Abstract
ObjectiveTo retrospectively evaluate the value of computerized 3D texture analysis for differentiating pulmonary metastases from non-metastatic lesions in pediatric patients with osteosarcoma.Materials and methodsThis retrospective study was approved by the institutional review board. The study comprised 42 pathologically confirmed pulmonary nodules in 16 children with osteosarcoma who had undergone preoperative computed tomography between January 2009 and December 2014. Texture analysis was performed using an in-house program. Multivariate logistic regression analysis was performed to identify factors for differentiating metastatic nodules from non-metastases. A subgroup analysis was performed to identify differentiating parameters in small non-calcified pulmonary nodules. The receiver operator characteristic curve was created to evaluate the discriminating performance of the established model.ResultsThere were 24 metastatic and 18 non-metastatic lesions. Multivariate analysis revealed that higher mean attenuation (adjusted odds ratio [OR], 1.014, P = 0.003) and larger effective diameter (OR, 1.745, P = 0.012) were significant differentiators. The analysis with small non-calcified pulmonary nodules (7 metastases and 18 non-metastases) revealed significant inter-group differences in various parameters. Logistic regression analysis revealed that higher mean attenuation (OR, 1.007, P = 0.008) was a significant predictor of non-calcified pulmonary metastases. The established logistic regression model of subgroups showed excellent discriminating performance in the ROC analysis (area under the curve, 0.865).ConclusionPulmonary metastases from osteosarcoma could be differentiated from non-metastases by using computerized texture analysis. Higher mean attenuation and larger diameter were significant predictors for pulmonary metastases, while higher mean attenuation was a significant predictor for small non-calcified pulmonary metastases.
Highlights
Osteosarcoma is the most common primary malignant bone tumor in children and adolescents [1]
Pulmonary metastases from osteosarcoma could be differentiated from non-metastases by using computerized texture analysis
Higher mean attenuation and larger diameter were significant predictors for pulmonary metastases, while higher mean attenuation was a significant predictor for small non-calcified pulmonary metastases
Summary
Osteosarcoma is the most common primary malignant bone tumor in children and adolescents [1]. Pulmonary metastasis is the most common metastatic disease associated with osteosarcoma, and approximately 15–20% of the patients have metastatic lesions when they are first diagnosed with osteosarcoma [1, 2]. The 5-year survival rate of patients with pulmonary metastasis has been reported to drop to 37%, whereas the 5-year survival rate of patients without metastatic disease is approximately 60–70% [3, 4]. Resection of the pulmonary metastases is known to be associated with improved survival in patients with osteosarcoma and resectable lung metastases [4]. The identification and differentiation of pulmonary metastases from non-metastatic lesions is very important for appropriate treatment. Computed tomography (CT) is the most widely used imaging technique for detecting and identifying pulmonary nodules. Distinguishing pulmonary metastasis from benign pulmonary nodules on CT is difficult, and only 64–74% of the nodules could be correctly identified by experienced radiologists via subjective assessment of CT findings [5]
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