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Accuracy of tumor segmentation from multi-parametric prostate MRI and (18)F-choline PET/CT for focal prostate cancer therapy applications

BACKGROUND: The study aims to assess the accuracy of multi-parametric prostate MRI (mpMRI) and (18)F-choline PET/CT in tumor segmentation for clinically significant prostate cancer. (18)F-choline PET/CT and 3 T mpMRI were performed in 10 prospective subjects prior to prostatectomy. All subjects had...

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Autores principales: Piert, Morand, Shankar, Prasad R., Montgomery, Jeffrey, Kunju, Lakshmi Priya, Rogers, Virginia, Siddiqui, Javed, Rajendiran, Thekkelnaycke, Hearn, Jason, George, Arvin, Shao, Xia, Davenport, Matthew S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869349/
https://www.ncbi.nlm.nih.gov/pubmed/29589155
http://dx.doi.org/10.1186/s13550-018-0377-5
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author Piert, Morand
Shankar, Prasad R.
Montgomery, Jeffrey
Kunju, Lakshmi Priya
Rogers, Virginia
Siddiqui, Javed
Rajendiran, Thekkelnaycke
Hearn, Jason
George, Arvin
Shao, Xia
Davenport, Matthew S.
author_facet Piert, Morand
Shankar, Prasad R.
Montgomery, Jeffrey
Kunju, Lakshmi Priya
Rogers, Virginia
Siddiqui, Javed
Rajendiran, Thekkelnaycke
Hearn, Jason
George, Arvin
Shao, Xia
Davenport, Matthew S.
author_sort Piert, Morand
collection PubMed
description BACKGROUND: The study aims to assess the accuracy of multi-parametric prostate MRI (mpMRI) and (18)F-choline PET/CT in tumor segmentation for clinically significant prostate cancer. (18)F-choline PET/CT and 3 T mpMRI were performed in 10 prospective subjects prior to prostatectomy. All subjects had a single biopsy-confirmed focus of Gleason ≥ 3+4 cancer. Two radiologists (readers 1 and 2) determined tumor boundaries based on in vivo mpMRI sequences, with clinical and pathologic data available. (18)F-choline PET data were co-registered to T2-weighted 3D sequences and a semi-automatic segmentation routine was used to define tumor volumes. Registration of whole-mount surgical pathology to in vivo imaging was conducted utilizing two ex vivo prostate specimen MRIs, followed by gross sectioning of the specimens within a custom-made 3D-printed plastic mold. Overlap and similarity coefficients of manual segmentations (seg1, seg2) and (18)F-choline-based segmented lesions (seg3) were compared to the pathologic reference standard. RESULTS: All segmentation methods greatly underestimated the true tumor volumes. Human readers (seg1, seg2) and the PET-based segmentation (seg3) underestimated an average of 79, 80, and 58% of the tumor volumes, respectively. Combining segmentation volumes (union of seg1, seg2, seg3 = seg4) decreased the mean underestimated tumor volume to 42% of the true tumor volume. When using the combined segmentation with 5 mm contour expansion, the mean underestimated tumor volume was significantly reduced to 0.03 ± 0.05 mL (2.04 ± 2.84%). Substantial safety margins up to 11–15 mm were needed to include all tumors when the initial segmentation boundaries were drawn by human readers or the semi-automated (18)F-choline segmentation tool. Combining MR-based human segmentations with the metabolic information based on (18)F-choline PET reduced the necessary safety margin to a maximum of 9 mm to cover all tumors entirely. CONCLUSIONS: To improve the outcome of focal therapies for significant prostate cancer, it is imperative to recognize the full extent of the underestimation of tumor volumes by mpMRI. Combining metabolic information from (18)F-choline with MRI-based segmentation can improve tumor coverage. However, this approach requires confirmation in further clinical studies.
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spelling pubmed-58693492018-03-30 Accuracy of tumor segmentation from multi-parametric prostate MRI and (18)F-choline PET/CT for focal prostate cancer therapy applications Piert, Morand Shankar, Prasad R. Montgomery, Jeffrey Kunju, Lakshmi Priya Rogers, Virginia Siddiqui, Javed Rajendiran, Thekkelnaycke Hearn, Jason George, Arvin Shao, Xia Davenport, Matthew S. EJNMMI Res Original Research BACKGROUND: The study aims to assess the accuracy of multi-parametric prostate MRI (mpMRI) and (18)F-choline PET/CT in tumor segmentation for clinically significant prostate cancer. (18)F-choline PET/CT and 3 T mpMRI were performed in 10 prospective subjects prior to prostatectomy. All subjects had a single biopsy-confirmed focus of Gleason ≥ 3+4 cancer. Two radiologists (readers 1 and 2) determined tumor boundaries based on in vivo mpMRI sequences, with clinical and pathologic data available. (18)F-choline PET data were co-registered to T2-weighted 3D sequences and a semi-automatic segmentation routine was used to define tumor volumes. Registration of whole-mount surgical pathology to in vivo imaging was conducted utilizing two ex vivo prostate specimen MRIs, followed by gross sectioning of the specimens within a custom-made 3D-printed plastic mold. Overlap and similarity coefficients of manual segmentations (seg1, seg2) and (18)F-choline-based segmented lesions (seg3) were compared to the pathologic reference standard. RESULTS: All segmentation methods greatly underestimated the true tumor volumes. Human readers (seg1, seg2) and the PET-based segmentation (seg3) underestimated an average of 79, 80, and 58% of the tumor volumes, respectively. Combining segmentation volumes (union of seg1, seg2, seg3 = seg4) decreased the mean underestimated tumor volume to 42% of the true tumor volume. When using the combined segmentation with 5 mm contour expansion, the mean underestimated tumor volume was significantly reduced to 0.03 ± 0.05 mL (2.04 ± 2.84%). Substantial safety margins up to 11–15 mm were needed to include all tumors when the initial segmentation boundaries were drawn by human readers or the semi-automated (18)F-choline segmentation tool. Combining MR-based human segmentations with the metabolic information based on (18)F-choline PET reduced the necessary safety margin to a maximum of 9 mm to cover all tumors entirely. CONCLUSIONS: To improve the outcome of focal therapies for significant prostate cancer, it is imperative to recognize the full extent of the underestimation of tumor volumes by mpMRI. Combining metabolic information from (18)F-choline with MRI-based segmentation can improve tumor coverage. However, this approach requires confirmation in further clinical studies. Springer Berlin Heidelberg 2018-03-27 /pmc/articles/PMC5869349/ /pubmed/29589155 http://dx.doi.org/10.1186/s13550-018-0377-5 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Research
Piert, Morand
Shankar, Prasad R.
Montgomery, Jeffrey
Kunju, Lakshmi Priya
Rogers, Virginia
Siddiqui, Javed
Rajendiran, Thekkelnaycke
Hearn, Jason
George, Arvin
Shao, Xia
Davenport, Matthew S.
Accuracy of tumor segmentation from multi-parametric prostate MRI and (18)F-choline PET/CT for focal prostate cancer therapy applications
title Accuracy of tumor segmentation from multi-parametric prostate MRI and (18)F-choline PET/CT for focal prostate cancer therapy applications
title_full Accuracy of tumor segmentation from multi-parametric prostate MRI and (18)F-choline PET/CT for focal prostate cancer therapy applications
title_fullStr Accuracy of tumor segmentation from multi-parametric prostate MRI and (18)F-choline PET/CT for focal prostate cancer therapy applications
title_full_unstemmed Accuracy of tumor segmentation from multi-parametric prostate MRI and (18)F-choline PET/CT for focal prostate cancer therapy applications
title_short Accuracy of tumor segmentation from multi-parametric prostate MRI and (18)F-choline PET/CT for focal prostate cancer therapy applications
title_sort accuracy of tumor segmentation from multi-parametric prostate mri and (18)f-choline pet/ct for focal prostate cancer therapy applications
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869349/
https://www.ncbi.nlm.nih.gov/pubmed/29589155
http://dx.doi.org/10.1186/s13550-018-0377-5
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