Reducing radiomics errors in nasopharyngeal cancer via deep learning-based synthetic CT generation from CBCT

This study investigates the impact of cone beam computed tomography (CBCT) image quality on radiomic analysis and evaluates the potential of deep learning-based enhancement to improve radiomic feature accuracy in nasopharyngeal cancer (NPC).

The CBAMRegGAN model was trained on 114 paired CT and CBCT datasets from 114 nasopharyngeal cancer patients to enhance CBCT images, with CT images as ground truth. The dataset was split into 82 patients for training, 12 for validation, and 20 for testing. The radiomic features in 6 different categories, including first-order, gray-level co-occurrence matrix (GLCM), gray-level run-length matrix (GLRLM), gray-level size-zone matrix(GLSZM), neighbouring gray tone difference matrix (NGTDM), and gray-level dependence matrix (GLDM), were extracted from the gross tumor volume (GTV) of original CBCT, enhanced CBCT, and CT. Comparing feature errors between original and enhanced CBCT showed that deep learning-based enhancement improves radiomic feature accuracy.

The CBAMRegGAN model achieved improved image quality with a peak signal-to-noise ratio (PSNR) of 29.52 ± 2.28 dB, normalized mean absolute error (NMAE) of 0.0129 ± 0.004, and structural similarity index (SSIM) of 0.910 ± 0.025 for enhanced CBCT images. This led to reduced errors in most radiomic features, with average reductions across 20 patients of 19.0%, 24.0%, 3.0%, 19%, 15.0%, and 5.0% for first-order, GLCM, GLRLM, GLSZM, NGTDM, and GLDM features.

This study demonstrates that CBCT image quality significantly influences radiomic analysis, and deep learning-based enhancement techniques can effectively improve both image quality and the accuracy of radiomic features in NPC.