The most rigorous comparative study of PET segmentation algorithms to date was carried out using a dataset that is the largest used in such studies so far. The hierarchy amongst the methods in terms of accuracy did not depend strongly on the subset of datasets or the metrics (or combination of metrics). All the methods submitted by the challengers except one demonstrated good performance with median accuracy scores above 0.8.

Automatic tumor segmentation from medical images is an important step for computer-aided cancer diagnosis and treatment. Recently, deep learning has been successfully applied to this task, leading to state-of-the-art performance. However, most of existing deep learning segmentation methods only work for a single imaging modality. PET/CT scanner is nowadays widely used in the clinic, and is able to provide both metabolic information and anatomical information through integrating PET and CT into the same utility. In this study, we proposed a novel multi-modality segmentation method based on a 3D fully convolutional neural network (FCN), which is capable of taking account of both PET and CT information simultaneously for tumor segmentation. The network started with a multi-task training module, in which two parallel sub-segmentation architectures constructed using deep convolutional neural networks (CNNs) were designed to automatically extract feature maps from PET and CT respectively. A feature fusion module was subsequently designed based on cascaded convolutional blocks, which re-extracted features from PET/CT feature maps using a weighted cross entropy minimization strategy. The tumor mask was obtained as the output at the end of the network using a softmax function. The effectiveness of the proposed method was validated on a clinic PET/CT dataset of 84 patients with lung cancer. The results demonstrated that the proposed network was effective, fast and robust and achieved significantly performance gain over CNN-based methods and traditional methods using PET or CT only, two V-net based co-segmentation methods, two variational co-segmentation methods based on fuzzy set theory and a deep learning co-segmentation method using W-net.

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Accurate tumor segmentation in PET is crucial in many oncology applications. We developed an adaptive region-growing (ARG) algorithm with a maximum curvature strategy (ARG_MC) for tumor segmentation in PET. The ARG_MC repeatedly applied a confidence connected region-growing (CCRG) algorithm with increasing relaxing factor f. The optimal relaxing factor (ORF) was then determined at the transition point on the f-volume curve, where the volume just grew from the tumor into the surrounding normal tissues. The ARG_MC along with five widely used algorithms were tested on a phantom with 6 spheres at different signal to background ratios and on two clinic datasets including 20 patients with esophageal cancer and 11 patients with non-Hodgkin lymphoma (NHL). The ARG_MC did not require any phantom calibration or any a priori knowledge of the tumor or PET scanner. The identified ORF varied with tumor types (mean ORF = 9.61, 3.78 and 2.55 respectively for the phantom, esophageal cancer, and NHL datasets), and varied from one tumor to another. For the phantom, the ARG_MC ranked the second in segmentation accuracy with an average Dice similarity index (DSI) of 0.86, only slightly worse than Daisne’s adaptive thresholding method (DSI=0.87), which required phantom calibration. For both the esophageal cancer dataset and the NHL dataset, the ARG_MC had the highest accuracy with an average DSI of 0.87 and 0.84, respectively. The ARG_MC was robust to parameter settings and region of interest selection, and it did not depend on scanners, imaging protocols, or tumor types. Furthermore, the ARG_MC made no assumption about the tumor size or tumor uptake distribution, making it suitable for segmenting tumors with heterogeneous FDG uptake. In conclusion, the ARG_MC was accurate, robust and easy to use, it provides a highly potential tool for PET tumor segmentation in clinic.