Anna Domenech

Obtaining quantitative global tumoral state indicators based on whole-body PET/CT scans: a breast cancer case study.

ObjectivesIn this work we address the need for the computation of quantitative global tumoral state indicators from oncological whole-body PET/computed tomography scans. The combination of such indicators with other oncological information such as tumor markers or biopsy results would prove useful in oncological decision-making scenarios. Materials and methodsFrom an ordering of 100 breast cancer patients on the basis of oncological state through visual analysis by a consensus of nuclear medicine specialists, a set of numerical indicators computed from image analysis of the PET/computed tomography scan is presented, which attempts to summarize a patient’s oncological state in a quantitative manner taking into consideration the total tumor volume, aggressiveness, and spread. ResultsResults obtained by comparative analysis of the proposed indicators with respect to the experts’ evaluation show up to 87% Pearson’s correlation coefficient when providing expert-guided PET metabolic tumor volume segmentation and 64% correlation when using completely automatic image analysis techniques. ConclusionGlobal quantitative tumor information obtained by whole-body PET/CT image analysis can prove useful in clinical nuclear medicine settings and oncological decision-making scenarios. The completely automatic computation of such indicators would improve its impact as time efficiency and specialist independence would be achieved.

A computational framework for cancer response assessment based on oncological PET-CT scans

In this work we present a comprehensive computational framework to help in the clinical assessment of cancer response from a pair of time consecutive oncological PET-CT scans. In this scenario, the design and implementation of a supervised machine learning system to predict and quantify cancer progression or response conditions by introducing a novel feature set that models the underlying clinical context is described. Performance results in 100 clinical cases (corresponding to 200 whole body PET-CT scans) in comparing expert-based visual analysis and classifier decision making show up to 70% accuracy within a completely automatic pipeline and 90% accuracy when providing the system with expert-guided PET tumor segmentation masks.

Deriving global quantitative tumor response parameters from 18F-FDG PET-CT scans in patients with non-Hodgkin's lymphoma.

Objectives The aim of the study was to address the need for quantifying the global cancer time evolution magnitude from a pair of time-consecutive positron emission tomography-computed tomography (PET-CT) scans. In particular, we focus on the computation of indicators using image-processing techniques that seek to model non-Hodgkin’s lymphoma (NHL) progression or response severity. Materials and methods A total of 89 pairs of time-consecutive PET-CT scans from NHL patients were stored in a nuclear medicine station for subsequent analysis. These were classified by a consensus of nuclear medicine physicians into progressions, partial responses, mixed responses, complete responses, and relapses. The cases of each group were ordered by magnitude following visual analysis. Thereafter, a set of quantitative indicators designed to model the cancer evolution magnitude within each group were computed using semiautomatic and automatic image-processing techniques. Performance evaluation of the proposed indicators was measured by a correlation analysis with the expert-based visual analysis. Results The set of proposed indicators achieved Pearson’s correlation results in each group with respect to the expert-based visual analysis: 80.2% in progressions, 77.1% in partial response, 68.3% in mixed response, 88.5% in complete response, and 100% in relapse. In the progression and mixed response groups, the proposed indicators outperformed the common indicators used in clinical practice [changes in metabolic tumor volume, mean, maximum, peak standardized uptake value (SUVmean, SUVmax, SUVpeak), and total lesion glycolysis] by more than 40%. Conclusion Computing global indicators of NHL response using PET-CT imaging techniques offers a strong correlation with the associated expert-based visual analysis, motivating the future incorporation of such quantitative and highly observer-independent indicators in oncological decision making or treatment response evaluation scenarios.

Computing quantitative indicators of structural renal damage in pediatric DMSA scans

OBJECTIVES The proposal and implementation of a computational framework for the quantification of structural renal damage from 99mTc-dimercaptosuccinic acid (DMSA) scans. The aim of this work is to propose, implement, and validate a computational framework for the quantification of structural renal damage from DMSA scans and in an observer-independent manner. MATERIALS AND METHODS From a set of 16 pediatric DMSA-positive scans and 16 matched controls and using both expert-guided and automatic approaches, a set of image-derived quantitative indicators was computed based on the relative size, intensity and histogram distribution of the lesion. A correlation analysis was conducted in order to investigate the association of these indicators with other clinical data of interest in this scenario, including C-reactive protein (CRP), white cell count, vesicoureteral reflux, fever, relative perfusion, and the presence of renal sequelae in a 6-month follow-up DMSA scan. RESULTS A fully automatic lesion detection and segmentation system was able to successfully classify DMSA-positive from negative scans (AUC=0.92, sensitivity=81% and specificity=94%). The image-computed relative size of the lesion correlated with the presence of fever and CRP levels (p<0.05), and a measurement derived from the distribution histogram of the lesion obtained significant performance results in the detection of permanent renal damage (AUC=0.86, sensitivity=100% and specificity=75%). CONCLUSIONS The proposal and implementation of a computational framework for the quantification of structural renal damage from DMSA scans showed a promising potential to complement visual diagnosis and non-imaging indicators.

Interpretación de incidentalomas tiroideos en estudios PET/TC con 18F-FDG

OBJECTIVE Thyroid findings or incidentalomas in (18)F-FDG PET/CT studies are relatively frequent, being its clinical significance subject of controversy. The aim of this study was to show our experience in the detection of thyroid incidentalomas by PET/CT studies as well as its follow up. MATERIAL AND METHODS A retrospective and descriptive review was conducted on patients who had thyroid incidentalomas detected in (18)F-FDG PET/CT studies between June 2010 and March 2013. Patients medical records were reviewed for age, genre, maximum standardized uptake value (SUVmax), thyroid diseases, TSH and antithyroid antibodies levels, ultrasound, fine-needle aspiration (FNA) and cytology. RESULTS 4085 PET/CT studies for several purposes were performed. Eighty-three of these studies (2.03%) showed thyroid incidentalomas. Thirty-seven patients showed a diffuse increase of glucose metabolism in the thyroid gland and 46 showed a focal increase of glucose metabolism. Five out of 46 patients with focal uptake were diagnosed of a neoplastic disease by cytology (11%). The SUVmax of malignant pathology did not differ from that of benign thyroid diseases (Mean: 10,26 and 5,92 respectively). CONCLUSION In our experience, focal thyroid incidentalomas detected in (18)F-FDG PET/CT studies are related to a significant risk of malignancy (11%). Therefore, in these situations, an ultrasound study with fine needle biopsy should be recommended. Moreover, a diffuse increase of glucose metabolism in the thyroid gland is often associated with benign thyroid pathology.

Riñón ectópico supernumerario. Un hallazgo incidental

A supernumerary kidney is defined as a true accessory organ with a collector system, blood circulation and independent encapsulated tissue. In contrast with the horseshoe kidney, this congenital abnormality is extremely rare.1 Kidney development begins in 2 structures during the fifth week of gestation: the distal portion of the wolffian duct in which the collector tubules originate, and the renal pelvis and ureters and the caudal portion of the nephrogenic blastema where the glomerules and tubules originate.1 It has been suggested that the presence of a supernumerary kidney is due to aberrant development of 2 ureteral buds at different points of the wolffian duct in contact with the nephrogenic blastema at 2 different positions. Nonetheless, other authors have suggested that this division may begin in the nephrogenic blastema.2