Archana Vadiraj Malagi1, Sivachander Shivaji2, Devasenathipathy Kandasamy2, Pramod Garg3, Siddhartha Datta Gupta4, Shivanand Gamanagatti 2, Raju Sharma2, and Amit Mehndiratta1,5
1Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India, 2Department of Radiodiagnosis, All India Institute of Medical Sciences Delhi, New Delhi, India, 3Department of Gastroenterology, All India Institute of Medical Sciences Delhi, New Delhi, India, 4Department of Pathology, All India Institute of Medical Sciences Delhi, New Delhi, India, 5Department of Biomedical Engineering, All India Institute of Medical Sciences Delhi, New Delhi, India
Synopsis
Tumor heterogeneity could be
detected non-invasively utilizing textural indicators from IVIM-DKI, which have
a high potential for early prognosis of pancreatic lesions. A novel technique
was investigated for tumor prediction model utilizing IVIM-DKI with total
variation penalty function, in which we employed combinations of texture
characteristics from IVIM-DKI parameters. In this study, texture
characteristics of the kurtosis(k) parameter had the high accuracy:93% and
AUC:1, and combinations of all IVIM-DKI parameters' textural features after
feature reduction had accuracy:84% and AUC:0.91 for classifying benign and
malignant pancreatic lesions. Whole-volumetric texture analysis of IVIM-DKI can
be employed for characterization of pancreatic lesions.
Introduction
Pancreatic ductal adenocarcinoma
(PDAC) accounts for over 90% of malignant neoplasm of the pancreas1.
The clinical manifestations are non-specific which leads to a delay in
diagnosis and consequently poor prognosis. Therefore, it is necessary to
identify biomarkers for early detection of pancreatic cancers. Image-guided fine-needle aspiration cytology (FNAC)
currently offers reliable findings for characterization of pancreatic lesions;
however, it is susceptible to tumor seeding in the sampling tract and sampling
errors2. Texture analysis (TA) on MRI can non-invasively
characterize pancreatic lesions and help in planning management3. No
prior studies have evaluated the TA of parameters estimated using intravoxel
incoherent motion coupled with diffusion kurtosis imaging (IVIM-DKI) in
classifying benign and malignant pancreatic lesions. This study explores the
application of a novel method in IVIM-DKI signal modeling with integration of
the total variation (TV) penalty function to reliably estimate the IVIM-DKI
parameters4,5. In addition, to study the effect of TA on IVIM-DKI
parameters using this novel model in the characterization of benign and
malignant pancreatic lesions.Methods
Study
population: Based on
the FNAC/biopsy or MRI findings, total of 47
patients with pancreatic lesions were divided into benign tumor
(n=22;mean±SD=43.3±14.3years;F:M=7:15) comprising of solid pseudopapillary
epithelial neoplasm (SPEN:n=4), mass-forming chronic pancreatitis (MFCP:n=6),
and pancreatic neuroendocrine tumor (PNET:n=12) and malignant tumors included
only pancreatic ductal adenocarcinoma (n=25; mean±SD=57.5±10.9 years; F:M=2:23)
as shown in figure 1.
IVIM-DKI
image analysis:
IVIM-DKI sequence was acquired at 1.5T scanner with 14 b-values(number of
averages) as 0(1),25(1),50(1),75(1),100(1),150(1),200(1),500(2),800(3),
1000(3),1250(4),1500(4),2000(5),2500(7)s/mm2 covering pancreas using
free-breathing technique. Non-linear least-squares optimization and parallel
computing with an in-house built toolbox were used for ADC estimation, and
IVIM-DKI parameters were generated using ivimDKI3Dtvtool_v1_2 application (https://github.com/amitvmehndiratta/IVIM-DKI-MRMP
2021)5 developed in MATLAB (version 9.9, The MathWorks, Inc.,
Natick, MA, USA).
Localization
of Region of interest:
Using ADC maps and morphological sequences like T2-weighted, contrast-enhanced T1-weighted, and DWI as a reference, lesion ROIs were manually drawn
throughout the whole volume of mass and delineated in matching slices of
IVIM-DKI images.
Texture
feature extraction and machine learning-based classification: Figure 2 shows the workflow of TA with
machine learning-based classification. A total of 30 texture features were
extracted from the global texture(3 features), Gray-Level Co-occurrence
Matrix(GLCM: 9 features), Gray-Level Run-Length Matrix(GLRLM: 13 features), and
Neighborhood Gray-Tone Difference Matrix(NGTDM: 5) with 26-voxel connectivity
using toolbox developed by Vallière, M. et al.6. The top six texture
features with high importance values were selected using the chi-square test
and were used as input to the random forest to classify benign from malignant
lesions. Accuracy, precession, recall, specificity, accuracy, F1 score, and
classification error on test data were estimated from each fold of 5-fold
cross-validation.Results
Figure 3 shows parameter maps
estimated using novel models that produce improvement in quality of parameter
maps. A total of 150 texture features(30*5) were extracted for each lesion
using 30 texture features derived from ADC, D, D*, f, and k. All IVIM-DKI
parameters and ADC features were combined to form a whole of 120(30 features
from each parameter, 30x4) texture feature sets. All features were fed to the
classifier model, where texture features from the D(30 textural features from
D) were observed to produce a high accuracy:92%, F1 score:91%, and AUC :1
respectively(figure 4). Further, using all IVIM-DKI parameters(120 features)
produced equally good results with accuracy and an F1 score of 83%, as shown in
figure 4.
Both accuracy and F1 score of top
six features for k parameter were 93% and AUC of 1 as shown in figure 5. In
addition, ADC showed good performance with accuracy and F1 score:89% and
AUC:0.99, and similarly, D showed accuracy and F1 score: 85% and AUC:0.97.
Except for D, classification performance increased after feature reduction.
Figures 4 and 5 illustrate the top six features arrangement in decreasing order
based on feature importance value. The top six texture features for both
combined IVIM-DKI parameters and ADC with combined IVIM-DKI parameters were
found to be the texture features of f and k parameters. Overall, variance,
GLRLM texture features such as SRHGE and LGRE have majorly contributed to
improvement in classification performance for all combinations except for the
parameter D*. Discussion
Texture analysis can detect non-invasive changes in the intensity of a lesion region and provide information on microscopic tissue heterogeneity that can be utilized to identify pancreatic lesions6. In this study, individual and combination of texture features from IVIM-DKI and ADC with feature reduction by chi-square test were utilized. After feature reduction, the classification performance of k increased significantly in terms of accuracy and AUC. GLCM and GLRLM features of k were selected, these features can capture tissue heterogeneity and complexity, potentially enhancing accurate diagnosis. Due to poor diagnostic performance in PDAC identification, the advantages of kurtosis have not been substantially researched in the literature7. f and k texture features were selected to produce high accuracy and AUC in both combinations of IVIM-DKI parameters and IVIM-DKI with ADC parameters. It can be shown that this combination of IVIM-DKI parameters can offer perfusion and tumor heterogeneity to represent the heterogeneous mass region. Conclusion
Whole-volumetric texture analysis combined with machine learning-based classification of pancreatic masses employing individual or combinations of IVIM-DKI parameters can aid in non-invasive characterization.Acknowledgements
This
study was supported by IIT Delhi and AIIMS Delhi. AVM was supported by research
fellowship fund from Ministry of Human Resource Development, Government of
India.References
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