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Histopathology-validated gross tumor volume delineations of intraprostatic lesions using PSMA-positron emission tomography/multiparametric magnetic resonance imaging

Grefve, Josefine ; Söderkvist, Karin ; Gunnlaugsson, Adalsteinn LU ; Sandgren, Kristina ; Jonsson, Joakim ; Keeratijarut Lindberg, Angsana ; Nilsson, Erik ; Axelsson, Jan ; Bergh, Anders and Zackrisson, Björn , et al. (2024) In Physics and imaging in radiation oncology 31.
Abstract

Background and purpose: Dose escalation in external radiotherapy of prostate cancer shows promising results in terms of biochemical disease-free survival. Boost volume delineation guidelines are sparse which may cause high interobserver variability. The aim of this research was to characterize gross tumor volume (GTV) delineations based on multiparametric magnetic resonance imaging (mpMRI) and prostate specific membrane antigen-positron emission tomography (PSMA-PET) in relation to histopathology-validated Gleason grade 4 and 5 regions. Material and methods: The study participants were examined with [68Ga]PSMA-PET/mpMRI prior to radical prostatectomy. Four radiation oncologists delineated GTVs in 15 study participants, on... (More)

Background and purpose: Dose escalation in external radiotherapy of prostate cancer shows promising results in terms of biochemical disease-free survival. Boost volume delineation guidelines are sparse which may cause high interobserver variability. The aim of this research was to characterize gross tumor volume (GTV) delineations based on multiparametric magnetic resonance imaging (mpMRI) and prostate specific membrane antigen-positron emission tomography (PSMA-PET) in relation to histopathology-validated Gleason grade 4 and 5 regions. Material and methods: The study participants were examined with [68Ga]PSMA-PET/mpMRI prior to radical prostatectomy. Four radiation oncologists delineated GTVs in 15 study participants, on four different image types; T2-weighted (T2w), diffusion weighted imaging (DWI), dynamic contrast enhanced (DCE) and PSMA-PET scans separately. The simultaneous truth and performance level estimation (STAPLE) algorithm was used to generate combined GTVs. GTVs were subsequently compared to histopathology. We analysed how Dice similarity coefficient (DSC) and lesion coverage are affected by using single versus multiple image types as well as by adding a clinical target volume (CTV) margin. Results: Median DSC (STAPLE) for different GTVs varied between 0.33 and 0.52. GTVPSMA-PET/mpMRI generated the highest median lesion coverage at 0.66. Combining different image types achieved similar lesion coverage as adding a CTV margin to contours from a single image type, while reducing non-malignant tissue inclusion within the target volume. Conclusion: The combined use of mpMRI or PSMA-PET/mpMRI shows promise, achieving higher DSC and lesion coverage while minimizing non-malignant tissue inclusion, in comparison to the use of a single image type with an added CTV margin.

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organization
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type
Contribution to journal
publication status
published
subject
in
Physics and imaging in radiation oncology
volume
31
article number
100633
publisher
Elsevier
external identifiers
  • scopus:85202586079
  • pmid:39286772
ISSN
2405-6316
DOI
10.1016/j.phro.2024.100633
language
English
LU publication?
yes
id
226cab02-4a16-40a0-8327-9959139521d3
date added to LUP
2025-01-09 15:15:34
date last changed
2025-07-25 07:29:19
@article{226cab02-4a16-40a0-8327-9959139521d3,
  abstract     = {{<p>Background and purpose: Dose escalation in external radiotherapy of prostate cancer shows promising results in terms of biochemical disease-free survival. Boost volume delineation guidelines are sparse which may cause high interobserver variability. The aim of this research was to characterize gross tumor volume (GTV) delineations based on multiparametric magnetic resonance imaging (mpMRI) and prostate specific membrane antigen-positron emission tomography (PSMA-PET) in relation to histopathology-validated Gleason grade 4 and 5 regions. Material and methods: The study participants were examined with [<sup>68</sup>Ga]PSMA-PET/mpMRI prior to radical prostatectomy. Four radiation oncologists delineated GTVs in 15 study participants, on four different image types; T2-weighted (T2w), diffusion weighted imaging (DWI), dynamic contrast enhanced (DCE) and PSMA-PET scans separately. The simultaneous truth and performance level estimation (STAPLE) algorithm was used to generate combined GTVs. GTVs were subsequently compared to histopathology. We analysed how Dice similarity coefficient (DSC) and lesion coverage are affected by using single versus multiple image types as well as by adding a clinical target volume (CTV) margin. Results: Median DSC (STAPLE) for different GTVs varied between 0.33 and 0.52. GTV<sub>PSMA-PET/mpMRI</sub> generated the highest median lesion coverage at 0.66. Combining different image types achieved similar lesion coverage as adding a CTV margin to contours from a single image type, while reducing non-malignant tissue inclusion within the target volume. Conclusion: The combined use of mpMRI or PSMA-PET/mpMRI shows promise, achieving higher DSC and lesion coverage while minimizing non-malignant tissue inclusion, in comparison to the use of a single image type with an added CTV margin.</p>}},
  author       = {{Grefve, Josefine and Söderkvist, Karin and Gunnlaugsson, Adalsteinn and Sandgren, Kristina and Jonsson, Joakim and Keeratijarut Lindberg, Angsana and Nilsson, Erik and Axelsson, Jan and Bergh, Anders and Zackrisson, Björn and Moreau, Mathieu and Thellenberg Karlsson, Camilla and Olsson, Lars E. and Widmark, Anders and Riklund, Katrine and Blomqvist, Lennart and Berg Loegager, Vibeke and Strandberg, Sara N. and Nyholm, Tufve}},
  issn         = {{2405-6316}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Physics and imaging in radiation oncology}},
  title        = {{Histopathology-validated gross tumor volume delineations of intraprostatic lesions using PSMA-positron emission tomography/multiparametric magnetic resonance imaging}},
  url          = {{http://dx.doi.org/10.1016/j.phro.2024.100633}},
  doi          = {{10.1016/j.phro.2024.100633}},
  volume       = {{31}},
  year         = {{2024}},
}