Deep Learning-Based Segmentation and Risk Stratification for Gastrointestinal Stromal Tumors in Transabdominal Ultrasound Imaging.

PURPOSE: To develop a deep neural network system for the automatic segmentation and risk stratification prediction of gastrointestinal stromal tumors (GISTs). METHODS: A total of 980 ultrasound (US) images from 245 GIST patients were retrospectively collected. These images were randomly divided (6:2:2) into a training set, a validation set, and an internal test set. Additionally, 188 US images from 47 prospective GIST patients were collected to evaluate the segmentation and diagnostic performance of the model. Five deep learning-based segmentation networks, namely, UNet, FCN, DeepLabV3+, Swin Transformer, and SegNeXt, were employed, along with the ResNet 18 classification network, to select the most suitable network combination. The performance of the segmentation models was evaluated using metrics such as the intersection over union (IoU), Dice similarity coefficient (DSC), recall, and precision. The classification performance was assessed based on accuracy and the area under the receiver operating characteristic curve (AUROC). RESULTS: Among the compared models, SegNeXt-ResNet18 exhibited the best segmentation and classification performance. On the internal test set, the proposed model achieved IoU, DSC, precision, and recall values of 82.1, 90.2, 91.7, and 88.8%, respectively. The accuracy and AUC for GIST risk prediction were 87.4 and 92.0%, respectively. On the external test set, the segmentation models exhibited IoU, DSC, precision, and recall values of 81.0, 89.5, 92.8, and 86.4%, respectively. The accuracy and AUC for GIST risk prediction were 86.7 and 92.5%, respectively. CONCLUSION: This two-stage SegNeXt-ResNet18 model achieves automatic segmentation and risk stratification prediction for GISTs and demonstrates excellent segmentation and classification performance.

Shear-wave elastography predicts T-restaging and pathologic complete response of rectal cancer post neoadjuvant chemoradiotherapy.

PURPOSE: To investigate the value of shear-wave elastography (SWE) in assessing the response to neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer. METHODS: In this study, 455 participants with locally advanced rectal cancer who underwent nCRT at our hospital between September 2021 and December 2022 were prospectively enrolled. The participants were randomly divided into training and test cohorts in a 3:2 ratio. Clinical baseline data, endorectal ultrasound examination data, and SWE measurements were collected for all participants. Logistic regression models were used to predict whether rectal cancer after nCRT had a low T staging (ypT 0-2 stage, Model A) and pathological complete response (pCR) (Model B). Paired Chi-square tests were used to compare the diagnostic performances of the radiologists to those of Models A and B. RESULTS: In total, 256 participants were included. The area under the receiver operating characteristic curve of Models A and B in the test cohort were 0.94 (0.87, 1.00) and 0.88 (0.80, 0.97), respectively. The optimal diagnostic thresholds for Models A and B were 14.9 kPa for peritumoral mesangial Emean and 15.2 kPa for tumor Emean, respectively. The diagnostic performance of the radiologists was significantly lower than that of Models A and B, respectively (p < 0.05). CONCLUSION: SWE can be used as a feasible method to evaluate the treatment response of nCRT for locally advanced rectal cancer.

Predicting the risk stratification of gastrointestinal stromal tumors using machine learning-based ultrasound radiomics.

PURPOSE: This study aimed to use conventional ultrasound features, ultrasound radiomics, and machine learning algorithms to establish a predictive model to assess the risk of post-surgical recurrence of gastrointestinal stromal tumors (GISTs). METHODS: This retrospective analysis included 230 patients with pathologically diagnosed GISTs. Radiomic features were extracted from manually annotated images. Radiomic features plus conventional ultrasound features were selected using the SelectKbest analysis of variance and stratified tenfold cross-validation recursive elimination methods. Finally, five different machine learning algorithms (logistic regression [LR], support vector machine [SVM], random forest [RF], extreme gradient boosting [XGBoost], and multilayer perceptron [MLP]) were established to predict risk stratification of GISTs. The predictive performance of the established model was mainly evaluated based on the area under the receiver operating characteristic (ROC) curve (AUC) and accuracy, whereas the predictive performance of the optimal machine learning algorithm and a radiologist's subjective assessment were compared using McNemar's test. RESULTS: Seven radiomics features and one conventional ultrasound feature were selected to construct the machine learning models for GIST risk classification. The mentioned five machine learning models were able to predict the malignant potential of GISTs. LR and SVM outperformed other classifiers on the test set, with LR achieving an accuracy of 0.852 (AUC, 0.881; sensitivity, 0.871; specificity, 0.826) and SVM achieving an accuracy of 0.852 (AUC, 0.879; sensitivity, 0.839; specificity, 0.870), and proved significantly better than the radiologist (accuracy, 0.691; sensitivity, 0.645; specificity, 0.813). CONCLUSION: Machine learning-based ultrasound radiomics features are able to noninvasively predict the biological risk of GISTs.

Use of a Convolutional Neural Network to Predict the Malignant Potential of Gastrointestinal Stromal Tumors in Transabdominal Ultrasound Images: Visualization of the Focus of the Prediction Model.

OBJECTIVE: We established a deep convolutional neural network (CNN) model based on ultrasound images (US-CNN) for predicting the malignant potential of gastrointestinal stromal tumors (GISTs). METHODS: A total of 980 ultrasound images from 245 pathology-confirmed GIST patients after surgical operation were retrospectively collected and divided into a low (very-low-risk, low-risk) and a high (medium-risk, high-risk) malignant potential group. Eight pre-trained CNN models were used to extract the features. The CNN model with the highest accuracy in the test set was selected. The model's performance was evaluated by calculating accuracy, sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV) and the F1 score. Three radiologists with different experience levels also predicted the malignant potential of GISTs in the same test set. US-CNN and human assessments were compared. Subsequently, gradient-weighted class activation diagrams (Grad-CAMs) were used to visualize the model's final classification decisions. RESULTS: Among the eight transfer learning-based CNNs, ResNet18 performed best. The accuracy, sensitivity, specificity, PPV, NPV and F1 score were 0.88, 0.86, 0.89, 0.82, 0.92 and 0.90, respectively, which were significantly better than those achieved by radiologists (resident doctor: 0.66, 0.55, 0.79, 0.74, 0.62 and 0.69; attending doctor: 0.68, 0.59, 0.78, 0.70, 0.69 and 0.73; professor: 0.69, 0.63, 0.72, 0.51, 0.80 and 0.76). Model interpretation with Grad-CAMs revealed that the activated areas mainly focused on cystic necrosis and margins. CONCLUSION: The US-CNN model predicts GIST malignant potential well, which can assist in clinical treatment decision-making.

Ultrasound radiomics model-based nomogram for predicting the risk Stratification of gastrointestinal stromal tumors.

This study aimed to develop and evaluate a nomogram based on an ultrasound radiomics model to predict the risk grade of gastrointestinal stromal tumors (GISTs). 216 GIST patients pathologically diagnosed between December 2016 and December 2021 were reviewed and divided into a training cohort (n = 163) and a validation cohort (n = 53) in a ratio of 3:1. The tumor region of interest was depicted on each patient's ultrasound image using ITK-SNAP, and the radiomics features were extracted. By filtering unstable features and using Spearman's correlation analysis, and the least absolute shrinkage and selection operator algorithm, a radiomics score was derived to predict the malignant potential of GISTs. a radiomics nomogram that combines the radiomics score and clinical ultrasound predictors was constructed and assessed in terms of calibration, discrimination, and clinical usefulness. The radiomics score from ultrasound images was significantly associated with the malignant potential of GISTs. The radiomics nomogram was superior to the clinical ultrasound nomogram and the radiomics score, and it achieved an AUC of 0.90 in the validation cohort. Based on the decision curve analysis, the radiomics nomogram was found to be more clinically significant and useful. A nomogram consisting of radiomics score and the maximum tumor diameter demonstrated the highest accuracy in the prediction of risk grade in GISTs. The outcomes of our study provide vital insights for important preoperative clinical decisions.

Application of ultrasonography in predicting the biological risk of gastrointestinal stromal tumors.

OBJECTIVES: To explore and establish a reliable and noninvasive ultrasound model for predicting the biological risk of gastrointestinal stromal tumors (GISTs). MATERIALS AND METHODS: We retrospectively reviewed 266 patients with pathologically-confirmed GISTs and 191 patients were included. Data on patient sex, age, tumor location, biological risk classification, internal echo, echo homogeneity, boundary, shape, blood flow signals, presence of necrotic cystic degeneration, long diameter, and short/long (S/L) diameter ratio were collected. All patients were divided into low-, moderate-, and high-risk groups according to the modified NIH classification criteria. All indicators were analyzed by univariate analysis. The indicators with inter-group differences were used to establish regression and decision tree models to predict the biological risk of GISTs. RESULTS: There were statistically significant differences in long diameter, S/L ratio, internal echo level, echo homogeneity, boundary, shape, necrotic cystic degeneration, and blood flow signals among the low-, moderate-, and high-risk groups (all p < .05). The logistic regression model based on the echo homogeneity, shape, necrotic cystic degeneration and blood flow signals had an accuracy rate of 76.96% for predicting the biological risk, which was higher than the 72.77% of the decision tree model (based on the long diameter, the location of tumor origin, echo homogeneity, shape, and internal echo) (p = .008). In the low-risk and high-risk groups, the predicting accuracy rates of the regression model reached 87.34 and 81.82%, respectively. CONCLUSIONS: Transabdominal ultrasound is highly valuable in predicting the biological risk of GISTs. The logistic regression model has greater predictive value than the decision tree model.

c-Src promotes the growth and tumorigenesis of hepatocellular carcinoma via the Hippo signaling pathway.

We investigated the association between c-Src and the progression of hepatocellular carcinoma (HCC) and its underlying mechanisms. The relationship between c-Src expression and the occurrence and development of HCC was explored using GEPIA and further confirmed by western blotting analysis and real-time quantitative PCR. CCK-8, flow cytometry, Transwell, and wound-healing assays were conducted to analyze the effects of c-Src on the growth, cell cycle, apoptosis, migration, and infiltration of HCC cells. Mouse models of transplanted xenogeneic human tumors were constructed to explore the effects of c-Src on HCC tumor growth. Compared with that in adjacent normal liver tissues, the expression level of c-Src in HCC tissues was significantly increased and was negatively correlated with patient survival. These findings are consistent with those in the GEPIA database. Downregulation of c-Src expression can inhibit the growth, infiltration, and migration of HCC cells. c-Src impeded the translocation of YAP from the nucleus to the cytoplasm and promoted Yes-associated protein transcriptional activity. In vivo experiments showed that c-Src inhibition suppressed tumor growth in mice. We found that c-Src can promote the growth and tumorigenesis of HCC cells by activating the Hippo signaling pathway.

Physiologic Factors Affecting the Circulatory Persistence of Copolymer Microbubbles and Comparison of Contrast-Enhanced Effects between Copolymer Microbubbles and Sonovue.

Ultrasound contrast agents have been widely used in clinical diagnosis. Knowledge of the physiologic factors affecting circulatory persistence is helpful in preparing long-lasting microbubbles (MBs) for blood perfusion and drug delivery research. In the study described here, we prepared copolymer MBs, compared their characteristics and contrast-enhanced effects with those of SonoVue and investigated the influence of external pressure, temperature, plasma components, renal microcirculation and cardiac motion on their circulatory persistence. The mean size of the copolymer MBs was 3.57 µm, larger than that of SonoVue. The copolymer MBs had longer circulatory persistence than SonoVue. At external pressures of 110 and 150 mm Hg, neither the quantity nor the morphology of the copolymer MBs changed. Further, their quantity and size were similar after incubation at 4°C and 39.4°C and when rabbit plasma and saline were compared. In vivo contrast-enhanced ultrasonography revealed a slightly larger area under the curve for the renal artery than for the renal vein. Thus, copolymer MBs exhibited good stability. However, the quantity of copolymer MBs decreased significantly after 180 s of circulation in an isolated toad heart perfusion model, indicating that cardiac motion was the main factor affecting their circulatory persistence.

Ultrasonography-Based Classification and Reporting System for the Malignant Risk of Thyroid Nodules.

OBJECTIVE: The aim of this study was to test the predictive value of a Thyroid Imaging Reporting and Data System (TI-RADS) for malignant thyroid nodules. METHODS: Ultrasonographic data was examined for 910 thyroid nodules with histopathologically confirmed diagnoses. Nodules were placed into incomplete (category 0) or complete final categories (1, 2, 3a, 3b, 3c, 4, or 5) based on the presence and number of ultrasonographic features of malignancy, and the predictive value for the malignancy of nodules in categories 2-4 was assessed. RESULTS: The overall rate of malignancy among thyroid nodules included in the study was 59.34%. The rate of malignancy gradually increased according to TI-RADS categories as follows: category 2, 5.4%; category 3 (a-c), 36% to 92%; and category 4, 99.0%. When nodules of category 2 were counted as benign, the reliability of the TI-RADS classification for determining the risk of malignancy was as follows; sensitivity, 98.15%; specificity, 47.84%; positive predictive value, 73.31%; negative predictive value, 94.65%; and odds ratio, 48.61. CONCLUSIONS: The TI-RADS classification used in this study is relatively simple and provides a reliable measure of the risk of malignancy of thyroid nodules.