T2加权磁共振成像放射组学在高级别髓内骨肉瘤中的应用：评估化疗组织学反应、总生存期和无病生存期的预测准确性

T2-weighted MRI radiomics in high-grade intramedullary osteosarcoma: predictive accuracy in assessing histologic response to chemotherapy, overall survival, and disease-free survival.

作者信息

White Lawrence M, Atinga Angela, Naraghi Ali M, Lajkosz Katherine, Wunder Jay S, Ferguson Peter, Tsoi Kim, Griffin Anthony, Haider Masoom

机构信息

Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.

Joint Department of Medical Imaging, Mount Sinai Hospital, University Health Network and Women's College Hospital, Rm 562-A, 600 University Ave, Toronto, ON, M5G 1X5, Canada.

出版信息

Skeletal Radiol. 2023 Mar;52(3):553-564. doi: 10.1007/s00256-022-04098-2. Epub 2022 Jul 1.

DOI:10.1007/s00256-022-04098-2

PMID:35778618

Abstract

OBJECTIVE

To analyze radiomic features obtained from pre-treatment T2-weighted MRI acquisitions in patients with histologically proven intramedullary high-grade osteosarcomas and assess the accuracy of radiomic modelling as predictive biomarker of tumor necrosis following neoadjuvant chemotherapy (NAC), overall survival (OS), and disease-free survival (DFS).

MATERIALS AND METHODS

Pre-treatment MRI exams in 105 consecutive patients who underwent NAC and resection of high-grade intramedullary osteosarcoma were evaluated. Histologic necrosis following NAC, and clinical outcome-survival data was collected for each case. Radiomic features were extracted from segmentations performed by two readers, with poorly reproducible features excluded from further analysis. Cox proportional hazard model and Spearman correlation with multivariable modelling were used for assessing relationships of radiomics features with OS, DFS, and histologic tumor necrosis.

RESULTS

Study included 74 males, 31 females (mean 32.5yrs, range 15-77 years). Histologic assessment of tumor necrosis following NAC was available in 104 cases, with good response (≥ 90% necrosis) in 41, and poor response in 63. Fifty-three of 105 patients were alive at follow-up (median 40 months, range: 2-213 months). Median OS was 89 months. Excluding 14 patients with metastases at presentation, median DFS was 19 months. Eleven radiomics features were employed in final radiomics model predicting histologic tumor necrosis (mean AUC 0.708 ± 0.046). Thirteen radiomic features were used in model predicting OS (mean concordance index 0.741 ± 0.011), and 12 features retained in predicting DFS (mean concordance index 0.745 ± 0.010).

CONCLUSIONS

T2-weighted MRI radiomic models demonstrate promising results as potential prognostic biomarkers of prospective tumor response to neoadjuvant chemotherapy and prediction of clinical outcomes in conventional osteosarcoma.

摘要

目的

分析经组织学证实的髓内高级别骨肉瘤患者治疗前T2加权MRI图像获取的影像组学特征，并评估影像组学模型作为新辅助化疗（NAC）后肿瘤坏死、总生存期（OS）和无病生存期（DFS）预测生物标志物的准确性。

材料与方法

对105例连续接受NAC及高级别髓内骨肉瘤切除术的患者的治疗前MRI检查进行评估。收集每例患者NAC后的组织学坏死情况及临床结局生存数据。由两名阅片者对图像进行分割并提取影像组学特征，将重复性差的特征排除在进一步分析之外。采用Cox比例风险模型以及Spearman相关性和多变量建模来评估影像组学特征与OS、DFS及组织学肿瘤坏死之间的关系。

结果

研究纳入74例男性、31例女性（平均32.5岁，范围15 - 77岁）。104例患者有NAC后肿瘤坏死的组织学评估结果，其中41例反应良好（坏死≥90%），63例反应较差。105例患者中有53例在随访时存活（中位时间40个月，范围：2 - 213个月）。中位OS为89个月。排除14例初诊时伴有转移的患者后，中位DFS为19个月。最终的影像组学模型采用11个影像组学特征预测组织学肿瘤坏死（平均AUC 0.708±0.046）。13个影像组学特征用于预测OS的模型（平均一致性指数0.741±0.011），12个特征用于预测DFS的模型（平均一致性指数0.745±0.010）。