Fine-UNETR for PSMA PET/CT Lesion Segmentation: Automated Tumor Quantification and Overall Survival Stratification in Prostate Cancer

Introduction: To develop and evaluate Fine-UNETR, a Vision Transformer-based architecture for automated segmentation of PSMA-avid lesions on whole-body PET/CT, and to assess clinical utility of AI-derived tumor burden biomarkers for overall survival stratification in radioligand therapy. Methods: In this retrospective study, 373 PSMA PET/CT scans (mean age, 71+-8 years) from patients with prostate cancer were analyzed. Fine-UNETR, a modified UNETR with 8x8x8 voxel patch embedding and axial sliding window training, was trained on 299 scans and validated on 74 scans. Overall survival stratification was assessed in an independent cohort of 67 pre-radioligand therapy patients using Kaplan-Meier analysis and log-rank testing. External validation was performed on 192 cases from the AutoPET IV PSMA PET/CT dataset. Results: Fine-UNETR achieved a Dice similarity coefficient (DSC) of 66.63%, sensitivity of 70.27%, precision of 67.77%, and a lesion detection rate of 79.53% (96.05% for lesions with SUVmax >= 5). On the external validation dataset, the model achieved a DSC of 44.11% and a lesion detection rate of 87.18%, indicating that lesion detection performance was preserved despite reduced voxel-level overlap. AI-derived biomarkers showed excellent agreement with ground truth (total tumor volume: r=0.984; total lesion uptake: r=0.989; lesion count: r=0.960). In the clinical cohort, total tumor volume (p=0.0019), SUVmax (p=0.014), and SUVmean (p=0.016) significantly stratified overall survival. Conclusion: Fine-UNETR enables accurate automated whole-body PSMA lesion segmentation and tumor burden quantification. Performance on an external dataset demonstrates robustness despite evidence of domain shift. AI-derived biomarkers significantly stratified overall survival in a pre-radioligand therapy cohort, supporting the clinical utility of automated PSMA PET/CT quantification for prognostication.

Normalized Blood Flow Index in Optical Coherence Tomography Angiography Provides a Sensitive Biomarker of Early Diabetic Retinopathy

Purpose: To evaluate the sensitivity of normalized blood flow index (NBFI) for detecting early diabetic retinopathy (DR). Methods: Optical coherence tomography angiography (OCTA) images of 30 eyes from 20 healthy controls, 21 eyes of diabetic patients with no DR (NoDR) and 26 eyes from 22 patients with mild non-proliferative DR (NPDR) were analyzed in this study. The OCTA images were centered on the fovea and covered a 6 mm x 6 mm area. Enface projections of the superficial vascular plexus (SVP) and the deep capillary plexus (DCP) were obtained for the quantitative OCTA feature analysis. Three quantitative OCTA features were examined: blood vessel density (BVD), blood flow flux (BFF), and normalized blood flow index (NBFI). Each feature was calculated from both the SVP and DCP and their sensitivity to distinguish the three cohorts of the study were evaluated. Results: The only quantitative feature that was capable of distinguishing between all three cohorts was NBFI in the DCP image. Comparative study revealed that both BVD and BFF were able to distinguish the controls from NoDR and mild NPDR. However, neither BVD nor BFF was sensitive enough to separate NoDR from the healthy controls. Conclusion: The NBFI has been demonstrated as a sensitive biomarker of early DR, revealing retinal blood flow abnormality better than traditional BVD and BFF. The NBFI in the DCP was verified as the most sensitive biomarker, supporting that diabetes affects the DCP earlier than SVP in DR.