Definition of Tumor Volume Based on 18F-Fludeoxyglucose Positron Emission Tomography in Radiation Therapy for Liver Metastases: An Relational Analysis Study between Image Parameters and Image Segmentation Methods

Heejin Kim; Seungwoo Park; Haijo Jung; Mi-Sook Kim; Hyung Jun Yoo; Young Hoon Ji; Chul-Young Yi; Kum Bae Kim

doi:10.14316/pmp.2013.24.2.99

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Kim, Park, Jung, Kim, Yoo, Ji, Yi, and Kim: Definition of Tumor Volume Based on 18F-Fludeoxyglucose Positron Emission Tomography in Radiation Therapy for Liver Metastases: An Relational Analysis Study between Image Parameters and Image Segmentation Methods

Original Article

Progress in Medical Physics 2013;24(2):99-107.

Published online: 17 June 2013

DOI: https://doi.org/10.14316/pmp.2013.24.2.99

Definition of Tumor Volume Based on 18F-Fludeoxyglucose Positron Emission Tomography in Radiation Therapy for Liver Metastases: An Relational Analysis Study between Image Parameters and Image Segmentation Methods

Heejin Kim^∗,^†, Seungwoo Park^†, Haijo Jung^∗,^†, Mi-Sook Kim^∗,^†, Hyung Jun Yoo^†, Young Hoon Ji^∗,^†, Chul-Young Yi^†, Kum Bae Kim^∗,^‡

^∗Radiological Cancer Medicine, University of Science and Technology, Daejeon, Korea

^†Research Center for Radiotherapy, Korea Institute of Radiological and Medical Sciences, Seoul, Korea

^‡Division of Metrology for Quality of Life, Korea Research Institute of Standards and Science, Daejeon, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The surgical resection was occurred mainly in liver metastasis before the development of radiation therapy techniques. Recently, Radiation therapy is increased gradually due to the development of radiation dose delivery techniques. 18F-FDG PET image showed better sensitivity and specificity in liver metastasis detection. This image modality is important in the radiation treatment with planning CT for tumor delineation. In this study, we applied automatic image segmentation methods on PET image of liver metastasis and examined the impact of image factors on these methods. We selected the patients who were received the radiation therapy and 18F-FDG PET/CT in Korea Cancer Center Hospital from 2009 to 2012. Then, three kinds of image segmentation methods had been applied; The relative threshold method, the Gradient method and the region growing method. Based on these results, we performed statistical analysis in two directions. 1. comparison of GTV and image segmentation results. 2. performance of regression analysis for relation between image factor affecting image segmentation techniques. The mean volume of GTV was 60.9±65.9 cc and the GTV_40% was 22.43±35.27 cc, and the GTV_50% was 10.11±17.92 cc, the GTV_RG was 32.89±36.84 cc, the GTV_GD was 30.34±35.77 cc, respectively. The most similar segmentation method with the GTV result was the region growing method. For the quantitative analysis of the image factors which influenced on the region growing method, we used the standardized coefficient β, factors affecting the region growing method show GTV, TumorSUV_MAX/MIN, SUV_max, TBR in order. The result of the region growing (automatic segmentation) method showed the most similar result with the CT based GTV and the region growing method was affected by image factors. If we define the tumor volume by the auto image segmentation method which reflect the PET image parameters, more accurate and consistent tumor contouring can be done. And we can irradiate the optimized radiation dose to the cancer, ultimately.

Keywords: Automatic image segmentation, 18F-FDG PET/CT, Liver metastases, Radiation treatment therapy

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Fig. 1.

Applying automatic image segmentation in PET image. (a) CT based GTV, (b) relative threshold method (40%), (c) relative threshold method (50%), (d) gradient method, and (e) region growing method.

Fig. 2.

Flow chart for tumor delineation and statistical analysis using image segmentation methods.

Fig. 3.

Comparison of mean tumor volumes. GTV range is 3.2 cc∼106.0 cc and mean volume is 60.9±65.9 cc, mean volume of GTV_40%, GTV_50%, GTV_RG and GTV_GD is 22.4±35.3 cc, 10.1±17.9 cc, 32.9±36.8 cc, and 30.3±35.8 cc respectively.

Fig. 4.

Correlation between GTV-GTV_RG and image parameter. each graph means regression analysis results; (a) GTV, (b) TumorSUV_MAX/MIN, (c) SUV_MAX, (d) Tumor-Background Ratio.

Table 1.

Patients's characteristics.

Characteristics of patients
Age (year)
Mean, range	64.8 (51∼79)
Sex
Men	10
Women	3
Type of primary tumor
Colon	7
Rectal	1
Gastric	1
Cholangiocarcinoma	4
Treatment intent
Definitive	5
Palliative	8
PET image aquisition time (min)	65 (58∼100)
Mean, range
Reconstruction method	OSEM 2D 2i8s

Table 2.

Results of automatic image segmentations. CT based GTV is reference volume, and volume of region growing is best fitness in GTV.

Patients	GTV (cc)	GTV_40% (cc)	GTV_50% (cc)	GTV_RG (cc)	GTV_GD (cc)	GTV-GTV_RG (cc)
1	12.3	4.2	5.6	12.4	10.2	−0.1
2	4.0	8.9	3.9	3.9	3.1	−2.7
3	6.3	2.8	1.0	7.0	0.2	3.0
4	62.6	27.0	4.8	61.3	58.7	1.3
5	3.2	7.0	2.7	12.1	12.7	−8.9
6	36.6	2.7	-	17.3	16.0	19.3
7	136.7	-	-	24.8	25.1	111.9
8	129.9	30.8	2.7	63.8	60.5	66.1
9	120.0	35.0	9.4	60.7	61.9	59.2
10	9.2	0.2	-	10.6	4.7	−1.5
11	206.0	128.0	61.0	130.5	121.9	75.5
12	23.5	9.3	4.3	4.1	0.8	19.4
13	41.0	13.3	5.9	20.1	18.8	20.9

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