Classification of Pulmonary Nodules in 2-[¹⁸F]FDG PET/CT Images with a 3D Convolutional Neural Network

2-[¹⁸F]FDG PET/CT plays an important role in the management of pulmonary nodules. Convolutional neural networks (CNNs) automatically learn features from images and have the potential to improve the discrimination between malignant and benign pulmonary nodules. The purpose of this study was to develop and validate a CNN model for classification of pulmonary nodules from 2-[¹⁸F]FDG PET images.

One hundred thirteen participants were retrospectively selected. One nodule per participant. The 2-[¹⁸F]FDG PET images were preprocessed and annotated with the reference standard. The deep learning experiment entailed random data splitting in five sets. A test set was held out for evaluation of the final model. Four-fold cross-validation was performed from the remaining sets for training and evaluating a set of candidate models and for selecting the final model. Models of three types of 3D CNNs architectures were trained from random weight initialization (Stacked 3D CNN, VGG-like and Inception-v2-like models) both in original and augmented datasets. Transfer learning, from ImageNet with ResNet-50, was also used.

The final model (Stacked 3D CNN model) obtained an area under the ROC curve of 0.8385 (95% CI: 0.6455-1.0000) in the test set. The model had a sensibility of 80.00%, a specificity of 69.23% and an accuracy of 73.91%, in the test set, for an optimised decision threshold that assigns a higher cost to false negatives.

A 3D CNN model was effective at distinguishing benign from malignant pulmonary nodules in 2-[¹⁸F]FDG PET images.

The online version contains supplementary material available at 10.1007/s13139-023-00821-6.