MRI-based radiomics to predict response in locally advanced rectal cancer: comparison of manual and automatic segmentation on external validation in a multicentre study.

BACKGROUND: Pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer (LARC) is achieved in 15-30% of cases. Our aim was to implement and externally validate a magnetic resonance imaging (MRI)-based radiomics pipeline to predict response to treatment and to investigate the impact of manual and automatic segmentations on the radiomics models. METHODS: Ninety-five patients with stage II/III LARC who underwent multiparametric MRI before chemoradiotherapy and surgical treatment were enrolled from three institutions. Patients were classified as responders if tumour regression grade was 1 or 2 and nonresponders otherwise. Sixty-seven patients composed the construction dataset, while 28 the external validation. Tumour volumes were manually and automatically segmented using a U-net algorithm. Three approaches for feature selection were tested and combined with four machine learning classifiers. RESULTS: Using manual segmentation, the best result reached an accuracy of 68% on the validation set, with sensitivity 60%, specificity 77%, negative predictive value (NPV) 63%, and positive predictive value (PPV) 75%. The automatic segmentation achieved an accuracy of 75% on the validation set, with sensitivity 80%, specificity 69%, and both NPV and PPV 75%. Sensitivity and NPV on the validation set were significantly higher (p = 0.047) for the automatic versus manual segmentation. CONCLUSION: Our study showed that radiomics models can pave the way to help clinicians in the prediction of tumour response to chemoradiotherapy of LARC and to personalise per-patient treatment. The results from the external validation dataset are promising for further research into radiomics approaches using both manual and automatic segmentations.

A fully automatic deep learning algorithm to segment rectal Cancer on MR images: a multi-center study.

The aim of the study is to present and tune a fully automatic deep learning algorithm to segment colorectal cancers (CRC) on MR images, based on a U-Net structure. It is a multicenter study, including 3 different Italian institutions, that used 4 different MRI scanners. Two of them were used for training and tuning the systems, while the other two for the validation. The implemented algorithm consists of a pre-processing step to normalize and to highlight the tumoral area, followed by the CRC segmentation using different U-net structures. Automatic masks were compared with manual segmentations performed by three experienced radiologists, one at each center. The two best performing systems (called mdl2 and mdl3), obtained a median Dice Similarity Coefficient of 0.68(mdl2) - 0.69(mdl3), precision of 0.75(md/2) - 0.71(md/3), and recall of 0.69(mdl2) - 0.73(mdl3) on the validation set. Both systems reached high detection rates, 0.98 and 0.95, respectively, on the validation set. These encouraging results, if confirmed on larger dataset, might improve the management of patients with CRC, since it can be used as a fast and precise tool for further radiomics analyses. Clinical Relevance - To provide a reliable tool able to automatically segment CRC tumors that can be used as first step in future radiomics studies aimed at predicting response to chemotherapy and personalizing treatment.

Comparison of radiomics approaches to predict resistance to 1st line chemotherapy in liver metastatic colorectal cancer.

Colorectal cancer (CRC) has the second-highest tumor incidence and is a leading cause of death by cancer. Nearly 20% of patients with CRC will have metastases (mts) at the time of diagnosis, and more than 50% of patients with CRC develop metastases during their disease. Unfortunately, only 45% of patients after a chemotherapy will respond to treatment. The aim of this study is to develop and validate a machine learning algorithm to predict response of individual liver mts, using CT scans. Understanding which mts will respond or not will help clinicians in providing a more efficient per-lesion treatment based on patient specific response and not only following a standard treatment. A group of 92 patients was enrolled from two Italian institutions. CT scans were collected, and the portal venous phase was manually segmented by an expert radiologist. Then, 75 radiomics features were extracted both from 7x7 ROIs that moved across the image and from the whole 3D mts. Feature selection was performed using a genetic algorithm. Results are presented as a comparison of the two different approaches of features extraction and different classification algorithms. Accuracy (ACC), sensitivity (SE), specificity (SP), negative and positive predictive values (NPV and PPV) were evaluated for all lesions (per-lesion analysis) and patients (per-patient analysis) in the construction and validation sets. Best results were obtained in the per-lesion analysis from the 3D approach using a Support Vector Machine as classifier. We reached on the training set an ACC of 81%, while on test set, we obtained SE of 76%, SP of 67%, PPV of 69% and NPV of 75%. On the validation set a SE of 61%, SP of 60%, PPV of 57% and NPV of 64% were reached. The promising results obtained in the validation dataset should be extended to a larger cohort of patient to further validate our method.Clinical Relevance- to develop a radiomics signatures predicting single liver mts response to therapy. A personalized mts approach is important to avoid unnecessary toxicity offering more suitable treatments and a better quality of life to oncological patients.

Recent developments and advances in secondary prevention of lung cancer.

Lung cancer prevention may include primary prevention strategies, such as corrections of working conditions and life style - primarily smoking cessation - as well as secondary prevention strategies, aiming at early detection that allows better survival rates and limited resections. This review summarizes recent developments and advances in secondary prevention, focusing on recent technological tools for an effective early diagnosis.

A Convolutional Neural Network based system for Colorectal cancer segmentation on MRI images.

The aim of the study is to present a new Convolutional Neural Network (CNN) based system for the automatic segmentation of the colorectal cancer. The algorithm implemented consists of several steps: a pre-processing to normalize and highlights the tumoral area, the classification based on CNNs, and a post-processing aimed at reducing false positive elements. The classification is performed using three CNNs: each of them classifies the same regions of interest acquired from three different MR sequences. The final segmentation mask is obtained by a majority voting. Performances were evaluated using a semi-automatic segmentation revised by an experienced radiologist as reference standard. The system obtained Dice Similarity Coefficient (DSC) of 0.60, Precision (Pr) of 0.76 and Recall (Re) of 0.55 on the testing set. After applying the leave-one-out validation, we obtained a median DSC=0.58, Pr=0.74, Re=0.54. The promising results obtained by this system, if validated on a larger dataset, could strongly improve personalized medicine.

Acute Kidney Injury With the RenalGuard System in Patients Undergoing Transcatheter Aortic Valve Replacement: The PROTECT-TAVI Trial (PROphylactic effecT of furosEmide-induCed diuresis with matched isotonic intravenous hydraTion in Transcatheter Aortic Valve Implantation).

OBJECTIVES: The purpose of this study was to investigate the effect of the RenalGuard System (PLC Medical Systems, Milford, Massachusetts) on prevention of acute kidney injury (AKI) in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: TAVR is associated with varying degrees of post-procedural AKI. The RenalGuard System is a dedicated device designed for contrast-induced AKI prevention. Whether this device is also effective in patients with severe aortic stenosis undergoing TAVR is unexplored. METHODS: The present is an investigator-driven, single-center, prospective, open-label, registry-based randomized study that used the TAVR institutional registry of the Ferrarotto Hospital in Catania, Italy, as the platform for randomization, data collection, and follow-up assessment. A total of 112 consecutive patients undergoing TAVR were randomly assigned to hydration with normal saline solution controlled by the RenalGuard system and furosemide (RenalGuard group) or normal saline solution (control group). The primary endpoint was the incidence of Valve Academic Research Consortium-defined AKI in the first 72 h after the procedure. RESULTS: The AKI rate was lower in the RenalGuard group than in the control group (n = 3 [5.4%] vs. n =14 [25.0%], respectively, p = 0.014). The majority of patients (5.4% vs. 23.2%) developed a mild AKI (stage 1); severe damage (stage 3) occurred only in 1 patient in the control group (0.0% vs. 1.8%). No case of in-hospital renal failure requiring dialysis was reported. No significant differences in terms of mortality, cerebrovascular events, bleeding, and hospitalization for heart failure were noted in both groups at 30 days. CONCLUSIONS: Furosemide-induced diuresis with matched isotonic intravenous hydration using the RenalGuard system is an effective therapeutic tool to reduce the occurrence of AKI in patients undergoing TAVR.