Case Western Reserve University scientists are developing artificial intelligence (AI) tools to help surgeons and oncologists identify the subtle but critical differences between a recurring tumor and damaged non-cancerous tissue on post-operative MRI scans of certain cancer patients.

The work is being led by Pallavi Tiwari, PhD, and Satish Viswanath, PhD. Both are faculty members in the Case Western Reserve School of Medicine and lead researchers in the Center for Computational Imaging and Personal Diagnostics (CCIPD) at the Case School of Engineering.

Tiwari, Viswanath and several collaborators were recently awarded a $1.15 million grant from the National Cancer Institute (NCI)’s Informatics Technology in Cancer Research (ITCR) program to pursue development and dissemination of the AI-informed tools.
Avoiding second surgeries

The potential benefit for doctors and their patients: Fewer unnecessary surgeries to remove suspect tissue which now can only be confirmed to be non-cancerous after initial therapy.

Doctors often end up performing those surgeries for one simple reason: Tissue that has been scarred and damaged—even killed—by chemotherapy or radiation resembles a recurring tumor on an MRI scan, the researchers said.

“They look very similar on the image, at least from what the human eye can perceive,” said Viswanath, who specializes in colorectal cancers, while Tiwari focuses on brain cancers.

For a colorectal cancer patient, that can often mean getting a proctectomy (a portion of the rectum removed), a radical procedure that significantly reduces quality of life, Viswanath said.

“So, until now, if you don’t take the lesion out, you can’t tell if it’s a tumor,” Tiwari said. “But you really don’t want to keep hitting cancer patients with unnecessary surgeries—and that’s especially true in both brain and colorectal cancers.”

Their proposed tool would harness the interpretive power of the center’s deep-learning computers, which will use the AI tools being designed and developed in this project to tease out miniscule variations between the tumors and damaged tissue on MRI scans.

Those previously unseen variations differentiate tumors from dead tissue (known as necrosis, when most or even all of the cells in the tissue have died) or severely damaged scar tissue (known as fibrosis).

The research covers brain and colorectal cancer because they are similar in “terms of over-treatment,” Viswanath said, referring to decisions by some surgeons to not risk a second surgery when it is actually necessary, or the earlier example of an unnecessary surgery.

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