Abstract
Purpose: The purpose of this study was to investigate the feasibility of Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) image-based radiomics in differentiating bone metastases from benign bone lesions in patients with tumors.Methods: A total of 192 lesions from 132 patients (134 in the training group, 58 in the validation group) diagnosed with vertebral bone metastases or benign bone lesions were enrolled. All images were evaluated and diagnosed independently by two physicians with more than 20 years of diagnostic experience for qualitative classification, the images were imported into MaZda software in Bitmap (BMP) format for feature extraction. All radiomics features were selected by least absolute shrinkage and selection operator (LASSO) regression and 10-fold cross-validation algorithms after the process of normalization and correlation analysis. Based on these selected features, two models were established: The CT model and SPECT model (radiomics features were derived from CT and SPECT images, respectively). In addition, a combination model (ComModel) combined CT and SPECT features was developed in order to better evaluate the predictive performance of radiomics models. Subsequently, the diagnostic performance between each model was separately evaluated by a confusion matrix.Results: There were 12, 13, and 18 features contained within the CT, SPECT, and ComModel, respectively. The constructed radiomics models based on SPECT/CT images to discriminate between bone metastases and benign bone lesions not only had high diagnostic efficacy in the training group (AUC of 0.894, 0.914, 0.951 for CT model, SPECT model, and ComModel, respectively), but also performed well in the validation group (AUC; 0.844, 0.871, 0.926). The AUC value of the human experts was 0.849 and 0.839 in the training and validation groups, respectively. Furthermore, both SPECT model and ComModel show higher classification performance than human experts in the training group (P = 0.021 and P = 0.001, respectively) and the validation group (P = 0.037 and P = 0.007, respectively). All models showed better diagnostic accuracy than human experts in the training group and the validation group.Conclusion: Radiomics derived from SPECT/CT images could effectively discriminate between bone metastases and benign bone lesions. This technique may be a new non-invasive way to help prevent unnecessary delays in diagnosis and a potential contribution in disease staging and treatment planning.
Highlights
Bone metastases were a common event in cancer evolution
A total of 192 lesions from 132 patients were enrolled in this study, which included 79 patients who were classified as bone metastasis (46 men, 33 women), while the remaining 53 patients were classified as benign bone lesions (32 men, 21 women)
SPECT/CT had significantly improved the diagnostic efficiency of spinal lesions and could diagnose bone metastases based on the criteria of osteolytic, osteoblastic, and mixed bone changes on SPECT/CT images and abnormal uptake of 99mTc-MDP in the corresponding area, some benign lesions such as fractures, degenerative changes, spinal tuberculosis, and osteoarthritis can show similar bone changes in CT and abnormal uptake of radioactive tracer, atypical bone lesions contributed to the challenge of differentiating between the bone metastases and benign bone disease [25]
Summary
Studies had shown that nearly 70% of cancer patients had metastases at autopsy, and 80% of the primary tumors were a prostate, breast, and lung cancers, bone-related events associated with bone metastases which can seriously affect patients’ quality of life [1]. Among patients with primary tumors with bone metastases or benign bone diseases, the early diagnosis was important for individualized patient treatment as treatment options vary widely [2]. Several researchers had indicated that bone metastases and benign bone lesions had similar imaging features, for patients with already known cancer [6,7,8], it remained difficult to discriminate bone metastases and benign bone lesions as studies had shown that 14.3% of patients still had an equivocal diagnosis after SPECT/CT examination [9, 10]. SPECT/CT diagnosis mainly depended on physicians’ personal experience, which inevitably had subjective factors, and it was difficult to quantify the intensity, uniformity, and heterogeneity of lesion distribution [11]
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