Clinically feasible semi-automatic workflows for measuring metabolically active tumour volume in metastatic melanoma
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ORIGINAL ARTICLE
Clinically feasible semi-automatic workflows for measuring metabolically active tumour volume in metastatic melanoma Joyce van Sluis 1 & Ellen C. de Heer 2 Ronald Boellaard 1,3
&
Mayke Boellaard 1 & Mathilde Jalving 2 & Adrienne H. Brouwers 1 &
Received: 25 May 2020 / Accepted: 12 October 2020 # The Author(s) 2020
Abstract Purpose Metabolically active tumour volume (MATV) is a potential quantitative positron emission tomography (PET) imaging biomarker in melanoma. Accumulating data indicate that low MATV may predict increased chance of response to immunotherapy and overall survival. However, metastatic melanoma can present with numerous (small) tumour lesions, making manual tumour segmentation time-consuming. The aim of this study was to evaluate multiple semi-automatic segmentation workflows to determine reliability and reproducibility of MATV measurements in patients with metastatic melanoma. Methods An existing cohort of 64 adult patients with histologically proven metastatic melanoma was used in this study. 18F-FDG PET/CT diagnostic baseline images were acquired using a European Association of Nuclear Medicine (EANM) Research Limited–accredited Siemens Biograph mCT PET/CT system (Siemens Healthineers, Knoxville, USA). PET data were analysed using manual, gradient-based segmentation and five different semi-automatic methods: three direct PET image–derived delineations (41MAX, A50P and SUV40) and two based on a majority-vote approach (MV2 and MV3), without and with (suffix ‘+’) manual lesion addition. Correlation between the different segmentation methods and their respective associations with overall survival was assessed. Results Correlation between the MATVs derived by the manual segmentation and semi-automated tumour segmentations ranged from R2 = 0.41 for A50P to R2 = 0.85 for SUV40+ and MV2+, respectively. Manual MATV segmentation did not differ significantly from the semi-automatic methods SUV40 (ΔMATV mean ± SD 0.08 ± 0.60 mL, P = 0.303), SUV40+ (ΔMATV − 0.10 ± 0.51 mL, P = 0.126), MV2+ (ΔMATV − 0.09 ± 0.62 mL, P = 0.252) and MV3+ (ΔMATV − 0.03 ± 0.55 mL, P = 0.615). Log-rank tests showed statistically significant overall survival differences between above and below median MATV patients for all segmentation methods with areas under the ROC curves of 0.806 for manual segmentation and between 0.756 [41MAX] and 0.807 [MV3+] for semi-automatic segmentations. Conclusions Simple and fast semi-automated FDG PET segmentation workflows yield accurate and reproducible MATV measurements that correlate well with manual segmentation in metastatic melanoma. The most readily applicable and user-friendly SUV40 method allows feasible MATV measurement in prospective multicentre studies required for validation of this potential PET imaging biomarker for clinical use. Keywords MATV . Quantification . Melanoma . Segmentation . FDG PET/CT This article is part of the Topical Collection on Technology Joyce van Sluis and Ellen C. de Heer are co-first authors. Electronic supplementary material The online vers
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