Head and neck automatic multi-organ segmentation on Dual-Energy Computed Tomography

Deep-learning-based automatic segmentation is widely used in radiation oncology to delineate organs-at-risk. Dual-energy CT (DECT) allows the reconstruction of enhanced contrast images that could help with manual and auto-delineation. This paper presents a performance evaluation of a commercial auto-segmentation software on image series generated by a DECT.

Different types of DECT images from seventy four head-and-neck (HN) patients were retrieved, including polyenergetic images at different voltages [80 kV reconstructed with a kernel corresponding to the commercial algorithm DirectDensity™ (PEI80-DD), 80 kV (PEI80), 120 kV-mixed (PEI120)] and a virtual-monoenergetic image at 40 keV (VMI40). Delineations used for treatment planning were considered as ground truth (GT) and were compared with the auto-segmentations performed on the 4 DECT images. A blinded qualitative evaluation of 3 structures (thyroid, left parotid, left nodes level II) was carried out. Performance metrics were calculated for thirteen HN structures to evaluate the auto-contours including dice similarity coefficient (DSC), 95th percentile Hausdorff distance (95HD) and mean surface distance (MSD).

We observed a high rate of low scores for PEI80-DD and VMI40 auto-segmentations on the thyroid and for GT and VMI40 contours on the nodes level II. All images received excellent scores for the parotid glands. The metrics comparison between GT and auto-segmented contours revealed that PEI80-DD had the highest DSC scores, significantly outperforming other reconstructed images for all organs (p < 0.05).

The results indicate that the auto-contouring system cannot generalize to images derived from DECT acquisition. It is therefore crucial to identify which organs benefit from these acquisitions to adapt the training datasets accordingly.