title: A Novel Framework for Automated Segmentation and Labeling of Homogeneous Versus Heterogeneous Lung Tumors in [18F]FDG-PET Imaging.
abstract: Determination of intra-tumor high-uptake area using 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) positron emission tomography (PET) imaging is an important consideration for dose painting in radiation treatment applications. The aim of our study was to develop a framework towards automated segmentation and labeling of homogeneous vs. heterogeneous tumors in clinical lung [18F]FDG-PET with the capability of intra-tumor high-uptake region delineation.
  
  
  
  We utilized and extended a fuzzy random walk PET tumor segmentation algorithm to delineate intra-tumor high-uptake areas. Tumor textural feature (TF) analysis was used to find a relationship between tumor type and TF values. Segmentation accuracy was evaluated quantitatively utilizing 70 clinical [18F]FDG-PET lung images of patients with a total of 150 solid tumors. For volumetric analysis, the Dice similarity coefficient (DSC) and Hausdorff distance (HD) measures were extracted with respect to gold-standard manual segmentation. A multi-linear regression model was also proposed for automated tumor labeling based on TFs, including cross-validation analysis.
  
  
  
  Two-tailed t test analysis of TFs between homogeneous and heterogeneous tumors revealed significant statistical difference for size-zone variability (SZV), intensity variability (IV), zone percentage (ZP), proposed parameters II and III, entropy and tumor volume (p < 0.001), dissimilarity, high intensity emphasis (HIE), and SUVmin(p < 0.01). Lower statistical differences were observed for proposed parameter I (p = 0.02), and no significant differences were observed for SUVmaxand SUVmean. Furthermore, the Spearman rank analysis between visual tumor labeling and TF analysis depicted a significant correlation for SZV, IV, entropy, parameters II and III, and tumor volume (0.68 ≤ ρ ≤ 0.84) and moderate correlation for ZP, HIE, homogeneity, dissimilarity, parameter I, and SUVmin(0.22 ≤ ρ ≤ 0.52), while no correlations were observed for SUVmaxand SUVmean(ρ < 0.08). The multi-linear regression model for automated tumor labeling process resulted in R2and RMSE values of 0.93 and 0.14, respectively (p < 0.001), and generated tumor labeling sensitivity and specificity of 0.93 and 0.89. With respect to baseline random walk segmentation, the results showed significant (p < 0.001) mean DSC, HD, and SUVmeanerror improvements of 21.4 ± 11.5 %, 1.4 ± 0.8 mm, and 16.8 ± 8.1 % in homogeneous tumors and 7.4 ± 4.4 %, 1.5 ± 0.6 mm, and 7.9 ± 2.7 % in heterogeneous lesions. In addition, significant (p < 0.001) mean DSC, HD, and SUVmeanerror improvements were observed for tumor sub-volume delineations, namely 5 ± 2 %, 1.5 ± 0.6 mm, and 7 ± 3 % for the proposed Fuzzy RW method compared to RW segmentation.
  
  
  
  We proposed and demonstrated an automatic framework for significantly improved segmentation and labeling of homogeneous vs. heterogeneous tumors in lung [18F]FDG-PET images.
authors: Department of Radiation Medicine Engineering, Shahid Beheshti University, Tehran, Iran.
authors: Motahare
authors: M
authors: Soufi
authors: Department of Radiation Medicine Engineering, Shahid Beheshti University, Tehran, Iran. a_r_kamali@yahoo.com.
authors: Alireza
authors: A
authors: Kamali-Asl
authors: Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors: Parham
authors: P
authors: Geramifar
authors: Department of Radiology, Johns Hopkins University, Baltimore, MD, USA. arahmim1@jhmi.edu.|Department of Electrical & Computer Engineering, Johns Hopkins University, Baltimore, MD, USA. arahmim1@jhmi.edu.
authors: Arman
authors: 0000-0002-9980-2403
authors: A
authors: Rahmim
mesh_terms: D000465:Algorithms; D001331:Automation; D019788:Fluorodeoxyglucose F18 / Q000737:chemistry*; D017143:Fuzzy Logic; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016014:Linear Models; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography; D013194:Staining and Labeling
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Automated PET image segmentation; Fuzzy logic; Heterogeneous tumor delineation; Random walk