Introduction: Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT), in combination with magnetic resonance imaging (MRI), may enhance the diagnosis and staging of prostate cancer. Image fusion of separately acquired PET/CT and MRI images serve to facilitate clinical integration and treatment planning. This study aimed to investigate different PSMA PET/CT and MRI image fusion workflows for prostate cancer visualisation. Methods: Eighteen patients with prostate cancer who underwent PSMA PET/CT and MRI prior to radical prostatectomy were retrospectively selected. Alignment of the prostate was performed between PET/CT and MRI via three techniques: semi-automatic rigid, automatic rigid, and automatic non-rigid. Image fusion accuracy was evaluated through boundary and volume agreement, quantified by the Dice Similarity Coefficient (DSC), 95% Hausdorff Distance (HD), and Mean Surface Distance (MSD), with comparison against reconstructed histopathology slices. Results: Image fusion using all techniques resulted in clear lesion visualisation from PSMA PET/CT overlay and anatomical detail afforded by the MRI base and was consistent with histopathology tumour location. Image fusion accuracy was within the recommended range based on a DSC of 0.8-0.9. The automatic non-rigid registration method had the highest volume agreement (DSC: 0.96 ± <0.01) and boundary agreement (HD: 1.17 ± 0.35 mm) when compared to automatic rigid (DSC 0.88 ± 0.02, HD 3.18 ± 0.29 mm) and semi-automatic rigid (DSC 0.80 ± 0.06, HD 5.25 ± 1.68 mm). Conclusions: Image fusion of clinically obtained PET/CT and MRI is feasible and clinically acceptable for use in prostate cancer diagnosis and surgical management. While the best accuracy was observed with the automatic non-rigid technique, which requires further validation, image fusion with clinically accessible methods (semi-automatic rigid) may currently aid patient education, pre-operative planning, and intra-operative guidance.
Journal of clinical medicine. 2024 Dec 04*** epublish ***
Georges Mehawed, Matthew J Roberts, Jessica Bugeja, Jason Dowling, Kate Stewart, Rivindi Gunasena, Frances Malczewski, Nicholas J Rukin, Rebecca Murray
Herston Biofabrication Institute, Metro North Health, Herston, QLD 4029, Australia., School of Medicine, University of Queensland, Herston, QLD 4029, Australia., Commonwealth Scientific and Industrial Research Organisation, Australian E-Health Research Centre, Herston, QLD 4029, Australia., Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Metro North Health, Herston, QLD 4029, Australia., Department of Radiology, Royal Brisbane and Women's Hospital, Metro North Health, Herston, QLD 4029, Australia., Department of Pathology, Royal Brisbane and Women's Hospital, Metro North Health, Herston, QLD 4029, Australia.