Purpose: To develop a contrastive language-image pretraining (CLIP) model based on transfer learning and combined with self-attention mechanism to predict the tumor-stroma ratio (TSR) in pancreatic ductal adenocarcinoma on preoperative enhanced CT images, in order to understand the biological characteristics of tumors for risk stratification and guiding feature fusion during artificial intelligence-based model representation.
Material and methods: This retrospective study collected a total of 207 PDAC patients from three hospitals. TSR assessments were performed on surgical specimens by pathologists and divided into high TSR and low TSR groups. This study developed one novel CLIP-adapter model that integrates the CLIP paradigm with a self-attention mechanism for better utilizing features from multi-phase imaging, thereby enhancing the accuracy and reliability of tumor-stroma ratio predictions. Additionally, clinical variables, traditional radiomics model and deep learning models (ResNet50, ResNet101, ViT_Base_32, ViT_Base_16) were constructed for comparison.
Results: The models showed significant efficacy in predicting TSR in PDAC. The performance of the CLIP-adapter model based on multi-phase feature fusion was superior to that based on any single phase (arterial or venous phase). The CLIP-adapter model outperformed traditional radiomics models and deep learning models, with CLIP-adapter_ViT_Base_32 performing the best, achieving the highest AUC (0.978) and accuracy (0.921) in the test set. Kaplan-Meier survival analysis showed longer overall survival in patients with low TSR compared to those with high TSR.
Conclusion: The CLIP-adapter model designed in this study provides a safe and accurate method for predicting the TSR in PDAC. The feature fusion module based on multi-modal (image and text) and multi-phase (arterial and venous phase) significantly improves model performance.
目的:开发一种基于迁移学习并结合自我注意机制的对比语言-图像预训练(CLIP)模型,用于预测术前增强CT图像上胰腺导管腺癌的肿瘤-间质比(TSR),以了解肿瘤的生物学特征,从而进行风险分层,并在基于人工智能的模型表示过程中指导特征融合:这项回顾性研究共收集了三家医院的 207 例 PDAC 患者。病理学家对手术标本进行了 TSR 评估,并将其分为高 TSR 组和低 TSR 组。本研究开发了一种新型 CLIP 适配器模型,该模型将 CLIP 范式与自我注意机制相结合,能更好地利用多相成像的特征,从而提高肿瘤-基质比预测的准确性和可靠性。此外,还构建了临床变量、传统放射组学模型和深度学习模型(ResNet50、ResNet101、ViT_Base_32、ViT_Base_16)进行比较:结果:这些模型在预测PDAC的TSR方面显示出明显的功效。基于多相特征融合的 CLIP-adapter 模型的性能优于基于任何单相(动脉或静脉相)的模型。CLIP-adapter模型的表现优于传统的放射组学模型和深度学习模型,其中CLIP-adapter_ViT_Base_32表现最佳,在测试集中获得了最高的AUC(0.978)和准确率(0.921)。Kaplan-Meier生存分析显示,与高TSR患者相比,低TSR患者的总生存期更长:结论:本研究设计的 CLIP-adapter 模型为预测 PDAC 的 TSR 提供了一种安全、准确的方法。基于多模态(图像和文本)和多阶段(动脉和静脉阶段)的特征融合模块显著提高了模型的性能。
{"title":"One novel transfer learning-based CLIP model combined with self-attention mechanism for differentiating the tumor-stroma ratio in pancreatic ductal adenocarcinoma.","authors":"Hongfan Liao, Jiang Yuan, Chunhua Liu, Jiao Zhang, Yaying Yang, Hongwei Liang, Haotian Liu, Shanxiong Chen, Yongmei Li","doi":"10.1007/s11547-024-01902-y","DOIUrl":"10.1007/s11547-024-01902-y","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a contrastive language-image pretraining (CLIP) model based on transfer learning and combined with self-attention mechanism to predict the tumor-stroma ratio (TSR) in pancreatic ductal adenocarcinoma on preoperative enhanced CT images, in order to understand the biological characteristics of tumors for risk stratification and guiding feature fusion during artificial intelligence-based model representation.</p><p><strong>Material and methods: </strong>This retrospective study collected a total of 207 PDAC patients from three hospitals. TSR assessments were performed on surgical specimens by pathologists and divided into high TSR and low TSR groups. This study developed one novel CLIP-adapter model that integrates the CLIP paradigm with a self-attention mechanism for better utilizing features from multi-phase imaging, thereby enhancing the accuracy and reliability of tumor-stroma ratio predictions. Additionally, clinical variables, traditional radiomics model and deep learning models (ResNet50, ResNet101, ViT_Base_32, ViT_Base_16) were constructed for comparison.</p><p><strong>Results: </strong>The models showed significant efficacy in predicting TSR in PDAC. The performance of the CLIP-adapter model based on multi-phase feature fusion was superior to that based on any single phase (arterial or venous phase). The CLIP-adapter model outperformed traditional radiomics models and deep learning models, with CLIP-adapter_ViT_Base_32 performing the best, achieving the highest AUC (0.978) and accuracy (0.921) in the test set. Kaplan-Meier survival analysis showed longer overall survival in patients with low TSR compared to those with high TSR.</p><p><strong>Conclusion: </strong>The CLIP-adapter model designed in this study provides a safe and accurate method for predicting the TSR in PDAC. The feature fusion module based on multi-modal (image and text) and multi-phase (arterial and venous phase) significantly improves model performance.</p>","PeriodicalId":20817,"journal":{"name":"Radiologia Medica","volume":null,"pages":null},"PeriodicalIF":9.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correction: What the urologist needs to know before radical prostatectomy: MRI effective support to pre‑surgery planning.","authors":"Ludovica Laschena, Emanuele Messina, Rocco Simone Flammia, Antonella Borrelli, Simone Novelli, Daniela Messineo, Costantino Leonardo, Alessandro Sciarra, Antonio Ciardi, Carlo Catalano, Valeria Panebianco","doi":"10.1007/s11547-024-01887-8","DOIUrl":"10.1007/s11547-024-01887-8","url":null,"abstract":"","PeriodicalId":20817,"journal":{"name":"Radiologia Medica","volume":null,"pages":null},"PeriodicalIF":9.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-09-03DOI: 10.1007/s11547-024-01886-9
Seong Ho Park, Kyunghwa Han, June-Goo Lee
Artificial intelligence (AI) has numerous applications in radiology. Clinical research studies to evaluate the AI models are also diverse. Consequently, diverse outcome metrics and measures are employed in the clinical evaluation of AI, presenting a challenge for clinical radiologists. This review aims to provide conceptually intuitive explanations of the outcome metrics and measures that are most frequently used in clinical research, specifically tailored for clinicians. While we briefly discuss performance metrics for AI models in binary classification, detection, or segmentation tasks, our primary focus is on less frequently addressed topics in published literature. These include metrics and measures for evaluating multiclass classification; those for evaluating generative AI models, such as models used in image generation or modification and large language models; and outcome measures beyond performance metrics, including patient-centered outcome measures. Our explanations aim to guide clinicians in the appropriate use of these metrics and measures.
{"title":"Conceptual review of outcome metrics and measures used in clinical evaluation of artificial intelligence in radiology.","authors":"Seong Ho Park, Kyunghwa Han, June-Goo Lee","doi":"10.1007/s11547-024-01886-9","DOIUrl":"10.1007/s11547-024-01886-9","url":null,"abstract":"<p><p>Artificial intelligence (AI) has numerous applications in radiology. Clinical research studies to evaluate the AI models are also diverse. Consequently, diverse outcome metrics and measures are employed in the clinical evaluation of AI, presenting a challenge for clinical radiologists. This review aims to provide conceptually intuitive explanations of the outcome metrics and measures that are most frequently used in clinical research, specifically tailored for clinicians. While we briefly discuss performance metrics for AI models in binary classification, detection, or segmentation tasks, our primary focus is on less frequently addressed topics in published literature. These include metrics and measures for evaluating multiclass classification; those for evaluating generative AI models, such as models used in image generation or modification and large language models; and outcome measures beyond performance metrics, including patient-centered outcome measures. Our explanations aim to guide clinicians in the appropriate use of these metrics and measures.</p>","PeriodicalId":20817,"journal":{"name":"Radiologia Medica","volume":null,"pages":null},"PeriodicalIF":9.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-10-14DOI: 10.1007/s11547-024-01890-z
Kun Huang, Haikuan Liu, Yanqin Wu, Wenzhe Fan, Yue Zhao, Miao Xue, Yiyang Tang, Shi-Ting Feng, Jiaping Li
Background: Due to heterogeneity of molecular biology and microenvironment, therapeutic efficacy varies among hepatocellular carcinoma (HCC) patients treated with transcatheter arterial chemoembolization (TACE) and tyrosine kinase inhibitors (TKIs). We examined combined models using clinicoradiological characteristics, mutational burden of signaling pathways, and radiomics features to predict survival prognosis.
Methods: Two cohorts comprising 111 patients with HCC were used to build prognostic models. The training and test cohorts included 78 and 33 individuals, respectively. Mutational burden was calculated based on 17 cancer-associated signaling pathways. Radiomic features were extracted and selected from computed tomography images using a pyradiomics system. Models based on clinicoradiological indicators, mutational burden, and radiomics score (rad-score) were built to predict overall survival (OS) and progression-free survival (PFS).
Results: Eastern Cooperative Oncology Group performance status, Child-Pugh class, peritumoral enhancement, PI3K_AKT and hypoxia mutational burden, and rad-score were used to create a combined model predicting OS. C-indices were 0.805 (training cohort) and 0.768 (test cohort). The areas under the curve (AUCs) were 0.889, 0.900, and 0.917 for 1-year, 2-year, and 3-year OS, respectively. To predict PFS, alpha-fetoprotein level, tumor enhancement pattern, hypoxia and receptor tyrosine kinase mutational burden, and rad-score were used. C-indices were 0.782 (training cohort) and 0.766 (test cohort). AUCs were 0.885 and 0.925 for 6-month and 12-month PFS, respectively. Calibration and decision curve analyses supported the model's accuracy and clinical potential.
Conclusions: The nomogram models are hopeful to predict OS and PFS in patients with intermediate-advanced HCC treated with TACE plus TKIs, offering a promising tool for treatment decisions and monitoring patient progress.
{"title":"Development and validation of survival prediction models for patients with hepatocellular carcinoma treated with transcatheter arterial chemoembolization plus tyrosine kinase inhibitors.","authors":"Kun Huang, Haikuan Liu, Yanqin Wu, Wenzhe Fan, Yue Zhao, Miao Xue, Yiyang Tang, Shi-Ting Feng, Jiaping Li","doi":"10.1007/s11547-024-01890-z","DOIUrl":"10.1007/s11547-024-01890-z","url":null,"abstract":"<p><strong>Background: </strong>Due to heterogeneity of molecular biology and microenvironment, therapeutic efficacy varies among hepatocellular carcinoma (HCC) patients treated with transcatheter arterial chemoembolization (TACE) and tyrosine kinase inhibitors (TKIs). We examined combined models using clinicoradiological characteristics, mutational burden of signaling pathways, and radiomics features to predict survival prognosis.</p><p><strong>Methods: </strong>Two cohorts comprising 111 patients with HCC were used to build prognostic models. The training and test cohorts included 78 and 33 individuals, respectively. Mutational burden was calculated based on 17 cancer-associated signaling pathways. Radiomic features were extracted and selected from computed tomography images using a pyradiomics system. Models based on clinicoradiological indicators, mutational burden, and radiomics score (rad-score) were built to predict overall survival (OS) and progression-free survival (PFS).</p><p><strong>Results: </strong>Eastern Cooperative Oncology Group performance status, Child-Pugh class, peritumoral enhancement, PI3K_AKT and hypoxia mutational burden, and rad-score were used to create a combined model predicting OS. C-indices were 0.805 (training cohort) and 0.768 (test cohort). The areas under the curve (AUCs) were 0.889, 0.900, and 0.917 for 1-year, 2-year, and 3-year OS, respectively. To predict PFS, alpha-fetoprotein level, tumor enhancement pattern, hypoxia and receptor tyrosine kinase mutational burden, and rad-score were used. C-indices were 0.782 (training cohort) and 0.766 (test cohort). AUCs were 0.885 and 0.925 for 6-month and 12-month PFS, respectively. Calibration and decision curve analyses supported the model's accuracy and clinical potential.</p><p><strong>Conclusions: </strong>The nomogram models are hopeful to predict OS and PFS in patients with intermediate-advanced HCC treated with TACE plus TKIs, offering a promising tool for treatment decisions and monitoring patient progress.</p>","PeriodicalId":20817,"journal":{"name":"Radiologia Medica","volume":null,"pages":null},"PeriodicalIF":9.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-10-13DOI: 10.1007/s11547-024-01891-y
Antonio Piras, Ilaria Morelli, Riccardo Ray Colciago, Luca Boldrini, Andrea D'Aviero, Francesca De Felice, Roberta Grassi, Giuseppe Carlo Iorio, Silvia Longo, Federico Mastroleo, Isacco Desideri, Viola Salvestrini
Purpose: Recently, the availability of online medical resources for radiation oncologists and trainees has significantly expanded, alongside the development of numerous artificial intelligence (AI)-based tools. This review evaluates the impact of web-based clinical decision-making tools in the clinical practice of radiation oncology.
Material and methods: We searched databases, including PubMed, EMBASE, and Scopus, using keywords related to web-based clinical decision-making tools and radiation oncology, adhering to PRISMA guidelines.
Results: Out of 2161 identified manuscripts, 70 were ultimately included in our study. These papers all supported the evidence that web-based tools can be transversally integrated into multiple radiation oncology fields, with online applications available for dose and clinical calculations, staging and other multipurpose intents. Specifically, the possible benefit of web-based nomograms for educational purposes was investigated in 35 of the evaluated manuscripts. As regards to the applications of digital and AI-based tools to treatment planning, diagnosis, treatment strategy selection and follow-up adoption, a total of 35 articles were selected. More specifically, 19 articles investigated the role of these tools in heterogeneous cancer types, while nine and seven articles were related to breast and head & neck cancers, respectively.
Conclusions: Our analysis suggests that employing web-based and AI tools offers promising potential to enhance the personalization of cancer treatment.
{"title":"The continuous improvement of digital assistance in the radiation oncologist's work: from web-based nomograms to the adoption of large-language models (LLMs). A systematic review by the young group of the Italian association of radiotherapy and clinical oncology (AIRO).","authors":"Antonio Piras, Ilaria Morelli, Riccardo Ray Colciago, Luca Boldrini, Andrea D'Aviero, Francesca De Felice, Roberta Grassi, Giuseppe Carlo Iorio, Silvia Longo, Federico Mastroleo, Isacco Desideri, Viola Salvestrini","doi":"10.1007/s11547-024-01891-y","DOIUrl":"10.1007/s11547-024-01891-y","url":null,"abstract":"<p><strong>Purpose: </strong>Recently, the availability of online medical resources for radiation oncologists and trainees has significantly expanded, alongside the development of numerous artificial intelligence (AI)-based tools. This review evaluates the impact of web-based clinical decision-making tools in the clinical practice of radiation oncology.</p><p><strong>Material and methods: </strong>We searched databases, including PubMed, EMBASE, and Scopus, using keywords related to web-based clinical decision-making tools and radiation oncology, adhering to PRISMA guidelines.</p><p><strong>Results: </strong>Out of 2161 identified manuscripts, 70 were ultimately included in our study. These papers all supported the evidence that web-based tools can be transversally integrated into multiple radiation oncology fields, with online applications available for dose and clinical calculations, staging and other multipurpose intents. Specifically, the possible benefit of web-based nomograms for educational purposes was investigated in 35 of the evaluated manuscripts. As regards to the applications of digital and AI-based tools to treatment planning, diagnosis, treatment strategy selection and follow-up adoption, a total of 35 articles were selected. More specifically, 19 articles investigated the role of these tools in heterogeneous cancer types, while nine and seven articles were related to breast and head & neck cancers, respectively.</p><p><strong>Conclusions: </strong>Our analysis suggests that employing web-based and AI tools offers promising potential to enhance the personalization of cancer treatment.</p>","PeriodicalId":20817,"journal":{"name":"Radiologia Medica","volume":null,"pages":null},"PeriodicalIF":9.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-08-31DOI: 10.1007/s11547-024-01885-w
Valerio Nardone, Alessio Bruni, Davide Franceschini, Beatrice Marini, Stefano Vagge, Patrizia Ciammella, Matteo Sepulcri, Anna Cappelli, Elisa D'Angelo, Giuseppina De Marco, Antonio Angrisani, Mattia Manetta, Melissa Scricciolo, Cesare Guida, Dario Aiello, Paolo Borghetti, Salvatore Cappabianca
Background: Recently, the PORT-C and LUNG-ART trials, which evaluated the role of postoperative radiation therapy (PORT), have significantly altered the treatment landscape for NSCLC pN2 patients who previously underwent surgery. In response, the Italian Association of Radiotherapy and Oncology Thoracic Oncology study group has initiated an observational multicenter trial to assess both acute and late toxicities of PORT in pN2 NSCLC patients treated with modern techniques.
Methods: Data on NSCLC patients submitted to PORT after radical surgery treated between 2015 and 2020 in six Italian Centers were collected. Heart, lung, and esophageal acute and late toxicities have been retrospectively analyzed and related to radiation therapy dosimetric parameters. Furthermore, loco-regional control, distant metastasis and overall survival have been analyzed.
Results: A total of 212 patients with a median age of 68 years from six different centers were included in this analysis (142 males and 70 females). Prior to undergoing PORT, 96 patients (45.8%) had a history of heart disease, 110 patients (51.9%) had hypertension, and 51 patients (24%) had COPD. Acute toxicity was observed in 147 patients (69.3%), with lung toxicity occurring in 93 patients (G1 in 70 patients, G2 in 17 patients, and G3 in 4 patients), esophageal toxicity in 114 patients (G1 in 89 patients, G2 in 23 patients, and G3 in 1 patient), and cardiac toxicity in 4 patients (G1 in 2 patients and G3 in 2 patients). Late side effects were found in 60 patients (28.3%), predominantly involving the lungs (51 patients: 32 G1, 11 G2, and 1 G3) and the esophagus (11 patients: 8 G1 and 3 G2), with no reported late cardiac side effects. Various clinical and dosimetric parameters were found to correlate with both acute and chronic toxicities. Over a median follow-up period of 54 months, 48 patients (22.6%) showed locoregional disease relapse, 106 patients (50%) developed distant metastases, and 66 patients (31.1%) died.
Conclusions: RAC-TAC retrospective multicentric study showed the low toxicity of PORT when advanced technology is used. At the same time, it's noteworthy to underline that 50% of the patients develop distant recurrences in the follow up.
{"title":"Adjuvant modern radiotherapy in resected pN2 NSCLC patients: results from a multicentre retrospective analysis on acute and late toxicity on behalf of AIRO thoracic oncology study group: the RAC-TAC study.","authors":"Valerio Nardone, Alessio Bruni, Davide Franceschini, Beatrice Marini, Stefano Vagge, Patrizia Ciammella, Matteo Sepulcri, Anna Cappelli, Elisa D'Angelo, Giuseppina De Marco, Antonio Angrisani, Mattia Manetta, Melissa Scricciolo, Cesare Guida, Dario Aiello, Paolo Borghetti, Salvatore Cappabianca","doi":"10.1007/s11547-024-01885-w","DOIUrl":"10.1007/s11547-024-01885-w","url":null,"abstract":"<p><strong>Background: </strong>Recently, the PORT-C and LUNG-ART trials, which evaluated the role of postoperative radiation therapy (PORT), have significantly altered the treatment landscape for NSCLC pN2 patients who previously underwent surgery. In response, the Italian Association of Radiotherapy and Oncology Thoracic Oncology study group has initiated an observational multicenter trial to assess both acute and late toxicities of PORT in pN2 NSCLC patients treated with modern techniques.</p><p><strong>Methods: </strong>Data on NSCLC patients submitted to PORT after radical surgery treated between 2015 and 2020 in six Italian Centers were collected. Heart, lung, and esophageal acute and late toxicities have been retrospectively analyzed and related to radiation therapy dosimetric parameters. Furthermore, loco-regional control, distant metastasis and overall survival have been analyzed.</p><p><strong>Results: </strong>A total of 212 patients with a median age of 68 years from six different centers were included in this analysis (142 males and 70 females). Prior to undergoing PORT, 96 patients (45.8%) had a history of heart disease, 110 patients (51.9%) had hypertension, and 51 patients (24%) had COPD. Acute toxicity was observed in 147 patients (69.3%), with lung toxicity occurring in 93 patients (G1 in 70 patients, G2 in 17 patients, and G3 in 4 patients), esophageal toxicity in 114 patients (G1 in 89 patients, G2 in 23 patients, and G3 in 1 patient), and cardiac toxicity in 4 patients (G1 in 2 patients and G3 in 2 patients). Late side effects were found in 60 patients (28.3%), predominantly involving the lungs (51 patients: 32 G1, 11 G2, and 1 G3) and the esophagus (11 patients: 8 G1 and 3 G2), with no reported late cardiac side effects. Various clinical and dosimetric parameters were found to correlate with both acute and chronic toxicities. Over a median follow-up period of 54 months, 48 patients (22.6%) showed locoregional disease relapse, 106 patients (50%) developed distant metastases, and 66 patients (31.1%) died.</p><p><strong>Conclusions: </strong>RAC-TAC retrospective multicentric study showed the low toxicity of PORT when advanced technology is used. At the same time, it's noteworthy to underline that 50% of the patients develop distant recurrences in the follow up.</p>","PeriodicalId":20817,"journal":{"name":"Radiologia Medica","volume":null,"pages":null},"PeriodicalIF":9.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142111384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-10-15DOI: 10.1007/s11547-024-01898-5
Tommaso D'Angelo, Giuseppe M Bucolo, Ibrahim Yel, Vitali Koch, Leon D Gruenewald, Simon S Martin, Leona S Alizadeh, Thomas J Vogl, Giorgio Ascenti, Ludovica R M Lanzafame, Silvio Mazziotti, Alfredo Blandino, Christian Booz
Purpose: To evaluate the diagnostic accuracy of dual-energy CT (DECT) iodine maps in comparison to conventional CT series for the assessment of non-occlusive mesenteric ischemia (NOMI).
Material and methods: We evaluated data from 142 patients (72 men; 50.7%) who underwent DECT between 2018 and 2022, with surgically confirmed diagnosis of NOMI. One board-certified radiologist performed region of interest (ROI) measurements in bowel segments on late arterial (LA) and portal venous (PV) phase DECT iodine maps as well as LA conventional series, in both ischemic and non-ischemic bowel loops, using surgical reports as reference standard, and in a control group of 97 patients. Intra- and inter-reader agreement with a second board-certified radiologist was also evaluated. Receiver operating characteristic (ROC) curve analysis was performed to calculate the optimal threshold for discriminating ischemic from non-ischemic bowel segments. Subjective image rating of LA and PV iodine maps was performed.
Results: DECT-based iodine concentration (IC) measurements showed significant differences in LA phase iodine maps between ischemic (median:0.72; IQR 0.52-0.91 mg/mL) and non-ischemic bowel loops (5.16; IQR 3.45-6.31 mg/ml) (P <.0001). IC quantification on LA phase revealed an AUC of 0.966 for the assessment of acute bowel ischemia, significantly higher compared to both IC quantification based on PV phase (0.951) and attenuation values evaluated on LA conventional CT series (0.828). Excellent intra-observer and strong inter-observer agreements were observed for the quantification of iodine concentration. Conversely, weak inter-observer agreement was noted for conventional HU assessments. The optimal LA phase-based IC threshold for assessing bowel ischemia was 1.34 mg/mL, yielding a sensitivity of 100% and specificity of 96.48%.
Conclusion: Iodine maps based on LA phase significantly improve the diagnostic accuracy for the assessment of NOMI compared to conventional CT series and PV phase iodine maps.
目的:评估双能 CT(DECT)碘图与传统 CT 系列在评估非闭塞性肠系膜缺血(NOMI)方面的诊断准确性:我们评估了2018年至2022年期间接受DECT检查、经手术确诊为NOMI的142名患者(72名男性;50.7%)的数据。一名经委员会认证的放射科医生以手术报告为参考标准,在缺血和非缺血肠襻的晚期动脉(LA)和门静脉(PV)相DECT碘图以及LA常规系列上对肠段进行了感兴趣区(ROI)测量,并对97名患者组成的对照组进行了测量。此外,还评估了与第二位经委员会认证的放射科医生的读片者内部和读片者之间的一致性。进行了接收者操作特征(ROC)曲线分析,以计算出区分缺血和非缺血肠段的最佳阈值。对 LA 和 PV 碘图进行了主观图像评级:结果:基于 DECT 的碘浓度(IC)测量显示,缺血肠段(中位数:0.72;IQR 0.52-0.91 mg/mL)和非缺血肠段(5.16;IQR 3.45-6.31 mg/ml)的 LA 相碘图存在显著差异(P 结论:缺血肠段和非缺血肠段的 LA 相碘图之间存在显著差异:与传统的 CT 系列和 PV 相碘图相比,基于 LA 相的碘图可显著提高评估 NOMI 的诊断准确性。
{"title":"Dual-energy CT late arterial phase iodine maps for the diagnosis of acute non-occlusive mesenteric ischemia.","authors":"Tommaso D'Angelo, Giuseppe M Bucolo, Ibrahim Yel, Vitali Koch, Leon D Gruenewald, Simon S Martin, Leona S Alizadeh, Thomas J Vogl, Giorgio Ascenti, Ludovica R M Lanzafame, Silvio Mazziotti, Alfredo Blandino, Christian Booz","doi":"10.1007/s11547-024-01898-5","DOIUrl":"10.1007/s11547-024-01898-5","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the diagnostic accuracy of dual-energy CT (DECT) iodine maps in comparison to conventional CT series for the assessment of non-occlusive mesenteric ischemia (NOMI).</p><p><strong>Material and methods: </strong>We evaluated data from 142 patients (72 men; 50.7%) who underwent DECT between 2018 and 2022, with surgically confirmed diagnosis of NOMI. One board-certified radiologist performed region of interest (ROI) measurements in bowel segments on late arterial (LA) and portal venous (PV) phase DECT iodine maps as well as LA conventional series, in both ischemic and non-ischemic bowel loops, using surgical reports as reference standard, and in a control group of 97 patients. Intra- and inter-reader agreement with a second board-certified radiologist was also evaluated. Receiver operating characteristic (ROC) curve analysis was performed to calculate the optimal threshold for discriminating ischemic from non-ischemic bowel segments. Subjective image rating of LA and PV iodine maps was performed.</p><p><strong>Results: </strong>DECT-based iodine concentration (IC) measurements showed significant differences in LA phase iodine maps between ischemic (median:0.72; IQR 0.52-0.91 mg/mL) and non-ischemic bowel loops (5.16; IQR 3.45-6.31 mg/ml) (P <.0001). IC quantification on LA phase revealed an AUC of 0.966 for the assessment of acute bowel ischemia, significantly higher compared to both IC quantification based on PV phase (0.951) and attenuation values evaluated on LA conventional CT series (0.828). Excellent intra-observer and strong inter-observer agreements were observed for the quantification of iodine concentration. Conversely, weak inter-observer agreement was noted for conventional HU assessments. The optimal LA phase-based IC threshold for assessing bowel ischemia was 1.34 mg/mL, yielding a sensitivity of 100% and specificity of 96.48%.</p><p><strong>Conclusion: </strong>Iodine maps based on LA phase significantly improve the diagnostic accuracy for the assessment of NOMI compared to conventional CT series and PV phase iodine maps.</p>","PeriodicalId":20817,"journal":{"name":"Radiologia Medica","volume":null,"pages":null},"PeriodicalIF":9.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-10-01DOI: 10.1007/s11547-024-01892-x
Mauro Loi, Marcel Verheij, Joost Nuyttens, Marta Scorsetti, Lorenzo Livi, Maria A Hawkins, Florence Huguet
Patients affected by resectable locally advanced gastric cancer (GC) should receive perioperative chemotherapy as a standard of care. However, an additional benefit of adjuvant chemoradiation (CRT) has been negated by modern trials in the era of extended surgical dissection, and CRT is currently only considered on an individual basis in case of suboptimal resection. However, the dismal prognosis of GC and the modest treatment completion rates of perioperative chemotherapy have pushed to reconsider CRT, particularly as a preoperative treatment, in light of modern treatment techniques, advances in the understanding of the immune landscape and development of targeted agents. The aim of this review is to critically assess the historical role of CRT, the limitations of current evidence and to debate its potential role in an integrated neoadjuvant strategy for patients with resectable GC.
{"title":"From twilight to starlight? Debating the role of chemoradiotherapy in gastric cancer in the D2 dissection era.","authors":"Mauro Loi, Marcel Verheij, Joost Nuyttens, Marta Scorsetti, Lorenzo Livi, Maria A Hawkins, Florence Huguet","doi":"10.1007/s11547-024-01892-x","DOIUrl":"10.1007/s11547-024-01892-x","url":null,"abstract":"<p><p>Patients affected by resectable locally advanced gastric cancer (GC) should receive perioperative chemotherapy as a standard of care. However, an additional benefit of adjuvant chemoradiation (CRT) has been negated by modern trials in the era of extended surgical dissection, and CRT is currently only considered on an individual basis in case of suboptimal resection. However, the dismal prognosis of GC and the modest treatment completion rates of perioperative chemotherapy have pushed to reconsider CRT, particularly as a preoperative treatment, in light of modern treatment techniques, advances in the understanding of the immune landscape and development of targeted agents. The aim of this review is to critically assess the historical role of CRT, the limitations of current evidence and to debate its potential role in an integrated neoadjuvant strategy for patients with resectable GC.</p>","PeriodicalId":20817,"journal":{"name":"Radiologia Medica","volume":null,"pages":null},"PeriodicalIF":9.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1007/s11547-024-01903-x
Zhuolin Jiang, Shijun Jia, Jie Zhang, Chun Liu, Xinyi Luo, Yixin Tang, Guonan Zhang, Yi Zhu
Purpose: To assess the diagnostic performance and inter-observer agreement of a PREoperative sarcoma scoring based on ultrasound (PRESS-US) in differentiating uterine leiomyosarcoma (uLMS) from leiomyoma (LM).
Methods: We conducted a retrospective evaluation of patients who underwent surgery and received standardized ultrasound examinations due to the presence of uterine myoma-like masses. Histological diagnosis was used as the reference standard. The masses were analyzed using morphological uterus sonographic assessment criteria, and the diagnostic accuracy of PRESS-US was evaluated using ROC curve analysis. Kappa (κ) statistics were used to assess the inter-observer agreement between a less experienced and an expert radiologist.
Results: Among the 646 patients, 632 (97.8%) were diagnosed with LM, and 14 (2.2%) had uLMS. The malignancy rates for low-risk and high-risk patients were 0.35% and 13.48%, respectively. The optimal PRESS-US cutoff was 17.5, resulting in an AUC of 89.7% (95% CI, 0.79-1.00), with a sensitivity of 85.7% and a specificity of 87.8%. The inter-observer agreement between a less experienced and an expert radiologist was excellent (κ = 0.811, P < 0.001).
Conclusions: PRESS-US provides effective risk stratification for uLMS for radiologists with different levels of experience, with high reliability. Subgrouping high-risk patients helps in better risk stratification.
{"title":"Preoperative identification from occult leiomyosarcomas in laparoscopic hysterectomy and laparoscopic myomectomy: accuracy of the ultrasound scoring system (PRESS-US).","authors":"Zhuolin Jiang, Shijun Jia, Jie Zhang, Chun Liu, Xinyi Luo, Yixin Tang, Guonan Zhang, Yi Zhu","doi":"10.1007/s11547-024-01903-x","DOIUrl":"https://doi.org/10.1007/s11547-024-01903-x","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the diagnostic performance and inter-observer agreement of a PREoperative sarcoma scoring based on ultrasound (PRESS-US) in differentiating uterine leiomyosarcoma (uLMS) from leiomyoma (LM).</p><p><strong>Methods: </strong>We conducted a retrospective evaluation of patients who underwent surgery and received standardized ultrasound examinations due to the presence of uterine myoma-like masses. Histological diagnosis was used as the reference standard. The masses were analyzed using morphological uterus sonographic assessment criteria, and the diagnostic accuracy of PRESS-US was evaluated using ROC curve analysis. Kappa (κ) statistics were used to assess the inter-observer agreement between a less experienced and an expert radiologist.</p><p><strong>Results: </strong>Among the 646 patients, 632 (97.8%) were diagnosed with LM, and 14 (2.2%) had uLMS. The malignancy rates for low-risk and high-risk patients were 0.35% and 13.48%, respectively. The optimal PRESS-US cutoff was 17.5, resulting in an AUC of 89.7% (95% CI, 0.79-1.00), with a sensitivity of 85.7% and a specificity of 87.8%. The inter-observer agreement between a less experienced and an expert radiologist was excellent (κ = 0.811, P < 0.001).</p><p><strong>Conclusions: </strong>PRESS-US provides effective risk stratification for uLMS for radiologists with different levels of experience, with high reliability. Subgrouping high-risk patients helps in better risk stratification.</p>","PeriodicalId":20817,"journal":{"name":"Radiologia Medica","volume":null,"pages":null},"PeriodicalIF":9.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1007/s11547-024-01908-6
Lara Tondi, Stefano Figliozzi, Sara Boveri, Francesco Sturla, Giulia Pasqualin, Antonia Camporeale, Giandomenico Disabato, Andrea Attanasio, Gianpaolo Carrafiello, Pietro Spagnolo, Massimo Lombardi
Background: Cardiovascular magnetic resonance (CMR) is the gold-standard to estimate right ventricular (RV) volumes, which are key for clinical management of patients with repaired tetralogy of Fallot (rTOF). Semi-automated threshold-based methods (SAT) have been proposed for CMR post-processing as alternatives to fully manual standard tracing. We investigated the impact of SAT on RV analysis using different thresholds in rTOF patients.
Methods: RV volumes and mass were estimated using SAT and standard fully manual tracing methods in rTOF patients. Two threshold levels were set for SAT, i.e., default 50 (SAT-50) and 30 (SAT-30). RV stroke volumes (SV) were compared to main pulmonary artery forward flow (MPA-FF). Post-processing time, intra- and interobserver variabilities were compared across methods.
Results: Sixty-two CMRs of rTOF patients were analyzed. Compared to the standard fully manual tracing, no significant differences in RV mass, volumes and ejection fraction were observed using SAT-30, whereas SAT-50 significantly underestimated RV end-diastolic-volume index (EDVi) by 10.4% (mean difference of - 11.8 ± 6.2 ml/m2, p 0.03) and overestimated RV mass index by 21.8% (mean difference of 14.2 ± 11.9 g/m2, p 0.002). Compared to MPA-FF, RVSV by standard fully manual method and SAT-30 showed minor biases, respectively, 0.03 ml/m2 and 0.7 ml/m2, while SAT-50 underestimated RVSV by 6.86 ml/m2 (p < 0.001). In six patients, the degree of RV EDVi underestimation by SAT-50 determined a change of category from dilated to non-dilated RV. Intra- and interobserver variabilities were good to excellent for all methods. Post-processing duration was shorter for SAT compared to standard manual segmentation (5.5 ± 1.7 min vs. 19.5 ± 4.4 min, p < 0.001).
Conclusion: CMR SAT-30 post-processing is a precise, accurate and time-saving method for biventricular assessment of volumes, ejection fraction and mass in rTOF.
{"title":"Cardiovascular magnetic resonance semi-automated threshold-based post-processing of right ventricular volumes in repaired tetralogy of Fallot.","authors":"Lara Tondi, Stefano Figliozzi, Sara Boveri, Francesco Sturla, Giulia Pasqualin, Antonia Camporeale, Giandomenico Disabato, Andrea Attanasio, Gianpaolo Carrafiello, Pietro Spagnolo, Massimo Lombardi","doi":"10.1007/s11547-024-01908-6","DOIUrl":"https://doi.org/10.1007/s11547-024-01908-6","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular magnetic resonance (CMR) is the gold-standard to estimate right ventricular (RV) volumes, which are key for clinical management of patients with repaired tetralogy of Fallot (rTOF). Semi-automated threshold-based methods (SAT) have been proposed for CMR post-processing as alternatives to fully manual standard tracing. We investigated the impact of SAT on RV analysis using different thresholds in rTOF patients.</p><p><strong>Methods: </strong>RV volumes and mass were estimated using SAT and standard fully manual tracing methods in rTOF patients. Two threshold levels were set for SAT, i.e., default 50 (SAT-50) and 30 (SAT-30). RV stroke volumes (SV) were compared to main pulmonary artery forward flow (MPA-FF). Post-processing time, intra- and interobserver variabilities were compared across methods.</p><p><strong>Results: </strong>Sixty-two CMRs of rTOF patients were analyzed. Compared to the standard fully manual tracing, no significant differences in RV mass, volumes and ejection fraction were observed using SAT-30, whereas SAT-50 significantly underestimated RV end-diastolic-volume index (EDVi) by 10.4% (mean difference of - 11.8 ± 6.2 ml/m<sup>2</sup>, p 0.03) and overestimated RV mass index by 21.8% (mean difference of 14.2 ± 11.9 g/m<sup>2</sup>, p 0.002). Compared to MPA-FF, RVSV by standard fully manual method and SAT-30 showed minor biases, respectively, 0.03 ml/m<sup>2</sup> and 0.7 ml/m<sup>2</sup>, while SAT-50 underestimated RVSV by 6.86 ml/m<sup>2</sup> (p < 0.001). In six patients, the degree of RV EDVi underestimation by SAT-50 determined a change of category from dilated to non-dilated RV. Intra- and interobserver variabilities were good to excellent for all methods. Post-processing duration was shorter for SAT compared to standard manual segmentation (5.5 ± 1.7 min vs. 19.5 ± 4.4 min, p < 0.001).</p><p><strong>Conclusion: </strong>CMR SAT-30 post-processing is a precise, accurate and time-saving method for biventricular assessment of volumes, ejection fraction and mass in rTOF.</p>","PeriodicalId":20817,"journal":{"name":"Radiologia Medica","volume":null,"pages":null},"PeriodicalIF":9.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}