Cancer therapy, even when highly targeted, typically fails because of the remarkable capacity of malignant cells to evolve effective adaptations. These evolutionary dynamics are both a cause and a consequence of cancer system heterogeneity at many scales, ranging from genetic properties of individual cells to large-scale imaging features. Tumors of the same organ and cell type can have remarkably diverse appearances in different patients. Furthermore, even within a single tumor, marked variations in imaging features, such as necrosis or contrast enhancement, are common. Similar spatial variations recently have been reported in genetic profiles. Radiologic heterogeneity within tumors is usually governed by variations in blood flow, whereas genetic heterogeneity is typically ascribed to random mutations. However, evolution within tumors, as in all living systems, is subject to Darwinian principles; thus, it is governed by predictable and reproducible interactions between environmental selection forces and cell phenotype (not genotype). This link between regional variations in environmental properties and cellular adaptive strategies may permit clinical imaging to be used to assess and monitor intratumoral evolution in individual patients. This approach is enabled by new methods that extract, report, and analyze quantitative, reproducible, and mineable clinical imaging data. However, most current quantitative metrics lack spatialness, expressing quantitative radiologic features as a single value for a region of interest encompassing the whole tumor. In contrast, spatially explicit image analysis recognizes that tumors are heterogeneous but not well mixed and defines regionally distinct habitats, some of which appear to harbor tumor populations that are more aggressive and less treatable than others. By identifying regional variations in key environmental selection forces and evidence of cellular adaptation, clinical imaging can enable us to define intratumoral Darwinian dynamics before and during therapy. Advances in image analysis will place clinical imaging in an increasingly central role in the development of evolution-based patient-specific cancer therapy.

© RSNA, 2013

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Quantitative Imaging in Cancer Evolution and Ecology

The objective of radiologic image compression is to reduce the data volume of and to achieve a low bit rate in the digital representation of radiologic images without perceived loss of image quality. However, the demand for transmission bandwidth and storage space in the digital radiology environment, especially picture archiving and communication systems (PACS) and teleradiology, and the proliferating use of various imaging modalities, such as magnetic resonance imaging, computed tomography, ultrasonography, nuclear medicine, computed radiography, and digital subtraction angiography, continue to outstrip the capabilities of existing technologies. The availability of lossy coding techniques for clinical diagnoses further implicates many complex legal and regulatory issues. This paper reviews the recent progress of lossless and lossy radiologic image compression and presents the legal challenges of using lossy compression of medical records. To do so, we first describe the fundamental concepts of radiologic imaging and digitization. Then, we examine current compression technology in the field of medical imaging and discuss important regulatory policies and legal questions facing the use of compression in this field. We conclude with a summary of future challenges and research directions. >

Radiologic image compression-a review

A comprehensive multidisciplinary approach has transformed osteosarcoma from a disease with a modest long-term survival to one in which at least two-thirds of patients will be cured. Surgery remains the vital modality for treating the primary tumor, whereas adjuvant chemotherapy plays an essential role in the control of subclinical metastatic disease. Complete surgical excision of the primary tumor remains an essential element of treatment. For many patients, a combination of advances in surgical technique, improved imaging modalities to accurately document tumor extent, and the effect of neoadjuvant chemotherapy has made limb salvage procedures a safe alternative to amputation. In some patients for whom complete surgical excision is impossible, the addition of radiation therapy may allow local tumor control. The most effective chemotherapy agents currently in use include high-dose methotrexate, doxorubicin, cisplatin, and ifosfamide/etoposide. The optimal schedule of therapy is still being investigated, as is the role of dose intensification. Unfortunately, some groups of patients remain at high risk of eventual relapse. Those whose tumors show relatively low degrees of necrosis after administration of chemotherapy have poorer survival than patients with more chemotherapy-responsive tumors. Similarly, patients who present with overt metastatic disease (particularly bone metastases), as well as patients with tumors that recur after treatment, continue to have an unsatisfactory outcome. These groups, in particular, may benefit from future investigations into novel agents, such as biological response modifiers, antiangiogenesis factors, and growth receptor modulation.

Current Treatment of Osteosarcoma

Causes and effects of heterogeneous perfusion in tumors.

Scintigraphic diagnosis, based on functional image interpretation, becomes more accurate and meaningful when supported by corresponding anatomical data. In order to produce anatomical images that are inherently registered with images of emission computerised tomography acquired with a gamma camera, an X-ray transmission system was mounted on the slip-ring gantry of a GEMS Millennium VG gamma camera. The X-ray imaging system is composed of an X-ray tube and a set of detectors located on opposite sides of the gantry rotor that moves around the patient along with the nuclear detectors. A cross-sectional anatomical transmission map is acquired as the system rotates around the patient in a manner similar to a third-generation computerised tomography (CT) system. Following transmission, single-photon emission tomography (SPET) or positron emission tomography (PET) coincidence detection images are acquired and the resultant emission images are thus inherently registered to the anatomical maps. Attenuation correction of the emission images is performed with the same anatomical maps to generate transmission maps. Phantom experiments of system performance and examples of first SPET and coincidence detection patient images are presented. Despite limitations of the system when compared with a state of the art CT scanner, the transmission anatomical maps allow for precise anatomical localisation and for attenuation correction of the emission images.

Gamma camera-mounted anatomical X-ray tomography: technology, system characteristics and first images

Nuclear Medicine is one of the first domains in which the analysis of image sequences was introduced. The development of this analysis was achieved parallel to the one of the computer systems linked to the scintillation cameras. The number of works that were performed in the research laboratories and have received an application in clinical routine is however limited. The authors indicate what could be the flow chart of the processing of dynamic sequences in scintigraphy and the kind of material that would be necessary to implement it. The possibilities of using the factor and compartmental analyses in clinical routine are particularly emphasized. The authors indicate why the factors and their associated images obtained by means of the factor analysis can have a physiological meaning.

Handling of Dynamic Sequences in Nuclear Medicine

In scintigraphy, the detection of scattered photons degrades both visual image analysis and quantitative accuracy. Many methods have been proposed and are still under investigation to cope with scattered photons. The main features of the problem of scattering in radionuclide imaging are presented first, to provide a sound foundation for a critical review of the existing scatter correction techniques. These are described using a classification relating to their aims and principles. Their theoretical potentials are analysed, as well as the difficulties of their practical implementation. Finally, the problems of their evaluation and comparison are discussed.

Scatter correction in scintigraphy: the state of the art.

Factor analysis of dynamic structures (FADS) can automatically provide ''physiological'' factors related to anatomical structures that have different temporal behavior, even if these structures overlap; it also yields images corresponding to the factors' spatial distributions. FADS has been applied to 45 gated cardiac studies. Results obtained by FADS were compared with those obtained from the amplitude and the phase of first-harmonic Fourier analysis (FA). The joint results were compared with the final diagnosis, established by real-time echocardiography and/or ventriculography. In normal patients, good agreement was obtained between the two approaches. On the whole set of patients, FADS was significantly better than FA.

https://jnm.snmjournals.org/content/25/10/1067.full.pdf

Factor analysis in gated cardiac studies.

PURPOSE To evaluate factor analysis of medical image sequences (FAMIS), a means whereby physiologic contrast enhancement kinetics, called factors, and their spatial distribution, termed factor images, are estimated after acquisition of dynamic MR images. The method is intended to recognize and characterize the different tissue kinetics automatically. METHODS This method was evaluated in a series of 22 patients with head and neck tumors. Eleven patients presented with a previously untreated lesion. Six were examined for tumor recurrence, previously treated by multiple therapies. Five patients had preoperative chemotherapy and underwent MR before and after chemotherapy. In all cases, MR images were correlated with surgical and pathologic data. MR examinations were performed on a 1.5-T unit with static sequences and dynamic sequences acquired after bolus injection of gadolinium and processed by FAMIS. RESULTS FAMIS was able to identify three factors representing contrast-enhancement kinetics and their associated factor images. The neoplastic component was associated with the earlier factor image, F1. Fibrosis and chemotherapy and/or radiation-induced changes were associated with the two later factors, F2 and F3. The limits of this method were highly vascularized tissues whose earlier factor was similar to that of neoplastic tissues (mucosae and salivary glands), patient motion, responsible for artifacts in FAMIS, and lesions of less than 5 mm. CONCLUSION FAMIS of dynamic MR studies was useful for differentiating neoplastic tissue from tissue having undergone changes by chemotherapy and/or radiotherapy, but it did not improve the ability of MR to characterize neoplastic tissues in previously untreated patients.

http://www.ajnr.org/content/ajnr/15/7/1359.full.pdf

Factor analysis of medical image sequences in MR of head and neck tumors.

As data compression plays now an important role in the development of medical PACS, a technique has been developed for medical image sequences storage and transmission in order to obtain very high compression ratio: in dynamic nuclear medicine studies it can achieve a compression ratio as high as 100:1 without significant degradation. The implemented technique combines two methods which multiply their effects. In a first step, a principal component analysis (PCA) of the image series is performed. It extracts a limited number of principal components and their associated images. For data compression it is not necessary to perform an oblique factor analysis to estimate the so-called ‘physiological functions’ and their spatial distributions as in factor analysis of dynamic structures (FADS). In a second step, the principal images are compressed by means of a transform coding procedure: an adaptive block-quantization technique using the 2D discrete cosine transform (DCT) is implemented, followed by a statistical quantization method to encode the DCT coefficients. To reconstruct the principal images, an inverse DCT is applied. Then the original series is computed from the reconstructed images combined with the principal components which have been stored without any modification. The reconstructed series is compared to the original series, as well as the time activity curves generated on different regions of interest (ROI) and the factor estimates obtained using FADS performed on the two series. Method and evaluation are illustrated on an example of first pass radionuclide angiocardiography.

R. Di Paola

Papers

Handling of Dynamic Sequences in Nuclear Medicine

Scatter correction in scintigraphy: the state of the art.

Factor analysis in gated cardiac studies.

Factor analysis of medical image sequences in MR of head and neck tumors.

High compression of nuclear medicine dynamic studies.