Volumetric analysis of liver metastases in computed tomography with the fuzzy C-means algorithm

Tumor size is often determined from computed tomography (CT) images to assess disease progression. A study was conducted to demonstrate the advantages of the fuzzy C-means (FCM) algorithm for volumetric analysis of colorectal liver metastases in comparison with manual contouring. Intra-and interobserver variability was assessed for manual contouring and the FCM algorithm in a study involving contrast-enhanced helical CT images of 43 hypoattenuating liver lesions from 15 patients with a history of colorectal cancer. Measurement accuracy and interscan variability of the FCM and manual methods were assessed in a phantom study using paraffin pseudotumors. In the clinical imaging study, intra-and interobserver variability was reduced using the FCM algorithm as compared with manual contouring (P = 0.0070 and P = 0.0019, respectively). Accuracy of the measurement of the pseudotumor volume was improved using the FCM method as compared with the manual method (P = 0.047). Interscan variability of the pseudotumor volumes was measured using the FCM method as compared with the manual method (P = 0.04). The FCM algorithm volume was highly correlated with the manual contouring volume (r = 0.9997). Finally, the shorter time spent in calculating tumor volume using the FCM method versus the manual contouring method was marginally statistically significant (P = 0.080). These results suggest that the FCM algorithm has substantial advantages over manual contouring for volumetric measurement of colorectal liver metastases from CT.