Invasiveness identification in pure ground-glass nodules: exploring the generalizability of radiomics based on external validation and stress testing.

PURPOSE: This study aimed to apply external validation and stress tests to evaluate the generalizability of radiomics models built using various machine-learning methods for identifying the invasiveness of lung adenocarcinomas manifesting as pure ground-glass nodules (pGGNs). METHODS: This retrospective study enrolled 495 patients (514 pGGNs) confirmed as lung adenocarcinomas by postoperative pathology from three centers. All nodules were included in the primary cohort (randomly divided into training and test cohorts), two external validation cohorts, and two stress test cohorts. Six machine-learning radiomics models were constructed in the training cohort using the optimal features. Performance of radiomics models and clinical models were compared in primary cohort and external validation cohorts. The stress tests included stratified performance evaluation and shifted performance evaluation and contrastive evaluation under three single-condition modification settings. The predictive performance was validated by area under curve (AUC) of receiver operating characteristic (ROC). RESULTS: Of the six radiomics models, the best logistic regression (LR) model was able to maintain high differential diagnostic capability (AUC: 0.849 ± 0.049) and good stability (relative standard deviation, 5.719%), but it showed poorer performance (AUC = 0.835) than the clinical model (AUC = 0.862) in the external validation cohort E1. The stress tests suggested LR model had no significant difference in performance between subgroups after stratification and had good consistency in the predictions before and after the three transformations (Kappa = 0.960, 0.840, and 0.933, respectively; p < 0.05, all). CONCLUSION: The rigorous testing procedure facilitates the selection of high-performance radiomics models with good clinical generalizability.

Radiomics based on enhanced CT for differentiating between pulmonary tuberculosis and pulmonary adenocarcinoma presenting as solid nodules or masses.

PURPOSE: To investigate the incremental value of enhanced CT-based radiomics in discriminating between pulmonary tuberculosis (PTB) and pulmonary adenocarcinoma (PAC) presenting as solid nodules or masses and to develop an optimal radiomics model. METHODS: A total of 128 lesions (from 123 patients) from three hospitals were retrospectively analyzed and were randomly divided into training and test datasets at a ratio of 7:3. Independent predictors in subjective image features were used to develop the subjective image model (SIM). The plain CT-based and enhanced CT-based radiomics features were screened by the correlation coefficient method, univariate analysis, and the least absolute shrinkage and selection operator, then used to build the plain CT radiomics model (PRM) and enhanced CT radiomics model (ERM), respectively. Finally, the combined model (CM) combining PRM and ERM was established. In addition, the performance of three radiologists and one respiratory physician was evaluated. The areas under the receiver operating characteristic curve (AUCs) were used to assess the performance of each model. RESULTS: The differential diagnostic capability of the ERM (training: AUC = 0.933; test: AUC = 0.881) was better than that of the PRM (training: AUC = 0.861; test: AUC = 0.756) and the SIM (training: AUC = 0.760; test: AUC = 0.611). The CM was optimal (training: AUC = 0.948; test: AUC = 0.917) and outperformed the respiratory physician and most radiologists. CONCLUSIONS: The ERM was more helpful than the PRM for identifying PTB and PAC that present as solid nodules or masses, and the CM was the best.

The adding value of contrast-enhanced CT radiomics: Differentiating tuberculosis from non-tuberculous infectious lesions presenting as solid pulmonary nodules or masses.

Purpose: To compare the value of contrast-enhanced CT (CECT) and non-contrast-enhanced CT (NCECT) radiomics models in differentiating tuberculosis (TB) from non-tuberculous infectious lesions (NTIL) presenting as solid pulmonary nodules or masses, and develop a combine radiomics model (RM). Materials and methods: This study was a retrospective analysis of 101 lesions in 95 patients, including 49 lesions (from 45 patients) in the TB group and 52 lesions (from 50 patients) in the NTIL group. Lesions were randomly divided into training and test sets in the ratio of 7:3. Conventional imaging features were used to construct a conventional imaging model (IM). Radiomics features screening and NCECT or CECT RM construction were carried out by correlation analysis and gradient boosting decision tree, and logistic regression. Finally, conventional IM, NCECT RM, and CECT RM were used for combine RM construction. Additionally, we recruited three radiologists for independent diagnosis. The differential diagnostic performance of each model was assessed using the areas under the receiver operating characteristic curve (AUCs). Results: The CECT RM (training AUC, 0.874; test AUC, 0.796) outperformed the conventional IM (training AUC, 0.792; test AUC, 0.708), the NCECT RM (training AUC, 0.835; test AUC, 0.704), and three radiologists. The diagnostic efficacy of the combine RM (training AUC, 0.922; test AUC, 0.833) was best in the training and test sets. Conclusions: The diagnostic efficacy of the CECT RM was superior to that of the NCECT RM in identifying TB from NTIL presenting as solid pulmonary nodules or masses. The combine RM had the best performance and may outperform expert radiologists.

Radiomics for identifying lung adenocarcinomas with predominant lepidic growth manifesting as large pure ground-glass nodules on CT images.

PURPOSE: To explore the value of radiomics in the identification of lung adenocarcinomas with predominant lepidic growth in pure ground-glass nodules (pGGNs) larger than 10 mm. METHODS: We retrospectively analyzed CT images of 204 patients with large pGGNs (≥ 10 mm) pathologically diagnosed as minimally invasive adenocarcinomas (MIAs), lepidic predominant adenocarcinomas (LPAs), and non-lepidic predominant adenocarcinomas (NLPAs). All pGGNs in the two groups (MIA/LPA and NLPA) were randomly divided into training and test cohorts. Forty-seven patients from another center formed the external validation cohort. Baseline features, including clinical data and CT morphological and quantitative parameters, were collected to establish a baseline model. The radiomics model was built with the optimal radiomics features. The combined model was developed using the rad_score and independent baseline predictors. The performance of the models was evaluated using the area under the receiver operating characteristic curve (AUC) and compared using the DeLong test. The differential diagnosis performance of the models was compared with three radiologists (with 20+, 10+, and 3 years of experience) in the test cohort. RESULTS: The radiomics (training AUC: 0.833; test AUC: 0.804; and external validation AUC: 0.792) and combined (AUC: 0.849, 0.820, and 0.775, respectively) models performed better for discriminating than the baseline model (AUC: 0.756, 0.762, and 0.725, respectively) developed by tumor location and mean CT value of the whole nodule. The DeLong test showed that the AUCs of the combined and radiomics models were significantly increased in the training cohort. The highest AUC value of the radiologists was 0.600. CONCLUSION: The application of CT radiomics improved the identification performance of lung adenocarcinomas with predominant lepidic growth appearing as pGGNs larger than 10 mm.

Compression Performance and Deformation Behavior of 3D-Printed PLA-Based Lattice Structures.

The aim of this study is to fabricate biodegradable PLA-based composite filaments for 3D printing to manufacture bear-loading lattice structures. First, CaCO3 and TCP as inorganic fillers were incorporated into a PLA matrix to fabricate a series of composite filaments. The material compositions, mechanical properties, and rheology behavior of the PLA/CaCO3 and PLA/TCP filaments were evaluated. Then, two lattice structures, cubic and Triply Periodic Minimal Surfaces-Diamond (TPMS-D), were geometrically designed and 3D-printed into fine samples. The axial compression results indicated that the addition of CaCO3 and TCP effectively enhances the compressive modulus and strength of lattice structures. In particular, the TPMS-D structure showed superior load-carrying capacity and specific energy absorption compared to those of its cubic counterparts. Furthermore, the deformation behavior of these two lattice structures was examined by image recording during compression and computed tomography (CT) scanning of samples after compression. It was observed that pore structure could be well held in TPMS-D, while that in cubic structure was destroyed due to the fracture of vertical struts. Therefore, this paper highlights promising 3D-printed biodegradable lattice structures with excellent energy-absorption capacity and high structural stability.

Value of breast MRI omics features and clinical characteristics in Breast Imaging Reporting and Data System (BI-RADS) category 4 breast lesions: an analysis of radiomics-based diagnosis.

BACKGROUND: The Breast Imaging Reporting and Data System (BI-RADS) category 4 breast lesions is categorized into 4A, 4B, and 4C, which reflect an increasing malignancy potential from low (2-10%) moderate (10-50%) and high (50-95%). Determining the benign and malignant of BI-RADS category 4 breast lesions is very important for accurate diagnosis and follow-up treatment. This study aimed to explore the value of breast magnetic resonance imaging (MRI) omics features and clinical characteristics in the assessment of BI-RADS category 4 breast lesions. METHODS: This retrospective study analyzed 96 lesions (39 benign and 57 malignant) from 92 patients diagnosed with MRI BI-RADS category 4 lesions in the Second Affiliated Hospital of Dalian Medical University between May 2017 and December 2019. The lesions were sub-categorized as BI-RADS 4A, 4B, or 4C based on the MRI findings. An imaging omics analysis model was applied to extract the MRI features. The positive predictive value (PPV) of each subcategory was calculated, and the area under the curve (AUC) was used to describe the efficiency for different diagnoses. Moreover, we analyzed 17 clinical indicators to assess their diagnostic value for BI-RADS category 4 breast lesions. RESULTS: The PPVs of BI-RADS 4A, 4B, and 4C were 7.1% (2/28), 41.2% (7/17), and 94.1% (48/51), respectively. The AUC, sensitivity, and specificity were 0.919, 84.2%, and 92.3%, respectively. The combination of T1-weighted images (T1WI) with dynamic contrast-enhanced (DCE) MRI yielded the best diagnostic results among all dual sequences. Two clinical indicators [progesterone receptor (PR) and Ki-67 expression] achieved an AUC almost equal to 1.0. The radiomics and redundancy reduction methods reduced the clinical data features from 1,233 to 14. CONCLUSIONS: High diagnostic performance can be achieved in distinguishing malignant breast BI-RADS category 4 lesions using the combination of T1WI and DCE in MRI. Combining the PR and Ki-67 expression variables can further improve MRI accuracy for breast BI-RADS category 4 lesions.

Less Is Better: Single-Digit Brain Functional Connections Predict T2DM and T2DM-Induced Cognitive Impairment.

Type 2 diabetes mellitus (T2DM) leads to a higher risk of brain damage and adversely affects cognition. The underlying neural mechanism of T2DM-induced cognitive impairment (T2DM-CI) remains unclear. This study proposes to identify a small number of dysfunctional brain connections as imaging biomarkers, distinguishing between T2DM-CI, T2DM with normal cognition (T2DM-NC), and healthy controls (HC). We have recruited 22 T2DM-CI patients, 31 T2DM-NC patients, and 39 HCs. The structural Magnetic Resonance Imaging (MRI) and resting state fMRI images are acquired, and neuropsychological tests are carried out. Amplitude of low frequency fluctuations (ALFF) is analyzed to identify impaired brain regions implicated with T2DM and T2DM-CI. The functional network is built and all connections connected to impaired brain regions are selected. Subsequently, L1-norm regularized sparse canonical correlation analysis and sparse logistic regression are used to identify discriminative connections and Support Vector Machine is trained to realize three two-category classifications. It is found that single-digit dysfunctional connections predict T2DM and T2DM-CI. For T2DM-CI versus HC, T2DM-NC versus HC, and T2DM-CI versus T2DM-NC, the number of connections is 6, 7, and 5 and the area under curve (AUC) can reach 0.912, 0.901, and 0.861, respectively. The dysfunctional connection is mainly related to Default Model Network (DMN) and long-distance links. The strength of identified connections is significantly different among groups and correlated with cognitive assessment score (p < 0.05). Via ALFF analysis and further feature selection algorithms, a small number of dysfunctional brain connections can be identified to predict T2DM and T2DM-CI. These connections might be the imaging biomarkers of T2DM-CI and targets of intervention.

The prognostic efficacy and improvements of the 7th edition Union for International Cancer Control tumor-node-metastasis classifications for Chinese patients with gastric cancer: Results based on a retrospective three-decade population study.

This study aimed to evaluate survival trends for patients with gastric cancer in northeast China in the most recent three decades and analyze the applicability of the UICC tumor-node-metastasis (TNM) classification 7th edition for Chinese patients with gastric cancer. A review of all inpatient and outpatient records of patients with gastric cancer was conducted in the first hospital of China Medical University and the Liaoning Cancer Hospital and Institute. All patients who met the inclusion criteria and were seen from January 1980 through December 2009 were included in the study. The primary outcome was 5-year survival, which was analyzed according to decade of diagnosis and TNM classifications. From 1980 through 2009, the 5-year survival rates for patients with gastric cancer (n=2414) increased from 39.1% to 57.3%. Decade of diagnosis was significantly associated with patient survival (p = 0.013), and the 5-year survival rate in the 2000s was remarkably higher than that in the 1980s and 1990s (p = 0.004 and 0.049, respectively). When classified according to the UICC TNM classification of gastric cancer 7th edition, the prognoses of stage IIIA and stage IIIB patients were not significantly different (p = 0.077). However, if stage T4b and stage N0 patients were classified as stage IIIA, the prognoses of stage IIIA and stage IIIB patients were significantly different (p < 0.001). Hence, there was a significant difference in survival during the three time periods in Northeast China. Classifying stage T4b and stage N0 patients as stage IIIA according to the 7th edition of UICC gastric cancer TNM classifications better stratified Chinese patients and predicted prognoses.