Comparing lesion and feature selections to predict progression in newly diagnosed DLBCL patients with FDG PET/CT radiomics features.

PURPOSE: Biomarkers that can accurately predict outcome in DLBCL patients are urgently needed. Radiomics features extracted from baseline [18F]-FDG PET/CT scans have shown promising results. This study aims to investigate which lesion- and feature-selection approaches/methods resulted in the best prediction of progression after 2 years. METHODS: A total of 296 patients were included. 485 radiomics features (n = 5 conventional PET, n = 22 morphology, n = 50 intensity, n = 408 texture) were extracted for all individual lesions and at patient level, where all lesions were aggregated into one VOI. 18 features quantifying dissemination were extracted at patient level. Several lesion selection approaches were tested (largest or hottest lesion, patient level [all with/without dissemination], maximum or median of all lesions) and compared to the predictive value of our previously published model. Several data reduction methods were applied (principal component analysis, recursive feature elimination (RFE), factor analysis, and univariate selection). The predictive value of all models was tested using a fivefold cross-validation approach with 50 repeats with and without oversampling, yielding the mean cross-validated AUC (CV-AUC). Additionally, the relative importance of individual radiomics features was determined. RESULTS: Models with conventional PET and dissemination features showed the highest predictive value (CV-AUC: 0.72-0.75). Dissemination features had the highest relative importance in these models. No lesion selection approach showed significantly higher predictive value compared to our previous model. Oversampling combined with RFE resulted in highest CV-AUCs. CONCLUSION: Regardless of the applied lesion selection or feature selection approach and feature reduction methods, patient level conventional PET features and dissemination features have the highest predictive value. Trial registration number and date: EudraCT: 2006-005174-42, 01-08-2008.

18F-FDG PET baseline radiomics features improve the prediction of treatment outcome in diffuse large B-cell lymphoma.

PURPOSE: Accurate prognostic markers are urgently needed to identify diffuse large B-Cell lymphoma (DLBCL) patients at high risk of progression or relapse. Our purpose was to investigate the potential added value of baseline radiomics features to the international prognostic index (IPI) in predicting outcome after first-line treatment. METHODS: Three hundred seventeen newly diagnosed DLBCL patients were included. Lesions were delineated using a semi-automated segmentation method (standardized uptake value ≥ 4.0), and 490 radiomics features were extracted. We used logistic regression with backward feature selection to predict 2-year time to progression (TTP). The area under the curve (AUC) of the receiver operator characteristic curve was calculated to assess model performance. High-risk groups were defined based on prevalence of events; diagnostic performance was assessed using positive and negative predictive values. RESULTS: The IPI model yielded an AUC of 0.68. The optimal radiomics model comprised the natural logarithms of metabolic tumor volume (MTV) and of SUVpeak and the maximal distance between the largest lesion and any other lesion (Dmaxbulk, AUC 0.76). Combining radiomics and clinical features showed that a combination of tumor- (MTV, SUVpeak and Dmaxbulk) and patient-related parameters (WHO performance status and age > 60 years) performed best (AUC 0.79). Adding radiomics features to clinical predictors increased PPV with 15%, with more accurate selection of high-risk patients compared to the IPI model (progression at 2-year TTP, 44% vs 28%, respectively). CONCLUSION: Prediction models using baseline radiomics combined with currently used clinical predictors identify patients at risk of relapse at baseline and significantly improved model performance. TRIAL REGISTRATION NUMBER AND DATE: EudraCT: 2006-005,174-42, 01-08-2008.

The Image Biomarker Standardization Initiative: Standardized Quantitative Radiomics for High-Throughput Image-based Phenotyping.

Background Radiomic features may quantify characteristics present in medical imaging. However, the lack of standardized definitions and validated reference values have hampered clinical use. Purpose To standardize a set of 174 radiomic features. Materials and Methods Radiomic features were assessed in three phases. In phase I, 487 features were derived from the basic set of 174 features. Twenty-five research teams with unique radiomics software implementations computed feature values directly from a digital phantom, without any additional image processing. In phase II, 15 teams computed values for 1347 derived features using a CT image of a patient with lung cancer and predefined image processing configurations. In both phases, consensus among the teams on the validity of tentative reference values was measured through the frequency of the modal value and classified as follows: less than three matches, weak; three to five matches, moderate; six to nine matches, strong; 10 or more matches, very strong. In the final phase (phase III), a public data set of multimodality images (CT, fluorine 18 fluorodeoxyglucose PET, and T1-weighted MRI) from 51 patients with soft-tissue sarcoma was used to prospectively assess reproducibility of standardized features. Results Consensus on reference values was initially weak for 232 of 302 features (76.8%) at phase I and 703 of 1075 features (65.4%) at phase II. At the final iteration, weak consensus remained for only two of 487 features (0.4%) at phase I and 19 of 1347 features (1.4%) at phase II. Strong or better consensus was achieved for 463 of 487 features (95.1%) at phase I and 1220 of 1347 features (90.6%) at phase II. Overall, 169 of 174 features were standardized in the first two phases. In the final validation phase (phase III), most of the 169 standardized features could be excellently reproduced (166 with CT; 164 with PET; and 164 with MRI). Conclusion A set of 169 radiomics features was standardized, which enabled verification and calibration of different radiomics software. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Kuhl and Truhn in this issue.

Quantitative Radiomics Features in Diffuse Large B-Cell Lymphoma: Does Segmentation Method Matter?

Radiomics features may predict outcome in diffuse large B-cell lymphoma (DLBCL). Currently, multiple segmentation methods are used to calculate metabolic tumor volume (MTV). We assessed the influence of segmentation method on the discriminative power of radiomics features in DLBCL at the patient level and for the largest lesion. Methods: Fifty baseline 18F-FDG PET/CT scans of DLBCL patients with progression or relapse within 2 years after diagnosis were matched on uptake time and reconstruction method with 50 baseline PET/CT scans of DLBCL patients without progression. Scans were analyzed using 6 semiautomatic segmentation methods (SUV threshold of 4.0 [SUV4.0], SUV threshold of 2.5, 41% of SUVmax, 50% of SUVpeak, a majority vote segmenting voxels detected by ≥2 methods, and a majority vote segmenting voxels detected by ≥3 methods). On the basis of these segmentations, 490 radiomics features were extracted at the patient level, and 486 features were extracted for the largest lesion. To quantify the agreement between features extracted from different segmentation methods, the intraclass correlation (ICC) agreement was calculated for each method compared with SUV4.0. The feature space was reduced by deleting features that had high Pearson correlations (≥0.7) with the previously established predictors MTV or SUVpeak Model performance was assessed using stratified repeated cross validation with 5 folds and 2,000 repeats, yielding the mean receiver-operating-characteristics curve integral for all segmentation methods using logistic regression with backward feature selection. Results: The percentage of features yielding an ICC of at least 0.75, compared with the SUV4.0 segmentation, was lowest for 50% of SUVpeak both at the patient level and for the largest lesion, with 77.3% and 66.7% of the features yielding an ICC of at least 0.75, respectively. Features did not correlate strongly with MTV, with at least 435 features at the patient level and 409 features for the largest lesion for all segmentation methods having a correlation coefficient of less than 0.7. Features correlated strongly with SUVpeak (at least 190 at patient level and 134 for the largest lesion were uncorrelated to SUVpeak, respectively). Receiver-operating-characteristics curve integrals ranged between 0.69 ± 0.11 and 0.84 ± 0.09 at the patient level and between 0.69 ± 0.11 and 0.73 ± 0.10 at the lesion level. Conclusion: Even though there are differences in the actual radiomics feature values derived and selected features among segmentation methods, there is no substantial difference in the discriminative power of radiomics features among segmentation methods.