Comprehensive Evaluation of Quantitative Measurements from Automated Deep Segmentations of PSMA PET/CT Images

This study performs a comprehensive evaluation of quantitative measurements as extracted from automated deep-learning-based segmentation methods, beyond traditional Dice Similarity Coefficient assessments, focusing on six quantitative metrics, namely SUVmax, SUVmean, total lesion activity (TLA), tumor volume (TMTV), lesion count, and lesion spread. We analyzed 380 prostate-specific membrane antigen (PSMA) targeted [18F]DCFPyL PET/CT scans of patients with biochemical recurrence of prostate cancer, training deep neural networks, U-Net, Attention U-Net and SegResNet with four loss functions: Dice Loss, Dice Cross Entropy, Dice Focal Loss, and our proposed L1 weighted Dice Focal Loss (L1DFL). Evaluations indicated that Attention U-Net paired with L1DFL achieved the strongest correlation with the ground truth (concordance correlation = 0.90-0.99 for SUVmax and TLA), whereas models employing the Dice Loss and the other two compound losses, particularly with SegResNet, underperformed. Equivalence testing (TOST, alpha = 0.05, Delta = 20%) confirmed high performance for SUV metrics, lesion count and TLA, with L1DFL yielding the best performance. By contrast, tumor volume and lesion spread exhibited greater variability. Bland-Altman, Coverage Probability, and Total Deviation Index analyses further highlighted that our proposed L1DFL minimizes variability in quantification of the ground truth clinical measures. The code is publicly available at: https://github.com/ObedDzik/pca\_segment.git.

How To Segment in 3D Using 2D Models: Automated 3D Segmentation of Prostate Cancer Metastatic Lesions on PET Volumes Using Multi-Angle Maximum Intensity Projections and Diffusion Models

Prostate specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) imaging provides a tremendously exciting frontier in visualization of prostate cancer (PCa) metastatic lesions. However, accurate segmentation of metastatic lesions is challenging due to low signal-to-noise ratios and variable sizes, shapes, and locations of the lesions. This study proposes a novel approach for automated segmentation of metastatic lesions in PSMA PET/CT 3D volumetric images using 2D denoising diffusion probabilistic models (DDPMs). Instead of 2D trans-axial slices or 3D volumes, the proposed approach segments the lesions on generated multi-angle maximum intensity projections (MA-MIPs) of the PSMA PET images, then obtains the final 3D segmentation masks from 3D ordered subset expectation maximization (OSEM) reconstruction of 2D MA-MIPs segmentations. Our proposed method achieved superior performance compared to state-of-the-art 3D segmentation approaches in terms of accuracy and robustness in detecting and segmenting small metastatic PCa lesions. The proposed method has significant potential as a tool for quantitative analysis of metastatic burden in PCa patients.

Observer study-based evaluation of TGAN architecture used to generate oncological PET images

The application of computer-vision algorithms in medical imaging has increased rapidly in recent years. However, algorithm training is challenging due to limited sample sizes, lack of labeled samples, as well as privacy concerns regarding data sharing. To address these issues, we previously developed (Bergen et al. 2022) a synthetic PET dataset for Head and Neck (H and N) cancer using the temporal generative adversarial network (TGAN) architecture and evaluated its performance segmenting lesions and identifying radiomics features in synthesized images. In this work, a two-alternative forced-choice (2AFC) observer study was performed to quantitatively evaluate the ability of human observers to distinguish between real and synthesized oncological PET images. In the study eight trained readers, including two board-certified nuclear medicine physicians, read 170 real/synthetic image pairs presented as 2D-transaxial using a dedicated web app. For each image pair, the observer was asked to identify the real image and input their confidence level with a 5-point Likert scale. P-values were computed using the binomial test and Wilcoxon signed-rank test. A heat map was used to compare the response accuracy distribution for the signed-rank test. Response accuracy for all observers ranged from 36.2% [27.9-44.4] to 63.1% [54.8-71.3]. Six out of eight observers did not identify the real image with statistical significance, indicating that the synthetic dataset was reasonably representative of oncological PET images. Overall, this study adds validity to the realism of our simulated H&N cancer dataset, which may be implemented in the future to train AI algorithms while favoring patient confidentiality and privacy protection.