Automatic segmentation for magnetic resonance imaging guided individual elective lymph node irradiation in head and neck cancer patients

Background and purpose: In head and neck squamous cell carcinoma (HNSCC) patients, the radiation dose to nearby organs at risk can be reduced by restricting elective neck irradiation from lymph node levels to individual lymph nodes. However, manual delineation of every individual lymph node is time-...

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Main Authors: Floris C.J. Reinders, Mark H.F. Savenije, Mischa de Ridder, Matteo Maspero, Patricia A.H. Doornaert, Chris H.J. Terhaard, Cornelis P.J. Raaijmakers, Kaveh Zakeri, Nancy Y. Lee, Eric Aliotta, Aneesh Rangnekar, Harini Veeraraghavan, Marielle E.P. Philippens
Format: Article
Language:English
Published: Elsevier 2024-10-01
Series:Physics and Imaging in Radiation Oncology
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Online Access:http://www.sciencedirect.com/science/article/pii/S2405631624001258
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author Floris C.J. Reinders
Mark H.F. Savenije
Mischa de Ridder
Matteo Maspero
Patricia A.H. Doornaert
Chris H.J. Terhaard
Cornelis P.J. Raaijmakers
Kaveh Zakeri
Nancy Y. Lee
Eric Aliotta
Aneesh Rangnekar
Harini Veeraraghavan
Marielle E.P. Philippens
author_facet Floris C.J. Reinders
Mark H.F. Savenije
Mischa de Ridder
Matteo Maspero
Patricia A.H. Doornaert
Chris H.J. Terhaard
Cornelis P.J. Raaijmakers
Kaveh Zakeri
Nancy Y. Lee
Eric Aliotta
Aneesh Rangnekar
Harini Veeraraghavan
Marielle E.P. Philippens
author_sort Floris C.J. Reinders
collection DOAJ
description Background and purpose: In head and neck squamous cell carcinoma (HNSCC) patients, the radiation dose to nearby organs at risk can be reduced by restricting elective neck irradiation from lymph node levels to individual lymph nodes. However, manual delineation of every individual lymph node is time-consuming and error prone. Therefore, automatic magnetic resonance imaging (MRI) segmentation of individual lymph nodes was developed and tested using a convolutional neural network (CNN). Materials and methods: In 50 HNSCC patients (UMC-Utrecht), individual lymph nodes located in lymph node levels Ib-II-III-IV-V were manually segmented on MRI by consensus of two experts, obtaining ground truth segmentations. A 3D CNN (nnU-Net) was trained on 40 patients and tested on 10. Evaluation metrics were Dice Similarity Coefficient (DSC), recall, precision, and F1-score. The segmentations of the CNN was compared to segmentations of two observers. Transfer learning was used with 20 additional patients to re-train and test the CNN in another medical center. Results: nnU-Net produced automatic segmentations of elective lymph nodes with median DSC: 0.72, recall: 0.76, precision: 0.78, and F1-score: 0.78. The CNN had higher recall compared to both observers (p = 0.002). No difference in evaluation scores of the networks in both medical centers was found after re-training with 5 or 10 patients. Conclusion: nnU-Net was able to automatically segment individual lymph nodes on MRI. The detection rate of lymph nodes using nnU-Net was higher than manual segmentations. Re-training nnU-Net was required to successfully transfer the network to the other medical center.
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spelling doaj-art-dec802e08b024a0a8001d0b685dc9a422024-12-19T10:55:38ZengElsevierPhysics and Imaging in Radiation Oncology2405-63162024-10-0132100655Automatic segmentation for magnetic resonance imaging guided individual elective lymph node irradiation in head and neck cancer patientsFloris C.J. Reinders0Mark H.F. Savenije1Mischa de Ridder2Matteo Maspero3Patricia A.H. Doornaert4Chris H.J. Terhaard5Cornelis P.J. Raaijmakers6Kaveh Zakeri7Nancy Y. Lee8Eric Aliotta9Aneesh Rangnekar10Harini Veeraraghavan11Marielle E.P. Philippens12Department of Radiotherapy, University Medical Centre Utrecht, the Netherlands; Corresponding author.Department of Radiotherapy, University Medical Centre Utrecht, the Netherlands; Computational Imaging Group for MR Therapy and Diagnostics, Cancer and Imaging Division, University Medical Center Utrecht, Utrecht, the NetherlandsDepartment of Radiotherapy, University Medical Centre Utrecht, the NetherlandsDepartment of Radiotherapy, University Medical Centre Utrecht, the Netherlands; Computational Imaging Group for MR Therapy and Diagnostics, Cancer and Imaging Division, University Medical Center Utrecht, Utrecht, the NetherlandsDepartment of Radiotherapy, University Medical Centre Utrecht, the NetherlandsDepartment of Radiotherapy, University Medical Centre Utrecht, the NetherlandsDepartment of Radiotherapy, University Medical Centre Utrecht, the NetherlandsDepartment of Radiotherapy, Memorial Sloan Kettering Cancer Centre, New York, United StatesDepartment of Radiotherapy, Memorial Sloan Kettering Cancer Centre, New York, United StatesDepartment of Radiotherapy, Memorial Sloan Kettering Cancer Centre, New York, United StatesDepartment of Radiotherapy, Memorial Sloan Kettering Cancer Centre, New York, United StatesDepartment of Radiotherapy, Memorial Sloan Kettering Cancer Centre, New York, United StatesDepartment of Radiotherapy, University Medical Centre Utrecht, the NetherlandsBackground and purpose: In head and neck squamous cell carcinoma (HNSCC) patients, the radiation dose to nearby organs at risk can be reduced by restricting elective neck irradiation from lymph node levels to individual lymph nodes. However, manual delineation of every individual lymph node is time-consuming and error prone. Therefore, automatic magnetic resonance imaging (MRI) segmentation of individual lymph nodes was developed and tested using a convolutional neural network (CNN). Materials and methods: In 50 HNSCC patients (UMC-Utrecht), individual lymph nodes located in lymph node levels Ib-II-III-IV-V were manually segmented on MRI by consensus of two experts, obtaining ground truth segmentations. A 3D CNN (nnU-Net) was trained on 40 patients and tested on 10. Evaluation metrics were Dice Similarity Coefficient (DSC), recall, precision, and F1-score. The segmentations of the CNN was compared to segmentations of two observers. Transfer learning was used with 20 additional patients to re-train and test the CNN in another medical center. Results: nnU-Net produced automatic segmentations of elective lymph nodes with median DSC: 0.72, recall: 0.76, precision: 0.78, and F1-score: 0.78. The CNN had higher recall compared to both observers (p = 0.002). No difference in evaluation scores of the networks in both medical centers was found after re-training with 5 or 10 patients. Conclusion: nnU-Net was able to automatically segment individual lymph nodes on MRI. The detection rate of lymph nodes using nnU-Net was higher than manual segmentations. Re-training nnU-Net was required to successfully transfer the network to the other medical center.http://www.sciencedirect.com/science/article/pii/S2405631624001258Deep learningArtificial intelligenceLymph nodesMagnetic resonance imagingRadiotherapySquamous cell carcinoma of head and neck
spellingShingle Floris C.J. Reinders
Mark H.F. Savenije
Mischa de Ridder
Matteo Maspero
Patricia A.H. Doornaert
Chris H.J. Terhaard
Cornelis P.J. Raaijmakers
Kaveh Zakeri
Nancy Y. Lee
Eric Aliotta
Aneesh Rangnekar
Harini Veeraraghavan
Marielle E.P. Philippens
Automatic segmentation for magnetic resonance imaging guided individual elective lymph node irradiation in head and neck cancer patients
Physics and Imaging in Radiation Oncology
Deep learning
Artificial intelligence
Lymph nodes
Magnetic resonance imaging
Radiotherapy
Squamous cell carcinoma of head and neck
title Automatic segmentation for magnetic resonance imaging guided individual elective lymph node irradiation in head and neck cancer patients
title_full Automatic segmentation for magnetic resonance imaging guided individual elective lymph node irradiation in head and neck cancer patients
title_fullStr Automatic segmentation for magnetic resonance imaging guided individual elective lymph node irradiation in head and neck cancer patients
title_full_unstemmed Automatic segmentation for magnetic resonance imaging guided individual elective lymph node irradiation in head and neck cancer patients
title_short Automatic segmentation for magnetic resonance imaging guided individual elective lymph node irradiation in head and neck cancer patients
title_sort automatic segmentation for magnetic resonance imaging guided individual elective lymph node irradiation in head and neck cancer patients
topic Deep learning
Artificial intelligence
Lymph nodes
Magnetic resonance imaging
Radiotherapy
Squamous cell carcinoma of head and neck
url http://www.sciencedirect.com/science/article/pii/S2405631624001258
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