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Tan Y, Patel RV, Wang Z, Luo Y, Chen J, Luo J, Chen W, Mao Z, Huang RY, Wang H, Bi WL, Yao S. Generation and applications of synthetic computed tomography images for neurosurgical planning. J Neurosurg 2024:1-10. [PMID: 38579358 DOI: 10.3171/2024.1.jns232196] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/26/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE CT and MRI are synergistic in the information provided for neurosurgical planning. While obtaining both types of images lends unique data from each, doing so adds to cost and exposes patients to additional ionizing radiation after MRI has been performed. Cross-modal synthesis of high-resolution CT images from MRI sequences offers an appealing solution. The authors therefore sought to develop a deep learning conditional generative adversarial network (cGAN) which performs this synthesis. METHODS Preoperative paired CT and contrast-enhanced MR images were collected for patients with meningioma, pituitary tumor, vestibular schwannoma, and cerebrovascular disease. CT and MR images were denoised, field corrected, and coregistered. MR images were fed to a cGAN that exported a "synthetic" CT scan. The accuracy of synthetic CT images was assessed objectively using the quantitative similarity metrics as well as by clinical features such as sella and internal auditory canal (IAC) dimensions and mastoid/clinoid/sphenoid aeration. RESULTS A total of 92,981 paired CT/MR images obtained in 80 patients were used for training/testing, and 10,068 paired images from 10 patients were used for external validation. Synthetic CT images reconstructed the bony skull base and convexity with relatively high accuracy. Measurements of the sella and IAC showed a median relative error between synthetic CT scans and ground truth images of 6%, with greater variability in IAC reconstruction compared with the sella. Aerations in the mastoid, clinoid, and sphenoid regions were generally captured, although there was heterogeneity in finer air cell septations. Performance varied based on pathology studied, with the highest limitation observed in evaluating meningiomas with intratumoral calcifications or calvarial invasion. CONCLUSIONS The generation of high-resolution CT scans from MR images through cGAN offers promise for a wide range of applications in cranial and spinal neurosurgery, especially as an adjunct for preoperative evaluation. Optimizing cGAN performance on specific anatomical regions may increase its clinical viability.
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Affiliation(s)
- Yiheng Tan
- 1Department of Neurosurgery, Center for Pituitary Tumor Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- 2Department of Radiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | | | - Zongming Wang
- 1Department of Neurosurgery, Center for Pituitary Tumor Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu Luo
- 4School of Computer Science, Guangdong University of Technology, Guangzhou, China; and
| | - Jinping Chen
- 1Department of Neurosurgery, Center for Pituitary Tumor Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Luo
- 5Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- 6Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wenli Chen
- 1Department of Neurosurgery, Center for Pituitary Tumor Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhigang Mao
- 1Department of Neurosurgery, Center for Pituitary Tumor Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Raymond Y Huang
- 5Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Haijun Wang
- 1Department of Neurosurgery, Center for Pituitary Tumor Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | | | - Shun Yao
- 1Department of Neurosurgery, Center for Pituitary Tumor Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Departments of3Neurosurgery and
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2
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Lim-Fat MJ, Iorgulescu JB, Rahman R, Bhave V, Muzikansky A, Woodward E, Whorral S, Allen M, Touat M, Li X, Xy G, Patel J, Gerstner ER, Kalpathy-Cramer J, Youssef G, Chukwueke U, McFaline-Figueroa JR, Nayak L, Lee EQ, Reardon DA, Beroukhim R, Huang RY, Bi WL, Ligon KL, Wen PY. Clinical and Genomic Predictors of Adverse Events in Newly Diagnosed Glioblastoma. Clin Cancer Res 2024; 30:1327-1337. [PMID: 38252427 DOI: 10.1158/1078-0432.ccr-23-3018] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/01/2023] [Accepted: 01/18/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE Adverse clinical events cause significant morbidity in patients with GBM (GBM). We examined whether genomic alterations were associated with AE (AE) in patients with GBM. EXPERIMENTAL DESIGN We identified adults with histologically confirmed IDH-wild-type GBM with targeted next-generation sequencing (OncoPanel) at Dana Farber Cancer Institute from 2013 to 2019. Seizure at presentation, lymphopenia, thromboembolic events, pseudoprogression, and early progression (within 6 months of diagnosis) were identified as AE. The biologic function of genetic variants was categorized as loss-of-function (LoF), no change in function, or gain-of-function (GoF) using a somatic tumor mutation knowledge base (OncoKB) and consensus protein function predictions. Associations between functional genomic alterations and AE were examined using univariate logistic regressions and multivariable regressions adjusted for additional clinical predictors. RESULTS Our study included 470 patients diagnosed with GBM who met the study criteria. We focused on 105 genes that had sequencing data available for ≥ 90% of the patients and were altered in ≥10% of the cohort. Following false-discovery rate (FDR) correction and multivariable adjustment, the TP53, RB1, IGF1R, and DIS3 LoF alterations were associated with lower odds of seizures, while EGFR, SMARCA4, GNA11, BRD4, and TCF3 GoF and SETD2 LoF alterations were associated with higher odds of seizures. For all other AE of interest, no significant associations were found with genomic alterations following FDR correction. CONCLUSIONS Genomic biomarkers based on functional variant analysis of a routine clinical panel may help identify AE in GBM, particularly seizures. Identifying these risk factors could improve the management of patients through better supportive care and consideration of prophylactic therapies.
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Affiliation(s)
- Mary Jane Lim-Fat
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - J Bryan Iorgulescu
- Molecular Diagnostics Laboratory, Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rifaquat Rahman
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Varun Bhave
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alona Muzikansky
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Eleanor Woodward
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sydney Whorral
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marie Allen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mehdi Touat
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | | | | | - Jay Patel
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth R Gerstner
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Gilbert Youssef
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ugonma Chukwueke
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - J Ricardo McFaline-Figueroa
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eudocia Q Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rameen Beroukhim
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Raymond Y Huang
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Keith L Ligon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Wu KC, Guenette JP, Huang RY, Al-Mefty O, Dunn IF, Bi WL. Improved optic nerve visualization and treatment planning through a dedicated optic nerve MRI protocol. Neurosurg Focus 2024; 56:E9. [PMID: 38560937 DOI: 10.3171/2024.1.focus23715] [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: 10/13/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE This study describes an innovative optic nerve MRI protocol for better delineating optic nerve anatomy from neighboring pathology. METHODS Twenty-two patients undergoing MRI examination of the optic nerve with the dedicated protocol were identified and included for analysis of imaging, surgical strategy, and outcomes. T2-weighted and fat-suppressed T1-weighted gadolinium-enhanced images were acquired perpendicular and parallel to the long axis of the optic nerve to achieve en face and in-line views along the course of the nerve. RESULTS Dedicated optic nerve MRI sequences provided enhanced visualization of the nerve, CSF within the nerve sheath, and local pathology. Optic nerve sequences leveraged the "CSF ring" within the optic nerve sheath to create contrast between pathology and normal tissue, highlighting areas of compression. Tumor was readily tracked along the longitudinal axis of the nerve by images obtained parallel to the nerve. The findings augmented treatment planning. CONCLUSIONS The authors present a dedicated optic nerve MRI protocol that is simple to use and affords improved cross-sectional and longitudinal visualization of the nerve, surrounding CSF, and pathology. This improved visualization enhances radiological evaluation and treatment planning for optic nerve lesions.
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Affiliation(s)
- Kyle C Wu
- 1Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- 2Division of Skull Base Neurosurgery, James Cancer Hospital, Columbus, Ohio
| | - Jeffrey P Guenette
- 3Division of Neuroradiology, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raymond Y Huang
- 3Division of Neuroradiology, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ossama Al-Mefty
- 4Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Ian F Dunn
- 5Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Wenya Linda Bi
- 4Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and
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Wan Q, Kim J, Lindsay C, Chen X, Li J, Iorgulescu JB, Huang RY, Zhang C, Reardon D, Young GS, Qin L. Auto-segmentation of Adult-Type Diffuse Gliomas: Comparison of Transfer Learning-Based Convolutional Neural Network Model vs. Radiologists. J Imaging Inform Med 2024:10.1007/s10278-024-01044-7. [PMID: 38383806 DOI: 10.1007/s10278-024-01044-7] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
Segmentation of glioma is crucial for quantitative brain tumor assessment, to guide therapeutic research and clinical management, but very time-consuming. Fully automated tools for the segmentation of multi-sequence MRI are needed. We developed and pretrained a deep learning (DL) model using publicly available datasets A (n = 210) and B (n = 369) containing FLAIR, T2WI, and contrast-enhanced (CE)-T1WI. This was then fine-tuned with our institutional dataset (n = 197) containing ADC, T2WI, and CE-T1WI, manually annotated by radiologists, and split into training (n = 100) and testing (n = 97) sets. The Dice similarity coefficient (DSC) was used to compare model outputs and manual labels. A third independent radiologist assessed segmentation quality on a semi-quantitative 5-scale score. Differences in DSC between new and recurrent gliomas, and between uni or multifocal gliomas were analyzed using the Mann-Whitney test. Semi-quantitative analyses were compared using the chi-square test. We found that there was good agreement between segmentations from the fine-tuned DL model and ground truth manual segmentations (median DSC: 0.729, std-dev: 0.134). DSC was higher for newly diagnosed (0.807) than recurrent (0.698) (p < 0.001), and higher for unifocal (0.747) than multi-focal (0.613) cases (p = 0.001). Semi-quantitative scores of DL and manual segmentation were not significantly different (mean: 3.567 vs. 3.639; 93.8% vs. 97.9% scoring ≥ 3, p = 0.107). In conclusion, the proposed transfer learning DL performed similarly to human radiologists in glioma segmentation on both structural and ADC sequences. Further improvement in segmenting challenging postoperative and multifocal glioma cases is needed.
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Affiliation(s)
- Qi Wan
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Radiology, the Key Laboratory of Advanced Interdisciplinary Studies Center, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jisoo Kim
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Clifford Lindsay
- Image Processing and Analysis Core (iPAC), Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Xin Chen
- School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Jing Li
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - J Bryan Iorgulescu
- Molecular Diagnostics Laboratory, Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chenxi Zhang
- Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - David Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Geoffrey S Young
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Lei Qin
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
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5
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Hoebel KV, Bridge CP, Ahmed S, Akintola O, Chung C, Huang RY, Johnson JM, Kim A, Ly KI, Chang K, Patel J, Pinho M, Batchelor TT, Rosen BR, Gerstner ER, Kalpathy-Cramer J. Expert-centered Evaluation of Deep Learning Algorithms for Brain Tumor Segmentation. Radiol Artif Intell 2024; 6:e220231. [PMID: 38197800 PMCID: PMC10831514 DOI: 10.1148/ryai.220231] [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: 10/31/2022] [Revised: 09/13/2023] [Accepted: 11/01/2023] [Indexed: 01/11/2024]
Abstract
Purpose To present results from a literature survey on practices in deep learning segmentation algorithm evaluation and perform a study on expert quality perception of brain tumor segmentation. Materials and Methods A total of 180 articles reporting on brain tumor segmentation algorithms were surveyed for the reported quality evaluation. Additionally, ratings of segmentation quality on a four-point scale were collected from medical professionals for 60 brain tumor segmentation cases. Results Of the surveyed articles, Dice score, sensitivity, and Hausdorff distance were the most popular metrics to report segmentation performance. Notably, only 2.8% of the articles included clinical experts' evaluation of segmentation quality. The experimental results revealed a low interrater agreement (Krippendorff α, 0.34) in experts' segmentation quality perception. Furthermore, the correlations between the ratings and commonly used quantitative quality metrics were low (Kendall tau between Dice score and mean rating, 0.23; Kendall tau between Hausdorff distance and mean rating, 0.51), with large variability among the experts. Conclusion The results demonstrate that quality ratings are prone to variability due to the ambiguity of tumor boundaries and individual perceptual differences, and existing metrics do not capture the clinical perception of segmentation quality. Keywords: Brain Tumor Segmentation, Deep Learning Algorithms, Glioblastoma, Cancer, Machine Learning Clinical trial registration nos. NCT00756106 and NCT00662506 Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Katharina V. Hoebel
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Christopher P. Bridge
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Sara Ahmed
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Oluwatosin Akintola
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Caroline Chung
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Raymond Y. Huang
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Jason M. Johnson
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Albert Kim
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - K. Ina Ly
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Ken Chang
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Jay Patel
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Marco Pinho
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Tracy T. Batchelor
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Bruce R. Rosen
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Elizabeth R. Gerstner
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Jayashree Kalpathy-Cramer
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
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Pan I, Huang RY. Artificial intelligence in neuroimaging of brain tumors: reality or still promise? Curr Opin Neurol 2023; 36:549-556. [PMID: 37973024 DOI: 10.1097/wco.0000000000001213] [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: 11/19/2023]
Abstract
PURPOSE OF REVIEW To provide an updated overview of artificial intelligence (AI) applications in neuro-oncologic imaging and discuss current barriers to wider clinical adoption. RECENT FINDINGS A wide variety of AI applications in neuro-oncologic imaging have been developed and researched, spanning tasks from pretreatment brain tumor classification and segmentation, preoperative planning, radiogenomics, prognostication and survival prediction, posttreatment surveillance, and differentiating between pseudoprogression and true disease progression. While earlier studies were largely based on data from a single institution, more recent studies have demonstrated that the performance of these algorithms are also effective on external data from other institutions. Nevertheless, most of these algorithms have yet to see widespread clinical adoption, given the lack of prospective studies demonstrating their efficacy and the logistical difficulties involved in clinical implementation. SUMMARY While there has been significant progress in AI and neuro-oncologic imaging, clinical utility remains to be demonstrated. The next wave of progress in this area will be driven by prospective studies measuring outcomes relevant to clinical practice and go beyond retrospective studies which primarily aim to demonstrate high performance.
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Affiliation(s)
- Ian Pan
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School
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7
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Karschnia P, Smits M, Reifenberger G, Le Rhun E, Ellingson BM, Galldiks N, Kim MM, Huse JT, Schnell O, Harter PN, Mohme M, von Baumgarten L, Albert NL, Huang RY, Mehta MP, van den Bent M, Weller M, Vogelbaum MA, Chang SM, Berger MS, Tonn JC. A framework for standardised tissue sampling and processing during resection of diffuse intracranial glioma: joint recommendations from four RANO groups. Lancet Oncol 2023; 24:e438-e450. [PMID: 37922934 PMCID: PMC10849105 DOI: 10.1016/s1470-2045(23)00453-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 11/07/2023]
Abstract
Surgical resection represents the standard of care for people with newly diagnosed diffuse gliomas, and the neuropathological and molecular profile of the resected tissue guides clinical management and forms the basis for research. The Response Assessment in Neuro-Oncology (RANO) consortium is an international, multidisciplinary effort that aims to standardise research practice in neuro-oncology. These recommendations represent a multidisciplinary consensus from the four RANO groups: RANO resect, RANO recurrent glioblastoma, RANO radiotherapy, and RANO/PET for a standardised workflow to achieve a representative tumour evaluation in a disease characterised by intratumoural heterogeneity, including recommendations on which tumour regions should be surgically sampled, how to define those regions on the basis of preoperative imaging, and the optimal sample volume. Practical recommendations for tissue sampling are given for people with low-grade and high-grade gliomas, as well as for people with newly diagnosed and recurrent disease. Sampling of liquid biopsies is also addressed. A standardised workflow for subsequent handling of the resected tissue is proposed to avoid information loss due to decreasing tissue quality or insufficient clinical information. The recommendations offer a framework for prospective biobanking studies.
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Affiliation(s)
- Philipp Karschnia
- Department of Neurosurgery, Ludwig-Maximilians-University of Munich, Munich, Germany; German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Marion Smits
- Department of Neuroradiology and Nuclear Medicine, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University Medical Faculty and University Hospital Düsseldorf, Düsseldorf, Germany
| | - Emilie Le Rhun
- Department of Neurosurgery, University Hospital of Zurich and University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; Research Center Juelich, Institute of Neuroscience and Medicine, Juelich, Germany
| | - Michelle M Kim
- Department of Radiation Oncology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Jason T Huse
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Oliver Schnell
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Patrick N Harter
- German Cancer Consortium, Partner Site Munich, Munich, Germany; Center for Neuropathology and Prion Research, Faculty of Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Malte Mohme
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Louisa von Baumgarten
- Department of Neurosurgery, Ludwig-Maximilians-University of Munich, Munich, Germany; German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Raymond Y Huang
- Division of Neuroradiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Martin van den Bent
- Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Michael Weller
- Department of Neurology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | | | - Susan M Chang
- Department of Neurosurgery and Division of Neuro-Oncology, University of California, San Francisco, CA, USA
| | - Mitchel S Berger
- Department of Neurosurgery and Division of Neuro-Oncology, University of California, San Francisco, CA, USA
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University of Munich, Munich, Germany; German Cancer Consortium, Partner Site Munich, Munich, Germany.
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8
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Zhu A, Shih R, Huang RY, DeMarco JK, Bhushan C, Morris HD, Kohls G, Yeo DTB, Marinelli L, Mitra J, Hood M, Ho VB, Foo TKF. Revealing tumor microstructure with oscillating diffusion encoding MRI in pre-surgical and post-treatment glioma patients. Magn Reson Med 2023; 90:1789-1801. [PMID: 37335831 DOI: 10.1002/mrm.29758] [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: 03/06/2023] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE We hypothesized that the time-dependent diffusivity at short diffusion times, as measured by oscillating gradient spin echo (OGSE) diffusion MRI, can characterize tissue microstructures in glioma patients. THEORY AND METHODS Five adult patients with known diffuse glioma, including two pre-surgical and three with new enhancing lesions after treatment for high-grade glioma, were scanned in an ultra-high-performance gradient 3.0T MRI system. OGSE diffusion MRI at 30-100 Hz and pulsed gradient spin echo diffusion imaging (approximated as 0 Hz) were obtained. The ADC and trace-diffusion-weighted image at each acquired frequency were calculated, that is, ADC (f) and TraceDWI (f). RESULTS In pre-surgical patients, biopsy-confirmed solid enhancing tumor in a high-grade glioblastoma showed higherADC ( f ) ADC ( 0 Hz ) $$ \frac{\mathrm{ADC}\ (f)}{\mathrm{ADC}\ \left(0\ \mathrm{Hz}\right)} $$ and lowerTraceDWI ( f ) TraceDWI ( 0 Hz ) $$ \frac{\mathrm{TraceDWI}\ (f)}{\mathrm{TraceDWI}\ \left(0\ \mathrm{Hz}\right)} $$ , compared to that at same OGSE frequency in a low-grade astrocytoma. In post-treatment patients, the enhancing lesions of two patients who were diagnosed with tumor progression contained more voxels with highADC ( f ) ADC ( 0 Hz ) $$ \frac{\mathrm{ADC}\ (f)}{\mathrm{ADC}\ \left(0\ \mathrm{Hz}\right)} $$ and lowTraceDWI ( f ) TraceDWI ( 0 Hz ) $$ \frac{\mathrm{TraceDWI}\left(\mathrm{f}\right)}{\mathrm{TraceDWI}\left(0\ \mathrm{Hz}\right)} $$ , compared to the enhancing lesions of a patient who was diagnosed with treatment effect. Non-enhancing T2 signal abnormality lesions in both the pre-surgical high-grade glioblastoma and post-treatment tumor progressions showed regions with highADC ( f ) ADC ( 0 Hz ) $$ \frac{\mathrm{ADC}\ (f)}{\mathrm{ADC}\ \left(0\ \mathrm{Hz}\right)} $$ and lowTraceDWI ( f ) TraceDWI ( 0 Hz ) $$ \frac{\mathrm{TraceDWI}\ \left(\mathrm{f}\right)}{\mathrm{TraceDWI}\ \left(0\ \mathrm{Hz}\right)} $$ , consistent with infiltrative tumor. The solid tumor of the glioblastoma, the enhancing lesions of post-treatment tumor progressions, and the suspected infiltrative tumors showed high diffusion time-dependency from 30 to 100 Hz, consistent with high intra-tumoral volume fraction (cellular density). CONCLUSION Different characteristics of OGSE-based time-dependent diffusivity can reveal heterogenous tissue microstructures that indicate cellular density in glioma patients.
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Affiliation(s)
- Ante Zhu
- GE Research, Niskayuna, New York, USA
| | - Robert Shih
- Uniformed Services University, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J Kevin DeMarco
- Uniformed Services University, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | | | - H Douglas Morris
- Uniformed Services University, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Gail Kohls
- Uniformed Services University, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | | | | | | | - Maureen Hood
- Uniformed Services University, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Vincent B Ho
- Uniformed Services University, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Thomas K F Foo
- GE Research, Niskayuna, New York, USA
- Uniformed Services University, Bethesda, Maryland, USA
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Li J, Zhang P, Qu L, Sun T, Duan Y, Wu M, Weng J, Li Z, Gong X, Liu X, Wang Y, Jia W, Su X, Yue Q, Li J, Zhang Z, Barkhof F, Huang RY, Chang K, Sair H, Ye C, Zhang L, Zhuo Z, Liu Y. Deep Learning for Noninvasive Assessment of H3 K27M Mutation Status in Diffuse Midline Gliomas Using MR Imaging. J Magn Reson Imaging 2023; 58:850-861. [PMID: 36692205 DOI: 10.1002/jmri.28606] [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: 10/21/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Determination of H3 K27M mutation in diffuse midline glioma (DMG) is key for prognostic assessment and stratifying patient subgroups for clinical trials. MRI can noninvasively depict morphological and metabolic characteristics of H3 K27M mutant DMG. PURPOSE This study aimed to develop a deep learning (DL) approach to noninvasively predict H3 K27M mutation in DMG using T2-weighted images. STUDY TYPE Retrospective and prospective. POPULATION For diffuse midline brain gliomas, 341 patients from Center-1 (27 ± 19 years, 184 males), 42 patients from Center-2 (33 ± 19 years, 27 males) and 35 patients (37 ± 18 years, 24 males). For diffuse spinal cord gliomas, 133 patients from Center-1 (30 ± 15 years, 80 males). FIELD STRENGTH/SEQUENCE 5T and 3T, T2-weighted turbo spin echo imaging. ASSESSMENT Conventional radiological features were independently reviewed by two neuroradiologists. H3 K27M status was determined by histopathological examination. The Dice coefficient was used to evaluate segmentation performance. Classification performance was evaluated using accuracy, sensitivity, specificity, and area under the curve. STATISTICAL TESTS Pearson's Chi-squared test, Fisher's exact test, two-sample Student's t-test and Mann-Whitney U test. A two-sided P value <0.05 was considered statistically significant. RESULTS In the testing cohort, Dice coefficients of tumor segmentation using DL were 0.87 for diffuse midline brain and 0.81 for spinal cord gliomas. In the internal prospective testing dataset, the predictive accuracies, sensitivities, and specificities of H3 K27M mutation status were 92.1%, 98.2%, 82.9% in diffuse midline brain gliomas and 85.4%, 88.9%, 82.6% in spinal cord gliomas. Furthermore, this study showed that the performance generalizes to external institutions, with predictive accuracies of 85.7%-90.5%, sensitivities of 90.9%-96.0%, and specificities of 82.4%-83.3%. DATA CONCLUSION In this study, an automatic DL framework was developed and validated for accurately predicting H3 K27M mutation using T2-weighted images, which could contribute to the noninvasive determination of H3 K27M status for clinical decision-making. EVIDENCE LEVEL 2 Technical Efficacy: Stage 2.
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Affiliation(s)
- Junjie Li
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Peng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Liying Qu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ting Sun
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Minghao Wu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jinyuan Weng
- Department of Medical Imaging Product, Neusoft, Group Ltd., Shenyang, People's Republic of China
| | - Zhaohui Li
- BioMind Inc., Beijing, People's Republic of China
| | - Xiaodong Gong
- Department of Medical Imaging Product, Neusoft, Group Ltd., Shenyang, People's Republic of China
| | - Xing Liu
- Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yongzhi Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wenqing Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaorui Su
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Qiang Yue
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Jianrui Li
- Department of Diagnostic Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Zhiqiang Zhang
- Department of Diagnostic Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Frederik Barkhof
- UCL Institutes of Neurology and Healthcare Engineering, London, UK
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ken Chang
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Haris Sair
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chuyang Ye
- School of Information and Electronics, Beijing Institute of Technology, Beijing, People's Republic of China
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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10
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Loken EK, Huang RY. Advanced Meningioma Imaging. Neurosurg Clin N Am 2023; 34:335-345. [PMID: 37210124 DOI: 10.1016/j.nec.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Noninvasive imaging methods are used to accurately diagnose meningiomas and track their growth and location. These techniques, including computed tomography, MRI, and nuclear medicine, are also being used to gather more information about the biology of the tumors and potentially predict their grade and impact on prognosis. In this article, we will discuss the current and developing uses of these imaging techniques including additional analysis using radiomics in the diagnosis and treatment of meningiomas, including treatment planning and prediction of tumor behavior.
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Affiliation(s)
- Erik K Loken
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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11
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Youssef G, Rahman R, Bay C, Wang W, Lim-Fat MJ, Arnaout O, Bi WL, Cagney DN, Chang YS, Cloughesy TF, DeSalvo M, Ellingson BM, Flood TF, Gerstner ER, Gonzalez Castro LN, Guenette JP, Kim AE, Lee EQ, McFaline-Figueroa JR, Potter CA, Reardon DA, Huang RY, Wen PY. Evaluation of Standard Response Assessment in Neuro-Oncology, Modified Response Assessment in Neuro-Oncology, and Immunotherapy Response Assessment in Neuro-Oncology in Newly Diagnosed and Recurrent Glioblastoma. J Clin Oncol 2023; 41:3160-3171. [PMID: 37027809 DOI: 10.1200/jco.22.01579] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/13/2023] [Accepted: 03/06/2023] [Indexed: 04/09/2023] Open
Abstract
PURPOSE The Response Assessment in Neuro-Oncology (RANO) criteria are widely used in high-grade glioma clinical trials. We compared the RANO criteria with updated modifications (modified RANO [mRANO] and immunotherapy RANO [iRANO] criteria) in patients with newly diagnosed glioblastoma (nGBM) and recurrent GBM (rGBM) to evaluate the performance of each set of criteria and inform the development of the planned RANO 2.0 update. MATERIALS AND METHODS Evaluation of tumor measurements and fluid-attenuated inversion recovery (FLAIR) sequences were performed by blinded readers to determine disease progression using RANO, mRANO, iRANO, and other response assessment criteria. Spearman's correlations between progression-free survival (PFS) and overall survival (OS) were calculated. RESULTS Five hundred twenty-six nGBM and 580 rGBM cases were included. Spearman's correlations were similar between RANO and mRANO (0.69 [95% CI, 0.62 to 0.75] v 0.67 [95% CI, 0.60 to 0.73]) in nGBM and rGBM (0.48 [95% CI, 0.40 to 0.55] v 0.50 [95% CI, 0.42 to 0.57]). In nGBM, requirement of a confirmation scan within 12 weeks of completion of radiotherapy to determine progression was associated with improved correlations. Use of the postradiation magnetic resonance imaging (MRI) as baseline scan was associated with improved correlation compared with use of the pre-radiation MRI (0.67 [95% CI, 0.60 to 0.73] v 0.53 [95% CI, 0.42 to 0.62]). Evaluation of FLAIR sequences did not improve the correlation. Among patients who received immunotherapy, Spearman's correlations were similar among RANO, mRANO, and iRANO. CONCLUSION RANO and mRANO demonstrated similar correlations between PFS and OS. Confirmation scans were only beneficial in nGBM within 12 weeks of completion of radiotherapy, and there was a trend in favor of the use of postradiation MRI as the baseline scan in nGBM. Evaluation of FLAIR can be omitted. The iRANO criteria did not add significant benefit in patients who received immune checkpoint inhibitors.
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Affiliation(s)
- Gilbert Youssef
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Rifaquat Rahman
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA
| | - Camden Bay
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Wei Wang
- Department of Neurology, Brigham and Women's Hospital, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Mary Jane Lim-Fat
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Omar Arnaout
- Department of Neurosurgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - Daniel N Cagney
- Radiotherapy Department, Mater Private Network, Dublin, Ireland
| | - Yuh-Shin Chang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, University of California Los Angeles, Los Angeles, CA
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Matthew DeSalvo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles, Los Angeles, CA
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Thomas F Flood
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - L Nicolas Gonzalez Castro
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Neurology, Brigham and Women's Hospital, Boston, MA
| | - Jeffrey P Guenette
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Albert E Kim
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Eudocia Q Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Christopher A Potter
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
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12
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Patel RV, Yao S, Huang RY, Bi WL. Application of radiomics to meningiomas: A systematic review. Neuro Oncol 2023; 25:1166-1176. [PMID: 36723606 PMCID: PMC10237421 DOI: 10.1093/neuonc/noad028] [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: 11/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Quantitative imaging analysis through radiomics is a powerful technology to non-invasively assess molecular correlates and guide clinical decision-making. There has been growing interest in image-based phenotyping for meningiomas given the complexities in management. METHODS We systematically reviewed meningioma radiomics analyses published in PubMed, Embase, and Web of Science until December 20, 2021. We compiled performance data and assessed publication quality using the radiomics quality score (RQS). RESULTS A total of 170 publications were grouped into 5 categories of radiomics applications to meningiomas: Tumor detection and segmentation (21%), classification across neurologic diseases (54%), grading (14%), feature correlation (3%), and prognostication (8%). A majority focused on technical model development (73%) versus clinical applications (27%), with increasing adoption of deep learning. Studies utilized either private institutional (50%) or public (49%) datasets, with only 68% using a validation dataset. For detection and segmentation, radiomic models had a mean accuracy of 93.1 ± 8.1% and a dice coefficient of 88.8 ± 7.9%. Meningioma classification had a mean accuracy of 95.2 ± 4.0%. Tumor grading had a mean area-under-the-curve (AUC) of 0.85 ± 0.08. Correlation with meningioma biological features had a mean AUC of 0.89 ± 0.07. Prognostication of the clinical course had a mean AUC of 0.83 ± 0.08. While clinical studies had a higher mean RQS compared to technical studies, quality was low overall with a mean RQS of 6.7 ± 5.9 (possible range -8 to 36). CONCLUSIONS There has been global growth in meningioma radiomics, driven by data accessibility and novel computational methodology. Translatability toward complex tasks such as prognostication requires studies that improve quality, develop comprehensive patient datasets, and engage in prospective trials.
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Affiliation(s)
- Ruchit V Patel
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Shun Yao
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Raymond Y Huang
- Division of Neuroradiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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13
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Hassanzadeh E, Huang RY. The natural history of incidental meningiomas. Neurooncol Pract 2023; 10:215-216. [PMID: 37188161 PMCID: PMC10180354 DOI: 10.1093/nop/npad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Affiliation(s)
- Elmira Hassanzadeh
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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14
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Tran NA, Palotai M, Hanna GJ, Schoenfeld JD, Bay CP, Rettig EM, Bunch PM, Juliano AF, Kelly HR, Suh CH, Zander DA, Morales Pinzon A, Kann BH, Huang RY, Haddad RI, Guttmann CRG, Guenette JP. Diagnostic performance of computed tomography features in detecting oropharyngeal squamous cell carcinoma extranodal extension. Eur Radiol 2023; 33:3693-3703. [PMID: 36719493 DOI: 10.1007/s00330-023-09407-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 12/06/2022] [Accepted: 12/27/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Accurate pre-treatment imaging determination of extranodal extension (ENE) could facilitate the selection of appropriate initial therapy for HPV-positive oropharyngeal squamous cell carcinoma (HPV + OPSCC). Small studies have associated 7 CT features with ENE with varied results and agreement. This article seeks to determine the replicable diagnostic performance of these CT features for ENE. METHODS Five expert academic head/neck neuroradiologists from 5 institutions evaluate a single academic cancer center cohort of 75 consecutive HPV + OPSCC patients. In a web-based virtual laboratory for imaging research and education, the experts performed training on 7 published CT features associated with ENE and then independently identified the "single most (if any) suspicious" lymph node and presence/absence of each of the features. Inter-rater agreement was assessed using percentage agreement, Gwet's AC1, and Fleiss' kappa. Sensitivity, specificity, and positive and negative predictive values were calculated for each CT feature based on histologic ENE. RESULTS All 5 raters identified the same node in 52 cases (69%). In 15 cases (20%), at least one rater selected a node and at least one rater did not. In 8 cases (11%), all raters selected a node, but at least one rater selected a different node. Percentage agreement and Gwet's AC1 coefficients were > 0.80 for lesion identification, matted/conglomerated nodes, and central necrosis. Fleiss' kappa was always < 0.6. CT sensitivity for histologically confirmed ENE ranged 0.18-0.94, specificity 0.41-0.88, PPV 0.26-0.36, and NPV 0.78-0.96. CONCLUSIONS Previously described CT features appear to have poor reproducibility among expert head/neck neuroradiologists and poor predictive value for histologic ENE. KEY POINTS • Previously described CT imaging features appear to have poor reproducibility among expert head and neck subspecialized neuroradiologists as well as poor predictive value for histologic ENE. • Although it may still be appropriate to comment on the presence or absence of these CT features in imaging reports, the evidence indicates that caution is warranted when incorporating these features into clinical decision-making regarding the likelihood of ENE.
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Affiliation(s)
- Ngoc-Anh Tran
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Miklos Palotai
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Glenn J Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Camden P Bay
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eleni M Rettig
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Paul M Bunch
- Division of Neuroradiology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Hillary R Kelly
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - David A Zander
- Division of Neuroradiology, University of Colorado, Aurora, CO, USA
| | - Alfredo Morales Pinzon
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin H Kann
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street Boston, Boston, MA, 02115, USA
| | - Robert I Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Charles R G Guttmann
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey P Guenette
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street Boston, Boston, MA, 02115, USA.
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15
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Vollmuth P, Foltyn M, Huang RY, Galldiks N, Petersen J, Isensee F, van den Bent MJ, Barkhof F, Park JE, Park YW, Ahn SS, Brugnara G, Meredig H, Jain R, Smits M, Pope WB, Maier-Hein K, Weller M, Wen PY, Wick W, Bendszus M. Artificial intelligence (AI)-based decision support improves reproducibility of tumor response assessment in neuro-oncology: An international multi-reader study. Neuro Oncol 2023; 25:533-543. [PMID: 35917833 PMCID: PMC10013635 DOI: 10.1093/neuonc/noac189] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 03/31/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To assess whether artificial intelligence (AI)-based decision support allows more reproducible and standardized assessment of treatment response on MRI in neuro-oncology as compared to manual 2-dimensional measurements of tumor burden using the Response Assessment in Neuro-Oncology (RANO) criteria. METHODS A series of 30 patients (15 lower-grade gliomas, 15 glioblastoma) with availability of consecutive MRI scans was selected. The time to progression (TTP) on MRI was separately evaluated for each patient by 15 investigators over two rounds. In the first round the TTP was evaluated based on the RANO criteria, whereas in the second round the TTP was evaluated by incorporating additional information from AI-enhanced MRI sequences depicting the longitudinal changes in tumor volumes. The agreement of the TTP measurements between investigators was evaluated using concordance correlation coefficients (CCC) with confidence intervals (CI) and P-values obtained using bootstrap resampling. RESULTS The CCC of TTP-measurements between investigators was 0.77 (95% CI = 0.69,0.88) with RANO alone and increased to 0.91 (95% CI = 0.82,0.95) with AI-based decision support (P = .005). This effect was significantly greater (P = .008) for patients with lower-grade gliomas (CCC = 0.70 [95% CI = 0.56,0.85] without vs. 0.90 [95% CI = 0.76,0.95] with AI-based decision support) as compared to glioblastoma (CCC = 0.83 [95% CI = 0.75,0.92] without vs. 0.86 [95% CI = 0.78,0.93] with AI-based decision support). Investigators with less years of experience judged the AI-based decision as more helpful (P = .02). CONCLUSIONS AI-based decision support has the potential to yield more reproducible and standardized assessment of treatment response in neuro-oncology as compared to manual 2-dimensional measurements of tumor burden, particularly in patients with lower-grade gliomas. A fully-functional version of this AI-based processing pipeline is provided as open-source (https://github.com/NeuroAI-HD/HD-GLIO-XNAT).
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Affiliation(s)
- Philipp Vollmuth
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martha Foltyn
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Jens Petersen
- Department of Medical Image Computing (MIC), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Fabian Isensee
- Department of Medical Image Computing (MIC), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.,Institutes of Neurology & Centre for Medical Image Computing, University College London, London, UK
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yae Won Park
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gianluca Brugnara
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hagen Meredig
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Rajan Jain
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Klaus Maier-Hein
- Department of Medical Image Computing (MIC), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Y Wen
- Center for Neuro-oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Wolfgang Wick
- Neurology Clinic, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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16
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Datta M, Chatterjee S, Perez EM, Gritsch S, Roberge S, Duquette M, Chen IX, Naxerova K, Kumar AS, Ghosh M, Emblem KE, Ng MR, Ho WW, Kumar P, Krishnan S, Dong X, Speranza MC, Neagu MR, Iorgulescu JB, Huang RY, Youssef G, Reardon DA, Sharpe AH, Freeman GJ, Suvà ML, Xu L, Jain RK. Losartan controls immune checkpoint blocker-induced edema and improves survival in glioblastoma mouse models. Proc Natl Acad Sci U S A 2023; 120:e2219199120. [PMID: 36724255 PMCID: PMC9963691 DOI: 10.1073/pnas.2219199120] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/29/2022] [Indexed: 02/03/2023] Open
Abstract
Immune checkpoint blockers (ICBs) have failed in all phase III glioblastoma trials. Here, we found that ICBs induce cerebral edema in some patients and mice with glioblastoma. Through single-cell RNA sequencing, intravital imaging, and CD8+ T cell blocking studies in mice, we demonstrated that this edema results from an inflammatory response following antiprogrammed death 1 (PD1) antibody treatment that disrupts the blood-tumor barrier. Used in lieu of immunosuppressive corticosteroids, the angiotensin receptor blocker losartan prevented this ICB-induced edema and reprogrammed the tumor microenvironment, curing 20% of mice which increased to 40% in combination with standard of care treatment. Using a bihemispheric tumor model, we identified a "hot" tumor immune signature prior to losartan+anti-PD1 therapy that predicted long-term survival. Our findings provide the rationale and associated biomarkers to test losartan with ICBs in glioblastoma patients.
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Affiliation(s)
- Meenal Datta
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Sampurna Chatterjee
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Elizabeth M. Perez
- Department of Pathology and Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Broad Institute of MIT and Harvard, Cambridge, MA02142
- Department of Systems Biology, Harvard Medical School, Boston, MA02115
| | - Simon Gritsch
- Department of Pathology and Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Broad Institute of MIT and Harvard, Cambridge, MA02142
| | - Sylvie Roberge
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Mark Duquette
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Ivy X. Chen
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Kamila Naxerova
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Ashwin S. Kumar
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
- Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA02142
| | - Mitrajit Ghosh
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Kyrre E. Emblem
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, 0372Norway
| | - Mei R. Ng
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - William W. Ho
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA02142
| | - Pragya Kumar
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Shanmugarajan Krishnan
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Xinyue Dong
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Maria C. Speranza
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA02115
- Department of Medicine, Harvard Medical School, Boston, MA02115
| | - Martha R. Neagu
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA
| | - J. Bryan Iorgulescu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA02115
| | - Raymond Y. Huang
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA02115
| | - Gilbert Youssef
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA02215
| | - David A. Reardon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA02115
- Department of Medicine, Harvard Medical School, Boston, MA02115
| | - Arlene H. Sharpe
- Broad Institute of MIT and Harvard, Cambridge, MA02142
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA
| | - Gordon J. Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA02115
- Department of Medicine, Harvard Medical School, Boston, MA02115
| | - Mario L. Suvà
- Department of Pathology and Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Broad Institute of MIT and Harvard, Cambridge, MA02142
| | - Lei Xu
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Rakesh K. Jain
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
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Pati S, Baid U, Edwards B, Sheller M, Wang SH, Reina GA, Foley P, Gruzdev A, Karkada D, Davatzikos C, Sako C, Ghodasara S, Bilello M, Mohan S, Vollmuth P, Brugnara G, Preetha CJ, Sahm F, Maier-Hein K, Zenk M, Bendszus M, Wick W, Calabrese E, Rudie J, Villanueva-Meyer J, Cha S, Ingalhalikar M, Jadhav M, Pandey U, Saini J, Garrett J, Larson M, Jeraj R, Currie S, Frood R, Fatania K, Huang RY, Chang K, Balaña C, Capellades J, Puig J, Trenkler J, Pichler J, Necker G, Haunschmidt A, Meckel S, Shukla G, Liem S, Alexander GS, Lombardo J, Palmer JD, Flanders AE, Dicker AP, Sair HI, Jones CK, Venkataraman A, Jiang M, So TY, Chen C, Heng PA, Dou Q, Kozubek M, Lux F, Michálek J, Matula P, Keřkovský M, Kopřivová T, Dostál M, Vybíhal V, Vogelbaum MA, Mitchell JR, Farinhas J, Maldjian JA, Yogananda CGB, Pinho MC, Reddy D, Holcomb J, Wagner BC, Ellingson BM, Cloughesy TF, Raymond C, Oughourlian T, Hagiwara A, Wang C, To MS, Bhardwaj S, Chong C, Agzarian M, Falcão AX, Martins SB, Teixeira BCA, Sprenger F, Menotti D, Lucio DR, LaMontagne P, Marcus D, Wiestler B, Kofler F, Ezhov I, Metz M, Jain R, Lee M, Lui YW, McKinley R, Slotboom J, Radojewski P, Meier R, Wiest R, Murcia D, Fu E, Haas R, Thompson J, Ormond DR, Badve C, Sloan AE, Vadmal V, Waite K, Colen RR, Pei L, Ak M, Srinivasan A, Bapuraj JR, Rao A, Wang N, Yoshiaki O, Moritani T, Turk S, Lee J, Prabhudesai S, Morón F, Mandel J, Kamnitsas K, Glocker B, Dixon LVM, Williams M, Zampakis P, Panagiotopoulos V, Tsiganos P, Alexiou S, Haliassos I, Zacharaki EI, Moustakas K, Kalogeropoulou C, Kardamakis DM, Choi YS, Lee SK, Chang JH, Ahn SS, Luo B, Poisson L, Wen N, Tiwari P, Verma R, Bareja R, Yadav I, Chen J, Kumar N, Smits M, van der Voort SR, Alafandi A, Incekara F, Wijnenga MMJ, Kapsas G, Gahrmann R, Schouten JW, Dubbink HJ, Vincent AJPE, van den Bent MJ, French PJ, Klein S, Yuan Y, Sharma S, Tseng TC, Adabi S, Niclou SP, Keunen O, Hau AC, Vallières M, Fortin D, Lepage M, Landman B, Ramadass K, Xu K, Chotai S, Chambless LB, Mistry A, Thompson RC, Gusev Y, Bhuvaneshwar K, Sayah A, Bencheqroun C, Belouali A, Madhavan S, Booth TC, Chelliah A, Modat M, Shuaib H, Dragos C, Abayazeed A, Kolodziej K, Hill M, Abbassy A, Gamal S, Mekhaimar M, Qayati M, Reyes M, Park JE, Yun J, Kim HS, Mahajan A, Muzi M, Benson S, Beets-Tan RGH, Teuwen J, Herrera-Trujillo A, Trujillo M, Escobar W, Abello A, Bernal J, Gómez J, Choi J, Baek S, Kim Y, Ismael H, Allen B, Buatti JM, Kotrotsou A, Li H, Weiss T, Weller M, Bink A, Pouymayou B, Shaykh HF, Saltz J, Prasanna P, Shrestha S, Mani KM, Payne D, Kurc T, Pelaez E, Franco-Maldonado H, Loayza F, Quevedo S, Guevara P, Torche E, Mendoza C, Vera F, Ríos E, López E, Velastin SA, Ogbole G, Soneye M, Oyekunle D, Odafe-Oyibotha O, Osobu B, Shu'aibu M, Dorcas A, Dako F, Simpson AL, Hamghalam M, Peoples JJ, Hu R, Tran A, Cutler D, Moraes FY, Boss MA, Gimpel J, Veettil DK, Schmidt K, Bialecki B, Marella S, Price C, Cimino L, Apgar C, Shah P, Menze B, Barnholtz-Sloan JS, Martin J, Bakas S. Author Correction: Federated learning enables big data for rare cancer boundary detection. Nat Commun 2023; 14:436. [PMID: 36702828 PMCID: PMC9879935 DOI: 10.1038/s41467-023-36188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Sarthak Pati
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
| | - Ujjwal Baid
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chiharu Sako
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Satyam Ghodasara
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michel Bilello
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Suyash Mohan
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Philipp Vollmuth
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gianluca Brugnara
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Felix Sahm
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Maximilian Zenk
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic, Heidelberg University Hospital, Heidelberg, Germany
| | - Evan Calabrese
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey Rudie
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Javier Villanueva-Meyer
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Soonmee Cha
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Madhura Ingalhalikar
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Manali Jadhav
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Umang Pandey
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - John Garrett
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Matthew Larson
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Robert Jeraj
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Stuart Currie
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Russell Frood
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Kavi Fatania
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ken Chang
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | | | | | - Josep Puig
- Department of Radiology (IDI), Girona Biomedical Research Institute (IdIBGi), Josep Trueta University Hospital, Girona, Spain
| | - Johannes Trenkler
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Josef Pichler
- Department of Neurooncology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Georg Necker
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Andreas Haunschmidt
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Stephan Meckel
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
- Institute of Diagnostic and Interventional Neuroradiology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Gaurav Shukla
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiation Oncology, Christiana Care Health System, Philadelphia, PA, USA
| | - Spencer Liem
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory S Alexander
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| | - Joseph Lombardo
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Adam E Flanders
- Department of Radiology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Haris I Sair
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Craig K Jones
- The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Archana Venkataraman
- Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Meirui Jiang
- The Chinese University of Hong Kong, Hong Kong, China
| | - Tiffany Y So
- The Chinese University of Hong Kong, Hong Kong, China
| | - Cheng Chen
- The Chinese University of Hong Kong, Hong Kong, China
| | | | - Qi Dou
- The Chinese University of Hong Kong, Hong Kong, China
| | - Michal Kozubek
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Filip Lux
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Jan Michálek
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Petr Matula
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Miloš Keřkovský
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
| | - Tereza Kopřivová
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
| | - Marek Dostál
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
- Department of Biophysics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Václav Vybíhal
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, and University Hospital and Czech Republic, Brno, Czech Republic
| | - Michael A Vogelbaum
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - J Ross Mitchell
- University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
| | - Joaquim Farinhas
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | - Marco C Pinho
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Divya Reddy
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James Holcomb
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- UCLA Neuro-Oncology Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CaA, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CaA, USA
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Talia Oughourlian
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Akifumi Hagiwara
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Chencai Wang
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Minh-Son To
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Sargam Bhardwaj
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Chee Chong
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Marc Agzarian
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, SA, Australia
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Bernardo C A Teixeira
- Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
- Department of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Flávia Sprenger
- Department of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - David Menotti
- Department of Informatics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Diego R Lucio
- Department of Informatics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Pamela LaMontagne
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Daniel Marcus
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
| | - Florian Kofler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
- Image-Based Biomedical Modeling, Department of Informatics, Technical University of Munich, Munich, Germany
| | - Ivan Ezhov
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
- Image-Based Biomedical Modeling, Department of Informatics, Technical University of Munich, Munich, Germany
| | - Marie Metz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rajan Jain
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Matthew Lee
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Yvonne W Lui
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Richard McKinley
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes Slotboom
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Piotr Radojewski
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Raphael Meier
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Derrick Murcia
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Eric Fu
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Rourke Haas
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - John Thompson
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - David Ryan Ormond
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Chaitra Badve
- Department of Radiology, University Hospitals Cleveland, Cleveland, OH, USA
| | - Andrew E Sloan
- Department of Neurological Surgery, University Hospitals-Seidman Cancer Center, Cleveland, OH, USA
- Case Comprehensive Cancer Center, Cleveland, OH, USA
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Vachan Vadmal
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kristin Waite
- National Cancer Institute, National Institute of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Rivka R Colen
- Department of Radiology, Neuroradiology Division, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Linmin Pei
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Murat Ak
- Department of Radiology, Neuroradiology Division, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashok Srinivasan
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - J Rajiv Bapuraj
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Arvind Rao
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Wang
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Ota Yoshiaki
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Toshio Moritani
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Sevcan Turk
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Joonsang Lee
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Snehal Prabhudesai
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Fanny Morón
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Jacob Mandel
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Konstantinos Kamnitsas
- Department of Computing, Imperial College London, London, UK
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Ben Glocker
- Department of Computing, Imperial College London, London, UK
| | - Luke V M Dixon
- Department of Radiology, Imperial College NHS Healthcare Trust, London, UK
| | - Matthew Williams
- Computational Oncology Group, Institute for Global Health Innovation, Imperial College London, London, UK
| | - Peter Zampakis
- Department of NeuroRadiology, University of Patras, Patras, Greece
| | | | - Panagiotis Tsiganos
- Clinical Radiology Laboratory, Department of Medicine, University of Patras, Patras, Greece
| | - Sotiris Alexiou
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | - Ilias Haliassos
- Department of Neuro-Oncology, University of Patras, Patras, Greece
| | - Evangelia I Zacharaki
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | | | | | | | | | | | | | - Sung Soo Ahn
- Yonsei University College of Medicine, Seoul, Korea
| | - Bing Luo
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Laila Poisson
- Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
- SJTU-Ruijin-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | | | - Ruchika Verma
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
- Case Western Reserve University, Cleveland, OH, USA
| | - Rohan Bareja
- Case Western Reserve University, Cleveland, OH, USA
| | - Ipsa Yadav
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Neeraj Kumar
- University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Sebastian R van der Voort
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Ahmed Alafandi
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Fatih Incekara
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Maarten M J Wijnenga
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Georgios Kapsas
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Renske Gahrmann
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Joost W Schouten
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Hendrikus J Dubbink
- Department of Pathology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Arnaud J P E Vincent
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Martin J van den Bent
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Pim J French
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Yading Yuan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tzu-Chi Tseng
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Saba Adabi
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Simone P Niclou
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Olivier Keunen
- Translation Radiomics, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Ann-Christin Hau
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
- Luxembourg Center of Neuropathology, Laboratoire National De Santé, Luxembourg, Luxembourg
| | - Martin Vallières
- Department of Computer Science, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - David Fortin
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Division of Neurosurgery and Neuro-Oncology, Faculty of Medicine and Health Science, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Martin Lepage
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Department of Nuclear Medicine and Radiobiology, Sherbrooke Molecular Imaging Centre, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Bennett Landman
- Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Karthik Ramadass
- Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Kaiwen Xu
- Department of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Silky Chotai
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lola B Chambless
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Akshitkumar Mistry
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Reid C Thompson
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuriy Gusev
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Krithika Bhuvaneshwar
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Anousheh Sayah
- Division of Neuroradiology & Neurointerventional Radiology, Department of Radiology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Camelia Bencheqroun
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Anas Belouali
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Subha Madhavan
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Neuroradiology, Ruskin Wing, King's College Hospital NHS Foundation Trust, London, UK
| | - Alysha Chelliah
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Haris Shuaib
- Stoke Mandeville Hospital, Mandeville Road, Aylesbury, UK
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Carmen Dragos
- Stoke Mandeville Hospital, Mandeville Road, Aylesbury, UK
| | | | | | | | | | - Shady Gamal
- University of Cairo School of Medicine, Giza, Egypt
| | | | | | | | - Ji Eun Park
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Jihye Yun
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Ho Sung Kim
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Abhishek Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust Pembroke Place, Liverpool, UK
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Sean Benson
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht, Netherlands
| | - Jonas Teuwen
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - William Escobar
- Clínica Imbanaco Grupo Quirón Salud, Cali, Colombia
- Universidad del Valle, Cali, Colombia
| | | | - Jose Bernal
- Universidad del Valle, Cali, Colombia
- The University of Edinburgh, Edinburgh, UK
| | | | - Joseph Choi
- Department of Industrial and Systems Engineering, University of Iowa, Iowa, USA
| | - Stephen Baek
- Department of Industrial and Systems Engineering, Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Yusung Kim
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Heba Ismael
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Bryan Allen
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | | | - Hongwei Li
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Tobias Weiss
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Andrea Bink
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Bertrand Pouymayou
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Prateek Prasanna
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Sampurna Shrestha
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Kartik M Mani
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
- Department of Radiation Oncology, Stony Brook University, Stony Brook, NY, USA
| | - David Payne
- Department of Radiology, Stony Brook University, Stony Brook, NY, USA
| | - Tahsin Kurc
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
- Scientific Data Group, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Enrique Pelaez
- Escuela Superior Politecnica del Litoral, Guayaquil, Guayas, Ecuador
| | | | - Francis Loayza
- Escuela Superior Politecnica del Litoral, Guayaquil, Guayas, Ecuador
| | | | | | | | | | - Franco Vera
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Elvis Ríos
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Eduardo López
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Sergio A Velastin
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Godwin Ogbole
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Mayowa Soneye
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Dotun Oyekunle
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | | | - Babatunde Osobu
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Mustapha Shu'aibu
- Department of Radiology, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria
| | - Adeleye Dorcas
- Department of Radiology, Obafemi Awolowo University Ile-Ife, Ile-Ife, Osun, Nigeria
| | - Farouk Dako
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amber L Simpson
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Mohammad Hamghalam
- School of Computing, Queen's University, Kingston, ON, Canada
- Department of Electrical Engineering, Qazvin Branch, Islamic Azad University, Qazvin, Iran
| | - Jacob J Peoples
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Ricky Hu
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Anh Tran
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Danielle Cutler
- The Faculty of Arts & Sciences, Queen's University, Kingston, ON, Canada
| | - Fabio Y Moraes
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Michael A Boss
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - James Gimpel
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Deepak Kattil Veettil
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Kendall Schmidt
- Data Science Institute, American College of Radiology, Reston, VA, USA
| | - Brian Bialecki
- Data Science Institute, American College of Radiology, Reston, VA, USA
| | - Sailaja Marella
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Cynthia Price
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Lisa Cimino
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Charles Apgar
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | | | - Bjoern Menze
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Jill S Barnholtz-Sloan
- National Cancer Institute, National Institute of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute (NCI), National Institute of Health, Bethesda, MD, USA
| | | | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA.
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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18
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Miller JJ, Gonzalez Castro LN, McBrayer S, Weller M, Cloughesy T, Portnow J, Andronesi O, Barnholtz-Sloan JS, Baumert BG, Berger MS, Bi WL, Bindra R, Cahill DP, Chang SM, Costello JF, Horbinski C, Huang RY, Jenkins RB, Ligon KL, Mellinghoff IK, Nabors LB, Platten M, Reardon DA, Shi DD, Schiff D, Wick W, Yan H, von Deimling A, van den Bent M, Kaelin WG, Wen PY. Isocitrate dehydrogenase (IDH) mutant gliomas: A Society for Neuro-Oncology (SNO) consensus review on diagnosis, management, and future directions. Neuro Oncol 2023; 25:4-25. [PMID: 36239925 PMCID: PMC9825337 DOI: 10.1093/neuonc/noac207] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [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] [Indexed: 01/12/2023] Open
Abstract
Isocitrate dehydrogenase (IDH) mutant gliomas are the most common adult, malignant primary brain tumors diagnosed in patients younger than 50, constituting an important cause of morbidity and mortality. In recent years, there has been significant progress in understanding the molecular pathogenesis and biology of these tumors, sparking multiple efforts to improve their diagnosis and treatment. In this consensus review from the Society for Neuro-Oncology (SNO), the current diagnosis and management of IDH-mutant gliomas will be discussed. In addition, novel therapies, such as targeted molecular therapies and immunotherapies, will be reviewed. Current challenges and future directions for research will be discussed.
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Affiliation(s)
- Julie J Miller
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - L Nicolas Gonzalez Castro
- Harvard Medical School, Boston, MA, USA
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Samuel McBrayer
- Children’s Medical Center Research Institute, University of Texas Southwestern Medical Center, 6000 Harry Hines Blvd, Dallas, Texas, 75235, USA
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | | | - Jana Portnow
- Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ovidiu Andronesi
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jill S Barnholtz-Sloan
- Informatics and Data Science (IDS), Center for Biomedical Informatics and Information Technology (CBIIT), Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), Bethesda, MD, USA
| | - Brigitta G Baumert
- Cantonal Hospital Graubunden, Institute of Radiation-Oncology, Chur, Switzerland
| | - Mitchell S Berger
- Department of Neurosurgery, University of California-San Francisco, San Francisco, California, USA
| | - Wenya Linda Bi
- Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Ranjit Bindra
- Department of Therapeutic Radiology, Brain Tumor Center, Yale School of Medicine, New Haven, CT, USA
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan M Chang
- Department of Neurosurgery, University of California-San Francisco, San Francisco, California, USA
| | - Joseph F Costello
- Department of Neurosurgery, University of California-San Francisco, San Francisco, California, USA
| | - Craig Horbinski
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Northwestern Medicine Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Raymond Y Huang
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Robert B Jenkins
- Individualized Medicine Research, Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, Minnesota 55901, USA
| | - Keith L Ligon
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ingo K Mellinghoff
- Department of Neurology, Evnin Family Chair in Neuro-Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - L Burt Nabors
- Department of Neurology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael Platten
- CCU Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - David A Reardon
- Harvard Medical School, Boston, MA, USA
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Diana D Shi
- Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - David Schiff
- Division of Neuro-Oncology, Department of Neurology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Wolfgang Wick
- Neuro-Oncology at the German Cancer Research Center (DKFZ), Program Chair of Neuro-Oncology at the National Center for Tumor Diseases (NCT), and Neurology and Chairman at the Neurology Clinic in Heidelberg, Heidelberg, Germany
| | - Hai Yan
- Genetron Health Inc, Gaithersburg, Maryland 20879, USA
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, and, Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), and, DKTK, INF 224, 69120 Heidelberg, Germany
| | - Martin van den Bent
- Brain Tumour Centre, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands
| | - William G Kaelin
- Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Patrick Y Wen
- Harvard Medical School, Boston, MA, USA
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
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19
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Pati S, Baid U, Edwards B, Sheller M, Wang SH, Reina GA, Foley P, Gruzdev A, Karkada D, Davatzikos C, Sako C, Ghodasara S, Bilello M, Mohan S, Vollmuth P, Brugnara G, Preetha CJ, Sahm F, Maier-Hein K, Zenk M, Bendszus M, Wick W, Calabrese E, Rudie J, Villanueva-Meyer J, Cha S, Ingalhalikar M, Jadhav M, Pandey U, Saini J, Garrett J, Larson M, Jeraj R, Currie S, Frood R, Fatania K, Huang RY, Chang K, Balaña C, Capellades J, Puig J, Trenkler J, Pichler J, Necker G, Haunschmidt A, Meckel S, Shukla G, Liem S, Alexander GS, Lombardo J, Palmer JD, Flanders AE, Dicker AP, Sair HI, Jones CK, Venkataraman A, Jiang M, So TY, Chen C, Heng PA, Dou Q, Kozubek M, Lux F, Michálek J, Matula P, Keřkovský M, Kopřivová T, Dostál M, Vybíhal V, Vogelbaum MA, Mitchell JR, Farinhas J, Maldjian JA, Yogananda CGB, Pinho MC, Reddy D, Holcomb J, Wagner BC, Ellingson BM, Cloughesy TF, Raymond C, Oughourlian T, Hagiwara A, Wang C, To MS, Bhardwaj S, Chong C, Agzarian M, Falcão AX, Martins SB, Teixeira BCA, Sprenger F, Menotti D, Lucio DR, LaMontagne P, Marcus D, Wiestler B, Kofler F, Ezhov I, Metz M, Jain R, Lee M, Lui YW, McKinley R, Slotboom J, Radojewski P, Meier R, Wiest R, Murcia D, Fu E, Haas R, Thompson J, Ormond DR, Badve C, Sloan AE, Vadmal V, Waite K, Colen RR, Pei L, Ak M, Srinivasan A, Bapuraj JR, Rao A, Wang N, Yoshiaki O, Moritani T, Turk S, Lee J, Prabhudesai S, Morón F, Mandel J, Kamnitsas K, Glocker B, Dixon LVM, Williams M, Zampakis P, Panagiotopoulos V, Tsiganos P, Alexiou S, Haliassos I, Zacharaki EI, Moustakas K, Kalogeropoulou C, Kardamakis DM, Choi YS, Lee SK, Chang JH, Ahn SS, Luo B, Poisson L, Wen N, Tiwari P, Verma R, Bareja R, Yadav I, Chen J, Kumar N, Smits M, van der Voort SR, Alafandi A, Incekara F, Wijnenga MMJ, Kapsas G, Gahrmann R, Schouten JW, Dubbink HJ, Vincent AJPE, van den Bent MJ, French PJ, Klein S, Yuan Y, Sharma S, Tseng TC, Adabi S, Niclou SP, Keunen O, Hau AC, Vallières M, Fortin D, Lepage M, Landman B, Ramadass K, Xu K, Chotai S, Chambless LB, Mistry A, Thompson RC, Gusev Y, Bhuvaneshwar K, Sayah A, Bencheqroun C, Belouali A, Madhavan S, Booth TC, Chelliah A, Modat M, Shuaib H, Dragos C, Abayazeed A, Kolodziej K, Hill M, Abbassy A, Gamal S, Mekhaimar M, Qayati M, Reyes M, Park JE, Yun J, Kim HS, Mahajan A, Muzi M, Benson S, Beets-Tan RGH, Teuwen J, Herrera-Trujillo A, Trujillo M, Escobar W, Abello A, Bernal J, Gómez J, Choi J, Baek S, Kim Y, Ismael H, Allen B, Buatti JM, Kotrotsou A, Li H, Weiss T, Weller M, Bink A, Pouymayou B, Shaykh HF, Saltz J, Prasanna P, Shrestha S, Mani KM, Payne D, Kurc T, Pelaez E, Franco-Maldonado H, Loayza F, Quevedo S, Guevara P, Torche E, Mendoza C, Vera F, Ríos E, López E, Velastin SA, Ogbole G, Soneye M, Oyekunle D, Odafe-Oyibotha O, Osobu B, Shu'aibu M, Dorcas A, Dako F, Simpson AL, Hamghalam M, Peoples JJ, Hu R, Tran A, Cutler D, Moraes FY, Boss MA, Gimpel J, Veettil DK, Schmidt K, Bialecki B, Marella S, Price C, Cimino L, Apgar C, Shah P, Menze B, Barnholtz-Sloan JS, Martin J, Bakas S. Federated learning enables big data for rare cancer boundary detection. Nat Commun 2022; 13:7346. [PMID: 36470898 PMCID: PMC9722782 DOI: 10.1038/s41467-022-33407-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/16/2022] [Indexed: 12/12/2022] Open
Abstract
Although machine learning (ML) has shown promise across disciplines, out-of-sample generalizability is concerning. This is currently addressed by sharing multi-site data, but such centralization is challenging/infeasible to scale due to various limitations. Federated ML (FL) provides an alternative paradigm for accurate and generalizable ML, by only sharing numerical model updates. Here we present the largest FL study to-date, involving data from 71 sites across 6 continents, to generate an automatic tumor boundary detector for the rare disease of glioblastoma, reporting the largest such dataset in the literature (n = 6, 314). We demonstrate a 33% delineation improvement for the surgically targetable tumor, and 23% for the complete tumor extent, over a publicly trained model. We anticipate our study to: 1) enable more healthcare studies informed by large diverse data, ensuring meaningful results for rare diseases and underrepresented populations, 2) facilitate further analyses for glioblastoma by releasing our consensus model, and 3) demonstrate the FL effectiveness at such scale and task-complexity as a paradigm shift for multi-site collaborations, alleviating the need for data-sharing.
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Affiliation(s)
- Sarthak Pati
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
| | - Ujjwal Baid
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chiharu Sako
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Satyam Ghodasara
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michel Bilello
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Suyash Mohan
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Philipp Vollmuth
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gianluca Brugnara
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Felix Sahm
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Maximilian Zenk
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic, Heidelberg University Hospital, Heidelberg, Germany
| | - Evan Calabrese
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey Rudie
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Javier Villanueva-Meyer
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Soonmee Cha
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Madhura Ingalhalikar
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Manali Jadhav
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Umang Pandey
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - John Garrett
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Matthew Larson
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Robert Jeraj
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Stuart Currie
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Russell Frood
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Kavi Fatania
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ken Chang
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | | | | | - Josep Puig
- Department of Radiology (IDI), Girona Biomedical Research Institute (IdIBGi), Josep Trueta University Hospital, Girona, Spain
| | - Johannes Trenkler
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Josef Pichler
- Department of Neurooncology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Georg Necker
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Andreas Haunschmidt
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Stephan Meckel
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
- Institute of Diagnostic and Interventional Neuroradiology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Gaurav Shukla
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiation Oncology, Christiana Care Health System, Philadelphia, PA, USA
| | - Spencer Liem
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory S Alexander
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| | - Joseph Lombardo
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Adam E Flanders
- Department of Radiology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Haris I Sair
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Craig K Jones
- The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Archana Venkataraman
- Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Meirui Jiang
- The Chinese University of Hong Kong, Hong Kong, China
| | - Tiffany Y So
- The Chinese University of Hong Kong, Hong Kong, China
| | - Cheng Chen
- The Chinese University of Hong Kong, Hong Kong, China
| | | | - Qi Dou
- The Chinese University of Hong Kong, Hong Kong, China
| | - Michal Kozubek
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Filip Lux
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Jan Michálek
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Petr Matula
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Miloš Keřkovský
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
| | - Tereza Kopřivová
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
| | - Marek Dostál
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
- Department of Biophysics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Václav Vybíhal
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, and University Hospital and Czech Republic, Brno, Czech Republic
| | - Michael A Vogelbaum
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - J Ross Mitchell
- University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
| | - Joaquim Farinhas
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | - Marco C Pinho
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Divya Reddy
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James Holcomb
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- UCLA Neuro-Oncology Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CaA, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CaA, USA
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Talia Oughourlian
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Akifumi Hagiwara
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Chencai Wang
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Minh-Son To
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Sargam Bhardwaj
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Chee Chong
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Marc Agzarian
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, SA, Australia
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Bernardo C A Teixeira
- Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
- Department of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Flávia Sprenger
- Department of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - David Menotti
- Department of Informatics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Diego R Lucio
- Department of Informatics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Pamela LaMontagne
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Daniel Marcus
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
| | - Florian Kofler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
- Image-Based Biomedical Modeling, Department of Informatics, Technical University of Munich, Munich, Germany
| | - Ivan Ezhov
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
- Image-Based Biomedical Modeling, Department of Informatics, Technical University of Munich, Munich, Germany
| | - Marie Metz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rajan Jain
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Matthew Lee
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Yvonne W Lui
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Richard McKinley
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes Slotboom
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Piotr Radojewski
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Raphael Meier
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Derrick Murcia
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Eric Fu
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Rourke Haas
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - John Thompson
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - David Ryan Ormond
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Chaitra Badve
- Department of Radiology, University Hospitals Cleveland, Cleveland, OH, USA
| | - Andrew E Sloan
- Department of Neurological Surgery, University Hospitals-Seidman Cancer Center, Cleveland, OH, USA
- Case Comprehensive Cancer Center, Cleveland, OH, USA
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Vachan Vadmal
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kristin Waite
- National Cancer Institute, National Institute of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Rivka R Colen
- Department of Radiology, Neuroradiology Division, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Linmin Pei
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Murat Ak
- Department of Radiology, Neuroradiology Division, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashok Srinivasan
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - J Rajiv Bapuraj
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Arvind Rao
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Wang
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Ota Yoshiaki
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Toshio Moritani
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Sevcan Turk
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Joonsang Lee
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Snehal Prabhudesai
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Fanny Morón
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Jacob Mandel
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Konstantinos Kamnitsas
- Department of Computing, Imperial College London, London, UK
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Ben Glocker
- Department of Computing, Imperial College London, London, UK
| | - Luke V M Dixon
- Department of Radiology, Imperial College NHS Healthcare Trust, London, UK
| | - Matthew Williams
- Computational Oncology Group, Institute for Global Health Innovation, Imperial College London, London, UK
| | - Peter Zampakis
- Department of NeuroRadiology, University of Patras, Patras, Greece
| | | | - Panagiotis Tsiganos
- Clinical Radiology Laboratory, Department of Medicine, University of Patras, Patras, Greece
| | - Sotiris Alexiou
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | - Ilias Haliassos
- Department of Neuro-Oncology, University of Patras, Patras, Greece
| | - Evangelia I Zacharaki
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | | | | | | | | | | | | | - Sung Soo Ahn
- Yonsei University College of Medicine, Seoul, Korea
| | - Bing Luo
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Laila Poisson
- Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
- SJTU-Ruijin-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | | | - Ruchika Verma
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
- Case Western Reserve University, Cleveland, OH, USA
| | - Rohan Bareja
- Case Western Reserve University, Cleveland, OH, USA
| | - Ipsa Yadav
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Neeraj Kumar
- University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Sebastian R van der Voort
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Ahmed Alafandi
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Fatih Incekara
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Maarten M J Wijnenga
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Georgios Kapsas
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Renske Gahrmann
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Joost W Schouten
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Hendrikus J Dubbink
- Department of Pathology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Arnaud J P E Vincent
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Martin J van den Bent
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Pim J French
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Yading Yuan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tzu-Chi Tseng
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Saba Adabi
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Simone P Niclou
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Olivier Keunen
- Translation Radiomics, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Ann-Christin Hau
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
- Luxembourg Center of Neuropathology, Laboratoire National De Santé, Luxembourg, Luxembourg
| | - Martin Vallières
- Department of Computer Science, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - David Fortin
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Division of Neurosurgery and Neuro-Oncology, Faculty of Medicine and Health Science, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Martin Lepage
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Department of Nuclear Medicine and Radiobiology, Sherbrooke Molecular Imaging Centre, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Bennett Landman
- Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Karthik Ramadass
- Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Kaiwen Xu
- Department of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Silky Chotai
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lola B Chambless
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Akshitkumar Mistry
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Reid C Thompson
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuriy Gusev
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Krithika Bhuvaneshwar
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Anousheh Sayah
- Division of Neuroradiology & Neurointerventional Radiology, Department of Radiology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Camelia Bencheqroun
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Anas Belouali
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Subha Madhavan
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Neuroradiology, Ruskin Wing, King's College Hospital NHS Foundation Trust, London, UK
| | - Alysha Chelliah
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Haris Shuaib
- Stoke Mandeville Hospital, Mandeville Road, Aylesbury, UK
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Carmen Dragos
- Stoke Mandeville Hospital, Mandeville Road, Aylesbury, UK
| | | | | | | | | | - Shady Gamal
- University of Cairo School of Medicine, Giza, Egypt
| | | | | | | | - Ji Eun Park
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Jihye Yun
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Ho Sung Kim
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Abhishek Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust Pembroke Place, Liverpool, UK
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Sean Benson
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht, Netherlands
| | - Jonas Teuwen
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - William Escobar
- Clínica Imbanaco Grupo Quirón Salud, Cali, Colombia
- Universidad del Valle, Cali, Colombia
| | | | - Jose Bernal
- Universidad del Valle, Cali, Colombia
- The University of Edinburgh, Edinburgh, UK
| | | | - Joseph Choi
- Department of Industrial and Systems Engineering, University of Iowa, Iowa, USA
| | - Stephen Baek
- Department of Industrial and Systems Engineering, Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Yusung Kim
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Heba Ismael
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Bryan Allen
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | | | - Hongwei Li
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Tobias Weiss
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Andrea Bink
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Bertrand Pouymayou
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Prateek Prasanna
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Sampurna Shrestha
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Kartik M Mani
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
- Department of Radiation Oncology, Stony Brook University, Stony Brook, NY, USA
| | - David Payne
- Department of Radiology, Stony Brook University, Stony Brook, NY, USA
| | - Tahsin Kurc
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
- Scientific Data Group, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Enrique Pelaez
- Escuela Superior Politecnica del Litoral, Guayaquil, Guayas, Ecuador
| | | | - Francis Loayza
- Escuela Superior Politecnica del Litoral, Guayaquil, Guayas, Ecuador
| | | | | | | | | | - Franco Vera
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Elvis Ríos
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Eduardo López
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Sergio A Velastin
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Godwin Ogbole
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Mayowa Soneye
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Dotun Oyekunle
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | | | - Babatunde Osobu
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Mustapha Shu'aibu
- Department of Radiology, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria
| | - Adeleye Dorcas
- Department of Radiology, Obafemi Awolowo University Ile-Ife, Ile-Ife, Osun, Nigeria
| | - Farouk Dako
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amber L Simpson
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Mohammad Hamghalam
- School of Computing, Queen's University, Kingston, ON, Canada
- Department of Electrical Engineering, Qazvin Branch, Islamic Azad University, Qazvin, Iran
| | - Jacob J Peoples
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Ricky Hu
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Anh Tran
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Danielle Cutler
- The Faculty of Arts & Sciences, Queen's University, Kingston, ON, Canada
| | - Fabio Y Moraes
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Michael A Boss
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - James Gimpel
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Deepak Kattil Veettil
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Kendall Schmidt
- Data Science Institute, American College of Radiology, Reston, VA, USA
| | - Brian Bialecki
- Data Science Institute, American College of Radiology, Reston, VA, USA
| | - Sailaja Marella
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Cynthia Price
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Lisa Cimino
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Charles Apgar
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | | | - Bjoern Menze
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Jill S Barnholtz-Sloan
- National Cancer Institute, National Institute of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute (NCI), National Institute of Health, Bethesda, MD, USA
| | | | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA.
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Aizer AA, Lamba N, Ahluwalia MS, Aldape K, Boire A, Brastianos PK, Brown PD, Camidge DR, Chiang VL, Davies MA, Hu LS, Huang RY, Kaufmann T, Kumthekar P, Lam K, Lee EQ, Lin NU, Mehta M, Parsons M, Reardon DA, Sheehan J, Soffietti R, Tawbi H, Weller M, Wen PY. Brain metastases: A Society for Neuro-Oncology (SNO) consensus review on current management and future directions. Neuro Oncol 2022; 24:1613-1646. [PMID: 35762249 PMCID: PMC9527527 DOI: 10.1093/neuonc/noac118] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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] [Indexed: 01/31/2023] Open
Abstract
Brain metastases occur commonly in patients with advanced solid malignancies. Yet, less is known about brain metastases than cancer-related entities of similar incidence. Advances in oncologic care have heightened the importance of intracranial management. Here, in this consensus review supported by the Society for Neuro-Oncology (SNO), we review the landscape of brain metastases with particular attention to management approaches and ongoing efforts with potential to shape future paradigms of care. Each coauthor carried an area of expertise within the field of brain metastases and initially composed, edited, or reviewed their specific subsection of interest. After each subsection was accordingly written, multiple drafts of the manuscript were circulated to the entire list of authors for group discussion and feedback. The hope is that the these consensus guidelines will accelerate progress in the understanding and management of patients with brain metastases, and highlight key areas in need of further exploration that will lead to dedicated trials and other research investigations designed to advance the field.
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Affiliation(s)
- Ayal A Aizer
- Corresponding Author: Dr. Ayal A. Aizer, MD/MHS, Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA ()
| | | | | | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland, USA
| | - Adrienne Boire
- Department of Neurology, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Priscilla K Brastianos
- Departments of Neuro-Oncology and Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - D Ross Camidge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Veronica L Chiang
- Departments of Neurosurgery and Radiation Oncology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael A Davies
- Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Leland S Hu
- Department of Radiology, Neuroradiology Division, Mayo Clinic, Phoenix, Arizona, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Priya Kumthekar
- Department of Neurology at The Feinberg School of Medicine at Northwestern University and The Malnati Brain Tumor Institute at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Keng Lam
- Department of Neurology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
| | - Eudocia Q Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Minesh Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida, USA
| | - Michael Parsons
- Departments of Oncology and Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David A Reardon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Riccardo Soffietti
- Division of Neuro-Oncology, Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Hussein Tawbi
- Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Y Wen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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21
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Nayak L, Standifer N, Dietrich J, Clarke JL, Dunn GP, Lim M, Cloughesy T, Gan HK, Flagg E, George E, Gaffey S, Hayden J, Holcroft C, Wen PY, Macri M, Park AJ, Ricciardi T, Ryan A, Schwarzenberger P, Venhaus R, de los Reyes M, Durham NM, Creasy T, Huang RY, Kaley T, Reardon DA. Circulating Immune Cell and Outcome Analysis from the Phase II Study of PD-L1 Blockade with Durvalumab for Newly Diagnosed and Recurrent Glioblastoma. Clin Cancer Res 2022; 28:2567-2578. [PMID: 35395080 PMCID: PMC9940445 DOI: 10.1158/1078-0432.ccr-21-4064] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 11/15/2021] [Revised: 01/15/2022] [Accepted: 04/05/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE PD-L1 is upregulated in glioblastoma and supports immunosuppression. We evaluated PD-L1 blockade with durvalumab among glioblastoma cohorts and investigated potential biomarkers. PATIENTS AND METHODS MGMT unmethylated newly diagnosed patients received radiotherapy plus durvalumab (cohort A; n = 40). Bevacizumab-naïve, recurrent patients received durvalumab alone (cohort B; n = 31) or in combination with standard bevacizumab (cohort B2; n = 33) or low-dose bevacizumab (cohort B3; n = 33). Bevacizumab-refractory patients received durvalumab plus bevacizumab (cohort C; n = 22). Primary endpoints were: OS-12 (A), PFS-6 (B, B2, B3), and OS-6 (C). Exploratory biomarkers included: a systematic, quantitative, and phenotypic evaluation of circulating immune cells; tumor mutational burden (TMB); and tumor immune activation signature (IAS). RESULTS No cohort achieved the primary efficacy endpoint. Outcome was comparable among recurrent, bevacizumab-naïve cohorts. No unexpected toxicities were observed. A widespread reduction of effector immune cell subsets was noted among recurrent patients compared with newly diagnosed patients that was partially due to dexamethasone use. A trend of increased CD8+Ki67+ T cells at day 15 was noted among patients who achieved the primary endpoint and were not on dexamethasone. Neither TMB nor IAS predicted outcome. CONCLUSIONS Patients with recurrent glioblastoma have markedly lower baseline levels of multiple circulating immune cell subsets compared with newly diagnosed patients. An early increase in systemic Ki67+CD8+ cells may warrant further evaluation as a potential biomarker of therapeutic benefit among patients with glioblastoma undergoing checkpoint therapy. Dexamethasone decreased immune cell subsets. PD-L1 blockade and combination with standard or reduced dose bevacizumab was ineffective.
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Affiliation(s)
- Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nathan Standifer
- Integrated Bioanalysis, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, South San Francisco, CA
| | - Jorg Dietrich
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Jennifer L. Clarke
- Departments of Neurology and Neurosurgery, University of California San Francisco, San Francisco, CA
| | - Gavin P. Dunn
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Hui K. Gan
- Department of Medical Oncology, Austin Health, Melbourne, AU
| | - Elizabeth Flagg
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA
| | - Elizabeth George
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Sarah Gaffey
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Julia Hayden
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Patrick Y. Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | | | | | | | - Melissa de los Reyes
- Translational Medicine Oncology, Early and Early Oncology, R&D, Gaithersburg, MD
| | - Nicholas M. Durham
- Translational Medicine Oncology, Early and Early Oncology, R&D, Gaithersburg, MD
| | - Todd Creasy
- Translational Medicine Oncology, Early and Early Oncology, R&D, Gaithersburg, MD
| | - Raymond Y. Huang
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA
| | - Thomas Kaley
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - David A. Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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22
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George E, Flagg E, Chang K, Bai HX, Aerts HJ, Vallières M, Reardon DA, Huang RY. Radiomics-Based Machine Learning for Outcome Prediction in a Multicenter Phase II Study of Programmed Death-Ligand 1 Inhibition Immunotherapy for Glioblastoma. AJNR Am J Neuroradiol 2022; 43:675-681. [PMID: 35483906 PMCID: PMC9089247 DOI: 10.3174/ajnr.a7488] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/17/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Imaging assessment of an immunotherapy response in glioblastoma is challenging due to overlap in the appearance of treatment-related changes with tumor progression. Our purpose was to determine whether MR imaging radiomics-based machine learning can predict progression-free survival and overall survival in patients with glioblastoma on programmed death-ligand 1 inhibition immunotherapy. MATERIALS AND METHODS Post hoc analysis was performed of a multicenter trial on the efficacy of durvalumab in glioblastoma (n = 113). Radiomics tumor features on pretreatment and first on-treatment time point MR imaging were extracted. The random survival forest algorithm was applied to clinical and radiomics features from pretreatment and first on-treatment MR imaging from a subset of trial sites (n = 60-74) to train a model to predict long overall survival and progression-free survival and was tested externally on data from the remaining sites (n = 29-43). Model performance was assessed using the concordance index and dynamic area under the curve from different time points. RESULTS The mean age was 55.2 (SD, 11.5) years, and 69% of patients were male. Pretreatment MR imaging features had a poor predictive value for overall survival and progression-free survival (concordance index = 0.472-0.524). First on-treatment MR imaging features had high predictive value for overall survival (concordance index = 0.692-0.750) and progression-free survival (concordance index = 0.680-0.715). CONCLUSIONS A radiomics-based machine learning model from first on-treatment MR imaging predicts survival in patients with glioblastoma on programmed death-ligand 1 inhibition immunotherapy.
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Affiliation(s)
- E George
- From the Department of Radiology and Biomedical Imaging (E.G.), University of California San Francisco, San Francisco, California
| | - E Flagg
- Department of Radiology (E.F., R.Y.H.), Brigham and Women's Hospital, Boston, Massachusetts
| | - K Chang
- Massachusetts Institute of Technology (K.C.), Cambridge, Massachusetts
| | - H X Bai
- Department of Diagnostic Imaging (H.X.B.), Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - H J Aerts
- Artificial Intelligence in Medicine Program (H.J.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Departments of Radiation Oncology and Radiology (H.J.A.), Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - M Vallières
- Department of Computer Science (M.V.), Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - D A Reardon
- Center for Neuro Oncology (D.A.R.), Dana-Farber Cancer Institute, Boston, Massachusetts
| | - R Y Huang
- Department of Radiology (E.F., R.Y.H.), Brigham and Women's Hospital, Boston, Massachusetts
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23
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Vagvala S, Guenette JP, Jaimes C, Huang RY. Imaging diagnosis and treatment selection for brain tumors in the era of molecular therapeutics. Cancer Imaging 2022; 22:19. [PMID: 35436952 PMCID: PMC9014574 DOI: 10.1186/s40644-022-00455-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/29/2022] [Indexed: 01/12/2023] Open
Abstract
Currently, most CNS tumors require tissue sampling to discern their molecular/genomic landscape. However, growing research has shown the powerful role imaging can play in non-invasively and accurately detecting the molecular signature of these tumors. The overarching theme of this review article is to provide neuroradiologists and neurooncologists with a framework of several important molecular markers, their associated imaging features and the accuracy of those features. A particular emphasis is placed on those tumors and mutations that have specific or promising imaging correlates as well as their respective therapeutic potentials.
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Affiliation(s)
- Saivenkat Vagvala
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, 75 Francis St, Boston, MA, 02115, USA
| | - Jeffrey P Guenette
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, 75 Francis St, Boston, MA, 02115, USA
| | - Camilo Jaimes
- Division of Neuroradiology, Boston Children's, 300 Longwood Ave., 2nd floor, Main Building, Boston, MA, 02115, USA
| | - Raymond Y Huang
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, 75 Francis St, Boston, MA, 02115, USA.
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24
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Peng J, Kim DD, Patel JB, Zeng X, Huang J, Chang K, Xun X, Zhang C, Sollee J, Wu J, Dalal DJ, Feng X, Zhou H, Zhu C, Zou B, Jin K, Wen PY, Boxerman JL, Warren KE, Poussaint TY, States LJ, Kalpathy-Cramer J, Yang L, Huang RY, Bai HX. Deep learning-based automatic tumor burden assessment of pediatric high-grade gliomas, medulloblastomas, and other leptomeningeal seeding tumors. Neuro Oncol 2022; 24:289-299. [PMID: 34174070 PMCID: PMC8804897 DOI: 10.1093/neuonc/noab151] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Longitudinal measurement of tumor burden with magnetic resonance imaging (MRI) is an essential component of response assessment in pediatric brain tumors. We developed a fully automated pipeline for the segmentation of tumors in pediatric high-grade gliomas, medulloblastomas, and leptomeningeal seeding tumors. We further developed an algorithm for automatic 2D and volumetric size measurement of tumors. METHODS The preoperative and postoperative cohorts were randomly split into training and testing sets in a 4:1 ratio. A 3D U-Net neural network was trained to automatically segment the tumor on T1 contrast-enhanced and T2/FLAIR images. The product of the maximum bidimensional diameters according to the RAPNO (Response Assessment in Pediatric Neuro-Oncology) criteria (AutoRAPNO) was determined. Performance was compared to that of 2 expert human raters who performed assessments independently. Volumetric measurements of predicted and expert segmentations were computationally derived and compared. RESULTS A total of 794 preoperative MRIs from 794 patients and 1003 postoperative MRIs from 122 patients were included. There was excellent agreement of volumes between preoperative and postoperative predicted and manual segmentations, with intraclass correlation coefficients (ICCs) of 0.912 and 0.960 for the 2 preoperative and 0.947 and 0.896 for the 2 postoperative models. There was high agreement between AutoRAPNO scores on predicted segmentations and manually calculated scores based on manual segmentations (Rater 2 ICC = 0.909; Rater 3 ICC = 0.851). Lastly, the performance of AutoRAPNO was superior in repeatability to that of human raters for MRIs with multiple lesions. CONCLUSIONS Our automated deep learning pipeline demonstrates potential utility for response assessment in pediatric brain tumors. The tool should be further validated in prospective studies.
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Affiliation(s)
- Jian Peng
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Daniel D Kim
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jay B Patel
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Xiaowei Zeng
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jiaer Huang
- School of Computer Science and Engineering, Central South University, Changsha, Hunan, China
| | - Ken Chang
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Xinping Xun
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chen Zhang
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - John Sollee
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jing Wu
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Deepa J Dalal
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Xue Feng
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Hao Zhou
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chengzhang Zhu
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- School of Computer Science and Engineering, Central South University, Changsha, Hunan, China
| | - Beiji Zou
- School of Computer Science and Engineering, Central South University, Changsha, Hunan, China
| | - Ke Jin
- Department of Radiology, Hunan Children’s Hospital, Changsha, Hunan, China
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jerrold L Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Katherine E Warren
- Department of Pediatrics, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tina Y Poussaint
- Department of Radiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Lisa J States
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jayashree Kalpathy-Cramer
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Li Yang
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Harrison X Bai
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
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25
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Kim CK, Choi JW, Jiao Z, Wang D, Wu J, Yi TY, Halsey KC, Eweje F, Tran TML, Liu C, Wang R, Sollee J, Hsieh C, Chang K, Yang FX, Singh R, Ou JL, Huang RY, Feng C, Feldman MD, Liu T, Gong JS, Lu S, Eickhoff C, Feng X, Kamel I, Sebro R, Atalay MK, Healey T, Fan Y, Liao WH, Wang J, Bai HX. An automated COVID-19 triage pipeline using artificial intelligence based on chest radiographs and clinical data. NPJ Digit Med 2022; 5:5. [PMID: 35031687 PMCID: PMC8760275 DOI: 10.1038/s41746-021-00546-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/25/2021] [Accepted: 11/28/2021] [Indexed: 01/08/2023] Open
Abstract
While COVID-19 diagnosis and prognosis artificial intelligence models exist, very few can be implemented for practical use given their high risk of bias. We aimed to develop a diagnosis model that addresses notable shortcomings of prior studies, integrating it into a fully automated triage pipeline that examines chest radiographs for the presence, severity, and progression of COVID-19 pneumonia. Scans were collected using the DICOM Image Analysis and Archive, a system that communicates with a hospital’s image repository. The authors collected over 6,500 non-public chest X-rays comprising diverse COVID-19 severities, along with radiology reports and RT-PCR data. The authors provisioned one internally held-out and two external test sets to assess model generalizability and compare performance to traditional radiologist interpretation. The pipeline was evaluated on a prospective cohort of 80 radiographs, reporting a 95% diagnostic accuracy. The study mitigates bias in AI model development and demonstrates the value of an end-to-end COVID-19 triage platform.
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Affiliation(s)
- Chris K Kim
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA.,Department of Computer Science, Brown University, Providence, RI, 02912, USA
| | - Ji Whae Choi
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA.,Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA
| | - Zhicheng Jiao
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA.,Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA
| | - Dongcui Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Jing Wu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Thomas Y Yi
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA.,Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA
| | - Kasey C Halsey
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA.,Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA
| | - Feyisope Eweje
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Thi My Linh Tran
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA.,Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA
| | - Chang Liu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Robin Wang
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - John Sollee
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA.,Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA
| | - Celina Hsieh
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA.,Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA
| | - Ken Chang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02129, USA
| | - Fang-Xue Yang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Ritambhara Singh
- Department of Computer Science, Brown University, Providence, RI, 02912, USA.,Center for Computational Molecular Biology, Brown University, Providence, RI, 02912, USA
| | - Jie-Lin Ou
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Cai Feng
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Michael D Feldman
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Tao Liu
- Department of Biostatistics, Brown University, Providence, RI, 02912, USA
| | - Ji Sheng Gong
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Shaolei Lu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Carsten Eickhoff
- Center for Biomedical Informatics, Brown University, Providence, RI, 02912, USA
| | - Xue Feng
- Carina Medical, Lexington, KY, 40513, USA
| | - Ihab Kamel
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Ronnie Sebro
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Michael K Atalay
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA.,Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA
| | - Terrance Healey
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA.,Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA
| | - Yong Fan
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Wei-Hua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
| | - Jianxin Wang
- School of Computer Science and Engineering, Central South University, Changsha, China.
| | - Harrison X Bai
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA. .,Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA. .,Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, 21205, USA.
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26
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Affiliation(s)
- Rifaquat Rahman
- Corresponding Author: Rifaquat Rahman, MD, Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, 75 Francis Street, ASB1-L2, Boston, MA 02115, USA ()
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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27
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Peng J, Kim DD, Patel JB, Zeng X, Huang J, Chang K, Xun X, Zhang C, Sollee J, Wu J, Dalal DJ, Feng X, Zhou H, Zhu C, Zou B, Jin K, Wen PY, Boxerman JL, Warren KE, Poussaint TY, States LJ, Kalpathy-Cramer J, Yang L, Huang RY, Bai HX. Corrigendum to: Deep learning-based automatic tumor burden assessment of pediatric high-grade gliomas, medulloblastomas, and other leptomeningeal seeding tumors. Neuro Oncol 2021; 23:2124. [PMID: 34551090 DOI: 10.1093/neuonc/noab226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jian Peng
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Daniel D Kim
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jay B Patel
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Xiaowei Zeng
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jiaer Huang
- School of Computer Science and Engineering, Central South University, Changsha, Hunan, China
| | - Ken Chang
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Xinping Xun
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chen Zhang
- School of Computer Science and Engineering, Central South University, Changsha, Hunan, China
| | - John Sollee
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jing Wu
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Deepa J Dalal
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Xue Feng
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Hao Zhou
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chengzhang Zhu
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Beiji Zou
- School of Computer Science and Engineering, Central South University, Changsha, Hunan, China
| | - Ke Jin
- Department of Radiology, Hunan Children's Hospital, Changsha, Hunan, China
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jerrold L Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Katherine E Warren
- Department of Pediatrics, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tina Y Poussaint
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lisa J States
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jayashree Kalpathy-Cramer
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Li Yang
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Harrison X Bai
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
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28
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Vachha BA, Huang RY. BOLD Asynchrony: An imaging biomarker of tumor burden in IDH-mutated gliomas. Neuro Oncol 2021; 24:88-89. [PMID: 34695182 DOI: 10.1093/neuonc/noab248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Behroze Adi Vachha
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts
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29
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Suh CH, Kim HS, Ahn SS, Seong M, Han K, Park JE, Jung SC, Choi CG, Kim SJ, Lee SM, Kim JH, Lee SK, Choi SH, Kim ST, Nayak L, Batchelor TT, Huang RY, Guenette JP. Body CT and PET/CT Detection of Extracranial Lymphoma in Patients with Newly Diagnosed Central Nervous System Lymphoma. Neuro Oncol 2021; 24:482-491. [PMID: 34611696 DOI: 10.1093/neuonc/noab234] [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: 11/13/2022] Open
Abstract
BACKGROUND We aimed to investigate the detection rate of body CT or PET/CT for sites of extracranial disease in patients with a new pathological diagnosis of CNS DLBCL and to identify factors associated with sites of extracranial disease. METHODS An international multicenter cohort study of consecutive immunocompetent patients with a new diagnosis of CNS DLBCL confirmed by brain biopsy who underwent CT and/or PET/CT to evaluate for sites of extracranial disease between 1998 and 2019. The primary outcome was the detection rate of extracranial lymphoma by CT or PET/CT. Subgroup analyses according to age and EBV status were also performed. Logistic regression analyses were performed to determine factors related to sites of extracranial disease. Detection rates of CT and PET/CT were compared. RESULTS 1043 patients were included. The overall detection rate of CT or PET/CT was 2.6% (27/1043). The treatment approach was adjusted in 74% of these patients. Multivariable analysis demonstrated that age>61-years (OR, 3.10; P=.016) and EBV positivity (OR, 3.78; P=.045) were associated with greater odds of extracranial lymphoma. There was no statistically significant difference in detection rate between CT and PET/CT (P=.802). In patients≤61 years old, the false-referral rates were significantly higher than the detection rates (P<.001). CONCLUSION Our results showed increased odds of extracranial lymphoma in patients with older age or EBV-positive lymphoma. Treatment was adjusted in a majority of patients diagnosed with extracranial lymphoma, thereby supporting the current guidelines for the use contrast-enhanced body CT or PET/CT in patients with newly diagnosed CNS DLBCL.
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Affiliation(s)
- Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minjung Seong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kichang Han
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Choong Gon Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Koo Lee
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Lakshmi Nayak
- Department of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - Tracy T Batchelor
- Department of Neurology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - Raymond Y Huang
- Department of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - Jeffrey P Guenette
- Department of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
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Abstract
This article reviews recent advances in the use of standard and advanced imaging techniques for diagnosis and treatment of central nervous system (CNS) tumors, including glioma and brain metastasis. Following the recent transition from a histology-based approach in classifying CNS tumors to one that integrates histology with the molecular information of tumor, the approaches for imaging CNS tumors have also been adapted to this new framework. Some challenges related to the diagnosis and treatment of CNS tumors, such as differentiating tumor from treatment-related imaging changes, require further progress to implement advanced imaging for clinical use.
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Affiliation(s)
- Raymond Y Huang
- Department of Neuroradiology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Whitney B Pope
- Radiology, Section of Neuroradiology, Brain Tumor Imaging, UCLA Medical Center, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine, University of California-Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA; Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA
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31
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Miskin N, Gaviola GC, Huang RY, Kim CJ, Lee TC, Small KM, Wieschhoff GG, Mandell JC. Standardized Classification of Lumbar Spine Degeneration on Magnetic Resonance Imaging Reduces Intra- and Inter-subspecialty Variability. Curr Probl Diagn Radiol 2021; 51:491-496. [PMID: 34556373 DOI: 10.1067/j.cpradiol.2021.08.001] [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: 05/10/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND PURPOSE To determine the efficacy of standardized definitions of degenerative change in reducing variability in interpretation of lumbar spine magnetic resonance imaging within and between groups of subspecialty-trained neuroradiologists (NR) and musculoskeletal radiologists (MSK). MATERIALS AND METHODS Six radiologists, three from both NR and MSK groups were trained on a standardized classification system of degenerative change. After an 11-month washout period, they independently re-interpreted fifty exams at the L4-L5 and L5-S1 levels. Responses were converted to a six-point ordinal scale for the assessment of neural foraminal stenosis and spinal canal stenosis (SCS), three-point scale for lateral recess stenosis, and four-point scale for facet osteoarthritis (FO). Intra-subspecialty and inter-subspecialty analysis was performed using the weighted Cohen's kappa with a binary matrix of all reader pairs. RESULTS Inter-subspecialty agreement improved from k=0.527 (moderate) to k=0.602 (substantial) for neural foraminal stenosis, from k=0.540 (moderate) to k=0.652 (substantial) for SCS, from k=0.0818 (slight) to k=0.337 (fair) for lateral recess stenosis, and from k=0.176 (slight) to k=0.495 (moderate) for FO. The NR group demonstrated improved intra-subspecialty agreement for the assessment of SCS, from k=0.368 (fair) to k=0.638 (substantial). The MSK group demonstrated improved intra-subspecialty agreement for the assessment of FO, from k=0.134 (slight) to k=0.413 (moderate). Intra-subspecialty agreement was similar for other parameters before and after training. CONCLUSIONS As result of the standardized definitions training, the NR and MSK groups each improved in one of the four parameters, while inter-subspecialty variability improved in all four parameters. These definitions may be useful in clinical practice across radiology subspecialties.
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Affiliation(s)
- Nityanand Miskin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Glenn C Gaviola
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christine J Kim
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Thomas C Lee
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kirstin M Small
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ged G Wieschhoff
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jacob C Mandell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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32
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Snyder JM, Huang RY, Bai H, Rao VR, Cornes S, Barnholtz-Sloan JS, Gutman D, Fasano R, Van Meir EG, Brat D, Eschbacher J, Quackenbush J, Wen PY, Lee JW. Analysis of morphological characteristics of IDH-mutant/wildtype brain tumors using whole-lesion phenotype analysis. Neurooncol Adv 2021; 3:vdab088. [PMID: 34409295 PMCID: PMC8367280 DOI: 10.1093/noajnl/vdab088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Although IDH-mutant tumors aggregate to the frontotemporal regions, the clustering pattern of IDH-wildtype tumors is less clear. As voxel-based lesion-symptom mapping (VLSM) has several limitations for solid lesion mapping, a new technique, whole-lesion phenotype analysis (WLPA), is developed. We utilize WLPA to assess spatial clustering of tumors with IDH mutation from The Cancer Genome Atlas and The Cancer Imaging Archive. Methods The degree of tumor clustering segmented from T1 weighted images is measured to every other tumor by a function of lesion similarity to each other via the Hausdorff distance. Each tumor is ranked according to the degree to which its neighboring tumors show identical phenotypes, and through a permutation technique, significant tumors are determined. VLSM was applied through a previously described method. Results A total of 244 patients of mixed-grade gliomas (WHO II-IV) are analyzed, of which 150 were IDH-wildtype and 139 were glioblastomas. VLSM identifies frontal lobe regions that are more likely associated with the presence of IDH mutation but no regions where IDH-wildtype was more likely to be present. WLPA identifies both IDH-mutant and -wildtype tumors exhibit statistically significant spatial clustering. Conclusion WLPA may provide additional statistical power when compared with VLSM without making several potentially erroneous assumptions. WLPA identifies tumors most likely to exhibit particular phenotypes, rather than producing anatomical maps, and may be used in conjunction with VLSM to understand the relationship between tumor morphology and biologically relevant tumor phenotypes.
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Affiliation(s)
- James M Snyder
- Departments of Neurosurgery and Neurology, Henry Ford Health System, Detroit, Michigan, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Harrison Bai
- Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Vikram R Rao
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Susannah Cornes
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Jill S Barnholtz-Sloan
- Department of Population and Quantitative Health Sciences, School of Medicine Case Western Reserve University and University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - David Gutman
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Rebecca Fasano
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Erwin G Van Meir
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Daniel Brat
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - John Quackenbush
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Center for Cancer Computational Biology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jong Woo Lee
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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33
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Hwang J, Suh C, Kim K, Kim H, Kim AI, Craig JW, Chen KX, Roberson J, Guenette JP, Huang RY. The Incidence and Treatment Response of Double Expression of MYC and BCL2 in Patients with Diffuse Large B-Cell Lymphoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:3369. [PMID: 34282799 PMCID: PMC8268769 DOI: 10.3390/cancers13133369] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022] Open
Abstract
MYC/BCL2 protein co-expression (i.e., double expressor) has been shown to be a negative predictor of outcome in diffuse large B-cell lymphoma (DLBCL). We aimed to establish the incidence of double expressor status in patients with de novo DLBCL and identify the predictive value of this biomarker on treatment response through systematic review and meta-analysis. PubMed and Embase were searched for studies published through December 2019 that reported proportions of double expressor DLBCL. The pooled proportions of MYC and BCL2 expression, both alone and in combination, were computed using the inverse variance method for calculating weights and by the DerSimonian-Laird method. The pooled odds ratios (ORs) of complete remission (CR) rate were calculated, and meta-regression analysis was conducted to explore heterogeneity. Forty-one studies (7054 patients) were included. The pooled incidence of double expressor status in DLBCL was 23% (95% confidence interval [CI], 20-26%), with an adjusted estimate of 31% (95% CI, 27-36%). Neither MYC/BCL2 protein cutoff values, race, mean, or median age of included patients, or overall study quality was a significant factor of heterogeneity (p ≥ 0.20). Cases without double expressor status demonstrated a higher probability of CR to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone treatment (OR, 2.69; 95% CI, 1.55-4.67). Our results reaffirm the predictive power of this important biomarker.
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Affiliation(s)
- Jisun Hwang
- Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, 7, Keunjaebong-gil, Hwaseong-si 18450, Gyeonggi-do, Korea;
| | - Chonghyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul 05505, Korea; (K.K.); (H.K.)
| | - Kyungwon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul 05505, Korea; (K.K.); (H.K.)
| | - Hosung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul 05505, Korea; (K.K.); (H.K.)
| | - Austin I. Kim
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA;
| | - Jeffrey W. Craig
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC V5Z 4E6, Canada;
| | - Ke Xun Chen
- Division of Neuroradiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (K.X.C.); (J.R.); (J.P.G.); (R.Y.H.)
| | - Joel Roberson
- Division of Neuroradiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (K.X.C.); (J.R.); (J.P.G.); (R.Y.H.)
| | - Jeffrey P. Guenette
- Division of Neuroradiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (K.X.C.); (J.R.); (J.P.G.); (R.Y.H.)
| | - Raymond Y. Huang
- Division of Neuroradiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (K.X.C.); (J.R.); (J.P.G.); (R.Y.H.)
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Wang R, Jiao Z, Yang L, Choi JW, Xiong Z, Halsey K, Tran TML, Pan I, Collins SA, Feng X, Wu J, Chang K, Shi LB, Yang S, Yu QZ, Liu J, Fu FX, Jiang XL, Wang DC, Zhu LP, Yi XP, Healey TT, Zeng QH, Liu T, Hu PF, Huang RY, Li YH, Sebro RA, Zhang PJL, Wang J, Atalay MK, Liao WH, Fan Y, Bai HX. Artificial intelligence for prediction of COVID-19 progression using CT imaging and clinical data. Eur Radiol 2021; 32:205-212. [PMID: 34223954 PMCID: PMC8256200 DOI: 10.1007/s00330-021-08049-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 11/20/2020] [Revised: 02/11/2021] [Accepted: 05/05/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Early recognition of coronavirus disease 2019 (COVID-19) severity can guide patient management. However, it is challenging to predict when COVID-19 patients will progress to critical illness. This study aimed to develop an artificial intelligence system to predict future deterioration to critical illness in COVID-19 patients. METHODS An artificial intelligence (AI) system in a time-to-event analysis framework was developed to integrate chest CT and clinical data for risk prediction of future deterioration to critical illness in patients with COVID-19. RESULTS A multi-institutional international cohort of 1,051 patients with RT-PCR confirmed COVID-19 and chest CT was included in this study. Of them, 282 patients developed critical illness, which was defined as requiring ICU admission and/or mechanical ventilation and/or reaching death during their hospital stay. The AI system achieved a C-index of 0.80 for predicting individual COVID-19 patients' to critical illness. The AI system successfully stratified the patients into high-risk and low-risk groups with distinct progression risks (p < 0.0001). CONCLUSIONS Using CT imaging and clinical data, the AI system successfully predicted time to critical illness for individual patients and identified patients with high risk. AI has the potential to accurately triage patients and facilitate personalized treatment. KEY POINT • AI system can predict time to critical illness for patients with COVID-19 by using CT imaging and clinical data.
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Affiliation(s)
- Robin Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.,Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Center for Biomedical Image Computation and Analytics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Zhicheng Jiao
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Center for Biomedical Image Computation and Analytics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Li Yang
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Ji Whae Choi
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA.,Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Zeng Xiong
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Kasey Halsey
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA.,Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Thi My Linh Tran
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA.,Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Ian Pan
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA
| | - Scott A Collins
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA
| | - Xue Feng
- Carina Medical, Carina, Australia
| | - Jing Wu
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Ken Chang
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lin-Bo Shi
- Department of Radiology, Yongzhou Central Hospital, Yongzhou, China
| | - Shuai Yang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Qi-Zhi Yu
- Department of Radiology, The First Hospital of Changsha, Changsha, China
| | - Jie Liu
- Department of Radiology, Changde Second People's Hospital, Changde, China
| | - Fei-Xian Fu
- Department of Radiology, Yiyang City Center Hospital, Yiyang, China
| | - Xiao-Long Jiang
- Department of Radiology, Affiliated Nan Hua Hospital, University of South China, Hengyang, China
| | - Dong-Cui Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Li-Ping Zhu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiao-Ping Yi
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Terrance T Healey
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA
| | - Qiu-Hua Zeng
- Department of Radiology, Loudi Central Hospital, Loudi, China
| | - Tao Liu
- Brown University School of Public Health, Providence, RI, USA
| | - Ping-Feng Hu
- Department of Radiology, Chenzhou Second People's Hospital, Chenzhou, China
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Yi-Hui Li
- Department of Radiology, Zhuzhou Central Hospital, Zhuzhou, China
| | - Ronnie A Sebro
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Center for Biomedical Image Computation and Analytics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Paul J L Zhang
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Center for Biomedical Image Computation and Analytics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jianxin Wang
- School of Computer Science and Engineering, Central South University, Changsha, China
| | - Michael K Atalay
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA
| | - Wei-Hua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.
| | - Yong Fan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Center for Biomedical Image Computation and Analytics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Harrison X Bai
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, 02903, USA. .,Warren Alpert Medical School at Brown University, Providence, RI, USA.
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Tang L, Liu S, Xiao Y, Tran TML, Choi JW, Wu J, Halsey K, Huang RY, Boxerman J, Patel SH, Kung D, Liu R, Feldman MD, Danoski DD, Liao WH, Kasner SE, Liu T, Xiao B, Zhang PJ, Reznik M, Bai HX, Yang L. Encephalopathy at admission predicts adverse outcomes in patients with SARS-CoV-2 infection. CNS Neurosci Ther 2021; 27:1127-1135. [PMID: 34132473 PMCID: PMC8444722 DOI: 10.1111/cns.13687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 01/08/2023] Open
Abstract
Aims To determine if neurologic symptoms at admission can predict adverse outcomes in patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Methods Electronic medical records of 1053 consecutively hospitalized patients with laboratory‐confirmed infection of SARS‐CoV‐2 from one large medical center in the USA were retrospectively analyzed. Univariable and multivariable Cox regression analyses were performed with the calculation of areas under the curve (AUC) and concordance index (C‐index). Patients were stratified into subgroups based on the presence of encephalopathy and its severity using survival statistics. In sensitivity analyses, patients with mild/moderate and severe encephalopathy (defined as coma) were separately considered. Results Of 1053 patients (mean age 52.4 years, 48.0% men [n = 505]), 35.1% (n = 370) had neurologic manifestations at admission, including 10.3% (n = 108) with encephalopathy. Encephalopathy was an independent predictor for death (hazard ratio [HR] 2.617, 95% confidence interval [CI] 1.481–4.625) in multivariable Cox regression. The addition of encephalopathy to multivariable models comprising other predictors for adverse outcomes increased AUCs (mortality: 0.84–0.86, ventilation/ intensive care unit [ICU]: 0.76–0.78) and C‐index (mortality: 0.78 to 0.81, ventilation/ICU: 0.85–0.86). In sensitivity analyses, risk stratification survival curves for mortality and ventilation/ICU based on severe encephalopathy (n = 15) versus mild/moderate encephalopathy (n = 93) versus no encephalopathy (n = 945) at admission were discriminative (p < 0.001). Conclusions Encephalopathy at admission predicts later progression to death in SARS‐CoV‐2 infection, which may have important implications for risk stratification in clinical practice.
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Affiliation(s)
- Lei Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Xiangya School of Medicine, Central South University, Changsha, China
| | - Shixin Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Xiangya School of Medicine, Central South University, Changsha, China
| | - Yanhe Xiao
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Thi My Linh Tran
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ji Whae Choi
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jing Wu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Kasey Halsey
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jerrold Boxerman
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sohil H Patel
- Department of Radiology, University of Virginia, Charlottesville, VA, USA
| | - David Kung
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Renyu Liu
- Department of Anaesthesiology and critical care medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael D Feldman
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel D Danoski
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Wei-Hua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Scott E Kasner
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Tao Liu
- Department of Biostatistics and Public Health, Brown University, Providence, RI, USA
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Paul J Zhang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Reznik
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Harrison X Bai
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Li Yang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
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Bi WL, Nayak L, Meredith DM, Driver J, Du Z, Hoffman S, Li Y, Lee EQ, Beroukhim R, Rinne M, McFaline-Figueroa R, Chukwueke U, McCluskey C, Gaffey S, Cherniack AD, Stefanik J, Doherty L, Taubert C, Cifrino M, LaFrankie D, Graillon T, Wen PY, Ligon KL, Al-Mefty O, Huang RY, Muzikansky A, Chiocca EA, Santagata S, Dunn IF, Reardon DA. Activity of PD-1 blockade with Nivolumab among patients with recurrent atypical/anaplastic meningioma: Phase II trial results. Neuro Oncol 2021; 24:101-113. [PMID: 34015129 DOI: 10.1093/neuonc/noab118] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Programmed death-1 ligand (PD-L1) contributes to tumor immunosuppression and is upregulated in aggressive meningiomas. We performed a phase II study of nivolumab, a programmed death-1 (PD-1) blocking antibody among patients with grade ≥2 meningioma that recurred after surgery and radiation therapy. METHODS Twenty-five patients received nivolumab (240 mg biweekly) until progression, voluntary withdrawal, unacceptable toxicity, or death. Tumor mutational burden (TMB) and quantification of tumor infiltrating lymphocytes (TIL) were evaluated as potential immunocorrelative biomarkers. Change in neurologic function was prospectively assessed using the Neurologic Assessment in Neuro-Oncology (NANO) scale. RESULTS Enrolled patients had multiple recurrences including ≥3 prior surgeries and ≥2 prior courses of radiation in 60% and 72%, respectively. Nivolumab was well tolerated with no unexpected AEs. PFS-6 was 42.4% (95% CI: 22.8, 60.7) and the median OS was 30.9 months (95% CI: 17.6, NA). One patient achieved radiographic response (ongoing at 4.5 years). TMB was > 10/Mb in 2 of 15 profiled tumors (13.3%). Baseline TIL density was low but increased post-treatment in 3 patients including both patients with elevated TMB. Most patients who achieved PFS-6 maintained neurologic function prior to progression as assessed by NANO. CONCLUSION Nivolumab was well tolerated but failed to improve PFS-6, although a subset of patients appeared to derive benefit. Low levels of TMB and TIL density were typically observed. NANO assessment of neurologic function contributed to outcome assessment. Future studies may consider rationally designed combinatorial regimens.
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Affiliation(s)
- Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - David M Meredith
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joseph Driver
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ziming Du
- Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Samantha Hoffman
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yvonne Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Eudocia Quant Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Rameen Beroukhim
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Mikael Rinne
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Ugonma Chukwueke
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christine McCluskey
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Sarah Gaffey
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Andrew D Cherniack
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jennifer Stefanik
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lisa Doherty
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christina Taubert
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Meghan Cifrino
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Deborah LaFrankie
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Thomas Graillon
- Faculté de Médecine, Aix Marseille Université, Marseille, France
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Keith L Ligon
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alona Muzikansky
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - E Antonio Chiocca
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Peng J, Zhou H, Tang O, Chang K, Wang P, Zeng X, Shen Q, Wu J, Xiao Y, Patel SH, Hu C, Jin K, Xiao B, Boxerman J, Gao X, Wen PY, Bai HX, Huang RY, Yang L. Evaluation of RAPNO criteria in medulloblastoma and other leptomeningeal seeding tumors using MRI and clinical data. Neuro Oncol 2021; 22:1536-1544. [PMID: 32215549 DOI: 10.1093/neuonc/noaa072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group has made recommendations for response assessment in patients with medulloblastoma (MBL) and leptomeningeal seeding tumors, these criteria have yet to be evaluated. METHODS We examined MR imaging and clinical data in a multicenter retrospective cohort of 269 patients with MBL diagnoses, high grade glioma, embryonal tumor, germ cell tumor, or choroid plexus papilloma. Interobserver agreement, objective response (OR) rates, and progression-free survival (PFS) were calculated. Landmark analyses were performed for OR and progression status at 0.5, 1.0, and 1.5 years after treatment initiation. Cox proportional hazards models were used to determine the associations between OR and progression with overall survival (OS). Subgroup analyses based on tumor subgroup and treatment modality were performed. RESULTS The median follow-up time was 4.0 years. In all patients, the OR rate was .0.565 (95% CI: 0.505-0.625) by RAPNO. The interobserver agreement of OR determination between 2 raters (a neuroradiologist and a neuro-oncologist) for the RAPNO criteria in all patients was 83.8% (k statistic = 0.815; P < 0.001). At 0.5-, 1.0-, and 1.5-year landmarks, both OR status and PFS determined by RAPNO were predictive of OS (hazard ratios [HRs] for 1-year landmark: OR HR = 0.079, P < 0.001; PFS HR = 10.192, P < 0.001). In subgroup analysis, OR status and PFS were predictive of OS for all tumor subtypes and treatment modalities. CONCLUSION RAPNO criteria showed excellent consistency in the treatment response evaluation of MBL and other leptomeningeal seeding tumors. OR and PFS determined by RAPNO criteria correlated with OS.
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Affiliation(s)
- Jian Peng
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hao Zhou
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Oliver Tang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ken Chang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Panpan Wang
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaowei Zeng
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qin Shen
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jing Wu
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yanhe Xiao
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Sohil H Patel
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Chongyu Hu
- Department of Neurology, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Ke Jin
- Department of Radiology, Hunan Children's Hospital, Changsha, Hunan, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jerrold Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Xiaoping Gao
- Department of Neurology, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Harrison X Bai
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Radiology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Li Yang
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Wang R, Cai Y, Lee IK, Hu R, Purkayastha S, Pan I, Yi T, Tran TML, Lu S, Liu T, Chang K, Huang RY, Zhang PJ, Zhang Z, Xiao E, Wu J, Bai HX. Correction to: Evaluation of a convolutional neural network for ovarian tumor differentiation based on magnetic resonance imaging. Eur Radiol 2021; 31:8816. [PMID: 33900434 DOI: 10.1007/s00330-021-07854-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Robin Wang
- Department of Radiology, the Second Xiangya Hospital, Central South University, Changsha, China
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Yeyu Cai
- Department of Radiology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Iris K Lee
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Rong Hu
- School of Computer Science and Engineering, Central South University, Changsha, China
| | - Subhanik Purkayastha
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Ian Pan
- Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Thomas Yi
- Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Thi My Linh Tran
- Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Shaolei Lu
- Department of Pathology, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Ken Chang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Paul J Zhang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Zishu Zhang
- Department of Radiology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Enhua Xiao
- Department of Radiology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Jing Wu
- Department of Radiology, the Second Xiangya Hospital, Central South University, Changsha, China.
| | - Harrison X Bai
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA.
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Huang RY, Young RJ, Ellingson BM, Veeraraghavan H, Wang W, Tixier F, Um H, Nawaz R, Luks T, Kim J, Gerstner ER, Schiff D, Peters KB, Mellinghoff IK, Chang SM, Cloughesy TF, Wen PY. Volumetric analysis of IDH-mutant lower-grade glioma: a natural history study of tumor growth rates before and after treatment. Neuro Oncol 2021; 22:1822-1830. [PMID: 32328652 PMCID: PMC7746936 DOI: 10.1093/neuonc/noaa105] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Lower-grade gliomas (LGGs) with isocitrate dehydrogenase 1 and/or 2 (IDH1/2) mutations have long survival times, making evaluation of treatment efficacy difficult. We investigated the volumetric growth rate of IDH mutant gliomas before and after treatment with established glioma therapies to determine whether a significant change in growth rate could be documented and perhaps be used in the future to evaluate treatment response to investigational agents in LGG trials. METHODS In this multicenter retrospective study, 230 adult patients with IDH1/2 mutated LGGs (World Health Organization grade II or III) undergoing surgery, radiation, or chemotherapy for progressive non-enhancing tumor were identified. Subjects were required to have 3 MRI scans containing T2/fluid attenuated inversion recovery imaging spanning a minimum of 6 months prior to treatment. A mixed-effect model was used to estimate tumor growth prior to treatment. A subset of 95 patients who received chemotherapy, radiotherapy, or chemoradiotherapy and had 2 posttreatment imaging time points available were evaluated for change in pre- and posttreatment volumetric growth rates using a piecewise mixed model. RESULTS The pretreatment volumetric growth rate across all 230 patients was 27.37%/180 days (95% CI: [23.36%, 31.51%]). In the 95 patients with both pre- and posttreatment scans available, there was a significant difference in volumetric growth rates before (26.63%/180 days, 95% CI: [19.31%, 34.40%]) and after treatment (-15.24% /180 days, 95% CI: [-21.37%, -8.62%]) (P < 0.0001). The growth rates for patient subgroup with 1p/19q codeletion (N = 118) was significantly slower than the rate of the 1p/19q non-codeleted group (N = 68) (22.84% vs 35.49%, P = 0.0108). CONCLUSION In this study, we evaluated the growth rates of IDH mutant gliomas before and after standard therapy. Further study is needed to establish whether a change in growth rate is associated with patient survival and its use as a surrogate endpoint in clinical trials for IDH mutant LGGs.
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Affiliation(s)
- Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert J Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Harini Veeraraghavan
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Wei Wang
- Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Florent Tixier
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hyemin Um
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rasheed Nawaz
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tracy Luks
- Department of Radiology, University of California San Francisco, San Francisco, California
| | - John Kim
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | | | - David Schiff
- Departments of Neurology, Neurological Surgery, and Medicine, University of Virginia, Charlottesville, Virginia
| | - Katherine B Peters
- Department of Neurology and Neurosurgery, Preston Robert Tisch Brain Tumor Center, Duke University, Durham, North Carolina
| | - Ingo K Mellinghoff
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan M Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Timothy F Cloughesy
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
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Bai HX, Wang R, Xiong Z, Hsieh B, Chang K, Halsey K, Tran TML, Choi JW, Wang DC, Shi LB, Mei J, Jiang XL, Pan I, Zeng QH, Hu PF, Li YH, Fu FX, Huang RY, Sebro R, Yu QZ, Atalay MK, Liao WH. Artificial Intelligence Augmentation of Radiologist Performance in Distinguishing COVID-19 from Pneumonia of Other Origin at Chest CT. Radiology 2021; 299:E225. [PMID: 33750227 PMCID: PMC8906348 DOI: 10.1148/radiol.2021219004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dmytriw AA, Huang RY. In search of predictive and response markers in antiangiogenic therapy of glioblastoma. Neuro Oncol 2021; 23:184-185. [PMID: 33470406 DOI: 10.1093/neuonc/noaa293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Adam A Dmytriw
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
Radiomics is a novel technique in which quantitative phenotypes or features are extracted from medical images. Machine learning enables analysis of large quantities of medical imaging data generated by radiomic feature extraction. A growing number of studies based on these methods have developed tools for neuro-oncology applications. Despite the initial promises, many of these imaging tools remain far from clinical implementation. One major limitation hindering the use of these models is their lack of reproducibility when applied across different institutions and clinical settings. In this article, we discuss the importance of standardization of methodology and reporting in our effort to improve reproducibility. Ongoing efforts of standardization for neuro-oncological imaging are reviewed. Challenges related to standardization and potential disadvantages in over-standardization are also described. Ultimately, greater multi-institutional collaborative effort is needed to provide and implement standards for data acquisition and analysis methods to facilitate research results to be interoperable and reliable for integration into different practice environments.
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Affiliation(s)
- Xiao Tian Li
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Park SI, Suh CH, Guenette JP, Huang RY, Kim HS. The T2-FLAIR mismatch sign as a predictor of IDH-mutant, 1p/19q-noncodeleted lower-grade gliomas: a systematic review and diagnostic meta-analysis. Eur Radiol 2021; 31:5289-5299. [PMID: 33409784 DOI: 10.1007/s00330-020-07467-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/30/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the diagnostic performance of the T2-FLAIR mismatch sign for prediction of isocitrate dehydrogenase (IDH)-mutant, 1p/19q-noncodeleted lower-grade gliomas (LGGs) and review studies with false positive results. METHODS The MEDLINE and EMBASE databases were searched up to March 13, 2020, to identify articles reporting the diagnostic performance of the T2-FLAIR mismatch sign for prediction of IDH-mutant, 1p/19q-noncodeleted LGGs (IDHmut-Noncodel) using the search terms (T2 FLAIR mismatch). Pooled sensitivity, specificity, and correlation coefficient for interobserver agreement were calculated. RESULTS Twelve studies including a total of 1053 patients were included. The median age was 43 (median; range, 14-56). The pooled sensitivity and specificity were 42% (95% CI, 28-58%) and 100% (95% CI, 88-100%), respectively. According to the HSROC curve, the area under the curve was 0.77 (95% CI, 0.73-0.80). Considerable heterogeneity was possible among the studies in terms of both sensitivity and specificity. A threshold effect was suggested and was considered to explain most of the heterogeneity. Four studies reported false positive results for the T2-FLAIR mismatch sign, including dysembryoplastic neuroepithelial tumor, pediatric-type gliomas, and non-neoplastic lesions. The 2 original articles with false positive results showed the highest sensitivities among the 10 studies included in the quantitative analysis, supporting the probability of the threshold effect. The pooled correlation coefficient was 0.87 (95% CI, 0.73-0.94). CONCLUSIONS The T2-FLAIR mismatch sign had a high specificity and interobserver agreement for the prediction of IDHmut-Noncodel. However, the sign demonstrated low sensitivity, and a few studies with false positive cases were also reported. KEY POINTS • The pooled sensitivity and specificity of the T2-FLAIR mismatch sign for prediction of IDH-mutant, 1p/19q-noncodeleted lower-grade gliomas were 42% and 100%, respectively. • Four studies reported false positive results. • The pooled correlation coefficient was 0.87, suggesting almost perfect interobserver agreement.
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Affiliation(s)
- Sang Ik Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul, 05505, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul, 05505, Republic of Korea.
| | - Jeffrey P Guenette
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Raymond Y Huang
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul, 05505, Republic of Korea
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Miskin N, Unadkat P, Carlton ME, Golby AJ, Young GS, Huang RY. Frequency and Evolution of New Postoperative Enhancement on 3 Tesla Intraoperative and Early Postoperative Magnetic Resonance Imaging. Neurosurgery 2020; 87:238-246. [PMID: 31584071 DOI: 10.1093/neuros/nyz398] [Citation(s) in RCA: 2] [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: 01/18/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intraoperative magnetic resonance imaging (IO-MRI) provides real-time assessment of extent of resection of brain tumor. Development of new enhancement during IO-MRI can confound interpretation of residual enhancing tumor, although the incidence of this finding is unknown. OBJECTIVE To determine the frequency of new enhancement during brain tumor resection on intraoperative 3 Tesla (3T) MRI. To optimize the postoperative imaging window after brain tumor resection using 1.5 and 3T MRI. METHODS We retrospectively evaluated 64 IO-MRI performed for patients with enhancing brain lesions referred for biopsy or resection as well as a subset with an early postoperative MRI (EP-MRI) within 72 h of surgery (N = 42), and a subset with a late postoperative MRI (LP-MRI) performed between 120 h and 8 wk postsurgery (N = 34). Three radiologists assessed for new enhancement on IO-MRI, and change in enhancement on available EP-MRI and LP-MRI. Consensus was determined by majority response. Inter-rater agreement was assessed using percentage agreement. RESULTS A total of 10 out of 64 (16%) of the IO-MRI demonstrated new enhancement. Seven of 10 patients with available EP-MRI demonstrated decreased/resolved enhancement. One out of 42 (2%) of the EP-MRI demonstrated new enhancement, which decreased on LP-MRI. Agreement was 74% for the assessment of new enhancement on IO-MRI and 81% for the assessment of new enhancement on the EP-MRI. CONCLUSION New enhancement occurs in intraoperative 3T MRI in 16% of patients after brain tumor resection, which decreases or resolves on subsequent MRI within 72 h of surgery. Our findings indicate the opportunity for further study to optimize the postoperative imaging window.
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Affiliation(s)
- Nityanand Miskin
- Department of Radiology, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts
| | - Prashin Unadkat
- Department of Radiology, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts.,Department of Neurosurgery, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts.,Department of Surgery, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts
| | - Michael E Carlton
- Department of Radiology, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts
| | - Alexandra J Golby
- Department of Radiology, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts.,Department of Neurosurgery, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts
| | - Geoffrey S Young
- Department of Radiology, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts
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45
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Kuo AH, Cho CH, Huang RY, Kim CJ, Lee TC. Target-specific yield rate and clinical utility of percutaneous tissue sampling in spinal infection. Clin Imaging 2020; 68:257-262. [DOI: 10.1016/j.clinimag.2020.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/04/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
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46
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Kim PH, Suh CH, Kim HS, Kim KW, Kim DY, Lee EQ, Aizer AA, Guenette JP, Huang RY. Immune Checkpoint Inhibitor with or without Radiotherapy in Melanoma Patients with Brain Metastases: A Systematic Review and Meta-Analysis. Korean J Radiol 2020; 22:584-595. [PMID: 33289357 PMCID: PMC8005357 DOI: 10.3348/kjr.2020.0728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/08/2020] [Revised: 06/09/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022] Open
Abstract
Objective Immune checkpoint inhibitor (ICI) therapy has shown activity against melanoma brain metastases. Recently, promising results have also been reported for ICI combination therapy and ICI combined with radiotherapy. We aimed to evaluate radiologic response and adverse event rates of these therapeutic options by a systematic review and meta-analysis. Materials and Methods A systematic literature search of Ovid-MEDLINE and EMBASE was performed up to October 12, 2019 and included studies evaluating the intracranial objective response rates (ORRs) and/or disease control rates (DCRs) of ICI with or without radiotherapy for treating melanoma brain metastases. We also evaluated safety-associated outcomes. Results Eleven studies with 14 cohorts (3 with ICI combination therapy; 5 with ICI combined with radiotherapy; 6 with ICI monotherapy) were included. ICI combination therapy {pooled ORR, 53% (95% confidence interval [CI], 44–61%); DCR, 57% (95% CI, 49–66%)} and ICI combined with radiotherapy (pooled ORR, 42% [95% CI, 31–54%]; DCR, 85% [95% CI, 63–95%]) showed higher local efficacy compared to ICI monotherapy (pooled ORR, 15% [95% CI, 11–20%]; DCR, 26% [95% CI, 21–32%]). The grade 3 or 4 adverse event rate was significantly higher with ICI combination therapy (60%; 95% CI, 52–67%) compared to ICI monotherapy (11%; 95% CI, 8–17%) and ICI combined with radiotherapy (4%; 95% CI, 1–19%). Grade 3 or 4 central nervous system (CNS)-related adverse event rates were not different (9% in ICI combination therapy; 8% in ICI combined with radiotherapy; 5% in ICI monotherapy). Conclusion ICI combination therapy or ICI combined with radiotherapy showed better local efficacy than ICI monotherapy for treating melanoma brain metastasis. The grade 3 or 4 adverse event rate was highest with ICI combination therapy, and the CNS-related grade 3 or 4 event rate was similar. Prospective trials will be necessary to compare the efficacy of ICI combination therapy and ICI combined with radiotherapy.
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Affiliation(s)
- Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Yeong Kim
- Department of Quarantine, Incheon Airport National Quarantine Station, Incheon, Korea
| | - Eudocia Q Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Ayal A Aizer
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jeffrey P Guenette
- Department of Radiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Kim PH, Suh CH, Kim HS, Kim KW, Kim DY, Aizer AA, Rahman R, Guenette JP, Huang RY. Immune checkpoint inhibitor therapy may increase the incidence of treatment-related necrosis after stereotactic radiosurgery for brain metastases: a systematic review and meta-analysis. Eur Radiol 2020; 31:4114-4129. [PMID: 33241519 DOI: 10.1007/s00330-020-07514-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/28/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To compare the incidence of treatment-related necrosis between combination SRS+ICI therapy and SRS therapy alone in patients with brain metastases from melanoma and non-small cell lung cancer (NSCLC). METHODS A systematic literature search of Ovid-MEDLINE and EMBASE was performed up to August 10, 2020. The difference in the pooled incidence of treatment-related necrosis after SRS+ICI or SRS alone was evaluated. The cumulative incidence of treatment-related necrosis at the specific time point after the treatment was calculated and plotted. Subgroup and meta-regression analyses were additionally performed. RESULTS Sixteen studies (14 on melanoma, 2 on NSCLC) were included. In NSCLC brain metastasis, the reported incidences of treatment-related necrosis in SRS+ICI and SRS alone ranged 2.9-3.4% and 0-2.9%, respectively. Meta-analysis was conducted including 14 studies on melanoma brain metastasis. The incidence of treatment-related necrosis was higher in SRS+ICI than SRS alone (16.0% vs. 6.5%; p = 0.065; OR, 2.35). The incidence showed rapid increase until 12 months after the SRS when combined with ICI therapy (14%; 95% CI, 8-22%) and its pace of increase slowed thereafter. Histopathologic diagnosis as the reference standard for treatment-related necrosis and inclusion of only symptomatic cases were the source of heterogeneity in SRS+ICI. CONCLUSIONS Treatment-related necrosis tended to occur 2.4 times more frequently in the setting of combination SRS+ICI therapy compared with SRS alone in melanoma brain metastasis showing high cumulative incidence within the first year. Treatment-related necrosis should be considered when SRS+ICI combination therapy is used for melanoma brain metastasis, especially in the first year. KEY POINTS • Treatment-related necrosis occurred 2.4 times more frequently in the setting of combination SRS+ICI therapy compared with SRS alone in melanoma brain metastasis. • Treatment-related necrosis more frequently occurred in brain metastases from melanoma than NSCLC. • Reference standard for treatment-related necrosis and inclusion of only symptomatic treatment-related necrosis were a significant source of heterogeneity, indicating varying definitions of treatment-related necrosis in the literature need to be unified.
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Affiliation(s)
- Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul, 05505, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul, 05505, Republic of Korea.
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul, 05505, Republic of Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul, 05505, Republic of Korea
| | - Dong Yeong Kim
- Department of Quarantine, Incheon Airport National Quarantine Station, Incheon, Republic of Korea
| | - Ayal A Aizer
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Rifaquat Rahman
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Jeffrey P Guenette
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Raymond Y Huang
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Wang R, Cai Y, Lee IK, Hu R, Purkayastha S, Pan I, Yi T, Tran TML, Lu S, Liu T, Chang K, Huang RY, Zhang PJ, Zhang Z, Xiao E, Wu J, Bai HX. Evaluation of a convolutional neural network for ovarian tumor differentiation based on magnetic resonance imaging. Eur Radiol 2020; 31:4960-4971. [PMID: 33052463 DOI: 10.1007/s00330-020-07266-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 04/04/2020] [Revised: 07/19/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES There currently lacks a noninvasive and accurate method to distinguish benign and malignant ovarian lesion prior to treatment. This study developed a deep learning algorithm that distinguishes benign from malignant ovarian lesion by applying a convolutional neural network on routine MR imaging. METHODS Five hundred forty-five lesions (379 benign and 166 malignant) from 451 patients from a single institution were divided into training, validation, and testing set in a 7:2:1 ratio. Model performance was compared with four junior and three senior radiologists on the test set. RESULTS Compared with junior radiologists averaged, the final ensemble model combining MR imaging and clinical variables had a higher test accuracy (0.87 vs 0.64, p < 0.001) and specificity (0.92 vs 0.64, p < 0.001) with comparable sensitivity (0.75 vs 0.63, p = 0.407). Against the senior radiologists averaged, the final ensemble model also had a higher test accuracy (0.87 vs 0.74, p = 0.033) and specificity (0.92 vs 0.70, p < 0.001) with comparable sensitivity (0.75 vs 0.83, p = 0.557). Assisted by the model's probabilities, the junior radiologists achieved a higher average test accuracy (0.77 vs 0.64, Δ = 0.13, p < 0.001) and specificity (0.81 vs 0.64, Δ = 0.17, p < 0.001) with unchanged sensitivity (0.69 vs 0.63, Δ = 0.06, p = 0.302). With the AI probabilities, the junior radiologists had higher specificity (0.81 vs 0.70, Δ = 0.11, p = 0.005) but similar accuracy (0.77 vs 0.74, Δ = 0.03, p = 0.409) and sensitivity (0.69 vs 0.83, Δ = -0.146, p = 0.097) when compared with the senior radiologists. CONCLUSIONS These results demonstrate that artificial intelligence based on deep learning can assist radiologists in assessing the nature of ovarian lesions and improve their performance. KEY POINTS • Artificial Intelligence based on deep learning can assess the nature of ovarian lesions on routine MRI with higher accuracy and specificity than radiologists. • Assisted by the deep learning model's probabilities, junior radiologists achieved better performance that matched those of senior radiologists.
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Affiliation(s)
- Robin Wang
- Department of Radiology, the Second Xiangya Hospital, Central South University, Changsha, China.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Yeyu Cai
- Department of Radiology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Iris K Lee
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Rong Hu
- School of Computer Science and Engineering, Central South University, Changsha, China
| | - Subhanik Purkayastha
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Ian Pan
- Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Thomas Yi
- Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Thi My Linh Tran
- Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Shaolei Lu
- Department of Pathology, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Ken Chang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Paul J Zhang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Zishu Zhang
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Enhua Xiao
- Department of Radiology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Jing Wu
- Department of Radiology, the Second Xiangya Hospital, Central South University, Changsha, China.
| | - Harrison X Bai
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA.
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Bai HX, Wang R, Xiong Z, Hsieh B, Chang K, Halsey K, Tran TML, Choi JW, Wang DC, Shi LB, Mei J, Jiang XL, Pan I, Zeng QH, Hu PF, Li YH, Fu FX, Huang RY, Sebro R, Yu QZ, Atalay MK, Liao WH. Artificial Intelligence Augmentation of Radiologist Performance in Distinguishing COVID-19 from Pneumonia of Other Origin at Chest CT. Radiology 2020; 296:E156-E165. [PMID: 32339081 PMCID: PMC7233483 DOI: 10.1148/radiol.2020201491] [Citation(s) in RCA: 239] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) and pneumonia of other diseases share similar CT characteristics, which contributes to the challenges in differentiating them with high accuracy. Purpose To establish and evaluate an artificial intelligence (AI) system for differentiating COVID-19 and other pneumonia at chest CT and assessing radiologist performance without and with AI assistance. Materials and Methods A total of 521 patients with positive reverse transcription polymerase chain reaction results for COVID-19 and abnormal chest CT findings were retrospectively identified from 10 hospitals from January 2020 to April 2020. A total of 665 patients with non-COVID-19 pneumonia and definite evidence of pneumonia at chest CT were retrospectively selected from three hospitals between 2017 and 2019. To classify COVID-19 versus other pneumonia for each patient, abnormal CT slices were input into the EfficientNet B4 deep neural network architecture after lung segmentation, followed by a two-layer fully connected neural network to pool slices together. The final cohort of 1186 patients (132 583 CT slices) was divided into training, validation, and test sets in a 7:2:1 and equal ratio. Independent testing was performed by evaluating model performance in separate hospitals. Studies were blindly reviewed by six radiologists without and then with AI assistance. Results The final model achieved a test accuracy of 96% (95% confidence interval [CI]: 90%, 98%), a sensitivity of 95% (95% CI: 83%, 100%), and a specificity of 96% (95% CI: 88%, 99%) with area under the receiver operating characteristic curve of 0.95 and area under the precision-recall curve of 0.90. On independent testing, this model achieved an accuracy of 87% (95% CI: 82%, 90%), a sensitivity of 89% (95% CI: 81%, 94%), and a specificity of 86% (95% CI: 80%, 90%) with area under the receiver operating characteristic curve of 0.90 and area under the precision-recall curve of 0.87. Assisted by the probabilities of the model, the radiologists achieved a higher average test accuracy (90% vs 85%, Δ = 5, P < .001), sensitivity (88% vs 79%, Δ = 9, P < .001), and specificity (91% vs 88%, Δ = 3, P = .001). Conclusion Artificial intelligence assistance improved radiologists' performance in distinguishing coronavirus disease 2019 pneumonia from non-coronavirus disease 2019 pneumonia at chest CT. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
| | | | - Zeng Xiong
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Ben Hsieh
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Ken Chang
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Kasey Halsey
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Thi My Linh Tran
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Ji Whae Choi
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Dong-Cui Wang
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Lin-Bo Shi
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Ji Mei
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Xiao-Long Jiang
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Ian Pan
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Qiu-Hua Zeng
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Ping-Feng Hu
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Yi-Hui Li
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Fei-Xian Fu
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Raymond Y. Huang
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Ronnie Sebro
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Qi-Zhi Yu
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Michael K. Atalay
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
| | - Wei-Hua Liao
- From the Department of Radiology, Xiangya Hospital, Central South
University, Changsha, Hunan 410008, China (Z.X., D.W., W.L.); Perelman School of
Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104 (R.W.);
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode
Island, 02903, United States (H.X.B., B.H., K.H., I.P., M.K.A.); Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States (K.C.);
Warren Alpert Medical School at Brown University, Providence, Rhode Island,
02903, United States (H.X.B., K.H., T.M.L.T., J.W.C., I.P.); Department of
Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, 425006, China (L.S.);
Department of Radiology, Changde Second People’s Hospital, Changde,
Hunan, 415001, China (J.M.); Department of Radiology, Affiliated Nan Hua
Hospital, University of South China, Hengyang, Hunan, 421002, China (X.J.);
Department of Radiology, Loudi Central Hospital, Loudi, Hunan, 417000, China
(Q.Z.); Department of Radiology, Chenzhou Second People’s Hospital,
Chenzhou, Hunan, 423000, China (P.H.); Department of Radiology, Zhuzhou Central
Hospital, Zhuzhou, Hunan, 412002, China (Y.L.); Department of Radiology, Yiyang
City Center Hospital, Yiyang, Hunan, 413000, China (F.F.); Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, 02115,
United States (R.Y.H.); Department of Radiology, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, 19104, United States (R.S.);
Department of Radiology, The First Hospital of Changsha, Changsha, Hunan,
410005, China (Q.Y.)
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Kim M, Suh CH, Lee SM, Kim HC, Aizer AA, Yanagihara TK, Bai HX, Guenette JP, Huang RY, Kim HS. Diagnostic Yield of Staging Brain MRI in Patients with Newly Diagnosed Non-Small Cell Lung Cancer. Radiology 2020; 297:419-427. [PMID: 32840470 DOI: 10.1148/radiol.2020201194] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Existing guidelines are inconsistent regarding the indications for staging brain MRI in patients with newly diagnosed, early-stage non-small cell lung cancer (NSCLC). Purpose To evaluate the diagnostic yield of staging brain MRI in the initial evaluation of lung cancer. Materials and Methods This retrospective, observational, single-institution study included patients with newly diagnosed NSCLC who underwent staging chest CT and staging brain MRI from November 2017 to October 2018. Diagnostic yield was defined as the proportion of patients with brain metastases among all patients. Yield was stratified into clinical stage groups per the eighth edition of the American Joint Committee on Cancer staging guidelines, based on staging chest CT and in adenocarcinoma with epidermal growth factor receptor (EGFR) gene mutation and anaplastic lymphoma kinase (ALK) gene rearrangement. Subgroup analyses were performed on the basis of cell types and molecular markers. The χ2 test was performed to compare the diagnostic yields, and Bonferroni correction was used to account for multiple testing between stage groups. Results A total of 1712 patients (mean age, 64 years ± 10 [standard deviation]; 1035 men) were included. The diagnostic yield of staging brain MRI in newly diagnosed NSCLC was 11.9% (203 of 1712; 95% confidence interval [CI]: 10.4%, 13.5%). In clinical stage IA, IB, and II disease, the diagnostic yields were 0.3% (two of 615; 95% CI: 0.0%, 1.2%), 3.8% (seven of 186; 95% CI: 1.5%, 7.6%), and 4.7% (eight of 171; 95% CI: 2.0%, 9.0%), respectively. The diagnostic yield was higher in patients with adenocarcinoma (13.6%; 176 of 1297; 95% CI: 11.8%, 15.6%) than squamous cell carcinoma (5.9%; 21 of 354; 95% CI: 3.7%, 8.9%) and in patients with EGFR mutation-positive adenocarcinoma (17.5%; 85 of 487; 95% CI: 14.2%, 21.1%) than with EGFR mutation-negative adenocarcinoma (10.6%; 68 of 639; 95% CI: 8.4%, 13.3%) (P < .001 for both). Conclusion The diagnostic yield of staging brain MRI in clinical stage IA non-small cell lung cancer was low, but staging brain MRI had a higher diagnostic yield in clinical stage IB and epidermal growth factor receptor mutation-positive adenocarcinoma. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Minjae Kim
- From the Department of Radiology and Research Institute of Radiology (M.K., C.H.S., S.M.L., H.S.K.) and Department of Pulmonology and Critical Care Medicine (H.C.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, Seoul 05505, Republic of Korea; Department of Radiation Oncology (A.A.A.) and Division of Neuroradiology (J.P.G., R.Y.H.), Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass; Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC (T.K.Y.); and Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI (H.X.B.)
| | - Chong Hyun Suh
- From the Department of Radiology and Research Institute of Radiology (M.K., C.H.S., S.M.L., H.S.K.) and Department of Pulmonology and Critical Care Medicine (H.C.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, Seoul 05505, Republic of Korea; Department of Radiation Oncology (A.A.A.) and Division of Neuroradiology (J.P.G., R.Y.H.), Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass; Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC (T.K.Y.); and Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI (H.X.B.)
| | - Sang Min Lee
- From the Department of Radiology and Research Institute of Radiology (M.K., C.H.S., S.M.L., H.S.K.) and Department of Pulmonology and Critical Care Medicine (H.C.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, Seoul 05505, Republic of Korea; Department of Radiation Oncology (A.A.A.) and Division of Neuroradiology (J.P.G., R.Y.H.), Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass; Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC (T.K.Y.); and Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI (H.X.B.)
| | - Ho Cheol Kim
- From the Department of Radiology and Research Institute of Radiology (M.K., C.H.S., S.M.L., H.S.K.) and Department of Pulmonology and Critical Care Medicine (H.C.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, Seoul 05505, Republic of Korea; Department of Radiation Oncology (A.A.A.) and Division of Neuroradiology (J.P.G., R.Y.H.), Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass; Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC (T.K.Y.); and Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI (H.X.B.)
| | - Ayal A Aizer
- From the Department of Radiology and Research Institute of Radiology (M.K., C.H.S., S.M.L., H.S.K.) and Department of Pulmonology and Critical Care Medicine (H.C.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, Seoul 05505, Republic of Korea; Department of Radiation Oncology (A.A.A.) and Division of Neuroradiology (J.P.G., R.Y.H.), Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass; Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC (T.K.Y.); and Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI (H.X.B.)
| | - Ted K Yanagihara
- From the Department of Radiology and Research Institute of Radiology (M.K., C.H.S., S.M.L., H.S.K.) and Department of Pulmonology and Critical Care Medicine (H.C.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, Seoul 05505, Republic of Korea; Department of Radiation Oncology (A.A.A.) and Division of Neuroradiology (J.P.G., R.Y.H.), Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass; Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC (T.K.Y.); and Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI (H.X.B.)
| | - Harrison X Bai
- From the Department of Radiology and Research Institute of Radiology (M.K., C.H.S., S.M.L., H.S.K.) and Department of Pulmonology and Critical Care Medicine (H.C.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, Seoul 05505, Republic of Korea; Department of Radiation Oncology (A.A.A.) and Division of Neuroradiology (J.P.G., R.Y.H.), Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass; Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC (T.K.Y.); and Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI (H.X.B.)
| | - Jeffrey P Guenette
- From the Department of Radiology and Research Institute of Radiology (M.K., C.H.S., S.M.L., H.S.K.) and Department of Pulmonology and Critical Care Medicine (H.C.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, Seoul 05505, Republic of Korea; Department of Radiation Oncology (A.A.A.) and Division of Neuroradiology (J.P.G., R.Y.H.), Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass; Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC (T.K.Y.); and Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI (H.X.B.)
| | - Raymond Y Huang
- From the Department of Radiology and Research Institute of Radiology (M.K., C.H.S., S.M.L., H.S.K.) and Department of Pulmonology and Critical Care Medicine (H.C.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, Seoul 05505, Republic of Korea; Department of Radiation Oncology (A.A.A.) and Division of Neuroradiology (J.P.G., R.Y.H.), Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass; Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC (T.K.Y.); and Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI (H.X.B.)
| | - Ho Sung Kim
- From the Department of Radiology and Research Institute of Radiology (M.K., C.H.S., S.M.L., H.S.K.) and Department of Pulmonology and Critical Care Medicine (H.C.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, Seoul 05505, Republic of Korea; Department of Radiation Oncology (A.A.A.) and Division of Neuroradiology (J.P.G., R.Y.H.), Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass; Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC (T.K.Y.); and Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI (H.X.B.)
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