Development of an ultrasound-based muscle texture analysis as a potential imaging biomarker for frailty phenotype

Las herramientas habituales para evaluar la fragilidad muestran, entre otras características, una baja sensibilidad y un bajo valor predictivo positivo. Es por eso que, en este estudio prospectivo-retrospectivo, nos preguntamos si es posible identificar y desarrollar biomarcadores cuantitativos a partir de imágenes de ultrasonido muscular, para la identificación de sujetos con riesgo de fragilidad. Para ello utlilizamos el análisis de textura de ecointensidad con ayuda del aprendizaje automático (machine learning, en inglés) como enfoque experimental para responder a esta pregunta. El proyecto se desarrolló en consulta externa, donde se realizó la ecografía muscular. Al final de la adquisición de las imágenes, se completó un cuestionario electrónico con los datos epidemiológicos, los criterios del fenotipo de fragilidad y calidad de vida de los adultos mayores. Los sujetos de 60 años o más participaron en el grupo experimental, que fue subdividido de acuerdo al fenotipo de fragilidad. En el grupo control incluyó sujetos de 20 a 59 años de edad. Se realizó un seguimiento de las comorbilidades y/o muerte por dos años. Luego se realizó el post-procesado de imágenes con el análisis de textura (43 características), de los músculos cuádriceps. Se utilizaron métodos estadísticos para extraer las características predeterminadas y se desarrollaron modelos predictivos para determinar las mejores características para el diagnóstico de fragilidad, con la ayuda de la tecnología de aprendizaje automático. Los resultados demuestran que los modelos desarrollados tienen buenas áreas bajo la curva para la identificación de los sujetos frágiles. El análisis de regresión logística múltiple demostró que los biomarcadores de imagen clasificaron correctamente 70 a 87% de los casos, y explicaron entre 23% y 80% de la varianza en la identificación de pacientes frágiles con los modelos predictivos por sí solos. Estos modelos mejoraron al incorporar el grosor del músculo o la velocidad de la marcha, clasificando correctamente del 87% al 100% de los casos. Después del ajuste, los modelos fueron independientes de la edad, el sexo, el índice de masa corporal, el tejido adiposo subcutáneo y la fuerza muscular. Estos modelos también se asociaron con una mayor morbilidad y mortalidad. Estos resultados indican que es posible identificar sujetos con riesgo de fragilidad con la ayuda de modelos predictivos de análisis de textura, ayudados por el aprendizaje automático, como biomarcadores cuantitativos obtenidos de imágenes de ultrasonido muscular. Creemos que la heterogeneidad de las características de la textura muscular capta la calidad muscular y/o la disfunción muscular de los sujetos. Estas características hacen que las imágenes de ultrasonido, con la ayuda del análisis de textura mediante el aprendizaje automático, sean buenos biomarcadores de fragilidad

Assessment and risk prediction of frailty using texture-based muscle ultrasound image analysis and machine learning techniques

[EN] The purpose of this study was to evaluate texture-based muscle ultrasound image analysis for the assessment and risk prediction of frailty phenotype. This retrospective study of prospectively acquired data included 101 participants who underwent ultrasound scanning of the anterior thigh. Participants were subdivided according to frailty phenotype and were followed up for two years. Primary and secondary outcome measures were death and comorbidity, respectively. Forty-three texture features were computed from the rectus femoris and the vastus intermedius muscles using statistical methods. Model performance was evaluated by computing the area under the receiver operating characteristic curve (AUC) while outcome prediction was evaluated using regression analysis. Models developed achieved a moderate to good AUC (0.67 <= AUC <= 0.79) for categorizing frailty. The stepwise multiple logistic regression analysis demonstrated that they correctly classified 70-87% of the cases. The models were associated with increased comorbidity (0.01 <= p <= 0.18) and were predictive of death for pre-frail and frail participants (0.001 <= p <= 0.016). In conclusion, texture analysis can be useful to identify frailty and assess risk prediction (i.e. mortality) using texture features extracted from muscle ultrasound images in combination with a machine learning approach.This work was supported by the following grants: Grant PID2020-113839RB-I00 funded by MCIN/AEI/10.13039/501100011033 to C.B. DM acknowledges financial support from the Conselleria d ' Educacio, Investigacio, Cultura i Esport, Generalitat Valenciana (grants AEST/2018/021 and AEST/2019/037) .Mirón-Mombiela, R.; Ruiz-España, S.; Moratal, D.; Borrás, C. (2023). Assessment and risk prediction of frailty using texture-based muscle ultrasound image analysis and machine learning techniques. Mechanisms of Ageing and Development. 215. https://doi.org/10.1016/j.mad.2023.11186021

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VII, nerves of the lower limb.

Funder: Università degli Studi di MilanoOBJECTIVES: To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton's neuroma) and provide clinical indications. METHODS: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton's neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper. RESULTS: Nine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. CONCLUSION: Despite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures. KEY POINTS: • Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. • US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. • US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. The volume of local anesthetic affects the size of the blocked sensory area

Diagnostic Performance of Muscle Echo Intensity and Fractal Dimension for the Detection of Frailty Phenotype

To determine the relationship between muscle echo intensity (EI) and fractal dimension (FD), and the diagnostic performance of both ultrasound parameters for the identification of frailty phenotype. A retrospective interpretation of ultrasound scans from a previous cohort (November 2014–February 2015) was performed. The sample included healthy participants <60 years old, and participants ≥60 divided into robust, pre-frail, and frail groups according to Fried frailty criteria. A region of interest of the rectus femoris from the ultrasound scan was segmented, and histogram function was applied to obtain EI. For fractal analysis, images were processed using two-dimensional box-counting techniques to calculate FD. Statistical analyses were performed with diagnostic performance tests. A total of 102 participants (mean age 63 ± 16, 57 men) were evaluated. Muscle fractal dimension correlated with EI (r = .38, p < .01) and showed different pattern in the scatter plots when participants were grouped by non-frail (control + robust) and frail (pre-frail + frail). The diagnostic accuracy for EI to categorize frailty was of 0.69 (95%CI: 0.59–0.78, p = .001), with high intra-rater (ICC: 0.98, 95%CI: 0.98–0.99); p < .001) and inter-rater (ICC: 0.89, 95%CI: 0.75–0.95; p < .001) reliability and low measurement error for both parameters (EI: −0.18, LOA95%: −10.8 to 10.5; FD: 0.00, LOA95%: −0.09 to 0.10) in arbitrary units. The ROC curve combining both parameters was not better than EI alone (p = .18). Muscle FD correlated with EI and showed different patterns according to frailty phenotype, with EI outperforming FD as a possible diagnostic tool for frailty.This work was supported by the Ministry of Economy and Competitiviness (PCIN-2017-117), the EU Joint Programming Initiative “A Healthy Diet for a Healthy Life” (JPI HDHL INTIMIC-085) to CB. This research was also funded by the Young Researchers Grant awarded by the European Society of Musculoskeletal Radiology to RM

What Genetics Can Do for Oncological Imaging: A Systematic Review of the Genetic Validation Data Used in Radiomics Studies

(1) Background: Radiogenomics is motivated by the concept that biomedical images contain information that reflects underlying pathophysiology. This review focused on papers that used genetics to validate their radiomics models and outcomes and assess their contribution to this emerging field. (2) Methods: All original research with the words radiomics and genomics in English and performed in humans up to 31 January 2022, were identified on Medline and Embase. The quality of the studies was assessed with Radiomic Quality Score (RQS) and the Cochrane recommendation for diagnostic accuracy study Quality Assessment 2. (3) Results: 45 studies were included in our systematic review, and more than 50% were published in the last two years. The studies had a mean RQS of 12, and the studied tumors were very diverse. Up to 83% investigated the prognosis as the main outcome, with the rest focusing on response to treatment and risk assessment. Most applied either transcriptomics (54%) and/or genetics (35%) for genetic validation. (4) Conclusions: There is enough evidence to state that new science has emerged, focusing on establishing an association between radiological features and genomic/molecular expression to explain underlying disease mechanisms and enhance prognostic, risk assessment, and treatment response radiomics models in cancer patients

Clinical indications for image-guided interventional procedures in the musculoskeletal system:a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part VII, nerves of the lower limb

OBJECTIVES: To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton’s neuroma) and provide clinical indications. METHODS: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton’s neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper. RESULTS: Nine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. CONCLUSION: Despite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures. KEY POINTS: • Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. • US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. • US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. The volume of local anesthetic affects the size of the blocked sensory area

Clinical indications for image-guided interventional procedures in the musculoskeletal system:a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part IV, hip

OBJECTIVES: Image-guided musculoskeletal interventional procedures around the hip are widely used in daily clinical practice. The need for clarity concerning the actual added value of imaging guidance and types of medications to be offered led the Ultrasound and the Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) to promote, with the support of its Research Committee, a collaborative project to review the published literature on image-guided musculoskeletal interventional procedures in the lower limb in order to derive a list of clinical indications. METHODS: In this article, we report the results of a Delphi-based consensus of 53 experts who reviewed the published literature for evidence on image-guided interventional procedures offered in the joint and soft tissues around the hip in order of their clinical indications. RESULTS: Ten statements concerning image-guided treatment procedures around the hip have been collected by the panel of ESSR experts. CONCLUSIONS: This work highlighted that there is still low evidence in the existing literature on some of these interventional procedures. Further large prospective randomized trials are essential to better confirm the benefits and objectively clarify the role of imaging to guide musculoskeletal interventional procedures around the hip. KEY POINTS: • Expert consensus produced a list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the hip. • The highest level of evidence was only reached for one statement. • Strong consensus was obtained for all statements. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00330-021-07997-5

Clinical indications for image-guided interventional procedures in the musculoskeletal system:a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part IV, hip

Funder: Università degli Studi di MilanoOBJECTIVES: Image-guided musculoskeletal interventional procedures around the hip are widely used in daily clinical practice. The need for clarity concerning the actual added value of imaging guidance and types of medications to be offered led the Ultrasound and the Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) to promote, with the support of its Research Committee, a collaborative project to review the published literature on image-guided musculoskeletal interventional procedures in the lower limb in order to derive a list of clinical indications. METHODS: In this article, we report the results of a Delphi-based consensus of 53 experts who reviewed the published literature for evidence on image-guided interventional procedures offered in the joint and soft tissues around the hip in order of their clinical indications. RESULTS: Ten statements concerning image-guided treatment procedures around the hip have been collected by the panel of ESSR experts. CONCLUSIONS: This work highlighted that there is still low evidence in the existing literature on some of these interventional procedures. Further large prospective randomized trials are essential to better confirm the benefits and objectively clarify the role of imaging to guide musculoskeletal interventional procedures around the hip. KEY POINTS: • Expert consensus produced a list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the hip. • The highest level of evidence was only reached for one statement. • Strong consensus was obtained for all statements