Abstract
To facilitate a more widespread use of volumetric tumor segmentation in clinical studies, there is an urgent need for reliable, user-friendly segmentation software. The aim of this study was therefore to compare three different software packages for semi-automatic brain tumor segmentation of glioblastoma; namely BrainVoyagerTM QX, ITK-Snap and 3D Slicer, and to make data available for future reference. Pre-operative, contrast enhanced T1-weighted 1.5 or 3 Tesla Magnetic Resonance Imaging (MRI) scans were obtained in 20 consecutive patients who underwent surgery for glioblastoma. MRI scans were segmented twice in each software package by two investigators. Intra-rater, inter-rater and between-software agreement was compared by using differences of means with 95% limits of agreement (LoA), Dice’s similarity coefficients (DSC) and Hausdorff distance (HD). Time expenditure of segmentations was measured using a stopwatch. Eighteen tumors were included in the analyses. Inter-rater agreement was highest for BrainVoyager with difference of means of 0.19 mL and 95% LoA from -2.42 mL to 2.81 mL. Between-software agreement and 95% LoA were very similar for the different software packages. Intra-rater, inter-rater and between-software DSC were ≥ 0.93 in all analyses. Time expenditure was approximately 41 min per segmentation in BrainVoyager, and 18 min per segmentation in both 3D Slicer and ITK-Snap. Our main findings were that there is a high agreement within and between the software packages in terms of small intra-rater, inter-rater and between-software differences of means and high Dice’s similarity coefficients. Time expenditure was highest for BrainVoyager, but all software packages were relatively time-consuming, which may limit usability in an everyday clinical setting.
Highlights
Glioblastomas are diffusely infiltrating tumors, and the true tumor volume is larger and more diffuse than observed with any current imaging modality [1,2,3,4]
The study was approved by the Regional Ethics Committee (Central) as part of a larger project, with waiver of informed consent for retrospective review of Magnetic Resonance Imaging (MRI) images obtained as part of clinical routine
Inter-rater agreement was highest for BrainVoyager with a difference of means of 0.19 mL and 95% limits of agreement (LoA) from -2.42 mL to 2.81 mL
Summary
Glioblastomas are diffusely infiltrating tumors, and the true tumor volume is larger and more diffuse than observed with any current imaging modality [1,2,3,4]. Some studies have instead used relatively simple geometric formulae based on post-contrast neuroimaging [14,15,16], and in many studies where progression-free survival is assessed, volume measures are based on crude assessments of tumor diameters (RECIST criteria, MacDonald Criteria, WHO, RANO criteria) [6, 17, 18]. With such diverging methodology, betweenstudy comparisons are difficult
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