Background:Neoadjuvant chemotherapy (NAC) plays an important role in the management of locally advanced breast cancer. It allows for downstaging of tumours, potentially allowing for breast conservation. NAC also allows for in-vivo testing of the tumours' response to chemotherapy and provides important prognostic information. There are currently no clearly de ned clinical models that incorporate imaging with clinical data to predict response to NAC. Thus, the aim of this work is to develop a predictive AI model based on routine CT imaging and clinical parameters to predict response to NAC. Methods:The CT scans of 324 patients with NAC from multiple centers in Singapore were used in this study. Four different radiomics models were built for predicting pathological complete response (pCR): rst two were based on textural features extracted from peri-tumoral and tumoral regions, the third model based on novel space-resolved radiomics which extract feature maps using voxel-based radiomics and the fourth model based on Deep Learning (DL). Clinical parameters were included to build a nal prognostic model. Results:The best performing models were based on space-resolved and deep learning approaches. Spaceresolved radiomics improves the clinical AUCs of pCR prediction from 0.743 (0.650 to 0.831) to 0.775 (0.685 to 0.860) and our DL model improved it from 0.743 (0.650 to 0.831) to 0.772 (0.685 to 0.853). The tumoral radiomics model performs the worst with no improvement of the AUC from the clinical model. The peri-tumoral combined model gives moderate performance with an AUC of 0.765 (0.671 to 0.855). Conclusions:Radiomics features extracted from diagnostic CT augments the predictive ability of pathological complete response when combined with clinical features. The novel space-resolved radiomics and deep learning radiomics approaches outperformed conventional radiomics techniques.
A 46-year-old Chinese woman presented to the emergency department with nausea and abdominal bloating, accompanied by vomiting that had increasingly worsened over the past four days. Apart from previous laparoscopic cholecystectomy and open appendicectomy, she had no other medical comorbidities. Physical examination revealed abdominal distension with central tenderness and active bowel sounds. There was no rebound tenderness or abdominal guarding. She was afebrile and her haemodynamic parameters were stable. Initial blood investigations revealed an elevated total white blood cell count Plain radiography of the abdomen (Fig. 1a) was performed at the emergency department. What do the radiographs show? Based on the patient's clinical presentation and radiographic findings, computed tomography (CT) of the abdomen and pelvis (Figs. 1b & c)
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