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| 2. |
- Kaboteh, Reza, et al.
(författare)
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Convolutional neural network based quantification of choline uptake in PET/CT studies is associated with overall survival in patients with prostate cancer
- 2017
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Ingår i: European Journal of Nuclear Medicine and Molecular Imaging. - 1619-7070 .- 1619-7089. ; 44:supplement 2
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Tidskriftsartikel (refereegranskat)abstract
- Aim : To develop a convolutional neural network (CNN) based automated method for quantification of 18F-choline uptake in the prostate gland in PET/CT studies and to study the association between this measure, clinical data and overall survival in patients with prostate cancer. Methods : A CNN was trained to segment the prostate gland in CT images using manual segmentations performed by a radiologist in a group of 100 patients, who had undergone 18F-FDG PET/CT. After the training process, the CNN automatically segmented the prostate gland in the CT images and SUV values in the corresponding PET images were automatically analyzed in a separate validation group consisting of 45 patients with biopsy-proven hormone-naïve prostate cancer. All patients had undergone an 18F-choline PET/CT as part of a previous research project. Voxels localized in the prostate gland and having a SUV >2.65 were defined as abnormal, as proposed by Reske S et al. (2006). Automated calculation of the following five PET measurements was performed: maximal SUV within the prostate gland - SUVmax; average SUV for voxels with SUV >2.65 - SUVmean; volume of voxels with SUV >2.65 - VOL; fraction of VOL related to the whole volume of the prostate gland - FRAC; product SUVmean x FRAC defined as Total Lesion Uptake - TLU. The association between the automated PET measurements, age, PSA, Gleason score and overall survival (OS) was evaluated using a univariate Cox proportional hazards regression model. Kaplan-Meier analysis was used to estimate the survival difference (log-rank test). Results : TLU and FRAC were significantly associated with OS in the Cox analysis while the other three PET measurements; age, PSA and Gleason score were not. Kaplan-Meier analysis showed that patients with SUVmax <5.3, SUVmean <3.5 and TLU <1 showed significantly longer survival times than patients with values higher than these thresholds. No significant differences were found when patients were stratified based on the other two PET measurements, PSA or Gleason score. Conclusion : Measurements reflecting 18F-choline PET uptake in the prostate gland obtained using a completely automated method were significantly associated with OS in patients with hormone-naïve prostate cancer. This type of objective quantification of PET/CT studies could be of value also for other PET tracers and other cancers in the future.
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| 3. |
- Kaboteh, Reza, et al.
(författare)
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Evaluation of changes in Bone Scan Index at different acquisition time-points in bone scintigraphy
- 2018
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Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961. ; 38:6, s. 1015-1020
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Tidskriftsartikel (refereegranskat)abstract
- Bone Scan Index (BSI) is a validated imaging biomarker to objectively assess tumour burden in bone in patients with prostate cancer, and can be used to monitor treatment response. It is not known if BSI is significantly altered when images are acquired at a time difference of 1h. The aim of this study was to investigate if automatic calculation of BSI is affected when images are acquired 1hour apart, after approximately 3 and 4h. We prospectively studied patients with prostate cancer who were referred for bone scintigraphy according to clinical routine. The patients performed a whole-body bone scan at approximately 3h after injection of radiolabelled bisphosphonate and a second 1h after the first. BSI values for each bone scintigraphy were obtained using EXINI bone(BSI) software. A total of 25 patients were included. Median BSI for the first acquisition was 005 (range 0-1193) and for the second acquisition 021 (range 0-1306). There was a statistically significant increase in BSI at the second image acquisition compared to the first (P<0001). In seven of 25 patients (28%) and in seven of 13 patients with BSI>0 (54%), a clinically significant increase (>03) was observed. The time between injection and scanning should be fixed when changes in BSI are important, for example when monitoring therapeutic efficacy.
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| 4. |
- Kalderstam, Jonas, et al.
(författare)
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Analysis of regional bone scan index measurements for the survival of patients with prostate cancer.
- 2014
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Ingår i: BMC Medical Imaging. - : Springer Science and Business Media LLC. - 1471-2342. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- A bone scan is a common method for monitoring bone metastases in patients with advanced prostate cancer. The Bone Scan Index (BSI) measures the tumor burden on the skeleton, expressed as a percentage of the total skeletal mass. Previous studies have shown that BSI is associated with survival of prostate cancer patients. The objective in this study was to investigate to what extent regional BSI measurements, as obtained by an automated method, can improve the survival analysis for advanced prostate cancer.
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| 5. |
- Levren, Gabriella, et al.
(författare)
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Relation between pain and skeletal metastasis in patients with prostate or breast cancer
- 2011
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Ingår i: Clinical Physiology and Functional Imaging. - 1475-0961. ; 31:3, s. 193-195
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to examine the relation between pain and bone metastases in a group of patients with prostate or breast cancer that had been referred for bone scintigraphy. Whole-body bone scans, anterior and posterior views obtained with a dual detector gamma camera were studied from 101 consecutive patients who had undergone scintigraphy (600 MBq Tc-99m MDP) because of suspected bone metastatic disease. At the time of the examination, all patients were asked whether they felt any pain or had recently a trauma. This information was correlated with the classifications regarding the presence or absence of bone metastases made by a group of three experienced physicians. In patients with prostate cancer, we found metastases in 47% (18/38) of the patients with pain, but only in 12% (2/17) of the patients without pain (p = 0·01). In patients with breast cancer, on the other hand, metastases were more common in patients without pain (71%; 10/14) than in patients with pain (34%; 11/32) (p = 0·02). In conclusion, a significant relation between pain and skeletal metastases could be found in patients with prostate cancer and a reverse relation in patients with breast cancer.
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| 6. |
- Lind, Erica, et al.
(författare)
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Automated quantification of reference levels in liver and mediastinum (blood pool) for the Deauville therapy response classification using FDG-PET/CT in lymphoma patients
- 2017
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Ingår i: European Journal of Nuclear Medicine and Molecular Imaging. - 1619-7070 .- 1619-7089. ; 44:supplement 2
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Tidskriftsartikel (refereegranskat)abstract
- Aim : To develop and validate a convolutional neural network (CNN) based method for automated quantification of reference levels in liver and mediastinum (blood pool) for the Deauville therapy response classification using FDG-PET/CT in lymphoma patients. Methods : CNNs were trained to segment the liver and the mediastinum, defined as the thoracic part of the aorta, in CT images from 81 consecutive lymphoma patients, who had undergone FDG-PET/CT examinations. Trained image readers segmented the liver and aorta manually in each of the CT images and these segmentations together with the CT images were used to train the CNN. After the training process, the CNN method was applied to a separate validation group consisting of six consecutive lymphoma patients (17-82 years, 3 female). First, the liver and mediastinum were automatically segmented in the CT images. Second, voxels in the corresponding FDG-PET images, which were localized in the liver and mediastinum, were selected and the median standard uptake value (SUV) was calculated. The CNN based analysis was compared to corresponding manual segmentations by two experienced radiologists. The Dice index was used to analyse the overlap between the segmentations by the CNN and the two radiologists. A Dice index of 1.00 indicates perfect matching. Results : The mean Dice indices for the comparison between CNN based liver segmentations and those of the two radiologists in the validation group were 0.95 and 0.95. A corresponding comparison between the two radiologists also resulted in a Dice index of 0.95. The mean liver volumes were 1,752ml, 1,757ml and 1,768ml for the CNN and two radiologists, respectively. The median SUV for the liver was on average 1.8 and the differences between median SUV based on CNN and manual segmentations were less or equal to 0.1. The mean Dice indices for the mediastinum were 0.80, 0.83 (CNN vs radiologists) and 0.86 (comparing the two radiologists). The mean mediastinum (aorta) volumes were 147ml, 140ml and 125ml for the CNN and two radiologists, respectively. The median SUV for the mediastinum was on average 1.4 and the differences between median SUV based on CNN and manual segmentations were less or equal to 0.14. Conclusion : A CNN based method for automated quantification of reference levels in liver and mediastinum show good agreement with results obtained by experienced radiologists, who manually segmented the CT images. This is a first and promising step towards a completely objective treatment response evaluation in patients with lymphoma based on FDG-PET/CT.
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| 7. |
- Lindgren Belal, Sarah, et al.
(författare)
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Association of PET index quantifying skeletal uptake in NaF PET/CT images with overall survival in prostate cancer patients
- 2017
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Ingår i: Journal of Clinical Oncology. - 0732-183X. ; 35:6 Suppl, s. 178-178
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Konferensbidrag (refereegranskat)abstract
- Background: Bone Scan Index (BSI) derived from 2D whole-body bone scans is considered an imaging biomarker of bone metastases burden carrying prognostic information. Sodium fluoride (NaF) PET/CT is more sensitive than bone scan in detecting bone changes due to metastases. We aimed to develop a semi-quantitative PET index similar to the BSI for NaF PET/CT imaging and to study its relationship to BSI and overall survival in patients with prostate cancer.Methods: NaF PET/CT and bone scans were analyzed in 48 patients (aged 53-92 years) with prostate cancer. Thoracic and lumbar spines, sacrum, pelvis, ribs, scapulae, clavicles, and sternum were automatically segmented from the CT images, representing approximately 1/3 of the total skeletal volume. Hotspots in the PET images, within the segmented parts in the CT images, were visually classified and hotspots interpreted as metastases were included in the analysis. The PET index was defined as the quotient obtained as the hotspot volume from the PET images divided by the segmented bone tissue volume from the CT images. BSI was automatically calculated using EXINIboneBSI.Results: The correlation between the PET index and BSI was r2= 0.54. The median BSI was 0.39 (IQR 0.08-2.05). The patients with a BSI ≥ 0.39 had a significantly shorter median survival time than patients with a BSI < 0.39 (2.3 years vs. not reached after 5 years). BSI was significantly associated with overall survival (HR 1.13, 95% CI 1.13 to 1.41; p < 0.001), and the C-index was 0.68. The median PET index was 0.53 (IQR 0.02-2.62). The patients with a PET index ≥ 0.53 had a significantly shorter median survival time than patients with a PET index < 0.53 (2.5 years vs. not reached after 5 years). The PET index was significantly associated with overall survival (HR 1.18, 95% CI 1.01 to 1.30; p < 0.001) and C-index was 0.68.Conclusions: PET index based on NaF PET/CT images was correlated to BSI and significantly associated with overall survival in patients with prostate cancer. Further studies are needed to evaluate the clinical value of this novel 3D PET index as a possible future imaging biomarker.
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| 8. |
- Ohlsson, Mattias, et al.
(författare)
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Automated Decision Support for Bone Scintigraphy
- 2009
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Ingår i: 2009 22nd IEEE International Symposium on Computer-Based Medical Systems. - 1063-7125. - 9781424448791 ; , s. 298-303
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Konferensbidrag (refereegranskat)abstract
- A quantitative analysis of metastatic bone involvement can be an important prognostic indicator of survival or a tool in monitoring treatment response in patients with cancer The purpose of this study was to develop a completely automated decision support system for whole-body bone scans using image analysis and artificial neural networks. The study population consisted of 795 whole-body bone scans. The decision support system first detects and classifies individual hotspots as being metastatic or not. A second prediction model then classifies the scan regarding metastatic disease on a patient level. The test set sensitivity and specificity was 95% and 64% respectively, corresponding to 95% area under the receiver operating characteristics curve.
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| 9. |
- Reza, Mariana, et al.
(författare)
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A prospective study to evaluate the intra-individual reproducibility of bone scans for quantitative assessment in patients with metastatic prostate cancer
- 2018
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Ingår i: BMC Medical Imaging. - : Springer Science and Business Media LLC. - 1471-2342. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Bone Scan Index (BSI) is used to quantitatively assess the total tumour burden in bone scans of patients with metastatic prostate cancer. The clinical utility of BSI has recently been validated as a prognostic imaging biomarker. However, the clinical utility of the on-treatment change in BSI is dependent on the reproducibility of bone scans. The objective of this prospective study is to evaluate the intra-patient reproducibility of two bone scan procedures performed at a one-week interval. Methods: We prospectively studied prostate cancer patients who were referred for bone scintigraphy at our centres according to clinical routine. All patients underwent two whole-body bone scans: one for clinical routine purposes and a second one as a repeated scan after approximately one week. BSI values were obtained for each bone scintigraph using EXINI boneBSI software. Results: A total of 20 patients were enrolled. There was no statistical difference between the BSI values of the first (median = 0.66, range 0-40.77) and second (median = 0.63, range 0-22.98) bone scans (p = 0.41). The median difference in BSI between the clinical routine and repeated scans was - 0.005 (range - 17.79 to 0). The 95% confidence interval for the median value was - 0.1 to 0. A separate analysis was performed for patients with BSI ≤ 10 (n = 17). Differences in BSI were smaller for patients with BSI ≤ 10 compared to the whole cohort (median - 0.1, range - 2.2-0, 95% confidence interval - 0.1 to 0). Conclusions: The automated BSI demonstrated high intra-individual reproducibility for BSI ≤ 10 in the two repeated bone scans of patients with prostate cancer. The study supports the use of BSI as a quantitative parameter to evaluate the change in total tumour burden in bone scans.
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| 10. |
- Sadik, May, 1970, et al.
(författare)
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3D prostate gland uptake of 18F-choline - association with overall survival in patients with hormone-naïve prostate cancer
- 2017
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Ingår i: Journal of Nuclear Medicine. - 0161-5505 .- 2159-662X. ; 58:supplement 1, s. 544-
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Tidskriftsartikel (refereegranskat)abstract
- Objectives : To develop a completely automated method to quantify prostate gland uptake of 18F-choline in PET/CT images and to study the relationship between this measure, clinical data and overall survival in patients with prostate cancer. Methods : An automated method for segmentation of the prostate gland in CT images was developed using a training group of 100 patients who had undergone PET/CT scanning. The algorithms were trained based on the manual segmentations of the prostate gland in the 100 CT scans performed by a single radiologist. A multi-atlas-based method was used applied for automated segmentation of the prostate gland. Each of a subset of the training images was registered separately to the test image. By applying the resulting transformations to the manual delineations a rough segmentation of the test image was obtained. This segmentation was refined using a random-forest classifier and the final segmentation was obtained with graph cuts. Voxels in the 18F-choline PET scans having a standard uptake value (SUV) >2.65 and localized in the prostate gland in the corresponding CT scan were defined as abnormal. Automated calculation of the following five PET measurements was performed: The maximal SUV within the prostate gland - SUVmax The average SUV within the abnormal part of the prostate gland - SUVmean The volume of abnormal uptake within the prostate gland - VOL The product SUVmean x VOL defined as Total Lesion Uptake - TLU The fraction of the prostate with abnormal uptake related to the whole volume of the prostate gland - FRAC The automated quantification method was retrospectively applied to a separate test group of 46 prostate cancer patients, aged 53-94 years, who had undergone 18F-choline PET/CT. These patients have previously been selected for a study aiming to compare whole-body bone scans, 18F-choline-PET/CT and 18F-NaF PET/CT with magnetic resonance imaging. The study entry criteria were biopsy-proven prostate cancer, a positive whole-body bone scan consistent with bone metastases, and no history of androgen deprivation. The association between the automated PET measurements, age, PSA, Gleason score and overall survival was evaluated using a univariate Cox proportional hazards regression model. Kaplan-Meier estimates were used to estimate the survival difference between patients with values above and below the median value for all variables analyzed. Results : The fraction of the prostate with abnormal uptake related to the whole volume of the prostate gland - FRAC and age were significantly associated with overall survival (Table) while PSA, Gleason score and other PET measurements were not. The patients with a FRAC above the median value (58.2%) had a significantly shorter median survival time than patients with a value below the median value (2.8 years vs. 5.5 years; p=0.04), see Figure. Conclusion : A completely automated method of quantifying 18F-choline PET uptake in the prostate gland yielded a measure of disease extent that was significantly associated with overall survival in patients with hormone-naïve prostate cancer. The method can also be applied to PET/CT scans with other tracers such as FDG or PSMA-targeted agents. It is our hope that these preliminary data will inspire further evaluation of this type of objective quantification of PET/CT scans.
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