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Table 4 Recommendations for the use of quantitative imaging biomarkers as decision-support tools

From: Validated imaging biomarkers as decision-making tools in clinical trials and routine practice: current status and recommendations from the EIBALL* subcommittee of the European Society of Radiology (ESR)


Current evidence

Action needed

Consider need for quantitation in relation to the decision being made

Semi-quantitative imaging biomarkers are successfully used in many clinical pathways.

• Classification systems retain a subjective element that could benefit from standardisation and refinement.

• Development of automated and thresholding would enable more quantitative assessments

Use validated IB methodology for semi-quantitative and quantitative measures

Many single and multicentre trials validating quantitative imaging biomarkers with clinical outcome now exist.

• Harmonisation of methodology

• Standardised reporting systems

Establish evidence on the use of quantitation by inclusion into clinical trials

Clinical trials are usually planned by non-imagers. Integration of imaging biomarkers into trials is dependent on what is available routinely to non-imagers in the clinic, rather than exploiting an imaging technique to its optimal potential.

• Inventory of imaging biomarkers accessible through a web-based portal would inform the inclusion and utilisation of imaging biomarkers within trials (The European Imaging Biomarkers Alliance initiative).

• Certified biomarkers conforming to set standards (Quantitative Imaging Biomarkers Alliance initiative)

Validate against pathology or clinical outcomes to make imaging a “virtual biopsy”

Several major databanks hold imaging and clinical or pathology data


• UK MRC Biobank (UK)

• German National Cohort Study (Germany)

• Large data collection for validation of imaging and pathology

• Curation in imaging biobanks

Select appropriate quality assured quantitative IB

Trials with embedded QA/QC procedures have indicated good reproducibility of quantitative imaging biomarkers (e.g. EU iMi QuIC:ConCePT project)

• Ensure curation and archiving of longitudinal imaging data with outcomes within trials

Open-source interchange kernel

Low comparability between image-derived biomarkers if hardware and software of different manufacturers are used.

• Harmonisation of image acquisition and post-processing over manufacturers