B one tumors include benign, intermediate, and malignant lesions, according to the classification system of the World Health Organization (1). Malignant neoplasms can be further divided into primary and secondary bone tumors or metastases (2,3). Radiography is the suggested primary imaging modality for the diagnosis of bone tumors because it can enable visualization of the location, destruction pattern, and periosteal reaction pattern of bone lesions (4,5). These destruction patterns reflect the biologic activity of bone lesions, through which they can be categorized as aggressive or nonaggressive (6). As demonstrated by Lodwick's well-established grading system, the destruction patterns of bone tumors observed on radiographs allow for evaluation of biologic activity and subsequently allow for risk assessment of malignancy (7,8). Primary bone tumors are uncommon. Thus, many radiologists may not be able to develop sufficient expertise to reliably identify and assess these lesions on radiographs (9). However, early detection and correct diagnosis are crucial for adequate and successful treatment (10). To improve the rates of early detection and correct assessment, an artificial intelligence model that could detect and accurately categorize bone lesions into malignant or benign bone lesions on radiographs may be beneficial. Recently, studies have shown that deep learning (DL) models reliably assess and detect a variety of diseases based on medical imaging data (11,12). Clinical implementation of these models may improve the reliability and accuracy of radiologic assessment, thus potentially leading to improved diagnostics and better patient outcomes (13). Recently, a preliminary study used DL to classify primary bone tumors on radiographs ( 14), but Background: An artificial intelligence model that assesses primary bone tumors on radiographs may assist in the diagnostic workflow.Purpose: To develop a multitask deep learning (DL) model for simultaneous bounding box placement, segmentation, and classification of primary bone tumors on radiographs. Materials and Methods:This retrospective study analyzed bone tumors on radiographs acquired prior to treatment and obtained from patient data from January 2000 to June 2020. Benign or malignant bone tumors were diagnosed in all patients by using the histopathologic findings as the reference standard. By using split-sample validation, 70% of the patients were assigned to the training set, 15% were assigned to the validation set, and 15% were assigned to the test set. The final performance was evaluated on an external test set by using geographic validation, with accuracy, sensitivity, specificity, and 95% CIs being used for classification, the intersection over union (IoU) being used for bounding box placements, and the Dice score being used for segmentations. Results:Radiographs from 934 patients (mean age, 33 years 6 19 [standard deviation]; 419 women) were evaluated in the internal data set, which included 667 benign bone tumors and 267 malignant bone tumors. Six hundred f...
The bone marrow proton density fat fraction (PDFF) assessed with MRI enables the differentiation between osteoporotic/osteopenic patients with and without vertebral fractures. Therefore, PDFF may be a potentially useful biomarker for bone fragility assessment. Introduction To evaluate whether magnetic resonance imaging (MRI)-based proton density fat fraction (PDFF) of vertebral bone marrow can differentiate between osteoporotic/osteopenic patients with and without vertebral fractures. Methods Of the 52 study patients, 32 presented with vertebral fractures of the lumbar spine (66.4 ± 14.4 years, 62.5% women; acute low-energy osteoporotic/osteopenic vertebral fractures, N = 25; acute high-energy traumatic vertebral fractures, N = 7). These patients were frequency matched for age and sex to patients without vertebral fractures (N = 20, 69.3 ± 10.1 years, 70.0% women). Trabecular bone mineral density (BMD) values were derived from quantitative computed tomography. Chemical shift encoding-based water-fat MRI of the lumbar spine was performed, and PDFF maps were calculated. Associations between fracture status and PDFF were assessed using multivariable linear regression models. Results Over all patients, mean PDFF and trabecular BMD correlated significantly (r = − 0.51, P < 0.001). In the osteoporotic/osteopenic group, those patients with osteoporotic/osteopenic fractures had a significantly higher PDFF than those without osteoporotic fractures after adjusting for age, sex, weight, height, and trabecular BMD (adjusted mean difference [95% confidence interval], 20.8% [10.4%, 30.7%]; P < 0.001), although trabecular BMD values showed no significant difference between the subgroups (P = 0.63). For the differentiation of patients with and without vertebral fractures in the osteoporotic/osteopenic subgroup using mean PDFF, an area under the receiver operating characteristic (ROC) curve (AUC) of 0.88 (P = 0.006) was assessed. When evaluating all patients with vertebral fractures, those with high-energy traumatic fractures had a significantly lower PDFF than those with low-energy osteoporotic/osteopenic vertebral fractures (P < 0.001). Conclusion MR-based PDFF enables the differentiation between osteoporotic/osteopenic patients with and without vertebral fractures, suggesting the use of PDFF as a potential biomarker for bone fragility. Keywords bone marrow • magnetic resonance imaging • osteoporosis • spine Abbreviations PDFFProton density fat fraction BME Bone marrow edema BMD Bone mineral density DXA Dual-energy x-ray absorptiometry Key findings• PDFF allows the differentiation between osteoporotic/ osteopenic patients with and without vertebral fractures.• PDFF may be a useful tool for fragility assessment in addition to the BMD.
Background: In patients with soft-tissue sarcomas of the extremities, the treatment decision is currently regularly based on tumor grading and size. The imaging-based analysis may pose an alternative way to stratify patients’ risk. In this work, we compared the value of MRI-based radiomics with expert-derived semantic imaging features for the prediction of overall survival (OS). Methods: Fat-saturated T2-weighted sequences (T2FS) and contrast-enhanced T1-weighted fat-saturated (T1FSGd) sequences were collected from two independent retrospective cohorts (training: 108 patients; testing: 71 patients). After preprocessing, 105 radiomic features were extracted. Semantic imaging features were determined by three independent radiologists. Three machine learning techniques (elastic net regression (ENR), least absolute shrinkage and selection operator, and random survival forest) were compared to predict OS. Results: ENR models achieved the best predictive performance. Histologies and clinical staging differed significantly between both cohorts. The semantic prognostic model achieved a predictive performance with a C-index of 0.58 within the test set. This was worse compared to a clinical staging system (C-index: 0.61) and the radiomic models (C-indices: T1FSGd: 0.64, T2FS: 0.63). Both radiomic models achieved significant patient stratification. Conclusions: T2FS and T1FSGd-based radiomic models outperformed semantic imaging features for prognostic assessment.
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