examinations provided to the participants respectively on September 5, 2022, October 7, 2022 and October 9, 2022. Seventy percent of the data from each center were used for training, and 30% for the evaluation. Seven teams with a total of 48 participants including data scientists, researchers, radiologists and engineering students were registered for participation. The metrics chosen for evaluation included areas under receiver operating characteristic curves, specificity and sensitivity for the classification task, and the coefficient of determination r2 for the regression tasks. The winning team achieved an overall score of 0.784. CONCLUSION This multicenter study suggests that the use of artificial intelligence for the diagnosis of pulmonary embolism is possible on real data. Moreover, providing quantitative measures is mandatory for the interpretability of the results, and is of great aid to the radiologists especially in emergency settings.
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Affiliation(s)
- Younes Belkouchi
- OPIS, CentraleSupelec, Inria, Université Paris-Saclay, 91190 Gif-Sur-Yvette, France; Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France.
| | | | - Amira Ben Afia
- Department of Radiology, APHP Nord, Hôpital Bichat, 75018 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Clement Fabre
- Department of Radiology, Centre Hospitalier de Laval, 53000 Laval, France
| | - Gilbert Ferretti
- Universite Grenobles Alpes, Service de Radiologie et Imagerie Médicale, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - Constance De Margerie
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, 75010 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Pierre Berge
- Department of Radiology, CHU Angers, 49000 Angers, France
| | - Renan Liberge
- Department of Radiology, CHU Nantes, 44000 Nantes, France
| | - Nicolas Elbaz
- Department of Radiology, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Maxime Blain
- Department of Radiology, Hopital Henri Mondor, AP-HP, 94000 Créteil, France
| | - Pierre-Yves Brillet
- Department of Radiology, Hôpital Avicenne, Paris 13 University, 93000 Bobigny, France
| | - Guillaume Chassagnon
- Department of Radiology, Hopital Cochin, APHP, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Farah Cadour
- APHM, Hôpital Universitaire Timone, CEMEREM, 13005 Marseille, France
| | - Caroline Caramella
- Department of Radiology, Groupe hospitalier Paris Saint-Joseph, Île-de-France, 75015 Paris, France
| | - Mostafa El Hajjam
- Department of Radiology, Ambroise Paré Hospital GH AP-HP Paris Saclay, UMR 1179 INSERM/UVSQ, Team 3, 92100 Boulogne-Billancourt, France
| | - Samia Boussouar
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Unité d'Imagerie Cardiovasculaire et Thoracique (ICT), 75013 Paris, France
| | - Joya Hadchiti
- Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
| | - Xavier Fablet
- Department of Radiology, CHU Rennes, 35000 Rennes, France
| | - Antoine Khalil
- Department of Radiology, APHP Nord, Hôpital Bichat, 75018 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Alain Luciani
- Medical Imaging Department, AP-HP, Henri Mondor University Hospital, 94000 Créteil, France; INSERM, U955, Team 18, 94000 Créteil, France
| | - Anne Cotten
- Department of Musculoskeletal Radiology, Univ. Lille, CHU Lille, MABlab ULR 4490, 59000 Lille, France
| | - Jean-Francois Meder
- Department of Neuroimaging, Sainte-Anne Hospital, 75013 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Hugues Talbot
- OPIS, CentraleSupelec, Inria, Université Paris-Saclay, 91190 Gif-Sur-Yvette, France
| | - Nathalie Lassau
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
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Decazes P, Ammari S, Belkouchi Y, Mottay L, Lawrance L, de Prévia A, Talbot H, Farhane S, Cournède PH, Marabelle A, Guisier F, Planchard D, Ibrahim T, Robert C, Barlesi F, Vera P, Lassau N. Synergic prognostic value of 3D CT scan subcutaneous fat and muscle masses for immunotherapy-treated cancer. J Immunother Cancer 2023; 11:e007315. [PMID: 37678919 PMCID: PMC10496660 DOI: 10.1136/jitc-2023-007315] [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] [Accepted: 08/14/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Our aim was to explore the prognostic value of anthropometric parameters in a large population of patients treated with immunotherapy. METHODS We retrospectively included 623 patients with advanced non-small cell lung cancer (NSCLC) (n=318) or melanoma (n=305) treated by an immune-checkpoint-inhibitor having a pretreatment (thorax-)abdomen-pelvis CT scan. An external validation cohort of 55 patients with NSCLC was used. Anthropometric parameters were measured three-dimensionally (3D) by a deep learning software (Anthropometer3DNet) allowing an automatic multislice measurement of lean body mass, fat body mass (FBM), muscle body mass (MBM), visceral fat mass (VFM) and sub-cutaneous fat mass (SFM). Body mass index (BMI) and weight loss (WL) were also retrieved. Receiver operator characteristic (ROC) curve analysis was performed and overall survival was calculated using Kaplan-Meier (KM) curve and Cox regression analysis. RESULTS In the overall cohort, 1-year mortality rate was 0.496 (95% CI: 0.457 to 0.537) for 309 events and 5-year mortality rate was 0.196 (95% CI: 0.165 to 0.233) for 477 events. In the univariate Kaplan-Meier analysis, prognosis was worse (p<0.001) for patients with low SFM (<3.95 kg/m2), low FBM (<3.26 kg/m2), low VFM (<0.91 kg/m2), low MBM (<5.85 kg/m2) and low BMI (<24.97 kg/m2). The same parameters were significant in the Cox univariate analysis (p<0.001) and, in the multivariate stepwise Cox analysis, the significant parameters were MBM (p<0.0001), SFM (0.013) and WL (0.0003). In subanalyses according to the type of cancer, all body composition parameters were statistically significant for NSCLC in ROC, KM and Cox univariate analysis while, for melanoma, none of them, except MBM, was statistically significant. In multivariate Cox analysis, the significant parameters for NSCLC were MBM (HR=0.81, p=0.0002), SFM (HR=0.94, p=0.02) and WL (HR=1.06, p=0.004). For NSCLC, a KM analysis combining SFM and MBM was able to separate the population in three categories with the worse prognostic for the patients with both low SFM (<5.22 kg/m2) and MBM (<6.86 kg/m2) (p<0001). On the external validation cohort, combination of low SFM and low MBM was pejorative with 63% of mortality at 1 year versus 25% (p=0.0029). CONCLUSIONS 3D measured low SFM and MBM are significant prognosis factors of NSCLC treated by immune checkpoint inhibitors and can be combined to improve the prognostic value.
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Affiliation(s)
- Pierre Decazes
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, 76000 Rouen, France
- QuantIF-LITIS (EA[Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, 76000 Rouen, France
| | - Samy Ammari
- Biomaps, UMR1281 INSERM, CEA, CNRS, University of Paris-Saclay, 94800 Villejuif, France
- Department of Imaging, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
| | - Younes Belkouchi
- Biomaps, UMR1281 INSERM, CEA, CNRS, University of Paris-Saclay, 94800 Villejuif, France
- Centre de Vision Numérique, CentraleSupélec, Inria, Université Paris-Saclay, 91190 Gif-Sur-Yvette, France
| | - Léo Mottay
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, 76000 Rouen, France
- QuantIF-LITIS (EA[Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, 76000 Rouen, France
| | - Littisha Lawrance
- Biomaps, UMR1281 INSERM, CEA, CNRS, University of Paris-Saclay, 94800 Villejuif, France
| | - Antoine de Prévia
- Biomaps, UMR1281 INSERM, CEA, CNRS, University of Paris-Saclay, 94800 Villejuif, France
| | - Hugues Talbot
- Centre de Vision Numérique, CentraleSupélec, Inria, Université Paris-Saclay, 91190 Gif-Sur-Yvette, France
| | - Siham Farhane
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, 94800 Villejuif, France
| | - Paul-Henry Cournède
- MICS Lab, CentraleSupelec, Universite Paris-Saclay, 91190 Gif-Sur-Yvette, France
| | - Aurelien Marabelle
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
| | - Florian Guisier
- QuantIF-LITIS (EA[Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, 76000 Rouen, France
- Department of Pneumology and Inserm CIC-CRB 1404, CHU Rouen, 76000 Rouen, France
| | - David Planchard
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
| | - Tony Ibrahim
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
| | - Caroline Robert
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
| | - Fabrice Barlesi
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
| | - Pierre Vera
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, 76000 Rouen, France
- QuantIF-LITIS (EA[Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, 76000 Rouen, France
| | - Nathalie Lassau
- Biomaps, UMR1281 INSERM, CEA, CNRS, University of Paris-Saclay, 94800 Villejuif, France
- Department of Imaging, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
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Hoferer I, Jourdain L, Girot C, Benatsou B, Leguerney I, Cournede PH, Marouf A, Hoarau Y, Lassau N, Pitre-Champagnat S. New calibration setup for quantitative DCE-US imaging protocol: Toward standardization. Med Phys 2023; 50:5541-5552. [PMID: 36939058 DOI: 10.1002/mp.16362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND The DCE-US (Dynamic Contrast-Enhanced Ultrasonography) imaging protocol predicts the vascular modifications compared with Response Evaluation Criteria in Solid Tumors (RECIST) based mainly on morphological changes. A quantitative biomarker has been validated through the DCE-US multi-centric study for early monitoring of the efficiency of anti-angiogenic cancer treatments. In this context, the question of transposing the use of this biomarker to other types of ultrasound scanners, probes and settings has arisen to maintain the follow-up of patients under anti-angiogenic treatments. As a consequence, radiologists encounter standardization issues between the different generations of ultrasound scanners to perform quantitative imaging protocols. PURPOSE The aim of this study was to develop a new calibration setup to transpose the DCE-US imaging protocol to the new generation of ultrasound scanners using both abdominal and linear probes. METHODS This calibration method has been designed to be easily reproducible and optimized, reducing the time required and cost incurred. It is based on an original set-up that includes using a concentration splitter to measure the variation of the harmonic signal intensity, obtained from the Area Under the time-intensity Curve (AUC) as a function of various contrast-agent concentrations. The splitter provided four different concentrations simultaneously ranging from 12.5% to 100% of the initial concentration of the SonoVue contrast agent (Bracco Imaging S.p.A., Milan, Italy), therefore, measuring four AUCs in a single injection. The plot of the AUC as a function of the four contrast agent concentrations represents the intensity variation of the harmonic signal: the slope being the calibration parameter. The standardization through this method implied that both generations of ultrasound scanners had to have the same slopes to be considered as calibrated. This method was tested on two ultrasound scanners from the same manufacturer (Aplio500, Aplioi900, Canon Medical Systems, Tokyo, Japan). The Aplio500 used the settings defined by the initial multicenter DCE-US study. The Mechanical Index (MI) and the Color Gain (CG) of the Aplioi900 have been adjusted to match those of the Aplio500. The reliability of the new setup was evaluated in terms of measurement repeatability, and reproducibility with the agreement between the measurements obtained once the two ultrasound scanners were calibrated. RESULTS The new setup provided excellent repeatability measurements with a value of 96.8%. Once the two ultrasound scanners have been calibrated for both types of probes, the reproducibility was excellent with the agreement between their respective quantitative measurement was at the lowest 95.4% and at the best 98.8%. The settings of the Aplioi900 (Canon Medical Systems) were adjusted to match those of the Aplio500 (Canon Medical Systems) and these validated settings were for the abdominal probe: MI = 0.13 and CG = 34 dB; and for the linear probe: MI = 0.10 and CG = 38 dB. CONCLUSION This new calibration setup provided reliable measurements and enabled the rapid transfer and the use of the DCE-US imaging protocol on new ultrasound scanners, thus permitting a continuation of the therapeutic evaluation of patients through quantitative imaging.
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Affiliation(s)
- Isaline Hoferer
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy Cancer Campus, Villejuif, France
- Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Laurene Jourdain
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy Cancer Campus, Villejuif, France
| | - Charly Girot
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy Cancer Campus, Villejuif, France
| | - Baya Benatsou
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy Cancer Campus, Villejuif, France
- Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Ingrid Leguerney
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy Cancer Campus, Villejuif, France
- Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Paul-Henry Cournede
- Université Paris-Saclay, CentraleSupélec, Laboratory of Mathematics and Computer Science (MICS), Gif-Sur-Yvette, France
| | | | - Yannick Hoarau
- Université de Strasbourg, CNRS, ICUBE UMR 7357, Strasbourg, France
| | - Nathalie Lassau
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy Cancer Campus, Villejuif, France
- Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
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Haroun F, Benmoussa N, Bidault F, Lassau N, Moya-Plana A, Leymarie N, Honart JF, Kolb F, Qassemyar Q, Gorphe P. Outcomes of mandibular reconstruction using three-dimensional custom-made porous titanium prostheses. J Stomatol Oral Maxillofac Surg 2023; 124:101281. [PMID: 36084893 DOI: 10.1016/j.jormas.2022.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/18/2022] [Accepted: 09/05/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Our aim was to report the long-term outcomes of mandibular reconstruction using CAD-CAM-designed 3D-printed porous titanium implants in patients not amenable to a free vascularized fibula flap reconstruction. METHODS The implants were designed with ProPlan CMF® 2.2 software and manufactured with a Selective Laser Melting (SLM) "layer-by-layer" 3D-printing of pure porous titanium powder beds. Primary endpoints were implant exposure and implant removal calculated using Gray's tests. Secondary endpoints were predictive factors of implant exposure and implant removal, and rates of dental rehabilitation. RESULTS Thirty-six patients were operated between 2015 and 2017 and were included in this study. Reconstruction using a porous titanium 3D-printed implant was proposed due to medical contraindication for a fibula free flap (n = 13), due to the failure of a previous fibula free flap reconstruction (n = 7), or due to refusal of a fibula free flap reconstruction by the patient (n = 16). The medical indications for mandibular reconstruction were a primary tumor requiring mandibulectomy in nine patients, mandibular osteoradionecrosis requiring mandibulectomy in nineteen patients, and secondary reconstruction in eight patients. The 2-year rates of implant exposure and implant removal were 69.4% and 52.8%. Reconstruction of the symphysis was a high-risk exposure variable (OR 30; p = 0.0003). Only one patient underwent a successful dental rehabilitation. CONCLUSION The use of a porous titanium 3D- implant for mandibular reconstruction in head and neck cancer patients resulted in high rates of implant exposure and of implant removal, notably when symphysis involvement.
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Affiliation(s)
- Fabienne Haroun
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France; BioMaps (UMR1281), University Paris Saclay, CNRS, INSERM, CEA, Orsay, France
| | - Nadia Benmoussa
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France
| | - François Bidault
- BioMaps (UMR1281), University Paris Saclay, CNRS, INSERM, CEA, Orsay, France; Department of Radiology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Nathalie Lassau
- BioMaps (UMR1281), University Paris Saclay, CNRS, INSERM, CEA, Orsay, France; Department of Radiology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France
| | - Nicolas Leymarie
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Jean-François Honart
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Fréderic Kolb
- Plastic and Reconstructive Surgery, UC San Diego, University of California, CA, United States
| | | | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France.
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Belkouchi Y, Talbot H, Lassau N, Lawrance L, Farhane S, Feki-Mkaouar R, Hadchiti J, Dawi L, Vibert J, Cournède PH, Cousteix C, Mazza C, Kind M, Italiano A, Marabelle A, Ammari S, Champiat S. Better than RECIST and faster than iRECIST: defining the Immunotherapy Progression Decision score to better manage progressive tumors on immunotherapy. Clin Cancer Res 2023; 29:1528-1534. [PMID: 36719966 DOI: 10.1158/1078-0432.ccr-22-0890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/27/2022] [Accepted: 01/27/2023] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of the study is to propose the immunotherapy progression decision (iPD) score, a practical tool based on patient features that are available at the first evaluation of immunotherapy treatment, to help oncologists decide whether to continue the treatment or switch rapidly to another therapeutic line when facing a progressive disease patient at the 1st evaluation. METHODS This retrospective study included 107 patients with progressive disease at first evaluation according to RECIST 1.1. Clinical, radiological, and biological data at baseline and 1st evaluation were analyzed. An external validation set consisting of 31 patients with similar baseline characteristics was used for the validation of the score. RESULTS Variables were analyzed in a univariate study. The iPD score was constructed using only independent variables, each considered as a worsening factor for the survival of patients. The patients were stratified in three groups: Good Prognosis (GP), Poor Prognosis (PP) and Critical Prognosis (CP). Each group showed significantly different survivals (GP: 11.4, PP: 4.4, CP: 2.3 months median OS, p<0.001 log-rank-test). Moreover, the iPD score was able to detect the pseudo-progressors better than other scores. On the validation set, CP patients had significantly worse survival than PP and GP patients (p<0.05, log-rank-test). CONCLUSION The iPD score provides oncologists with a new evaluation, computable at first-progression, to decide if treatment should be continued (for the GP group), or immediately changed for the PP and CP groups. Further validation on larger cohorts is needed to prove its efficacy in clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | - Lama Dawi
- Institut Gustave Roussy, Villejuif, France
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Couteaux V, Zhang C, Mulé S, Milot L, Valette PJ, Raynaud C, Vlachomitrou AS, Ciofolo-Veit C, Lawrance L, Belkouchi Y, Vilgrain V, Lewin M, Trillaud H, Hoeffel C, Laurent V, Ammari S, Morand E, Faucoz O, Tenenhaus A, Talbot H, Luciani A, Lassau N, Lazarus C. Synthetic MR image generation of macrotrabecular-massive hepatocellular carcinoma using generative adversarial networks. Diagn Interv Imaging 2023; 104:243-247. [PMID: 36681532 DOI: 10.1016/j.diii.2023.01.003] [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: 10/20/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this study was to develop a method for generating synthetic MR images of macrotrabecular-massive hepatocellular carcinoma (MTM-HCC). MATERIALS AND METHODS A set of abdominal MR images including fat-saturated T1-weighted images obtained during the arterial and portal venous phases of enhancement and T2-weighted images of 91 patients with MTM-HCC, and another set of MR abdominal images from 67 other patients were used. Synthetic images were obtained using a 3-step pipeline that consisted in: (i), generating a synthetic MTM-HCC tumor on a neutral background; (ii), randomly selecting a background among the 67 patients and a position inside the liver; and (iii), merging the generated tumor in the background at the specified location. Synthetic images were qualitatively evaluated by three radiologists and quantitatively assessed using a mix of 1-nearest neighbor classifier metric and Fréchet inception distance. RESULTS A set of 1000 triplets of synthetic MTM-HCC images with consistent contrasts were successfully generated. Evaluation of selected synthetic images by three radiologists showed that the method gave realistic, consistent and diversified images. Qualitative and quantitative evaluation led to an overall score of 0.64. CONCLUSION This study shows the feasibility of generating realistic synthetic MR images with very few training data, by leveraging the wide availability of liver backgrounds. Further studies are needed to assess the added value of those synthetic images for automatic diagnosis of MTM-HCC.
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Affiliation(s)
| | - Cheng Zhang
- Philips Research France, 92150 Suresnes, France
| | - Sébastien Mulé
- Medical Imaging Department, AP-HP, Henri Mondor University Hospital, 94000 Créteil, France; INSERM, U955, Team 18, 94000 Créteil, France
| | - Laurent Milot
- Body and VIR Radiology Department, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003 Lyon, France
| | - Pierre-Jean Valette
- Body and VIR Radiology Department, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003 Lyon, France
| | | | | | | | - Littisha Lawrance
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France
| | - Younes Belkouchi
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; OPIS - Optimisation Imagerie et Santé, Université Paris-Saclay, Inria, CentraleSupélec, CVN - Centre de vision numérique, 91190 Gif-Sur-Yvette, France
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord-Val de Seine, Hôpital Beaujon, 92210 Clichy, France; Université Paris Cité, CRI INSERM, 75006 Paris, France
| | - Maité Lewin
- Department of Radiology, AP-HP Hôpital Paul Brousse, 94800 Villejuif, France; Faculté de Médecine, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Hervé Trillaud
- CHU de Bordeaux, Department of Radiology, Université de Bordeaux, F-33000 Bordeaux, France
| | - Christine Hoeffel
- Department of Radiology, Reims University Hospital, 51092 Reims, France; CRESTIC, University of Reims Champagne-Ardenne, 51100 Reims, France
| | - Valérie Laurent
- Department of Radiology, Nancy University Hospital, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | - Samy Ammari
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, Université Paris-Saclay, 94800 Villejuif, France
| | - Eric Morand
- Centre National d'Etudes Spatiales, Centre Spatial de Toulouse, 31000 Toulouse, France
| | - Orphee Faucoz
- Centre National d'Etudes Spatiales, Centre Spatial de Toulouse, 31000 Toulouse, France
| | - Arthur Tenenhaus
- Université Paris-Saclay, Centrale Supélec, Laboratoire des Signaux et Systèmes, 91190 Gif-sur-Yvette, France
| | - Hugues Talbot
- OPIS - Optimisation Imagerie et Santé, Université Paris-Saclay, Inria, CentraleSupélec, CVN - Centre de vision numérique, 91190 Gif-Sur-Yvette, France
| | - Alain Luciani
- Medical Imaging Department, AP-HP, Henri Mondor University Hospital, 94000 Créteil, France; INSERM, U955, Team 18, 94000 Créteil, France
| | - Nathalie Lassau
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, Université Paris-Saclay, 94800 Villejuif, France
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Mulé S, Lawrance L, Belkouchi Y, Vilgrain V, Lewin M, Trillaud H, Hoeffel C, Laurent V, Ammari S, Morand E, Faucoz O, Tenenhaus A, Cotten A, Meder JF, Talbot H, Luciani A, Lassau N. Generative adversarial networks (GAN)-based data augmentation of rare liver cancers: The SFR 2021 Artificial Intelligence Data Challenge. Diagn Interv Imaging 2023; 104:43-48. [PMID: 36207277 DOI: 10.1016/j.diii.2022.09.005] [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: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE The 2021 edition of the Artificial Intelligence Data Challenge was organized by the French Society of Radiology together with the Centre National d'Études Spatiales and CentraleSupélec with the aim to implement generative adversarial networks (GANs) techniques to provide 1000 magnetic resonance imaging (MRI) cases of macrotrabecular-massive (MTM) hepatocellular carcinoma (HCC), a rare and aggressive subtype of HCC, generated from a limited number of real cases from multiple French centers. MATERIALS AND METHODS A dedicated platform was used by the seven inclusion centers to securely upload their anonymized MRI examinations including all three cross-sectional images (one late arterial and one portal-venous phase T1-weighted images and one fat-saturated T2-weighted image) in compliance with general data protection regulation. The quality of the database was checked by experts and manual delineation of the lesions was performed by the expert radiologists involved in each center. Multidisciplinary teams competed between October 11th, 2021 and February 13th, 2022. RESULTS A total of 91 MTM-HCC datasets of three images each were collected from seven French academic centers. Six teams with a total of 28 individuals participated in this challenge. Each participating team was asked to generate one thousand 3-image cases. The qualitative evaluation was performed by three radiologists using the Likert scale on ten randomly selected cases generated by each participant. A quantitative evaluation was also performed using two metrics, the Frechet inception distance and a leave-one-out accuracy of a 1-Nearest Neighbor algorithm. CONCLUSION This data challenge demonstrates the ability of GANs techniques to generate a large number of images from a small sample of imaging examinations of a rare malignant tumor.
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Affiliation(s)
- Sébastien Mulé
- Medical Imaging Department, AP-HP, Henri Mondor University Hospital, Créteil 94000, France; INSERM, U955, Team 18, Créteil 94000, France.
| | - Littisha Lawrance
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, Inserm, CNRS, CEA, BIOMAPS, UMR 1281, Université Paris-Saclay, Villejuif 94800, France
| | - Younes Belkouchi
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, Inserm, CNRS, CEA, BIOMAPS, UMR 1281, Université Paris-Saclay, Villejuif 94800, France; OPIS-Optimisation Imagerie et Santé, Inria, CentraleSupélec, CVN-Centre de Vision Numérique, Université Paris-Saclay, Gif-Sur-Yvette 91190, France
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Hôpital Beaujon, Clichy 92110, France; CRI INSERM, Université Paris Cité, Paris 75018, France
| | - Maité Lewin
- Department of Radiology, AP-HP Hôpital Paul Brousse, Villejuif 94800, France; Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre 94270, France
| | - Hervé Trillaud
- CHU de Bordeaux, Department of Radiology, Université de Bordeaux, Bordeaux 33000, France
| | - Christine Hoeffel
- Department of Radiology, Reims University Hospital, Reims 51092, France; CRESTIC, University of Reims Champagne-Ardenne, Reims 51100, France
| | - Valérie Laurent
- Department of Radiology, Nancy University Hospital, University of Lorraine, Vandoeuvre-ls-Nancy 54500, France
| | - Samy Ammari
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, Inserm, CNRS, CEA, BIOMAPS, UMR 1281, Université Paris-Saclay, Villejuif 94800, France; Department of Imaging, Institut Gustave Roussy, Université Paris-Saclay, Villejuif 94800, France
| | - Eric Morand
- Centre National d'Etudes Spatiales-CNES, Centre Spatial de Toulouse, Toulouse 31401 CEDEX 9 University, France
| | - Orphée Faucoz
- Centre National d'Etudes Spatiales-CNES, Centre Spatial de Toulouse, Toulouse 31401 CEDEX 9 University, France
| | - Arthur Tenenhaus
- CentraleSupélec, Laboratoire des Signaux et Systèmes, Université Paris-Saclay, Gif-sur-Yvette 91190, France
| | - Anne Cotten
- Department of Musculoskeletal Radiology, Centre de Consultations Et D'imagerie de L'appareil Locomoteur, Lille 59037, France; Lille University School of Medicine, Lille, France
| | - Jean-François Meder
- Department of Neuroimaging, Sainte-Anne Hospital, Paris 75013 University, France; Université Paris Cité, Paris 75006, France
| | - Hugues Talbot
- OPIS-Optimisation Imagerie et Santé, Inria, CentraleSupélec, CVN-Centre de Vision Numérique, Université Paris-Saclay, Gif-Sur-Yvette 91190, France
| | - Alain Luciani
- Medical Imaging Department, AP-HP, Henri Mondor University Hospital, Créteil 94000, France; INSERM, U955, Team 18, Créteil 94000, France
| | - Nathalie Lassau
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, Inserm, CNRS, CEA, BIOMAPS, UMR 1281, Université Paris-Saclay, Villejuif 94800, France; Department of Imaging, Institut Gustave Roussy, Université Paris-Saclay, Villejuif 94800, France
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12
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Sedlaczek OL, Kleesiek J, Gallagher FA, Murray J, Prinz S, Perez-Lopez R, Sala E, Caramella C, Diffetock S, Lassau N, Priest AN, Suzuki C, Vargas R, Giandini T, Vaiani M, Messina A, Blomqvist LK, Beets-Tan RGH, Oberrauch P, Schlemmer HP, Bach M. Quantification and reduction of cross-vendor variation in multicenter DWI MR imaging: results of the Cancer Core Europe imaging task force. Eur Radiol 2022; 32:8617-8628. [PMID: 35678860 PMCID: PMC9705481 DOI: 10.1007/s00330-022-08880-7] [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: 03/25/2022] [Revised: 03/25/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In the Cancer Core Europe Consortium (CCE), standardized biomarkers are required for therapy monitoring oncologic multicenter clinical trials. Multiparametric functional MRI and particularly diffusion-weighted MRI offer evident advantages for noninvasive characterization of tumor viability compared to CT and RECIST. A quantification of the inter- and intraindividual variation occurring in this setting using different hardware is missing. In this study, the MRI protocol including DWI was standardized and the residual variability of measurement parameters quantified. METHODS Phantom and volunteer measurements (single-shot T2w and DW-EPI) were performed at the seven CCE sites using the MR hardware produced by three different vendors. Repeated measurements were performed at the sites and across the sites including a traveling volunteer, comparing qualitative and quantitative ROI-based results including an explorative radiomics analysis. RESULTS For DWI/ADC phantom measurements using a central post-processing algorithm, the maximum deviation could be decreased to 2%. However, there is no significant difference compared to a decentralized ADC value calculation at the respective MRI devices. In volunteers, the measurement variation in 2 repeated scans did not exceed 11% for ADC and is below 20% for single-shot T2w in systematic liver ROIs. The measurement variation between sites amounted to 20% for ADC and < 25% for single-shot T2w. Explorative radiomics classification experiments yield better results for ADC than for single-shot T2w. CONCLUSION Harmonization of MR acquisition and post-processing parameters results in acceptable standard deviations for MR/DW imaging. MRI could be the tool in oncologic multicenter trials to overcome the limitations of RECIST-based response evaluation. KEY POINTS • Harmonizing acquisition parameters and post-processing homogenization, standardized protocols result in acceptable standard deviations for multicenter MR-DWI studies. • Total measurement variation does not to exceed 11% for ADC in repeated measurements in repeated MR acquisitions, and below 20% for an identical volunteer travelling between sites. • Radiomic classification experiments were able to identify stable features allowing for reliable discrimination of different physiological tissue samples, even when using heterogeneous imaging data.
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Affiliation(s)
- Oliver Lukas Sedlaczek
- Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
- Division of Translational Medical Oncology, National Center for Tumor Diseases Heidelberg (NCT) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
- Department of Radiology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Jens Kleesiek
- Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | | | - Jacob Murray
- Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Sebastian Prinz
- Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Raquel Perez-Lopez
- Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Evia Sala
- Department of Radiology, University of Cambridge and Cancer Research UK Cambridge Centre, Cambridge, UK
| | - Caroline Caramella
- Imaging Department, Gustave Roussy, BIOMAPS, UMR1281, INSERM, CEA, CNRS, Université Paris Saclay, Villejuif, Paris, France
| | - Sebastian Diffetock
- Imaging Department, Gustave Roussy, BIOMAPS, UMR1281, INSERM, CEA, CNRS, Université Paris Saclay, Villejuif, Paris, France
| | - Nathalie Lassau
- Imaging Department, Gustave Roussy, BIOMAPS, UMR1281, INSERM, CEA, CNRS, Université Paris Saclay, Villejuif, Paris, France
| | - Andrew N Priest
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - Chikako Suzuki
- Department of Radiation Physics and Nuclear Medicine, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - Roberto Vargas
- Department of Radiology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - Tommaso Giandini
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Vaiani
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonella Messina
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lennart K Blomqvist
- Department of Radiation Physics and Nuclear Medicine, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petra Oberrauch
- Division of Translational Medical Oncology, National Center for Tumor Diseases Heidelberg (NCT) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Division of Translational Medical Oncology, National Center for Tumor Diseases Heidelberg (NCT) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Michael Bach
- Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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13
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Belkouchi Y, Nebot-Bral L, Lawrance L, Kind M, David C, Ammari S, Cournède PH, Talbot H, Vuagnat P, Smolenschi C, Kannouche PL, Chaput N, Lassau N, Hollebecque A. Predicting immunotherapy outcomes in patients with MSI tumors using NLR and CT global tumor volume. Front Oncol 2022; 12:982790. [PMID: 36387101 PMCID: PMC9641225 DOI: 10.3389/fonc.2022.982790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/04/2022] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Anti-PD-(L)1 treatment is indicated for patients with mismatch repair-deficient (MMRD) tumors, regardless of tumor origin. However, the response rate is highly heterogeneous across MMRD tumors. The objective of the study is to find a score that predicts anti-PD-(L)1 response in patients with MMRD tumors. METHODS Sixty-one patients with various origin of MMRD tumors and treated with anti-PD-(L)1 were retrospectively included in this study. An expert radiologist annotated all tumors present at the baseline and first evaluation CT-scans for all the patients by circumscribing them on their largest axial axis (single slice), allowing us to compute an approximation of their tumor volume. In total, 2120 lesions were annotated, which led to the computation of the total tumor volume for each patient. The RECIST sum of target lesions' diameters and neutrophile-to-lymphocyte (NLR) were also reported at both examinations. These parameters were determined at baseline and first evaluation and the variation between the first evaluation and baseline was calculated, to determine a comprehensive score for overall survival (OS) and progression-free survival (PFS). RESULTS Total tumor volume at baseline was found to be significantly correlated to the OS (p-value: 0.005) and to the PFS (p-value:<0.001). The variation of the RECIST sum of target lesions' diameters, total tumor volume and NLR were found to be significantly associated to the OS (p-values:<0.001, 0.006,<0.001 respectively) and to the PFS (<0.001,<0.001, 0.007 respectively). The concordance score combining total tumor volume and NLR variation was better at stratifying patients compared to the tumor volume or NLR taken individually according to the OS (pairwise log-rank test p-values: 0.033,<0.001, 0.002) and PFS (pairwise log-rank test p-values: 0.041,<0.001, 0.003). CONCLUSION Total tumor volume appears to be a prognostic biomarker of anti-PD-(L)1 response to immunotherapy in metastatic patients with MMRD tumors. Combining tumor volume and NLR with a simple concordance score stratifies patients well according to their survival and offers a good predictive measure of response to immunotherapy.
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Affiliation(s)
- Younes Belkouchi
- Laboratoire d’Imagerie Biomédicale Multimodale Paris-Saclay (BIOMAPS), UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, Villejuif, France
- OPtimisation Imagerie et Santé (OPIS), Inria, CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
| | - Laetitia Nebot-Bral
- UMR9019 - CNRS, Intégrité du Génome et Cancer, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Littisha Lawrance
- Laboratoire d’Imagerie Biomédicale Multimodale Paris-Saclay (BIOMAPS), UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, Villejuif, France
| | - Michele Kind
- Département d’Imagerie Médicale, Institut Bergonié, Bordeaux, France
| | - Clémence David
- Laboratoire d’Imagerie Biomédicale Multimodale Paris-Saclay (BIOMAPS), UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, Villejuif, France
| | - Samy Ammari
- Laboratoire d’Imagerie Biomédicale Multimodale Paris-Saclay (BIOMAPS), UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, Villejuif, France
- Département d’Imagerie, Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Paul-Henry Cournède
- Mathématiques et Informatique pour la Complexité et les Systèmes (MICS), CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
| | - Hugues Talbot
- OPtimisation Imagerie et Santé (OPIS), Inria, CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
| | - Perrine Vuagnat
- Département d’Innovation Thérapeutique et d’Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Cristina Smolenschi
- Département d’Innovation Thérapeutique et d’Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Patricia L. Kannouche
- UMR9019 - CNRS, Intégrité du Génome et Cancer, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Nathalie Chaput
- UMR9019 - CNRS, Intégrité du Génome et Cancer, Université Paris-Saclay, Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Faculté de Pharmacie, Chatenay-Malabry, France
- Laboratoire d’Immunomonitoring en Oncologie, Gustave Roussy, Villejuif, France
| | - Nathalie Lassau
- Laboratoire d’Imagerie Biomédicale Multimodale Paris-Saclay (BIOMAPS), UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, Villejuif, France
- Département d’Imagerie, Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Antoine Hollebecque
- Département d’Innovation Thérapeutique et d’Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
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14
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Dong W, Volk A, Djaroum M, Girot C, Balleyguier C, Lebon V, Garcia G, Ammari S, Temam S, Gorphe P, Wei L, Pitre-Champagnat S, Lassau N, Bidault F. Influence of Different Measurement Methods of Arterial Input Function on Quantitative Dynamic Contrast-Enhanced MRI Parameters in Head and Neck Cancer. J Magn Reson Imaging 2022. [PMID: 36269053 DOI: 10.1002/jmri.28486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Head and neck cancer (HNC) is the sixth most prevalent cancer worldwide. Dynamic contrast-enhanced MRI (DCE-MRI) helps in diagnosis and prognosis. Quantitative DCE-MRI requires an arterial input function (AIF), which affects the values of pharmacokinetic parameters (PKP). PURPOSE To evaluate influence of four individual AIF measurement methods on quantitative DCE-MRI parameters values (Ktrans , ve , kep , and vp ), for HNC and muscle. STUDY TYPE Prospective. POPULATION A total of 34 HNC patients (23 males, 11 females, age range 24-91) FIELD STRENGTH/SEQUENCE: A 3 T; 3D SPGR gradient echo sequence with partial saturation of inflowing spins. ASSESSMENT Four AIF methods were applied: automatic AIF (AIFa) with up to 50 voxels selected from the whole FOV, manual AIF (AIFm) with four voxels selected from the internal carotid artery, both conditions without (Mc-) or with (Mc+) motion correction. Comparison endpoints were peak AIF values, PKP values in tumor and muscle, and tumor/muscle PKP ratios. STATISTICAL TESTS Nonparametric Friedman test for multiple comparisons. Nonparametric Wilcoxon test, without and with Benjamini Hochberg correction, for pairwise comparison of AIF peak values and PKP values for tumor, muscle and tumor/muscle ratio, P value ≤ 0.05 was considered statistically significant. RESULTS Peak AIF values differed significantly for all AIF methods, with mean AIFmMc+ peaks being up to 66.4% higher than those for AIFaMc+. Almost all PKP values were significantly higher for AIFa in both, tumor and muscle, up to 76% for mean Ktrans values. Motion correction effect was smaller. Considering tumor/muscle parameter ratios, most differences were not significant (0.068 ≤ Wilcoxon P value ≤ 0.8). DATA CONCLUSION We observed important differences in PKP values when using either AIFa or AIFm, consequently choice of a standardized AIF method is mandatory for DCE-MRI on HNC. From the study findings, AIFm and inflow compensation are recommended. The use of the tumor/muscle PKP ratio should be of interest for multicenter studies. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Wanxin Dong
- Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, Inserm (UMR1281), CNRS (UMR9011), CEA, France
| | - Andreas Volk
- Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, Inserm (UMR1281), CNRS (UMR9011), CEA, France
| | - Meriem Djaroum
- Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, Inserm (UMR1281), CNRS (UMR9011), CEA, France
| | - Charly Girot
- Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, Inserm (UMR1281), CNRS (UMR9011), CEA, France
| | - Corinne Balleyguier
- Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, Inserm (UMR1281), CNRS (UMR9011), CEA, France.,Department of Medical Imaging, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - Vincent Lebon
- Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, Inserm (UMR1281), CNRS (UMR9011), CEA, France
| | - Gabriel Garcia
- Department of Medical Imaging, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - Samy Ammari
- Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, Inserm (UMR1281), CNRS (UMR9011), CEA, France.,Department of Medical Imaging, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - Stéphane Temam
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - Lecong Wei
- Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, Inserm (UMR1281), CNRS (UMR9011), CEA, France
| | - Stéphanie Pitre-Champagnat
- Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, Inserm (UMR1281), CNRS (UMR9011), CEA, France
| | - Nathalie Lassau
- Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, Inserm (UMR1281), CNRS (UMR9011), CEA, France.,Department of Medical Imaging, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - François Bidault
- Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, Inserm (UMR1281), CNRS (UMR9011), CEA, France.,Department of Medical Imaging, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
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15
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Wick KD, Aggarwal NR, Curley MAQ, Fowler AA, Jaber S, Kostrubiec M, Lassau N, Laterre PF, Lebreton G, Levitt JE, Mebazaa A, Rubin E, Sinha P, Ware LB, Matthay MA. Opportunities for improved clinical trial designs in acute respiratory distress syndrome. Lancet Respir Med 2022; 10:916-924. [PMID: 36057279 DOI: 10.1016/s2213-2600(22)00294-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/02/2022] [Accepted: 07/19/2022] [Indexed: 02/08/2023]
Abstract
The acute respiratory distress syndrome (ARDS) is a common critical illness syndrome with high morbidity and mortality. There are no proven pharmacological therapies for ARDS. The current definition of ARDS is based on shared clinical characteristics but does not capture the heterogeneity in clinical risk factors, imaging characteristics, physiology, timing of onset and trajectory, and biology of the syndrome. There is increasing interest within the ARDS clinical trialist community to design clinical trials that reduce heterogeneity in the trial population. This effort must be balanced with ongoing work to craft an inclusive, global definition of ARDS, with important implications for trial design. Ultimately, the two aims-to design trials that are applicable to the diverse global ARDS population while also advancing opportunities to identify targetable traits-should coexist. In this Personal View, we recommend two primary strategies to improve future ARDS trials: the development of new methods to target treatable traits in clinical trial populations, and improvements in the representativeness of ARDS trials, with the inclusion of global populations. We emphasise that these two strategies are complementary. We also discuss how a proposed expansion of the definition of ARDS could affect the future of clinical trials.
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Affiliation(s)
- Katherine D Wick
- Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - Neil R Aggarwal
- Division of Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado, Aurora, CO, USA; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Martha A Q Curley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Alpha A Fowler
- Division of Pulmonary Disease and Critical Care, Virginia Commonwealth University, Richmond, VA, USA
| | - Samir Jaber
- University Hospital, CHU de Montpellier Hôpital Saint Eloi, Intensive Care Unit and Transplantation, Department of Anesthesiology DAR B, Montpellier, France
| | - Maciej Kostrubiec
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Nathalie Lassau
- Department of Imaging, Gustave Roussy, Université Paris Saclay, Villejuif, France; Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris Saclay, Villejuif, France
| | - Pierre François Laterre
- Intensive Care Medicine, Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Guillaume Lebreton
- Institute of Cardiometabolism and Nutrition, Inserm, UMRS 1166-ICAN, Sorbonne University, Paris, France; Cardiac Surgery Service, Institute of Cardiology, AP-HP, Sorbonne University, Paris, France
| | - Joseph E Levitt
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA, USA
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Paris, France
| | | | - Pratik Sinha
- Department of Anesthesiology, Washington University in St Louis, St Louis, MO, USA
| | - Lorraine B Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael A Matthay
- Cardiovascular Research Institute, University of California, San Francisco, CA, USA; Departments of Medicine and Anesthesia, University of California, San Francisco, CA, USA.
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16
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Schutte K, Brulport F, Harguem-Zayani S, Schiratti JB, Ghermi R, Jehanno P, Jaeger A, Alamri T, Naccache R, Haddag-Miliani L, Orsi T, Lamarque JP, Hoferer I, Lawrance L, Benatsou B, Bousaid I, Azoulay M, Verdon A, Bidault F, Balleyguier C, Aubert V, Bendjebbar E, Maussion C, Loiseau N, Schmauch B, Sefta M, Wainrib G, Clozel T, Ammari S, Lassau N. An artificial intelligence model predicts the survival of solid tumour patients from imaging and clinical data. Eur J Cancer 2022; 174:90-98. [PMID: 35985252 DOI: 10.1016/j.ejca.2022.06.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND The need for developing new biomarkers is increasing with the emergence of many targeted therapies. Artificial Intelligence (AI) algorithms have shown great promise in the medical imaging field to build predictive models. We developed a prognostic model for solid tumour patients using AI on multimodal data. PATIENTS AND METHODS Our retrospective study included examinations of patients with seven different cancer types performed between 2003 and 2017 in 17 different hospitals. Radiologists annotated all metastases on baseline computed tomography (CT) and ultrasound (US) images. Imaging features were extracted using AI models and used along with the patients' and treatments' metadata. A Cox regression was fitted to predict prognosis. Performance was assessed on a left-out test set with 1000 bootstraps. RESULTS The model was built on 436 patients and tested on 196 patients (mean age 59, IQR: 51-6, 411 men out of 616 patients). On the whole, 1147 US images were annotated with lesions delineation, and 632 thorax-abdomen-pelvis CTs (total of 301,975 slices) were fully annotated with a total of 9516 lesions. The developed model reaches an average concordance index of 0.71 (0.67-0.76, 95% CI). Using the median predicted risk as a threshold value, the model is able to significantly (log-rank test P value < 0.001) isolate high-risk patients from low-risk patients (respective median OS of 11 and 31 months) with a hazard ratio of 3.5 (2.4-5.2, 95% CI). CONCLUSION AI was able to extract prognostic features from imaging data, and along with clinical data, allows an accurate stratification of patients' prognoses.
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Affiliation(s)
| | | | - Sana Harguem-Zayani
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805, Villejuif, France
| | | | | | - Paul Jehanno
- Owkin Lab, Owkin, Inc., 10003, New York, NY, USA
| | - Alexandre Jaeger
- Owkin Lab, Owkin, Inc., 10003, New York, NY, USA; Calypse Consulting, 75002, Paris, France
| | - Talal Alamri
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805, Villejuif, France
| | - Raphaël Naccache
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805, Villejuif, France
| | - Leila Haddag-Miliani
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805, Villejuif, France
| | - Teresa Orsi
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805, Villejuif, France
| | - Jean-Philippe Lamarque
- Direction of Digital Transformation & Information Systems, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Isaline Hoferer
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805, Villejuif, France; Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805, Villejuif, France
| | - Littisha Lawrance
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805, Villejuif, France; Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805, Villejuif, France
| | - Baya Benatsou
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805, Villejuif, France; Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805, Villejuif, France
| | - Imad Bousaid
- Direction of Digital Transformation & Information Systems, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Mikael Azoulay
- Direction of Digital Transformation & Information Systems, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Antoine Verdon
- Direction of Digital Transformation & Information Systems, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - François Bidault
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805, Villejuif, France; Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805, Villejuif, France
| | - Corinne Balleyguier
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805, Villejuif, France; Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805, Villejuif, France
| | | | | | | | | | | | - Meriem Sefta
- Owkin Lab, Owkin, Inc., 10003, New York, NY, USA
| | | | | | - Samy Ammari
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805, Villejuif, France; Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805, Villejuif, France
| | - Nathalie Lassau
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805, Villejuif, France; Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805, Villejuif, France
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Schutte K, Brulport F, Harguem-Zayani S, Schiratti JB, Ghermi R, Jehanno P, Jaeger A, Alamri T, Naccache R, Haddag-Miliani L, Orsi T, Lamarque JP, Hoferer I, Lawrance L, Benatsou B, Bousaid I, Azoulay M, Verdon A, Bidault F, Balleyguier C, Aubert V, Bendjebbar E, Maussion C, Loiseau N, Schmauch B, Sefta M, Wainrib G, Clozel T, Ammari S, Lassau N. Abstract 1924: PULS-AI: A multimodal artificial intelligence model to predict survival of solid tumor patients treated with antiangiogenics. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The need for developing new biomarkers is increasing with the emergence of many targeted therapies. In this study, we used artificial intelligence (AI) to develop a multimodal model (PULS-AI) predicting the survival of solid tumor patients treated with antiangiogenic treatments.
Our retrospective, multicentric study included 616 patients with 7 different cancer types: renal cell carcinoma, colorectal carcinoma, hepatocellular carcinoma, gastrointestinal carcinoma, melanoma, breast cancer, and sarcoma. A set of 196 patients was left out of the study for validation. Clinical data including patient, treatment, and cancer metadata were collected at baseline for all patients, as well as computed tomography (CT) and ultrasound (US) images. Radiologists annotated all metastases on the CT images and the visible tumor lesion on the US images. AI models were used to extract relevant features from the regions of interest on CT and US images. In addition, handcrafted features related to the tumor burden were extracted from the annotations of all lesions on CT such as the number of lesions and the tumor burden volume per organ (lungs, liver, skull, bone, other). Finally, a Cox regression model was fitted to the set of imaging features and clinical features.
The annotation process led to 1147 annotated US images with lesions delineation and 4564 reviewed CTs, of which 989 were selected and fully annotated with a total of 9516 annotated lesions.The developed model reaches an average concordance index of 0.71 (0.67-0.75, 95% CI). Using a risk threshold of 50%, PULS-AI model is able to significantly isolate (log-rank test P-value < 0.001) high-risk patients from low-risk patients (respective median OS of 12 and 32 months) with a hazard ratio of 3.52 (2.35-5.28, 95% CI).
The results of this study show that AI algorithms are able to extract relevant information from radiology images and to aggregate data from multiple modalities to build powerful prognostic tools. Such tools may provide assistance to oncology clinicians in therapeutic decision-making.
Citation Format: Kathryn Schutte, Fabien Brulport, Sana Harguem-Zayani, Jean-Baptiste Schiratti, Ridouane Ghermi, Paul Jehanno, Alexandre Jaeger, Talal Alamri, Raphael Naccache, Leila Haddag-Miliani, Teresa Orsi, Jean-Philippe Lamarque, Isaline Hoferer, Littisha Lawrance, Baya Benatsou, Imad Bousaid, Mickael Azoulay, Antoine Verdon, François Bidault, Corinne Balleyguier, Victor Aubert, Etienne Bendjebbar, Charles Maussion, Nicolas Loiseau, Benoit Schmauch, Meriem Sefta, Gilles Wainrib, Thomas Clozel, Samy Ammari, Nathalie Lassau. PULS-AI: A multimodal artificial intelligence model to predict survival of solid tumor patients treated with antiangiogenics [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1924.
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Evin C, Lassau N, Balleyguier C, Assi T, Ammari S. Posterior Reversible Encephalopathy Syndrome Following Chemotherapy and Immune Checkpoint Inhibitor Combination in a Patient with Small-Cell Lung Cancer. Diagnostics (Basel) 2022; 12:diagnostics12061369. [PMID: 35741179 PMCID: PMC9221884 DOI: 10.3390/diagnostics12061369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 12/10/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare neurological complication that occurs following a sudden blood pressure increase. We report the case of a 64-year-old patient presenting PRES several hours after the administration of a combination of chemotherapy and a checkpoint inhibitor (carboplatin-etoposide-atezolizumab) for small-cell lung cancer. He presented consciousness disorders associated with partial epileptic seizure secondarily generalized. His arterial blood pressure was elevated and brain imaging showed multiple bilateral subcortical parietal, temporal, occipital and cerebellar T2 high signals, predominantly in the posterior region. There were no abnormal T1 signals nor bleeding but a left apparent diffusion coefficient restriction was noted. On arterial spin labelling perfusion sequences, there was an increased perfusion within the left temporo-parieto-occipital, left thalamic and right cerebellar regions. Finally, the neurological symptoms completely regressed after several days of optimal antihypertensive and antiepileptic treatment. The clinical context and radiological features, as well as the progressive resolution of the neurological symptoms, were all in favor of PRES. PRES can occur after the administration of chemotherapy and/or immunotherapy. Prompt diagnosis is crucial through a spectrum of suspicious clinical and radiological characteristics that must be rapidly recognized to quickly anticipate the optimal therapeutic strategy and avoid unnecessary complications.
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Affiliation(s)
- Cécile Evin
- Department of Imaging, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France; (C.E.); (N.L.); (C.B.)
| | - Nathalie Lassau
- Department of Imaging, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France; (C.E.); (N.L.); (C.B.)
- Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805 Villejuif, France
| | - Corinne Balleyguier
- Department of Imaging, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France; (C.E.); (N.L.); (C.B.)
- Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805 Villejuif, France
| | - Tarek Assi
- Department of Oncology, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France;
| | - Samy Ammari
- Department of Imaging, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France; (C.E.); (N.L.); (C.B.)
- Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805 Villejuif, France
- Correspondence:
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Naccache R, Belkouchi Y, Lawrance L, Benatsou B, Hadchiti J, Cournede PH, Ammari S, Talbot H, Lassau N. Prediction of Early Response to Immunotherapy: DCE-US as a New Biomarker. Cancers (Basel) 2022; 14:cancers14051337. [PMID: 35267645 PMCID: PMC8909556 DOI: 10.3390/cancers14051337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Immune checkpoint inhibitors (ICI) have revolutionized cancer care. However, assessing the efficacy of these new molecules with targeted therapeutic responses may induce too much delay when using classical biomarkers derived from morphological imaging (CT). The objective of our study is to propose fast, cost-effective, convenient, and effective biomarkers using the perfusion parameters from dynamic contrast-enhanced ultrasound (DCE-US) for the evaluation of ICI early response. In a population of 63 patients with metastatic cancer eligible for immunotherapy, we demonstrate that a decrease of more than 45% in the area under the perfusion curve (AUC) between baseline and day 21 is significantly associated with better overall survival. Thus, AUC from DCE-US looks to be a promising new biomarker for the early evaluation of response to immunotherapy. Abstract Purpose: The objective of our study is to propose fast, cost-effective, convenient, and effective biomarkers using the perfusion parameters from dynamic contrast-enhanced ultrasound (DCE-US) for the evaluation of immune checkpoint inhibitors (ICI) early response. Methods: The retrospective cohort used in this study included 63 patients with metastatic cancer eligible for immunotherapy. DCE-US was performed at baseline, day 8 (D8), and day 21 (D21) after treatment onset. A tumor perfusion curve was modeled on these three dates, and change in the seven perfusion parameters was measured between baseline, D8, and D21. These perfusion parameters were studied to show the impact of their variation on the overall survival (OS). Results: After the removal of missing or suboptimal DCE-US, the Baseline-D8, the Baseline-D21, and the D8-D21 groups included 37, 53, and 33 patients, respectively. A decrease of more than 45% in the area under the perfusion curve (AUC) between baseline and D21 was significantly associated with better OS (p = 0.0114). A decrease of any amount in the AUC between D8 and D21 was also significantly associated with better OS (p = 0.0370). Conclusion: AUC from DCE-US looks to be a promising new biomarker for fast, effective, and convenient immunotherapy response evaluation.
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Affiliation(s)
- Raphael Naccache
- Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France; (B.B.); (J.H.); (S.A.); (N.L.)
- Correspondence: (R.N.); (Y.B.)
| | - Younes Belkouchi
- CVN INRIA, CentraleSupelec, Universite Paris-Saclay, 91190 Gif-Sur-Yvette, France;
- Laboratoire d’Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France;
- Correspondence: (R.N.); (Y.B.)
| | - Littisha Lawrance
- Laboratoire d’Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France;
| | - Baya Benatsou
- Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France; (B.B.); (J.H.); (S.A.); (N.L.)
- Laboratoire d’Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France;
| | - Joya Hadchiti
- Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France; (B.B.); (J.H.); (S.A.); (N.L.)
| | - Paul-Henry Cournede
- MICS Lab, CentraleSupelec, Universite Paris-Saclay, 91190 Gif-Sur-Yvette, France;
| | - Samy Ammari
- Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France; (B.B.); (J.H.); (S.A.); (N.L.)
- Laboratoire d’Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France;
| | - Hugues Talbot
- CVN INRIA, CentraleSupelec, Universite Paris-Saclay, 91190 Gif-Sur-Yvette, France;
| | - Nathalie Lassau
- Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France; (B.B.); (J.H.); (S.A.); (N.L.)
- Laboratoire d’Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France;
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Ammari S, Bône A, Balleyguier C, Moulton E, Chouzenoux É, Volk A, Menu Y, Bidault F, Nicolas F, Robert P, Rohé MM, Lassau N. Can Deep Learning Replace Gadolinium in Neuro-Oncology?: A Reader Study. Invest Radiol 2022; 57:99-107. [PMID: 34324463 DOI: 10.1097/rli.0000000000000811] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
MATERIALS AND METHODS This monocentric retrospective study leveraged 200 multiparametric brain MRIs acquired between November 2019 and February 2020 at Gustave Roussy Cancer Campus (Villejuif, France). A total of 145 patients were included: 107 formed the training sample (55 ± 14 years, 58 women) and 38 the separate test sample (62 ± 12 years, 22 women). Patients had glioma, brain metastases, meningioma, or no enhancing lesion. T1, T2-FLAIR, diffusion-weighted imaging, low-dose, and standard-dose postcontrast T1 sequences were acquired. A deep network was trained to process the precontrast and low-dose sequences to predict "virtual" surrogate images for contrast-enhanced T1. Once trained, the deep learning method was evaluated on the test sample. The discrepancies between the predicted virtual images and the standard-dose MRIs were qualitatively and quantitatively evaluated using both automated voxel-wise metrics and a reader study, where 2 radiologists graded image qualities and marked all visible enhancing lesions. RESULTS The automated analysis of the test brain MRIs computed a structural similarity index of 87.1% ± 4.8% between the predicted virtual sequences and the reference contrast-enhanced T1 MRIs, a peak signal-to-noise ratio of 31.6 ± 2.0 dB, and an area under the curve of 96.4% ± 3.1%. At Youden's operating point, the voxel-wise sensitivity (SE) and specificity were 96.4% and 94.8%, respectively. The reader study found that virtual images were preferred to standard-dose MRI in terms of image quality (P = 0.008). A total of 91 reference lesions were identified in the 38 test T1 sequences enhanced with full dose of contrast agent. On average across readers, the brain lesion SE of the virtual images was 83% for lesions larger than 10 mm (n = 42), and the associated false detection rate was 0.08 lesion/patient. The corresponding positive predictive value of detected lesions was 92%, and the F1 score was 88%. Lesion detection performance, however, dropped when smaller lesions were included: average SE was 67% for lesions larger than 5 mm (n = 74), and 56% with all lesions included regardless of their size. The false detection rate remained below 0.50 lesion/patient in all cases, and the positive predictive value remained above 73%. The composite F1 score was 63% at worst. CONCLUSIONS The proposed deep learning method for virtual contrast-enhanced T1 brain MRI prediction showed very high quantitative performance when evaluated with standard voxel-wise metrics. The reader study demonstrated that, for lesions larger than 10 mm, good detection performance could be maintained despite a 4-fold division in contrast agent usage, unveiling a promising avenue for reducing the gadolinium exposure of returning patients. Small lesions proved, however, difficult to handle for the deep network, showing that full-dose injections remain essential for accurate first-line diagnosis in neuro-oncology.
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Affiliation(s)
| | | | | | | | - Émilie Chouzenoux
- Center for Visual Computing, CentraleSupélec, Inria, Université Paris-Saclay, Gif-sur-Yvette, France
| | | | - Yves Menu
- From the Imaging Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif
| | - François Bidault
- From the Imaging Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif
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21
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Goubet AG, Dubuisson A, Geraud A, Danlos FX, Terrisse S, Silva CAC, Drubay D, Touri L, Picard M, Mazzenga M, Silvin A, Dunsmore G, Haddad Y, Pizzato E, Ly P, Flament C, Melenotte C, Solary E, Fontenay M, Garcia G, Balleyguier C, Lassau N, Maeurer M, Grajeda-Iglesias C, Nirmalathasan N, Aprahamian F, Durand S, Kepp O, Ferrere G, Thelemaque C, Lahmar I, Fahrner JE, Meziani L, Ahmed-Belkacem A, Saïdani N, La Scola B, Raoult D, Gentile S, Cortaredona S, Ippolito G, Lelouvier B, Roulet A, Andre F, Barlesi F, Soria JC, Pradon C, Gallois E, Pommeret F, Colomba E, Ginhoux F, Kazandjian S, Elkrief A, Routy B, Miyara M, Gorochov G, Deutsch E, Albiges L, Stoclin A, Gachot B, Florin A, Merad M, Scotte F, Assaad S, Kroemer G, Blay JY, Marabelle A, Griscelli F, Zitvogel L, Derosa L. Prolonged SARS-CoV-2 RNA virus shedding and lymphopenia are hallmarks of COVID-19 in cancer patients with poor prognosis. Cell Death Differ 2021; 28:3297-3315. [PMID: 34230615 PMCID: PMC8259103 DOI: 10.1038/s41418-021-00817-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 01/30/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/13/2022] Open
Abstract
Patients with cancer are at higher risk of severe coronavirus infectious disease 2019 (COVID-19), but the mechanisms underlying virus-host interactions during cancer therapies remain elusive. When comparing nasopharyngeal swabs from cancer and noncancer patients for RT-qPCR cycle thresholds measuring acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in 1063 patients (58% with cancer), we found that malignant disease favors the magnitude and duration of viral RNA shedding concomitant with prolonged serum elevations of type 1 IFN that anticorrelated with anti-RBD IgG antibodies. Cancer patients with a prolonged SARS-CoV-2 RNA detection exhibited the typical immunopathology of severe COVID-19 at the early phase of infection including circulation of immature neutrophils, depletion of nonconventional monocytes, and a general lymphopenia that, however, was accompanied by a rise in plasmablasts, activated follicular T-helper cells, and non-naive Granzyme B+FasL+, EomeshighTCF-1high, PD-1+CD8+ Tc1 cells. Virus-induced lymphopenia worsened cancer-associated lymphocyte loss, and low lymphocyte counts correlated with chronic SARS-CoV-2 RNA shedding, COVID-19 severity, and a higher risk of cancer-related death in the first and second surge of the pandemic. Lymphocyte loss correlated with significant changes in metabolites from the polyamine and biliary salt pathways as well as increased blood DNA from Enterobacteriaceae and Micrococcaceae gut family members in long-term viral carriers. We surmise that cancer therapies may exacerbate the paradoxical association between lymphopenia and COVID-19-related immunopathology, and that the prevention of COVID-19-induced lymphocyte loss may reduce cancer-associated death.
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Affiliation(s)
- Anne-Gaëlle Goubet
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Agathe Dubuisson
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Arthur Geraud
- Gustave Roussy Cancer Campus, Villejuif, France
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Villejuif, France
| | - François-Xavier Danlos
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Safae Terrisse
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Carolina Alves Costa Silva
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Damien Drubay
- Gustave Roussy Cancer Campus, Villejuif, France
- Département de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale Oncostat, U1018, Equipe labellisée par la Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
| | - Lea Touri
- Gustave Roussy Cancer Campus, Villejuif, France
- Médecine du travail, Gustave Roussy, Villejuif, France
| | - Marion Picard
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
- Institut Pasteur, Unit Biology and Genetics of the Bacterial Cell Wall, Paris, France
- CNRS UMR2001, Paris, France
- INSERM, Equipe Avenir, Paris, France
| | - Marine Mazzenga
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Aymeric Silvin
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Garett Dunsmore
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Yacine Haddad
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Eugenie Pizzato
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Pierre Ly
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Caroline Flament
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Cléa Melenotte
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Eric Solary
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, U1287, Gustave Roussy, Villejuif, France
- Département d'Hématologie, Gustave Roussy, Villejuif, France
| | - Michaela Fontenay
- Université de Paris, Institut Cochin, Centre National de la Recherche Scientifique UMR8104, Institut National de la Santé et de la Recherche Médicale, Paris, France
- Service d'hématologie biologique, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris.Centre-Université de Paris, Paris, France
| | - Gabriel Garcia
- Gustave Roussy Cancer Campus, Villejuif, France
- Département d'Imagerie Médicale, Gustave Roussy, Villejuif, France
| | - Corinne Balleyguier
- Gustave Roussy Cancer Campus, Villejuif, France
- Département d'Imagerie Médicale, Gustave Roussy, Villejuif, France
| | - Nathalie Lassau
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Gustave Roussy Cancer Campus, Villejuif, France
- Département d'Imagerie Médicale, Gustave Roussy, Villejuif, France
- Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Paris, France
| | - Markus Maeurer
- Immunotherapy/Immunosurgery, Champalimaud foundation, Lisboa, Portugal
| | - Claudia Grajeda-Iglesias
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, Inserm U1138, Institut Universitaire de France, Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Center, Université Paris Saclay, Villejuif, France
| | - Nitharsshini Nirmalathasan
- Gustave Roussy Cancer Campus, Villejuif, France
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, Inserm U1138, Institut Universitaire de France, Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Center, Université Paris Saclay, Villejuif, France
| | - Fanny Aprahamian
- Gustave Roussy Cancer Campus, Villejuif, France
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, Inserm U1138, Institut Universitaire de France, Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Center, Université Paris Saclay, Villejuif, France
| | - Sylvère Durand
- Gustave Roussy Cancer Campus, Villejuif, France
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, Inserm U1138, Institut Universitaire de France, Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Center, Université Paris Saclay, Villejuif, France
| | - Oliver Kepp
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, Inserm U1138, Institut Universitaire de France, Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Center, Université Paris Saclay, Villejuif, France
| | - Gladys Ferrere
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Cassandra Thelemaque
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Imran Lahmar
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Jean-Eudes Fahrner
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
| | - Lydia Meziani
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, U1030, Gustave Roussy, Villejuif, France
| | | | - Nadia Saïdani
- Service de maladies infectieuses, Centre Hospitalier de Cornouaille, Quimper, France
| | - Bernard La Scola
- Aix-Marseille Université, Institut de Recherche pour le Développement, Assistance Publique - Hôpitaux de Marseille, Microbes Evolution Phylogeny and Infections, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix-Marseille Université, Institut de Recherche pour le Développement, Assistance Publique - Hôpitaux de Marseille, Microbes Evolution Phylogeny and Infections, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Stéphanie Gentile
- Aix Marseille Univ, School of medicine-La Timone Medical Campus, EA 3279: CEReSS-Health Service Research and Quality of life Center, Marseille, France
| | - Sébastien Cortaredona
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille Université, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Giuseppe Ippolito
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | | | | | - Fabrice Andre
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Gustave Roussy Cancer Campus, Villejuif, France
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, U981, Gustave Roussy, Villejuif, France
| | - Fabrice Barlesi
- Gustave Roussy Cancer Campus, Villejuif, France
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France
- Aix Marseille University, CNRS, INSERM, CRCM, Marseille, France
| | - Jean-Charles Soria
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Gustave Roussy Cancer Campus, Villejuif, France
| | - Caroline Pradon
- Gustave Roussy Cancer Campus, Villejuif, France
- Centre de ressources biologiques, ET-EXTRA, Gustave Roussy, Villejuif, France
- Département de Biologie Médicale et Pathologie Médicales, service de biochimie, Gustave Roussy, Villejuif, France
| | - Emmanuelle Gallois
- Gustave Roussy Cancer Campus, Villejuif, France
- Département de Biologie Médicale et Pathologie Médicales, service de microbiologie, Gustave Roussy, Villejuif, France
| | - Fanny Pommeret
- Gustave Roussy Cancer Campus, Villejuif, France
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France
| | - Emeline Colomba
- Gustave Roussy Cancer Campus, Villejuif, France
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France
| | - Florent Ginhoux
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Shanghai Institute of Immunology, Shangai, China
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Center, Singapore, Singapore
| | - Suzanne Kazandjian
- Cedar's Cancer Center, McGill University Healthcare Centre, Montreal, QC, Canada
| | - Arielle Elkrief
- Cedar's Cancer Center, McGill University Healthcare Centre, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Bertrand Routy
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Hematology-Oncology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Makoto Miyara
- Institut National de la Santé et de la Recherche Médicale, U1135, Centre d'Immunologie et des Maladies Infectieuses, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guy Gorochov
- Institut National de la Santé et de la Recherche Médicale, U1135, Centre d'Immunologie et des Maladies Infectieuses, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Deutsch
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, U1030, Gustave Roussy, Villejuif, France
- Département de Radiothérapie, Gustave Roussy, Villejuif, France
| | - Laurence Albiges
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Gustave Roussy Cancer Campus, Villejuif, France
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France
| | - Annabelle Stoclin
- Gustave Roussy Cancer Campus, Villejuif, France
- Service de Réanimation Médicale, Gustave Roussy, Villejuif, France
| | - Bertrand Gachot
- Gustave Roussy Cancer Campus, Villejuif, France
- Service de Pathologie Infectieuse, Gustave Roussy, Villejuif, France
| | - Anne Florin
- Gustave Roussy Cancer Campus, Villejuif, France
- Médecine du travail, Gustave Roussy, Villejuif, France
| | - Mansouria Merad
- Gustave Roussy Cancer Campus, Villejuif, France
- Service de médecine aigue d'urgence en cancérologie, Gustave Roussy, Villejuif, France
| | - Florian Scotte
- Gustave Roussy Cancer Campus, Villejuif, France
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Villejuif, France
| | - Souad Assaad
- Centre Léon Bérard, Lyon, France
- Université Claude Bernard, Lyon, France
- Unicancer, Paris, France
| | - Guido Kroemer
- Gustave Roussy Cancer Campus, Villejuif, France
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, Inserm U1138, Institut Universitaire de France, Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Center, Université Paris Saclay, Villejuif, France
- Université de Paris, Paris, France
- Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Pôle de Biologie, Hôpital Européen George Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Suzhou Institute for Systems Biology, Chinese Academy of Medical Sciences, Suzhou, China
| | - Jean-Yves Blay
- Centre Léon Bérard, Lyon, France
- Université Claude Bernard, Lyon, France
- Unicancer, Paris, France
| | - Aurélien Marabelle
- Gustave Roussy Cancer Campus, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Villejuif, France
- Center of Clinical Investigations BIOTHERIS, Gustave Roussy, Villejuif, France
| | - Frank Griscelli
- Gustave Roussy Cancer Campus, Villejuif, France
- Département de Biologie Médicale et Pathologie Médicales, service de microbiologie, Gustave Roussy, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale-UMR935/UA9, Université Paris-Saclay, Villejuif, France
- INGESTEM National IPSC Infrastructure, Université de Paris-Saclay, Villejuif, France
- Université de Paris, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
| | - Laurence Zitvogel
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France.
- Gustave Roussy Cancer Campus, Villejuif, France.
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France.
- Center of Clinical Investigations BIOTHERIS, Gustave Roussy, Villejuif, France.
| | - Lisa Derosa
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France.
- Gustave Roussy Cancer Campus, Villejuif, France.
- Institut National de la Santé et de la Recherche Médicale, UMR1015, Gustave Roussy, Villejuif, France.
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France.
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22
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Girot C, Volk A, Walczak C, Lassau N, Pitre-Champagnat S. New method for quantification of intratumoral heterogeneity: a feasibility study on K trans maps from preclinical DCE-MRI. MAGMA 2021; 34:845-857. [PMID: 34091826 DOI: 10.1007/s10334-021-00930-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 12/31/2022]
Abstract
OBJECT To develop new imaging biomarkers of therapeutic efficacy through the quantification of intratumoral microvascular heterogeneity. MATERIALS AND METHODS The described method was a combination of non-supervised clustering and extraction of intratumoral complexity features (ICF): number of non-connected objects, volume fraction. It was applied to a set of 3D DCE-MRI Ktrans maps acquired previously on tumor bearing mice prior to and on day 4 of anti-angiogenic treatment. Evolutions of ICF were compared to conventional summary statistics (CSS) and to heterogeneity related whole tumor texture features (TF) on treated (n = 9) and control (n = 6) mice. RESULTS Computed optimal number of clusters per tumor was 4. Several intratumoral features extracted from the clusters were able to monitor a therapy effect. Whereas no feature significantly changed for the control group, 6 features significantly changed for the treated group (4 ICF, 2 CSS). Among these, 5 also significantly differentiated the two groups (3 ICF, 2 CSS). TF failed in demonstrating differences within and between the two groups. DISCUSSION ICF are potential imaging biomarkers for anti-angiogenic therapy assessment. The presented method may be expected to have advantages with respect to texture analysis-based methods regarding interpretability of results and setup of standardized image analysis protocols.
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Affiliation(s)
- Charly Girot
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France.
| | - Andreas Volk
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Christine Walczak
- Institut Curie, Inserm, Université Paris-Saclay, CNRS, 91405, Orsay, France
| | - Nathalie Lassau
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France.,Département de Radiologie, Gustave Roussy, 94805, Villejuif, France
| | - Stéphanie Pitre-Champagnat
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
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23
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Ammari S, Sallé de Chou R, Balleyguier C, Chouzenoux E, Touat M, Quillent A, Dumont S, Bockel S, Garcia GCTE, Elhaik M, Francois B, Borget V, Lassau N, Khettab M, Assi T. A Predictive Clinical-Radiomics Nomogram for Survival Prediction of Glioblastoma Using MRI. Diagnostics (Basel) 2021; 11:diagnostics11112043. [PMID: 34829395 PMCID: PMC8624566 DOI: 10.3390/diagnostics11112043] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 01/01/2023] Open
Abstract
Glioblastoma (GBM) is the most common and aggressive primary brain tumor in adult patients with a median survival of around one year. Prediction of survival outcomes in GBM patients could represent a huge step in treatment personalization. The objective of this study was to develop machine learning (ML) algorithms for survival prediction of GBM patient. We identified a radiomic signature on a training-set composed of data from the 2019 BraTS challenge (210 patients) from MRI retrieved at diagnosis. Then, using this signature along with the age of the patients for training classification models, we obtained on test-sets AUCs of 0.85, 0.74 and 0.58 (0.92, 0.88 and 0.75 on the training-sets) for survival at 9-, 12- and 15-months, respectively. This signature was then validated on an independent cohort of 116 GBM patients with confirmed disease relapse for the prediction of patients surviving less or more than the median OS of 22 months. Our model insured an AUC of 0.71 (0.65 on train). The Kaplan–Meier method showed significant OS difference between groups (log-rank p = 0.05). These results suggest that radiomic signatures may improve survival outcome predictions in GBM thus creating a solid clinical tool for tailoring therapy in this population.
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Affiliation(s)
- Samy Ammari
- Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805 Villejuif, France; (S.A.); (C.B.); (M.E.); (B.F.); (V.B.); (N.L.)
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805 Villejuif, France;
| | - Raoul Sallé de Chou
- Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805 Villejuif, France; (S.A.); (C.B.); (M.E.); (B.F.); (V.B.); (N.L.)
- Correspondence:
| | - Corinne Balleyguier
- Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805 Villejuif, France; (S.A.); (C.B.); (M.E.); (B.F.); (V.B.); (N.L.)
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805 Villejuif, France;
| | - Emilie Chouzenoux
- Centre de Vision Numérique, OPIS, CentraleSupélec, Inria, Université Paris-Saclay, 91190 Gif-sur-Yvette, France; (E.C.); (A.Q.)
| | - Mehdi Touat
- Service de Neurologie 2-Mazarin, AP-HP Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, 75013 Paris, France;
- Institut du Cerveau et de la Moelle Epinière, CNRS, UMR S 1127, Inserm, Sorbonne Université, 75013 Paris, France
| | - Arnaud Quillent
- Centre de Vision Numérique, OPIS, CentraleSupélec, Inria, Université Paris-Saclay, 91190 Gif-sur-Yvette, France; (E.C.); (A.Q.)
| | - Sarah Dumont
- Department of oncology, Gustave Roussy, Université Paris Saclay, 94805 Villejuif, France; (S.D.); (T.A.)
| | - Sophie Bockel
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 94800 Villejuif, France;
| | | | - Mickael Elhaik
- Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805 Villejuif, France; (S.A.); (C.B.); (M.E.); (B.F.); (V.B.); (N.L.)
| | - Bidault Francois
- Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805 Villejuif, France; (S.A.); (C.B.); (M.E.); (B.F.); (V.B.); (N.L.)
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805 Villejuif, France;
| | - Valentin Borget
- Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805 Villejuif, France; (S.A.); (C.B.); (M.E.); (B.F.); (V.B.); (N.L.)
| | - Nathalie Lassau
- Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94805 Villejuif, France; (S.A.); (C.B.); (M.E.); (B.F.); (V.B.); (N.L.)
- Department of Imaging, Gustave Roussy, Université Paris Saclay, 94805 Villejuif, France;
| | - Mohamed Khettab
- Medical Oncology Unit, CHU de La Réunion, Université de La Réunion, 97410 Saint Pierre, France;
| | - Tarek Assi
- Department of oncology, Gustave Roussy, Université Paris Saclay, 94805 Villejuif, France; (S.D.); (T.A.)
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24
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Fournier L, Costaridou L, Bidaut L, Michoux N, Lecouvet FE, de Geus-Oei LF, Boellaard R, Oprea-Lager DE, Obuchowski NA, Caroli A, Kunz WG, Oei EH, O'Connor JPB, Mayerhoefer ME, Franca M, Alberich-Bayarri A, Deroose CM, Loewe C, Manniesing R, Caramella C, Lopci E, Lassau N, Persson A, Achten R, Rosendahl K, Clement O, Kotter E, Golay X, Smits M, Dewey M, Sullivan DC, van der Lugt A, deSouza NM, European Society Of Radiology. Incorporating radiomics into clinical trials: expert consensus endorsed by the European Society of Radiology on considerations for data-driven compared to biologically driven quantitative biomarkers. Eur Radiol 2021; 31:6001-6012. [PMID: 33492473 PMCID: PMC8270834 DOI: 10.1007/s00330-020-07598-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [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: 07/14/2020] [Revised: 11/16/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023]
Abstract
Existing quantitative imaging biomarkers (QIBs) are associated with known biological tissue characteristics and follow a well-understood path of technical, biological and clinical validation before incorporation into clinical trials. In radiomics, novel data-driven processes extract numerous visually imperceptible statistical features from the imaging data with no a priori assumptions on their correlation with biological processes. The selection of relevant features (radiomic signature) and incorporation into clinical trials therefore requires additional considerations to ensure meaningful imaging endpoints. Also, the number of radiomic features tested means that power calculations would result in sample sizes impossible to achieve within clinical trials. This article examines how the process of standardising and validating data-driven imaging biomarkers differs from those based on biological associations. Radiomic signatures are best developed initially on datasets that represent diversity of acquisition protocols as well as diversity of disease and of normal findings, rather than within clinical trials with standardised and optimised protocols as this would risk the selection of radiomic features being linked to the imaging process rather than the pathology. Normalisation through discretisation and feature harmonisation are essential pre-processing steps. Biological correlation may be performed after the technical and clinical validity of a radiomic signature is established, but is not mandatory. Feature selection may be part of discovery within a radiomics-specific trial or represent exploratory endpoints within an established trial; a previously validated radiomic signature may even be used as a primary/secondary endpoint, particularly if associations are demonstrated with specific biological processes and pathways being targeted within clinical trials. KEY POINTS: • Data-driven processes like radiomics risk false discoveries due to high-dimensionality of the dataset compared to sample size, making adequate diversity of the data, cross-validation and external validation essential to mitigate the risks of spurious associations and overfitting. • Use of radiomic signatures within clinical trials requires multistep standardisation of image acquisition, image analysis and data mining processes. • Biological correlation may be established after clinical validation but is not mandatory.
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Affiliation(s)
- Laure Fournier
- PARCC, INSERM, Radiology Department, AP-HP, Hopital europeen Georges Pompidou, Université de Paris, F-75015, Paris, France
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
| | - Lena Costaridou
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- School of Medicine, University of Patras, University Campus, Rio, 26 500, Patras, Greece
| | - Luc Bidaut
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- College of Science, University of Lincoln, Lincoln, LN6 7TS, UK
| | - Nicolas Michoux
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), B-1200, Brussels, Belgium
| | - Frederic E Lecouvet
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), B-1200, Brussels, Belgium
| | - Lioe-Fee de Geus-Oei
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
| | - Ronald Boellaard
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology & Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centers (VU University), Amsterdam, The Netherlands
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, IL, USA
| | - Daniela E Oprea-Lager
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology & Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centers (VU University), Amsterdam, The Netherlands
| | - Nancy A Obuchowski
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, IL, USA
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Anna Caroli
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Biomedical Engineering, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Wolfgang G Kunz
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Edwin H Oei
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - James P B O'Connor
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Marius E Mayerhoefer
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Manuela Franca
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology, Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas de Abel Salazar, University of Porto, Porto, Portugal
| | - Angel Alberich-Bayarri
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Quantitative Imaging Biomarkers in Medicine (QUIBIM), Valencia, Spain
| | - Christophe M Deroose
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Christian Loewe
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Division of Cardiovascular and Interventional Radiology, Dept. for Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rashindra Manniesing
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Caroline Caramella
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Radiology Department, Hôpital Marie Lannelongue, Institut d'Oncologie Thoracique, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Egesta Lopci
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Nuclear Medicine, Humanitas Clinical and Research Hospital - IRCCS, Rozzano, MI, Italy
| | - Nathalie Lassau
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, IL, USA
- Imaging Department, Gustave Roussy Cancer Campus Grand, Paris, UMR 1281, INSERM, CNRS, CEA, Universite Paris-Saclay, Saint-Aubin, France
| | - Anders Persson
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology, and Department of Health, Medicine and Caring Sciences, Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Rik Achten
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology and Medical Imaging, Ghent University Hospital, Gent, Belgium
| | - Karen Rosendahl
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Olivier Clement
- PARCC, INSERM, Radiology Department, AP-HP, Hopital europeen Georges Pompidou, Université de Paris, F-75015, Paris, France
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
| | - Elmar Kotter
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology, University Medical Center Freiburg, Freiburg, Germany
| | - Xavier Golay
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, IL, USA
- Queen Square Institute of Neurology, University College London, London, UK
| | - Marion Smits
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marc Dewey
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel C Sullivan
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, IL, USA
- Dept. of Radiology, Duke University, 311 Research Dr, Durham, NC, 27710, USA
| | - Aad van der Lugt
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Nandita M deSouza
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria.
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium.
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, IL, USA.
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK.
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Lassau N, Bousaid I, Chouzenoux E, Verdon A, Balleyguier C, Bidault F, Mousseaux E, Harguem-Zayani S, Gaillandre L, Bensalah Z, Doutriaux-Dumoulin I, Monroc M, Haquin A, Ceugnart L, Bachelle F, Charlot M, Thomassin-Naggara I, Fourquet T, Dapvril H, Orabona J, Chamming's F, El Haik M, Zhang-Yin J, Guillot MS, Ohana M, Caramella T, Diascorn Y, Airaud JY, Cuingnet P, Gencer U, Lawrance L, Luciani A, Cotten A, Meder JF. Three artificial intelligence data challenges based on CT and ultrasound. Diagn Interv Imaging 2021; 102:669-674. [PMID: 34312111 DOI: 10.1016/j.diii.2021.06.005] [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] [Received: 05/11/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE The 2020 edition of these Data Challenges was organized by the French Society of Radiology (SFR), from September 28 to September 30, 2020. The goals were to propose innovative artificial intelligence solutions for the current relevant problems in radiology and to build a large database of multimodal medical images of ultrasound and computed tomography (CT) on these subjects from several French radiology centers. MATERIALS AND METHODS This year the attempt was to create data challenge objectives in line with the clinical routine of radiologists, with less preprocessing of data and annotation, leaving a large part of the preprocessing task to the participating teams. The objectives were proposed by the different organizations depending on their core areas of expertise. A dedicated platform was used to upload the medical image data, to automatically anonymize the uploaded data. RESULTS Three challenges were proposed including classification of benign or malignant breast nodules on ultrasound examinations, detection and contouring of pathological neck lymph nodes from cervical CT examinations and classification of calcium score on coronary calcifications from thoracic CT examinations. A total of 2076 medical examinations were included in the database for the three challenges, in three months, by 18 different centers, of which 12% were excluded. The 39 participants were divided into six multidisciplinary teams among which the coronary calcification score challenge was solved with a concordance index > 95%, and the other two with scores of 67% (breast nodule classification) and 63% (neck lymph node calcifications).
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Affiliation(s)
- Nathalie Lassau
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay. BIOMAPS, UMR 1281. Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France.
| | - Imad Bousaid
- Direction de la Transformation Numérique et des Systèmes d'Information, Institut Gustave Roussy, 94800 Villejuif, France
| | | | - Antoine Verdon
- Direction de la Transformation Numérique et des Systèmes d'Information, Institut Gustave Roussy, 94800 Villejuif, France
| | - Corinne Balleyguier
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay. BIOMAPS, UMR 1281. Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
| | - François Bidault
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay. BIOMAPS, UMR 1281. Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
| | - Elie Mousseaux
- Unité Fonctionnelle d'Imagerie Cardiovasculaire Non Invasive, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Sana Harguem-Zayani
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay. BIOMAPS, UMR 1281. Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
| | - Loic Gaillandre
- Centre Libéral d'Imagerie Médicale Agglomération Lille, 59800 Lille, France
| | - Zoubir Bensalah
- Department of Radiology, Centre Hospitalier St Jean, 66000 Perpignan, France
| | | | - Michèle Monroc
- Department of Radiology, Clinique Saint Antoine, 76230 Bois-Guillaume, France
| | - Audrey Haquin
- Department of Radiology, Hôpital de la Croix-Rousse - HCL, 69004 Lyon, France
| | - Luc Ceugnart
- Department of Radiology, Centre Oscar Lambret, 59000 Lille, France
| | | | - Mathilde Charlot
- Department of Radiology, Hôpital Lyon Sud - HCL, 69310 Pierre-Bénite, France
| | | | - Tiphaine Fourquet
- Department of Radiology, Centre Hospitalier Universitaire de Lille, 59000 Lille, France
| | - Héloise Dapvril
- Service d'Imagerie de la Femme, Centre Hospitalier de Valenciennes, 59300 Valenciennes, France
| | - Joseph Orabona
- Department of Radiology, Centre Hospitalier de Bastia, 20600 Bastia, France
| | | | - Mickael El Haik
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay. BIOMAPS, UMR 1281. Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
| | - Jules Zhang-Yin
- Department of Radiology, Hôpital Tenon, AP-HP, 75020 Paris, France
| | - Marc-Samir Guillot
- Unité Fonctionnelle d'Imagerie Cardiovasculaire Non Invasive, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Mickaël Ohana
- Department of Radiology, Centre Hospitalier Universitaire de Strasbourg, 67200 Strasbourg, France
| | - Thomas Caramella
- Department of Radiology, Institut Arnault Tzanck, 06700 Saint-Laurent du Var, France
| | - Yann Diascorn
- Department of Radiology, Institut Arnault Tzanck, 06700 Saint-Laurent du Var, France
| | | | - Philippe Cuingnet
- Department of Radiology, Centre Hospitalier de Douai, 59507 Douai, France
| | - Umit Gencer
- Unité Fonctionnelle d'Imagerie Cardiovasculaire Non Invasive, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Littisha Lawrance
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay. BIOMAPS, UMR 1281. Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France
| | - Alain Luciani
- Collège des Enseignants de Radiologie de France, 75013 Paris, France; Department of Radiology, Centre Hospitalier Henri Mondor, 94000 Créteil, France
| | - Anne Cotten
- Musculoskeletal Imaging Department, Lille Regional University Hospital, 59000 Lille, France
| | - Jean-François Meder
- Department of Neuroradiology, Centre Hospitalier Sainte-Anne, 75014 Paris, France; Université de Paris, Faculté de Médecine, 75006 Paris, France
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Gogin N, Viti M, Nicodème L, Ohana M, Talbot H, Gencer U, Mekukosokeng M, Caramella T, Diascorn Y, Airaud JY, Guillot MS, Bensalah Z, Dam Hieu C, Abdallah B, Bousaid I, Lassau N, Mousseaux E. Automatic coronary artery calcium scoring from unenhanced-ECG-gated CT using deep learning. Diagn Interv Imaging 2021; 102:683-690. [PMID: 34099435 DOI: 10.1016/j.diii.2021.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of this study was to develop and evaluate an algorithm that can automatically estimate the amount of coronary artery calcium (CAC) from unenhanced electrocardiography (ECG)-gated computed tomography (CT) cardiac volume acquisitions by using convolutional neural networks (CNN). MATERIALS AND METHODS The method used a set of five CNN with three-dimensional (3D) U-Net architecture trained on a database of 783 CT examinations to detect and segment coronary artery calcifications in a 3D volume. The Agatston score, the conventional CAC scoring, was then computed slice by slice from the resulting segmentation mask and compared to the ground truth manually estimated by radiologists. The quality of the estimation was assessed with the concordance index (C-index) on CAC risk category on a separate testing set of 98 independent CT examinations. RESULTS The final model yielded a C-index of 0.951 on the testing set. The remaining errors of the method were mainly observed on small-size and/or low-density calcifications, or calcifications located near the mitral valve or ring. CONCLUSION The deep learning-based method proposed here to compute automatically the CAC score from unenhanced-ECG-gated cardiac CT is fast, robust and yields accuracy similar to those of other artificial intelligence methods, which could improve workflow efficiency, eliminating the time spent on manually selecting coronary calcifications to compute the Agatston score.
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Affiliation(s)
| | - Mario Viti
- General Electric Healthcare, 78530 Buc, France; CentraleSupélec, Université Paris-Saclay, CentraleSupélec, Inria, 91192 Gif-sur-Yvette, France
| | | | - Mickaël Ohana
- Service de Radiologie, CHU de Strasbourg, 67000 Strasbourg, France
| | - Hugues Talbot
- CentraleSupélec, Université Paris-Saclay, CentraleSupélec, Inria, 91192 Gif-sur-Yvette, France
| | - Umit Gencer
- Radiology Department, AP-HP, Hôpital Européen Georges Pompidou, Georges Pompidou, Université de Paris, PARCC, INSERM, 75015 Paris, France
| | | | | | - Yann Diascorn
- Institut Arnault Tzanck, 06123 Saint-Laurent-du-Var, France
| | - Jean-Yves Airaud
- Department of Radiology, Polyclinique Inkermann, 79000 Niort, France
| | - Marc-Samir Guillot
- Radiology Department, AP-HP, Hôpital Européen Georges Pompidou, Georges Pompidou, Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Zoubir Bensalah
- Department of Radiology, Centre Hospitalier de Perpignan, 66000 Perpignan, France
| | | | | | - Imad Bousaid
- Imaging Department, Gustave-Roussy, Université Paris-Saclay, 94076 Villejuif, France
| | - Nathalie Lassau
- Imaging Department, Gustave-Roussy, Université Paris-Saclay, 94076 Villejuif, France; Biomaps, UMR 1281 INSERM, CEA, CNRS, Université Paris-Saclay, 94076 Villejuif, France
| | - Elie Mousseaux
- Radiology Department, AP-HP, Hôpital Européen Georges Pompidou, Georges Pompidou, Université de Paris, PARCC, INSERM, 75015 Paris, France
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Ammari S, Sallé de Chou R, Elhaik M, Quillent A, Chouzenoux E, Balleyguier C, Lassau N. Identification de biomarqueurs prédisant la survie de patients atteints de glioblastomes et traités au Bevacizumab. J Neuroradiol 2021. [DOI: 10.1016/j.neurad.2021.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ammari S, Quillent A, Elhaik M, Sallé de Chou R, Lassau N, Chouzenoux É, Balleyguier C. Analyse automatique de caractéristiques radiomiques pour le diagnostic des tumeurs de la glande parotide. J Neuroradiol 2021. [DOI: 10.1016/j.neurad.2021.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Courot A, Cabrera DLF, Gogin N, Gaillandre L, Rico G, Zhang-Yin J, Elhaik M, Bidault F, Bousaid I, Lassau N. Automatic cervical lymphadenopathy segmentation from CT data using deep learning. Diagn Interv Imaging 2021; 102:675-681. [PMID: 34023232 DOI: 10.1016/j.diii.2021.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study was to develop a fast and automatic algorithm to detect and segment lymphadenopathy from head and neck computed tomography (CT) examination. MATERIALS AND METHODS An ensemble of three convolutional neural networks (CNNs) based on a U-Net architecture were trained to segment the lymphadenopathies in a fully supervised framework. The resulting predictions were assessed using the Dice similarity coefficient (DSC) on examinations presenting one or more adenopathies. On examinations without adenopathies, the score was given by the formula M/(M+A) where M was the mean adenopathy volume per patient and A the volume segmented by the algorithm. The networks were trained on 117 annotated CT acquisitions. RESULTS The test set included 150 additional CT acquisitions unseen during the training. The performance on the test set yielded a mean score of 0.63. CONCLUSION Despite limited available data and partial annotations, our CNN based approach achieved promising results in the task of cervical lymphadenopathy segmentation. It has the potential to bring precise quantification to the clinical workflow and to assist the clinician in the detection task.
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Affiliation(s)
| | - Diana L F Cabrera
- General Electric Healthcare, 78530 Buc, France; Université de Reims Champagne Ardenne, CReSTIC EA 3804, 51097 Reims, France
| | | | - Loic Gaillandre
- Centre Libéral d'Imagerie Médicale de l'Agglomération Lilloise, 59000 Lille, France
| | | | | | | | - François Bidault
- Department of Radiology, Institut Gustave Roussy, 94800 Villejuif, France; Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay. BIOMAPS, UMR 1281. Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France
| | - Imad Bousaid
- Institut Gustave Roussy, 94800 Villejuif, France
| | - Nathalie Lassau
- Department of Radiology, Institut Gustave Roussy, 94800 Villejuif, France; Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay. BIOMAPS, UMR 1281. Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France
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Courcier J, De La Taille A, Lassau N, Ingels A. Comorbidity and frailty assessment in renal cell carcinoma patients. World J Urol 2021; 39:2831-2841. [PMID: 33616708 DOI: 10.1007/s00345-021-03632-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/13/2020] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Renal cell carcinoma (RCC) incidence has considerably increased during the last decades without any real impact on age-standardized mortality. It questions the relevance of aggressive treatments carrying potential side effects. Conservative management should be considered for frail patients. Comorbidity and frailty assessment in RCC patients is paramount before engaging a treatment. METHODS Narrative, non-systematic review based on PubMed and EMBASE search with the terms "renal neoplasm", "elderly, frail", "comorbidities", "active surveillance", "metastatic". The selection was restricted to articles written in English. RESULTS Comorbidity and frailty assessment go along with the cancer-specific aggressivity and intervention risks assessment. In localized disease, several standardized algorithms offer patient health evaluation to define how suitable the patient would be for curative treatment. The pre-operative American Society of Anesthesiologists and the age-adjusted Charlson's scores are the most widely used. At the metastatic stage, drug combinations based on immunotherapies and targeted therapies improved cancer outcomes at the price of significant toxicities. Frail patients are not always suitable for such strategies. Commonly used scores like the International Metastatic RCC Database Consortium or Memorial Sloan Kettering Cancer Center integrate features to define patients' risk groups, more specifically the Karnofsky Performance Score is an easy way to document the frailty. CONCLUSIONS Comorbidity and frailty have to be assessed at any stage of the RCC disease based on a standardized scoring system to define the most suitable treatment strategy ranging from surveillance to aggressive treatment.
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Affiliation(s)
- Jean Courcier
- Department of Urology, University Hospital Henri Mondor, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
- Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France
| | - Alexandre De La Taille
- Department of Urology, University Hospital Henri Mondor, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Nathalie Lassau
- Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France
- Department of Imaging, Institut Gustave Roussy, Villejuif, France
| | - Alexandre Ingels
- Department of Urology, University Hospital Henri Mondor, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
- Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France.
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31
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Lassau N, Ammari S, Chouzenoux E, Gortais H, Herent P, Devilder M, Soliman S, Meyrignac O, Talabard MP, Lamarque JP, Dubois R, Loiseau N, Trichelair P, Bendjebbar E, Garcia G, Balleyguier C, Merad M, Stoclin A, Jegou S, Griscelli F, Tetelboum N, Li Y, Verma S, Terris M, Dardouri T, Gupta K, Neacsu A, Chemouni F, Sefta M, Jehanno P, Bousaid I, Boursin Y, Planchet E, Azoulay M, Dachary J, Brulport F, Gonzalez A, Dehaene O, Schiratti JB, Schutte K, Pesquet JC, Talbot H, Pronier E, Wainrib G, Clozel T, Barlesi F, Bellin MF, Blum MGB. Integrating deep learning CT-scan model, biological and clinical variables to predict severity of COVID-19 patients. Nat Commun 2021; 12:634. [PMID: 33504775 PMCID: PMC7840774 DOI: 10.1038/s41467-020-20657-4] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/09/2020] [Indexed: 12/11/2022] Open
Abstract
The SARS-COV-2 pandemic has put pressure on intensive care units, so that identifying predictors of disease severity is a priority. We collect 58 clinical and biological variables, and chest CT scan data, from 1003 coronavirus-infected patients from two French hospitals. We train a deep learning model based on CT scans to predict severity. We then construct the multimodal AI-severity score that includes 5 clinical and biological variables (age, sex, oxygenation, urea, platelet) in addition to the deep learning model. We show that neural network analysis of CT-scans brings unique prognosis information, although it is correlated with other markers of severity (oxygenation, LDH, and CRP) explaining the measurable but limited 0.03 increase of AUC obtained when adding CT-scan information to clinical variables. Here, we show that when comparing AI-severity with 11 existing severity scores, we find significantly improved prognosis performance; AI-severity can therefore rapidly become a reference scoring approach.
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Affiliation(s)
- Nathalie Lassau
- Imaging Department, Gustave Roussy, Université Paris -Saclay, Villejuif, 94805, France
- Biomaps, UMR 1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, 94805, France
| | - Samy Ammari
- Imaging Department, Gustave Roussy, Université Paris -Saclay, Villejuif, 94805, France
- Biomaps, UMR 1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, 94805, France
| | - Emilie Chouzenoux
- Centre de Vision Numérique, Université Paris-Saclay, CentraleSupélec, Inria, 91190, Gif-sur-Yvette, France
| | - Hugo Gortais
- Radiology Department, Hôpital de Bicêtre - AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | | | - Matthieu Devilder
- Radiology Department, Hôpital de Bicêtre - AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Samer Soliman
- Radiology Department, Hôpital de Bicêtre - AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Olivier Meyrignac
- Radiology Department, Hôpital de Bicêtre - AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Marie-Pauline Talabard
- Radiology Department, Hôpital de Bicêtre - AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jean-Philippe Lamarque
- Imaging Department, Gustave Roussy, Université Paris -Saclay, Villejuif, 94805, France
- Biomaps, UMR 1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, 94805, France
| | | | | | | | | | - Gabriel Garcia
- Imaging Department, Gustave Roussy, Université Paris -Saclay, Villejuif, 94805, France
| | - Corinne Balleyguier
- Imaging Department, Gustave Roussy, Université Paris -Saclay, Villejuif, 94805, France
- Biomaps, UMR 1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, 94805, France
| | - Mansouria Merad
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Université Paris-Saclay, Villejuif, 94805, France
| | - Annabelle Stoclin
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Université Paris-Saclay, Villejuif, 94805, France
| | | | - Franck Griscelli
- Département de Biologie, Gustave Roussy, Université Paris-Saclay, Villejuif, 94805, France
| | - Nicolas Tetelboum
- Imaging Department, Gustave Roussy, Université Paris -Saclay, Villejuif, 94805, France
| | - Yingping Li
- Biomaps, UMR 1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, 94805, France
- Centre de Vision Numérique, Université Paris-Saclay, CentraleSupélec, Inria, 91190, Gif-sur-Yvette, France
| | - Sagar Verma
- Centre de Vision Numérique, Université Paris-Saclay, CentraleSupélec, Inria, 91190, Gif-sur-Yvette, France
| | - Matthieu Terris
- Centre de Vision Numérique, Université Paris-Saclay, CentraleSupélec, Inria, 91190, Gif-sur-Yvette, France
| | - Tasnim Dardouri
- Centre de Vision Numérique, Université Paris-Saclay, CentraleSupélec, Inria, 91190, Gif-sur-Yvette, France
| | - Kavya Gupta
- Centre de Vision Numérique, Université Paris-Saclay, CentraleSupélec, Inria, 91190, Gif-sur-Yvette, France
| | - Ana Neacsu
- Centre de Vision Numérique, Université Paris-Saclay, CentraleSupélec, Inria, 91190, Gif-sur-Yvette, France
| | - Frank Chemouni
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Université Paris-Saclay, Villejuif, 94805, France
| | | | | | - Imad Bousaid
- Direction de la Transformation Numérique et des Systèmes d'Information, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Yannick Boursin
- Direction de la Transformation Numérique et des Systèmes d'Information, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Emmanuel Planchet
- Direction de la Transformation Numérique et des Systèmes d'Information, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Mikael Azoulay
- Direction de la Transformation Numérique et des Systèmes d'Information, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | | | | | | | | | | | | | - Jean-Christophe Pesquet
- Centre de Vision Numérique, Université Paris-Saclay, CentraleSupélec, Inria, 91190, Gif-sur-Yvette, France
| | - Hugues Talbot
- Centre de Vision Numérique, Université Paris-Saclay, CentraleSupélec, Inria, 91190, Gif-sur-Yvette, France
| | | | | | | | - Fabrice Barlesi
- Département d'Oncologie Médicale, Gustave Roussy, Université Paris-Saclay, Villejuif, 94805, France
| | - Marie-France Bellin
- Radiology Department, Hôpital de Bicêtre - AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
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Kas B, Talbot H, Ferrara R, Richard C, Lamarque JP, Pitre-Champagnat S, Planchard D, Balleyguier C, Besse B, Mezquita L, Lassau N, Caramella C. Clarification of Definitions of Hyperprogressive Disease During Immunotherapy for Non-Small Cell Lung Cancer. JAMA Oncol 2021; 6:1039-1046. [PMID: 32525513 DOI: 10.1001/jamaoncol.2020.1634] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Hyperprogressive disease (HPD) is an aggressive pattern of progression reported for patients treated with programmed cell death 1 (PD-1)/programmed cell death 1 ligand (PD-L1) inhibitors as a single agent in several studies. However, the use of different definitions of HPD introduces the risk of describing different tumoral behaviors. Objective To assess the accuracy of each HPD definition to identify the frequency of HPD and the association with poorer outcomes of immune-checkpoint inhibitor (ICI) treatment in patients with advanced non-small cell lung cancer (NSCLC) and to provide an optimized and homogenized definition based on all previous criteria for identifying HPD. Design, Setting, and Participants This retrospective cohort study included 406 patients with advanced NSCLC treated with PD-1/PD-L1 inhibitors from November 1, 2012, to April 5, 2017, in 8 French institutions. Measurable lesions were defined using the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria on at least 2 computed tomographic scans before the initiation of ICI therapy and 1 computed tomographic scan during treatment. Data were analyzed from November 1, 2012, to August 1, 2019. Exposures Advanced NSCLC and treatment with PD-1/PD-L1 inhibitors. Main Outcomes and Measures Association of the definition with the related incidence and the HPD subset constitution and the association between each HPD definition and overall survival. All dynamic indexes used in the previous proposed definitions, such as the tumor growth rate (TGR) or tumor growth kinetics (TGK), were calculated before and during treatment. Results Among the 406 patients with NSCLC included in the analysis (259 male [63.8%]; median age at start of ICI treatment, 64 [range, 30-91] years), the different definitions resulted in incidences of the HPD phenomenon varying from 5.4% (n = 22; definition based on a progression pace >2-fold and a time to treatment failure of <2 months) to 18.5% (n = 75; definition based on the TGR ratio). The concordance between these different definitions (using the Jaccard similarity index) varied from 33.3% to 69.3%. For every definition, HPD was associated with poorer survival (range of median overall survival, 3.4 [95% CI, 1.9-8.4] to 6.0 [95% CI, 3.7-9.4] months). The difference between TGR before and during therapy (ΔTGR) was the most correlated with poor overall survival with an initial plateau for a larger number of patients and a slower increase, and it had the highest ability to distinguish patients with HPD from those with progressive disease not classified as HPD. In addition, an optimal threshold of ΔTGR of greater than 100 was identified for this distinction. Conclusions and Relevance The findings of this retrospective cohort study of patients with NSCLC suggest that the previous 5 definitions of HPD were not associated with the same tumor behavior. A new definition, based on ΔTGR of greater than 100, appeared to be associated with the characteristics expected with HPD (increase of the tumor kinetics and poor survival). Additional studies on larger groups of patients are necessary to confirm the accuracy and validate this proposed definition.
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Affiliation(s)
- Baptiste Kas
- UMR (Unité Mixte de Recherche) 1281, Université Paris-Saclay, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Commissariat à l'énergie Atomique et Aux Énergies Alternatives, Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, Villejuif, France
| | - Hugues Talbot
- Center for Visual Computing, CentraleSupelec, Inria, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Roberto Ferrara
- Department of Medical Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy
| | - Colombe Richard
- UMR (Unité Mixte de Recherche) 1281, Université Paris-Saclay, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Commissariat à l'énergie Atomique et Aux Énergies Alternatives, Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, Villejuif, France
| | - Jean-Philippe Lamarque
- UMR (Unité Mixte de Recherche) 1281, Université Paris-Saclay, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Commissariat à l'énergie Atomique et Aux Énergies Alternatives, Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, Villejuif, France
| | - Stéphanie Pitre-Champagnat
- UMR (Unité Mixte de Recherche) 1281, Université Paris-Saclay, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Commissariat à l'énergie Atomique et Aux Énergies Alternatives, Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, Villejuif, France
| | - David Planchard
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Corinne Balleyguier
- UMR (Unité Mixte de Recherche) 1281, Université Paris-Saclay, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Commissariat à l'énergie Atomique et Aux Énergies Alternatives, Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, Villejuif, France.,Radiology Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Benjamin Besse
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Laura Mezquita
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Medical Oncology Department, Hospital Clínic, Barcelona, Spain.,Translational Genomics and Targeted Therapeutics in Solid Tumours, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Nathalie Lassau
- UMR (Unité Mixte de Recherche) 1281, Université Paris-Saclay, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Commissariat à l'énergie Atomique et Aux Énergies Alternatives, Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, Villejuif, France.,Radiology Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Caroline Caramella
- UMR (Unité Mixte de Recherche) 1281, Université Paris-Saclay, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Commissariat à l'énergie Atomique et Aux Énergies Alternatives, Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, Villejuif, France.,Radiology Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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Ammari S, Pitre-Champagnat S, Dercle L, Chouzenoux E, Moalla S, Reuze S, Talbot H, Mokoyoko T, Hadchiti J, Diffetocq S, Volk A, El Haik M, Lakiss S, Balleyguier C, Lassau N, Bidault F. Influence of Magnetic Field Strength on Magnetic Resonance Imaging Radiomics Features in Brain Imaging, an In Vitro and In Vivo Study. Front Oncol 2021; 10:541663. [PMID: 33552944 PMCID: PMC7855708 DOI: 10.3389/fonc.2020.541663] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The development and clinical adoption of quantitative imaging biomarkers (radiomics) has established the need for the identification of parameters altering radiomics reproducibility. The aim of this study was to assess the impact of magnetic field strength on magnetic resonance imaging (MRI) radiomics features in neuroradiology clinical practice. METHODS T1 3D SPGR sequence was acquired on two phantoms and 10 healthy volunteers with two clinical MR devices from the same manufacturer using two different magnetic fields (1.5 and 3T). Phantoms varied in terms of gadolinium concentrations and textural heterogeneity. 27 regions of interest were segmented (phantom: 21, volunteers: 6) using the LIFEX software. 34 features were analyzed. RESULTS In the phantom dataset, 10 (67%) out of 15 radiomics features were significantly different when measured at 1.5T or 3T (student's t-test, p < 0.05). Gray levels resampling, and pixel size also influence part of texture features. These findings were validated in healthy volunteers. CONCLUSIONS According to daily used protocols for clinical examinations, radiomic features extracted on 1.5T should not be used interchangeably with 3T when evaluating texture features. Such confounding factor should be adjusted when adapting the results of a study to a different platform, or when designing a multicentric trial.
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Affiliation(s)
- Samy Ammari
- Department of Radiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
- BioMaps (UMR1281), Université Paris-Saclay, CNRS, INSERM, CEA, Orsay and Gustave Roussy, Villejuif, France
| | - Stephanie Pitre-Champagnat
- BioMaps (UMR1281), Université Paris-Saclay, CNRS, INSERM, CEA, Orsay and Gustave Roussy, Villejuif, France
| | - Laurent Dercle
- Department of Radiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
- Immunology of Tumours and Immunotherapy INSERM U1015, Gustave Roussy Cancer Campus, Université Paris Saclay, Villejuif, France
- Radiology Department, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, United States
| | - Emilie Chouzenoux
- Center for Visual Computing, CentraleSupelec, Inria, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Salma Moalla
- Department of Radiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Sylvain Reuze
- Department of Radiotherapy - Medical Physics, Gustave Roussy, Université ParisSaclay, Villejuif, France
| | - Hugues Talbot
- Center for Visual Computing, CentraleSupelec, Inria, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Tite Mokoyoko
- Department of Radiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Joya Hadchiti
- Department of Radiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Sebastien Diffetocq
- Department of Radiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Andreas Volk
- BioMaps (UMR1281), Université Paris-Saclay, CNRS, INSERM, CEA, Orsay and Gustave Roussy, Villejuif, France
| | - Mickeal El Haik
- Department of Radiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Sara Lakiss
- Department of Radiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Corinne Balleyguier
- Department of Radiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
- BioMaps (UMR1281), Université Paris-Saclay, CNRS, INSERM, CEA, Orsay and Gustave Roussy, Villejuif, France
| | - Nathalie Lassau
- Department of Radiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
- BioMaps (UMR1281), Université Paris-Saclay, CNRS, INSERM, CEA, Orsay and Gustave Roussy, Villejuif, France
| | - Francois Bidault
- Department of Radiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
- BioMaps (UMR1281), Université Paris-Saclay, CNRS, INSERM, CEA, Orsay and Gustave Roussy, Villejuif, France
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Blanc-Durand P, Schiratti JB, Schutte K, Jehanno P, Herent P, Pigneur F, Lucidarme O, Benaceur Y, Sadate A, Luciani A, Ernst O, Rouchaud A, Creze M, Dallongeville A, Banaste N, Cadi M, Bousaid I, Lassau N, Jegou S. Abdominal musculature segmentation and surface prediction from CT using deep learning for sarcopenia assessment. Diagn Interv Imaging 2020; 101:789-794. [DOI: 10.1016/j.diii.2020.04.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 12/18/2022]
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Lassau N, Bousaid I, Chouzenoux E, Lamarque J, Charmettant B, Azoulay M, Cotton F, Khalil A, Lucidarme O, Pigneur F, Benaceur Y, Sadate A, Lederlin M, Laurent F, Chassagnon G, Ernst O, Ferreti G, Diascorn Y, Brillet P, Creze M, Cassagnes L, Caramella C, Loubet A, Dallongeville A, Abassebay N, Ohana M, Banaste N, Cadi M, Behr J, Boussel L, Fournier L, Zins M, Beregi J, Luciani A, Cotten A, Meder J. Three artificial intelligence data challenges based on CT and MRI. Diagn Interv Imaging 2020; 101:783-788. [DOI: 10.1016/j.diii.2020.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/12/2020] [Indexed: 02/07/2023]
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Blanc D, Racine V, Khalil A, Deloche M, Broyelle JA, Hammouamri I, Sinitambirivoutin E, Fiammante M, Verdier E, Besson T, Sadate A, Lederlin M, Laurent F, Chassagnon G, Ferretti G, Diascorn Y, Brillet PY, Cassagnes L, Caramella C, Loubet A, Abassebay N, Cuingnet P, Ohana M, Behr J, Ginzac A, Veyssiere H, Durando X, Bousaïd I, Lassau N, Brehant J. Artificial intelligence solution to classify pulmonary nodules on CT. Diagn Interv Imaging 2020; 101:803-810. [PMID: 33168496 DOI: 10.1016/j.diii.2020.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study was to create an algorithm to detect and classify pulmonary nodules in two categories based on their volume greater than 100 mm3 or not, using machine learning and deep learning techniques. MATERIALS AND METHOD The dataset used to train the model was provided by the organization team of the SFR (French Radiological Society) Data Challenge 2019. An asynchronous and parallel 3-stages pipeline was developed to process all the data (a data "pre-processing" stage; a "nodule detection" stage; a "classifier" stage). Lung segmentation was achieved using 3D U-NET algorithm; nodule detection was done using 3D Retina-UNET and classifier stage with a support vector machine algorithm on selected features. Performances were assessed using area under receiver operating characteristics curve (AUROC). RESULTS The pipeline showed good performance for pathological nodule detection and patient diagnosis. With the preparation dataset, an AUROC of 0.9058 (95% confidence interval [CI]: 0.8746-0.9362) was obtained, 87% yielding accuracy (95% CI: 84.83%-91.03%) for the "nodule detection" stage, corresponding to 86% specificity (95% CI: 82%-92%) and 89% sensitivity (95% CI: 84.83%-91.03%). CONCLUSION A fully functional pipeline using 3D U-NET, 3D Retina-UNET and classifier stage with a support vector machine algorithm was developed, resulting in high capabilities for pulmonary nodule classification.
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Affiliation(s)
- D Blanc
- QuantaCell, IRMB, Hôpital Saint-Eloi, 34090 Montpellier, France
| | - V Racine
- QuantaCell, IRMB, Hôpital Saint-Eloi, 34090 Montpellier, France
| | - A Khalil
- Department of Radiology, Neuroradiology unit, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard, 75018 Paris, France; Université de Paris, 75010, Paris, France
| | - M Deloche
- >IBM Cognitive Systems Lab, 34000 Montpellier, France
| | - J-A Broyelle
- >IBM Cognitive Systems Lab, 34000 Montpellier, France
| | - I Hammouamri
- >IBM Cognitive Systems Lab, 34000 Montpellier, France
| | | | - M Fiammante
- IBM Cognitive Systems France, 92270 Bois-Colombes, France
| | - E Verdier
- IBM Cognitive Systems France, 92270 Bois-Colombes, France
| | - T Besson
- IBM Cognitive Systems France, 92270 Bois-Colombes, France
| | - A Sadate
- Department of Radiology and Medical Imaging, CHU Nîmes, University Montpellier, EA2415, 30029 Nîmes, France
| | - M Lederlin
- Department of Radiology, Hôpital Universitaire Pontchaillou, 35000 Rennes, France
| | - F Laurent
- Department of thoracic and cardiovascular Imaging, Respiratory Diseases Service, Respiratory Functional Exploration Service, Hôpital universitaire de Bordeaux, CIC 1401, 33600 Pessac, France
| | - G Chassagnon
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France & Université de Paris, 75006 Paris, France
| | - G Ferretti
- Department of Radiology and Medical Imaging, CHU Grenoble Alpes, 38700 Grenoble, France
| | - Y Diascorn
- Department of Radiology, Hôpital Universitaire Pasteur, Nice, France
| | - P-Y Brillet
- Inserm UMR 1272, Université Sorbonne Paris Nord, Assistance Publique-Hôpitaux de Paris, Department of Radiology, Hôpital Avicenne, 93430 Bobigny, France
| | - Lucie Cassagnes
- Department of radiology B, CHU Gabriel Montpied, 63003 Clermont-Ferrand, France
| | - C Caramella
- Department of Radiology, Institut Gustave Roussy, 94800 Villejuif, France
| | - A Loubet
- Department of Neuroradiology, Hôpital Gui-de-Chauliac, CHRU de Montpellier, 34000 Montpellier, France
| | - N Abassebay
- Department of Radiology, CH Douai, 59507 Douai, France
| | - P Cuingnet
- Department of Radiology, CH Douai, 59507 Douai, France
| | - M Ohana
- Department of Radiology, Nouvel Hôpital Civil, 67000 Strasbourg, France
| | - J Behr
- Department of Radiology, CHRU de Jean-Minjoz Besançon, 25030 Besançon, France
| | - A Ginzac
- Clinical Research Unit, Clinical Research and Innovation Delegation, Centre de Lutte contre le Cancer, Centre Jean Perrin, 63011 Clermont-Ferrand Cedex 1, France; Université Clermont Auvergne,INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Centre Jean Perrin, 63011 Clermont-Ferrand, France; Clinical Investigation Center, UMR501, 63011 Clermont-Ferrand, France
| | - H Veyssiere
- Clinical Research Unit, Clinical Research and Innovation Delegation, Centre de Lutte contre le Cancer, Centre Jean Perrin, 63011 Clermont-Ferrand Cedex 1, France; Université Clermont Auvergne,INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Centre Jean Perrin, 63011 Clermont-Ferrand, France; Clinical Investigation Center, UMR501, 63011 Clermont-Ferrand, France
| | - X Durando
- Clinical Research Unit, Clinical Research and Innovation Delegation, Centre de Lutte contre le Cancer, Centre Jean Perrin, 63011 Clermont-Ferrand Cedex 1, France; Université Clermont Auvergne,INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Centre Jean Perrin, 63011 Clermont-Ferrand, France; Clinical Investigation Center, UMR501, 63011 Clermont-Ferrand, France; Department of Medical Oncology, Centre Jean Perrin, 63011 Clermont-Ferrand, France
| | - I Bousaïd
- Digital Transformation and Information Systems Division, Gustave Roussy, 94800 Villejuif, France
| | - N Lassau
- Multimodal Biomedical Imaging Laboratory Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, Department of Radiology, Institut Gustave Roussy, 94800, Villejuif, France
| | - J Brehant
- Department of Radiology, Centre Jean Perrin, 63011 Clermont-Ferrand, France.
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Moalla S, Girot C, Franchi-Abella S, Ammari S, Balleyguier C, Lassau N, Pitre-Champagnat S. Methodological Study to Investigate the Potential of Ultrasound-Based Elastography and Texture as Biomarkers to Monitor Liver Tumors. Diagnostics (Basel) 2020; 10:E811. [PMID: 33066135 PMCID: PMC7602000 DOI: 10.3390/diagnostics10100811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/01/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 12/31/2022] Open
Abstract
AIMS AND OBJECTIVES In order to evaluate the responses of hepatic lesions to treatment in terms of tissue stiffness and heterogeneity, this work investigated the robustness of 2D shear-wave elastography (2D SWE) stiffness measurements and texture analyses in vitro and in vivo in terms of repeatability and variability. METHODS AND MATERIALS A multioperator (n = 5) study was performed with an ultrasonic elastography device on two sets of phantoms. For the first set of phantoms, 10 measurements for each of the eight inclusions were performed by each observer, whereas the second set of phantoms was used to evaluate the influence of depth on the stiffness measurements. Variability of the stiffness measurements was evaluated in vivo on 10 healthy livers, with 10 measurements for each hepatic segment. Texture analyses were performed in B-mode, obtaining elastography images for every hepatic segment. RESULTS Stiffness measurements were influenced by depth, particularly when exceeding 7 cm. In vivo measurements demonstrated that measurements of segments I, VII, and VIII were less reliable, mainly due to their deeper locations. The protocols used were more flexible in terms of acquisition setup and probe placement than those currently used with Fibroscan®. For texture analysis on the B-mode images, 12 features showed low variability regardless of the evaluated hepatic segment. On elastogram, only two features showed low variability, but not in every segment. CONCLUSION We demonstrated the robustness of two methodologies for the quantification of liver stiffness and heterogeneity. Further clinical studies should evaluate whether these techniques can assess tumor responses to treatment and, therefore, have the potential to be used as imaging biomarkers.
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Affiliation(s)
- Salma Moalla
- Department of Diagnostic Imaging, Gustave Roussy, 114 Rue Edourad Vaillant, 94840 Villejuif, France; (S.A.); (C.B.); (N.L.)
| | - Charly Girot
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps Gustave Roussy, 94805 Villejuif, France; (C.G.); (S.F.-A.); (S.P.-C.)
| | - Stéphanie Franchi-Abella
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps Gustave Roussy, 94805 Villejuif, France; (C.G.); (S.F.-A.); (S.P.-C.)
- Department of Paediatric radiology, Hôpital Bicêtre, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Samy Ammari
- Department of Diagnostic Imaging, Gustave Roussy, 114 Rue Edourad Vaillant, 94840 Villejuif, France; (S.A.); (C.B.); (N.L.)
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps Gustave Roussy, 94805 Villejuif, France; (C.G.); (S.F.-A.); (S.P.-C.)
| | - Corinne Balleyguier
- Department of Diagnostic Imaging, Gustave Roussy, 114 Rue Edourad Vaillant, 94840 Villejuif, France; (S.A.); (C.B.); (N.L.)
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps Gustave Roussy, 94805 Villejuif, France; (C.G.); (S.F.-A.); (S.P.-C.)
| | - Nathalie Lassau
- Department of Diagnostic Imaging, Gustave Roussy, 114 Rue Edourad Vaillant, 94840 Villejuif, France; (S.A.); (C.B.); (N.L.)
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps Gustave Roussy, 94805 Villejuif, France; (C.G.); (S.F.-A.); (S.P.-C.)
| | - Stéphanie Pitre-Champagnat
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps Gustave Roussy, 94805 Villejuif, France; (C.G.); (S.F.-A.); (S.P.-C.)
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Dietrich CF, Nolsøe CP, Barr RG, Berzigotti A, Burns PN, Cantisani V, Chammas MC, Chaubal N, Choi BI, Clevert DA, Cui X, Dong Y, D'Onofrio M, Fowlkes JB, Gilja OH, Huang P, Ignee A, Jenssen C, Kono Y, Kudo M, Lassau N, Lee WJ, Lee JY, Liang P, Lim A, Lyshchik A, Meloni MF, Correas JM, Minami Y, Moriyasu F, Nicolau C, Piscaglia F, Saftoiu A, Sidhu PS, Sporea I, Torzilli G, Xie X, Zheng R. Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver - Update 2020 - WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultraschall Med 2020; 41:562-585. [PMID: 32707595 DOI: 10.1055/a-1177-0530] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS), first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications.The 2012 guideline requires updating as previously the differences of the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including the United States Food and Drug Administration (FDA) approval as well as the extensive Asian experience, to produce a truly international perspective.These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCA) and are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis to improve the management of patients.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- Johann Wolfgang Goethe Universitätsklinik Frankfurt, Germany
| | - Christian Pállson Nolsøe
- Center for Surgical Ultrasound, Dep of Surgery, Zealand University Hospital, Køge. Copenhagen Academy for Medical Education and Simulation (CAMES). University of Copenhagen, Denmark
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA and Southwoods Imaging, Youngstown, Ohio, USA
| | - Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, DBMR, Inselspital, University of Bern, Switzerland
| | - Peter N Burns
- Dept Medical Biophysics, University of Toronto, Imaging Research, Sunnybrook Research Institute, Toronto
| | - Vito Cantisani
- Uos Ecografia Internistico-chirurgica, Dipartimento di Scienze Radiologiche, Oncologiche, Anatomo-Patologiche, Policlinico Umberto I, Univ. Sapienza, Rome, Italy
| | - Maria Cristina Chammas
- Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mirko D'Onofrio
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - J Brian Fowlkes
- Basic Radiological Sciences Division, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, United States
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Pintong Huang
- Department of Ultrasound in Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Andre Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland, Department of Internal Medicine, Strausberg/Wriezen, Germany
| | - Yuko Kono
- Departments of Medicine and Radiology, University of California, San Diego, USA
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Nathalie Lassau
- Imaging Department. Gustave Roussy and BIOMAPS. Université Paris-Saclay, Villejuif, France
| | - Won Jae Lee
- Department of Radiology and Center For Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Departments of Health and Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London United Kingdom
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | | | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Fuminori Moriyasu
- Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Carlos Nicolau
- Radiology Department, Hospital Clinic. University of Barcelona, Barcelona, Spain
| | - Fabio Piscaglia
- Unit of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary & General Surgery, Humanitas University & Research Hospital, Rozzano, Milano, Italy
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Dietrich CF, Nolsøe CP, Barr RG, Berzigotti A, Burns PN, Cantisani V, Chammas MC, Chaubal N, Choi BI, Clevert DA, Cui X, Dong Y, D'Onofrio M, Fowlkes JB, Gilja OH, Huang P, Ignee A, Jenssen C, Kono Y, Kudo M, Lassau N, Lee WJ, Lee JY, Liang P, Lim A, Lyshchik A, Meloni MF, Correas JM, Minami Y, Moriyasu F, Nicolau C, Piscaglia F, Saftoiu A, Sidhu PS, Sporea I, Torzilli G, Xie X, Zheng R. Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver-Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultrasound Med Biol 2020; 46:2579-2604. [PMID: 32713788 DOI: 10.1016/j.ultrasmedbio.2020.04.030] [Citation(s) in RCA: 196] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/16/2020] [Accepted: 04/24/2020] [Indexed: 05/14/2023]
Abstract
The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast-enhanced ultrasound, first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology. The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications. The 2012 guideline requires updating as, previously, the differences in the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including U.S. Food and Drug Administration approval and the extensive Asian experience, to produce a truly international perspective. These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCAs) and are intended to create standard protocols for the use and administration of UCAs in liver applications on an international basis to improve the management of patients.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland; Johann Wolfgang Goethe Universitätsklinik, Frankfurt, Germany.
| | - Christian Pállson Nolsøe
- Center for Surgical Ultrasound, Dep of Surgery, Zealand University Hospital, Køge. Copenhagen Academy for Medical Education and Simulation (CAMES). University of Copenhagen, Denmark
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA; Southwoods Imaging, Youngstown, Ohio, USA
| | - Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, DBMR, Inselspital, University of Bern, Switzerland
| | - Peter N Burns
- Department of Medical Biophysics, University of Toronto, Imaging Research, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Vito Cantisani
- Uos Ecografia Internistico-chirurgica, Dipartimento di Scienze Radiologiche, Oncologiche, Anatomo-Patologiche, Policlinico Umberto I, Univ. Sapienza, Rome, Italy
| | - Maria Cristina Chammas
- Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mirko D'Onofrio
- Department of Radiology, G. B. Rossi University Hospital, University of Verona, Verona, Italy
| | - J Brian Fowlkes
- Basic Radiological Sciences Division, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Pintong Huang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Andre Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland, Department of Internal Medicine, Strausberg/Wriezen, Germany
| | - Yuko Kono
- Departments of Medicine and Radiology, University of California, San Diego, California, USA
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Nathalie Lassau
- Imaging Department, Gustave Roussy and BIOMAPS, Université Paris-Saclay, Villejuif, France
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Departments of Health and Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London, United Kingdom
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Fuminori Moriyasu
- Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Carlos Nicolau
- Radiology Department, Hospital Clinic. University of Barcelona, Barcelona, Spain
| | - Fabio Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London, United Kingdom
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary & General Surgery, Humanitas University & Research Hospital, Rozzano, Milan, Italy
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Courcier J, de la Taille A, Nourieh M, Leguerney I, Lassau N, Ingels A. Carbonic Anhydrase IX in Renal Cell Carcinoma, Implications for Disease Management. Int J Mol Sci 2020; 21:E7146. [PMID: 32998233 PMCID: PMC7582814 DOI: 10.3390/ijms21197146] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 01/14/2023] Open
Abstract
Carbonic Anhydrase IX (CAIX) is a well-described enzyme in renal cell carcinoma, with its expression being regulated by the hypoxia-inducible factor 1 alpha, it is known for interfering with hypoxia processes. Renal carcinoma encompasses a broad spectrum of histological entities and is also described as a heterogeneous malignant tumor. Recently, various combinations of checkpoint inhibitors and targeted therapies have been validated to manage this disease. Reliable markers to confirm the diagnosis, estimate the prognosis, predict or monitor the treatment response are required. Molecular imaging developments allow a comprehensive analysis of the tumor, overcoming the spatial heterogeneity issue. CAIX, being highly expressed at the tumor cell surfaces of clear cell renal carcinoma, also represents a potential treatment target. In this manuscript we reviewed the current knowledge from the literature on the pathophysiological interactions between renal cell carcinoma and CAIX, the role of CAIX as a marker for diagnosis, prognosis, treatment monitoring and molecular imaging, and the potential target for therapeutic strategies.
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MESH Headings
- Antibodies, Monoclonal/therapeutic use
- Antigens, Neoplasm/genetics
- Antigens, Neoplasm/metabolism
- Antineoplastic Agents, Immunological/therapeutic use
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Carbonic Anhydrase IX/antagonists & inhibitors
- Carbonic Anhydrase IX/genetics
- Carbonic Anhydrase IX/metabolism
- Carcinoma, Renal Cell/diagnostic imaging
- Carcinoma, Renal Cell/drug therapy
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/immunology
- Cell Cycle Checkpoints/drug effects
- Cell Cycle Checkpoints/genetics
- Disease Management
- Gene Expression Regulation, Neoplastic
- Granulocyte-Macrophage Colony-Stimulating Factor/therapeutic use
- Humans
- Hypoxia/diagnostic imaging
- Hypoxia/drug therapy
- Hypoxia/genetics
- Hypoxia/immunology
- Kidney Neoplasms/diagnostic imaging
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/genetics
- Kidney Neoplasms/immunology
- Molecular Imaging/methods
- Molecular Targeted Therapy/methods
- Prognosis
- Recombinant Fusion Proteins/therapeutic use
- Signal Transduction
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Affiliation(s)
- Jean Courcier
- Biomaps, UMR1281, INSERM, Centre National de la Recherche Scientifique (CNRS), Commissariat à l’Energie Atomique (CEA), Université Paris Saclay, 94800 Villejuif, France; (J.C.); (I.L.); (N.L.)
- Department of Urology, Henri Mondor Hospital, Université Paris Est Créteil (UPEC), 94000 Créteil, France;
| | - Alexandre de la Taille
- Department of Urology, Henri Mondor Hospital, Université Paris Est Créteil (UPEC), 94000 Créteil, France;
| | - Maya Nourieh
- Department of Pathology, Henri Mondor Hospital, UPEC, 94000 Créteil, France;
| | - Ingrid Leguerney
- Biomaps, UMR1281, INSERM, Centre National de la Recherche Scientifique (CNRS), Commissariat à l’Energie Atomique (CEA), Université Paris Saclay, 94800 Villejuif, France; (J.C.); (I.L.); (N.L.)
| | - Nathalie Lassau
- Biomaps, UMR1281, INSERM, Centre National de la Recherche Scientifique (CNRS), Commissariat à l’Energie Atomique (CEA), Université Paris Saclay, 94800 Villejuif, France; (J.C.); (I.L.); (N.L.)
- Department of Imaging, Institute Gustave Roussy, 94800 Villejuif, France
| | - Alexandre Ingels
- Biomaps, UMR1281, INSERM, Centre National de la Recherche Scientifique (CNRS), Commissariat à l’Energie Atomique (CEA), Université Paris Saclay, 94800 Villejuif, France; (J.C.); (I.L.); (N.L.)
- Department of Urology, Henri Mondor Hospital, Université Paris Est Créteil (UPEC), 94000 Créteil, France;
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Dinnoo A, Bidault F, Lassau N, Elmaalouf M, Moya-Plana A, Ruffier A, Janot F, Benmoussa N. Long-term recurrences of jaw osteoradionecrosis after apparent healing with the PENTOCLO protocol. Journal of Stomatology, Oral and Maxillofacial Surgery 2020; 121:286-287. [DOI: 10.1016/j.jormas.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 06/21/2019] [Indexed: 04/10/2023]
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Besse B, Dormieux A, Mezquita L, Monnet R, Tazdait M, Lacroix L, Rouleau E, Adam J, Remon Masip J, Bluthgen M, Facchinetti F, Tzelikas L, Lavaud P, Naltet C, Le Pechoux C, Balleyguier C, Planchard D, Lassau N, Cournede PH, Caramella C. Prediction of the molecular status in non-small cell lung cancer based on metastatic pattern: A free webtool powered by artificial intelligence. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9535 Background: Molecular characterization of metastatic lung adenocarcinomas is mandatory but might be hampered by the quantity of tissue, restricted access to molecular platforms or limited economical resources. Our aim was to develop a tool supported by the hypothesis that radiological patterns of pts could help predict the rate of positivity of the most common oncogenic drivers. Methods: We defined an algorithm based on a molecularly defined cohort of 656 pts with stage IV lung adenocarcinoma. Two radiologists centrally reviewed the baseline imaging. Clinical data were retrospectively collected. There were 135 EGFR mutations, 81 ALK fusions, 47 BRAF mutations, 141 KRAS mutations, and 146 pan-negative tumors for these 4 oncogenic drivers. Univariate correlation analyses were performed to define an algorithm predicting the molecular testing positivity based on the metastatic pattern. Subsequently, an online tool was developed. This study was approved by our institutional review board. Results: Metastatic patterns correlated with the genomic drivers when compared to the pan-negative group. In the EGFR group, pleural metastases were more frequent (32% vs. 20%; p = 0.021), whereas adrenal and node metastases less frequent (6% vs.23%; p < 0.001 and 11% vs. 23% respectively; p = 0.011). In the ALK group, there were more brain and lung metastases (respectively 42% vs. 29%; p = 0.043 and 37% vs. 24% respectively; p = 0.037). In the BRAF group, pleural and pericardial metastases were more common (47% vs. 20%; p < 0.001 and 11% vs. 3% respectively; p = 0.04) and bone metastases less common (21% vs. 42%; p = 0.011). Lymphangitis was more frequent in EGFR, ALK and BRAF groups (6%, 7% and 15% vs. 1%; p = 0,016, p = 0,009 and p < 0,001 respectively). A free online access to the algorithm is now available after registration at http//tactic-ct.fr. Physicians enter age, sex, smoking status and the sites of metastases at diagnosis (present/absent/unknown). A mutation score is calculated, reflecting the % of chance to find an oncogenic driver. On the website, contributors can also enter new cases and an artificial intelligence will refine the algorithm and expand the number of oncogenic drivers. Conclusions: Our free access tool allows establishing a hierarchy in the molecular testing based on simple clinical and radiological information. Continual learning from new cases entered in the database will increase the sensitivity of the tool. This tool might save time, tumor tissue, economical resources and accelerate access to personalized treatment.
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Affiliation(s)
| | | | - Laura Mezquita
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | | | | | | | | | - Julien Adam
- Gustave Roussy Cancer Campus, Villejuif, France
| | - Jordi Remon Masip
- Centro Integral Oncología Clara Campal Barcelona, HM-Delfos, Barcelona, Spain
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Dormieux A, Mezquita L, Cournede PH, Remon J, Tazdait M, Lacroix L, Rouleau E, Adam J, Bluthgen MV, Facchinetti F, Tselikas L, Aboubakar F, Naltet C, Lavaud P, Gazzah A, Le Pechoux C, Lassau N, Balleyguier C, Planchard D, Besse B, Caramella C. Association of metastatic pattern and molecular status in stage IV non-small cell lung cancer adenocarcinoma. Eur Radiol 2020; 30:5021-5028. [PMID: 32323012 DOI: 10.1007/s00330-020-06784-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 02/02/2020] [Accepted: 02/28/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of our study was to investigate the association between driver oncogene alterations and metastatic patterns on imaging assessment, in a large cohort of metastatic lung adenocarcinoma patients. METHODS From January 2010 to May 2017, 550 patients with stage IV lung adenocarcinoma with molecular analysis were studied retrospectively including 135 EGFR-mutated, 81 ALK-rearrangement, 47 BRAF-mutated, 141 KRAS-mutated, and 146 negative tumors for these 4 mutations (4N). After review of the complete imaging report by two radiologists (junior and senior) to identify metastatic sites, univariate correlation analyzes were performed. RESULTS We found differences in metastatic tropism depending on the molecular alteration type when compared with the non-mutated 4N group: in the EGFR group, pleural metastases were more frequent (32% versus 20%; p = 0.021), and adrenal and node metastases less common (6% versus 23%; p < 0.001 and 11% versus 23%; p = 0.011). In the ALK group, there were more brain and lung metastases (respectively 42% versus 29%; p = 0.043 and 37% versus 24%; p = 0.037). In the BRAF group, pleural and pericardial metastases were more common (respectively 47% versus 20%; p < 0.001 and 11% versus 3%; p = 0.04) and bone metastases were rarer (21% versus 42%; p = 0.011). Lymphangitis was more frequent in EGFR, ALK, and BRAF groups (respectively 6%, 7%, and 15% versus 1%); p = 0.016; p = 0.009; and p < 0.001. CONCLUSION The application of these correlations between molecular status and metastatic tropism in clinical practice may lead to earlier and more accurate identification of patients for targeted therapy. KEY POINTS • Bone and brain metastasis are the most common organs involved in lung adenocarcinoma but the relative incidence of each metastatic site depends on the molecular alteration. • EGFR-mutated tumors preferentially spread to the pleura and less commonly to adrenals, ALK-rearrangement tumors usually spread to the brain and the lungs, whereas BRAF-mutated tumors are unlikely to spread to bones and have a serous (pericardial ad pleural) tropism. • These correlations could help in the clinical management of patients with metastatic lung adenocarcinoma.
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Affiliation(s)
- Alison Dormieux
- Imaging Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Laura Mezquita
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Paul Henry Cournede
- MICS laboratory, CentraleSupélec, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Jordi Remon
- Medical Oncology Department, Centro Integral Oncología Clara Campal Bacelona, HM-Delfos, Barcelona, Spain
| | - Melodie Tazdait
- Imaging Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Ludovic Lacroix
- Molecular Biology Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Etienne Rouleau
- Molecular Biology Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Julien Adam
- Pathology Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Maria-Virginia Bluthgen
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Francesco Facchinetti
- Research Department (U981), Gustave Roussy Cancer Campus, Université Paris-Saclay, F-94805, Villejuif, France
| | - Lambros Tselikas
- Imaging Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Frank Aboubakar
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Charles Naltet
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Pernelle Lavaud
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Anas Gazzah
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Cécile Le Pechoux
- Radiation Therapy Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Nathalie Lassau
- Imaging Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
- IR4M, UMR 8081, CNRS, Université Paris-Saclay, F-91400, Orsay, France
| | - Corinne Balleyguier
- Imaging Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
- IR4M, UMR 8081, CNRS, Université Paris-Saclay, F-91400, Orsay, France
| | - David Planchard
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Benjamin Besse
- Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Caroline Caramella
- Imaging Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France.
- IR4M, UMR 8081, CNRS, Université Paris-Saclay, F-91400, Orsay, France.
- Radiology Department, Gustave Roussy, 114 Rue Édouard-Vaillant, 94805, Villejuif Cedex, France.
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Lassau N. Advanced Ultrasound Imaging for Patients in Oncology: DCE-US. Recent Results Cancer Res 2020; 216:765-771. [PMID: 32594405 DOI: 10.1007/978-3-030-42618-7_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Neovascularization is a key stage in the growth of malignancies beyond 2-3 mm3. This neoangiogenesis is an important target for novel anticancer treatments [1], and many new antiangiogenesis or antivascular treatments aim at destroying or limiting the growth of tumor vessels [2].
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Affiliation(s)
- Nathalie Lassau
- Institut Gustave Roussy, Villejuif, France.
- Université of Paris-Saclay, Villejuif, France.
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Alexandre I, Leguerney I, Cournède P, Irani J, Ferlicot S, Sebrié C, Benatsou B, Jourdain L, Guillot G, Pitre-champagnat S, Patard J, Lassau N. Échographie moléculaire dans le cancer du rein : modèle pré-clinique de suivi des traitements anti-angiogéniques à partir de microbulles couplées au VEGFR1 et FSHR. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lassau N, Estienne T, de Vomecourt P, Azoulay M, Cagnol J, Garcia G, Majer M, Jehanno E, Renard-Penna R, Balleyguier C, Bidault F, Caramella C, Jacques T, Dubrulle F, Behr J, Poussange N, Bocquet J, Montagne S, Cornelis F, Faruch M, Bresson B, Brunelle S, Jalaguier-Coudray A, Amoretti N, Blum A, Paisant A, Herreros V, Rouviere O, Si-Mohamed S, Di Marco L, Hauger O, Garetier M, Pigneur F, Bergère A, Cyteval C, Fournier L, Malhaire C, Drape JL, Poncelet E, Bordonne C, Cauliez H, Budzik JF, Boisserie M, Willaume T, Molière S, Peyron Faure N, Caius Giurca S, Juhan V, Caramella T, Perrey A, Desmots F, Faivre-Pierre M, Abitbol M, Lotte R, Istrati D, Guenoun D, Luciani A, Zins M, Meder JF, Cotten A. Five simultaneous artificial intelligence data challenges on ultrasound, CT, and MRI. Diagn Interv Imaging 2019; 100:199-209. [DOI: 10.1016/j.diii.2019.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/04/2019] [Indexed: 12/18/2022]
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Schmauch B, Herent P, Jehanno P, Dehaene O, Saillard C, Aubé C, Luciani A, Lassau N, Jégou S. Diagnosis of focal liver lesions from ultrasound using deep learning. Diagn Interv Imaging 2019; 100:227-233. [DOI: 10.1016/j.diii.2019.02.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/22/2019] [Indexed: 02/06/2023]
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Couteaux V, Si-Mohamed S, Renard-Penna R, Nempont O, Lefevre T, Popoff A, Pizaine G, Villain N, Bloch I, Behr J, Bellin MF, Roy C, Rouvière O, Montagne S, Lassau N, Boussel L. Kidney cortex segmentation in 2D CT with U-Nets ensemble aggregation. Diagn Interv Imaging 2019; 100:211-217. [DOI: 10.1016/j.diii.2019.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
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Bourgier C, Auperin A, Rivera S, Boisselier P, Petit B, Lang P, Lassau N, Taourel P, Tetreau R, Azria D, Bourhis J, Deutsch E, Vozenin MC. Pravastatin Reverses Established Radiation-Induced Cutaneous and Subcutaneous Fibrosis in Patients With Head and Neck Cancer: Results of the Biology-Driven Phase 2 Clinical Trial Pravacur. Int J Radiat Oncol Biol Phys 2019; 104:365-373. [PMID: 30776452 DOI: 10.1016/j.ijrobp.2019.02.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/12/2019] [Accepted: 02/08/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE The "PRAVACUR" phase 2 trial (NCT01268202) assessed the efficacy of pravastatin as an antifibrotic agent in patients with established cutaneous and subcutaneous radiation-induced fibrosis (RIF) after head and neck squamous cell carcinoma (HNSCC) radiation therapy and/or radiochemotherapy. METHODS AND MATERIALS The main inclusion criteria were: NSCC in remission, grade ≥2 cutaneous and subcutaneous neck RIF (National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0), and no current treatment with statins or fibrates. Patients received pravastatin 40 mg/d for 12 months. The primary endpoint was reduction of RIF thickness by more than 30% at 12 months, as measured by cutaneous high-frequency ultrasonography. Secondary endpoints included RIF severity reduction, pravastatin tolerance, and quality of life. RESULTS Sixty patients with grade 2 (n = 37), grade 3 (n = 22), or grade 4 (n = 1) RIF were enrolled from February 2011 to April 2016. The mean interval between RIF diagnosis and pravastatin initiation was 17.1 months. Pravastatin was stopped before 11 months of treatment in 18 patients (because of grade ≥2 adverse events related to pravastatin in 8 patients [13%]). In the 40 patients in whom pravastatin efficacy was assessed by high-frequency ultrasonography at baseline and at 12 months of treatment, a reduction of RIF thickness ≥30% was observed in 15 of 42 patients (35.7%; 95% confidence interval, 21.6%-52.0%). At the 12-month clinical evaluation, RIF severity was decreased in 50% of patients (n = 21; 95% confidence interval, 34.2%-65.8%), and the patients' self-perception, mood state, and social functioning were significantly improved. Pravastatin was well tolerated, with a very low occurrence of grade 3 toxicities (myalgia, n = 1) and grade 2 toxicities (myalgia/arthralgia or esophagitis, n = 3). CONCLUSIONS This phase 2 prospective study supports the notion of radioinduced fibrosis reversibility. It showed that pravastatin (40 mg/d for 12 months) is an efficient antifibrotic agent in patients with grade ≥2 cutaneous and subcutaneous fibrosis after HNSCC radiation therapy.
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Affiliation(s)
- Celine Bourgier
- INSERM, U1194, IRCM, Université de Montpellier, Montpellier, France; Department of Radiation Oncology, ICM-Val d'Aurelle, Université de Montpellier, Montpellier, France.
| | - Anne Auperin
- Biostatistics Department, Gustave Roussy Institute, Villejuif, France
| | - Sofia Rivera
- Department of Radiation Oncology, INSERM 1030, Université de Paris-Sud, Gustave Roussy Cancer Campus, Villejuif, France, Université de Paris-Saclay
| | - Pierre Boisselier
- Department of Radiation Oncology, ICM-Val d'Aurelle, Université de Montpellier, Montpellier, France
| | - Benoit Petit
- Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Philippe Lang
- Department of Radiation Oncology, Centre Hospitalier Universitaire, Université de Montpellier, Nîmes, France
| | - Nathalie Lassau
- Imaging Department, Gustave Roussy Institute, IR4M, Université de Paris-Sud, Villejuif, France
| | - Patrice Taourel
- Radiology Department, Centre Hospitalier Universitaire, Lapeyronie, Université de Montpellier, Montpellier, France
| | - Raphael Tetreau
- Radiology Department, ICM-Val d'Aurelle, Université de Montpellier, Montpellier, France
| | - David Azria
- INSERM, U1194, IRCM, Université de Montpellier, Montpellier, France; Department of Radiation Oncology, ICM-Val d'Aurelle, Université de Montpellier, Montpellier, France
| | - Jean Bourhis
- Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Eric Deutsch
- Department of Radiation Oncology, INSERM 1030, Université de Paris-Sud, Gustave Roussy Cancer Campus, Villejuif, France, Université de Paris-Saclay
| | - Marie-Catherine Vozenin
- Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Dietrich CF, Trenker C, Fontanilla T, Görg C, Hausmann A, Klein S, Lassau N, Miquel R, Schreiber-Dietrich D, Dong Y. New Ultrasound Techniques Challenge the Diagnosis of Sinusoidal Obstruction Syndrome. Ultrasound Med Biol 2018; 44:2171-2182. [PMID: 30076031 DOI: 10.1016/j.ultrasmedbio.2018.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/14/2018] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Abstract
Sinusoidal obstruction syndrome, also known as veno-occlusive disease (SOS/VOD), is a potentially life-threatening complication that can develop after hematopoietic cell transplantation. Clinically, SOS/VOD is characterized by hepatomegaly, right upper quadrant pain, jaundice and ascites, most often occurring within the first 3 wk after hematopoietic cell transplantation. Early therapeutic intervention is pivotal for survival in SOS/VOD. Thus, a rapid and reliable diagnosis has to be made. Diagnosis of SOS/VOD is based on clinical criteria, such as the Seattle, Baltimore or recently issued European Society for Blood and Marrow Transplantation criteria, to which hemodynamic and/or ultrasound evidence of SOS were added for the first time. However, to rule out major differential diagnoses and to verify the diagnosis, a reliable imaging method is needed. Ultrasound techniques have been proposed in SOS/VOD. Nevertheless, the sensitivity and specificity of transabdominal ultrasound and Doppler techniques need to be improved. Innovative ultrasound methods such as a combination of Doppler ultrasound with shear wave elastography and contrast-enhanced ultrasound techniques should be evaluated for diagnosis and follow-up of SOS/VOD. The goals of this review are to discuss currently available ultrasound techniques and to identify areas for future studies in SOS/VOD.
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Affiliation(s)
- Christoph F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany; Ultrasound Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Corinna Trenker
- Department of Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Teresa Fontanilla
- Radiology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Christian Görg
- Interdisciplinary Center of Ultrasound, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | | | - Stefan Klein
- Department of Hematology and Oncology, University Clinic Mannheim, Mannheim, Germany
| | - Nathalie Lassau
- Gustave Roussy Imaging Department, CNRS Université Paris-Sud, Paris, France
| | - Rosa Miquel
- Liver Histopathology, Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | | | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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