Comparative methods for PET image segmentation in pharyngolaryngeal squamous cell carcinoma

Purpose: Several methods have been proposed for the segmentation of 18F-FDG uptake in PET. In this study, we assessed the performance of four categories of 18F-FDG PET image segmentation techniques in pharyngolaryngeal squamous cell carcinoma using clinical studies where the surgical specimen served as the benchmark. Methods: Nine PET image segmentation techniques were compared including: five thresholding methods; the level set technique (active contour); the stochastic expectation-maximization approach; fuzzy clustering-based segmentation (FCM); and a variant of FCM, the spatial wavelet-based algorithm (FCM-SW) which incorporates spatial information during the segmentation process, thus allowing the handling of uptake in heterogeneous lesions. These algorithms were evaluated using clinical studies in which the segmentation results were compared to the 3-D biological tumour volume (BTV) defined by histology in PET images of seven patients with T3-T4 laryngeal squamous cell carcinoma who underwent a total laryngectomy. The macroscopic tumour specimens were collected "en bloc”, frozen and cut into 1.7- to 2-mm thick slices, then digitized for use as reference. Results: The clinical results suggested that four of the thresholding methods and expectation-maximization overestimated the average tumour volume, while a contrast-oriented thresholding method, the level set technique and the FCM-SW algorithm underestimated it, with the FCM-SW algorithm providing relatively the highest accuracy in terms of volume determination (−5.9 ± 11.9%) and overlap index. The mean overlap index varied between 0.27 and 0.54 for the different image segmentation techniques. The FCM-SW segmentation technique showed the best compromise in terms of 3-D overlap index and statistical analysis results with values of 0.54 (0.26-0.72) for the overlap index. Conclusion: The BTVs delineated using the FCM-SW segmentation technique were seemingly the most accurate and approximated closely the 3-D BTVs defined using the surgical specimens. Adaptive thresholding techniques need to be calibrated for each PET scanner and acquisition/processing protocol, and should not be used without optimizatio