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Automated whole-body PET/CT lesion tracking for lesion-wise response evaluation in metastatic breast cancer
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.ORCID iD: 0000-0001-8389-975X
Antaros Medical AB, SE-43153 Mölndal, Sweden.
Department of Medical Oncology, University Medical Center Groningen, University of Groningen.
Department of Medical Oncology, University Medical Center Groningen, University of Groningen.
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2025 (English)In: Proceedings of 2024 International Conference on Medical Imaging and Computer-Aided Diagnosis (MICAD 2024) / [ed] Ruidan Su; Alejandro F. Frangi; Yudong Zhang, Singapore: Springer, 2025Conference paper, Published paper (Refereed)
Abstract [en]

Breast cancer responds heterogeneously to treatment. This study evaluated the efficacy of image registration-based lesion tracking for assessing lesion-wise response in metastatic breast cancer (MBC). [18F]FDG PET/CT images from 15 patients with MBC from the multi-center IMPACT-MBC study were analyzed. Manual segmentation identified 644 lesions in baseline scans and 804 lesions in 2-week post-treatment scans. A deformable image registration method, validated for whole-body PET/CT scans of patients with cancer, was applied. Lesion tracking was performed using spatial overlap resulting from within-subject image registration, yielding a precision of 0.93 ± 0.07, a sensitivity of 0.87 ± 0.17, and an F1 score of 0.89 ± 0.10. Performance was consistent across lesion sites and lesion count-based disease burden. Sensitivity decreased for lesions under 1 mL. Image registration direction did not affect results. Between-subject registration enabled quantitative visualization and analysis of metabolic response patterns in bone lesions across the cohort. Results demonstrate the potential for automated, accurate lesion-wise response assessment, which may improve treatment monitoring in MBC.

Place, publisher, year, edition, pages
Singapore: Springer, 2025.
Series
Lecture Notes in Electrical Engineering, ISSN 1876-1100, E-ISSN 1876-1119 ; 1372
National Category
Radiology and Medical Imaging Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-551444DOI: 10.1007/978-981-96-3863-5_26ISI: 001491664600026Scopus ID: 2-s2.0-105003260989OAI: oai:DiVA.org:uu-551444DiVA, id: diva2:1942755
Conference
5th International Conference on Medical Imaging and Computer-Aided Diagnosis (MICAD 2024), Nov. 19-21, 2024, Manchester, UK
Available from: 2025-03-06 Created: 2025-03-06 Last updated: 2025-10-14Bibliographically approved
In thesis
1. Whole-body PET/CT image registration and analysis in cancer
Open this publication in new window or tab >>Whole-body PET/CT image registration and analysis in cancer
2025 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Whole-body positron emission tomography/computed tomography (PET/CT) imaging is primarily used for cancer patients and provides comprehensive information about disease extent and overall patient health. However, the manual analysis and interpretation of these images is often time-consuming and complex, necessitating computer-aided methods to maximize data utilization. This thesis presents the development, evaluation, and investigation of applications of an image registration method aimed at advancing visualization and analysis of standard-of-care whole-body PET/CT images. Paper I describes an image registration method that aligns whole-body PET/CT images by incorporating both low-level features from the CT scan and high-level features from tissue segmentation masks. This method effectively aligned major organs and anatomical structures within reasonable computation times for both within- and between-subject registration, as demonstrated in lymphoma and head and neck cancer patients. Paper II applied this image registration technique to track lesions in metastatic breast cancer patients by comparing pre- and post-treatment images. High performance in lesion tracking confirmed the method’s potential utility for automated treatment response evaluation. Paper III investigated longitudinal image features extracted through within-subject registration of whole-body [18F]fluorodeoxyglucose PET/CT images in patients with locally advanced non-small cell lung cancer. These features were shown to have prognostic value, with whole-body image analysis providing improved survival prediction compared to chest-focused analysis in certain cases. Paper IV explored spatial tumor heterogeneity across patients with lung cancer, lymphoma, and melanoma, and showed the feasibility of using whole-body group-wise analysis to visualize tumor characteristics. These results collectively demonstrate the utility of whole-body PET/CT image registration-based analysis across various cancer types. The developed image registration method enables detailed comparative analysis of whole-body PET/CT images for longitudinal studies and cohort-based characterization of disease patterns. Its versatility in cancer image analysis suggests that its application has promising potential to improve cancer care, including staging, treatment planning, and patient outcomes. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2025. p. 82
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 2133
Keywords
cancer, image registration, medical image analysis, positron emission tomography-computed tomography, whole-body
National Category
Radiology, Nuclear Medicine and Medical Imaging Cancer and Oncology Medical Imaging
Research subject
Computerized Image Processing
Identifiers
urn:nbn:se:uu:diva-549483 (URN)978-91-513-2424-1 (ISBN)
Public defence
2025-05-05, H:son Holmdahlsalen, Akademiska sjukhuset, ing. 100, Uppsala, 13:00 (English)
Opponent
Supervisors
Available from: 2025-04-10 Created: 2025-03-14 Last updated: 2025-04-10

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Jönsson, HannaAhlström, HåkanKullberg, Joel

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Citation style
  • apa
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