Cui Can, Yao Xiaochen, Xu Lei, Chao Yuelin, Hu Yao, Zhao Shuang, Hu Yuxiao, Zhang Jia
Department of PET/CT Center, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China.
Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China.
J Pers Med. 2023 Mar 17;13(3):539. doi: 10.3390/jpm13030539.
The characteristic magnetic resonance imaging (MRI) and the positron emission tomography (PET) findings of PCNSL often overlap with other intracranial tumors, making definitive diagnosis challenging. PCNSL typically shows iso-hypointense to grey matter on T2-weighted imaging. However, a particular part of PCNSL can demonstrate T2-weighted hyperintensity as other intracranial tumors. Moreover, normal high uptake of FDG in the basal ganglia, thalamus, and grey matter can mask underlying PCNSL in F-FDG PET. In order to promote the efficiency of diagnosis, the MRI-based or PET/CT-based radiomics models combining histograms with texture features in diagnosing glioma and brain metastases have been widely established. However, the diagnosing model for PCNSL has not been widely reported. The study was designed to investigate a machine-learning (ML) model based on multiple parameters of 2-deoxy-2-[18F]-floor-D-glucose (F-FDG) PET for differential diagnosis of PCNSL and metastases in the brain. Patients who underwent an F-FDG PET scan with untreated PCNSL or metastases in the brain were included between May 2016 and May 2022. A total of 126 lesions from 51 patients (43 patients with untreated brain metastases and eight patients with untreated PCNSL), including 14 lesions of PCNSL, and 112 metastatic lesions in the brain, met the inclusion criteria. PCNSL or brain metastasis was confirmed after pathology or clinical history. Principal component analysis (PCA) was used to decompose the datasets. Logistic regression (LR), support vector machine (SVM), and random forest classification (RFC) models were trained by two different groups of datasets, the group of multi-class features and the group of density features, respectively. The model with the highest mean precision score was selected. The testing sets and original data were used to examine the efficacy of models separately by using the weighted average 1 and area under the curve (AUC) of the receiver operating characteristic curve (ROC). The multi-class features-based RFC and SVM models reached identical weighted-average 1 in the testing set, and the score was 0.98. The AUCs of RFC and SVM models calculated from the testing set were 1.00 equally. Evaluated by the original dataset, the RFC model based on multi-class features performs better than the SVM model, whose weighted-average 1 of the RFC model calculated from the original data were 0.85 with an AUC of 0.93. The ML based on multi-class features of F-FDG PET exhibited the potential to distinguish PCNSL from brain metastases. The RFC models based on multi-class features provided comparatively high efficiency in our study.
原发性中枢神经系统淋巴瘤(PCNSL)的特征性磁共振成像(MRI)和正电子发射断层扫描(PET)表现常与其他颅内肿瘤重叠,这使得明确诊断具有挑战性。PCNSL在T2加权成像上通常表现为与灰质等低信号。然而,PCNSL的特定部分可表现出与其他颅内肿瘤一样的T2加权高信号。此外,基底神经节、丘脑和灰质中正常的氟代脱氧葡萄糖(FDG)高摄取可掩盖F-FDG PET中潜在的PCNSL。为提高诊断效率,基于MRI或PET/CT、结合直方图和纹理特征来诊断胶质瘤和脑转移瘤的放射组学模型已广泛建立。然而,关于PCNSL的诊断模型尚未有广泛报道。本研究旨在探究一种基于2-脱氧-2-[18F]-氟-D-葡萄糖(F-FDG)PET多参数的机器学习(ML)模型,用于鉴别PCNSL和脑转移瘤。纳入2016年5月至2022年5月期间接受F-FDG PET扫描且患有未经治疗的PCNSL或脑转移瘤的患者。来自51例患者(43例未经治疗的脑转移瘤患者和8例未经治疗的PCNSL患者)的126个病灶符合纳入标准,其中包括14个PCNSL病灶和112个脑转移瘤病灶。PCNSL或脑转移瘤经病理或临床病史确诊。采用主成分分析(PCA)对数据集进行分解。分别通过两组不同的数据集,即多类特征组和密度特征组,训练逻辑回归(LR)、支持向量机(SVM)和随机森林分类(RFC)模型。选择平均精度得分最高的模型。使用测试集和原始数据,通过加权平均1和受试者操作特征曲线(ROC)的曲线下面积(AUC)分别检验模型的有效性。基于多类特征的RFC和SVM模型在测试集中的加权平均1相同,均为0.98。从测试集计算得到的RFC和SVM模型的AUC均为1.00。通过原始数据集评估,基于多类特征的RFC模型比SVM模型表现更好,RFC模型从原始数据计算得到的加权平均1为0.85,AUC为0.93。基于F-FDG PET多类特征的ML表现出区分PCNSL和脑转移瘤的潜力。在我们的研究中,基于多类特征的RFC模型提供了相对较高的效率。
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