Skip to main content
Top
Published in: BMC Medical Imaging 1/2020

Open Access 01-12-2020 | Metastasis | Research article

Cervical spine osteoradionecrosis or bone metastasis after radiotherapy for nasopharyngeal carcinoma? The MRI-based radiomics for characterization

Authors: Xi Zhong, Li Li, Huali Jiang, Jinxue Yin, Bingui Lu, Wen Han, Jiansheng Li, Jian Zhang

Published in: BMC Medical Imaging | Issue 1/2020

Login to get access

Abstract

Background

To develop and validate an MRI-based radiomics nomogram for differentiation of cervical spine ORN from metastasis after radiotherapy (RT) in nasopharyngeal carcinoma (NPC).

Methods

A radiomics nomogram was developed in a training set that comprised 46 NPC patients after RT with 95 cervical spine lesions (ORN, n = 51; metastasis, n = 44), and data were gathered from January 2008 to December 2012. 279 radiomics features were extracted from the axial contrast-enhanced T1-weighted image (CE-T1WI). A radiomics signature was created by using the least absolute shrinkage and selection operator (LASSO) algorithm. A nomogram model was developed based on the radiomics scores. The performance of the nomogram was determined in terms of its discrimination, calibration, and clinical utility. An independent validation set contained 25 consecutive patients with 47 lesions (ORN, n = 25; metastasis, n = 22) from January 2013 to December 2015.

Results

The radiomics signature that comprised eight selected features was significantly associated with the differentiation of cervical spine ORN and metastasis. The nomogram model demonstrated good calibration and discrimination in the training set [AUC, 0.725; 95% confidence interval (CI), 0.622–0.828] and the validation set (AUC, 0.720; 95% CI, 0.573–0.867). The decision curve analysis indicated that the radiomics nomogram was clinically useful.

Conclusions

MRI-based radiomics nomogram shows potential value to differentiate cervical spine ORN from metastasis after RT in NPC.
Appendix
Available only for authorised users
Literature
1.
go back to reference Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.CrossRef Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.CrossRef
2.
go back to reference Lin JC, Jan JS, Hsu CY, Liang WM, Jiang RS, Wang WY. Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol. 2003;21(4):631–7.CrossRef Lin JC, Jan JS, Hsu CY, Liang WM, Jiang RS, Wang WY. Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol. 2003;21(4):631–7.CrossRef
3.
go back to reference Huang XM, Zheng YQ, Zhang XM, Mai HQ, Zeng L, Liu X, et al. Diagnosis and management of skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma. Laryngoscope. 2006;116(9):1626–31.CrossRef Huang XM, Zheng YQ, Zhang XM, Mai HQ, Zeng L, Liu X, et al. Diagnosis and management of skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma. Laryngoscope. 2006;116(9):1626–31.CrossRef
4.
go back to reference Cheung JP, Wei WI, Luk KD. Cervical spine complications after treatment of nasopharyngeal carcinoma. Eur Spine J. 2013;22(3):584–92.CrossRef Cheung JP, Wei WI, Luk KD. Cervical spine complications after treatment of nasopharyngeal carcinoma. Eur Spine J. 2013;22(3):584–92.CrossRef
5.
go back to reference Kaltoft B, Kruse A, Jensen LT, Elberg JJ. Reconstruction of the cervical spine with two osteocutaneous fibular flap after radiotherapy and resection of osteoclastoma : a case report. J Plast Reconstr Aesthet Surg. 2012;65(9):1262–4.CrossRef Kaltoft B, Kruse A, Jensen LT, Elberg JJ. Reconstruction of the cervical spine with two osteocutaneous fibular flap after radiotherapy and resection of osteoclastoma : a case report. J Plast Reconstr Aesthet Surg. 2012;65(9):1262–4.CrossRef
6.
go back to reference Khorsandi AS, Su HK, Mourad WF, Urken ML, Persky MS, Lazarus CL, et al. Osteoradionecrosis of the subaxial cervical spine following treatment for head and neck carcinomas. Br J Radiol. 2015;88(1045):20140436.CrossRef Khorsandi AS, Su HK, Mourad WF, Urken ML, Persky MS, Lazarus CL, et al. Osteoradionecrosis of the subaxial cervical spine following treatment for head and neck carcinomas. Br J Radiol. 2015;88(1045):20140436.CrossRef
7.
go back to reference Rashid MZ, Ariffin MH, Rhani SA, Baharudin A, Ibrahim K. Osteoradionecrosis in subaxial cervical spine - a rare and devastating complication: a case report. Malays Orthop J. 2017;11(3):53–5.CrossRef Rashid MZ, Ariffin MH, Rhani SA, Baharudin A, Ibrahim K. Osteoradionecrosis in subaxial cervical spine - a rare and devastating complication: a case report. Malays Orthop J. 2017;11(3):53–5.CrossRef
8.
go back to reference Kosaka Y, Okuno Y, Tagawa Y, Ueki N, Itoh K, Shinohara S, et al. Osteoradionecrosis of the cervical vertebrae in patients irradiated for head and neck cancers. Jpn J Radiol. 2010;28(5):388–94.CrossRef Kosaka Y, Okuno Y, Tagawa Y, Ueki N, Itoh K, Shinohara S, et al. Osteoradionecrosis of the cervical vertebrae in patients irradiated for head and neck cancers. Jpn J Radiol. 2010;28(5):388–94.CrossRef
9.
go back to reference King AD, Griffith JF, Abrigo JM, Leung SF, Yau FK, Tse GM, et al. Osteoradionecrosis of the upper cervical spine: MR imaging following radiotherapy for nasopharyngeal carcinoma. Eur J Radiol. 2010;73(3):629–35.CrossRef King AD, Griffith JF, Abrigo JM, Leung SF, Yau FK, Tse GM, et al. Osteoradionecrosis of the upper cervical spine: MR imaging following radiotherapy for nasopharyngeal carcinoma. Eur J Radiol. 2010;73(3):629–35.CrossRef
10.
go back to reference Wu LA, Liu HM, Wang CW, Chen YF, Hong RL, Ko JY. Osteoradionecrosis of the upper cervical spine after radiation therapy for head and neck cancer: differentiation from recurrent or metastatic disease with MR imaging. Radiology. 2012;264(1):136–45.CrossRef Wu LA, Liu HM, Wang CW, Chen YF, Hong RL, Ko JY. Osteoradionecrosis of the upper cervical spine after radiation therapy for head and neck cancer: differentiation from recurrent or metastatic disease with MR imaging. Radiology. 2012;264(1):136–45.CrossRef
11.
go back to reference Yin P, Mao N, Wang S, Sun C, Hong N. Clinical-radiomics nomograms for pre-operative differentiation of sacral chordoma and sacral giant cell tumor based on 3D computed tomography and multiparametric magnetic resonance imaging. Br J Radiol. 2019;92(1101):20190155.CrossRef Yin P, Mao N, Wang S, Sun C, Hong N. Clinical-radiomics nomograms for pre-operative differentiation of sacral chordoma and sacral giant cell tumor based on 3D computed tomography and multiparametric magnetic resonance imaging. Br J Radiol. 2019;92(1101):20190155.CrossRef
12.
go back to reference Xie H, Hu J, Zhang X, Ma S, Liu Y, Wang X. Preliminary utilization of radiomics in differentiating uterine sarcoma from atypical leiomyoma: comparison on diagnostic efficacy of MRI features and radiomic features. Eur J Radiol. 2019;115:39–45.CrossRef Xie H, Hu J, Zhang X, Ma S, Liu Y, Wang X. Preliminary utilization of radiomics in differentiating uterine sarcoma from atypical leiomyoma: comparison on diagnostic efficacy of MRI features and radiomic features. Eur J Radiol. 2019;115:39–45.CrossRef
13.
go back to reference Park YW, Choi YS, Ahn SS, Chang JH, Kim SH, Lee SK. Radiomics MRI Phenotyping with machine learning to predict the grade of lower-grade Gliomas: a study focused on nonenhancing tumors. Korean J Radiol. 2019;20(9):1381–9.CrossRef Park YW, Choi YS, Ahn SS, Chang JH, Kim SH, Lee SK. Radiomics MRI Phenotyping with machine learning to predict the grade of lower-grade Gliomas: a study focused on nonenhancing tumors. Korean J Radiol. 2019;20(9):1381–9.CrossRef
14.
go back to reference Wu S, Zheng J, Li Y, Yu H, Shi S, Xie W, Liu H, et al. A Radiomics Nomogram for the preoperative prediction of lymph node metastasis in bladder Cancer. Clin Cancer Res. 2017;23(22):6904–11.CrossRef Wu S, Zheng J, Li Y, Yu H, Shi S, Xie W, Liu H, et al. A Radiomics Nomogram for the preoperative prediction of lymph node metastasis in bladder Cancer. Clin Cancer Res. 2017;23(22):6904–11.CrossRef
15.
go back to reference Huang YQ, Liang CH, He L, Tian J, Liang CS, Chen X, et al. Development and validation of a Radiomics Nomogram for preoperative prediction of lymph node metastasis in colorectal Cancer. J Clin Oncol. 2016;34(18):2157–64.CrossRef Huang YQ, Liang CH, He L, Tian J, Liang CS, Chen X, et al. Development and validation of a Radiomics Nomogram for preoperative prediction of lymph node metastasis in colorectal Cancer. J Clin Oncol. 2016;34(18):2157–64.CrossRef
16.
go back to reference Yuan C, Wang Z, Gu D, Tian J, Zhao P, Wei J, et al. Prediction early recurrence of hepatocellular carcinoma eligible for curative ablation using a Radiomics nomogram. Cancer Imaging. 2019;19(1):21.CrossRef Yuan C, Wang Z, Gu D, Tian J, Zhao P, Wei J, et al. Prediction early recurrence of hepatocellular carcinoma eligible for curative ablation using a Radiomics nomogram. Cancer Imaging. 2019;19(1):21.CrossRef
17.
go back to reference Yin P, Mao N, Liu X, Sun C, Wang S, Chen L, Hong N. Can clinical radiomics nomogram based on 3D multiparametric MRI features and clinical characteristics estimate early recurrence of pelvic chondrosarcoma? J Magn Reson Imaging. 2020;51(2):435–45.CrossRef Yin P, Mao N, Liu X, Sun C, Wang S, Chen L, Hong N. Can clinical radiomics nomogram based on 3D multiparametric MRI features and clinical characteristics estimate early recurrence of pelvic chondrosarcoma? J Magn Reson Imaging. 2020;51(2):435–45.CrossRef
18.
go back to reference Mao J, Fang J, Duan X, Yang Z, Cao M, Zhang F, et al. Predictive value of pretreatment MRI texture analysis in patients with primary nasopharyngeal carcinoma. Eur Radiol. 2019;29(8):4105–13.CrossRef Mao J, Fang J, Duan X, Yang Z, Cao M, Zhang F, et al. Predictive value of pretreatment MRI texture analysis in patients with primary nasopharyngeal carcinoma. Eur Radiol. 2019;29(8):4105–13.CrossRef
19.
go back to reference Wu Y, Xu L, Yang P, Lin N, Huang X, Pan W, et al. Survival prediction in high-grade osteosarcoma using Radiomics of diagnostic computed tomography. EBioMedicine. 2018;34:27–34.CrossRef Wu Y, Xu L, Yang P, Lin N, Huang X, Pan W, et al. Survival prediction in high-grade osteosarcoma using Radiomics of diagnostic computed tomography. EBioMedicine. 2018;34:27–34.CrossRef
20.
go back to reference Herlidou S, Grebe R, Grados F, Leuyer N, Fardellone P, Meyer ME. Influence of age and osteoporosis on calcaneus trabecular bone structure: a preliminary in vivo MRI study by quantitative texture analysis. Magn Reson Imaging. 2004;22(2):237–43.CrossRef Herlidou S, Grebe R, Grados F, Leuyer N, Fardellone P, Meyer ME. Influence of age and osteoporosis on calcaneus trabecular bone structure: a preliminary in vivo MRI study by quantitative texture analysis. Magn Reson Imaging. 2004;22(2):237–43.CrossRef
21.
go back to reference Burian E, Subburaj K, Mookiah MRK, Rohrmeier A, Hedderich DM, Dieckmeyer M, et al. Texture analysis of vertebral bone marrow using chemical shift encoding-based water-fat MRI: a feasibility study. Osteoporos Int. 2019;30(6):1265–74.CrossRef Burian E, Subburaj K, Mookiah MRK, Rohrmeier A, Hedderich DM, Dieckmeyer M, et al. Texture analysis of vertebral bone marrow using chemical shift encoding-based water-fat MRI: a feasibility study. Osteoporos Int. 2019;30(6):1265–74.CrossRef
22.
go back to reference MacKay JW, Murray PJ, Kasmai B, Johnson G, Donell ST, Toms AP. Subchondral bone in osteoarthritis: association between MRI texture analysis and histomorphometry. Osteoarthr Cartil. 2017;25(5):700–7.CrossRef MacKay JW, Murray PJ, Kasmai B, Johnson G, Donell ST, Toms AP. Subchondral bone in osteoarthritis: association between MRI texture analysis and histomorphometry. Osteoarthr Cartil. 2017;25(5):700–7.CrossRef
23.
go back to reference Abdollahi H, Mahdavi SR, Shiri I, Mofid B, Bakhshandeh M, Rahmani K. Magnetic resonance imaging radiomic feature analysis of radiation-induced femoral head changes in prostate cancer radiotherapy. J Cancer Res Ther. 2019;15(Supplement):S11–9.CrossRef Abdollahi H, Mahdavi SR, Shiri I, Mofid B, Bakhshandeh M, Rahmani K. Magnetic resonance imaging radiomic feature analysis of radiation-induced femoral head changes in prostate cancer radiotherapy. J Cancer Res Ther. 2019;15(Supplement):S11–9.CrossRef
24.
go back to reference Acar E, Leblebici A, Ellidokuz BE, Basbinar Y, Kaya GC. Machine learning for differentiating metastatic and completely responded sclerotic bone lesion in prostate cancer: a retrospective radiomics study. Br J Radiol. 2019;92(1101):20190286.CrossRef Acar E, Leblebici A, Ellidokuz BE, Basbinar Y, Kaya GC. Machine learning for differentiating metastatic and completely responded sclerotic bone lesion in prostate cancer: a retrospective radiomics study. Br J Radiol. 2019;92(1101):20190286.CrossRef
25.
go back to reference Frighetto-Pereira L, Rangayyan RM, Metzner GA, de Azevedo-Marques PM, Nogueira-Barbosa MH. Shape, texture and statistical features for classification of benign and malignant vertebral compression fractures in magnetic resonance images. Comput Biol Med. 2016;73:147–56.CrossRef Frighetto-Pereira L, Rangayyan RM, Metzner GA, de Azevedo-Marques PM, Nogueira-Barbosa MH. Shape, texture and statistical features for classification of benign and malignant vertebral compression fractures in magnetic resonance images. Comput Biol Med. 2016;73:147–56.CrossRef
26.
go back to reference Mayerhoefer ME, Schima W, Trattnig S, Pinker K, Berger-Kulemann V, Ba-Ssalamah A. Texture-based classification of focal liver lesions on MRI at 3.0 tesla: a feasibility study in cysts and hemangiomas. J Magn Reson Imaging. 2010;32(2):352–9.CrossRef Mayerhoefer ME, Schima W, Trattnig S, Pinker K, Berger-Kulemann V, Ba-Ssalamah A. Texture-based classification of focal liver lesions on MRI at 3.0 tesla: a feasibility study in cysts and hemangiomas. J Magn Reson Imaging. 2010;32(2):352–9.CrossRef
27.
go back to reference Holli K, Laaperi AL, Harrison L, Luukkaala T, Toivonen T, Ryymin P, et al. Characterization of breast cancer types by texture analysis of magnetic resonance images. Acad Radiol. 2010;17(2):135–41.CrossRef Holli K, Laaperi AL, Harrison L, Luukkaala T, Toivonen T, Ryymin P, et al. Characterization of breast cancer types by texture analysis of magnetic resonance images. Acad Radiol. 2010;17(2):135–41.CrossRef
28.
go back to reference Zhang L, Dong D, Li H, Tian J, Ouyang F, Mo X, Zhang B, et al. Development and validation of a magnetic resonance imaging-based model for the prediction of distant metastasis before initial treatment of nasopharyngeal carcinoma: a retrospective cohort study. EBioMedicine. 2019;40:327–35.CrossRef Zhang L, Dong D, Li H, Tian J, Ouyang F, Mo X, Zhang B, et al. Development and validation of a magnetic resonance imaging-based model for the prediction of distant metastasis before initial treatment of nasopharyngeal carcinoma: a retrospective cohort study. EBioMedicine. 2019;40:327–35.CrossRef
29.
30.
go back to reference Kramer AA, Zimmerman JE. Assessing the calibration of mortality benchmarks in critical care: the Hosmer-Lemeshow test revisited. Crit Care Med. 2007;35(9):2052–6.CrossRef Kramer AA, Zimmerman JE. Assessing the calibration of mortality benchmarks in critical care: the Hosmer-Lemeshow test revisited. Crit Care Med. 2007;35(9):2052–6.CrossRef
31.
go back to reference Balachandran VP, Gonen M, Smith JJ, DeMatteo RP. Nomograms in oncology: more than meets the eye. Lancet Oncol. 2015;16(4):e173–80.CrossRef Balachandran VP, Gonen M, Smith JJ, DeMatteo RP. Nomograms in oncology: more than meets the eye. Lancet Oncol. 2015;16(4):e173–80.CrossRef
32.
go back to reference Thawait SK, Marcus MA, Morrison WB, Klufas RA, Eng J, Carrino JA. Research synthesis: what is the diagnostic performance of magnetic resonance imaging to discriminate benign from malignant vertebral compression fractures? Systematic review and meta-analysis. Spine. 2012;37(12):E736–44.CrossRef Thawait SK, Marcus MA, Morrison WB, Klufas RA, Eng J, Carrino JA. Research synthesis: what is the diagnostic performance of magnetic resonance imaging to discriminate benign from malignant vertebral compression fractures? Systematic review and meta-analysis. Spine. 2012;37(12):E736–44.CrossRef
33.
go back to reference Sung JK, Jee WH, Jung JY, Choi M, Lee SY, Kim YH, et al. Differentiation of acute osteoporotic and malignant compression fractures of the spine: use of additive qualitative and quantitative axial diffusion-weighted MR imaging to conventional MR imaging at 3.0 T. Radiology. 2014;271(2):488–98.CrossRef Sung JK, Jee WH, Jung JY, Choi M, Lee SY, Kim YH, et al. Differentiation of acute osteoporotic and malignant compression fractures of the spine: use of additive qualitative and quantitative axial diffusion-weighted MR imaging to conventional MR imaging at 3.0 T. Radiology. 2014;271(2):488–98.CrossRef
34.
go back to reference Filograna L, Lenkowicz J, Cellini F, Dinapoli N, Manfrida S, Magarelli N, et al. Identification of the most significant magnetic resonance imaging (MRI) radiomic features in oncological patients with vertebral bone marrow metastatic disease: a feasibility study. Radiol Med. 2019;124(1):50–7.CrossRef Filograna L, Lenkowicz J, Cellini F, Dinapoli N, Manfrida S, Magarelli N, et al. Identification of the most significant magnetic resonance imaging (MRI) radiomic features in oncological patients with vertebral bone marrow metastatic disease: a feasibility study. Radiol Med. 2019;124(1):50–7.CrossRef
35.
go back to reference Localio AR, Goodman S. Beyond the usual prediction accuracy metrics: reporting results for clinical decision making. Ann Intern Med. 2012;157(4):294–5.CrossRef Localio AR, Goodman S. Beyond the usual prediction accuracy metrics: reporting results for clinical decision making. Ann Intern Med. 2012;157(4):294–5.CrossRef
36.
go back to reference Van Calster B, Vickers AJ. Calibration of risk prediction models: impact on decision-analytic performance. Med Decis Mak. 2015;35(2):162–9.CrossRef Van Calster B, Vickers AJ. Calibration of risk prediction models: impact on decision-analytic performance. Med Decis Mak. 2015;35(2):162–9.CrossRef
Metadata
Title
Cervical spine osteoradionecrosis or bone metastasis after radiotherapy for nasopharyngeal carcinoma? The MRI-based radiomics for characterization
Authors
Xi Zhong
Li Li
Huali Jiang
Jinxue Yin
Bingui Lu
Wen Han
Jiansheng Li
Jian Zhang
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Medical Imaging / Issue 1/2020
Electronic ISSN: 1471-2342
DOI
https://doi.org/10.1186/s12880-020-00502-2

Other articles of this Issue 1/2020

BMC Medical Imaging 1/2020 Go to the issue