[Evaluation of a new software tool for the automatic volume calculation of hepatic tumors. First results]

Comparison of semi-automated and manual methods to measure the volume of liver tumours on MDCT images

OBJECTIVE

To retrospectively compare semi-automated and manual volume measurements of malignant liver tumours and inter- and intra-observer variability using commercially available software.

METHODS

This study was performed on 60 consecutive patients with untreated liver metastases (30) and HCCs (30), i.e. 92 lesions (49 metastases, 43 HCCs) using hepatic MDCT. Lesion volumes were manually measured independently by two radiologists and semi-automatically by the same two radiologists and a technician. Those measurements were repeated on 20 patients (10 metastases and 10 HCCs) a week later. An independent operator timed all the measurements. Using the Spearman correlation coefficient and Bland-Altman plots, statistical analyses were performed.

RESULTS

Liver lesion volumes obtained with semi-automated and manual methods were well correlated (Spearman, r = 0.98 and 0.91). Their agreement was high for intra-observer measurements with the semi-automated method (Spearman, r = 0.91 and 0.94). The agreement was lower for inter-observer measurements with both methods (Spearman, r = 0.87 for semi-automated and 0.91 for manual). The semi-automated method significantly reduced the post-processing duration (23s ± 19s vs. 33s ± 11s, p value <0.0001).

CONCLUSION

In our study, semi-automated volume analysis of malignant liver tumours correlated well with the manual method. Furthermore, the semi-automated volume analysis was significantly quicker.

Value of three-dimensional reconstructions in pancreatic carcinoma using multidetector CT: Initial results

AIM: To evaluate the use of three-dimensional imaging of pancreatic carcinoma using multidetector computed tomography (CT) in a prospective study.

METHODS: Ten patients with suspected pancreatic tumors were examined prospectively using multidetector CT (Somatom Sensation 16, Siemens, Erlangen, Germany). The images were evaluated for the presence of a pancreatic carcinoma and invasion of the peripancreatic vessels and surrounding organs. Using the isotropic CT data sets, a three-dimensional image was created with automatic vascular analysis and semi-automatic segmentation of the organs and pancreatic tumor by a radiologist. The CT examinations and the three-dimensional images were presented to the surgeon directly before and during the patient’s operation using the Medical Imaging Interaction Toolkit-based software “ReLiver”. Immediately after surgery, the value of the two images was judged by the surgeon. The operation and the histological results served as the gold standard.

RESULTS: Nine patients had a pancreatic carcinoma (all pT3), and one patient had a serous cystadenoma. One tumor infiltrated the superior mesenteric vein. The infiltration was correctly evaluated. All carcinomas were resectable. In comparison to the CT image with axial and coronal reconstructions, the three-dimensional image was judged by the surgeons as better for operation planning and consistently described as useful.

CONCLUSION: A 3D-image of the pancreas represents an invaluable aid to the surgeon. However, the 3D-software must be further developed in order to be integrated into daily clinical routine.

[Volumetry of metastases from renal cell carcinoma: comparison with the RECIST criteria]

For patients with metastasized renal cell carcinoma (RCC), imaging techniques are of great importance. Currently, therapy widely relies on antiangiogenic factors, which frequently lead to relatively subtle changes in the size of lesions. From this aspect the commonly used RECIST criteria (response evaluation criteria in solid tumors) must be considered as imprecise for the evaluation of the response to therapy. This article gives a review on new software-based volumetric methods, which allow therapy-induced changes in the size of metastases from RCC to be detected with higher sensitivity and reproducibility. A comparison of RECIST and volumetry was carried out with data from patients with metastasized RCC to demonstrate the higher sensitivity of the 3D volumetric procedure.