Cédric Draulans1,2, Robin De Roover3,4, Uulke A van der Heide5, Linda Kerkmeijer6,7, Robert J Smeenk6, Floris Pos5, Wouter V Vogel8, James Nagarajah9, Marcel Janssen9, Sofie Isebaert3,4, Frederik Maes10,11, Cindy Mai12, Raymond Oyen12, Steven Joniau13,14, Martina Kunze-Busch6, Karolien Goffin15, Karin Haustermans16,17. 1. Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium. cedric.draulans@uzleuven.be. 2. Department of Oncology, KU Leuven, Leuven, Belgium. cedric.draulans@uzleuven.be. 3. Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium. 4. Department of Oncology, KU Leuven, Leuven, Belgium. 5. Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 6. Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands. 7. Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands. 8. Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 9. Department of Radiology & Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands. 10. Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium. 11. Medical Imaging Research Centre, University Hospitals Leuven, Leuven, Belgium. 12. Department of Radiology, University Hospitals Leuven, Leuven, Belgium. 13. Department of Urology, University Hospitals Leuven, Leuven, Belgium. 14. Department of Development and Regeneration, KU Leuven, Leuven, Belgium. 15. Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium. 16. Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium. karin.haustermans@uzleuven.be. 17. Department of Oncology, KU Leuven, Leuven, Belgium. karin.haustermans@uzleuven.be.
Abstract
PURPOSE: This study proposes optimal tracer-specific threshold-based window levels for PSMA PET-based intraprostatic gross tumour volume (GTV) contouring to reduce interobserver delineation variability. METHODS: Nine 68Ga-PSMA-11 and nine 18F-PSMA-1007 PET scans including GTV delineations of four expert teams (GTVmanual) and a majority-voted GTV (GTVmajority) were assessed with respect to a registered histopathological GTV (GTVhisto) as the gold standard reference. The standard uptake values (SUVs) per voxel were converted to a percentage (SUV%) relative to the SUVmax. The statistically optimised SUV% threshold (SOST) was defined as those that maximises accuracy for threshold-based contouring. A leave-one-out cross-validation receiver operating characteristic (ROC) curve analysis was performed to determine the SOST for each tracer. The SOST analysis was performed twice, first using the GTVhisto contour as training structure (GTVSOST-H) and second using the GTVmajority contour as training structure (GTVSOST-MA) to correct for any limited misregistration. The accuracy of both GTVSOST-H and GTVSOST-MA was calculated relative to GTVhisto in the 'leave-one-out' patient of each fold and compared with the accuracy of GTVmanual. RESULTS: ROC curve analysis for 68Ga-PSMA-11 PET revealed a median threshold of 25 SUV% (range, 22-27 SUV%) and 41 SUV% (40-43 SUV%) for GTVSOST-H and GTVSOST-MA, respectively. For 18F-PSMA-1007 PET, a median threshold of 42 SUV% (39-45 SUV%) for GTVSOST-H and 44 SUV% (42-45 SUV%) for GTVSOST-MA was found. A significant pairwise difference was observed when comparing the accuracy of the GTVSOST-H contours with the median accuracy of the GTVmanual contours (median, - 2.5%; IQR, - 26.5-0.2%; p = 0.020), whereas no significant pairwise difference was found for the GTVSOST-MA contours (median, - 0.3%; IQR, - 4.4-0.6%; p = 0.199). CONCLUSIONS: Threshold-based contouring using GTVmajority-trained SOSTs achieves an accuracy comparable with manual contours in delineating GTVhisto. The median SOSTs of 41 SUV% for 68Ga-PSMA-11 PET and 44 SUV% for 18F-PSMA-1007 PET form a base for tracer-specific window levelling. TRIAL REGISTRATION: Clinicaltrials.gov ; NCT03327675; 31-10-2017.
PURPOSE: This study proposes optimal tracer-specific threshold-based window levels for PSMA PET-based intraprostatic gross tumour volume (GTV) contouring to reduce interobserver delineation variability. METHODS: Nine 68Ga-PSMA-11 and nine 18F-PSMA-1007 PET scans including GTV delineations of four expert teams (GTVmanual) and a majority-voted GTV (GTVmajority) were assessed with respect to a registered histopathological GTV (GTVhisto) as the gold standard reference. The standard uptake values (SUVs) per voxel were converted to a percentage (SUV%) relative to the SUVmax. The statistically optimised SUV% threshold (SOST) was defined as those that maximises accuracy for threshold-based contouring. A leave-one-out cross-validation receiver operating characteristic (ROC) curve analysis was performed to determine the SOST for each tracer. The SOST analysis was performed twice, first using the GTVhisto contour as training structure (GTVSOST-H) and second using the GTVmajority contour as training structure (GTVSOST-MA) to correct for any limited misregistration. The accuracy of both GTVSOST-H and GTVSOST-MA was calculated relative to GTVhisto in the 'leave-one-out' patient of each fold and compared with the accuracy of GTVmanual. RESULTS: ROC curve analysis for 68Ga-PSMA-11 PET revealed a median threshold of 25 SUV% (range, 22-27 SUV%) and 41 SUV% (40-43 SUV%) for GTVSOST-H and GTVSOST-MA, respectively. For 18F-PSMA-1007 PET, a median threshold of 42 SUV% (39-45 SUV%) for GTVSOST-H and 44 SUV% (42-45 SUV%) for GTVSOST-MA was found. A significant pairwise difference was observed when comparing the accuracy of the GTVSOST-H contours with the median accuracy of the GTVmanual contours (median, - 2.5%; IQR, - 26.5-0.2%; p = 0.020), whereas no significant pairwise difference was found for the GTVSOST-MA contours (median, - 0.3%; IQR, - 4.4-0.6%; p = 0.199). CONCLUSIONS: Threshold-based contouring using GTVmajority-trained SOSTs achieves an accuracy comparable with manual contours in delineating GTVhisto. The median SOSTs of 41 SUV% for 68Ga-PSMA-11 PET and 44 SUV% for 18F-PSMA-1007 PET form a base for tracer-specific window levelling. TRIAL REGISTRATION: Clinicaltrials.gov ; NCT03327675; 31-10-2017.
Authors: Peter Steenbergen; Karin Haustermans; Evelyne Lerut; Raymond Oyen; Liesbeth De Wever; Laura Van den Bergh; Linda G W Kerkmeijer; Frank A Pameijer; Wouter B Veldhuis; Jochem R N van der Voort van Zyp; Floris J Pos; Stijn W Heijmink; Robin Kalisvaart; Hendrik J Teertstra; Cuong V Dinh; Ghazaleh Ghobadi; Uulke A van der Heide Journal: Radiother Oncol Date: 2015-04-29 Impact factor: 6.280
Authors: Kambiz Rahbar; Ali Afshar-Oromieh; Martin Bögemann; Stefan Wagner; Michael Schäfers; Lars Stegger; Matthias Weckesser Journal: Eur J Nucl Med Mol Imaging Date: 2018-03-14 Impact factor: 9.236
Authors: Alisa S Bettermann; Constantinos Zamboglou; Selina Kiefer; Cordula A Jilg; Simon Spohn; Jasmin Kranz-Rudolph; Thomas F Fassbender; Peter Bronsert; Nils H Nicolay; Christian Gratzke; Michael Bock; Juri Ruf; Matthias Benndorf; Anca L Grosu Journal: Radiother Oncol Date: 2019-08-17 Impact factor: 6.280
Authors: Constantinos Zamboglou; Thomas F Fassbender; Lina Steffan; Florian Schiller; Tobias Fechter; Montserrat Carles; Selina Kiefer; Hans C Rischke; Kathrin Reichel; Nina-Sophie Schmidt-Hegemann; Harun Ilhan; Alin F Chirindel; Guillaume Nicolas; Christoph Henkenberens; Thorsten Derlin; Peter Bronsert; Panayiotis Mavroidis; Ronald C Chen; Philipp T Meyer; Juri Ruf; Anca L Grosu Journal: Radiother Oncol Date: 2019-08-17 Impact factor: 6.280
Authors: Patrick A Kupelian; Jay Ciezki; Chandana A Reddy; Eric A Klein; Arul Mahadevan Journal: Int J Radiat Oncol Biol Phys Date: 2007-11-08 Impact factor: 7.038
Authors: Freddie Bray; Jacques Ferlay; Isabelle Soerjomataram; Rebecca L Siegel; Lindsey A Torre; Ahmedin Jemal Journal: CA Cancer J Clin Date: 2018-09-12 Impact factor: 508.702
Authors: Irene M Lips; Uulke A van der Heide; Karin Haustermans; Emile N J T van Lin; Floris Pos; Stefan P G Franken; Alexis N T J Kotte; Carla H van Gils; Marco van Vulpen Journal: Trials Date: 2011-12-05 Impact factor: 2.279
Authors: Isabel Rauscher; Markus Krönke; Michael König; Andrei Gafita; Tobias Maurer; Thomas Horn; Kilian Schiller; Wolfgang Weber; Matthias Eiber Journal: J Nucl Med Date: 2019-06-28 Impact factor: 11.082
Authors: Frederik L Giesel; B Hadaschik; J Cardinale; J Radtke; M Vinsensia; W Lehnert; C Kesch; Y Tolstov; S Singer; N Grabe; S Duensing; M Schäfer; O C Neels; W Mier; U Haberkorn; K Kopka; C Kratochwil Journal: Eur J Nucl Med Mol Imaging Date: 2016-11-26 Impact factor: 9.236
Authors: David P Dearnaley; Gordana Jovic; Isabel Syndikus; Vincent Khoo; Richard A Cowan; John D Graham; Edwin G Aird; David Bottomley; Robert A Huddart; Chakiath C Jose; John H L Matthews; Jeremy L Millar; Claire Murphy; J Martin Russell; Christopher D Scrase; Mahesh K B Parmar; Matthew R Sydes Journal: Lancet Oncol Date: 2014-02-26 Impact factor: 41.316
Authors: Sebastian Zschaeck; Stephanie Bela Andela; Holger Amthauer; Christian Furth; Julian M Rogasch; Marcus Beck; Frank Hofheinz; Kai Huang Journal: Front Oncol Date: 2022-04-22 Impact factor: 5.738
Authors: Mathieu Gaudreault; David Chang; Nicholas Hardcastle; Price Jackson; Tomas Kron; Michael S Hofman; Shankar Siva Journal: Clin Transl Radiat Oncol Date: 2022-05-17
Authors: Simon K B Spohn; Maria Kramer; Selina Kiefer; Peter Bronsert; August Sigle; Wolfgang Schultze-Seemann; Cordula A Jilg; Tanja Sprave; Lara Ceci; Thomas F Fassbender; Nils H Nicolay; Juri Ruf; Anca L Grosu; Constantinos Zamboglou Journal: Front Oncol Date: 2020-12-07 Impact factor: 6.244
Authors: S K B Spohn; S Adebahr; M Huber; C Jenkner; R Wiehle; B Nagavci; C Schmucker; E G Carl; R C Chen; W A Weber; M Mix; A Rühle; T Sprave; N H Nicolay; C Gratzke; M Benndorf; T Wiegel; J Weis; D Baltas; A L Grosu; C Zamboglou Journal: BMC Cancer Date: 2022-03-28 Impact factor: 4.430
Authors: Lena M Mittlmeier; Matthias Brendel; Leonie Beyer; Nathalie L Albert; Andrei Todica; Mathias J Zacherl; Vera Wenter; Annika Herlemann; Alexander Kretschmer; Stephan T Ledderose; Nina-Sophie Schmidt-Hegemann; Wolfgang G Kunz; Jens Ricke; Peter Bartenstein; Harun Ilhan; Marcus Unterrainer Journal: Front Oncol Date: 2021-05-21 Impact factor: 6.244
Authors: Simon K B Spohn; Ilias Sachpazidis; Rolf Wiehle; Benedikt Thomann; August Sigle; Peter Bronsert; Juri Ruf; Matthias Benndorf; Nils H Nicolay; Tanja Sprave; Anca L Grosu; Dimos Baltas; Constantinos Zamboglou Journal: Front Oncol Date: 2021-05-14 Impact factor: 6.244
Authors: Paola Mapelli; Samuele Ghezzo; Ana Maria Samanes Gajate; Erik Preza; Anna Palmisano; Vito Cucchiara; Giorgio Brembilla; Carolina Bezzi; Riccardo Rigamonti; Patrizia Magnani; Elisa Toninelli; Valentino Bettinardi; Nazareno Suardi; Luigi Gianolli; Paola Scifo; Alberto Briganti; Francesco De Cobelli; Antonio Esposito; Maria Picchio Journal: Cancers (Basel) Date: 2022-01-11 Impact factor: 6.639