Treatment Response Assessment for Bladder Cancer on CT Based on Computerized Volume Analysis, World Health Organization Criteria, and RECIST

OBJECTIVE. The purpose of this study was to evaluate the accuracy of our autoinitialized cascaded level set 3D segmentation system as compared with the World Health Organization (WHO) criteria and the Response Evaluation Criteria In Solid Tumors (RECIST) for estimation of treatment response of bladder cancer in CT urography. MATERIALS AND METHODS. CT urograms before and after neoadjuvant chemotherapy treatment were collected from 18 patients with muscle-invasive localized or locally advanced bladder cancers. The disease stage as determined on pathologic samples at cystectomy after chemotherapy was considered as reference standard of treatment response. Two radiologists measured the longest diameter and its perpendicular on the pre- and posttreatment scans. Full 3D contours for all tumors were manually outlined by one radiologist. The autoinitialized cascaded level set method was used to automatically extract 3D tumor boundary. The prediction accuracy of pTO disease (complete response) at cystectomy was estimated by the manual, autoinitialized cascaded level set, WHO, and RECIST methods on the basis of the AUC. RESULTS. The AUC for prediction of pTO disease at cystectomy was 0.78 +/- 0.11 for autoinitialized cascaded level set compared with 0.82 +/- 0.10 for manual segmentation. The difference did not reach statistical significance (p = 0.67). The AUCs using RECIST criteria were 0.62 +/- 0.16 and 0.71 +/- 0.12 for the two radiologists, both lower than those of the two 3D methods. The AUCs using WHO criteria were 0.56 +/- 0.15 and 0.60 +/- 0.13 and thus were lower than all other methods. CONCLUSION. The pre-and posttreatment 3D volume change estimates obtained by the radiologist's manual outlines and the autoinitialized cascaded level set segmentation were more accurate for irregularly shaped tumors than were those based on RECIST and WHO criteria.