Finding Reproducible and Prognostic Radiomic Features in Variable Slice Thickness Contrast Enhanced CT of Colorectal Liver Metastases

Establishing the reproducibility of radiomic signatures is a critical step in the path to clinical adoption of quantitative imaging biomarkers; however, radiomic signatures must also be meaningfully related to an outcome of clinical importance to be of value for personalized medicine. In this study, we analyze both the reproducibility and prognostic value of radiomic features extracted from the liver parenchyma and largest liver metastases in contrast enhanced CT scans of patients with colorectal liver metastases (CRLM). A prospective cohort of 81 patients from two major US cancer centers was used to establish the reproducibility of radiomic features extracted from images reconstructed with different slice thicknesses. A publicly available, single-center cohort of 197 preoperative scans from patients who underwent hepatic resection for treatment of CRLM was used to evaluate the prognostic value of features and models to predict overall survival. A standard set of 93 features was extracted from all images, with a set of eight different extractor settings. The feature extraction settings producing the most reproducible, as well as the most prognostically discriminative feature values were highly dependent on both the region of interest and the specific feature in question. While the best overall predictive model was produced using features extracted with a particular setting, without accounting for reproducibility, (C-index = 0.630 (0.603--0.649)) an equivalent-performing model (C-index = 0.629 (0.605--0.645)) was produced by pooling features from all extraction settings, and thresholding features with low reproducibility ($\mathrm{CCC} \geq 0.85$), prior to feature selection. Our findings support a data-driven approach to feature extraction and selection, preferring the inclusion of many features, and narrowing feature selection based on reproducibility when relevant data is available.

Evaluating the Performance of StyleGAN2-ADA on Medical Images

Although generative adversarial networks (GANs) have shown promise in medical imaging, they have four main limitations that impeded their utility: computational cost, data requirements, reliable evaluation measures, and training complexity. Our work investigates each of these obstacles in a novel application of StyleGAN2-ADA to high-resolution medical imaging datasets. Our dataset is comprised of liver-containing axial slices from non-contrast and contrast-enhanced computed tomography (CT) scans. Additionally, we utilized four public datasets composed of various imaging modalities. We trained a StyleGAN2 network with transfer learning (from the Flickr-Faces-HQ dataset) and data augmentation (horizontal flipping and adaptive discriminator augmentation). The network's generative quality was measured quantitatively with the Fr\'echet Inception Distance (FID) and qualitatively with a visual Turing test given to seven radiologists and radiation oncologists. The StyleGAN2-ADA network achieved a FID of 5.22 ($\pm$ 0.17) on our liver CT dataset. It also set new record FIDs of 10.78, 3.52, 21.17, and 5.39 on the publicly available SLIVER07, ChestX-ray14, ACDC, and Medical Segmentation Decathlon (brain tumors) datasets. In the visual Turing test, the clinicians rated generated images as real 42% of the time, approaching random guessing. Our computational ablation study revealed that transfer learning and data augmentation stabilize training and improve the perceptual quality of the generated images. We observed the FID to be consistent with human perceptual evaluation of medical images. Finally, our work found that StyleGAN2-ADA consistently produces high-quality results without hyperparameter searches or retraining.