Radiomic Machine Learning for Characterization of Prostate Lesions with MRI: Comparison to ADC Values.

Journal: Radiology
Published Date: Jul 31, 2018

Abstract

Purpose To compare biparametric contrast-free radiomic machine learning (RML), mean apparent diffusion coefficient (ADC), and radiologist assessment for characterization of prostate lesions detected during prospective MRI interpretation. Materials and Methods This single-institution study included 316 men (mean age ± standard deviation, 64.0 years ± 7.8) with an indication for MRI-transrectal US fusion biopsy between May 2015 and September 2016 (training cohort, 183 patients; test cohort, 133 patients). Lesions identified by prospective clinical readings were manually segmented for mean ADC and radiomics analysis. Global and zone-specific random forest RML and mean ADC models for classification of clinically significant prostate cancer (Gleason grade group ≥ 2) were developed on the training set and the fixed models tested on an independent test set. Clinical readings, mean ADC, and radiomics were compared by using the McNemar test and receiver operating characteristic (ROC) analysis. Results In the test set, radiologist interpretation had a per-lesion sensitivity of 88% (53 of 60) and specificity of 50% (79 of 159). Quantitative measurement of the mean ADC (cut-off 732 mm/sec) significantly reduced false-positive (FP) lesions from 80 to 60 (specificity 62% [99 of 159]) and false-negative (FN) lesions from seven to six (sensitivity 90% [54 of 60]) (P = .048). Radiologist interpretation had a per-patient sensitivity of 89% (40 of 45) and specificity of 43% (38 of 88). Quantitative measurement of the mean ADC reduced the number of patients with FP lesions from 50 to 43 (specificity 51% [45 of 88]) and the number of patients with FN lesions from five to three (sensitivity 93% [42 of 45]) (P = .496). Comparison of the area under the ROC curve (AUC) for the mean ADC (AUC = 0.84; AUC ≤ 0.87) vs the RML (AUC = 0.88, P = .176; AUC ≤ 0.89, P ≥ .493) showed no significantly different performance. Conclusion Quantitative measurement of the mean apparent diffusion coefficient (ADC) improved differentiation of benign versus malignant prostate lesions, compared with clinical assessment. Radiomic machine learning had comparable but not better performance than mean ADC assessment. © RSNA, 2018 Online supplemental material is available for this article.

Authors

  • David Bonekamp
    From the Department of Radiology (D.B., P.S., J.P.R., P.K., K.Y., M.F., H.P.S.), Division of Medical Image Computing (S.K., M.G., N.G., K.H.M.H.), Division of Statistics (M.W.), and Department of Medical Physics (T.A.K., F.D.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany (D.B., H.P.S., K.H.M.H.); and Departments of Urology (J.P.R., B.H., M.H., B.A.H.) and Neuroradiology (P.K.), University of Heidelberg Medical Center, Heidelberg, Germany.
  • Simon Kohl
    From the Department of Radiology (D.B., P.S., J.P.R., P.K., K.Y., M.F., H.P.S.), Division of Medical Image Computing (S.K., M.G., N.G., K.H.M.H.), Division of Statistics (M.W.), and Department of Medical Physics (T.A.K., F.D.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany (D.B., H.P.S., K.H.M.H.); and Departments of Urology (J.P.R., B.H., M.H., B.A.H.) and Neuroradiology (P.K.), University of Heidelberg Medical Center, Heidelberg, Germany.
  • Manuel Wiesenfarth
    Division of Biostatistics, German Cancer Research Center, Im Neuenheimer Feld 581, 69210, Heidelberg, Germany.
  • Patrick Schelb
    From the Department of Radiology (D.B., P.S., J.P.R., P.K., K.Y., M.F., H.P.S.), Division of Medical Image Computing (S.K., M.G., N.G., K.H.M.H.), Division of Statistics (M.W.), and Department of Medical Physics (T.A.K., F.D.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany (D.B., H.P.S., K.H.M.H.); and Departments of Urology (J.P.R., B.H., M.H., B.A.H.) and Neuroradiology (P.K.), University of Heidelberg Medical Center, Heidelberg, Germany.
  • Jan Philipp Radtke
    From the Department of Radiology (D.B., P.S., J.P.R., P.K., K.Y., M.F., H.P.S.), Division of Medical Image Computing (S.K., M.G., N.G., K.H.M.H.), Division of Statistics (M.W.), and Department of Medical Physics (T.A.K., F.D.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany (D.B., H.P.S., K.H.M.H.); and Departments of Urology (J.P.R., B.H., M.H., B.A.H.) and Neuroradiology (P.K.), University of Heidelberg Medical Center, Heidelberg, Germany.
  • Michael Götz
    Medical Image Analysis, Division Medical Image Computing, DKFZ Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany. Electronic address: m.goetz@dkfz-heidelberg.de.
  • Philipp Kickingereder
    From the Department of Radiology (D.B., P.S., J.P.R., P.K., K.Y., M.F., H.P.S.), Division of Medical Image Computing (S.K., M.G., N.G., K.H.M.H.), Division of Statistics (M.W.), and Department of Medical Physics (T.A.K., F.D.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany (D.B., H.P.S., K.H.M.H.); and Departments of Urology (J.P.R., B.H., M.H., B.A.H.) and Neuroradiology (P.K.), University of Heidelberg Medical Center, Heidelberg, Germany.
  • Kaneschka Yaqubi
    From the Department of Radiology (D.B., P.S., J.P.R., P.K., K.Y., M.F., H.P.S.), Division of Medical Image Computing (S.K., M.G., N.G., K.H.M.H.), Division of Statistics (M.W.), and Department of Medical Physics (T.A.K., F.D.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany (D.B., H.P.S., K.H.M.H.); and Departments of Urology (J.P.R., B.H., M.H., B.A.H.) and Neuroradiology (P.K.), University of Heidelberg Medical Center, Heidelberg, Germany.
  • Bertram Hitthaler
    From the Department of Radiology (D.B., P.S., J.P.R., P.K., K.Y., M.F., H.P.S.), Division of Medical Image Computing (S.K., M.G., N.G., K.H.M.H.), Division of Statistics (M.W.), and Department of Medical Physics (T.A.K., F.D.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany (D.B., H.P.S., K.H.M.H.); and Departments of Urology (J.P.R., B.H., M.H., B.A.H.) and Neuroradiology (P.K.), University of Heidelberg Medical Center, Heidelberg, Germany.
  • Nils Gählert
    From the Department of Radiology (D.B., P.S., J.P.R., P.K., K.Y., M.F., H.P.S.), Division of Medical Image Computing (S.K., M.G., N.G., K.H.M.H.), Division of Statistics (M.W.), and Department of Medical Physics (T.A.K., F.D.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany (D.B., H.P.S., K.H.M.H.); and Departments of Urology (J.P.R., B.H., M.H., B.A.H.) and Neuroradiology (P.K.), University of Heidelberg Medical Center, Heidelberg, Germany.
  • Tristan Anselm Kuder
    From the Department of Radiology (D.B., P.S., J.P.R., P.K., K.Y., M.F., H.P.S.), Division of Medical Image Computing (S.K., M.G., N.G., K.H.M.H.), Division of Statistics (M.W.), and Department of Medical Physics (T.A.K., F.D.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany (D.B., H.P.S., K.H.M.H.); and Departments of Urology (J.P.R., B.H., M.H., B.A.H.) and Neuroradiology (P.K.), University of Heidelberg Medical Center, Heidelberg, Germany.
  • Fenja Deister
    From the Department of Radiology (D.B., P.S., J.P.R., P.K., K.Y., M.F., H.P.S.), Division of Medical Image Computing (S.K., M.G., N.G., K.H.M.H.), Division of Statistics (M.W.), and Department of Medical Physics (T.A.K., F.D.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany (D.B., H.P.S., K.H.M.H.); and Departments of Urology (J.P.R., B.H., M.H., B.A.H.) and Neuroradiology (P.K.), University of Heidelberg Medical Center, Heidelberg, Germany.
  • Martin Freitag
    From the Department of Radiology (D.B., P.S., J.P.R., P.K., K.Y., M.F., H.P.S.), Division of Medical Image Computing (S.K., M.G., N.G., K.H.M.H.), Division of Statistics (M.W.), and Department of Medical Physics (T.A.K., F.D.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany (D.B., H.P.S., K.H.M.H.); and Departments of Urology (J.P.R., B.H., M.H., B.A.H.) and Neuroradiology (P.K.), University of Heidelberg Medical Center, Heidelberg, Germany.
  • Markus Hohenfellner
    From the Department of Radiology (D.B., P.S., J.P.R., P.K., K.Y., M.F., H.P.S.), Division of Medical Image Computing (S.K., M.G., N.G., K.H.M.H.), Division of Statistics (M.W.), and Department of Medical Physics (T.A.K., F.D.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany (D.B., H.P.S., K.H.M.H.); and Departments of Urology (J.P.R., B.H., M.H., B.A.H.) and Neuroradiology (P.K.), University of Heidelberg Medical Center, Heidelberg, Germany.
  • Boris A Hadaschik
    From the Department of Radiology (D.B., P.S., J.P.R., P.K., K.Y., M.F., H.P.S.), Division of Medical Image Computing (S.K., M.G., N.G., K.H.M.H.), Division of Statistics (M.W.), and Department of Medical Physics (T.A.K., F.D.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany (D.B., H.P.S., K.H.M.H.); and Departments of Urology (J.P.R., B.H., M.H., B.A.H.) and Neuroradiology (P.K.), University of Heidelberg Medical Center, Heidelberg, Germany.
  • Heinz-Peter Schlemmer
    From the Department of Radiology (D.B., P.S., J.P.R., P.K., K.Y., M.F., H.P.S.), Division of Medical Image Computing (S.K., M.G., N.G., K.H.M.H.), Division of Statistics (M.W.), and Department of Medical Physics (T.A.K., F.D.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany (D.B., H.P.S., K.H.M.H.); and Departments of Urology (J.P.R., B.H., M.H., B.A.H.) and Neuroradiology (P.K.), University of Heidelberg Medical Center, Heidelberg, Germany.
  • Klaus H Maier-Hein
    Medical Image Computing (MIC), German Cancer Research Center (DKFZ), Heidelberg, Germany. Electronic address: k.maier-hein@dkfz.de.

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