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Zhang X, Olesinski EA, Duong Q, Truong MT, Lee S, Jang S, Mak KS, Parekh A, Hirsch AE. Development and Assessment of a Multi-Purpose Knowledge-Based Planning Model (RapidPlan) for Prostate Radiation. Int J Radiat Oncol Biol Phys 2023; 117:e497. [PMID: 37785565 DOI: 10.1016/j.ijrobp.2023.06.1737] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) RapidPlan (RP) is a knowledge-based planning (KBP) tool to improve plan quality, planning speed, and reduce inter-patient plan variability. For small to medium institutions, it is difficult to find sufficient patient numbers to configure a reliable KBP-RP model. This study aimed to build a multi-purpose KBP-RP model for prostate cancers. MATERIALS/METHODS A total of 124 prostate plans from 2018-2022 at our institution were selected to configure the initial RP model. After model training, outliers were removed. 77 patients were used for the final RP model. Three fine-tuned RP sub-models with different optimized constraints corresponding to prostate bed, prostate + seminal vesicles (SV), and prostate boost plans were generated. RP models were validated by comparing plan quality with the original manually optimized plans (MP). 54 independent plans were selected to validate the RP models. Validation included: dose to 99% and 2% of PTV (D99%, D2%), PTV conformity index (CI); for organs at risk (OARs), volume receiving >70Gy and >60Gy (V70Gy, V60Gy) to bladder and rectum, maximum dose (Dmax) to femur heads (FHs) and small bowel. Statistical t-test analysis was performed with a significance of p<0.05. RESULTS A total of 48/54 model-based plans were clinically approved after single RP optimization. 6/54 failed plans were prostate bed plans and were deemed acceptable after additional minor constraint adjustments. For PTV, D99%, D2%, and CI were comparable (p>0.05) to MP. Bladder and rectum V70Gy were comparable (p>0.05), and V60Gy were significantly lower to MP (p<0.05), with an average Dmean of 23.21±14.58Gy and 16.41±10.63Gy vs 26.36±16.89Gy and 18.24±12.81Gy for RP and MP. RP significantly reduced Dmax to FHs and small bowel (p<0.05), with average Dmax of 34.95±6.06Gy and 35.62±18.99Gy vs 36.81±7.05Gy and 38.14±17.81Gy, respectively. CONCLUSION Multi-purpose prostate RP model was configured and approved plans were generated after single optimization. Prostate RP plans had equivalent PTV coverage with better or comparable OAR constraints.
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Affiliation(s)
- X Zhang
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | | | - Q Duong
- Boston Medical Center, Boston, MA
| | - M T Truong
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - S Lee
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - S Jang
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - K S Mak
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - A Parekh
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - A E Hirsch
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
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2
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Godoy MCB, Truong MT, Jimenez CA, Shroff GS, Vlahos I, Casal RF. Imaging of therapeutic airway interventions in thoracic oncology. Clin Radiol 2021; 77:58-72. [PMID: 34736758 DOI: 10.1016/j.crad.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
Tracheobronchial obstruction, haemoptysis, and airway fistulas caused by airway involvement by primary or metastatic malignancies may result in dyspnoea, wheezing, stridor, hypoxaemia, and obstructive atelectasis or pneumonia, and can lead to life-threatening respiratory failure if untreated. Complex minimally invasive endobronchial interventions are being used increasingly to treat cancer patients with tracheobronchial conditions with curative or, most often, palliative intent, to improve symptoms and quality of life. The selection of the appropriate treatment strategy depends on multiple factors, including tumour characteristics, whether the lesion is predominately endobronchial, shows extrinsic compression, or a combination of both, the patient's clinical status, the urgency of the clinical scenario, physician expertise, and availability of tools. Pre-procedure multidetector computed tomography (MDCT) imaging can aid in the most appropriate selection of bronchoscopic treatment. Follow-up imaging is invaluable for the early recognition and management of any potential complication. This article reviews the most commonly used endobronchial procedures in the oncological setting and illustrates the role of MDCT in planning, assisting, and follow-up of endobronchial therapeutic procedures.
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Affiliation(s)
- M C B Godoy
- Department of Thoracic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
| | - M T Truong
- Department of Thoracic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - C A Jimenez
- Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - G S Shroff
- Department of Thoracic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - I Vlahos
- Department of Thoracic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - R F Casal
- Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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3
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Carter BW, Altan M, Shroff GS, Truong MT, Vlahos I. Post-chemotherapy and targeted therapy imaging of the chest in lung cancer. Clin Radiol 2021; 77:e1-e10. [PMID: 34538577 DOI: 10.1016/j.crad.2021.08.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/03/2021] [Indexed: 12/22/2022]
Abstract
Non-small-cell lung cancer (NSCLC) is frequently diagnosed when it is not amenable to local therapies; therefore, systemic agents are the mainstay of therapy for many patients. In recent years, treatment of advanced NSCLC has evolved from a general approach primarily involving chemotherapy to a more personalised strategy in which biomarkers such as the presence of genomic tumour aberrations and the expression of immune proteins such as programmed death-ligand 1 (PD-L1), in combination with other elements of clinical information such as histology and clinical stage, guide management. For instance, pathways resulting in uncontrolled growth and proliferation of tumour cells due to epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements may be targeted by tyrosine kinase inhibitors (TKIs). In this article, we review the current state of medical oncology, imaging characteristics of mutations, pitfalls in response assessments and the imaging of complications.
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Affiliation(s)
- B W Carter
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - M Altan
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - G S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - M T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - I Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Ahuja J, de Groot PM, Shroff GS, Strange CD, Vlahos I, Rajaram R, Truong MT, Wu CC. The postoperative chest in lung cancer. Clin Radiol 2021; 77:6-18. [PMID: 34154835 DOI: 10.1016/j.crad.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/05/2021] [Indexed: 12/17/2022]
Abstract
Most of the complications following lung cancer surgery occur in the early postoperative period and can result in significant morbidity and mortality. Delayed complications can also occur. Diagnosing these complications can be challenging because clinical manifestations are non-specific. Imaging plays an important role in detecting these complications in a timely manner and facilitates prompt interventions. Hence, it is important to have knowledge of the expected anatomical alterations following lung cancer surgeries, and the spectrum of post-surgical complications and their respective imaging findings to avoid misinterpretations or delay in diagnosis.
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Affiliation(s)
- J Ahuja
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - P M de Groot
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C D Strange
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - I Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Rajaram
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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5
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Shroff GS, Strange CD, Altan M, Carter BW, Ahuja J, Godoy MCB, Truong MT, Vlahos I. Post-immunotherapy imaging in lung cancer. Clin Radiol 2021; 77:44-57. [PMID: 34103147 DOI: 10.1016/j.crad.2021.05.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/12/2021] [Indexed: 12/22/2022]
Abstract
By boosting the immune system, immunotherapy with immune checkpoint inhibitors (ICIs) has altered the management of patients with various cancers including those with metastatic non-small cell lung cancer (NSCLC). As a result of immune system activation, ICIs are associated with unique response patterns (that are not addressed by traditional response criteria) and inflammatory side effects termed immune-related adverse events. In this article, we will review the role of immunotherapy in cancer treatment, specifically ICIs used in NSCLC treatment, radiological response criteria of immunotherapy, and the imaging spectrum of immune-related adverse events.
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Affiliation(s)
- G S Shroff
- The University of Texas MD Anderson Cancer Center, Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030, USA.
| | - C D Strange
- The University of Texas MD Anderson Cancer Center, Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030, USA
| | - M Altan
- The University of Texas MD Anderson Cancer Center, Thoracic/Head and Neck Medical Oncology, 1515 Holcombe Blvd. Unit 0432, Houston, TX 77030, USA
| | - B W Carter
- The University of Texas MD Anderson Cancer Center, Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030, USA
| | - J Ahuja
- The University of Texas MD Anderson Cancer Center, Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030, USA
| | - M C B Godoy
- The University of Texas MD Anderson Cancer Center, Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030, USA
| | - M T Truong
- The University of Texas MD Anderson Cancer Center, Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030, USA
| | - I Vlahos
- The University of Texas MD Anderson Cancer Center, Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030, USA
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6
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Strange CD, Shroff GS, Truong MT, Nguyen QN, Vlahos I, Erasmus JJ. Imaging of the post-radiation chest in lung cancer. Clin Radiol 2021; 77:19-30. [PMID: 34090709 DOI: 10.1016/j.crad.2021.04.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/29/2021] [Indexed: 12/25/2022]
Abstract
Radiation therapy using conventional fractionated external-beam or high-precision dose techniques including three-dimensional conformal radiotherapy, stereotactic body radiation therapy, intensity-modulated radiation therapy, and proton therapy, is a key component in the treatment of patients with lung cancer. Knowledge of the radiation technique used, radiation treatment plan, expected temporal evolution of radiation-induced lung injury and patient-specific parameters, such as previous radiotherapy, concurrent chemoradiotherapy, and/or immunotherapy, is important in imaging interpretation. This review discusses factors that affect the development and severity of radiation-induced lung injury and its radiological manifestations with emphasis on the differences between conventional radiation and high-precision dose radiotherapy techniques.
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Affiliation(s)
- C D Strange
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - G S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - M T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - Q-N Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - I Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - J J Erasmus
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA.
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7
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Fujima N, Andreu-Arasa VC, Meibom SK, Mercier GA, Salama AR, Truong MT, Sakai O. Prediction of the treatment outcome using machine learning with FDG-PET image-based multiparametric approach in patients with oral cavity squamous cell carcinoma. Clin Radiol 2021; 76:711.e1-711.e7. [PMID: 33934877 DOI: 10.1016/j.crad.2021.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/26/2021] [Indexed: 12/15/2022]
Abstract
AIM To investigate the value of machine learning-based multiparametric analysis using 2-[18F]-fluoro-2-deoxy-d-glucose positron-emission tomography (FDG-PET) images to predict treatment outcome in patients with oral cavity squamous cell carcinoma (OCSCC). MATERIALS AND METHODS Ninety-nine patients with OCSCC who received pretreatment integrated FDG-PET/computed tomography (CT) were included. They were divided into the training (66 patients) and validation (33 patients) cohorts. The diagnosis of local control or local failure was obtained from patient's medical records. Conventional FDG-PET parameters, including the maximum and mean standardised uptake values (SUVmax and SUVmean), metabolic tumour volume (MTV), and total lesion glycolysis (TLG), quantitative tumour morphological parameters, intratumoural histogram, and texture parameters, as well as T-stage and clinical stage, were evaluated by a machine learning analysis. The diagnostic ability of T-stage, clinical stage, and conventional FDG-PET parameters (SUVmax, SUVmean, MTV, and TLG) was also assessed separately. RESULTS In support-vector machine analysis of the training dataset, the final selected parameters were T-stage, SUVmax, TLG, morphological irregularity, entropy, and run-length non-uniformity. In the validation dataset, the diagnostic performance of the created algorithm was as follows: sensitivity 0.82, specificity 0.7, positive predictive value 0.86, negative predictive value 0.64, and accuracy 0.79. In a univariate analysis using conventional FDG-PET parameters, T-stage and clinical stage, diagnostic accuracy of each variable was revealed as follows: 0.61 in T-stage, 0.61 in clinical stage, 0.64 in SUVmax, 0.61 in SUVmean, 0.64 in MTV, and 0.7 in TLG. CONCLUSION A machine-learning-based approach to analysing FDG-PET images by multiparametric analysis might help predict local control or failure in patients with OCSCC.
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Affiliation(s)
- N Fujima
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, USA; Research Center for Cooperative Projects, Hokkaido University Graduate School of Medicine, Japan
| | - V C Andreu-Arasa
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, USA
| | - S K Meibom
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, USA
| | - G A Mercier
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, USA
| | - A R Salama
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, USA; Department of Oral & Maxillofacial Surgery, Boston Medical Center, Boston University Henry M. Goldman School of Dental Medicine, USA
| | - M T Truong
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, USA
| | - O Sakai
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, USA; Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, USA; Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, USA.
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8
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Shroff GS, Shroff S, Ahuja J, Truong MT, Vlahos I. Imaging spectrum of adverse events of immune checkpoint inhibitors. Clin Radiol 2020; 76:262-272. [PMID: 33375984 DOI: 10.1016/j.crad.2020.11.117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/20/2020] [Indexed: 12/16/2022]
Abstract
Immune checkpoint inhibitors (ICIs), a form of immunotherapy, are increasingly used for a variety of malignancies and have been linked to numerous treatment-related side effects known as immune-related adverse events (irAEs). IrAEs can affect multiple organ systems and are important to recognise in order to avoid misinterpretation as progressive tumour and to ensure appropriate management. In this pictorial review, we will briefly discuss radiological response criteria of immunotherapy and describe the imaging appearances of the wide spectrum of these ICI-associated toxicities.
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Affiliation(s)
- G S Shroff
- MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 1478, Houston, TX, 77030, USA.
| | - S Shroff
- Houston Methodist, 6560 Fannin St. Ste 802, Houston, TX, 77030, USA
| | - J Ahuja
- MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 1478, Houston, TX, 77030, USA
| | - M T Truong
- MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 1478, Houston, TX, 77030, USA
| | - I Vlahos
- MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 1478, Houston, TX, 77030, USA
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Kuno H, Garg N, Qureshi MM, Chapman MN, Li B, Meibom SK, Truong MT, Takumi K, Sakai O. CT Texture Analysis of Cervical Lymph Nodes on Contrast-Enhanced [ 18F] FDG-PET/CT Images to Differentiate Nodal Metastases from Reactive Lymphadenopathy in HIV-Positive Patients with Head and Neck Squamous Cell Carcinoma. AJNR Am J Neuroradiol 2019; 40:543-550. [PMID: 30792253 DOI: 10.3174/ajnr.a5974] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 01/05/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating nodal metastases from reactive adenopathy in HIV-infected patients with [18F] FDG-PET/CT can be challenging because lymph nodes in HIV-positive patients often show increased [18F] FDG uptake. The purpose of this study was to assess CT textural analysis characteristics of HIV-positive and HIV-negative lymph nodes on [18F] FDG-PET/CT to differentiate nodal metastases from disease-specific nodal reactivity. MATERIALS AND METHODS Nine HIV-positive patients with head and neck squamous cell carcinoma (7 men, 2 women; 29-62 years of age; median age, 48 years) with 22 lymph nodes (≥1 cm) who underwent contrast-enhanced CT with [18F] FDG-PET followed by pathologic evaluation of cervical lymph nodes were retrospectively reviewed. Twenty-six HIV-negative patients with head and neck squamous cell carcinoma with 61 lymph nodes were evaluated as a control group. Each lymph node was manually segmented, and an in-house-developed Matlab-based texture analysis program extracted 41 texture features from each segmented volume. A mixed linear regression model was used to compare the pathologically proved malignant lymph nodes with benign nodes in the 2 enrolled groups. RESULTS Thirteen (59%) lymph nodes in the HIV-positive group and 22 (36%) lymph nodes in the HIV-negative control group were confirmed as positive for metastases. There were 7 histogram features (P = .017-0.032), 3 gray-level co-occurrence features (P = .009-.025), and 9 gray-level run-length features (P < .001-.033) that demonstrated a significant difference in HIV-positive patients with either benign or malignant lymph nodes. CONCLUSIONS CT texture analysis may be useful as a noninvasive method of obtaining additional quantitative information to differentiate nodal metastases from disease-specific nodal reactivity in HIV-positive patients with head and neck squamous cell carcinoma.
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Affiliation(s)
- H Kuno
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.).,Department of Diagnostic Radiology (H.K.), National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - N Garg
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.)
| | - M M Qureshi
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.).,Radiation Oncology (M.M.Q., M.T.T., O.S.)
| | - M N Chapman
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.)
| | - B Li
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.)
| | - S K Meibom
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.)
| | - M T Truong
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.).,Radiation Oncology (M.M.Q., M.T.T., O.S.)
| | - K Takumi
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.).,Department of Radiology (K.T.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - O Sakai
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.) .,Radiation Oncology (M.M.Q., M.T.T., O.S.).,Otolaryngology-Head and Neck Surgery (O.S.), Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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Kuno H, Qureshi MM, Chapman MN, Li B, Andreu-Arasa VC, Onoue K, Truong MT, Sakai O. CT Texture Analysis Potentially Predicts Local Failure in Head and Neck Squamous Cell Carcinoma Treated with Chemoradiotherapy. AJNR Am J Neuroradiol 2017; 38:2334-2340. [PMID: 29025727 DOI: 10.3174/ajnr.a5407] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/16/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE The accurate prediction of prognosis and failure is crucial for optimizing treatment strategies for patients with cancer. The purpose of this study was to assess the performance of pretreatment CT texture analysis for the prediction of treatment failure in primary head and neck squamous cell carcinoma treated with chemoradiotherapy. MATERIALS AND METHODS This retrospective study included 62 patients diagnosed with primary head and neck squamous cell carcinoma who underwent contrast-enhanced CT examinations for staging, followed by chemoradiotherapy. CT texture features of the whole primary tumor were measured using an in-house developed Matlab-based texture analysis program. Histogram, gray-level co-occurrence matrix, gray-level run-length, gray-level gradient matrix, and Laws features were used for texture feature extraction. Receiver operating characteristic analysis was used to identify the optimal threshold of any significant texture parameter. We used multivariate Cox proportional hazards models to examine the association between the CT texture parameter and local failure, adjusting for age, sex, smoking, primary tumor stage, primary tumor volume, and human papillomavirus status. RESULTS Twenty-two patients (35.5%) developed local failure, and the remaining 40 (64.5%) showed local control. Multivariate analysis revealed that 3 histogram features (geometric mean [hazard ratio = 4.68, P = .026], harmonic mean [hazard ratio = 8.61, P = .004], and fourth moment [hazard ratio = 4.56, P = .048]) and 4 gray-level run-length features (short-run emphasis [hazard ratio = 3.75, P = .044], gray-level nonuniformity [hazard ratio = 5.72, P = .004], run-length nonuniformity [hazard ratio = 4.15, P = .043], and short-run low gray-level emphasis [hazard ratio = 5.94, P = .035]) were significant predictors of outcome after adjusting for clinical variables. CONCLUSIONS Independent primary tumor CT texture analysis parameters are associated with local failure in patients with head and neck squamous cell carcinoma treated with chemoradiotherapy.
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Affiliation(s)
- H Kuno
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.).,Department of Diagnostic Radiology (H.K.), National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - M M Qureshi
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.).,Radiation Oncology (M.M.Q., M.T.T., O.S.)
| | - M N Chapman
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.)
| | - B Li
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.)
| | - V C Andreu-Arasa
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.)
| | - K Onoue
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.)
| | - M T Truong
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.).,Radiation Oncology (M.M.Q., M.T.T., O.S.)
| | - O Sakai
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.) .,Radiation Oncology (M.M.Q., M.T.T., O.S.).,Otolaryngology-Head and Neck Surgery (O.S.), Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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Godoy MCB, Viswanathan C, Marchiori E, Truong MT, Benveniste MF, Rossi S, Marom EM. The reversed halo sign: update and differential diagnosis. Br J Radiol 2012; 85:1226-35. [PMID: 22553298 DOI: 10.1259/bjr/54532316] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The reversed halo sign is characterised by a central ground-glass opacity surrounded by denser air-space consolidation in the shape of a crescent or a ring. It was first described on high-resolution CT as being specific for cryptogenic organising pneumonia. Since then, the reversed halo sign has been reported in association with a wide range of pulmonary diseases, including invasive pulmonary fungal infections, paracoccidioidomycosis, pneumocystis pneumonia, tuberculosis, community-acquired pneumonia, lymphomatoid granulomatosis, Wegener granulomatosis, lipoid pneumonia and sarcoidosis. It is also seen in pulmonary neoplasms and infarction, and following radiation therapy and radiofrequency ablation of pulmonary malignancies. In this article, we present the spectrum of neoplastic and non-neoplastic diseases that may show the reversed halo sign and offer helpful clues for assisting in the differential diagnosis. By integrating the patient's clinical history with the presence of the reversed halo sign and other accompanying radiological findings, the radiologist should be able to narrow the differential diagnosis substantially, and may be able to provide a presumptive final diagnosis, which may obviate the need for biopsy in selected cases, especially in the immunosuppressed population.
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Affiliation(s)
- M C B Godoy
- Department of Diagnostic Radiology, University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA.
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Truong MT, Saito N, Ozonoff A, Wang J, Lee R, Qureshi MM, Jalisi S, Sakai O. Prediction of locoregional control in head and neck squamous cell carcinoma with serial CT perfusion during radiotherapy. AJNR Am J Neuroradiol 2011; 32:1195-201. [PMID: 21757530 DOI: 10.3174/ajnr.a2501] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [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: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Tumor hypoxia is a known factor of radioresistance in HNSCC. CTP is a noninvasive method of measuring tumor perfusion in vivo. The purpose of our study was to determine serial changes in tumor perfusion in HNSCC during a course of RT by using CTP and to correlate tumor perfusion measurements to LRC. MATERIALS AND METHODS A prospective study was performed in 15 patients with HNSCC receiving definitive RT who underwent serial CTP before RT; at weeks 2, 4, and 6 of RT; and 6 weeks after RT. The median follow-up was 28 months (range, 6-44 months). Thirteen patients achieved LRC, and 2 patients had LRF. Tumor perfusion parameters, including BF, BV, MTT, and CP, were obtained by using a deconvolution-based analysis. RESULTS Pretreatment tumor BF was significantly higher in patients who achieved LRC, 118.0 mL/100 g/min, compared with those with LRF, 53.4 mL/100 g/min (P = .004). Similarly, pretreatment CP was higher in patients with LRC, 16.6 mL/100 g/min, compared with those with LRF, 7.7 mL/100 g/min (P = .02). At week 2 of RT, tumor BF parameters showed a 27.5% increase versus an 18.1% decrease from pretreatment BF values (P = .046) in patients with LRC and LRF, respectively. A decrease in BF and BV was observed in both groups 6 weeks after RT compared with these values at baseline scanning. CONCLUSIONS An increase in tumor BF and CP by using CTP early during a course of RT predicts LRC in patients with HNSCC treated with RT.
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Affiliation(s)
- M T Truong
- Departments of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
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Kim ES, Kies M, Sabichi A, Ginsberg L, Burke B, Holsinger C, Feng L, Truong MT, Glisson B, Hong WK. Phase II study of combination cisplatin, docetaxel and erlotinib in patients with metastatic/recurrent head and neck squamous cell carcinoma (HNSCC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5546] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - M. Kies
- MD Anderson Cancer Ctr, Houston, TX
| | | | | | - B. Burke
- MD Anderson Cancer Ctr, Houston, TX
| | | | - L. Feng
- MD Anderson Cancer Ctr, Houston, TX
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Yang CH, Kies MS, Glisson B, Burke BJ, Ginsberg LE, Truong MT, Sugrue MM, Hong WK, Khuri FR, Kim ES. A phase II study of lonafarnib (SCH66336) in patients with chemo-refractory advanced head and neck squamous cell carcinoma (HNSCC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5565] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. H. Yang
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - M. S. Kies
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - B. Glisson
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - B. J. Burke
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - L. E. Ginsberg
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - M. T. Truong
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - M. M. Sugrue
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - W. K. Hong
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - F. R. Khuri
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - E. S. Kim
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
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Laronga C, Meric F, Truong MT, Mayfield C, Mansfield P. A treatment algorithm for pneumothoraces complicating central venous catheter insertion. Am J Surg 2000; 180:523-6; discussion 526-7. [PMID: 11182411 DOI: 10.1016/s0002-9610(00)00542-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [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: 11/23/2022]
Abstract
BACKGROUND We investigated the role of observation or insertion of a small French pigtail catheter with Heimlich valve as alternative management to a tube thoracostomy for iatrogenic pneumothorax complicating central venous catheter (CVC) insertion. METHODS A retrospective review of 9,637 consecutive patients who had had subclavian CVCs inserted on an outpatient basis identified 100 patients with pneumothoraces. Treatment consisted of (1) observation, (2) outpatient insertion of a Heimlich valve, or (3) inpatient tube thoracostomy. RESULTS The median pneumothorax size was 10% (range 1% to 100%). Fifty-eight patients had observation as initial treatment, and this strategy was successful in 35 (60%). Thirty-four patients were treated initially with Heimlich valves, and this strategy was successful in 29 (85%). Tube thoracostomy as initial therapy was successful in 7 (88%) of 8 patients. Patients in who initial treatment failed were treated with insertion of a Heimlich valve or tube thoracostomy. CONCLUSION In appropriately selected patients, pneumothorax after insertion of a subclavian CVC can be successfully managed in the outpatient setting with observation. Patients in whom observation fails can be treated with insertion of a Heimlich valve. Tube thoracostomy can be reserved for refractory PTX or emergent situations.
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Affiliation(s)
- C Laronga
- Department of Surgical Oncology, the University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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