Exploration of PET and MRI radiomic features for decoding breast cancer phenotypes and prognosis.

Radiomics is an emerging technology for imaging biomarker discovery and disease-specific personalized treatment management. This paper aims to determine the benefit of using multi-modality radiomics data from PET and MR images in the characterization breast cancer phenotype and prognosis. Eighty-four features were extracted from PET and MR images of 113 breast cancer patients. Unsupervised clustering based on PET and MRI radiomic features created three subgroups. These derived subgroups were statistically significantly associated with tumor grade (p = 2.0 × 10-6), tumor overall stage (p = 0.037), breast cancer subtypes (p = 0.0085), and disease recurrence status (p = 0.0053). The PET-derived first-order statistics and gray level co-occurrence matrix (GLCM) textural features were discriminative of breast cancer tumor grade, which was confirmed by the results of L2-regularization logistic regression (with repeated nested cross-validation) with an estimated area under the receiver operating characteristic curve (AUC) of 0.76 (95% confidence interval (CI) = [0.62, 0.83]). The results of ElasticNet logistic regression indicated that PET and MR radiomics distinguished recurrence-free survival, with a mean AUC of 0.75 (95% CI = [0.62, 0.88]) and 0.68 (95% CI = [0.58, 0.81]) for 1 and 2 years, respectively. The MRI-derived GLCM inverse difference moment normalized (IDMN) and the PET-derived GLCM cluster prominence were among the key features in the predictive models for recurrence-free survival. In conclusion, radiomic features from PET and MR images could be helpful in deciphering breast cancer phenotypes and may have potential as imaging biomarkers for prediction of breast cancer recurrence-free survival

PET-Derived Radiomics and Artificial Intelligence in Breast Cancer: A Systematic Review

Breast cancer (BC) is a heterogeneous malignancy that still represents the second cause of cancer-related death among women worldwide. Due to the heterogeneity of BC, the correct identification of valuable biomarkers able to predict tumor biology and the best treatment approaches are still far from clear. Although molecular imaging with positron emission tomography/computed tomography (PET/CT) has improved the characterization of BC, these methods are not free from drawbacks. In recent years, radiomics and artificial intelligence (AI) have been playing an important role in the detection of several features normally unseen by the human eye in medical images. The present review provides a summary of the current status of radiomics and AI in different clinical settings of BC. A systematic search of PubMed, Web of Science and Scopus was conducted, including all articles published in English that explored radiomics and AI analyses of PET/CT images in BC. Several studies have demonstrated the potential role of such new features for the staging and prognosis as well as the assessment of biological characteristics. Radiomics and AI features appear to be promising in different clinical settings of BC, although larger prospective trials are needed to confirm and to standardize this evidence

Heterogeneidad tumoral en imágenes PET-CT

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Ciencias Físicas, Departamento de Estructura de la Materia, Física Térmica y Electrónica, leída el 28/01/2021Cancer is a leading cause of morbidity and mortality [1]. The most frequent cancers worldwide are non–small cell lung carcinoma (NSCLC) and breast cancer [2], being their management a challenging task [3]. Tumor diagnosis is usually made through biopsy [4]. However, medical imaging also plays an important role in diagnosis, staging, response to treatment, and recurrence assessment [5]. Tumor heterogeneity is recognized to be involved in cancer treatment failure, with worse clinical outcomes for highly heterogeneous tumors [6,7]. This leads to the existence of tumor sub-regions with different biological behavior (some more aggressive and treatment-resistant than others) [8-10]. Which are characterized by a different pattern of vascularization, vessel permeability, metabolism, cell proliferation, cell death, and other features, that can be measured by modern medical imaging techniques, including positron emission tomography/computed tomography (PET/CT) [10-12]. Thus, the assessment of tumor heterogeneity through medical images could allow the prediction of therapy response and long-term outcomes of patients with cancer [13]. PET/CT has become essential in oncology [14,15] and is usually evaluated through semiquantitative metabolic parameters, such as maximum/mean standard uptake value (SUVmax, SUVmean) or metabolic tumor volume (MTV), which are valuables as prognostic image-based biomarkers in several tumors [16-17], but these do not assess tumor heterogeneity. Likewise, fluorodeoxyglucose (18F-FDG) PET/CT is important to differentiate malignant from benign solitary pulmonary nodules (SPN), reducing so the number of patients who undergo unnecessary surgical biopsies. Several publications have shown that some quantitative image features, extracted from medical images, are suitable for diagnosis, tumor staging, the prognosis of treatment response, and long-term evolution of cancer patients [18-20]. The process of extracting and relating image features with clinical or biological variables is called “Radiomics” [9,20-24]. Radiomic parameters, such as textural features have been related directly to tumor heterogeneity [25]. This thesis investigated the relationships of the tumor heterogeneity, assessed by 18F-FDG-PET/CT texture analysis, with metabolic parameters and pathologic staging in patients with NSCLC, and explored the diagnostic performance of different metabolic, morphologic, and clinical criteria for classifying (malignant or not) of solitary pulmonary nodules (SPN). Furthermore, 18F-FDG-PET/CT radiomic features of patients with recurrent/metastatic breast cancer were used for constructing predictive models of response to the chemotherapy, based on an optimal combination of several feature selection and machine learning (ML) methods...El cáncer es una de las principales causas de morbilidad y mortalidad. Los más frecuentes son el carcinoma de pulmón de células no pequeñas (NSCLC) y el cáncer de mama, siendo su tratamiento un reto. El diagnóstico se suele realizar mediante biopsia. La heterogeneidad tumoral (HT) está implicada en el fracaso del tratamiento del cáncer, con peores resultados clínicos para tumores muy heterogéneos. Esta conduce a la existencia de subregiones tumorales con diferente comportamiento biológico (algunas más agresivas y resistentes al tratamiento); las cuales se caracterizan por diferentes patrones de vascularización, permeabilidad de los vasos sanguíneos, metabolismo, proliferación y muerte celular, que se pueden medir mediante imágenes médicas, incluida la tomografía por emisión de positrones/tomografía computarizada con fluorodesoxiglucosa (18F-FDG-PET/CT). La evaluación de la HT a través de imágenes médicas, podría mejorar la predicción de la respuesta al tratamiento y de los resultados a largo plazo, en pacientes con cáncer. La 18F-FDG-PET/CT es esencial en oncología, generalmente se evalúa con parámetros metabólicos semicuantitativos, como el valor de captación estándar máximo/medio (SUVmáx, SUVmedio) o el volumen tumoral metabólico (MTV), que tienen un gran valor pronóstico en varios tumores, pero no evalúan la HT. Asimismo, es importante para diferenciar los nódulos pulmonares solitarios (NPS) malignos de los benignos, reduciendo el número de pacientes que van a biopsias quirúrgicas innecesarias. Publicaciones recientes muestran que algunas características cuantitativas, extraídas de las imágenes médicas, son robustas para diagnóstico, estadificación, pronóstico de la respuesta al tratamiento y la evolución, de pacientes con cáncer. El proceso de extraer y relacionar estas características con variables clínicas o biológicas se denomina “Radiomica”. Algunos parámetros radiómicos, como la textura, se han relacionado directamente con la HT. Esta tesis investigó las relaciones entre HT, evaluada mediante análisis de textura (AT) de imágenes 18F-FDG-PET/CT, con parámetros metabólicos y estadificación patológica en pacientes con NSCLC, y exploró el rendimiento diagnóstico de diferentes criterios metabólicos, morfológicos y clínicos para la clasificación de NPS. Además, se usaron características radiómicas de imágenes 18F-FDG-PET/CT de pacientes con cáncer de mama recurrente/metastásico, para construir modelos predictivos de la respuesta a la quimioterapia, combinándose varios métodos de selección de características y aprendizaje automático (ML)...Fac. de Ciencias FísicasTRUEunpu

A new challenge in Radiology: Radiomics in breast cancer diagnostics

Breast cancer is one of the most common and widespread cancers that women can have. In order to prevent the occurrence of cancer, it is important to perform a preventive examination, which includes ultrasound and mammography. Radiology as a branch of medicine has seen rapid development in recent decades thanks to the development of technology, and artificial intelligence is increasingly used in radiology. Radiomics is a new method of radiological image processing that uses software programs to analyse tissue during diagnostic imaging. It is a combination of multiple imaging modalities with the aim of highlighting pathological formations that are not visible to the naked eye or are less significant. The aim of the paper is to introduce to the readers with radiomics and to explain in more detail how it works, and how it was integrated into certain radiological diagnostics and greatly facilitated the image processing process and the diagnosis of breast cancer. Many studies have confirmed that radiomics is a method with numerous advantages, but like any new field, it has its drawbacks. The main limitation is the computer system, which must be standardised so that radiomic data processing can be used in all institutions and so that these institutions can exchange information with each other without difficulty. The problem is also false positive findings, which greatly increase the costs of institutions and the time it takes for patients to reach a diagnosis. The solution to these allegations is the development of new computer algorithms and an increase in the sensitivity of computer detection of lesions. Radiomics will certainly play an important role in diagnostics and image analysis over a period of time. Given that artificial intelligence is still in the process of development, radiomics may not have an independent application, but it will certainly make the work of doctors easier in the analysis of radiological images

Computational Imaging Biomarkers For Precision Medicine: Characterizing Heterogeneity In Breast Cancer

In the United States, 1 in 8 women are diagnosed with breast cancer. Breast tumor heterogeneity is well-established, with intratumor heterogeneity manifesting spatially and temporally. Increased heterogeneity is associated with adverse clinical outcomes. Current critical disease treatment decisions are made on the basis of biomarkers acquired from tissue samples, largely under sampling the heterogeneous disease burden. In order to drive precision medicine treatment strategies for cancer, personalized biomarkers are needed to truly characterize intratumor heterogeneity. Medical imaging can provide anon-invasive, whole tumor sampling of disease burden at the time of diagnosis and allows for longitudinal monitoring of disease progression. The studies outlined in this thesis introduce analytical tools developed through computer vision, bioinformatics, and machine learning and use diagnostic and longitudinal clinical images of breast cancer to develop computational imaging biomarkers characterizing intratumor heterogeneity. Intrinsic imaging phenotypes of spatial heterogeneity, identified in dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) images at the time of diagnosis, were identified and validated, demonstrating improved prognostic value over conventional histopathologic biomarkers when predicting 10-year recurrence free survival. Intrinsic phenotypes of longitudinal change in spatial heterogeneity in response to neoadjuvant treatment, identified in DCE-MRI were identified and leveraged as prognostic and predictive biomarkers, demonstrating augmented prognostic value when added to conventional histopathologic and personalized molecular biomarkers. To better characterize 4-D spatial and temporal heterogeneity, illuminated through dynamic positron emission tomography imaging, a novel 4-D segmentation algorithm was developed to identify spatially constrained, functionally discrete intratumor sub-regions. Quantifying the identified sub-regions through a novel imaging signature demonstrated the prognostic value of characterizing intratumor heterogeneity when predicting recurrence free survival, demonstrating prognostic improvement over established histopathologic biomarkers and conventional kinetic model derived parameters. Collectively, the studies in this thesis demonstrate the value of leveraging computational imaging biomarkers to characterize intratumor heterogeneity. Such biomarkers have the potential to be utilized towards precision medicine for cancer care

Radiomics and imaging genomics in precision medicine

“Radiomics,” a field of study in which high-throughput data is extracted and large amounts of advanced quantitative imaging features are analyzed from medical images, and “imaging genomics,” the field of study of high-throughput methods of associating imaging features with genomic data, has gathered academic interest. However, a radiomics and imaging genomics approach in the oncology world is still in its very early stages and many problems remain to be solved. In this review, we will look through the steps of radiomics and imaging genomics in oncology, specifically addressing potential applications in each organ and focusing on technical issues

Investigation of intra-tumour heterogeneity to identify texture features to characterise and quantify neoplastic lesions on imaging

The aim of this work was to further our knowledge of using imaging data to discover image derived biomarkers and other information about the imaged tumour. Using scans obtained from multiple centres to discover and validate the models has advanced earlier research and provided a platform for further larger centre prospective studies. This work consists of two major studies which are describe separately: STUDY 1: NSCLC Purpose The aim of this multi-center study was to discover and validate radiomics classifiers as image-derived biomarkers for risk stratification of non-small-cell lung cancer (NSCLC). Patients and methods Pre-therapy PET scans from 358 Stage I–III NSCLC patients scheduled for radical radiotherapy/chemoradiotherapy acquired between October 2008 and December 2013 were included in this seven-institution study. Using a semiautomatic threshold method to segment the primary tumors, radiomics predictive classifiers were derived from a training set of 133 scans using TexLAB v2. Least absolute shrinkage and selection operator (LASSO) regression analysis allowed data dimension reduction and radiomics feature vector (FV) discovery. Multivariable analysis was performed to establish the relationship between FV, stage and overall survival (OS). Performance of the optimal FV was tested in an independent validation set of 204 patients, and a further independent set of 21 (TESTI) patients. Results Of 358 patients, 249 died within the follow-up period [median 22 (range 0–85) months]. From each primary tumor, 665 three-dimensional radiomics features from each of seven gray levels were extracted. The most predictive feature vector discovered (FVX) was independent of known prognostic factors, such as stage and tumor volume, and of interest to multi-center studies, invariant to the type of PET/CT manufacturer. Using the median cut-off, FVX predicted a 14-month survival difference in the validation cohort (N = 204, p = 0.00465; HR = 1.61, 95% CI 1.16–2.24). In the TESTI cohort, a smaller cohort that presented with unusually poor survival of stage I cancers, FVX correctly indicated a lack of survival difference (N = 21, p = 0.501). In contrast to the radiomics classifier, clinically routine PET variables including SUVmax, SUVmean and SUVpeak lacked any prognostic information. Conclusion PET-based radiomics classifiers derived from routine pre-treatment imaging possess intrinsic prognostic information for risk stratification of NSCLC patients to radiotherapy/chemo-radiotherapy. STUDY 2: Ovarian Cancer Purpose The 5-year survival of epithelial ovarian cancer is approximately 35-40%, prompting the need to develop additional methods such as biomarkers for personalised treatment. Patient and Methods 657 texture features were extracted from the CT scans of 364 untreated EOC patients. A 4-texture feature ‘Radiomic Prognostic Vector (RPV)’ was developed using machine learning methods on the training set. Results The RPV was able to identify the 5% of patients with the worst prognosis, significantly improving established prognostic methods and was further validated in two independent, multi-centre cohorts. In addition, the genetic, transcriptomic and proteomic analysis from two independent datasets demonstrated that stromal and DNA damage response pathways are activated in RPV-stratified tumours. Conclusion RPV could be used to guide personalised therapy of EOC. Overall, the two large datasets of different imaging modalities have increased our knowledge of texture analysis, improving the models currently available and provided us with more areas with which to implement these tools in the clinical setting.Open Acces

The Era of Radiogenomics in Precision Medicine: An Emerging Approach to Support Diagnosis, Treatment Decisions, and Prognostication in Oncology

With the rapid development of new technologies, including artificial intelligence and genome sequencing, radiogenomics has emerged as a state-of-the-art science in the field of individualized medicine. Radiogenomics combines a large volume of quantitative data extracted from medical images with individual genomic phenotypes and constructs a prediction model through deep learning to stratify patients, guide therapeutic strategies, and evaluate clinical outcomes. Recent studies of various types of tumors demonstrate the predictive value of radiogenomics. And some of the issues in the radiogenomic analysis and the solutions from prior works are presented. Although the workflow criteria and international agreed guidelines for statistical methods need to be confirmed, radiogenomics represents a repeatable and cost-effective approach for the detection of continuous changes and is a promising surrogate for invasive interventions. Therefore, radiogenomics could facilitate computer-aided diagnosis, treatment, and prediction of the prognosis in patients with tumors in the routine clinical setting. Here, we summarize the integrated process of radiogenomics and introduce the crucial strategies and statistical algorithms involved in current studies

A Systematic Review of PET Textural Analysis and Radiomics in Cancer

Background: Although many works have supported the utility of PET radiomics, several authors have raised concerns over the robustness and replicability of the results. This study aimed to perform a systematic review on the topic of PET radiomics and the used methodologies. Methods: PubMed was searched up to 15 October 2020. Original research articles based on human data specifying at least one tumor type and PET image were included, excluding those that apply only first-order statistics and those including fewer than 20 patients. Each publication, cancer type, objective and several methodological parameters (number of patients and features, validation approach, among other things) were extracted. Results: A total of 290 studies were included. Lung (28%) and head and neck (24%) were the most studied cancers. The most common objective was prognosis/treatment response (46%), followed by diagnosis/staging (21%), tumor characterization (18%) and technical evaluations (15%). The average number of patients included was 114 (median = 71; range 20–1419), and the average number of high-order features calculated per study was 31 (median = 26, range 1–286). Conclusions: PET radiomics is a promising field, but the number of patients in most publications is insufficient, and very few papers perform in-depth validations. The role of standardization initiatives will be crucial in the upcoming yearsThis research was partially funded by DTS17/00138 (Instituto de Salud Carlos III) and ED431F 2017/04 project (GAIN-Xunta de Galicia)S