Accuracy of target delineation by positron emission tomography-based auto-segmentation methods after deformable image registration: A phantom study

PurposeDiagnostic positron emission tomography and computed tomography (PET/CT) images can be fused to the planning CT images by a deformable image registration (DIR). The aim of this study was to evaluate the standardized uptake value (SUV) and target delineation on deformed PET images.MethodsWe used a cylindrical phantom and removable inserts of four spheres (16–38 mm in diameter) and three ellipsoids with a volume equal to the 38-mm-diameter sphere (S38) in each. S38 was filled with 18F-fluorodeoxyglucose activity, and then PET/CT images were acquired. The contours of S38 were generated using original PET images by PET auto-segmentation (PET-AS) methods of (1) SUV2.5, (2) 40% of maximum SUV (SUV40%max), and (3) gradient-based (GB), and were deformed to the other inserts by DIR. We compared the volumes and the SUV_max with the generated contours using the deformed PET images.ResultsThe SUV_max was slightly decreased by DIR; the mean absolute difference was −0.10 ± 0.04. For SUV2.5 and SUV40%max, the differences in S38 volumes between the original and deformed PET images were less than 5%, regardless of deformation type. For the GB, the contoured volumes obtained from deformed PET images were larger than those of the original PET images for the deformation type of ellipsoids. When the S38 was deformed to the 16-mm-diameter sphere, the maximum volume difference was −22.8%.ConclusionsAlthough SUV fluctuations by DIR were negligible, the target delineation on deformed PET images by the GB should be carefully considered owing to the distortion of intensity profiles.     

Influence of inter-observer delineation variability on radiomic features of the parotid gland

PurposeThis study aimed to quantify the variability in the values of radiomic features extracted from a right parotid gland (RPG) delineated by a series of independent observers.MethodsThis was a secondary analysis of anonymous data from a delineation workshop. Inter-observer variability of the RPG from 40 participants was quantified using DICE similarity coefficient (DSC) and Hausdorff distance (HD). An additional contour was generated using Varian SmartSegmentation. Radiomic features extracted include four shape features, six histogram features, and 32 texture features. The absolute mean paired percentage difference (PPD) in feature values from the expert and participants were ranked . Feature robustness was classified using pre- determined thresholds.Results63% of participants achieved a DSC > 0.7, the auto- segmentation DSC was 0.76. The average HD for the participants was 16.16 mm ± 0.66 mm, and 15.16 mm for the auto-segmentation. 48% (n = 20) and 33% (n = 14) of features were deemed to be robust with a mean absolute PPD < 5%, for the auto-segmentation and manual delineations respectively; the majority of which were from the grey-run length matrix family. 7% (n = 3) of features from the auto- segmentation and 10% (n = 4) from the manual contours were deemed to be unstable with a mean absolute PPD > 50%. The value of the most robust feature was not related to DSC and HD.ConclusionInter-observer delineation variability affects the value of the radiomic features extracted from the RPG. This study identifies the radiomic features least sensitive to these uncertainties. Further investigation of the clinical relevance of these features in prediction of xerostomia is warranted.     

Deformable registration-based segmentation of the bowel on Megavoltage CT during pelvic radiotherapy

During pelvic radiotherapy bowel loops (BL) are subject to inter-fraction changes. MVCT images have the potential to provide daily bowel segmentation. We assess the feasibility of deformable registration and contour propagation in replacing manual BL segmentation on MVCT.Four observers delineated BL on the planning kVCT and on one therapy MVCT in eight patients. Inter-observer variations in BLs contouring were quantified using DICE index. BLs were then automatically propagated onto MVCT by a commercial software for image deformation and subsequently manually corrected. The agreement between propagated BL/propagated + manually corrected BL vs manual were quantified using the DICE. Contouring times were also compared. The impact on DVH of using the deformable-registration method was assessed. The same procedures were repeated on high-resolution planning-kVCT and therapy-kVCT.MVCTs are adequate to visualize BL (average DICE: 0.815), although worse than kVCT (average DICE:0.889). When comparing propagated vs manual BL, a poor agreement was found (average DICE: 0.564/0.646 for MVCT/KVCT). After manual correction, average DICE indexes increased to 0.810/0.897. The contouring time was reduced to 15 min with the semi-automatic approach from 30 min with manual contouring. DVH parameters of propagated BL were significantly different from manual BL (p < 0.0001); after manual correction, no significant differences were seen.MVCT are suitable for BL visualization. The use of a software to segment BL on MVCT starting from BL-kVCT contours was feasible if followed by manual correction. The method resulted in a substantial reduction of contouring time without detrimental effect on the quality of bowel segmentation and DVH estimates.     

Investigating multi-radiomic models for enhancing prediction power of cervical cancer treatment outcomes

Quantitative image features, also known as radiomic features, have shown potential for predicting treatment outcomes in several body sites. We quantitatively analyzed ¹⁸Fluorine–fluorodeoxyglucose (¹⁸F-FDG) Positron Emission Tomography (PET) uptake heterogeneity in the Metabolic Tumor Volume (MTV) of eighty cervical cancer patients to investigate the predictive performance of radiomic features for two treatment outcomes: the development of distant metastases (DM) and loco-regional recurrent disease (LRR). We aimed to fit the highest predictive features in multiple logistic regression models (MLRs). To generate such models, we applied backward feature selection method as part of Leave-One-Out Cross Validation (LOOCV) within a training set consisting of 70% of the original patient cohort. The trained MLRs were tested on an independent set consisted of 30% of the original cohort. We evaluated the performance of the final models using the Area under the Receiver Operator Characteristic Curve (AUC). Accordingly, six models demonstrated superior predictive performance for both outcomes (four for DM and two for LRR) when compared to both univariate-radiomic feature models and Standard Uptake Value (SUV) measurements. This demonstrated approach suggests that the ability of the pre-radiochemotherapy PET radiomics to stratify patient risk for DM and LRR could potentially guide management decisions such as adjuvant systemic therapy or radiation dose escalation.     

PET textural features stability and pattern discrimination power for radiomics analysis: An “ad-hoc” phantoms study

PurposeThe analysis of PET images by textural features, also known as radiomics, shows promising results in tumor characterization. However, radiomic metrics (RMs) analysis is currently not standardized and the impact of the whole processing chain still needs deep investigation. We characterized the impact on RM values of: i) two discretization methods, ii) acquisition statistics, and iii) reconstruction algorithm. The influence of tumor volume and standardized-uptake-value (SUV) on RM was also investigated.MethodsThe Chang-Gung-Image-Texture-Analysis (CGITA) software was used to calculate 39 RMs using phantom data. Thirty noise realizations were acquired to measure statistical effect size indicators for each RM. The parameter η² (fraction of variance explained by the nuisance factor) was used to assess the effect of categorical variables, considering η² < 20% and 20% < η² < 40% as representative of a “negligible” and a “small” dependence respectively. The Cohen’s d was used as discriminatory power to quantify the separation of two distributions.ResultsWe found the discretization method based on fixed-bin-number (FBN) to outperform the one based on fixed-bin-size in units of SUV (FBS), as the latter shows a higher SUV dependence, with 30 RMs showing η² > 20%. FBN was also less influenced by the acquisition and reconstruction setup: with FBN 37 RMs had η² < 40%, only 20 with FBS. Most RMs showed a good discriminatory power among heterogeneous PET signals (for FBN: 29 out of 39 RMs with d > 3).ConclusionsFor RMs analysis, FBN should be preferred. A group of 21 RMs was suggested for PET radiomics analysis.     

Multicenter study of quantitative PET system harmonization using NIST-traceable 68Ge/68Ga cross-calibration kit

PurposeThe present study aimed to define the errors in SUV and demonstrate the feasibility of SUV harmonization among contemporary PET/CT scanners using a novel National Institute of Standards and Technology (NIST)-traceable ⁶⁸Ge/⁶⁸Ga source as the reference standard.MethodsWe used ⁶⁸Ge/⁶⁸Ga dose calibrator and PET sources made with same batch of ⁶⁸Ge/⁶⁸Ga embedded in epoxy that is traceable to the NIST standard. Bias in the amount of radioactivity and the radioactive concentrations measured by the dose calibrators and PET/CT scanners, respectively, was determined at five Japanese sites. We adjusted optimal dial setting of the dose calibrators and PET reconstruction parameters to close the actual amount of radioactivity and the radioactive concentration, respectively, of the NIST-traceable ⁶⁸Ge/⁶⁸Ga sources to harmonize SUV. Errors in SUV before and after harmonization were then calculated at each site.ResultsThe average bias in the amount of radioactivity and the radioactive concentrations measured by dose calibrator and PET scanner was −4.94% and −12.22%, respectively, before, and −0.14% and −4.81%, respectively, after harmonization. Corresponding averaged errors in SUV measured under clinical conditions were underestimated by 7.66%, but improved by −4.70% under optimal conditions.ConclusionOur proposed method using an NIST-traceable ⁶⁸Ge/⁶⁸Ga source identified bias in values obtained using dose calibrators and PET scanners, and reduced SUV variability to within 5% across different models of PET scanners at five sites. Our protocol using a standard source has considerable potential for harmonizing the SUV when contemporary PET scanners are involved in multicenter studies.     

Impact of coronal and sagittal views on lung gross tumor volume delineation

Background and purposeTo study the impact of coronal and sagittal views (CSV) on the gross tumor volume (GTV) delineation on CT and matched PET/CT scans in non-small cell lung cancer.Material and methodsGTV delineations were performed by 11 experienced radiation oncologists on CT and PET/CT in 22 patients. Two tumor groups were defined: Group I: Primary tumors surrounded by lung or visceral pleura, without venous invasion, and without large extensions to the chest wall or the mediastinum. Group II: Tumors invading the hilar region, heart, large vessels, pericardium, and the mediastinum and/or associated with atelectasis. Tumor volumes and inter-observers variations (SD) were calculated and compared according to the use of axial view only (AW), axial/coronal/sagittal views (ACSW) and ACSW/PET (ACSWP).ResultsCSV were not frequently used (57.4% out of 242 delineations on CT). For group I, ACSW didn’t improve significantly mean GTVs. SDs were small on CT and on PET (SD = 0.3 cm). For group II, ACSW had 27–46% smaller observer variation (mean SD = 0.7 cm) than AW (mean SD = 1.1 cm). The smaller observer variation of ACSW users was associated with, on average, a 40% smaller delineated volume (p = 0.038). Mean GTV of ACSWP was 21% larger than mean GTV of ACSW on CT.ConclusionsFor smaller lung tumors surrounded by healthy lung tissue the effect of multiple axis delineation is limited. However, application of coronal and sagittal windows is highly beneficial for delineation of more complex tumors, with atelectasis and/or pathological lymph nodes even if PET is used.     

Comparaison de différentes méthodes de segmentation en TEP/TDM pour le ciblage en radiothérapie des carcinomes épidermoïdes des VADS

IntroductionTo assess interobserver variability for biological target volume (BTV) delineation and to compare the reproductibility of different semiautomatic segmentation methods in pretreatment 18-fluorodeoxyglucose positron emission tomography (PET/CT) of head and neck squamous cell carcinoma (HNSCC).Patients and methodsPatients with histologically proved HNSCC referred to the nuclear medicine service in Brest for pretreatment PET/CT were prospectively included from February 2009 to June 2010. Three nuclear medicine physicians (two specialized in oncology) delineated manually and independently BTV on each primary tumor. Four semiautomatic segmentation methods have been studied; three using a fixed threshold and one applying an adaptive threshold based on the signal-to-background ratio (Daisne). The variability between κ observers and/or methods has been assessed. The concordance between the various BTV intersections and unions has been also assessed.ResultsThirty patients (29M; 1F) were included. The primary site location was oropharynx in six patients, oral cavity in 10 patients, hypopharynx in five patients and larynx in nine patients. A statistically significant global interobserver variability (P = 0.01) was showed, but without statistically difference between the two experienced oncologists (P = 0.15). The maximal concordance of the two experienced observers with the semiautomatic methods was found for the Daisne method (CI = 61.5%; κ = 0.68), expressing a good agreement according to the Landis and Koch criteria, better than with the segmentation method using a fixed threshold with 40% of maximal signal intensity (CI = 52.1%; κ = 0.53).ConclusionOur results suggest the feasibility of achieving HNSCC BTV delineation by PET/CT using semiautomatic methods, in particular those which apply an adaptative threshold but under the supervision of an experienced operator.     

A segmentation tool for pulmonary nodules in lung cancer screening: Testing and clinical usage

PurposeWith the future goal of defining a large dataset based on low-dose CT with labelled pulmonary lesions for lung cancer screening (LCS) research, the aim of this work is to propose and evaluate into a clinical context a tool for semi-automatic segmentation able to facilitate the process of labels collection from a LCS study (COSMOS, Continuous Observation of SMOking Subjects).MethodsConsidering a preliminary set of manual annotations, a segmentation model based on a 2D-Unet was trained from scratch. Contour quality of the final 2D-Unet was assessed on an internal test set of manual annotations and on a subset of the public available LIDC dataset used as external test set. The tool for semi-automatic segmentation was then designed integrating the tested model into a Graphical User Interface. According to the opinion of two clinical users, the percentage of lesions properly contoured through the tool was quantified (Acceptance Rate, AR). The variability between segmentations derived by the two readers was estimated as mean percentage of difference (MPD) between the two sets of volumes and comparing the likelihood of malignancy derived from Volume Doubling Time (VDT).ResultsPerformance in test sets were found similar (DICE ~ 0.75(0.15)). Accordingly, a good mean AR (80.1%) resulted from the two readers. Variability in terms of MPD was equal to 23.6% while 2.7% was the VDTs percentage of disagreement.ConclusionsA semi-automatic segmentation tool was developed and its applicability evaluated into a clinical context demonstrating the efficacy of the tool in facilitating the collection of labelled data.     

Positron Emission Tomography studies with [11C]PBR28 in the Healthy Rodent Brain: Validating SUV as an Outcome Measure of Neuroinflammation

Molecular imaging of the 18 kD Translocator protein (TSPO) with positron emission tomography (PET) is of great value for studying neuroinflammation in rodents longitudinally. Quantification of the TSPO in rodents is, however, quite challenging. There is no suitable reference region and the use of plasma-derived input is not an option for longitudinal studies. The aim of this study was therefore to evaluate the use of the standardized uptake value (SUV) as an outcome measure for TSPO imaging in rodent brain PET studies, using [¹¹C]PBR28. In the first part of the study, healthy male Wistar rats (n = 4) were used to determine the correlation between the distribution volume (V_T, calculated with Logan graphical analysis) and the SUV. In the second part, healthy male Wistar rats (n = 4) and healthy male C57BL/6J mice (n = 4), were used to determine the test-retest variability of the SUV, with a 7-day interval between measurements. Dynamic PET scans of 63 minutes were acquired with a nanoScan PET/MRI and nanoScan PET/CT. An MRI scan was made for anatomical reference with each measurement. The whole brain V_T of [¹¹C]PBR28 in rats was 42.9 ± 1.7. A statistically significant correlation (r² = 0.96; p < 0.01) was found between the V_T and the SUV. The test-retest variability in 8 brain region ranged from 8 to 20% in rats and from 7 to 23% in mice. The interclass correlation coefficient (ICC) was acceptable to excellent for rats, but poor to acceptable for mice. In conclusion: The SUV of [¹¹C]PBR28 showed a high correlation with V_T as well as good test-retest variability. For future longitudinal small animal PET studies the SUV can thus be used to describe [¹¹C]PBR28 uptake in healthy brain tissue. Based on the present observations, further studies are needed to explore the applicability of this approach in small animal disease models, with special regard to neuroinflammatory models.     

Semi-Automatic Quantification of Subsolid Pulmonary Nodules: Comparison with Manual Measurements

Rationale

Accurate measurement of subsolid pulmonary nodules (SSN) is becoming increasingly important in the management of these nodules. SSNs were previously quantified with time-consuming manual measurements. The aim of the present study is to test the feasibility of semi-automatic SSNs measurements and to compare the results to the manual measurements.

Methods

In 33 lung cancer screening participants with 33 SSNs, the nodules were previously quantified by two observers manually. In the present study two observers quantified these nodules by using semi-automated nodule volumetry software. Nodules were quantified for effective diameter, volume and mass. The manual and semi-automatic measurements were compared using Bland-Altman plots and paired T tests. Observer agreement was calculated as an intraclass correlation coefficient. Data are presented as mean (SD).

Results

Semi-automated measurements were feasible in all 33 nodules. Nodule diameter, volume and mass were 11.2 (3.3) mm, 935 (691) ml and 379 (311) milligrams for observer 1 and 11.1 (3.7) mm, 986 (797) ml and 399 (344) milligrams for observer 2, respectively. Agreement between observers and within observer 1 for the semi-automatic measurements was good with an intraclass correlation coefficient >0.89. For observer 1 and observer 2, measured diameter was 8.8% and 10.3% larger (p<0.001), measured volume was 24.3% and 26.5% larger (p<0.001) and measured mass was 10.6% and 12.0% larger (p<0.001) with the semi-automatic program compared to the manual measurements.

Conclusion

Semi-automated measurement of the diameter, volume and mass of SSNs is feasible with good observer agreement. Semi-automated measurement makes quantification of mass and volume feasible in daily practice.     

Intérêt de la TEP dans le bilan d’extension et l’évaluation de la maladie résiduelle des séminomes testiculaires : étude rétrospective

AimsTo evaluate the value of PET/CT comparatively to CT in staging and restaging after chemotherapy of testicular seminoma, to assess quantitative methods and prognostic value of PET in post-chemotherapy residual masses.MethodsThirty-two patients and a maximum of 65 targeted lesions visualized on PET-CT and CT performed for staging and therapeutic response assessment were analysed and compared. Each lesion was quantified according to miscellaneous SUV normalized methods. Optimal threshold of SUV for prediction of residual disease was obtained (ROC method). The prognostic value of PET/CT at the completion of treatment was determined with progression free survival study (Kaplan-Meier method).ResultsPET/CT exhibited higher accuracy than CT in the initial staging and assessment of therapeutic response, respectively 98% versus 83.3% and 95.1% versus 75.6%. Quantification, whichever method, was not more efficient than visual reading for prediction of residual disease. Progression-free survival was higher with negative than with positive PET/CT (P = 0.0033).ConclusionOur work demonstrates that PET/CT exhibits better accuracy than CT in both staging and restaging at the end of treatment. Quantification methods do not improve accuracy of PET/CT for prediction of viable residual disease. The prognostic value of PET/CT appears very promising and needs to be confirmed by large prospective studies. PET/CT appears to be a relevant method of prognostic stratification of the risk of relapse in seminoma.     

Comparison of radiomic features in diagnostic CT images with and without contrast enhancement in the delayed phase for NSCLC patients

PurposeTo compare radiomic features extracted from diagnostic computed tomography (CT) images with and without contrast enhancement in delayed phase for non-small cell lung cancer (NSCLC) patients.MethodsDiagnostic CT images from 269 tumors [non-contrast CT, 188 (dataset NE); contrast-enhanced CT, 81 (dataset CE)] were enrolled in this study. Eighteen first-order and seventy-five texture features were extracted by setting five bin width levels for CT values. Reproducible features were selected by the intraclass correlation coefficient (ICC). Radiomic features were compared between datasets NE and CE. Subgroup analyses were performed based on the CT acquisition period, exposure value, and patient characteristics.ResultsEighty features were considered reproducible (0.5 ≤ ICC). Twelve of the sixteen first-order features, independent of the bin width levels, were statistically different between datasets NE and CE (p < 0.05), and the p-values of two first-order features depending on the bin width levels were reduced with narrower bin widths. Sixteen out of sixty-two features showed a significant difference, regardless of the bin width (p < 0.05). There were significant differences between datasets NE and CE with older age, lighter body weight, better performance status, being a smoker, larger gross tumor volume, and tumor location at central region.ConclusionsContrast enhancement in the delayed phase of CT images for NSCLC patients affected some of the radiomic features and the variability of radiomic features due to contrast uptake may depend largely on the patient characteristics.     

Evaluation of fully automated a priori MCO treatment planning in VMAT for head-and-neck cancer

PurposeAutomated planning techniques aim to reduce manual planning time and inter-operator variability without compromising the plan quality which is particularly challenging for head-and-neck (HN) cancer radiotherapy. The objective of this study was to evaluate the performance of an a priori-multicriteria plan optimization algorithm on a cohort of HN patients.MethodsA total of 14 nasopharyngeal carcinoma (upper-HN) and 14 “middle-lower indications” (lower-HN) previously treated in our institution were enrolled in this study. Automatically generated plans (autoVMAT) were compared to manual VMAT or Helical Tomotherapy planning (manVMAT-HT) by assessing differences in dose delivered to targets and organs at risk (OARs), calculating plan quality indexes (PQIs) and performing blinded comparisons by clinicians. Quality control of the plans and measurements of the delivery times were also performed.ResultsFor the 14 lower-HN patients, with equivalent planning target volume (PTV) dosimetric criteria and dose homogeneity, significant decrease in the mean doses to the oral cavity, esophagus, trachea and larynx were observed for autoVMAT compared to manVMAT-HT. Regarding the 14 upper-HN cases, the PTV coverage was generally significantly superior for autoVMAT which was also confirmed with higher calculated PQIs on PTVs for 13 out of 14 patients, whereas PQIs calculated on OARs were generally equivalent. Number of MUs and total delivery time were significantly higher for autoVMAT compared to manVMAT. All plans were considered clinically acceptable by clinicians.ConclusionsOverall superiority of autoVMAT compared to manVMAT-HT plans was demonstrated for HN cancer. The obtained plans were operator-independent and required no post-optimization or manual intervention.     

Evaluation of inter- and intra-observer variations in prostate gland delineation using CT-alone versus CT/TPUS

BackgroundThis study aims to explore the role of four-dimensional (4D) transperineal ultrasound (TPUS) in the contouring of prostate gland with planning computed tomography (CT) images, in the absence of magnetic resonance imaging (MRI).Materials and methodsFive radiation oncologists (ROs) performed two rounds of prostate gland contouring (single-blinded) on CT-alone and CT/TPUS datasets obtained from 10 patients who underwent TPUS-guided external beam radiotherapy. Parameters include prostate volume, DICE similarity coefficient (DSC) and centroid position. Wilcoxon signed-rank test assessed the significance of inter-modality differences, and the intraclass correlation coefficient (ICC ) reflected inter- and intra-observer reliability of parameters.ResultsInter-modality analysis revealed high agreement (based on DSC and centroid position) of prostate gland contours between CT-alone and CT/TPUS. Statistical significant difference was observed in the superior-inferior direction of the prostate centroid position (p = 0.011). All modalities yielded excellent inter-observer reliability of delineated prostate volume with ICC > 0.9, mean DSC > 0.8 and centroid position: CT-alone (ICC = 1.000) and CT/TPUS (ICC = 0.999) left-right (L/R); CT-alone (ICC = 0.999) and CT/TPUS (ICC = 0.998) anterior-posterior (A/P); CT-alone (ICC = 0.999) and CT/TPUS (ICC = 1.000) superior-inferior (S/I). Similarly, all modalities yielded excellent intra-observer reliability of delineated prostate volume, ICC > 0.9 and mean DSC > 0.8. Lastly, intra-observer reliability was excellent on both imaging modalities for the prostate centroid position, ICC > 0.9.ConclusionTPUS does not add significantly to the amount of anatomical information provided by CT images. However, TPUS can supplement planning CT to achieve a higher positional accuracy in the S/I direction if access to CT/MRI fusion is limited.     

Variation de la captation hépatique de 18-FDG dans l’évaluation intermédiaire des lymphomes B diffus à grandes cellules en TEP/TDM

IntroductionThe aim of this study was to evaluate the variability of 18F-FDG liver uptake at interim PET/CT among patients with high-grade lymphomas.MethodsForty-six patients with diffuse large B-cell lymphomas (DLBCL) who underwent 18F-FDG PET/CT at baseline (PET1) and after a few cycles of therapy (PET2) were included retrospectively. SUV mean normalized for body weight (SUVmean) and for lean body mass (SULmean) were obtained from 2-dimensional regions of interest (ROI) in the right lobe of the liver.ResultsLiver SUVmean values for the 46 patients were not different before and after the courses of chemotherapy. On univariate and multivariate analysis, liver SUVmean values increased with BMI (P = 0.0031). No significant correlation was found between delay post-injection, blood glucose level, age, gender and liver SUVmean. We found no statistically significant correlation between the liver SULmean or mediastinum SUVmean and studied variables. No factors affecting intrapatient hepatic uptake variation between PET1 and PET2 were found on correlation analysis.ConclusionAt interim PET in diffuse large B-cell lymphomas, liver SUVmean depends on BMI, but not liver SULmean. Caution is required when using liver SUV as reference in patients with high BMI.     

Segmentation d’images de lésions cérébrales primitives en TEP FET : influence du volume de travail

Purpose(1) Evaluate the reproducibility of segmentation methods depending on the preselection region for tumour volume determination on ¹⁸F-fluoro-ethyl-tyrosine (FET) PET. (2) Evaluate the intra and inter-operator reproducibility of the manual delineation. (3) Compare this delineation with the segmentation methods.Materials and methodsEighteen FET PET of patients with glioblastoma were analysed. Preselection regions were determined prior to any segmentation. Two physicians delineated the tumour volume manually. The tumour volume was also delineated with a threshold method (40 and 70% of SUV_max), and a random walk based method. Pearson coefficient (r) (P < 0.05 for r > 0.468) and Jaccard indices (JI) were used to compare the volumes.ResultsManual delineation was reproducible with r = 0.97 and IJ = 0.65 for intra-operator, and r = 0.76 and IJ = 0.45 for inter-operator reproducibility. The preselection regions for a given lesion were different and the segmentation varied with the preselection region: r = 0.55 JI = 0.58; r = 0.85 JI = 0.83; r = 0.70 JI = 0.39 respectively for the threshold of 40%, 70% and the random walk. The segmentation differed form de manual delineation with r = 0.37 and JI = 0.16; r = 0.54 and JI = 0.42; r = 0.43 and JI = 0.37 respectively for the threshold of 40%, 70% and the random walk.ConclusionThe reproducibility of the segmentation methods depends extensively on the preselection region. The intra-operator reproducibility of cerebral lesion delineation on FET PET is satisfactory. The inter-operator reproducibility could be improved.     

A Semi-Automated Technique Determining the Liver Standardized Uptake Value Reference for Tumor Delineation in FDG PET-CT

Background

¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)-computed tomography (CT) has been an essential modality in oncology. We propose a semi-automated algorithm to objectively determine liver standardized uptake value (SUV), which is used as a threshold for tumor delineation.

Methods

A large spherical volume of interest (VOI) was placed manually to roughly enclose the right lobe (RL) of the liver. For each voxel in this VOI, a coefficient of variation of voxel values (CVv) was calculated for neighboring voxels within a radius of d/2. The voxel with the minimum CVv was then selected, where a 30-mm spherical VOI was placed at that voxel in accordance with PERCIST criteria. Two nuclear medicine physicians independently defined 30-mm VOIs manually on 124 studies in 62 patients to generate the standard values, against which the results from the new method were compared.

Results

The semi-automated method was successful in determining the liver SUV that was consistent between the two physicians in all the studies (d = 80 mm). The liver SUV threshold (mean +3 SD within 30-mm VOI) determined by the new semi-automated method (3.12±0.61) was not statistically different from those determined by the manual method (Physician-1: 3.14±0.58, Physician-2: 3.15±0.58). The semi-automated method produced tumor volumes that were not statistically different from those by experts'' manual operation. Furthermore, the volume change in the two sequential studies had no statistical difference between semi-automated and manual methods.

Conclusions

Our semi-automated method could define the liver SUV robustly as the threshold value used for tumor volume measurements according to PERCIST. The method could avoid possible subjective bias of manual liver VOI placement and is thus expected to improve clinical performance of volume-based parameters for prediction of cancer treatment response.     

Fast chlorophyll fluorescence transient and nitrogen fixing ability of chickpea nodulation variants

High nodulating (HN) selections of the cultivars ICC 4948 and ICC 5003 had the highest nodule number and nodule dry mass followed by low nodulating (LN) selections of the same cultivar. Both non-nodulating (NN) selections of cv. ICC 4993 and ICC 4918 did not show any nodule. Using N-difference method the HN selection of cv. 1CC 4948 was able to meet 73 % of its demand of N through biological fixation of N₂ [P(fix)], while 27 % of N demand was met by uptake from the soil, whereas its LN selection was able to meet only 54 % of its demand of N through biological fixation of N₂. Similarly in cv. ICC 5003 HN and LN selections the P(fix) was 76 and 64 %, respectively. Fast chlorophyll (Chl) fluorescence transient data analysis showed that performance index PI(abs) was 62.0 in cv. ICC 4948 HN selection and 44.5 in its respective LN selections. Corresponding values for cv. ICC 5003 were 32.4 and 28.4. In NN selections of ICC 4993 and ICC 4918 it was 12.6 and 30.7, respectively. Structure function index of the plants SFI(abs) and driving force for photosynthesis (DF) were highest in the HN selections followed by LN selections and lowest in the NN selections. The total uptake of N by chickpea plants was significantly and positively correlated with the density of reaction centres ABS/CS₀, TR₀/CS₀, and DI₀/CS_M, whereas total N uptake by chickpea seeds was significantly positively correlated with N and TR₀/CS₀. The percentage of P(fix) was highly significantly positively correlated with N, the so-called turnover number which indicates how many times Q_A has been reduced in the time span from 0 to t_Fmax and TR₀/CS₀. Fast Chl a fluorescence measurement can be used as a model system to assess the N fixation ability in chickpea.