| 1. |
- Bradley, William G, et al.
(författare)
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Globalization of P4 Medicine: Predictive, Personalized, Preemptive, and Participatory-Summary of the Proceedings of the Eighth International Symposium of the International Society for Strategic Studies in Radiology, August 27-29, 2009
- 2011
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Ingår i: RADIOLOGY. - : Radiological Society of North America. - 0033-8419 .- 1527-1315. ; 258:2, s. 571-582
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Tidskriftsartikel (refereegranskat)abstract
- In August 2009, the International Society for Strategic Studies in Radiology held its eighth biennial meeting. The program focused on the globalization of predictive medicine-or P4 medicine-as it relates to the practice of radiology and radiology research. P4 medicine refers to predictive, personalized, preemptive, and participatory medicine and was the inspiration of Elias Zerhouni, MD, former director of the National Institutes of Health. This article is a summary of some of the key concepts presented at the meeting by an international group of radiologists, imaging scientists, and leaders of industry. In predictive medicine, imaging and imaging-related technologies will likely play an increasing role in the early detection of disease and, thus, the preemption of the development of advanced, hard-to-treat disease. Research into systems biology and molecular imaging promises to personalize medicine, facilitating the provision of the right care to the right patient at the right time. In participatory medicine, increasing interactions with referring physicians and patients will be helpful in raising awareness and recognition of the role of radiologists and will have a positive effect on professionalism. There is also a need to increase awareness of the vital role of radiologists as imaging and radiation safety experts who evaluate the necessity and appropriateness of examinations, monitor performance quality, and are available for postexamination consultations.
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| 2. |
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| 3. |
- Häggström, Ida, 1982, et al.
(författare)
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Deep learning for [ 18 F]fluorodeoxyglucose-PET-CT classification in patients with lymphoma: a dual-centre retrospective analysis
- 2024
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Ingår i: The Lancet Digital Health. - 2589-7500. ; 6:2, s. e114-e125
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Tidskriftsartikel (refereegranskat)abstract
- Background : The rising global cancer burden has led to an increasing demand for imaging tests such as [18F]fluorodeoxyglucose ([18F]FDG)-PET-CT. To aid imaging specialists in dealing with high scan volumes, we aimed to train a deep learning artificial intelligence algorithm to classify [18F]FDG-PET-CT scans of patients with lymphoma with or without hypermetabolic tumour sites. Methods : In this retrospective analysis we collected 16 583 [18F]FDG-PET-CTs of 5072 patients with lymphoma who had undergone PET-CT before or after treatment at the Memorial Sloa Kettering Cancer Center, New York, NY, USA. Using maximum intensity projection (MIP), three dimensional (3D) PET, and 3D CT data, our ResNet34-based deep learning model (Lymphoma Artificial Reader System [LARS]) for [18F]FDG-PET-CT binary classification (Deauville 1–3 vs 4–5), was trained on 80% of the dataset, and tested on 20% of this dataset. For external testing, 1000 [18F]FDG-PET-CTs were obtained from a second centre (Medical University of Vienna, Vienna, Austria). Seven model variants were evaluated, including MIP-based LARS-avg (optimised for accuracy) and LARS-max (optimised for sensitivity), and 3D PET-CT-based LARS-ptct. Following expert curation, areas under the curve (AUCs), accuracies, sensitivities, and specificities were calculated. Findings : In the internal test cohort (3325 PET-CTs, 1012 patients), LARS-avg achieved an AUC of 0·949 (95% CI 0·942–0·956), accuracy of 0·890 (0·879–0·901), sensitivity of 0·868 (0·851–0·885), and specificity of 0·913 (0·899–0·925); LARS-max achieved an AUC of 0·949 (0·942–0·956), accuracy of 0·868 (0·858–0·879), sensitivity of 0·909 (0·896–0·924), and specificity of 0·826 (0·808–0·843); and LARS-ptct achieved an AUC of 0·939 (0·930–0·948), accuracy of 0·875 (0·864–0·887), sensitivity of 0·836 (0·817–0·855), and specificity of 0·915 (0·901–0·927). In the external test cohort (1000 PET-CTs, 503 patients), LARS-avg achieved an AUC of 0·953 (0·938–0·966), accuracy of 0·907 (0·888–0·925), sensitivity of 0·874 (0·843–0·904), and specificity of 0·949 (0·921–0·960); LARS-max achieved an AUC of 0·952 (0·937–0·965), accuracy of 0·898 (0·878–0·916), sensitivity of 0·899 (0·871–0·926), and specificity of 0·897 (0·871–0·922); and LARS-ptct achieved an AUC of 0·932 (0·915–0·948), accuracy of 0·870 (0·850–0·891), sensitivity of 0·827 (0·793–0·863), and specificity of 0·913 (0·889–0·937). Interpretation : Deep learning accurately distinguishes between [18F]FDG-PET-CT scans of lymphoma patients with and without hypermetabolic tumour sites. Deep learning might therefore be potentially useful to rule out the presence of metabolically active disease in such patients, or serve as a second reader or decision support tool. Funding: National Institutes of Health-National Cancer Institute Cancer Center Support Grant.
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| 4. |
- Sciarra, Alessandro, et al.
(författare)
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Advances in Magnetic Resonance Imaging: How They Are Changing the Management of Prostate Cancer
- 2011
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Ingår i: European Urology. - : Elsevier BV. - 1873-7560 .- 0302-2838. ; 59:6, s. 962-977
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Forskningsöversikt (refereegranskat)abstract
- Context: Although magnetic resonance imaging (MRI) is emerging as the most commonly used imaging modality for prostate cancer (PCa) detection, treatment planning, and follow-up, its acceptance has not been uniform. Recently, great interest has been shown in multiparametric MRI, which combines anatomic T2-weighted (T2W) imaging with MR spectroscopic imaging (MRSI), dynamic contrast-enhanced MRI (DCE-MRI), and diffusion-weighted imaging (DWI). Objective: The aim of this article is to review the current roles of these MR techniques in different aspects of PCa management: initial diagnosis, biopsy strategies, planning of radical prostatectomy (RP) and external radiation therapy (RT), and implementation of alternative focal therapies. Evidence acquisition: The authors searched the Medline and Cochrane Library databases (primary fields: prostatic neoplasm, magnetic resonance). The search was performed without language restriction from January 2008 to November 2010. Evidence synthesis: Initial diagnosis: The data suggest that the combination of T2W MRI and DWI or MRSI with DCE-MRI has the potential to guide biopsy to the most aggressive cancer foci in patients with previously negative biopsies, increasing the accuracy of the procedure. Transrectal MR-guided prostate biopsy can improve PCa detection, but its availability is still limited and the examination time is rather long. Planning of RP: It appears that adding MRSI, DWI, and/or DCE-MRI to T2W MRI can facilitate better preoperative characterization of cancer with regard to location, size, and relationship to prostatic and extraprostatic structures, and it may also facilitate early detection of local recurrence. Thus, use of these MR techniques may improve surgical, oncologic, and functional management. Planning of external RT and focal therapies: MR techniques have similar potential in these areas, but the published data remain very limited. Conclusions: MRI technology is continuously evolving, and more extensive use of MRI technology in clinical trials and practice will help to improve PCa diagnosis and treatment planning. (C) 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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| 5. |
- Seitz, Michael, et al.
(författare)
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Functional Magnetic Resonance Imaging in Prostate Cancer
- 2009
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Ingår i: European Urology. - : Elsevier BV. - 1873-7560 .- 0302-2838. ; 55:4, s. 801-814
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Tidskriftsartikel (refereegranskat)abstract
- Context: Magnetic resonance imaging (MRI) combined with magnetic resonance spectroscopy imaging (MRSI), dynamic contrast-enhanced MRI, and diffusion-weighted MRI emerged as promising tests in the diagnosis of prostate cancer, and they show encouraging results. Objective: This review emphasizes different functional MRI techniques in the diagnosis of prostate cancer and includes information about their clinical value and usefulness. Evidence acquisition: The authors searched the Medline, Embase, and Cochrane Library databases. There were no language restrictions. The last search was performed in October 2008. Evidence synthesis: The combination of conventional MRI with functional MRI techniques is more reliable for differentiating benign and malignant prostate tissues than any other diagnostic procedure. At present, no guideline is available that outlines which technique is best in a specific clinical situation. It also remains uncertain whether improved spatial resolution and signal-to-noise ratio of 3-T MRI will improve diagnostic performance. Conclusions: A limited number of small studies suggest that functional MRI may improve the diagnosis and staging of prostate cancer. This finding needs further confirmation in larger studies, and cost-effectiveness needs to be established. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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| 6. |
- Vargas, Hebert Alberto, et al.
(författare)
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Bone Metastases in Castration-Resistant Prostate Cancer : Associations between Morphologic CT Patterns, Glycolytic Activity, and Androgen Receptor Expression on PET and Overall Survival
- 2014
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Ingår i: Radiology. - : Radiological Society of North America (RSNA). - 0033-8419 .- 1527-1315. ; 271:1, s. 220-229
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To compare the features of bone metastases at computed tomography (CT) to tracer uptake at fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and fluorine 18 16 beta-fluoro-5-dihydrotestosterone (FDHT) PET and to determine associations between these imaging features and overall survival in men with castration-resistant prostate cancer. Materials and Methods: This is a retrospective study of 38 patients with castration- resistant prostate cancer. Two readers independently evaluated CT, FDG PET, and FDHT PET features of bone metastases. Associations between imaging findings and overall survival were determined by using univariate Cox proportional hazards regression. Results: n 38 patients, reader 1 detected 881 lesions and reader 2 detected 867 lesions. Attenuation coefficients at CT correlated inversely with FDG (reader 1: r = -0.3007; P < .001; reader 2: r = -0.3147; P < .001) and FDHT (reader 1: r = -0.2680; P = .001; reader 2: r = -0.3656; P < .001) uptake. The number of lesions on CT scans was significantly associated with overall survival (reader 1: hazard ratio [HR], 1.025; P = .05; reader 2: HR, 1.021; P = .04). The numbers of lesions on FDG and FDHT PET scans were significantly associated with overall survival for reader 1 (HR, 1.051-1.109; P < .001) and reader 2 (HR, 1.026-1.082; P <= .009). Patients with higher FDHT uptake (lesion with the highest maximum standardized uptake value) had significantly shorter overall survival (reader 1: HR, 1.078; P = .02; reader 2: HR, 1.092; P =.02). FDG uptake intensity was not associated with overall survival (reader 1, P = .65; reader 2, P = .38). Conculsion: In patients with castration-resistant prostate cancer, numbers of bone lesions on CT, FDG PET, and FDHT PET scans and the intensity of FDHT uptake are significantly associated with overall survival.
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| 7. |
- Vargas, Hebert Alberto, et al.
(författare)
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Response.
- 2015
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Ingår i: Radiology. - 0033-8419 .- 1527-1315. ; 274:2
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Tidskriftsartikel (refereegranskat)
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