  Segmentation of lymphoma lesions is challenging due to their varied sizes and
locations in whole-body PET scans. This work presents a fully-automated
segmentation technique using a multi-center dataset of diffuse large B-cell
lymphoma (DLBCL) with heterogeneous characteristics. We utilized a dataset of
[18F]FDG-PET scans (n=194) from two different imaging centers, including cases
with primary mediastinal large B-cell lymphoma (PMBCL) (n=104). Automated brain
and bladder removal approaches were utilized as preprocessing steps to tackle
false positives caused by normal hypermetabolic uptake in these organs. Our
segmentation model is a convolutional neural network (CNN) based on a 3D U-Net
architecture that includes squeeze and excitation (SE) modules. Hybrid
distribution, region, and boundary-based losses (Unified Focal and Mumford-Shah
(MS)) were utilized that showed the best performance compared to other
combinations (p<0.05). Cross-validation between different centers, DLBCL and
PMBCL cases, and three random splits were applied on train/validation data. The
ensemble of these six models achieved a Dice similarity coefficient (DSC) of
0.77 +- 0.08 and Hausdorff distance (HD) of 16.5 +-12.5. Our 3D U-net model
with SE modules for segmentation with hybrid loss performed significantly
better (p<0.05) as compared to the 3D U-Net (without SE modules) using the same
loss function (Unified Focal and MS loss) (DSC= 0.64 +-0.21 and HD= 26.3 +-
18.7). Our model can facilitate a fully automated quantification pipeline in a
multi-center context that opens the possibility for routine reporting of total
metabolic tumor volume (TMTV) and other metrics shown useful for the management
of lymphoma.
