Rationale and Objectives
Quantitative measurement provides essential information about disease progression and treatment response in patients with glioblastoma multiforme (GBM). The goal of this article is to present and validate a software pipeline for semi-automatic GBM segmentation, called AFINITI (Assisted Follow-up in NeuroImaging of Therapeutic Intervention), using clinical data from GBM patients.
Materials and Methods
Our software adopts the current state-of-the-art tumor segmentation algorithms and combines them into one clinically usable pipeline. Both the advantages of the traditional voxel-based and the deformable shape-based segmentation are embedded into the software pipeline. The former provides an automatic tumor segmentation scheme based on T1- and T2-weighted magnetic resonance (MR) brain data, and the latter refines the segmentation results with minimal manual input.
Results
Twenty-six clinical MR brain images of GBM patients were processed and compared with manual results. The results can be visualized using the embedded graphic user interface.
Conclusion
Validation results using clinical GBM data showed high correlation between the AFINITI results and manual annotation. Compared to the voxel-wise segmentation, AFINITI yielded more accurate results in segmenting the enhanced GBM from multimodality MR imaging data. The proposed pipeline could be used as additional information to interpret MR brain images in neuroradiology.
Introduction
Despite the best available standard therapies, including surgery, radiation, and chemotherapy, the survival in patients diagnosed with glioblastoma multiforme (GBM) remains dismal at 14 months . Newer therapeutic strategies aiming at targeting specific molecules are being developed and tested in clinical trials . Temozolomide chemoradiation has significantly prolonged survival but produces pseudoprogression that is difficult or impossible to distinguish from recurrence in 30%–50% of patients . In addition, antiangiogenic therapies have been used in combination with conventional chemotherapy in patients with recurrent GBM, demonstrating radiographic response rates of 35%–50% . These agents improve significantly patient quality of life but alter the pattern of recurrence by a potent effect on tumor permeability, suppressing enhancement within a solid tumor with a resulting increase in the frequency of infiltrative recurrence .
These therapy-induced alterations in the natural history and imaging appearance of treated GBM have made imaging follow-up by conventional magnetic resonance imaging (MRI) difficult, which motivates widespread ongoing research to discover additional imaging biomarkers and has led to a revision in response criteria. Although the most commonly used imaging criteria for evaluating treatment response are still based on measurement of enhancing tumor (the Macdonald Criteria) , the increase in infiltrative recurrence and the difficulty in distinguishing recurrence from progression has led to proposal of a new criteria for tumor response that includes abnormality on T2-weighted or fluid-attenuated inversion recovery images as additional markers for progression (the RANO criteria) . The RANO criteria also recommends the use of volumetric measurements of enhancing tumor because reliance on cross product diameters is problematic and highly operator dependent in cases of irregularly shaped tumor, multifocal tumor, or tumor with cystic or necrotic components. Recently, volumetric measures were found comparable or superior to linear diameter measures as indicators of tumor evaluation.
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Methods
Patients and Data
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The AFINITI Software Pipeline
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Brain tumor segmentation pipeline
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Automatic segmentation step
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Interactive processing step
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Results
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Table 1
Detailed AFINITI Segmentation Results (mL)
AFINITI Results Manual Results Intersection Union Intersection/AFINITI (%) Intersection/Union (Jaccard Index; %) 6.57 7.26 6.16 7.67 93.7 80.2 20.63 27.60 16.47 31.76 79.8 51.9 28.95 41.32 24.38 45.88 84.2 53.1 2.52 4.27 2.49 4.30 98.6 57.8 53.91 81.80 51.81 83.91 96.1 61.8 22.84 28.03 22.72 28.14 99.5 80.7 10.35 19.65 10.26 19.74 99.1 52.0 21.54 20.79 17.00 25.33 78.9 67.1 4.63 13.96 4.30 14.29 92.8 30.1 6.49 21.09 6.45 21.13 99.4 30.2 1.22 2.27 1.18 2.32 96.5 51.1 3.73 6.62 3.71 6.64 99.5 55.9 40.71 58.44 40.67 58.49 99.9 69.5 8.19 17.13 7.71 17.61 94.2 43.8 35.61 45.60 34.22 46.99 96.1 72.8 15.24 19.99 14.79 20.44 97.1 72.4 12.49 14.74 12.08 15.15 96.8 79.8 7.59 20.48 7.54 20.53 99.3 36.7 1.36 2.34 1.31 2.39 96.6 54.9 10.14 16.04 8.10 18.08 79.9 44.8 17.98 43.75 15.90 45.83 88.4 34.7 64.66 90.07 64.16 90.56 99.2 70.8 1.42 3.13 1.40 3.15 98.5 44.5 39.76 51.85 35.93 55.68 90.4 64.5 9.24 25.32 6.86 27.70 74.3 24.8 14.90 44.10 13.91 45.09 93.3 30.8
AFINITI, Assisted Follow-up in NeuroImaging of Therapeutic Intervention.
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Table 2
Detailed Voxel-based Segmentation Results (mL)
FAST Results Manual Results Intersection Union Intersection/FAST (%) Intersection/Union (Jaccard Index; %) 6.60 7.26 6.16 7.69 93.4 80.1 61.03 27.60 17.04 71.58 27.9 23.8 80.03 41.32 27.39 93.96 34.2 29.2 2.52 4.27 2.49 4.30 98.6 57.8 73.75 81.80 54.34 101.21 73.7 53.7 23.16 28.03 23.03 28.16 99.4 81.8 10.91 19.65 10.72 19.83 98.3 54.1 27.81 20.79 17.20 31.39 61.9 54.8 10.19 13.96 5.70 18.45 55.9 30.9 7.01 21.09 6.54 21.57 93.2 30.3 1.26 2.27 1.21 2.32 96.1 52.0 3.73 6.62 3.71 6.64 99.5 55.9 40.93 58.44 40.86 58.51 99.8 69.8 10.75 17.13 8.19 19.70 76.2 41.6 37.40 45.60 35.71 47.29 95.5 75.5 17.59 19.99 15.50 22.08 88.1 70.2 12.55 14.74 12.14 15.15 96.7 80.1 7.59 20.48 7.54 20.53 99.3 36.7 1.38 2.34 1.33 2.39 96.7 55.8 15.32 16.04 9.03 22.34 58.9 40.4 18.34 43.75 16.11 45.99 87.8 35.0 65.10 90.07 64.51 90.65 99.1 71.2 1.48 3.13 1.46 3.15 98.4 46.2 85.36 51.85 40.13 97.08 47.0 41.3 0.01 25.32 0.00 25.33 0.0 0.0 9.48 44.10 9.42 44.15 99.4 21.3
AFINITI, Assisted Follow-up in NeuroImaging of Therapeutic Intervention.
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Discussion
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Conclusion
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