Multiphase computed tomography radiomics of pancreatic intraductal papillary mucinous neoplasms to predict malignancy

doi:10.3748/wjg.v26.i24.3458

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World Journal of Gastroenterology

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1007-9327

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Retrospective Cohort Study

World J Gastroenterol. Jun 28, 2020; 26(24): 3458-3471
Published online Jun 28, 2020. doi: 10.3748/wjg.v26.i24.3458

Table 1 Radiomic features evaluated in the intraductal papillary mucinous neoplasm study cohort (n = 39)

HU based features	Length features	Shape features	GLCM features
Mean HU	Volumetric length	Surface area volume	GLCM row mean
Minimum HU	Craniocaudal length	Surface area to volume ratio	GLCM row variance
Maximum HU	Transverse length	Compactness 1^st order	GLCM row standard deviation
Median HU	Anterior-posterior length	Compactness 2^nd order	GLCM column means
Variance HU		Spherical disproportion	GLCM column variance
Standard deviation HU		Sphericity	GLCM column standard deviation
Root mean square HU			GLCM correlation
Energy HU			GLCM energy
Entropy HU (histogram)			GLCM entropy
Kurtosis HU (histogram)			GLCM contrast
Skewness HU (histogram)			GLCM homogeneity
Mean deviation HU			GLCM dissimilarity
Uniformity HU			GLCM angular second moment
Normalized above mean deviation HU
Uniformity

HU: Hounsfield units; GLCM: Gray level co-occurrence matrix.

Table 2 Computed tomography Hounsfield units measured in the intraductal papillary mucinous neoplasm study cohort by contrast phase

	Benign	Malignant	P value
	n = 22	n = 29	P value
Hounsfield units
Noncontrast aorta	41 ± 6	42 ± 6	0.38
Noncontrast IVC	40 ± 7	40 ± 6	0.85
Arterial phase aorta	322 ± 62	311 ± 70	0.64
Arterial phase IVC	71 ± 30	68 ± 43	0.50
Venous phase aorta	152 ± 30	144 ± 26	0.37
Venous phase IVC	116 ± 30	118 ± 35	0.97

IVC: Inferior vena cava.

Table 3 Noncontrast phase radiomics features (P < 0.05) for the intraductal papillary mucinous neoplasm study cohort

Variables	SD	P value	OR per 1 SD increase	95%CI lower	Upper	AUC (95%CI)
Log2 (energy_HU)	2.511	0.002	4.33	1.69	11.11	0.82 (0.689-0.951)
Median_HU	10.72	0.003	4.43	1.65	11.85	0.794 (0.658-0.929)
Log2 (GLCM_row_mean)	1.129	0.007	9.21E+39	8.82E+10	9.62E+68	0.785 (0.648-0.923)
Root_mean_square	10.38	0.011	8.03	1.61	40	0.779 (0.641-0.917)
Mean_HU	11.22	0.006	3.73	1.47	9.46	0.773 (0.631-0.916)
Log2 (surface_area_mm²)	1.592	0.006	3.18	1.4	7.22	0.765 (0.613-0.918)
Volumetric_length_mm	25.05	0.007	4.46	1.5	13.26	0.759 (0.602-0.916)
Compactness2_mm	0.144	0.017	0.38	0.17	0.84	0.749 (0.59-0.908)
Sphericity_mm	0.076	0.034	0.39	0.17	0.93	0.749 (0.59-0.908)
Transverse_length_mm	18.14	0.012	2.99	1.28	6.98	0.741 (0.585-0.896)
GLCM_entropy	1.642	0.01	3.04	1.31	7.05	0.737 (0.581-0.893)
Log2 (GLCM_energy)	0.764	0.011	0.33	0.14	0.78	0.735 (0.581-0.889)
Log2 (GLCM_ASM)	1.527	0.011	0.33	0.14	0.78	0.735 (0.581-0.889)
Compactness1_mm	30.29	0.047	2.27	1.02	5.05	0.729 (0.568-0.89)
Antpost_length_mm	15.85	0.04	2.35	1.04	5.3	0.715 (0.55-0.879)
Log2 (max_HU)	1.043	0.043	2.94	1.04	8.28	0.712 (0.559-0.864)
Surface_area_to_volume_ratio_mm	0.2	0.019	0.38	0.17	0.84	0.694 (0.527-0.862)
Cranialcaudal_length_mm	14.55	0.043	2.03	1.03	4	0.687 (0.521-0.854)

SD: Standard deviation; OR: Odds ratio; CI: Confidence interval; AUC: Area under the curve; HU: Hounsfield units; GLCM: Gray level co-occurrence matrix; ASM: Angular second moment; Max: Maximum.

Table 4 Arterial phase radiomics features (P < 0.05) for the intraductal papillary mucinous neoplasm study cohort

Variables	SD	P value	OR per 1 SD increase	95%CI lower	Upper	AUC (95%CI)
Log2 (energy_HU)	2.588	0.002	4.14	1.69	10.14	0.806 (0.674-0.937)
Log2 (max_HU)	1.002	0.008	4.13	1.46	11.72	0.787 (0.648-0.927)
Log2 (GLCM_energy)	0.778	0.007	0.28	0.11	0.7	0.775 (0.635-0.915)
Log2 (GLCM_ASM)	1.555	0.007	0.28	0.11	0.7	0.775 (0.635-0.915)
GLCM_entropy	1.666	0.007	3.42	1.41	8.29	0.769 (0.624-0.914)
Entropy_HU	0.319	0.007	3.01	1.36	6.66	0.763 (0.619-0.907)
Compactness2_mm	0.15	0.015	0.32	0.13	0.8	0.749 (0.598-0.900)
Sphericity_mm	0.081	0.023	0.3	0.11	0.85	0.749 (0.598-0.900)
Spherical_disproportion_mm	0.14	0.038	3.78	1.08	13.24	0.749 (0.598-0.900)
Root_mean_square	14.8	0.012	4.21	1.38	12.88	0.747 (0.604-0.890)
Log2 (GLCM_row_mean)	0.983	0.028	4.16E+17	106.87	1.62E+33	0.726 (0.575-0.877)
Log2 (surface_area_mm²)	1.624	0.012	2.63	1.24	5.57	0.721 (0.554-0.888)
Volumetric_length_mm	26.97	0.049	2.62	1.01	6.78	0.721 (0.554-0.888)
Transverse_length_mm	18.4	0.03	2.61	1.1	6.18	0.719 (0.556-0.881)
Mean_HU	16.22	0.022	2.62	1.15	5.96	0.715 (0.561-0.869)
Median_HU	15.71	0.026	2.56	1.12	5.82	0.712 (0.557-0.867)
Log2 (GLCM_col_mean)	0.896	0.038	5.04E+12	5.51	4.61E+24	0.696 (0.539-0.854)
Surface_area_to_volume_ratio_mm	0.19	0.032	0.43	0.2	0.93	0.672 (0.496-0.848)
Mean_deviation_HU	4.72	0.042	2.24	1.03	4.85	0.668 (0.507-0.829)

SD: Standard deviation; OR: Odds ratio; CI: Confidence interval; AUC: Area under the curve; HU: Hounsfield units; GLCM: Gray level co-occurrence matrix; ASM: Angular second moment.

Table 5 Venous phase radiomics features (P < 0.05) for the intraductal papillary mucinous neoplasm study cohort

Variables	SD	P value	OR per 1 SD increase	95%CI lower	Upper	AUC(95%CI)
Log2 (GLCM_energy)	0.805	0.006	0.28	0.11	0.69	0.836 (0.717-0.955)
Log2 (energy_HU)	2.575	0.002	4.46	1.75	11.37	0.834 (0.716-0.953)
Log2 (GLCM_angular_ second_moment)	1.609	0.006	0.28	0.11	0.7	0.834 (0.714-0.954)
GLCM_entropy	1.709	0.006	3.53	1.44	8.63	0.822 (0.703- 0.941)
Log2 (max_HU)	0.832	0.019	4.57	1.29	16.17	0.762 (0.613-0.911)
Entropy_HU	0.379	0.016	2.5	1.19	5.26	0.757 (0.616-0.899)
Transverse_length_mm	18.85	0.018	2.78	1.19	6.48	0.743 (0.588-0.898)
Log2 (surface_area_mm²)	1.639	0.012	2.67	1.25	5.73	0.735 (0.574-0.895)
Volumetric_length_mm	26.82	0.028	3.01	1.13	7.99	0.731 (0.565-0.897)
Antpost_length_mm	16.65	0.049	2.28	1.01	5.18	0.729 (0.565-0.893)
Log2 (GLCM_row_var)	0.766	0.04	2.33	1.04	5.2	0.709 (0.554-0.863)
GLCM_row_SD	10.69	0.042	2.99	1.05	8.55	0.709 (0.554-0.863)
Log2 (variance_HU)	0.765	0.04	2.33	1.04	5.19	0.707 (0.552-0.861)
SD_HU	10.68	0.042	2.98	1.04	8.52	0.707 (0.552-0.861)
Cranialcaudal_length_mm	16.91	0.047	2.05	1.01	4.14	0.706 (0.543-0.868)
Log2 (GLCM_col_var)	0.758	0.026	2.57	1.13	5.84	0.705 (0.549-0.86)
Surface_area_to_volume_ratio_mm	0.204	0.042	0.42	0.18	0.96	0.705 (0.54-0.869)
GLCM_col_SD	11.37	0.032	2.89	1.1	7.55	0.702 (0.547-0.858)
Root_mean_square	19.63	0.045	2.18	1.02	4.66	0.702 (0.543-0.862)
Mean_deviation_HU	6.058	0.041	2.11	1.03	4.32	0.696 (0.539-0.853)
GLCM_correlation	0.099	0.027	2.19	1.1	4.38	0.684 (0.527-0.841)

SD: Standard deviation; OR: Odds ratio; CI: Confidence interval; AUC: Area under the curve; GLCM: Gray level co-occurrence matrix; HU: Hounsfield units; VAR: Variance; COL: Column.

Table 6 Distribution of International Consensus Guidelines criteria in benign vs malignant intraductal papillary mucinous neoplasm cases

	Benign	Malignant	P value
	n = 22	n = 29	P value
Morphology (duct)
Main/mixed	2	17	< 0.001
Side branch	20	12	< 0.001
High risk stigmata (1 or more)	3	18	< 0.001
Enhancing solid component > 5 mm	3	15	0.005
Main duct ≥ 10 mm	0	5	0.04
Obstructive jaundice	0	1	0.379
Worrisome features (1 or more)	10	28	< 0.001
Cyst ≥ 3 cm	7	21	0.004
Thickened enhancing cyst wall	2	11	0.019
Enhancing mural nodule < 5 mm	2	10	0.034
Main pancreatic duct 5-9 mm	3	12	0.039
Lymphadenopathy	1	12	0.003
Abrupt change in caliber of pancreatic duct with distal atrophy	1	4	0.445
Cyst growth rate ≥ 5 mm in two years			NA¹
Elevated Ca19-9	3/14	8/24	0.557

¹Adequate historical imaging was widely unavailable.

Table 7 Multivariable model analysis

Model	Included features	Feature category	P value	AUC of model (95%CI)
ICG	Thickened enhancing cyst wall	ICG	0.001	0.817 (0.709-0.926)
ICG	Enhancing mural nodule < 5 mm	ICG	0.048
Arterial phase radiomics	Log2 (GLCM_col_mean)	Arterial	0.009	0.871 (0.767--0.974)
Arterial phase radiomics	GLCM_entropy	Arterial	0.002
Venous phase radiomics	Log2 (energy_HU)	Venous	0.002	0.834 (0.716-0.953)
Combined model	High risk stigmata (1 or more)	ICG	0.022	0.927 (0.851–1.000)
	Log2 (GLCM_col_mean)	Arterial	0.011
	GLCM_entropy	Arterial	0.014

Features with P value of < 0.1 were considered to build multivariable models. Based on these features, backward elimination method (stay level of 0.05), the listed features remained within each model. AUC: Area under the curve; CI: Confidence interval; ICG: International Consensus Guidelines; GLCM: Gray level co-occurrence matrix; COL: Column; HU: Hounsfield units.

Citation: Polk SL, Choi JW, McGettigan MJ, Rose T, Ahmed A, Kim J, Jiang K, Balagurunathan Y, Qi J, Farah PT, Rathi A, Permuth JB, Jeong D. Multiphase computed tomography radiomics of pancreatic intraductal papillary mucinous neoplasms to predict malignancy. World J Gastroenterol 2020; 26(24): 3458-3471
URL: https://www.wjgnet.com/1007-9327/full/v26/i24/3458.htm
DOI: https://dx.doi.org/10.3748/wjg.v26.i24.3458