László Papp | Medical University of Vienna (original) (raw)
Papers by László Papp
Background Hybrid imaging became an instrumental part of medical imaging, particularly cancer ima... more Background Hybrid imaging became an instrumental part of medical imaging, particularly cancer imaging processes in clinical routine. To date, several radiomic and machine learning studies investigated the feasibility of in vivo tumor characterization with variable outcomes. This study aims to investigate the effect of recently proposed fuzzy radiomics and compare its predictive performance to conventional radiomics in cancer imaging cohorts. In addition, lesion vs. lesion + surrounding fuzzy and conventional radiomic analysis was conducted. Methods Previously published 11C Methionine (MET) positron emission tomography (PET) glioma, 18F-FDG PET/computed tomography (CT) lung and 68GA-PSMA-11 PET/magneto-resonance imaging (MRI) prostate cancer retrospective cohorts were included in the analysis to predict their respective clinical end-points. Four delineation methods including manually-defined reference binary (Ref-B), its smoothed, fuzzified version (Ref-F), as well as extended binary...
![Research paper thumbnail of Analysis of Cross-Combinations of Feature Selection and Machine-Learning Classification Methods Based on [18F]F-FDG PET/CT Radiomic Features for Metabolic Response Prediction of Metastatic Breast Cancer Lesions](https://attachments.academia-assets.com/106567707/thumbnails/1.jpg)
](Cancers
Background: This study aimed to identify optimal combinations between feature selection methods a... more Background: This study aimed to identify optimal combinations between feature selection methods and machine-learning classifiers for predicting the metabolic response of individual metastatic breast cancer lesions, based on clinical variables and radiomic features extracted from pretreatment [18F]F-FDG PET/CT images. Methods: A total of 48 patients with confirmed metastatic breast cancer, who received different treatments, were included. All patients had an [18F]F-FDG PET/CT scan before and after the treatment. From 228 metastatic lesions identified, 127 were categorized as responders (complete or partial metabolic response) and 101 as non-responders (stable or progressive metabolic response), by using the percentage changes in SULpeak (peak standardized uptake values normalized for body lean body mass). The lesion pool was divided into training (n = 182) and testing cohorts (n = 46); for each lesion, 101 image features from both PET and CT were extracted (202 features per lesion). ...
![Research paper thumbnail of Breast Tumor Characterization Using [18F]FDG-PET/CT Imaging Combined with Data Preprocessing and Radiomics](https://attachments.academia-assets.com/106567705/thumbnails/1.jpg)
](Cancers, 2021
Background: This study investigated the performance of ensemble learning holomic models for the d... more Background: This study investigated the performance of ensemble learning holomic models for the detection of breast cancer, receptor status, proliferation rate, and molecular subtypes from [18F]FDG-PET/CT images with and without incorporating data pre-processing algorithms. Additionally, machine learning (ML) models were compared with conventional data analysis using standard uptake value lesion classification. Methods: A cohort of 170 patients with 173 breast cancer tumors (132 malignant, 38 benign) was examined with [18F]FDG-PET/CT. Breast tumors were segmented and radiomic features were extracted following the imaging biomarker standardization initiative (IBSI) guidelines combined with optimized feature extraction. Ensemble learning including five supervised ML algorithms was utilized in a 100-fold Monte Carlo (MC) cross-validation scheme. Data pre-processing methods were incorporated prior to machine learning, including outlier and borderline noisy sample detection, feature sele...
Cancers, 2021
Pituitary adenomas count among the most common intracranial tumors. During pituitary oncogenesis ... more Pituitary adenomas count among the most common intracranial tumors. During pituitary oncogenesis structural, textural, metabolic and molecular changes occur which can be revealed with our integrated ultrahigh-resolution multimodal imaging approach including optical coherence tomography (OCT), multiphoton microscopy (MPM) and line scan Raman microspectroscopy (LSRM) on an unprecedented cellular level in a label-free manner. We investigated 5 pituitary gland and 25 adenoma biopsies, including lactotroph, null cell, gonadotroph, somatotroph and mammosomatotroph as well as corticotroph. First-level binary classification for discrimination of pituitary gland and adenomas was performed by feature extraction via radiomic analysis on OCT and MPM images and achieved an accuracy of 88%. Second-level multi-class classification was performed based on molecular analysis of the specimen via LSRM to discriminate pituitary adenomas subtypes with accuracies of up to 99%. Chemical compounds such as l...
57. Jahrestagung der Deutschen Gesellschaft für Nuklearmedizin, 2019
Journal of Nuclear Medicine, 2018
Radiomics analysis of 18 F-FDG PET/CT images promises well for an improved in vivo disease charac... more Radiomics analysis of 18 F-FDG PET/CT images promises well for an improved in vivo disease characterization. To date, several studies have reported significant variations in textural features due to differences in patient preparation, imaging protocols, lesion delineation, and feature extraction. Our objective was to study variations in features before a radiomics analysis of 18 F-FDG PET data and to identify those feature extraction and imaging protocol parameters that minimize radiomic feature variations across PET imaging systems. Methods: A whole-body National Electrical Manufacturers Association image-quality phantom was imaged with 13 PET/CT systems at 12 different sites following local protocols. We selected 37 radiomic features related to the 4 largest spheres (17-37 mm) in the phantom. On the basis of a combined analysis of voxel size, bin size, and lesion volume changes, feature and imaging system ranks were established. A 1-way ANOVA was performed over voxel size, bin size, and lesion volume subgroups to identify the dependency and the trend change in feature variations across these parameters. Results: Feature ranking revealed that the gray-level cooccurrence matrix and shape features are the least sensitive to PET imaging system variations. Imaging system ranking illustrated that the use of point-spread function, small voxel sizes, and narrow gaussian postfiltering helped minimize feature variations. ANOVA subgroup analysis indicated that variations in each of the 37 features and for a given voxel size and bin size can be minimized. Conclusion: Our results provide guidance to selecting optimized features from 18 F-FDG PET/CT studies. We were able to demonstrate that feature variations can be minimized for selected image parameters and imaging systems. These results can help imaging specialists and feature engineers in increasing the quality of future radiomics studies involving PET/CT.
Oncotarget, 2018
Purpose: Prostate cancer is most common tumor in men causing significant patient mortality and mo... more Purpose: Prostate cancer is most common tumor in men causing significant patient mortality and morbidity. In newer diagnostic/therapeutic agents PSMA linked ones are specifically important. Analysis of textural heterogeneity parameters is associated with determination of innately aggressive and therapy resistant cell lines thus emphasizing their importance in therapy planning. The objective of current study was to assess predictive ability of tumor textural heterogeneity parameters from baseline 68 Ga-PSMA PET prior to 177 Lu-PSMA therapy. Results: Entropy showed a negative correlation (r s =-0.327, p = 0.006, AUC = 0.695) and homogeneity showed a positive correlation (r s = 0.315, p = 0.008, AUC = 0.683) with change in pre and post therapy PSA levels. Conclusions: Study showed potential for response prediction through baseline PET scan using textural features. It suggested that increase in heterogeneity of PSMA expression seems to be associated with an increased response to PSMA radionuclide therapy. Materials and Methods: Retrospective analysis of 70 patients was performed. All patients had metastatic prostate cancer and were planned to undergo 177 Lu-PSMA therapy. Pre-therapeutic 68 Ga-PSMA PET scans were used for analysis. 3D volumes (VOIs) of 3 lesions each in bones and lymph nodes were manually delineated in static PET images. Five PET based textural heterogeneity parameters (COV, entropy, homogeneity, contrast, size variation) were determined. Results obtained were then compared with clinical parameters including pre and post therapy PSA, alkaline phosphate, bone specific alkaline phosphate levels and ECOG criteria. Spearman correlation was used to determine statistical dependence among variables. ROC analysis was performed to estimate the optimal cutoff value and AUC.
Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging, Jan 16, 2018
Early identification of aggressive disease could improve decision support in pancreatic neuroendo... more Early identification of aggressive disease could improve decision support in pancreatic neuroendocrine tumor (pNET) patients prior to peptide receptor radionuclide therapy (PRRT). The prognostic value of intratumoral textural features (TF) determined by baseline somatostatin receptor (SSTR)-positron emission tomography (PET) before PRRT was analyzed. Thirty-one patients with G1/G2 pNET were enrolled (G2, n = 23/31). Prior to PRRT with [Lu]DOTATATE (mean, 3.6 cycles), baseline SSTR-PET computed tomography was performed. By segmentation of 162 (median per patient, 5) metastases, intratumoral TF were computed. The impact of conventional PET parameters (SUV), imaging-based TF, and clinical parameters (Ki67, CgA) for prediction of both progression-free survival (PFS) and overall survival (OS) after PRRT were evaluated. Within a median follow-up of 3.7 years, tumor progression was detected in 21 patients (median, 1.5 years) and 13/31 deceased (median, 1.9 years). In ROC analysis, the TF e...
Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging, Jan 14, 2018
The article "Pre-therapy Somatostatin Receptor-Based Heterogeneity Predicts Overall Survival... more The article "Pre-therapy Somatostatin Receptor-Based Heterogeneity Predicts Overall Survival in Pancreatic Neuroendocrine Tumor Patients Undergoing Peptide Receptor Radionuclide Therapy," was originally published electronically on the publisher's internet portal without open access.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, Jan 24, 2017
Gliomas are the most common types of tumors in the brain. While the definite diagnosis is routine... more Gliomas are the most common types of tumors in the brain. While the definite diagnosis is routinely made ex vivo by histopathologic and molecular examination, diagnostic work-up of patients with suspected glioma is mainly done by using magnetic resonance imaging (MRI). Nevertheless, L-S-methyl-C-methionine (C-MET) Positron Emission Tomography (PET) holds a great potential in characterization of gliomas. The aim of this study was to establish machine learning (ML) driven survival models for glioma built onC-MET-PET, ex vivo and patient characteristics.70 patients with a treatment naïve glioma, who had a positiveC-MET-PET and histopathology-derived ex vivo feature extraction, such as World Health Organization (WHO) 2007 tumor grade, histology and isocitrate dehydrogenase (IDH1-R132H) mutation status were included. TheC-MET-positive primary tumors were delineated semi-automatically on PET images followed by the feature extraction of tumor-to-background ratio based general and higher-or...
Oncotarget, Jan 2, 2016
The NETTER-1 trial demonstrated significantly improved progression-free survival (PFS) for peptid... more The NETTER-1 trial demonstrated significantly improved progression-free survival (PFS) for peptide receptor radionuclide therapy (PRRT) in neuroendocrine tumors (NET) emphasizing the high demand for response prediction in appropriate candidates. In this multicenter study, we aimed to elucidate the prognostic value of tumor heterogeneity as assessed by somatostatin receptor (SSTR)-PET/CT. 141 patients with SSTR-expressing tumors were analyzed obtaining SSTR-PET/CT before PRRT (1-6 cycles, 177Lu somatostatin analog). Using the Interview Fusion Workstation (Mediso), a total of 872 metastases were manually segmented. Conventional PET parameters as well as textural features representing intratumoral heterogeneity were computed. The prognostic ability for PFS and overall survival (OS) were examined. After performing Cox regression, independent parameters were determined by ROC analysis to obtain cut-off values to be used for Kaplan-Meier analysis. Within follow-up (median, 43.1 months), 7...
Cancer imaging : the official publication of the International Cancer Imaging Society, Jan 7, 2016
Because of the increasing importance of computer-assisted post processing of image data in modern... more Because of the increasing importance of computer-assisted post processing of image data in modern medical diagnostic we studied the value of an algorithm for assessment of single photon emission computed tomography/computed tomography (SPECT/CT)-data, which has been used for the first time for lymph node staging in penile cancer with non-palpable inguinal lymph nodes. In the guidelines of the relevant international expert societies, sentinel lymph node-biopsy (SLNB) is recommended as a diagnostic method of choice. The aim of this study is to evaluate the value of the afore-mentioned algorithm and in the clinical context the reliability and the associated morbidity of this procedure. Between 2008 and 2015, 25 patients with invasive penile cancer and inconspicuous inguinal lymph node status underwent SLNB after application of the radiotracer Tc-99m labelled nanocolloid. We recorded in a prospective approach the reliability and the complication rate of the procedure. In addition, we ev...
Endocrine, 2016
As an orphan malignancy, only limited treatment options are available in adrenocortical carcinoma... more As an orphan malignancy, only limited treatment options are available in adrenocortical carcinoma (ACC). Non-invasive risk assessment has not been described but may be of value to stratify patients for treatment. We aimed to evaluate the potential value of intra-individual tumor heterogeneity as assessed by (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) for outcome prediction in treatment-naïve ACC patients. Ten patients with primary diagnosis of ACC were included in this study. Prior to any treatment initiation, baseline (18)F-FDG PET scans were performed. Tumor staging was performed using the European Network for the Study of Adrenal Tumors (ENS@T). Intratumoral heterogeneity of the primary tumor was assessed by manual segmentation using conventional PET parameters (standardized uptake values and tumor-to-liver ratios) and textural features. The impact of tumoral heterogeneity based on pre-therapeutic (18)F-FDG PET to predict progression-free (PFS) and overall survival (OS) was evaluated by receiver operating characteristic analysis. On average, tumor recurrence or progression was detected after median of 561 days (range 71-1434 days) after the pre-therapeutic baseline PET scan. 50 % of the patients died of ACC within the follow-up period (mean 983 ± 404 days). Pre-therapeutic tumor volume was associated with PFS (r = -0.67, p = 0.05) and Ki67 index with OS (r = -0.66, p = 0.04). ENS@T tumor stage was the only parameter to correlate with both PFS and OS (r = -0.82, p = 0.001, and r = -0.72, p = 0.01, respectively). In the subgroup of patients without distant metastases (ENS@T stages II and III), age and pre-therapeutic tumor volume correlated significantly with PFS (r = 0.96, p = 0.01 and r = -0.93, p = 0.02, respectively) and OS (r = 0.95, p = 0.02 and r = -0.90, p = 0.04, respectively). None of the investigated classic or textural PET parameters predicted PFS or OS. In this pilot study in treatment-naïve ACC patients, conventional (18)F-FDG PET-derived parameters and textural tumor heterogeneity features were not suitable to identify high-risk patients.
Society of Nuclear Medicine Annual Meeting Abstracts, May 1, 2014
Society of Nuclear Medicine Annual Meeting Abstracts, May 1, 2014
Society of Nuclear Medicine Annual Meeting Abstracts, May 1, 2013
PloS one, 2015
To determine the metabolically active whole-body tumor volume (WB-MTV) on F-18-fluorodeoxyglucose... more To determine the metabolically active whole-body tumor volume (WB-MTV) on F-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT) in individuals with neurofibromatosis type 1 (NF1) using a three-dimensional (3D) segmentation and computerized volumetry technique, and to compare PET WB-MTV between patients with benign and malignant peripheral nerve sheath tumors (PNSTs). Thirty-six NF1 patients (18 patients with malignant PNSTs and 18 age- and sex-matched controls with benign PNSTs) were examined by F-18-FDG PET/CT. WB-MTV, whole-body total lesion glycolysis (WB-TLG) and a set of semi-quantitative imaging-based parameters were analyzed both on a per-patient and a per-lesion basis. On a per-lesion basis, malignant PNSTs demonstrated both a significantly higher MTV and TLG than benign PNSTs (p < 0.0001). On a per-patient basis, WB-MTV and WB-TLG were significantly higher in patients with malignant PNSTs compared to patients with benign PNSTs (p <...
![Research paper thumbnail of Textural features in pre-treatment [F18]-FDG-PET/CT are correlated with risk of local recurrence and disease-specific survival in early stage NSCLC patients receiving primary stereotactic radiation therapy](https://attachments.academia-assets.com/106567741/thumbnails/1.jpg)
](Radiation oncology (London, England), Jan 22, 2015
Textural features in FDG-PET have been shown to provide prognostic information in a variety of tu... more Textural features in FDG-PET have been shown to provide prognostic information in a variety of tumor entities. Here we evaluate their predictive value for recurrence and prognosis in NSCLC patients receiving primary stereotactic radiation therapy (SBRT). 45 patients with early stage NSCLC (T1 or T2 tumor, no lymph node or distant metastases) were included in this retrospective study and followed over a median of 21.4 months (range 3.1-71.1). All patients were considered non-operable due to concomitant disease and referred to SBRT as the primary treatment modality. Pre-treatment FDG-PET/CT scans were obtained from all patients. SUV and volume-based analysis as well as extraction of textural features based on neighborhood gray-tone difference matrices (NGTDM) and gray-level co-occurence matrices (GLCM) were performed using InterView Fusion™ (Mediso Inc., Budapest). The ability to predict local recurrence (LR), lymph node (LN) and distant metastases (DM) was measured using the receiver...
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2011
An extended registration framework is presented to accurately register follow-up PET-CT study tri... more An extended registration framework is presented to accurately register follow-up PET-CT study triples. Since there are six images to register, sophisticated feature extraction and similarity measurement methods are proposed. An irregular sampling method is introduced to decrease the processing speed of the hextuple registration. The similarity measurement is based on a normalized hybrid extended SSD (Sum of Squared Differences) and and extended NMI (Normalized mutual Information). The method has been tested on a huge amount of simulated data to avoid observer specific results. Based on the validation, our method outperforms prior solutions in both speed and accuracy, hence it should be the subject of further investigations.
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2011
We present a novel detection and classification method to process SPECT-CT images representing br... more We present a novel detection and classification method to process SPECT-CT images representing breast and prostate lymph nodes. Lymph nodes are those nodes that are near the primer tumor and may become cancerous in time, hence their early detection is a key factor for the successful treatment of the patient. Prior methods focus on the visual aid to manually detect the lymph nodes which still makes the process time-consuming. Other solutions segment the lymph nodes only on CT, where the small lymph nodes may not be located accurately. Our solution processed both SPECT and CT data to provide an accurate classification of all SPECT hot spots. The method has been validated on a huge amount of medical data. Results show that our method is a very effective tool to support physicians working with related images in the field of nuclear medicine.
Background Hybrid imaging became an instrumental part of medical imaging, particularly cancer ima... more Background Hybrid imaging became an instrumental part of medical imaging, particularly cancer imaging processes in clinical routine. To date, several radiomic and machine learning studies investigated the feasibility of in vivo tumor characterization with variable outcomes. This study aims to investigate the effect of recently proposed fuzzy radiomics and compare its predictive performance to conventional radiomics in cancer imaging cohorts. In addition, lesion vs. lesion + surrounding fuzzy and conventional radiomic analysis was conducted. Methods Previously published 11C Methionine (MET) positron emission tomography (PET) glioma, 18F-FDG PET/computed tomography (CT) lung and 68GA-PSMA-11 PET/magneto-resonance imaging (MRI) prostate cancer retrospective cohorts were included in the analysis to predict their respective clinical end-points. Four delineation methods including manually-defined reference binary (Ref-B), its smoothed, fuzzified version (Ref-F), as well as extended binary...
Cancers
Background: This study aimed to identify optimal combinations between feature selection methods a... more Background: This study aimed to identify optimal combinations between feature selection methods and machine-learning classifiers for predicting the metabolic response of individual metastatic breast cancer lesions, based on clinical variables and radiomic features extracted from pretreatment [18F]F-FDG PET/CT images. Methods: A total of 48 patients with confirmed metastatic breast cancer, who received different treatments, were included. All patients had an [18F]F-FDG PET/CT scan before and after the treatment. From 228 metastatic lesions identified, 127 were categorized as responders (complete or partial metabolic response) and 101 as non-responders (stable or progressive metabolic response), by using the percentage changes in SULpeak (peak standardized uptake values normalized for body lean body mass). The lesion pool was divided into training (n = 182) and testing cohorts (n = 46); for each lesion, 101 image features from both PET and CT were extracted (202 features per lesion). ...
Cancers, 2021
Background: This study investigated the performance of ensemble learning holomic models for the d... more Background: This study investigated the performance of ensemble learning holomic models for the detection of breast cancer, receptor status, proliferation rate, and molecular subtypes from [18F]FDG-PET/CT images with and without incorporating data pre-processing algorithms. Additionally, machine learning (ML) models were compared with conventional data analysis using standard uptake value lesion classification. Methods: A cohort of 170 patients with 173 breast cancer tumors (132 malignant, 38 benign) was examined with [18F]FDG-PET/CT. Breast tumors were segmented and radiomic features were extracted following the imaging biomarker standardization initiative (IBSI) guidelines combined with optimized feature extraction. Ensemble learning including five supervised ML algorithms was utilized in a 100-fold Monte Carlo (MC) cross-validation scheme. Data pre-processing methods were incorporated prior to machine learning, including outlier and borderline noisy sample detection, feature sele...
Cancers, 2021
Pituitary adenomas count among the most common intracranial tumors. During pituitary oncogenesis ... more Pituitary adenomas count among the most common intracranial tumors. During pituitary oncogenesis structural, textural, metabolic and molecular changes occur which can be revealed with our integrated ultrahigh-resolution multimodal imaging approach including optical coherence tomography (OCT), multiphoton microscopy (MPM) and line scan Raman microspectroscopy (LSRM) on an unprecedented cellular level in a label-free manner. We investigated 5 pituitary gland and 25 adenoma biopsies, including lactotroph, null cell, gonadotroph, somatotroph and mammosomatotroph as well as corticotroph. First-level binary classification for discrimination of pituitary gland and adenomas was performed by feature extraction via radiomic analysis on OCT and MPM images and achieved an accuracy of 88%. Second-level multi-class classification was performed based on molecular analysis of the specimen via LSRM to discriminate pituitary adenomas subtypes with accuracies of up to 99%. Chemical compounds such as l...
57. Jahrestagung der Deutschen Gesellschaft für Nuklearmedizin, 2019
Journal of Nuclear Medicine, 2018
Radiomics analysis of 18 F-FDG PET/CT images promises well for an improved in vivo disease charac... more Radiomics analysis of 18 F-FDG PET/CT images promises well for an improved in vivo disease characterization. To date, several studies have reported significant variations in textural features due to differences in patient preparation, imaging protocols, lesion delineation, and feature extraction. Our objective was to study variations in features before a radiomics analysis of 18 F-FDG PET data and to identify those feature extraction and imaging protocol parameters that minimize radiomic feature variations across PET imaging systems. Methods: A whole-body National Electrical Manufacturers Association image-quality phantom was imaged with 13 PET/CT systems at 12 different sites following local protocols. We selected 37 radiomic features related to the 4 largest spheres (17-37 mm) in the phantom. On the basis of a combined analysis of voxel size, bin size, and lesion volume changes, feature and imaging system ranks were established. A 1-way ANOVA was performed over voxel size, bin size, and lesion volume subgroups to identify the dependency and the trend change in feature variations across these parameters. Results: Feature ranking revealed that the gray-level cooccurrence matrix and shape features are the least sensitive to PET imaging system variations. Imaging system ranking illustrated that the use of point-spread function, small voxel sizes, and narrow gaussian postfiltering helped minimize feature variations. ANOVA subgroup analysis indicated that variations in each of the 37 features and for a given voxel size and bin size can be minimized. Conclusion: Our results provide guidance to selecting optimized features from 18 F-FDG PET/CT studies. We were able to demonstrate that feature variations can be minimized for selected image parameters and imaging systems. These results can help imaging specialists and feature engineers in increasing the quality of future radiomics studies involving PET/CT.
Oncotarget, 2018
Purpose: Prostate cancer is most common tumor in men causing significant patient mortality and mo... more Purpose: Prostate cancer is most common tumor in men causing significant patient mortality and morbidity. In newer diagnostic/therapeutic agents PSMA linked ones are specifically important. Analysis of textural heterogeneity parameters is associated with determination of innately aggressive and therapy resistant cell lines thus emphasizing their importance in therapy planning. The objective of current study was to assess predictive ability of tumor textural heterogeneity parameters from baseline 68 Ga-PSMA PET prior to 177 Lu-PSMA therapy. Results: Entropy showed a negative correlation (r s =-0.327, p = 0.006, AUC = 0.695) and homogeneity showed a positive correlation (r s = 0.315, p = 0.008, AUC = 0.683) with change in pre and post therapy PSA levels. Conclusions: Study showed potential for response prediction through baseline PET scan using textural features. It suggested that increase in heterogeneity of PSMA expression seems to be associated with an increased response to PSMA radionuclide therapy. Materials and Methods: Retrospective analysis of 70 patients was performed. All patients had metastatic prostate cancer and were planned to undergo 177 Lu-PSMA therapy. Pre-therapeutic 68 Ga-PSMA PET scans were used for analysis. 3D volumes (VOIs) of 3 lesions each in bones and lymph nodes were manually delineated in static PET images. Five PET based textural heterogeneity parameters (COV, entropy, homogeneity, contrast, size variation) were determined. Results obtained were then compared with clinical parameters including pre and post therapy PSA, alkaline phosphate, bone specific alkaline phosphate levels and ECOG criteria. Spearman correlation was used to determine statistical dependence among variables. ROC analysis was performed to estimate the optimal cutoff value and AUC.
Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging, Jan 16, 2018
Early identification of aggressive disease could improve decision support in pancreatic neuroendo... more Early identification of aggressive disease could improve decision support in pancreatic neuroendocrine tumor (pNET) patients prior to peptide receptor radionuclide therapy (PRRT). The prognostic value of intratumoral textural features (TF) determined by baseline somatostatin receptor (SSTR)-positron emission tomography (PET) before PRRT was analyzed. Thirty-one patients with G1/G2 pNET were enrolled (G2, n = 23/31). Prior to PRRT with [Lu]DOTATATE (mean, 3.6 cycles), baseline SSTR-PET computed tomography was performed. By segmentation of 162 (median per patient, 5) metastases, intratumoral TF were computed. The impact of conventional PET parameters (SUV), imaging-based TF, and clinical parameters (Ki67, CgA) for prediction of both progression-free survival (PFS) and overall survival (OS) after PRRT were evaluated. Within a median follow-up of 3.7 years, tumor progression was detected in 21 patients (median, 1.5 years) and 13/31 deceased (median, 1.9 years). In ROC analysis, the TF e...
Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging, Jan 14, 2018
The article "Pre-therapy Somatostatin Receptor-Based Heterogeneity Predicts Overall Survival... more The article "Pre-therapy Somatostatin Receptor-Based Heterogeneity Predicts Overall Survival in Pancreatic Neuroendocrine Tumor Patients Undergoing Peptide Receptor Radionuclide Therapy," was originally published electronically on the publisher's internet portal without open access.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, Jan 24, 2017
Gliomas are the most common types of tumors in the brain. While the definite diagnosis is routine... more Gliomas are the most common types of tumors in the brain. While the definite diagnosis is routinely made ex vivo by histopathologic and molecular examination, diagnostic work-up of patients with suspected glioma is mainly done by using magnetic resonance imaging (MRI). Nevertheless, L-S-methyl-C-methionine (C-MET) Positron Emission Tomography (PET) holds a great potential in characterization of gliomas. The aim of this study was to establish machine learning (ML) driven survival models for glioma built onC-MET-PET, ex vivo and patient characteristics.70 patients with a treatment naïve glioma, who had a positiveC-MET-PET and histopathology-derived ex vivo feature extraction, such as World Health Organization (WHO) 2007 tumor grade, histology and isocitrate dehydrogenase (IDH1-R132H) mutation status were included. TheC-MET-positive primary tumors were delineated semi-automatically on PET images followed by the feature extraction of tumor-to-background ratio based general and higher-or...
Oncotarget, Jan 2, 2016
The NETTER-1 trial demonstrated significantly improved progression-free survival (PFS) for peptid... more The NETTER-1 trial demonstrated significantly improved progression-free survival (PFS) for peptide receptor radionuclide therapy (PRRT) in neuroendocrine tumors (NET) emphasizing the high demand for response prediction in appropriate candidates. In this multicenter study, we aimed to elucidate the prognostic value of tumor heterogeneity as assessed by somatostatin receptor (SSTR)-PET/CT. 141 patients with SSTR-expressing tumors were analyzed obtaining SSTR-PET/CT before PRRT (1-6 cycles, 177Lu somatostatin analog). Using the Interview Fusion Workstation (Mediso), a total of 872 metastases were manually segmented. Conventional PET parameters as well as textural features representing intratumoral heterogeneity were computed. The prognostic ability for PFS and overall survival (OS) were examined. After performing Cox regression, independent parameters were determined by ROC analysis to obtain cut-off values to be used for Kaplan-Meier analysis. Within follow-up (median, 43.1 months), 7...
Cancer imaging : the official publication of the International Cancer Imaging Society, Jan 7, 2016
Because of the increasing importance of computer-assisted post processing of image data in modern... more Because of the increasing importance of computer-assisted post processing of image data in modern medical diagnostic we studied the value of an algorithm for assessment of single photon emission computed tomography/computed tomography (SPECT/CT)-data, which has been used for the first time for lymph node staging in penile cancer with non-palpable inguinal lymph nodes. In the guidelines of the relevant international expert societies, sentinel lymph node-biopsy (SLNB) is recommended as a diagnostic method of choice. The aim of this study is to evaluate the value of the afore-mentioned algorithm and in the clinical context the reliability and the associated morbidity of this procedure. Between 2008 and 2015, 25 patients with invasive penile cancer and inconspicuous inguinal lymph node status underwent SLNB after application of the radiotracer Tc-99m labelled nanocolloid. We recorded in a prospective approach the reliability and the complication rate of the procedure. In addition, we ev...
Endocrine, 2016
As an orphan malignancy, only limited treatment options are available in adrenocortical carcinoma... more As an orphan malignancy, only limited treatment options are available in adrenocortical carcinoma (ACC). Non-invasive risk assessment has not been described but may be of value to stratify patients for treatment. We aimed to evaluate the potential value of intra-individual tumor heterogeneity as assessed by (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) for outcome prediction in treatment-naïve ACC patients. Ten patients with primary diagnosis of ACC were included in this study. Prior to any treatment initiation, baseline (18)F-FDG PET scans were performed. Tumor staging was performed using the European Network for the Study of Adrenal Tumors (ENS@T). Intratumoral heterogeneity of the primary tumor was assessed by manual segmentation using conventional PET parameters (standardized uptake values and tumor-to-liver ratios) and textural features. The impact of tumoral heterogeneity based on pre-therapeutic (18)F-FDG PET to predict progression-free (PFS) and overall survival (OS) was evaluated by receiver operating characteristic analysis. On average, tumor recurrence or progression was detected after median of 561 days (range 71-1434 days) after the pre-therapeutic baseline PET scan. 50 % of the patients died of ACC within the follow-up period (mean 983 ± 404 days). Pre-therapeutic tumor volume was associated with PFS (r = -0.67, p = 0.05) and Ki67 index with OS (r = -0.66, p = 0.04). ENS@T tumor stage was the only parameter to correlate with both PFS and OS (r = -0.82, p = 0.001, and r = -0.72, p = 0.01, respectively). In the subgroup of patients without distant metastases (ENS@T stages II and III), age and pre-therapeutic tumor volume correlated significantly with PFS (r = 0.96, p = 0.01 and r = -0.93, p = 0.02, respectively) and OS (r = 0.95, p = 0.02 and r = -0.90, p = 0.04, respectively). None of the investigated classic or textural PET parameters predicted PFS or OS. In this pilot study in treatment-naïve ACC patients, conventional (18)F-FDG PET-derived parameters and textural tumor heterogeneity features were not suitable to identify high-risk patients.
Society of Nuclear Medicine Annual Meeting Abstracts, May 1, 2014
Society of Nuclear Medicine Annual Meeting Abstracts, May 1, 2014
Society of Nuclear Medicine Annual Meeting Abstracts, May 1, 2013
PloS one, 2015
To determine the metabolically active whole-body tumor volume (WB-MTV) on F-18-fluorodeoxyglucose... more To determine the metabolically active whole-body tumor volume (WB-MTV) on F-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT) in individuals with neurofibromatosis type 1 (NF1) using a three-dimensional (3D) segmentation and computerized volumetry technique, and to compare PET WB-MTV between patients with benign and malignant peripheral nerve sheath tumors (PNSTs). Thirty-six NF1 patients (18 patients with malignant PNSTs and 18 age- and sex-matched controls with benign PNSTs) were examined by F-18-FDG PET/CT. WB-MTV, whole-body total lesion glycolysis (WB-TLG) and a set of semi-quantitative imaging-based parameters were analyzed both on a per-patient and a per-lesion basis. On a per-lesion basis, malignant PNSTs demonstrated both a significantly higher MTV and TLG than benign PNSTs (p < 0.0001). On a per-patient basis, WB-MTV and WB-TLG were significantly higher in patients with malignant PNSTs compared to patients with benign PNSTs (p <...
Radiation oncology (London, England), Jan 22, 2015
Textural features in FDG-PET have been shown to provide prognostic information in a variety of tu... more Textural features in FDG-PET have been shown to provide prognostic information in a variety of tumor entities. Here we evaluate their predictive value for recurrence and prognosis in NSCLC patients receiving primary stereotactic radiation therapy (SBRT). 45 patients with early stage NSCLC (T1 or T2 tumor, no lymph node or distant metastases) were included in this retrospective study and followed over a median of 21.4 months (range 3.1-71.1). All patients were considered non-operable due to concomitant disease and referred to SBRT as the primary treatment modality. Pre-treatment FDG-PET/CT scans were obtained from all patients. SUV and volume-based analysis as well as extraction of textural features based on neighborhood gray-tone difference matrices (NGTDM) and gray-level co-occurence matrices (GLCM) were performed using InterView Fusion™ (Mediso Inc., Budapest). The ability to predict local recurrence (LR), lymph node (LN) and distant metastases (DM) was measured using the receiver...
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2011
An extended registration framework is presented to accurately register follow-up PET-CT study tri... more An extended registration framework is presented to accurately register follow-up PET-CT study triples. Since there are six images to register, sophisticated feature extraction and similarity measurement methods are proposed. An irregular sampling method is introduced to decrease the processing speed of the hextuple registration. The similarity measurement is based on a normalized hybrid extended SSD (Sum of Squared Differences) and and extended NMI (Normalized mutual Information). The method has been tested on a huge amount of simulated data to avoid observer specific results. Based on the validation, our method outperforms prior solutions in both speed and accuracy, hence it should be the subject of further investigations.
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2011
We present a novel detection and classification method to process SPECT-CT images representing br... more We present a novel detection and classification method to process SPECT-CT images representing breast and prostate lymph nodes. Lymph nodes are those nodes that are near the primer tumor and may become cancerous in time, hence their early detection is a key factor for the successful treatment of the patient. Prior methods focus on the visual aid to manually detect the lymph nodes which still makes the process time-consuming. Other solutions segment the lymph nodes only on CT, where the small lymph nodes may not be located accurately. Our solution processed both SPECT and CT data to provide an accurate classification of all SPECT hot spots. The method has been validated on a huge amount of medical data. Results show that our method is a very effective tool to support physicians working with related images in the field of nuclear medicine.