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OBJECTIVE. The purpose of this study is to develop and evaluate an unenhanced CT-based radiomics model to predict brain metastasis (BM) in patients with category T1 lung adenocarcinoma. MATERIALS AND METHODS. A total of 89 eligible patients with category T1 lung adenocarcinoma were enrolled and classified as patients with BM (n = 35) or patients without BM (n = 54). A total of 1160 quantitative radiomic features were extracted from unenhanced CT images of each patient. Three prediction models (the clinical model, the radiomics model, and a hybrid [clinical plus radiomics] model) were established. The ROC AUC value and 10-fold cross-validation were used to evaluate the prediction performance of the models. RESULTS. In terms of predictive performance, the mean AUC value was 0.759 (95% CI, 0.643-0.867; sensitivity, 82.9%; specificity, 57.4%) for the clinical model, 0.847 (95% CI, 0.739-0.915; sensitivity, 80.0%; specificity, 81.5%) for the radiomics model, and 0.871 (95% CI, 0.767-0.933; sensitivity = 82.9%, specificity = 83.3%) for the hybrid model. The hybrid and radiomics models (p = 0.0072 and 0.0492, respectively) performed significantly better than the clinical model. No significant difference was found between the radiomics model and the hybrid model (p = 0.1022). CONCLUSION. A CT-based radiomics model presented good predictive performance and great potential for predicting BM in patients with category T1 lung adenocarcinoma. As a promising adjuvant tool, it can be helpful for guiding BM screening and thus benefiting personalized surveillance for patients with lung cancer.
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PURPOSE: To evaluate the diagnostic performance of extended models of diffusion-weighted (DW) imaging to help differentiate the epidermal growth factor receptor (EGFR) mutation status in stage IIIA-IV lung adenocarcinoma. MATERIALS AND METHODS: This retrospective study had institutional research board approval and was HIPAA compliant. Preoperative extended DW imaging including intravoxel incoherent motion (IVIM) and diffusional kurtosis imaging (DKI) 3 Tesla MRI were retrospectively evaluated in 53 patients with pathologically confirmed non-early stage (IIIA-IV) lung adenocarcinoma. EGFR mutationsat exons 18-21 were determined by using polymerase chain reaction-based ARMS. Quantitative parameters (mean, kurtosis, skewness, 10th and 90th percentiles) of IVIM (true-diffusion coefficient D, pseudo-diffusion coefficient D*, and perfusion fraction f) and DKI (kurtosis value Kapp, kurtosis corrected diffusion coefficient Dapp) were calculated by outlining entire-volume histogram analysis. Receiver operating characteristic analysis was constructed to determine the diagnostic performance of each parameter. Multivariate logistic regression was used to differentiate the probability of EGFR mutation status. RESULTS: Twenty-four of 53 patients with lung adenocarcinoma were EGFR mutations, which occurred most often in acinar (10 of 13 [76.9%]) and papillary predominant tumors (9 of 13 [69.2%]). Patients with EGFR mutation showed significant higher 10th percentile of D, lower D* value in terms of kurtosis, and lower Kapp value in terms of mean, skewness, 10th and 90th percentiles (all P values < 0.05). The 90th Kapp showed significantly higher sensitivity (97%; P < 0.05) and Az (0.817; P < 0.05) value. Multivariate logistic regression showed 90th Kapp was a independent factor for determining EGFR mutation with odds ratio -1.657. CONCLUSION: Multiple IVIM and DKI parameters, especially the histogram 90th Kapp value, helped differentiate EGFR mutation status in stage IIIA-IV lung adenocarcinoma. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:281-289.
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Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/genética , Imagem de Difusão por Ressonância Magnética/métodos , Receptores ErbB/genética , Interpretação de Imagem Assistida por Computador/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/genética , Modelos Biológicos , Polimorfismo de Nucleotídeo Único/genética , Adenocarcinoma de Pulmão , Adulto , Idoso , Feminino , Predisposição Genética para Doença/genética , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Mutação , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: To compare a multi-feature-based radiomic biomarker with volumetric analysis in discriminating lung adenocarcinomas with different disease-specific survival on computed tomography (CT) scans. METHODS: This retrospective study obtained institutional review board approval and was Health Insurance Portability and Accountability Act (HIPAA) compliant. Pathologically confirmed lung adenocarcinoma (n = 431) manifested as subsolid nodules on CT were identified. Volume and percentage solid volume were measured by using a computer-assisted segmentation method. Radiomic features quantifying intensity, texture and wavelet were extracted from the segmented volume of interest (VOI). Twenty best features were chosen by using the Relief method and subsequently fed to a support vector machine (SVM) for discriminating adenocarcinoma in situ (AIS)/minimally invasive adenocarcinoma (MIA) from invasive adenocarcinoma (IAC). Performance of the radiomic signatures was compared with volumetric analysis via receiver-operating curve (ROC) analysis and logistic regression analysis. RESULTS: The accuracy of proposed radiomic signatures for predicting AIS/MIA from IAC achieved 80.5% with ROC analysis (Az value, 0.829; sensitivity, 72.1%; specificity, 80.9%), which showed significantly higher accuracy than volumetric analysis (69.5%, P = 0.049). Regression analysis showed that radiomic signatures had superior prognostic performance to volumetric analysis, with AIC values of 81.2% versus 70.8%, respectively. CONCLUSIONS: The radiomic tumour-phenotypes biomarker exhibited better diagnostic accuracy than traditional volumetric analysis in discriminating lung adenocarcinoma with different disease-specific survival. KEY POINTS: ⢠Radiomic biomarker on CT was designed to identify phenotypes of lung adenocarcinoma ⢠Built up radiomic signature for lung adenocarcinoma manifested as subsolid nodules ⢠Retrospective study showed radiomic signature had greater diagnostic accuracy than volumetric analysis ⢠Radiomics help to evaluate intratumour heterogeneity within lung adenocarcinoma ⢠Medical decision can be given with more confidence.
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Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Biomarcadores Tumorais , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma in Situ/diagnóstico por imagem , Adenocarcinoma in Situ/patologia , Adenocarcinoma de Pulmão , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Máquina de Vetores de SuporteAssuntos
Neoplasias da Mama/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/epidemiologia , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Carcinoma/complicações , Carcinoma/terapia , China , Feminino , Seguimentos , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
PURPOSE The aim of this study was to evaluate the diagnostic performance of iodine uptake parameters using dual-energy computed tomography (DECT) in discriminating inflammatory nodules from malignant tumors. METHODS This retrospective study included 116 solid pulmonary nodules from 112 patients who were admitted to our hospital between January and September 2018. All nodules were confirmed by surgery or puncture. The degree of enhancement of a single-section region of interest was evalu ated. After total tumor volume-of-interest segmentation, the mean iodine density of the whole tumor was measured. Meanwhile, iodine uptake parameters, including total iodine uptake vol ume, total iodine concentration, vital iodine uptake volume, and vital iodine concentration, were calculated, and a predictive model was established. The overall ability to discriminate between inflammatory and malignant nodules was analyzed using an independent samples t-test for normally distributed variables. The diagnostic accuracy and prognostic performance of DECT parameters were evaluated and compared using receiver operating characteristic curve analysis and logistic regression analysis. A multivariate logistic regression analysis was used to determine the prognostic factors and goodness-of-fit of the whole tumor mean iodine and iodine uptake parameters for discriminating malignant nodules. RESULTS There were 116 non-calcified nodules, including 64 inflammatory nodules and 52 malignant nodules. The degree of enhancement in malignant nodules was significantly lower than that in inflammatory nodules (P=.043). All iodine uptake parameters in malignant nodules were signifi cantly higher than those in inflammatory nodules (P < .001). The area under the receiver operat ing curve value, accuracy, sensitivity, and specificity of the established model based on iodine uptake parameters were 0.803, 76.72%, 82.69%, and 84.37%, respectively, which exhibited bet ter diagnostic performance than the degree of enhancement on weighted average images with respective values of 0.609, 59.48%, 61.54%, and 59.38%. CONCLUSION The iodine uptake parameters of DECT exhibited better diagnostic accuracy in discriminating inflammatory nodules from malignant nodules than the degree of enhancement on weighted average images.
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Iodo , Nódulos Pulmonares Múltiplos , Humanos , Tomografia Computadorizada por Raios X/métodos , Diagnóstico Diferencial , Estudos Retrospectivos , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Meios de ContrasteRESUMO
OBJECTIVE: To construct a predictive model to discriminate adenocarcinoma in situ (AIS) or minimally invasive adenocarcinoma (MIA) from invasive adenocarcinoma (IAC) appearing as pure ground-glass nodules (pGGNs) using computed tomography (CT) histogram analysis combined with morphological characteristics and to evaluate its diagnostic performance. MATERIALS AND METHODS: Two hundred eighty-nine patients with surgically resected solitary pGGN and pathologically diagnosed with AIS, MIA, or IAC in our institution from January 2014 to May 2018 were enrolled in our study. Two hundred twenty-six pGGNs (79 AIS, 84 MIA, and 63 IAC) were randomly selected and assigned to a model-development cohort, and the remaining 63 pGGNs (11 AIS, 29 MIA and 23 IAC) were assigned to a validation cohort. The morphological characteristics were established as model A and histogram parameters as model B. The diagnostic performances of model A, model B, and model A + B were evaluated and compared via receiver operating curve (ROC) analysis and logistic regression analysis. RESULTS: Entropy (odd ratio [OR] = 23.25, 95%CI: 6.83-79.15, p < 0.001), microvascular sign (OR = 8.62, 95%CI: 3.72-19.98, p < 0.001) and the maximum diameter (OR = 4.37, 95%CI: 2.44-7.84, p < 0.001) were identified as independent predictors in the IAC group. The area under the ROC (Az value), accuracy, sensitivity and specificity of model A + B were 0.896, 88.1%, 79.4% and 91.4%, respectively, exhibiting a significantly higher Az value than either model A or model B alone (0.785 vs 0.896, p < 0.001; 0.849 vs 0.896, p = 0.029). Model A + B also conveyed a good diagnostic performance in the validation cohort, with an Az value of 0.851. CONCLUSION: Histogram analysis combined with morphological characteristics exhibit a superior diagnostic performance in discriminating AIS-MIA from IAC appearing as pGGNs.
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Adenocarcinoma/patologia , Neoplasias Pulmonares/patologia , Adenocarcinoma in Situ/patologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodosRESUMO
Benign metastasizing leiomyoma (BML) in the lung is a very rare metastatic disease. BML accompanied with primary lung cancer is even more uncommon. In our report, a 38-year-old female who undertook routine computed tomography (CT) scan revealed the pulmonary abnormality. Chest CT imaging showed a ground-glass opacity (GGO) nodule coexisted with a solid mass, which was prone to be diagnosed as a primary lung cancer with metastasis. However, the pathological immunohistochemical staining result proved the diagnosis of BML accompany with primary lung adenocarcinoma. Our case presented a valuable report for radiologist and clinician to identify the diagnosis and differentiated diagnosis, and understand the pathogenesis, treatment and prognosis of the tumor in further.
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PURPOSE: To evaluate the safety and efficacy of the hook wire system in the simultaneous localizations for multiple pulmonary nodules (PNs) before video-assisted thoracoscopic surgery (VATS), and to clarify the risk factors for pneumothorax associated with the localization procedure. METHODS: Between January 2010 and February 2016, 67 patients (147 nodules, Group A) underwent simultaneous localizations for multiple PNs using a hook wire system. The demographic, localization procedure-related information and the occurrence rate of pneumothorax were assessed and compared with a control group (349 patients, 349 nodules, Group B). Multivariate logistic regression analyses were used to determine the risk factors for pneumothorax during the localization procedure. RESULTS: All the 147 nodules were successfully localized. Four (2.7%) hook wires dislodged before VATS procedure, but all these four lesions were successfully resected according to the insertion route of hook wire. Pathological diagnoses were acquired for all 147 nodules. Compared with Group B, Group A demonstrated significantly longer procedure time (p < 0.001) and higher occurrence rate of pneumothorax (p = 0.019). Multivariate logistic regression analysis indicated that position change during localization procedure (OR 2.675, p = 0.021) and the nodules located in the ipsilateral lung (OR 9.404, p < 0.001) were independent risk factors for pneumothorax. CONCLUSION: Simultaneous localizations for multiple PNs using a hook wire system before VATS procedure were safe and effective. Compared with localization for single PN, simultaneous localizations for multiple PNs were prone to the occurrence of pneumothorax. Position change during localization procedure and the nodules located in the ipsilateral lung were independent risk factors for pneumothorax.