Simon K. B. Spohn

Shrajan Bhandary, Dejan Kuhn, Zahra Babaiee et al.

Accurate segmentation of prostate tumours from PET images presents a formidable challenge in medical image analysis. Despite considerable work and improvement in delineating organs from CT and MR modalities, the existing standards do not transfer well and produce quality results in PET related tasks. Particularly, contemporary methods fail to accurately consider the intensity-based scaling applied by the physicians during manual annotation of tumour contours. In this paper, we observe that the prostate-localised uptake threshold ranges are beneficial for suppressing outliers. Therefore, we utilize the intensity threshold values, to implement a new custom-feature-clipping normalisation technique. We evaluate multiple, established U-Net variants under different normalisation schemes, using the nnU-Net framework. All models were trained and tested on multiple datasets, obtained with two radioactive tracers: [68-Ga]Ga-PSMA-11 and [18-F]PSMA-1007. Our results show that the U-Net models achieve much better performance when the PET scans are preprocessed with our novel clipping technique.

Dejan Kostyszyn, Tobias Fechter, Nico Bartl et al.

Accurate delineation of the intraprostatic gross tumour volume (GTV) is a prerequisite for treatment approaches in patients with primary prostate cancer (PCa). Prostate-specific membrane antigen positron emission tomography (PSMA-PET) may outperform MRI in GTV detection. However, visual GTV delineation underlies interobserver heterogeneity and is time consuming. The aim of this study was to develop a convolutional neural network (CNN) for automated segmentation of intraprostatic tumour (GTV-CNN) in PSMA-PET. Methods: The CNN (3D U-Net) was trained on [68Ga]PSMA-PET images of 152 patients from two different institutions and the training labels were generated manually using a validated technique. The CNN was tested on two independent internal (cohort 1: [68Ga]PSMA-PET, n=18 and cohort 2: [18F]PSMA-PET, n=19) and one external (cohort 3: [68Ga]PSMA-PET, n=20) test-datasets. Accordance between manual contours and GTV-CNN was assessed with Dice-Sørensen coefficient (DSC). Sensitivity and specificity were calculated for the two internal test-datasets by using whole-mount histology. Results: Median DSCs for cohorts 1-3 were 0.84 (range: 0.32-0.95), 0.81 (range: 0.28-0.93) and 0.83 (range: 0.32-0.93), respectively. Sensitivities and specificities for GTV-CNN were comparable with manual expert contours: 0.98 and 0.76 (cohort 1) and 1 and 0.57 (cohort 2), respectively. Computation time was around 6 seconds for a standard dataset. Conclusion: The application of a CNN for automated contouring of intraprostatic GTV in [68Ga]PSMA- and [18F]PSMA-PET images resulted in a high concordance with expert contours and in high sensitivities and specificities in comparison with histology reference. This robust, accurate and fast technique may be implemented for treatment concepts in primary PCa. The trained model and the study's source code are available in an open source repository.