Lorenz Joshua W, Schott Diane, Rein Lisa, Mostafaei Farshad, Noid George, Lawton Colleen, Bedi Meena, Li X A, Schultz Christopher J, Paulson Eric, Hall William A
Radiation Oncology, Medical College of Wisconsin, Milwaukee, USA.
Biostatistics, Medical College of Wisconsin, Milwaukee, USA.
Cureus. 2019 Apr 20;11(4):e4510. doi: 10.7759/cureus.4510.
"Delta-radiomics" investigates variations in quantitative image metrics over time and can yield important clinical information. We hypothesized that in patients undergoing active radiation therapy (RT) for prostate cancer (PCa), there would exist observable variation in the quantitative metrics that describe the T-weighted (T) intensity histogram in the prostate and surrounding organs at risk (OAR) over time. We investigated the feasibility of acquisition and subsequent analysis of the delta-radiomic profiles of these regions of interest (ROI) in serial T magnetic resonance (MR) images obtained on a 1.5 Tesla (T) Magnetic Resonance Linear Accelerator (MRL). Principally, we sought to illustrate the significance of longitudinal radiomic data acquisition for tissue response monitoring and provide a framework for future hypothesis driven research. Patients with PCa undergoing treatment with RT were compiled from an ongoing prospective observational imaging trial using a 1.5 T MRL (NCT30500081). Contiguous axial slices of prostate parenchyma were contoured and temporally normalized to sections of Sartorius muscle which served as a control. Similarly, contiguous sections of rectal and bladder wall adjacent to the prostate were contoured and temporally normalized to regions of these organs further removed from the planning target volume (PTV). First order statistical descriptors of the T intensity histogram were extracted and evaluated for changes over time using linear mixed effects regression modeling and post-hoc contrasts. Benjamini-Hochberg corrections were employed to reduce the effects of multiple testing and control for the false discovery rate (FDR). Four patients with a median age of 69 comprised this exploratory cohort. One patient had low-risk disease, two had intermediate (one favorable, one unfavorable), and one had high risk disease. Three out of four patients underwent definitive radiation to 75.6 Gray (Gy) in 42 fractions and one received hypofractionated therapy to a total dose of 70 Gy over 28 fractions, and all received treatment on a conventional linear accelerator. The most significant acute toxicity event was grade 2 GU dysfunction observed in two patients. Follow up ranged from 1 month to 10 months post treatment, and no long-term complications were reported in patients who completed treatment at least one month prior. Bladder wall adjacent to the prostate demonstrated significant variation in the mean and median metric values after the first week of treatment. In addition, rectal wall adjacent to the prostate exhibited significant variation in the mean, median, and standard deviation metric values by the second week of treatment. No significant variation in any radiomic feature was observed in the Sartorius control. This exploratory study is one of the earliest examining the delta-radiomic characteristics of the T intensity histogram in OAR extracted from images acquired on a 1.5 T MRL in patients actively being treated with RT for PCa. We demonstrated a feasible approach to longitudinal radiomic data acquisition providing limitless opportunity for future research. Analysis of the delta-radiomic profiles in OAR revealed significant variation in metrics after only one week of RT in bladder and rectal wall adjacent to the prostate. These findings must be further investigated and validated with expanded data sets with long-term follow up and correlation to clinical outcomes including toxicity and tumor control.
“增量放射组学”研究定量图像指标随时间的变化,并能产生重要的临床信息。我们假设,在接受前列腺癌(PCa)根治性放射治疗(RT)的患者中,描述前列腺及周围危及器官(OAR)的T加权(T)强度直方图的定量指标会随时间出现可观察到的变化。我们研究了在1.5特斯拉(T)磁共振直线加速器(MRL)上获取的连续T加权磁共振(MR)图像中,对这些感兴趣区域(ROI)的增量放射组学特征进行采集及后续分析的可行性。主要而言,我们试图阐明纵向放射组学数据采集对组织反应监测的意义,并为未来基于假设的研究提供一个框架。接受RT治疗的PCa患者来自一项正在进行的前瞻性观察性成像试验,该试验使用1.5T MRL(NCT30500081)。勾勒出前列腺实质的连续轴位切片,并在时间上与作为对照的缝匠肌切片进行归一化。同样,勾勒出前列腺相邻的直肠和膀胱壁的连续切片,并在时间上与这些器官中远离计划靶体积(PTV)的区域进行归一化。提取T强度直方图的一阶统计描述符,并使用线性混合效应回归模型和事后对比评估其随时间的变化。采用Benjamini-Hochberg校正来减少多重检验的影响并控制错误发现率(FDR)。这个探索性队列包括4名中位年龄为69岁的患者。1例为低危疾病,2例为中危(1例有利,1例不利),1例为高危疾病。4名患者中有3名接受了42次分割、总量75.6格雷(Gy)的根治性放疗,1名接受了2天次分割、总量70Gy的大分割放疗,且均在传统直线加速器上接受治疗。最显著的急性毒性事件是2例患者出现2级泌尿生殖系统功能障碍。随访时间为治疗后1个月至10个月,至少在1个月前完成治疗的患者未报告长期并发症。治疗第一周后,前列腺相邻的膀胱壁在均值和中位数指标值上表现出显著变化。此外,治疗第二周后,前列腺相邻的直肠壁在均值、中位数和标准差指标值上表现出显著变化。在缝匠肌对照中未观察到任何放射组学特征的显著变化。这项探索性研究是最早研究从接受PCa根治性RT治疗患者的1.5T MRL图像中提取的OAR中T强度直方图的增量放射组学特征的研究之一。我们展示了一种可行的纵向放射组学数据采集方法,为未来研究提供了无限机会。对OAR中增量放射组学特征的分析显示,RT仅一周后,前列腺相邻的膀胱和直肠壁的指标就出现了显著变化。这些发现必须通过扩大数据集进行进一步研究和验证,并进行长期随访以及与包括毒性和肿瘤控制在内的临床结果建立相关性。