A Confidence Habitats Methodology in MR Quantitative Diffusion for the Classification of Neuroblastic Tumors.

Leonor Cerdá Alberich,Luis Martí-Bonmatí,Adela Cañete,Cinta Sangüesa Nebot,José Miguel Carot Sierra,Blanca Martínez De Las Heras,Angel Alberich-Bayarri,Diana Veiga Canuto

doi:10.3390/cancers12123858

Abstract

Simple SummaryThere is growing interest in applying quantitative diffusion techniques to magnetic resonance imaging for cancer diagnosis and treatment. These measurements are used as a surrogate marker of tumor cellularity and aggressiveness, although there may be factors that introduce some bias to these approaches. Thus, we explored a novel methodology based on confidence habitats and voxel uncertainty to improve the power of the apparent diffusion coefficient to discriminate between benign and malignant neuroblastic tumor profiles in children. We were able to show this offered an improved sensitivity and negative predictive value relative to standard voxel-based methodologies.Background/Aim: In recent years, the apparent diffusion coefficient (ADC) has been used in many oncology applications as a surrogate marker of tumor cellularity and aggressiveness, although several factors may introduce bias when calculating this coefficient. The goal of this study was to develop a novel methodology (Fit-Cluster-Fit) based on confidence habitats that could be applied to quantitative diffusion-weighted magnetic resonance images (DWIs) to enhance the power of ADC values to discriminate between benign and malignant neuroblastic tumor profiles in children. Methods: Histogram analysis and clustering-based algorithms were applied to DWIs from 33 patients to perform tumor voxel discrimination into two classes. Voxel uncertainties were quantified and incorporated to obtain a more reproducible and meaningful estimate of ADC values within a tumor habitat. Computational experiments were performed by smearing the ADC values in order to obtain confidence maps that help identify and remove noise from low-quality voxels within high-signal clustered regions. The proposed Fit-Cluster-Fit methodology was compared with two other methods: conventional voxel-based and a cluster-based strategy. Results: The cluster-based and Fit-Cluster-Fit models successfully differentiated benign and malignant neuroblastic tumor profiles when using values from the lower ADC habitat. In particular, the best sensitivity (91%) and specificity (89%) of all the combinations and methods explored was achieved by removing uncertainties at a 70% confidence threshold, improving standard voxel-based sensitivity and negative predictive values by 4% and 10%, respectively. Conclusions: The Fit-Cluster-Fit method improves the performance of imaging biomarkers in classifying pediatric solid tumor cancers and it can probably be adapted to dynamic signal evaluation for any tumor.

Highlights

Neuroblastic tumors are rare lesions, they are the most frequent extracranial solid neuroblastic tumors are rare lesions, they are the most frequent extracranial solid cancer in children, and they include neuroblastoma, nodular ganglioneuroblastoma, intermixed cancer in children, andand theyganglioneuroma include neuroblastoma, nodular intermixed ganglioneuroblastoma [1]
In the main,from tumor diagnosis, prognosis monitoring decisions areand initially based on information obtained magnetic resonance (MR) and and monitoring decisions are initially based
Is standard-of-care MR technique that enables the microscopic movement of water molecules in the aextracellular standard-of-care technique that enables the microscopic movement of water molecules in the space of biological tissues to be visualized by calculating the apparent diffusion extracellular space of biological tissueswith to beneuroblastic visualized bytumors calculating apparent diffusionobtained coefficient coefficient (ADC) maps

Summary

Introduction

Neuroblastic tumors are rare lesions, they are the most frequent extracranial solid. Neuroblastic tumors are rare lesions, they are the most frequent extracranial solid cancer in children, and they include neuroblastoma, nodular ganglioneuroblastoma, intermixed cancer in children, andand theyganglioneuroma include neuroblastoma, nodular intermixed ganglioneuroblastoma [1]. In the main,ganglioneuroblastoma, tumor diagnosis, prognosis and ganglioneuroblastoma ganglioneuroma [1]. In the main,from tumor diagnosis, prognosis monitoring decisions areand initially based on information obtained magnetic resonance (MR) and and monitoring decisions are initially based (mIBG). MR technique that enables the microscopic movement of water molecules in the space of biological tissues to be visualized by calculating the apparent diffusion extracellular space of biological tissueswith to beneuroblastic visualized bytumors calculating apparent diffusionobtained coefficient coefficient (ADC) maps.

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