Application of multivariate image analysis to prostate cancer for improving the comprehension of the related physiological phenomena and the development and validation of new imaging biomarkers

Resumen

The increase in life expectancy and population with age higher than 50 years is producing a major number of detected cases of prostate cancer (PCa). For this reason, the resources are focused in the early diagnosis and effective treatment. In spite of multiple studies with histologic discriminant biomarkers, it is hard to clearly differentiate the low aggressiveness PCa cases from those that will progress and produce mortality or rather a decrease in the life expectancy. With the objective of improving the diagnosis, location and gradation of the malignant tumors, Magnetic Resonance Imaging (MRI) has come up as the most appropriate image acquisition technique for cancer studies, which provides a non-invasive, sensitive and specific diagnosis, based on morphological and functional (blood perfusion and water diffusion) sequences. The different characteristics and parameters extracted from these sequences, known as imaging biomarkers, can evaluate the different processes associated to tumor development, like pharmacokinetic modeling for angiogenesis assessment (perfusion) or mono- and bi-exponential signal decay modeling for cellularization (diffusion). Normally, these imaging biomarkers are analyzed in a "univariate" way, without taking advantage of the internal correlation structures among them. One way to improve this analysis is by applying Multivariate Image Analysis (MIA) statistical techniques, obtaining simplified (latent) structures that help to understand the relation between parameters (variables) and the inner physiological processes, moreover reducing the uncertainty in the estimation of the biomarkers. In this thesis, new imaging biomarkers are developed for perfusion and diffusion by applying MIA tools like Multivariate Curve Resolution Alternating Least Squares (MCR-ALS), obtaining parameters with direct clinical interpretation. Partial Least Squares (PLS) based methods are then used for studying the classification capability of these biomarkers. First, perfusion imaging biomarkers have been tested for tumor detection (control vs lesion). Then, diffusion + perfusion have been combined to study tumor aggressiveness by applying PLS-multiblock methods (SMB-PLS). The results showed that MCR-based perfusion biomarkers performed better than state-of-the-art pharmacokinetic parameters for lesion differentiation. Regarding the assessment of tumor aggressiveness, the combination of diffusion-based imaging biomarkers (using both the parametric models and MCR) and normalized T2-weighted measurements provided the best discriminating outcome, while perfusion was not needed as it did not supply additional information. In conclusion, MIA can be applied to morphologic and functional MRI to improve the diagnosis and aggressiveness assessment of prostate tumors by obtaining new quantitative parameters and combining them with state-of-the-art imaging biomarkers.