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      Nomogram combining dual-energy computed tomography features and radiomics for differentiating parotid warthin tumor from pleomorphic adenoma: a retrospective study

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          Abstract

          Introduction

          Accurate differentiation between pleomorphic adenomas (PA) and Warthin tumors (WT) in the parotid gland is challenging owing to overlapping imaging features. This study aimed to evaluate a nomogram combining dual-energy computed tomography (DECT) quantitative parameters and radiomics to enhance diagnostic precision.

          Methods

          This retrospective study included 120 patients with pathologically confirmed PA or WT, randomly divided into training and test sets (7:3). DECT features, including tumor CT values from 70 keV virtual monochromatic images (VMIs), iodine concentration (IC), and normalized IC (NIC), were analyzed. Independent predictors were identified via logistic regression. Radiomic features were extracted from segmented regions of interest and filtered using the K-best and least absolute shrinkage and selection operator. Radiomic models based on 70 keV VMIs and material decomposition images were developed using logistic regression (LR), support vector machine (SVM), and random forest (RF). The best-performing radiomics model was combined with independent DECT predictors to construct a model and nomogram. Model performance was assessed using ROC curves, calibration curves, and decision curve analysis (DCA).

          Results

          IC (venous phase), NIC (arterial phase), and NIC (venous phase) were independent DECT predictors. The DECT feature model achieved AUCs of 0.842 and 0.853 in the training and test sets, respectively, outperforming the traditional radiomics model (AUCs 0.836 and 0.834, respectively). The DECT radiomics model using arterial phase water-based images with LR showed improved performance (AUCs 0.883 and 0.925). The combined model demonstrated the highest discrimination power, with AUCs of 0.910 and 0.947. The combined model outperformed the DECT features and conventional radiomics models, with AUCs of 0.910 and 0.947, respectively (P<0.05). While the difference in AUC between the combined model and the DECT radiomics model was not statistically significant (P>0.05), it showed higher specificity, accuracy, and precision. DCA found that the nomogram gave the greatest net therapeutic effect across a broad range of threshold probabilities.

          Discussion

          The nomogram combining DECT features and radiomics offers a promising non-invasive tool for differentiating PA and WT in clinical practice.

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          Most cited references52

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          The Image Biomarker Standardization Initiative: Standardized Quantitative Radiomics for High-Throughput Image-based Phenotyping

          Background Radiomic features may quantify characteristics present in medical imaging. However, the lack of standardized definitions and validated reference values have hampered clinical use. Purpose To standardize a set of 174 radiomic features. Materials and Methods Radiomic features were assessed in three phases. In phase I, 487 features were derived from the basic set of 174 features. Twenty-five research teams with unique radiomics software implementations computed feature values directly from a digital phantom, without any additional image processing. In phase II, 15 teams computed values for 1347 derived features using a CT image of a patient with lung cancer and predefined image processing configurations. In both phases, consensus among the teams on the validity of tentative reference values was measured through the frequency of the modal value and classified as follows: less than three matches, weak; three to five matches, moderate; six to nine matches, strong; 10 or more matches, very strong. In the final phase (phase III), a public data set of multimodality images (CT, fluorine 18 fluorodeoxyglucose PET, and T1-weighted MRI) from 51 patients with soft-tissue sarcoma was used to prospectively assess reproducibility of standardized features. Results Consensus on reference values was initially weak for 232 of 302 features (76.8%) at phase I and 703 of 1075 features (65.4%) at phase II. At the final iteration, weak consensus remained for only two of 487 features (0.4%) at phase I and 19 of 1347 features (1.4%) at phase II. Strong or better consensus was achieved for 463 of 487 features (95.1%) at phase I and 1220 of 1347 features (90.6%) at phase II. Overall, 169 of 174 features were standardized in the first two phases. In the final validation phase (phase III), most of the 169 standardized features could be excellently reproduced (166 with CT; 164 with PET; and 164 with MRI). Conclusion A set of 169 radiomics features was standardized, which enabled verification and calibration of different radiomics software. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Kuhl and Truhn in this issue.
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            Introduction to Radiomics

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              Virtual monochromatic spectral imaging with fast kilovoltage switching: improved image quality as compared with that obtained with conventional 120-kVp CT.

              To compare image quality obtained in phantoms with virtual monochromatic spectral (VMS) imaging with that obtained with conventional 120-kVp computed tomography (CT) for a given radiation dose. Three syringes were filled with a diluted contrast medium (each syringe contained a contrast medium with a different iodine concentration [5, 10, or 15 mg of iodine per milliliter]), and a fourth syringe was filled with water. These syringes were placed in a torso phantom meant to simulate the standard human physique. The phantom was examined with a CT system and use of the fast kilovoltage switching (80 and 140 kVp) and conventional (120 kVp) modes. Image noise and contrast-to-noise (CNR) ratio were analyzed on VMS images and 120-kVp CT images. Image noise on VMS images in the range of 67-72 keV was significantly lower than that on the 120-kVp CT images (P < .014). Image noise was lowest at 69 keV and was 12% lower when compared with that on 120-kVp CT images. CNR on the VMS images was highest at 68 keV. CNR on the VMS images obtained at 68 keV in the syringes filled with diluted contrast material (5, 10, and 15 mg of iodine per milliliter) was 28%, 31%, and 30% higher, respectively, compared with that on the 120-kVp CT images (P < .001). VMS imaging at approximately 70 keV yielded lower image noise and higher CNR than did 120-kVp CT for a given radiation dose. VMS imaging has the potential to replace 120-kVp CT as the standard CT imaging modality, since optimal VMS imaging may be expected to yield improved image quality in a patient with standard body habitus. © RSNA, 2011.
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                Author and article information

                Contributors
                URI : https://loop.frontiersin.org/people/2845897Role: Role: Role: Role: Role: Role:
                URI : https://loop.frontiersin.org/people/1380675Role: Role:
                Role: Role:
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                URI : https://loop.frontiersin.org/people/2351264Role: Role: Role:
                Journal
                Front Oncol
                Front Oncol
                Front. Oncol.
                Frontiers in Oncology
                Frontiers Media S.A.
                2234-943X
                04 March 2025
                2025
                : 15
                : 1505385
                Affiliations
                [1] 1 Department of Radiology, The First Affiliated Hospital of Dalian Medical University , Dalian, China
                [2] 2 CT Imaging Research Center, GE Healthcare , Shanghai, China
                Author notes

                Edited by: Abhishek Mahajan, The Clatterbridge Cancer Centre, United Kingdom

                Reviewed by: Lorenzo Faggioni, University of Pisa, Italy

                Tianjun Lan, Sun Yat-sen Memorial Hospital, China

                *Correspondence: Lijun Wang, wanglj345@ 123456163.com
                Article
                10.3389/fonc.2025.1505385
                11914106
                40104493
                a4ef6d75-d8df-49f0-96e9-260c7ba93e59
                Copyright © 2025 Gong, Li, Han, Chen and Wang

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 02 October 2024
                : 27 January 2025
                Page count
                Figures: 8, Tables: 4, Equations: 3, References: 52, Pages: 14, Words: 6420
                Funding
                The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by Liaoning Medical Education Research Program, China, Grant number: 2022-N005-05.
                Categories
                Oncology
                Original Research
                Custom metadata
                Head and Neck Cancer

                Oncology & Radiotherapy
                parotid tumor,dual-energy computed tomography,radiomics,machine learning,combined nomogram,identification

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