Early-stage non-small cell lung cancer (NSCLC) patients have a relatively high recurrence rate within the first five years of surgery, reflecting a need to predict post-surgical recurrence and offer personalized adjuvant therapies. Quantitative features extracted from radiology and pathology images can provide valuable information for the NSCLC recurrence prediction task, with radiomic features capturing global tumor phenotypes and pathomic features capturing local cellular and tumor microenvironment information. In this study, we propose to combine radiomic and pathomic features to predict progression-free survival within five years of curative resection in early-stage lung adenocarcinoma (LUAD), the most common subtype of NSCLC. Using 106 cases from the National Lung Screening Trial dataset, we extracted radiomic features from lung nodules on pre-surgery computed tomography (CT) scans guided by radiologist’s segmentation and pathomic features from hematoxylin and eosin (H&E)-stained whole slide images (WSIs) of the resected tissue. We leveraged both hand-crafted and deep features in each modality and used a Cox proportional hazards model. Models were trained with 5-fold cross-validation with ten repetitions, and metrics such as the concordance index (C-index) were calculated by the mean performance on the test set. The fused model using combined radiomic and pathomic features has a C-index of 0.634. Our study shows that combining radiomic and pathomic features results in a more accurate progression-free survival prediction model as compared to only using radiomic features (C-index=0.612), pathomic features (C-index=0.584), or clinical features (C-index= 0.477).
Purpose: To rule out hemorrhage, non-contrast CT (NCCT) scans are used for early evaluation of patients with suspected stroke. Recently, artificial intelligence tools have been developed to assist with determining eligibility for reperfusion therapies by automating measurement of the Alberta Stroke Program Early CT Score (ASPECTS), a 10-point scale with > 7 or ≤ 7 being a threshold for change in functional outcome prediction and higher chance of symptomatic hemorrhage, and hypodense volume. The purpose of this work was to investigate the effects of CT reconstruction kernel and slice thickness on ASPECTS and hypodense volume. Methods: The NCCT series image data of 87 patients imaged with a CT stroke protocol at our institution were reconstructed with 3 kernels (H10s-smooth, H40s-medium, H70h-sharp) and 2 slice thicknesses (1.5mm and 5mm) to create a reference condition (H40s/5mm) and 5 non-reference conditions. Each reconstruction for each patient was analyzed with the Brainomix e-Stroke software (Brainomix, Oxford, England) which yields an ASPECTS value and measure of total hypodense volume (mL). Results: An ASPECTS value was returned for 74 of 87 cases in the reference condition (13 failures). ASPECTS in non-reference conditions changed from that measured in the reference condition for 59 cases, 7 of which changed above or below the clinical threshold of 7 for 3 non-reference conditions. ANOVA tests were performed to compare the differences in protocols, Dunnett’s post-hoc tests were performed after ANOVA, and a significance level of p < 0.05 was defined. There was no significant effect of kernel (p = 0.91), a significant effect of slice thickness (p < 0.01) and no significant interaction between these factors (p = 0.91). Post-hoc tests indicated no significant difference between ASPECTS estimated in the reference and any non-reference conditions. There was a significant effect of kernel (p < 0.01) and slice thickness (p < 0.01) on hypodense volume, however there was no significant interaction between these factors (p = 0.79). Post-hoc tests indicated significantly different hypodense volume measurements for H10s/1.5mm (p = 0.03), H40s/1.5mm (p < 0.01), H70h/5mm (p < 0.01). No significant difference was found in hypodense volume measured in the H10s/5mm condition (p = 0.96). Conclusion: Automated ASPECTS and hypodense volume measurements can be significantly impacted by reconstruction kernel and slice thickness.
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