Publications by authors named "Martijn Starmans"

AI tools in radiology are revolutionising the diagnosis, evaluation, and management of patients. However, there is a major gap between the large number of developed AI tools and those translated into daily clinical practice, which can be primarily attributed to limited usefulness and trust in current AI tools. Instead of technically driven development, little effort has been put into value-based development to ensure AI tools will have a clinically relevant impact on patient care.

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Background: Segmentations are crucial in medical imaging for morphological, volumetric, and radiomics biomarkers. Manual segmentation is accurate but not feasible in clinical workflow, while automatic segmentation generally performs sub-par.

Purpose: To develop a minimally interactive deep learning-based segmentation method for soft-tissue tumors (STTs) on CT and MRI.

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Background: Histopathological growth patterns are one of the strongest prognostic factors in patients with resected colorectal liver metastases. Development of an efficient, objective and ideally automated histopathological growth pattern scoring method can substantially help the implementation of histopathological growth pattern assessment in daily practice and research. This study aimed to develop and validate a deep-learning algorithm, namely neural image compression, to distinguish desmoplastic from non-desmoplastic histopathological growth patterns of colorectal liver metastases based on digital haematoxylin and eosin-stained slides.

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Article Synopsis
  • The study evaluated the prognostic significance of total tumor volume (TTV) in predicting early recurrence and overall survival in patients with colorectal liver metastases (CRLM) who received systemic therapy followed by local treatment.
  • Results showed that both baseline TTV and changes in TTV after treatment were significantly associated with early recurrence and overall survival, while conventional measures like RECIST1.1 did not show predictive value.
  • Findings were validated in an external patient cohort, confirming that TTV provides important prognostic information beyond traditional clinical factors for patients with initially unresectable CRLM.
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Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft-tissue tumors prevalent in neurofibromatosis type 1 (NF1) patients, posing a significant risk of metastasis and recurrence. Current magnetic resonance imaging (MRI) imaging lacks decisiveness in distinguishing benign peripheral nerve sheath tumors (BPNSTs) and MPNSTs, necessitating invasive biopsies. This study aims to develop a radiomics model using quantitative imaging features and machine learning to distinguish MPNSTs from BPNSTs.

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Advances in therapeutic approaches for melanoma urge the need for biomarkers that can identify patients at risk for recurrence and to guide treatment. The potential use of liquid biopsies in identifying biomarkers is increasingly being recognized. Here, we present a head-to-head comparison of several techniques to analyze circulating tumor cells (CTCs) and cell-free DNA (cfDNA) in 20 patients with metastatic melanoma.

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Objective: To provide a comprehensive framework for value assessment of artificial intelligence (AI) in radiology.

Methods: This paper presents the RADAR framework, which has been adapted from Fryback and Thornbury's imaging efficacy framework to facilitate the valuation of radiology AI from conception to local implementation. Local efficacy has been newly introduced to underscore the importance of appraising an AI technology within its local environment.

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Objectives: Independent internal and external validation of three previously published CT-based radiomics models to predict local tumor progression (LTP) after thermal ablation of colorectal liver metastases (CRLM).

Materials And Methods: Patients with CRLM treated with thermal ablation were collected from two institutions to collect a new independent internal and external validation cohort. Ablation zones (AZ) were delineated on portal venous phase CT 2-8 weeks post-ablation.

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Rationale And Objectives: Distinguishing malignant from benign liver lesions based on magnetic resonance imaging (MRI) is an important but often challenging task, especially in noncirrhotic livers. We developed and externally validated a radiomics model to quantitatively assess T2-weighted MRI to distinguish the most common malignant and benign primary solid liver lesions in noncirrhotic livers.

Materials And Methods: Data sets were retrospectively collected from three tertiary referral centers (A, B, and C) between 2002 and 2018.

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Artificial intelligence (AI) is transforming the field of medical imaging and has the potential to bring medicine from the era of 'sick-care' to the era of healthcare and prevention. The development of AI requires access to large, complete, and harmonized real-world datasets, representative of the population, and disease diversity. However, to date, efforts are fragmented, based on single-institution, size-limited, and annotation-limited datasets.

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Article Synopsis
  • Approximately 25% of patients with muscle-invasive bladder cancer (MIBC) who are considered node negative actually have hidden lymph node metastases when examined after surgery.
  • The study focused on using preoperative CT scans and machine learning techniques to try to distinguish between those with positive lymph node involvement (pN+) and those without (pN0) in clinical stage MIBC patients.
  • Despite analyzing a significant number of patients and lymph nodes, the study found that CT-based radiomics did not effectively differentiate between pN+ and pN0, performing no better than random chance.
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Treatment planning of gastrointestinal stromal tumors (GISTs) includes distinguishing GISTs from other intra-abdominal tumors and GISTs' molecular analysis. The aim of this study was to evaluate radiomics for distinguishing GISTs from other intra-abdominal tumors, and in GISTs, predict the c-KIT, PDGFRA, BRAF mutational status, and mitotic index (MI). Patients diagnosed at the Erasmus MC between 2004 and 2017, with GIST or non-GIST intra-abdominal tumors and a contrast-enhanced venous-phase CT, were retrospectively included.

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The computer-aided analysis of prostate multiparametric MRI (mpMRI) could improve significant-prostate-cancer (PCa) detection. Various deep-learning- and radiomics-based methods for significant-PCa segmentation or classification have been reported in the literature. To be able to assess the generalizability of the performance of these methods, using various external data sets is crucial.

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Histopathological growth patterns (HGPs) are independent prognosticators for colorectal liver metastases (CRLM). Currently, HGPs are determined postoperatively. In this study, we evaluated radiomics for preoperative prediction of HGPs on computed tomography (CT), and its robustness to segmentation and acquisition variations.

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Metastatic mesenteric masses of small intestinal neuroendocrine tumors (SI-NETs) are known to often cause intestinal complications. The aim of this study was to identify patients at risk to develop these complications based on routinely acquired CT scans using a standardized set of clinical criteria and radiomics. Retrospectively, CT scans of SI-NET patients with a mesenteric mass were included and systematically evaluated by five clinicians.

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Patients with mutated (-mt) metastatic melanoma benefit significantly from treatment with BRAF inhibitors. Currently, the status is determined on archival tumor tissue or on fresh tumor tissue from an invasive biopsy. The aim of this study was to evaluate whether radiomics can predict the status in a non-invasive manner.

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Article Synopsis
  • Radiomics applied in MRI shows promise for classifying prostate cancer lesions, but existing studies often lack external validation, raising concerns about model reliability on unseen data.
  • This study aimed to test the generalizability of these radiomics models across multiple centers and to compare their diagnostic performance against expert radiologists.
  • Results indicated that while single-center models performed well, their accuracy dropped significantly with external data; however, in a multi-center setting, the radiomics model outperformed radiologists, suggesting it could be a more reliable tool for predicting cancer malignancy.
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Purpose: Diagnosing desmoid-type fibromatosis (DTF) requires an invasive tissue biopsy with β-catenin staining and CTNNB1 mutational analysis, and is challenging due to its rarity. The aim of this study was to evaluate radiomics for distinguishing DTF from soft tissue sarcomas (STS), and in DTF, for predicting the CTNNB1 mutation types.

Methods: Patients with histologically confirmed extremity STS (non-DTF) or DTF and at least a pretreatment T1-weighted (T1w) MRI scan were retrospectively included.

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Purpose: One of the most frequently cited radiomics investigations showed that features automatically extracted from routine clinical images could be used in prognostic modeling. These images have been made publicly accessible via The Cancer Imaging Archive (TCIA). There have been numerous requests for additional explanatory metadata on the following datasets - RIDER, Interobserver, Lung1, and Head-Neck1.

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Purpose: Patients with 1p/19q codeleted low-grade glioma (LGG) have longer overall survival and better treatment response than patients with 1p/19q intact tumors. Therefore, it is relevant to know the 1p/19q status. To investigate whether the 1p/19q status can be assessed prior to tumor resection, we developed a machine learning algorithm to predict the 1p/19q status of presumed LGG based on preoperative MRI.

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Purpose: The aim of this paper is to describe a public, open-access, computed tomography (CT) phantom image set acquired at three centers and collected especially for radiomics reproducibility research. The dataset is useful to test radiomic features reproducibility with respect to various parameters, such as acquisition settings, scanners, and reconstruction algorithms.

Acquisition And Validation Methods: Three phantoms were scanned in three independent institutions.

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