Comprehensive framework for evaluation of deep neural networks in detection and quantification of lymphoma from PET/CT images: clinical insights, pitfalls, and observer agreement analyses

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Main Authors: Ahamed, Shadab, Xu, Yixi, Kurkowska, Sara, Gowdy, Claire, O, Joo H., Bloise, Ingrid, Wilson, Don, Martineau, Patrick, Bénard, François, Yousefirizi, Fereshteh, Dodhia, Rahul, Lavista, Juan M., Weeks, William B., Uribe, Carlos F., Rahmim, Arman
Format: Preprint
Published: 2023
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author Ahamed, Shadab
Xu, Yixi
Kurkowska, Sara
Gowdy, Claire
O, Joo H.
Bloise, Ingrid
Wilson, Don
Martineau, Patrick
Bénard, François
Yousefirizi, Fereshteh
Dodhia, Rahul
Lavista, Juan M.
Weeks, William B.
Uribe, Carlos F.
Rahmim, Arman
author_facet Ahamed, Shadab
Xu, Yixi
Kurkowska, Sara
Gowdy, Claire
O, Joo H.
Bloise, Ingrid
Wilson, Don
Martineau, Patrick
Bénard, François
Yousefirizi, Fereshteh
Dodhia, Rahul
Lavista, Juan M.
Weeks, William B.
Uribe, Carlos F.
Rahmim, Arman
contents This study addresses critical gaps in automated lymphoma segmentation from PET/CT images, focusing on issues often overlooked in existing literature. While deep learning has been applied for lymphoma lesion segmentation, few studies incorporate out-of-distribution testing, raising concerns about model generalizability across diverse imaging conditions and patient populations. We highlight the need to compare model performance with expert human annotators, including intra- and inter-observer variability, to understand task difficulty better. Most approaches focus on overall segmentation accuracy but overlook lesion-specific measures important for precise lesion detection and disease quantification. To address these gaps, we propose a clinically relevant framework for evaluating deep segmentation networks. Using this lesion measure-specific evaluation, we assess the performance of four deep networks (ResUNet, SegResNet, DynUNet, and SwinUNETR) across 611 cases from multi-institutional datasets, covering various lymphoma subtypes and lesion characteristics. Beyond standard metrics like the Dice similarity coefficient, we evaluate clinical lesion measures and their prediction errors. We also introduce detection criteria for lesion localization and propose a new detection Criterion 3 based on metabolic characteristics. We show that networks perform better on large, intense lesions with higher metabolic activity. Finally, we compare network performance to physicians via intra- and inter-observer variability analyses, demonstrating that network errors closely resemble those made by experts, i.e., the small and faint lesions remain challenging for both humans and networks. This study aims to improve automated lesion segmentation's clinical relevance, supporting better treatment decisions for lymphoma patients. The code is available at: https://github.com/microsoft/lymphoma-segmentation-dnn.
format Preprint
id arxiv_https___arxiv_org_abs_2311_09614
institution arXiv
publishDate 2023
record_format arxiv
spellingShingle Comprehensive framework for evaluation of deep neural networks in detection and quantification of lymphoma from PET/CT images: clinical insights, pitfalls, and observer agreement analyses
Ahamed, Shadab
Xu, Yixi
Kurkowska, Sara
Gowdy, Claire
O, Joo H.
Bloise, Ingrid
Wilson, Don
Martineau, Patrick
Bénard, François
Yousefirizi, Fereshteh
Dodhia, Rahul
Lavista, Juan M.
Weeks, William B.
Uribe, Carlos F.
Rahmim, Arman
Computer Vision and Pattern Recognition
Artificial Intelligence
Machine Learning
This study addresses critical gaps in automated lymphoma segmentation from PET/CT images, focusing on issues often overlooked in existing literature. While deep learning has been applied for lymphoma lesion segmentation, few studies incorporate out-of-distribution testing, raising concerns about model generalizability across diverse imaging conditions and patient populations. We highlight the need to compare model performance with expert human annotators, including intra- and inter-observer variability, to understand task difficulty better. Most approaches focus on overall segmentation accuracy but overlook lesion-specific measures important for precise lesion detection and disease quantification. To address these gaps, we propose a clinically relevant framework for evaluating deep segmentation networks. Using this lesion measure-specific evaluation, we assess the performance of four deep networks (ResUNet, SegResNet, DynUNet, and SwinUNETR) across 611 cases from multi-institutional datasets, covering various lymphoma subtypes and lesion characteristics. Beyond standard metrics like the Dice similarity coefficient, we evaluate clinical lesion measures and their prediction errors. We also introduce detection criteria for lesion localization and propose a new detection Criterion 3 based on metabolic characteristics. We show that networks perform better on large, intense lesions with higher metabolic activity. Finally, we compare network performance to physicians via intra- and inter-observer variability analyses, demonstrating that network errors closely resemble those made by experts, i.e., the small and faint lesions remain challenging for both humans and networks. This study aims to improve automated lesion segmentation's clinical relevance, supporting better treatment decisions for lymphoma patients. The code is available at: https://github.com/microsoft/lymphoma-segmentation-dnn.
title Comprehensive framework for evaluation of deep neural networks in detection and quantification of lymphoma from PET/CT images: clinical insights, pitfalls, and observer agreement analyses
topic Computer Vision and Pattern Recognition
Artificial Intelligence
Machine Learning
url https://arxiv.org/abs/2311.09614