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Register a new userImproving Prognostic Performance in Resectable Pancreatic Ductal Adenocarcinoma using Radiomics and Deep Learning Features Fusion in CT Images
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As an analytic pipeline for quantitative imaging feature extraction and analysis, radiomics has grown rapidly in the past a few years. Recent studies in radiomics aim to investigate the relationship between tumors imaging features and clinical outcomes. Open source radiomics feature banks enable the extraction and analysis of thousands of predefined features. On the other hand, recent advances in deep learning have shown significant potential in the quantitative medical imaging field, raising the research question of whether predefined radiomics features have predictive information in addition to deep learning features. In this study, we propose a feature fusion method and investigate whether a combined feature bank of deep learning and predefined radiomics features can improve the prognostics performance. CT images from resectable Pancreatic Adenocarcinoma (PDAC) patients were used to compare the prognosis performance of common feature reduction and fusion methods and the proposed risk-score based feature fusion method for overall survival. It was shown that the proposed feature fusion method significantly improves the prognosis performance for overall survival in resectable PDAC cohorts, elevating the area under ROC curve by 51% compared to predefined radiomics features alone, by 16% compared to deep learning features alone, and by 32% compared to existing feature fusion and reduction methods for a combination of deep learning and predefined radiomics features.
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Cox proportional hazard model (CPH) is commonly used in clinical research for survival analysis. In quantitative medical imaging (radiomics) studies, CPH plays an important role in feature reduction and modeling. However, the underlying linear assumption of CPH model limits the prognostic performance. In addition, the multicollinearity of radiomic features and multiple testing problem further impedes the CPH models performance. In this work, using transfer learning, a convolutional neural network (CNN) based survival model was built and tested on preoperative CT images of resectable Pancreatic Ductal Adenocarcinoma (PDAC) patients. The proposed CNN-based survival model outperformed the traditional CPH-based radiomics approach in terms of concordance index by 22%, providing a better fit for patients survival patterns. The proposed CNN-based survival model outperforms CPH-based radiomics pipeline in PDAC prognosis. This approach offers a better fit for survival patterns based on CT images and overcomes the limitations of conventional survival models.
Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers among the population. Screening for PDACs in dynamic contrast-enhanced CT is beneficial for early diagnosis. In this paper, we investigate the problem of automated detecting PDACs in multi-phase (arterial and venous) CT scans. Multiple phases provide more information than single phase, but they are unaligned and inhomogeneous in texture, making it difficult to combine cross-phase information seamlessly. We study multiple phase alignment strategies, i.e., early alignment (image registration), late alignment (high-level feature registration), and slow alignment (multi-level feature registration), and suggest an ensemble of all these alignments as a promising way to boost the performance of PDAC detection. We provide an extensive empirical evaluation on two PDAC datasets and show that the proposed alignment ensemble significantly outperforms previous state-of-the-art approaches, illustrating the strong potential for clinical use.
As a means to extract biomarkers from medical imaging, radiomics has attracted increased attention from researchers. However, reproducibility and performance of radiomics in low dose CT scans are still poor, mostly due to noise. Deep learning generative models can be used to denoise these images and in turn improve radiomics reproducibility and performance. However, most generative models are trained on paired data, which can be difficult or impossible to collect. In this article, we investigate the possibility of denoising low dose CTs using cycle generative adversarial networks (GANs) to improve radiomics reproducibility and performance based on unpaired datasets. Two cycle GANs were trained: 1) from paired data, by simulating low dose CTs (i.e., introducing noise) from high dose CTs; and 2) from unpaired real low dose CTs. To accelerate convergence, during GAN training, a slice-paired training strategy was introduced. The trained GANs were applied to three scenarios: 1) improving radiomics reproducibility in simulated low dose CT images and 2) same-day repeat low dose CTs (RIDER dataset) and 3) improving radiomics performance in survival prediction. Cycle GAN results were compared with a conditional GAN (CGAN) and an encoder-decoder network (EDN) trained on simulated paired data.The cycle GAN trained on simulated data improved concordance correlation coefficients (CCC) of radiomic features from 0.87 to 0.93 on simulated noise CT and from 0.89 to 0.92 on RIDER dataset, as well improving the AUC of survival prediction from 0.52 to 0.59. The cycle GAN trained on real data increased the CCCs of features in RIDER to 0.95 and the AUC of survival prediction to 0.58. The results show that cycle GANs trained on both simulated and real data can improve radiomics reproducibility and performance in low dose CT and achieve similar results compared to CGANs and EDNs.
Accurate and automated tumor segmentation is highly desired since it has the great potential to increase the efficiency and reproducibility of computing more complete tumor measurements and imaging biomarkers, comparing to (often partial) human measurements. This is probably the only viable means to enable the large-scale clinical oncology patient studies that utilize medical imaging. Deep learning approaches have shown robust segmentation performances for certain types of tumors, e.g., brain tumors in MRI imaging, when a training dataset with plenty of pixel-level fully-annotated tumor images is available. However, more than often, we are facing the challenge that only (very) limited annotations are feasible to acquire, especially for hard tumors. Pancreatic ductal adenocarcinoma (PDAC) segmentation is one of the most challenging tumor segmentation tasks, yet critically important for clinical needs. Previous work on PDAC segmentation is limited to the moderate amounts of annotated patient images (n<300) from venous or venous+arterial phase CT scans. Based on a new self-learning framework, we propose to train the PDAC segmentation model using a much larger quantity of patients (n~=1,000), with a mix of annotated and un-annotated venous or multi-phase CT images. Pseudo annotations are generated by combining two teacher models with different PDAC segmentation specialties on unannotated images, and can be further refined by a teaching assistant model that identifies associated vessels around the pancreas. A student model is trained on both manual and pseudo annotated multi-phase images. Experiment results show that our proposed method provides an absolute improvement of 6.3% Dice score over the strong baseline of nnUNet trained on annotated images, achieving the performance (Dice = 0.71) similar to the inter-observer variability between radiologists.
Radiomics is an active area of research focusing on high throughput feature extraction from medical images with a wide array of applications in clinical practice, such as clinical decision support in oncology. However, noise in low dose computed tomography (CT) scans can impair the accurate extraction of radiomic features. In this article, we investigate the possibility of using deep learning generative models to improve the performance of radiomics from low dose CTs. We used two datasets of low dose CT scans -NSCLC Radiogenomics and LIDC-IDRI - as test datasets for two tasks - pre-treatment survival prediction and lung cancer diagnosis. We used encoder-decoder networks and conditional generative adversarial networks (CGANs) trained in a previous study as generative models to transform low dose CT images into full dose CT images. Radiomic features extracted from the original and improved CT scans were used to build two classifiers - a support vector machine (SVM) and a deep attention based multiple instance learning model - for survival prediction and lung cancer diagnosis respectively. Finally, we compared the performance of the models derived from the original and improved CT scans. Encoder-decoder networks and CGANs improved the area under the curve (AUC) of survival prediction from 0.52 to 0.57 (p-value<0.01). On the other hand, Encoder-decoder network and CGAN can improve the AUC of lung cancer diagnosis from 0.84 to 0.88 and 0.89 respectively (p-value<0.01). Moreover, there are no statistically significant differences in improving AUC by using encoder-decoder network and CGAN (p-value=0.34) when networks trained at 75 and 100 epochs. Generative models can improve the performance of low dose CT-based radiomics in different tasks. Hence, denoising using generative models seems to be a necessary pre-processing step for calculating radiomic features from low dose CTs.
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