Interobserver ground-truth variability limits performance of automated glioblastoma segmentation on [¹⁸F]FET PET

Abstract

Positron emission tomography (PET) with a [18F]fluoroethyl)-L-tyrosine ([18F]FET) tracer is of growing importance in the management of glioblastoma for the estimation of tumor extent and extraction of diagnostic and prognostic parameters. Robust and accurate glioblastoma segmentation methods are essential to maximize the benefits of this imaging modality. Given the importance of setting the foreground threshold during manual tumor delineation, this study investigates the added value of incorporating such prior knowledge to guide the automated segmentation and improve performance. Two segmentation networks were trained based on the nnU-Net guidelines: one with the [18F]FET PET image as sole input, and one with an additional input channel for the threshold map. For the latter, we investigate the benefit of manually obtained thresholds and explore automated prediction and generation of such maps. A fully automated pipeline was constructed by selecting the best performing threshold prediction approach and cascading this with the tumor segmentation model.