title: Automated tumor volumetry using computer-aided image segmentation.
abstract: OBJECTIVE
  Accurate segmentation of brain tumors, and quantification of tumor volume, is important for diagnosis, monitoring, and planning therapeutic intervention. Manual segmentation is not widely used because of time constraints. Previous efforts have mainly produced methods that are tailored to a particular type of tumor or acquisition protocol and have mostly failed to produce a method that functions on different tumor types and is robust to changes in scanning parameters, resolution, and image quality, thereby limiting their clinical value. Herein, we present a semiautomatic method for tumor segmentation that is fast, accurate, and robust to a wide variation in image quality and resolution.
  
  
  METHODS
  A semiautomatic segmentation method based on the geodesic distance transform was developed and validated by using it to segment 54 brain tumors. Glioblastomas, meningiomas, and brain metastases were segmented. Qualitative validation was based on physician ratings provided by three clinical experts. Quantitative validation was based on comparing semiautomatic and manual segmentations.
  
  
  RESULTS
  Tumor segmentations obtained using manual and automatic methods were compared quantitatively using the Dice measure of overlap. Subjective evaluation was performed by having human experts rate the computerized segmentations on a 0-5 rating scale where 5 indicated perfect segmentation.
  
  
  CONCLUSIONS
  The proposed method addresses a significant, unmet need in the field of neuro-oncology. Specifically, this method enables clinicians to obtain accurate and reproducible tumor volumes without the need for manual segmentation.
authors.affiliation: Department of Radiology, University of Pennsylvania, 3600 Market St, Suite 380, Philadelphia, Pennsylvania, 19104 (B.G., M.B., M.S.S., H.A., X.D., C.D.); Center for Biomedical Image Computing and Analytics (B.G., L.M., M.B., H.A., X.D., C.D.) and Department of Neurosurgery (L.M., M.A.A., Z.S.A., D.O.R., S.M.G.), University of Pennsylvania, Philadelphia, Pennsylvania; and Siemens Medical Solutions, Malvern, Pennsylvania (Y.Z.).
authors.forename: Bilwaj
authors.initials: B
authors.lastname: Gaonkar
authors.affiliation: Department of Radiology, University of Pennsylvania, 3600 Market St, Suite 380, Philadelphia, Pennsylvania, 19104 (B.G., M.B., M.S.S., H.A., X.D., C.D.); Center for Biomedical Image Computing and Analytics (B.G., L.M., M.B., H.A., X.D., C.D.) and Department of Neurosurgery (L.M., M.A.A., Z.S.A., D.O.R., S.M.G.), University of Pennsylvania, Philadelphia, Pennsylvania; and Siemens Medical Solutions, Malvern, Pennsylvania (Y.Z.).
authors.forename: Luke
authors.initials: L
authors.lastname: Macyszyn
authors.affiliation: Department of Radiology, University of Pennsylvania, 3600 Market St, Suite 380, Philadelphia, Pennsylvania, 19104 (B.G., M.B., M.S.S., H.A., X.D., C.D.); Center for Biomedical Image Computing and Analytics (B.G., L.M., M.B., H.A., X.D., C.D.) and Department of Neurosurgery (L.M., M.A.A., Z.S.A., D.O.R., S.M.G.), University of Pennsylvania, Philadelphia, Pennsylvania; and Siemens Medical Solutions, Malvern, Pennsylvania (Y.Z.).
authors.forename: Michel
authors.initials: M
authors.lastname: Bilello
authors.affiliation: Department of Radiology, University of Pennsylvania, 3600 Market St, Suite 380, Philadelphia, Pennsylvania, 19104 (B.G., M.B., M.S.S., H.A., X.D., C.D.); Center for Biomedical Image Computing and Analytics (B.G., L.M., M.B., H.A., X.D., C.D.) and Department of Neurosurgery (L.M., M.A.A., Z.S.A., D.O.R., S.M.G.), University of Pennsylvania, Philadelphia, Pennsylvania; and Siemens Medical Solutions, Malvern, Pennsylvania (Y.Z.).
authors.forename: Mohammed Salehi
authors.initials: MS
authors.lastname: Sadaghiani
authors.affiliation: Department of Radiology, University of Pennsylvania, 3600 Market St, Suite 380, Philadelphia, Pennsylvania, 19104 (B.G., M.B., M.S.S., H.A., X.D., C.D.); Center for Biomedical Image Computing and Analytics (B.G., L.M., M.B., H.A., X.D., C.D.) and Department of Neurosurgery (L.M., M.A.A., Z.S.A., D.O.R., S.M.G.), University of Pennsylvania, Philadelphia, Pennsylvania; and Siemens Medical Solutions, Malvern, Pennsylvania (Y.Z.).
authors.forename: Hamed
authors.initials: H
authors.lastname: Akbari
authors.affiliation: Department of Radiology, University of Pennsylvania, 3600 Market St, Suite 380, Philadelphia, Pennsylvania, 19104 (B.G., M.B., M.S.S., H.A., X.D., C.D.); Center for Biomedical Image Computing and Analytics (B.G., L.M., M.B., H.A., X.D., C.D.) and Department of Neurosurgery (L.M., M.A.A., Z.S.A., D.O.R., S.M.G.), University of Pennsylvania, Philadelphia, Pennsylvania; and Siemens Medical Solutions, Malvern, Pennsylvania (Y.Z.).
authors.forename: Mark A
authors.initials: MA
authors.lastname: Atthiah
authors.affiliation: Department of Radiology, University of Pennsylvania, 3600 Market St, Suite 380, Philadelphia, Pennsylvania, 19104 (B.G., M.B., M.S.S., H.A., X.D., C.D.); Center for Biomedical Image Computing and Analytics (B.G., L.M., M.B., H.A., X.D., C.D.) and Department of Neurosurgery (L.M., M.A.A., Z.S.A., D.O.R., S.M.G.), University of Pennsylvania, Philadelphia, Pennsylvania; and Siemens Medical Solutions, Malvern, Pennsylvania (Y.Z.).
authors.forename: Zarina S
authors.initials: ZS
authors.lastname: Ali
authors.affiliation: Department of Radiology, University of Pennsylvania, 3600 Market St, Suite 380, Philadelphia, Pennsylvania, 19104 (B.G., M.B., M.S.S., H.A., X.D., C.D.); Center for Biomedical Image Computing and Analytics (B.G., L.M., M.B., H.A., X.D., C.D.) and Department of Neurosurgery (L.M., M.A.A., Z.S.A., D.O.R., S.M.G.), University of Pennsylvania, Philadelphia, Pennsylvania; and Siemens Medical Solutions, Malvern, Pennsylvania (Y.Z.).
authors.forename: Xiao
authors.initials: X
authors.lastname: Da
authors.affiliation: Department of Radiology, University of Pennsylvania, 3600 Market St, Suite 380, Philadelphia, Pennsylvania, 19104 (B.G., M.B., M.S.S., H.A., X.D., C.D.); Center for Biomedical Image Computing and Analytics (B.G., L.M., M.B., H.A., X.D., C.D.) and Department of Neurosurgery (L.M., M.A.A., Z.S.A., D.O.R., S.M.G.), University of Pennsylvania, Philadelphia, Pennsylvania; and Siemens Medical Solutions, Malvern, Pennsylvania (Y.Z.).
authors.forename: Yiqang
authors.initials: Y
authors.lastname: Zhan
authors.affiliation: Department of Radiology, University of Pennsylvania, 3600 Market St, Suite 380, Philadelphia, Pennsylvania, 19104 (B.G., M.B., M.S.S., H.A., X.D., C.D.); Center for Biomedical Image Computing and Analytics (B.G., L.M., M.B., H.A., X.D., C.D.) and Department of Neurosurgery (L.M., M.A.A., Z.S.A., D.O.R., S.M.G.), University of Pennsylvania, Philadelphia, Pennsylvania; and Siemens Medical Solutions, Malvern, Pennsylvania (Y.Z.).
authors.forename: Donald
authors.initials: D
authors.lastname: O'Rourke
authors.affiliation: Department of Radiology, University of Pennsylvania, 3600 Market St, Suite 380, Philadelphia, Pennsylvania, 19104 (B.G., M.B., M.S.S., H.A., X.D., C.D.); Center for Biomedical Image Computing and Analytics (B.G., L.M., M.B., H.A., X.D., C.D.) and Department of Neurosurgery (L.M., M.A.A., Z.S.A., D.O.R., S.M.G.), University of Pennsylvania, Philadelphia, Pennsylvania; and Siemens Medical Solutions, Malvern, Pennsylvania (Y.Z.).
authors.forename: Sean M
authors.initials: SM
authors.lastname: Grady
authors.affiliation: Department of Radiology, University of Pennsylvania, 3600 Market St, Suite 380, Philadelphia, Pennsylvania, 19104 (B.G., M.B., M.S.S., H.A., X.D., C.D.); Center for Biomedical Image Computing and Analytics (B.G., L.M., M.B., H.A., X.D., C.D.) and Department of Neurosurgery (L.M., M.A.A., Z.S.A., D.O.R., S.M.G.), University of Pennsylvania, Philadelphia, Pennsylvania; and Siemens Medical Solutions, Malvern, Pennsylvania (Y.Z.).
authors.forename: Christos
authors.initials: C
authors.lastname: Davatzikos
mesh_terms: D001932:Brain Neoplasms / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D010363:Pattern Recognition, Automated / Q000379:methods*; D012189:Retrospective Studies; D047368:Tumor Burden
keywords: Tumor segmentation; geodesic distance; volumetric analysis