Zeppa Pietro, Neitzert Luca, Mammi Marco, Monticelli Matteo, Altieri Roberto, Castaldo Margherita, Cofano Fabio, Borrè Alda, Zenga Francesco, Melcarne Antonio, Garbossa Diego
Dipartimento di Neuroscienze, Università degli Studi di Torino, Turin, Italy.
Dipartimento di Neurochirurgia, Policlinico G. Rodolico, Catania, Italy.
Neurosurgery. 2020 Nov 16;87(6):E672-E679. doi: 10.1093/neuros/nyaa282.
Gliomas are the most common malignant primary brain tumors. Assessment of the tumor volume represents a crucial point in preoperative and postoperative evaluation.
To compare pre- and postoperative tumor volumes obtained with an automated, semi-automatic, and manual segmentation tool. Mean processing time of each segmentation techniques was measured.
Manual segmentation was performed on preoperative and postoperative magnetic resonance images with the open-source software Horos (Horos Project). "SmartBrush," a tool of the IPlan Cranial software (Brainlab, Feldkirchen, Germany), was used to carry out the semi-automatic segmentation. The open-source BraTumIA software (NeuroImaging Tools and Resources Collaboratory) was employed for the automated segmentation. Pearson correlation coefficient was used to assess volumetric comparison. Subsequently deviation/range and average discrepancy were determined. The Wilcoxon signed-rank test was used to assess statistical significance.
A total of 58 patients with a newly diagnosed high-grade glioma were enrolled. The comparison of the volumes calculated with Horos and IPlan showed a strong agreement both on preoperative and postoperative images (respectively: "enhancing" ρ = 0.99-0.78, "fluid-attenuated inversion recovery" ρ = 0.97-0.92, and "total tumor volume" ρ = 0.98-0.95). Agreement between BraTumIA and the other 2 techniques appeared to be strong for preoperative images, but showed a higher disagreement on postoperative images. Mean time expenditure for tumor segmentation was 27 min with manual segmentation, 17 min with semi-automated, and 8 min with automated software.
The considered segmentation tools showed high agreement in preoperative volumetric assessment. Both manual and semi-automated software appear adequate for the postoperative quantification of residual volume. The evaluated automated software is not yet reliable. Automated software considerably reduces the time expenditure.
胶质瘤是最常见的原发性恶性脑肿瘤。肿瘤体积评估是术前和术后评估的关键环节。
比较使用自动、半自动和手动分割工具获得的术前和术后肿瘤体积。测量每种分割技术的平均处理时间。
使用开源软件Horos（Horos项目）对术前和术后磁共振图像进行手动分割。使用IPlan Cranial软件（德国费尔德kirchen的Brainlab公司）的“智能画笔”工具进行半自动分割。使用开源的BraTumIA软件（神经影像工具与资源协作实验室）进行自动分割。采用Pearson相关系数评估体积比较情况。随后确定偏差/范围和平均差异。使用Wilcoxon符号秩检验评估统计学意义。
共纳入58例新诊断的高级别胶质瘤患者。用Horos和IPlan计算的体积比较显示，术前和术后图像均具有高度一致性（分别为：“强化”ρ = 0.99 - 0.78，“液体衰减反转恢复”ρ = 0.97 - 0.92，“肿瘤总体积”ρ = 0.98 - 0.95）。BraTumIA与其他两种技术在术前图像上的一致性似乎较强，但在术后图像上的分歧较大。手动分割肿瘤的平均时间为27分钟，半自动分割为17分钟，自动软件分割为8分钟。
所考虑的分割工具在术前体积评估中显示出高度一致性。手动和半自动软件似乎都适用于术后残余体积的量化。评估的自动软件尚不可靠。自动软件可显著减少时间消耗。
