Prediction of Effectiveness and Toxicities of Immune Checkpoint Inhibitors Using Real-World Patient Data.

PURPOSE: Although immune checkpoint inhibitors (ICIs) have improved outcomes in certain patients with cancer, they can also cause life-threatening immunotoxicities. Predicting immunotoxicity risks alongside response could provide a personalized risk-benefit profile, inform therapeutic decision making, and improve clinical trial cohort selection. We aimed to build a machine learning (ML) framework using routine electronic health record (EHR) data to predict hepatitis, colitis, pneumonitis, and 1-year overall survival. METHODS: Real-world EHR data of more than 2,200 patients treated with ICI through December 31, 2018, were used to develop predictive models. Using a prediction time point of ICI initiation, a 1-year prediction time window was applied to create binary labels for the four outcomes for each patient. Feature engineering involved aggregating laboratory measurements over appropriate time windows (60-365 days). Patients were randomly partitioned into training (80%) and test (20%) sets. Random forest classifiers were developed using a rigorous model development framework. RESULTS: The patient cohort had a median age of 63 years and was 61.8% male. Patients predominantly had melanoma (37.8%), lung cancer (27.3%), or genitourinary cancer (16.4%). They were treated with PD-1 (60.4%), PD-L1 (9.0%), and CTLA-4 (19.7%) ICIs. Our models demonstrate reasonably strong performance, with AUCs of 0.739, 0.729, 0.755, and 0.752 for the pneumonitis, hepatitis, colitis, and 1-year overall survival models, respectively. Each model relies on an outcome-specific feature set, though some features are shared among models. CONCLUSION: To our knowledge, this is the first ML solution that assesses individual ICI risk-benefit profiles based predominantly on routine structured EHR data. As such, use of our ML solution will not require additional data collection or documentation in the clinic.

Frontal and anterior temporal hypometabolism post chemoradiation in head and neck cancer: A real-world PET study.

BACKGROUND AND PURPOSE: Adverse neurological effects after cancer therapy are common, but biomarkers to diagnose, monitor, or risk stratify patients are still not validated or used clinically. An accessible imaging method, such as fluorodeoxyglucose positron emission tomography (FDG PET) of the brain, could meet this gap and serve as a biomarker for functional brain changes. We utilized FDG PET to evaluate which brain regions are most susceptible to altered glucose metabolism after chemoradiation in patients with head and neck cancer (HNCa). METHODS: Real-world FDG PET images were acquired as standard of care before and after chemoradiation for HNCa in 68 patients. Linear mixed-effects voxelwise models assessed changes after chemoradiation in cerebral glucose metabolism quantified with standardized uptake value ratio (SUVR), covarying for follow-up time and patient demographics. RESULTS: Voxelwise analysis revealed two large clusters of decreased glucose metabolism in the medial frontal and polar temporal cortices following chemoradiation, with decreases of approximately 5% SUVR after therapy. CONCLUSIONS: These findings provide evidence that standard chemoradiation for HNCa can lead to decreased neuronal glucose metabolism, contributing to literature emphasizing the vulnerability of the frontal and anterior temporal lobes, especially in HNCa, where these areas may be particularly vulnerable to indirect radiation-induced injury. FDG PET shows promise as a sensitive biomarker for assessing these changes.

Quantitative Evaluation of Temporal Regularizers in Compressed Sensing Dynamic Contrast Enhanced MRI of the Breast.

PURPOSE: Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) is used in cancer imaging to probe tumor vascular properties. Compressed sensing (CS) theory makes it possible to recover MR images from randomly undersampled k-space data using nonlinear recovery schemes. The purpose of this paper is to quantitatively evaluate common temporal sparsity-promoting regularizers for CS DCE-MRI of the breast. METHODS: We considered five ubiquitous temporal regularizers on 4.5x retrospectively undersampled Cartesian in vivo breast DCE-MRI data: Fourier transform (FT), Haar wavelet transform (WT), total variation (TV), second-order total generalized variation (TGV α2), and nuclear norm (NN). We measured the signal-to-error ratio (SER) of the reconstructed images, the error in tumor mean, and concordance correlation coefficients (CCCs) of the derived pharmacokinetic parameters Ktrans (volume transfer constant) and ve (extravascular-extracellular volume fraction) across a population of random sampling schemes. RESULTS: NN produced the lowest image error (SER: 29.1), while TV/TGV α2 produced the most accurate Ktrans (CCC: 0.974/0.974) and ve (CCC: 0.916/0.917). WT produced the highest image error (SER: 21.8), while FT produced the least accurate Ktrans (CCC: 0.842) and ve (CCC: 0.799). CONCLUSION: TV/TGV α2 should be used as temporal constraints for CS DCE-MRI of the breast.

A novel anthropomorphic flow phantom for the quantitative evaluation of prostate DCE-MRI acquisition techniques.

A novel anthropomorphic flow phantom device has been developed, which can be used for quantitatively assessing the ability of magnetic resonance imaging (MRI) scanners to accurately measure signal/concentration time-intensity curves (CTCs) associated with dynamic contrast-enhanced (DCE) MRI. Modelling of the complex pharmacokinetics of contrast agents as they perfuse through the tumour capillary network has shown great promise for cancer diagnosis and therapy monitoring. However, clinical adoption has been hindered by methodological problems, resulting in a lack of consensus regarding the most appropriate acquisition and modelling methodology to use and a consequent wide discrepancy in published data. A heretofore overlooked source of such discrepancy may arise from measurement errors of tumour CTCs deriving from the imaging pulse sequence itself, while the effects on the fidelity of CTC measurement of using rapidly-accelerated sequences such as parallel imaging and compressed sensing remain unknown. The present work aimed to investigate these features by developing a test device in which 'ground truth' CTCs were generated and presented to the MRI scanner for measurement, thereby allowing for an assessment of the DCE-MRI protocol to accurately measure this curve shape. The device comprised a four-pump flow system wherein CTCs derived from prior patient prostate data were produced in measurement chambers placed within the imaged volume. The ground truth was determined as the mean of repeat measurements using an MRI-independent, custom-built optical imaging system. In DCE-MRI experiments, significant discrepancies between the ground truth and measured CTCs were found for both tumorous and healthy tissue-mimicking curve shapes. Pharmacokinetic modelling revealed errors in measured K trans, v e and k ep values of up to 42%, 31%, and 50% respectively, following a simple variation of the parallel imaging factor and number of signal averages in the acquisition protocol. The device allows for the quantitative assessment and standardisation of DCE-MRI protocols (both existing and emerging).

DCEMRI.jl: a fast, validated, open source toolkit for dynamic contrast enhanced MRI analysis.

We present a fast, validated, open-source toolkit for processing dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) data. We validate it against the Quantitative Imaging Biomarkers Alliance (QIBA) Standard and Extended Tofts-Kety phantoms and find near perfect recovery in the absence of noise, with an estimated 10-20× speedup in run time compared to existing tools. To explain the observed trends in the fitting errors, we present an argument about the conditioning of the Jacobian in the limit of small and large parameter values. We also demonstrate its use on an in vivo data set to measure performance on a realistic application. For a 192 × 192 breast image, we achieved run times of <1 s. Finally, we analyze run times scaling with problem size and find that the run time per voxel scales as O(N (1.9)), where N is the number of time points in the tissue concentration curve. DCEMRI.jl was much faster than any other analysis package tested and produced comparable accuracy, even in the presence of noise.

Potential of compressed sensing in quantitative MR imaging of cancer.

Classic signal processing theory dictates that, in order to faithfully reconstruct a band-limited signal (e.g., an image), the sampling rate must be at least twice the maximum frequency contained within the signal, i.e., the Nyquist frequency. Recent developments in applied mathematics, however, have shown that it is often possible to reconstruct signals sampled below the Nyquist rate. This new method of compressed sensing (CS) requires that the signal have a concise and extremely dense representation in some mathematical basis. Magnetic resonance imaging (MRI) is particularly well suited for CS approaches, owing to the flexibility of data collection in the spatial frequency (Fourier) domain available in most MRI protocols. With custom CS acquisition and reconstruction strategies, one can quickly obtain a small subset of the full data and then iteratively reconstruct images that are consistent with the acquired data and sparse by some measure. Successful use of CS results in a substantial decrease in the time required to collect an individual image. This extra time can then be harnessed to increase spatial resolution, temporal resolution, signal-to-noise, or any combination of the three. In this article, we first review the salient features of CS theory and then discuss the specific barriers confronting CS before it can be readily incorporated into clinical quantitative MRI studies of cancer. We finally illustrate applications of the technique by describing examples of CS in dynamic contrast-enhanced MRI and dynamic susceptibility contrast MRI.

Robustness of quantitative compressive sensing MRI: the effect of random undersampling patterns on derived parameters for DCE- and DSC-MRI.

Compressive sensing (CS) in Cartesian magnetic resonance imaging (MRI) involves random partial Fourier acquisitions. The random nature of these acquisitions can lead to variance in reconstruction errors. In quantitative MRI, variance in the reconstructed images translates to an uncertainty in the derived quantitative maps. We show that for a spatially regularized 2 ×-accelerated human breast CS DCE-MRI acquisition with a 192 (2) matrix size, the coefficients of variation (CoVs) in voxel-level parameters due to the random acquisition are 1.1%, 0.96%, and 1.5% for the tissue parameters K(trans), v(e), and v(p), with an average error in the mean of -2.5%, -2.0%, and -3.7%, respectively. Only 5% of the acquisition schemes had a systematic underestimation larger than than 4.2%, 3.7%, and 6.1%, respectively. For a 2 × -accelerated rat brain CS DSC-MRI study with a 64(2) matrix size, the CoVs due to the random acquisition were 19%, 9.5%, and 15% for the cerebral blood flow and blood volume and mean transit time, respectively, and the average errors in the tumor mean were 9.2%, 0.49%, and -7.0%, respectively. Across 11 000 different CS reconstructions, we saw no outliers in the distribution of parameters, suggesting that, despite the random undersampling schemes, CS accelerated quantitative MRI may have a predictable level of performance.

Quantitative effects of using compressed sensing in dynamic contrast enhanced MRI.

Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) involves the acquisition of images before, during and after the injection of a contrast agent. In order to perform quantitative modeling on the resulting signal intensity time course, data must be acquired rapidly, which compromises spatial resolution, signal to noise and/or field of view. One approach that may allow for gains in temporal or spatial resolution or signal to noise of an individual image is to use compressed sensing (CS) MRI. In this study, we demonstrate the accuracy of extracted pharmacokinetic parameters from DCE-MRI data obtained as part of pre-clinical and clinical studies in which fully sampled acquisitions have been retrospectively undersampled by factors of 2, 3 and 4 in Fourier space and then reconstructed with CS. The mean voxel-level concordance correlation coefficient for K(trans) (i.e. the volume transfer constant) obtained from the 2× accelerated and the fully sampled data is 0.92 and 0.90 for mouse and human data, respectively; for 3×, the results are 0.79 and 0.79, respectively; for 4×, the results are 0.64 and 0.70, respectively. The mean error in the tumor mean K(trans) for the mouse and human data at 2× acceleration is 1.8% and -4.2%, respectively; at 3×, 3.6% and -10%, respectively; at 4×, 7.8% and -12%, respectively. These results suggest that CS combined with appropriate reduced acquisitions may be an effective approach to improving image quality in DCE-MRI.

A review of perioperative glucose control in the neurosurgical population.

Significant fluctuations in serum glucose levels accompany the stress response of surgery or acute injury and may be associated with vascular or neurologic morbidity. Maintenance of euglycemia with intensive insulin therapy (IIT) continues to be investigated as a therapeutic intervention to decrease morbidity associated with derangements in glucose metabolism. Hypoglycemia is a common side effect of IIT with potential for significant morbidity, especially in the neurologically injured patient. Differences in cerebral versus systemic glucose metabolism, the time course of cerebral response to injury, and heterogeneity of pathophysiology in neurosurgical patient populations are important to consider in evaluating the risks and benefits of IIT. While extremes of glucose levels are to be avoided, there are little data to support specific use of IIT for maintenance of euglycemia in the perioperative management of neurosurgical patients. Existing data are summarized and reviewed in this context.

Fluorescence polarization immunoassays for pesticides.

Fluorescence polarization immunoassay methods for the detection of pesticides and their metabolites or degradation products are reviewed. Advantages and limitations for application to pesticide detection in environmental and food samples are discussed. The influence of the structure of fluorescent-labeled tracers and the affinity and specificity of antibodies on analytical performance is examined. The methods are simple, readily automated, and rapid (total time for assay of a water sample is about 1 min) with sensitivity of 1 - 10 ng/ml pesticide in 0.01 - 0.1 ml sample.