Evaluating a Machine Learning Tool for the Classification of Pathological Uptake in Whole-Body PSMA-PET-CT Scans

The importance of machine learning (ML) in the clinical environment increases constantly. Differentiation of pathological from physiological tracer-uptake in positron emission tomography/computed tomography (PET/CT) images is considered time-consuming and attention intensive, hence crucial for diagnosis and treatment planning. This study aimed at comparing and validating supervised ML algorithms to classify pathological uptake in prostate cancer (PC) patients based on prostate-specific membrane antigen (PSMA)-PET/CT. Retrospective analysis of (68)Ga-PSMA-PET/CTs of 72 PC patients resulted in a total of 77 radiomics features from 2452 manually delineated hotspots for training and labeled pathological (1629) or physiological (823) as ground truth (GT). As the held-out test dataset, 331 hotspots (path.:128, phys.: 203) were delineated in 15 other patients. Three ML classifiers were trained and ranked to assess classification performance. As a result, a high overall average performance (area under the curve (AUC) of 0.98) was achieved, especially to detect pathological uptake (0.97 mean sensitivity). However, there is still room for improvement to detect physiological uptake (0.82 mean specificity), especially for glands. The ML algorithm applied to manually delineated lesions predicts hotspot labels with high accuracy on unseen data and may be an important tool to assist in clinical diagnosis.