Publications
274 results found
Rockall AG, 2021, Databases and Data Retrieval, Practical Imaging Informatics: Foundations and Applications for Medical Imaging: Second Edition, Pages: 165-178, ISBN: 9781071617557
Databases are the critical means for information storage and retrieval. There are entire fields of study within computer science devoted to database optimization and structure. This chapter is intended to provide an introduction to databases and practical tips for utilizing these critical resources.
Sadowski EA, Maturen KE, Rockall A, et al., 2021, Ovary: MRI characterisation and O-RADS MRI, BRITISH JOURNAL OF RADIOLOGY, Vol: 94, ISSN: 0007-1285
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- Citations: 8
Barwick T, Orton M, Koh DM, et al., 2021, Repeatability and reproducibility of apparent diffusion coefficient and fat fraction measurement of focal myeloma lesions on whole body magnetic resonance imaging, BRITISH JOURNAL OF RADIOLOGY, Vol: 94, ISSN: 0007-1285
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- Citations: 5
Arshad MA, Gitau S, Tam H, et al., 2020, Optimal method for metabolic tumour volume assessment of cervical cancers with inter-observer agreement on [18F]-fluoro-deoxy-glucose positron emission tomography with computed tomography, European Journal of Nuclear Medicine and Molecular Imaging, Pages: 1-15, ISSN: 0340-6997
PurposeCervical cancer metabolic tumour volume (MTV) derived from [18F]-FDG PET/CT has a role in prognostication and therapy planning. There is no standard method of outlining MTV on [18F]-FDG PET/CT. The aim of this study was to assess the optimal method to outline primary cervical tumours on [18F]-FDG PET/CT using MRI-derived tumour volumes as the reference standard.Methods81 consecutive cervical cancer patients with pre-treatment staging MRI and [18F]-FDG PET/CT imaging were included. MRI volumes were compared with different PET segmentation methods. Method 1 measured MTVs at different SUVmax thresholds ranging from 20 to 60% (MTV20-MTV60) with bladder masking and manual adjustment when required. Method 2 created an isocontour around the tumour prior to different SUVmax thresholds being applied. Method 3 used an automated gradient method. Inter-observer agreement of MTV, following manual adjustment when required, was recorded.ResultsFor method 1, the MTV25 and MTV30 were closest to the MRI volumes for both readers (mean percentage change from MRI volume of 2.9% and 13.4% for MTV25 and − 13.1% and − 2.0% for MTV30 for readers 1 and 2). 70% of lesions required manual adjustment at MTV25 compared with 45% at MTV30. There was excellent inter-observer agreement between MTV30 to MTV60 (ICC ranged from 0.898–0.976 with narrow 95% confidence intervals (CIs)) and moderate agreement at lower thresholds (ICC estimates of 0.534 and 0.617, respectively for the MTV20 and MTV25 with wide 95% CIs). Bladder masking was performed in 86% of cases overall. For method 2, excellent correlation was demonstrated at MTV25 and MTV30 (mean % change from MRI volume of −3.9% and − 8.6% for MTV25 and − 16.9% and 19% for MTV30 for readers 1 and 2, respectively). This method also demonstrated excellent ICC across all thresholds with no manual adjustment. Method 3 demonstrated excellent ICC of 0.96 (95% CI 0.94–0.97) but had a
Rockall A, Rockall A, Brady AP, et al., 2020, The identity and role of the radiologist in 2020: a survey among ESR full radiologist members, INSIGHTS INTO IMAGING, Vol: 11, ISSN: 1869-4101
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- Citations: 19
Salib MY, Russell JHB, Stewart VR, et al., 2020, 2018 FIGO Staging Classification for Cervical Cancer: Added Benefits of Imaging, RADIOGRAPHICS, Vol: 40, Pages: 1807-1822, ISSN: 0271-5333
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- Citations: 26
Miles A, Evans REC, Halligan S, et al., 2020, Predictors of patient preference for either whole body magnetic resonance imaging (WB-MRI) or CT/ PET-CT for staging colorectal or lung cancer, JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Vol: 64, Pages: 537-545, ISSN: 1754-9477
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- Citations: 6
Kanavati F, Islam S, Arain Z, et al., 2020, Fully-automated deep learning slice-based muscle estimation from CT images for sarcopenia assessment, Publisher: arXiv
Objective: To demonstrate the effectiveness of using a deep learning-basedapproach for a fully automated slice-based measurement of muscle mass forassessing sarcopenia on CT scans of the abdomen without any case exclusioncriteria. Materials and Methods: This retrospective study was conducted using acollection of public and privately available CT images (n = 1070). The methodconsisted of two stages: slice detection from a CT volume and single-slice CTsegmentation. Both stages used Fully Convolutional Neural Networks (FCNN) andwere based on a UNet-like architecture. Input data consisted of CT volumes witha variety of fields of view. The output consisted of a segmented muscle mass ona CT slice at the level of L3 vertebra. The muscle mass is segmented intoerector spinae, psoas, and rectus abdominus muscle groups. The output wastested against manual ground-truth segmentation by an expert annotator. Results: 3-fold cross validation was used to evaluate the proposed method.The slice detection cross validation error was 1.41+-5.02 (in slices). Thesegmentation cross validation Dice overlaps were 0.97+-0.02, 0.95+-0.04,0.94+-0.04 for erector spinae, psoas, and rectus abdominus, respectively, and0.96+-0.02 for the combined muscle mass. Conclusion: A deep learning approach to detect CT slices and segment musclemass to perform slice-based analysis of sarcopenia is an effective andpromising approach. The use of FCNN to accurately and efficiently detect aslice in CT volumes with a variety of fields of view, occlusions, and slicethicknesses was demonstrated.
Avesani G, Arshad M, Lu H, et al., 2020, Radiological assessment of Peritoneal Cancer Index on preoperative CT in ovarian cancer is related to surgical outcome and survival, La Radiologia Medica, Vol: 125, Pages: 770-776, ISSN: 0033-8362
PurposeTo evaluate whether Peritoneal Cancer Index (PCI) assessed on preoperative CT (CT-PCI) can be used as non-invasive preoperative tool to predict surgical outcome, disease-free survival (DFS) and overall survival (OS).Materials and methodsThis is a retrospective, observational cohort study performed in a single institution. We considered all patients with diagnosis of ovarian cancer and preoperative CT, who had undergone upfront cytoreductive surgery between 2008 and 2010 and had post-operative clinical follow-up to December 2015. Two radiologists reviewed CT scans and assessed CT-PCI using Sugarbaker’s diagram. We assessed the discriminatory capacity of the CT-PCI score on the surgical outcome by ROC curve analysis. DFS and OS were assessed by Kaplan–Meier nonparametric curves and by multivariable Cox-regression analysis.ResultsA total of 297 patients were included in the present analysis. CT-PCI was positively correlated with post-operative residual disease [odds ratio (OR) 1.04, 95% CI 1.01–1.07, p = 0.003]. ROC curve analysis returned AUC = 0.64 for the prediction of total macroscopic tumour clearance. In multivariable analysis, patients with no peritoneal disease seen on CT had a significantly longer DFS [Hazard ratio (HR) 2.28, p = 0.007]. Radiological serosal small bowel involvement was an independent predictor for shorter OS (HR 3.01, p = 0.002).ConclusionRadiological PCI assessed on preoperative CT is associated with the probability of residual disease after cytoreductive surgery; however, it has low performance as a triage test to reliably identify patients who are likely to have complete cytoreductive surgery. CT-PCI is positively correlated with both DFS and OS and may be used as an independent prognostic factor, for example in patients with high FIGO stages.
Evans REC, Taylor SA, Kalasthry J, et al., 2020, Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI., Clinical Radiology, Vol: 75, Pages: 308-315, ISSN: 0009-9260
AIM: To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden. MATERIALS AND METHODS: A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression. RESULTS: One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan. CONCLUSIONS: Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.
Rockall A, Howlett D, Brady A, et al., 2020, The current status of radiological clinical audit and feedback on the ESR Guide to Clinical Audit in Radiology and the ESR Clinical Audit Tool (Esperanto) – an ESR Survey of European Radiology Departments, Insights into Imaging, Vol: 11, ISSN: 1869-4101
Clinical audit “according to national procedures” is a legal requirement as defined within the recently implemented European Council Basic Safety Standards Directive (BSSD), 2013/59/Euratom. A survey was undertaken in 2019 to assess the current status of clinical audit in European radiology departments and for feedback on the recently published “ESR Guide to Clinical Audit in Radiology” and the “ESR Clinical Audit Tool (Esperanto)”. The survey was distributed within the European Society of Radiology (ESR) EuroSafe Imaging Star network and also to European national radiological societies which are institutional members of the ESR.
Thomassin-Naggara I, Poncelet E, Jalaguier-Coudray A, et al., 2020, Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) score for risk stratification of sonographically indeterminate adnexal masses., JAMA Network Open, Vol: 3, Pages: 1-14, ISSN: 2574-3805
Importance: Approximately one-quarter of adnexal masses detected at ultrasonography are indeterminate for benignity or malignancy, posing a substantial clinical dilemma. Objective: To validate the accuracy of a 5-point Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) score for risk stratification of adnexal masses. Design, Setting, and Participants: This multicenter cohort study was conducted between March 1, 2013, and March 31, 2016. Among patients undergoing expectant management, 2-year follow-up data were completed by March 31, 2018. A routine pelvic MRI was performed among consecutive patients referred to characterize a sonographically indeterminate adnexal mass according to routine diagnostic practice at 15 referral centers. The MRI score was prospectively applied by 2 onsite readers and by 1 reader masked to clinical and ultrasonographic data. Data analysis was conducted between April and November 2018. Main Outcomes and Measures: The primary end point was the joint analysis of true-negative and false-negative rates according to the MRI score compared with the reference standard (ie, histology or 2-year follow-up). Results: A total of 1340 women (mean [range] age, 49 [18-96] years) were enrolled. Of 1194 evaluable women, 1130 (94.6%) had a pelvic mass on MRI with a reference standard (surgery, 768 [67.9%]; 2-year follow-up, 362 [32.1%]). A total of 203 patients (18.0%) had at least 1 malignant adnexal or nonadnexal pelvic mass. No invasive cancer was assigned a score of 2. Positive likelihood ratios were 0.01 for score 2, 0.27 for score 3, 4.42 for score 4, and 38.81 for score 5. Area under the receiver operating characteristic curve was 0.961 (95% CI, 0.948-0.971) among experienced readers, with a sensitivity of 0.93 (95% CI, 0.89-0.96; 189 of 203 patients) and a specificity of 0.91 (95% CI, 0.89-0.93; 848 of 927 patients). There was good interrater agreement among both experienced and junior readers (κ = 0.784
Rockall A, Schmid MP, Adam JA, 2020, Response assessment and follow-up by imaging in gyn tumours, Medical Radiology, Pages: 517-530
Imaging plays an important role in the staging and management of all main gynaecological tumours. Gynaecological tumours treated primarily with radiotherapy such as cervical, vaginal or vulvar cancer typically show considerable tumour shrinkage during treatment. Following the successful completion of initial treatment, there is no strong evidence to support posttreatment imaging surveillance of asymptomatic women. In general, gynaeco-oncological practice, the initial suspicion of disease relapse relies largely on clinical symptoms rather than radiological evidence. However, once clinical relapse is suspected, imaging plays a crucial role in planning salvage therapy. Typical treatment concepts in locally advanced (non-tubo-ovarian) gynaecological cancers consist of external beam radiotherapy (EBRT) and concomitant chemotherapy followed by brachytherapy. Due to the substantial tumour shrinkage during external beam radiotherapy, the GYN GEC-ESTRO group defined an adaptive target volume concept for MRI-based brachytherapy. So far, target concepts for cervical and vaginal cancer were elaborated. The integration of functional imaging into the delineation process could help to reduce interobserver variations and further differentiate subvolumes with increased risk for recurrence. In cervical cancer, MRI performed at 6 months post end of RT, the cervix should be normal or small in size and of low T2 signal intensity, with no evidence of restricted diffusion, to suggest a complete response. [18F]FDG PET/CT has been shown to be a strong predictor of patient outcome, with better survival outcomes in patients with a complete metabolic response. Imaging plays an essential role when recurrence is suspected. The initial steps will involve confirmation of the relapse, defining the extent of disease and determining the available treatment options. If there is no substrate for rising markers on CT or MRI, an [18F]FDG PET/CT should be performed due to its high sensitivity and spe
Lai AYT, Riddell A, Barwick T, et al., 2020, Interobserver agreement of whole-body magnetic resonance imaging is superior to whole-body computed tomography for assessing disease burden in patients with multiple myeloma, European Radiology, Vol: 30, Pages: 320-327, ISSN: 0938-7994
ObjectivesWhole-body MRI (WB-MRI) is recommended by the International Myeloma Working Group for all patients with asymptomatic myeloma and solitary plasmacytoma and by the UK NICE guidance for all patients with suspected myeloma. Some centres unable to offer WB-MRI offer low-dose whole-body CT (WB-CT). There are no studies comparing interobserver agreement and disease detection of contemporary WB-MRI (anatomical imaging and DWI) versus WB-CT. Our primary aim is to compare the interobserver agreement between WB-CT and WB-MRI in the diagnosis of myeloma.MethodsConsecutive patients with newly diagnosed myeloma imaged with WB-MRI and WB-CT were prospectively reviewed. For each body region and modality, two experienced and two junior radiologists scored disease burden with final scores by consensus. Intraclass correlation coefficients (ICC), median scores, Wilcoxon signed-rank test and Spearman’s correlation coefficients were calculated.ResultsThere was no significant difference in overall observer scores between WB-MRI and WB-CT (p = 0.87). For experienced observers, interobserver agreement for WB-MRI was superior to WB-CT overall and for each region, without overlap in whole-skeleton confidence intervals (ICC 0.98 versus 0.77, 95%CI 0.96–0.99 versus 0.45–0.91). For inexperienced observers, although there is a trend for a better interobserver score for the whole skeleton on WB-MRI (ICC 0.95, 95%CI 0.72–0.98) than on WB-CT (ICC 0.72, 95%CI 0.34–0.88), the confidence intervals overlap.ConclusionsWB-MRI offers excellent interobserver agreement which is superior to WB-CT for experienced observers. Although the overall burden was similar across both modalities, patients with lower disease burdens where MRI could be advantageous are not included in this series.
Rockall A, 2020, From hype to hope to hard work: developing responsible AI for radiology, CLINICAL RADIOLOGY, Vol: 75, Pages: 1-2, ISSN: 0009-9260
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- Citations: 5
Hameed M, Sandhu A, Soneji N, et al., 2020, Pictorial review of whole body MRI in myeloma: emphasis on diffusion-weighted imaging, BRITISH JOURNAL OF RADIOLOGY, Vol: 93, ISSN: 0007-1285
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Taylor SA, Mallett S, Miles A, et al., 2019, Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies., Health Technology Assessment, Vol: 23, Pages: 1-270, ISSN: 1366-5278
BACKGROUND: Whole-body magnetic resonance imaging is advocated as an alternative to standard pathways for staging cancer. OBJECTIVES: The objectives were to compare diagnostic accuracy, efficiency, patient acceptability, observer variability and cost-effectiveness of whole-body magnetic resonance imaging and standard pathways in staging newly diagnosed non-small-cell lung cancer (Streamline L) and colorectal cancer (Streamline C). DESIGN: The design was a prospective multicentre cohort study. SETTING: The setting was 16 NHS hospitals. PARTICIPANTS: Consecutive patients aged ≥ 18 years with histologically proven or suspected colorectal (Streamline C) or non-small-cell lung cancer (Streamline L). INTERVENTIONS: Whole-body magnetic resonance imaging. Standard staging investigations (e.g. computed tomography and positron emission tomography-computed tomography). REFERENCE STANDARD: Consensus panel decision using 12-month follow-up data. MAIN OUTCOME MEASURES: The primary outcome was per-patient sensitivity difference between whole-body magnetic resonance imaging and standard staging pathways for metastasis. Secondary outcomes included differences in specificity, the nature of the first major treatment decision, time and number of tests to complete staging, patient experience and cost-effectiveness. RESULTS: Streamline C - 299 participants were included. Per-patient sensitivity for metastatic disease was 67% (95% confidence interval 56% to 78%) and 63% (95% confidence interval 51% to 74%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -5% to 13%; p = 0.51). Specificity was 95% (95% confidence interval 92% to 97%) and 93% (95% confidence interval 90% to 96%) respectively, a difference of 2% (95% confidence interval -2% to 6%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 96% and 95% of cases, respectively, a differe
Miles A, Taylor SA, Evans REC, et al., 2019, Patient preferences for whole-body MRI or conventional staging pathways in lung and colorectal cancer: a discrete choice experiment, European Radiology, Vol: 29, Pages: 3889-3900, ISSN: 0938-7994
ObjectivesTo determine the importance placed by patients on attributes associated with whole-body MRI (WB-MRI) and standard cancer staging pathways and ascertain drivers of preference.MethodsPatients recruited to two multi-centre diagnostic accuracy trials comparing WB-MRI with standard staging pathways in lung and colorectal cancer were invited to complete a discrete choice experiment (DCE), choosing between a series of alternate pathways in which 6 attributes (accuracy, time to diagnosis, scan duration, whole-body enclosure, radiation exposure, total scan number) were varied systematically. Data were analysed using a conditional logit regression model and marginal rates of substitution computed. The relative importance of each attribute and probabilities of choosing WB-MRI-based pathways were estimated.ResultsA total of 138 patients (mean age 65, 61% male, lung n = 72, colorectal n = 66) participated (May 2015 to September 2016). Lung cancer patients valued time to diagnosis most highly, followed by accuracy, radiation exposure, number of scans, and time in the scanner. Colorectal cancer patients valued accuracy most highly, followed by time to diagnosis, radiation exposure, and number of scans. Patients were willing to wait 0.29 (lung) and 0.45 (colorectal) weeks for a 1% increase in pathway accuracy. Patients preferred WB-MRI-based pathways (probability 0.64 [lung], 0.66 [colorectal]) if they were equivalent in accuracy, total scan number, and time to diagnosis compared with a standard staging pathway.ConclusionsStaging pathways based on first-line WB-MRI are preferred by the majority of patients if they at least match standard pathways for diagnostic accuracy, time to diagnosis, and total scan number.
Taylor SA, Mallett S, Beare S, et al., 2019, Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial, Lancet Gastroenterology and Hepatology, Vol: 4, Pages: 529-537, ISSN: 2468-1253
BACKGROUND: Whole-body MRI (WB-MRI) could be an alternative to multimodality staging of colorectal cancer, but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in colorectal cancer. METHODS: The Streamline C trial was a prospective, multicentre trial done in 16 hospitals in England. Eligible patients were 18 years or older, with newly diagnosed colorectal cancer. Exclusion criteria were severe systemic disease, pregnancy, contraindications to MRI, or polyp cancer. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete and the first treatment decision made. The multidisciplinary team recorded its treatment decision based on standard investigations, then on the WB-MRI staging pathway (WB-MRI plus additional tests generated), and finally on all tests. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12 months, in the per-protocol population. Secondary outcomes were difference in per-patient specificity for metastatic disease detection between standard and WB-MRI staging pathways, differences in treatment decisions, staging efficiency (time taken, test number, and costs), and per-organ sensitivity and specificity for metastases and per-patient agreement for local T and N stage. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN43958015, and is complete. FINDINGS: Between March 26, 2013, and Aug 19, 2016, 1020 patients were screened for eligibility. 370 patients were recruited, 299 of whom completed the trial; 68 (23%) had metastasis at baseline. Pathway sensitivity was 67% (95% CI 56 to 78) for WB-MRI and 63% (51 to 74) for standard pathways
Gandy N, Arshad MA, Park W-HE, et al., 2019, FDG-PET Imaging in Cervical Cancer, Seminars in Nuclear Medicine, ISSN: 0001-2998
Taylor SA, Mallett S, Ball S, et al., 2019, Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed non-small-cell lung cancer: The prospective Streamline L trial., Lancet Respiratory Medicine, Vol: 7, Pages: 523-532, ISSN: 2213-2600
BACKGROUND: Whole-body magnetic resonance imaging (WB-MRI) could be an alternative to multi-modality staging of non-small-cell lung cancer (NSCLC), but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in NSCLC. METHODS: The Streamline L trial was a prospective, multicentre trial done in 16 hospitals in England. Eligible patients were 18 years or older, with newly diagnosed NSCLC that was potentially radically treatable on diagnostic chest CT (defined as stage IIIb or less). Exclusion criteria were severe systemic disease, pregnancy, contraindications to MRI, or histologies other than NSCLC. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete and the first treatment decision made. The multidisciplinary team recorded its treatment decision based on standard investigations, then on the WB-MRI staging pathway (WB-MRI plus additional tests generated), and finally on all tests. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12 months, in the per-protocol population. Secondary outcomes were difference in per-patient specificity for metastatic disease detection between standard and WB-MRI staging pathways, differences in treatment decisions, staging efficiency (time taken, test number, and costs) and per-organ sensitivity and specificity for metastases and per-patient agreement for local T and N stage. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN50436483, and is complete. FINDINGS: Between Feb 26, 2013, and Sept 5, 2016, 976 patients were screened for eligibility. 353 patients were recruited, 187 of whom completed the trial; 52 (28%)
Lu H, Arshad M, Thornton A, et al., 2019, A mathematical descriptor of tumour mesoscopic structure from computed tomography images annotates prognostic and molecular phenotypes of epithelial ovarian cancer, Publisher: WILEY, Pages: 89-89, ISSN: 1470-0328
Lavdas I, Glocker B, Rueckert D, et al., 2019, Machine learning in whole-body MRI: experiences and challenges from an applied study using multicentre data, Clinical Radiology, Vol: 74, Pages: 346-356, ISSN: 0009-9260
Machine learning is now being increasingly employed in radiology to assist with tasks such as automatic lesion detection, segmentation, and characterisation. We are currently involved in an National Institute of Health Research (NIHR)-funded project, which aims to develop machine learning methods to improve the diagnostic performance and reduce the radiology reading time of whole-body magnetic resonance imaging (MRI) scans, in patients being staged for cancer (MALIBO study). We describe here the main challenges we have encountered during the course of this project. Data quality and uniformity are the two most important data traits to be considered in clinical trials incorporating machine learning. Robust data pre-processing and machine learning pipelines have been employed in MALIBO, a task facilitated by the now freely available machine learning libraries and toolboxes. Another important consideration for achieving the desired clinical outcome in MALIBO, was to effectively host the resulting machine learning output, along with the clinical images, for reading in a clinical environment. Finally, a range of legal, ethical, and clinical acceptance issues should be considered when attempting to incorporate computer-assisting tools into clinical practice. The road from translating computational methods into potentially useful clinical tools involves an analytical, stepwise adaptation approach, as well as engagement of a multidisciplinary team.
Lu H, Arshad M, Thornton A, et al., 2019, A mathematical-descriptor of tumor-mesoscopic-structure from computed-tomography images annotates prognostic and molecular-phenotypes of epithelial ovarian cancer, Nature Communications, Vol: 10, ISSN: 2041-1723
The five-year survival rate of epithelial ovarian cancer (EOC) is approximately 35–40% despite maximal treatment efforts, highlighting a need for stratification biomarkers for personalized treatment. Here we extract 657 quantitative mathematical descriptors from the preoperative CT images of 364 EOC patients at their initial presentation. Using machine learning, we derive a non-invasive summary-statistic of the primary ovarian tumor based on 4 descriptors, which we name “Radiomic Prognostic Vector” (RPV). RPV reliably identifies the 5% of patients with median overall survival less than 2 years, significantly improves established prognostic methods, and is validated in two independent, multi-center cohorts. Furthermore, genetic, transcriptomic and proteomic analysis from two independent datasets elucidate that stromal phenotype and DNA damage response pathways are activated in RPV-stratified tumors. RPV and its associated analysis platform could be exploited to guide personalized therapy of EOC and is potentially transferrable to other cancer types.
Arshad MA, Thornton A, Lu H, et al., 2019, Discovery of pre-therapy 2-deoxy-2-F-18-fluoro-D-glucose positron emission tomography-based radiomics classifiers of survival outcome in non-small-cell lung cancer patients, European Journal of Nuclear Medicine and Molecular Imaging, Vol: 46, Pages: 455-466, ISSN: 0340-6997
PurposeThe aim of this multi-center study was to discover and validate radiomics classifiers as image-derived biomarkers for risk stratification of non-small-cell lung cancer (NSCLC).Patients and methodsPre-therapy PET scans from a total of 358 Stage I–III NSCLC patients scheduled for radiotherapy/chemo-radiotherapy acquired between October 2008 and December 2013 were included in this seven-institution study. A semi-automatic threshold method was used to segment the primary tumors. Radiomics predictive classifiers were derived from a training set of 133 scans using TexLAB v2. Least absolute shrinkage and selection operator (LASSO) regression analysis was used for data dimension reduction and radiomics feature vector (FV) discovery. Multivariable analysis was performed to establish the relationship between FV, stage and overall survival (OS). Performance of the optimal FV was tested in an independent validation set of 204 patients, and a further independent set of 21 (TESTI) patients.ResultsOf 358 patients, 249 died within the follow-up period [median 22 (range 0–85) months]. From each primary tumor, 665 three-dimensional radiomics features from each of seven gray levels were extracted. The most predictive feature vector discovered (FVX) was independent of known prognostic factors, such as stage and tumor volume, and of interest to multi-center studies, invariant to the type of PET/CT manufacturer. Using the median cut-off, FVX predicted a 14-month survival difference in the validation cohort (N = 204, p = 0.00465; HR = 1.61, 95% CI 1.16–2.24). In the TESTI cohort, a smaller cohort that presented with unusually poor survival of stage I cancers, FVX correctly indicated a lack of survival difference (N = 21, p = 0.501). In contrast to the radiomics classifier, clinically routine PET variables including SUVmax, SUVmean and SUVpeak lacked any prognostic information.ConclusionPET-based radiomics classifiers deriv
Nougaret S, Horta M, Sala E, et al., 2019, Endometrial Cancer MRI staging: Updated Guidelines of the European Society of Urogenital Radiology, EUROPEAN RADIOLOGY, Vol: 29, Pages: 792-805, ISSN: 0938-7994
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- Citations: 125
Castellani F, Nganga EC, Dumas L, et al., 2019, Imaging in the pre-operative staging of ovarian cancer, Abdominal Radiology, ISSN: 2366-004X
© 2018, Springer Science+Business Media, LLC, part of Springer Nature. The main prognostic factor in ovarian cancer is the stage of disease at diagnosis. The staging system in use (FIGO classification, updated in 2014) is based on the surgical-pathological findings. Although surgical staging is the gold standard in ovarian cancer, the initial patient management depends on the imaging-based pre-surgical staging assessment, in order to identify unresectable or difficult to resect disease. Radiologists need to be aware of the strengths of the available imaging modalities, as well as the imaging pitfalls. Clear understanding of pattern of disease spread and review areas are critical for accurate staging and treatment planning. The current standard of care for pre-surgical staging is CT of the thorax, abdomen, and pelvis. This allows a rapid evaluation of disease extent and is fairly accurate in identifying bulky disease but has definite limitations in assessing the extent of small volume disease and in the confirmation of certain sites of disease beyond the abdomen. Functional MRI has been reported to be superior in detecting small peritoneal deposits. PET/CT may be used as a problem-solving tool in some patients where determination remains unclear, particularly in confirmation of advanced stage beyond the abdomen.
The European Institute for Biomedical Imaging Research EIBIR, 2019, Strategic research agenda for biomedical imaging, INSIGHTS INTO IMAGING, Vol: 10, Pages: 1-14, ISSN: 1869-4101
This Strategic Research Agenda identifies current challenges and needs in healthcare, illustrates how biomedical imaging and derived data can help to address these, and aims to stimulate dedicated research funding efforts.Medicine is currently moving towards a more tailored, patient-centric approach by providing personalised solutions for the individual patient. Innovation in biomedical imaging plays a key role in this process as it addresses the current needs for individualised prevention, treatment, therapy response monitoring, and image-guided surgery.The use of non-invasive biomarkers facilitates better therapy prediction and monitoring, leading to improved patient outcomes. Innovative diagnostic imaging technologies provide information about disease characteristics which, coupled with biological, genetic and -omics data, will contribute to an individualised diagnosis and therapy approach.In the emerging field of theranostics, imaging tools together with therapeutic agents enable the selection of best treatments and allow tailored therapeutic interventions.For prenatal monitoring, the use of innovative imaging technologies can ensure an early detection of malfunctions or disease.The application of biomedical imaging for diagnosis and management of lifestyle-induced diseases will help to avoid disease development through lifestyle changes.Artificial intelligence and machine learning in imaging will facilitate the improvement of image interpretation and lead to better disease prediction and therapy planning.As biomedical imaging technologies and analysis of existing imaging data provide solutions to current challenges and needs in healthcare, appropriate funding for dedicated research is needed to implement the innovative approaches for the wellbeing of citizens and patients.
Davis A, Rockall A, 2019, Acute and chronic pelvic pain disorders, Medical Radiology, Pages: 381-405
This chapter will cover common gynecological and non-gynecological causes of acute and chronic pelvic pain, with particular focus on the differential diagnosis and imaging characteristics. The relative frequency of each diagnosis by MRI or CT is listed in Table 1. Gynecologic disorders highly associated with chronic pelvic pain such as endometriosis, uterine leiomyomas, and adenomyosis are discussed in previous chapters in this book.
Barwick T, Bretsztajn L, Wallitt K, et al., 2019, Imaging in myeloma with focus on advanced imaging techniques., British Journal of Radiology, Vol: 92, Pages: 1-13, ISSN: 0007-1285
In recent years, there have been major advances in the imaging of myeloma with whole body MRI incorporating diffusion-weighted imaging, emerging as the most sensitive modality. Imaging is now a key component in the work-up of patients with a suspected diagnosis of myeloma. The International Myeloma Working Group now specifies that more than one focal lesion on MRI or lytic lesion on whole body low-dose CT or fludeoxyglucose (FDG) PET/CT fulfil the criteria for bone damage requiring therapy. The recent National Institute for Health and Care Excellence myeloma guidelines recommend imaging in all patients with suspected myeloma. In addition, there is emerging data supporting the use of functional imaging techniques (WB-DW MRI and FDG PET/CT) to predict outcome and evaluate response to therapy. This review summarises the imaging modalities used in myeloma, the latest guidelines relevant to imaging and future directions.
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