APPIAN application to 18F-DOPA PET pediatric scans

[rosella1234]

I am a postdoc fellow at University of Genoa starting to work on pediatric PET images. First of all, I was looking for an automated image processing software for PET and I came into APPIAN. I have read both the original paper and the relative software documentation, and had a couple of questions about its implementation for my specific case.

I would like to try and automatically reproduce some image processing step conducted semi-quantitatively by a group of radiologists on a bunch of pediatric PET/CT images on subjects affected by pontine gliomas. Specifically,

• PET scanner in use is PET/CT Discovery ST system (GE Healthcare, Milwaukee, WI, USA).
• MRI examinations were performed on 1.5T and 3T (5 patients; Ingenia Cx, Philips, Best, the Netherlands) scanners
• Co-registration and fusion of 18F-DOPA PET and MR images to ensure precise anatomical comparability.
• Volumetric tumor analysis on axial 18F-DOPA PET and MRI FLAIR images. In detail, the anatomic tumor extent was delineated on MRI FLAIR images using a perimeter technique with user-assisted semi-automated software; 18F-DOPA PET tumor volume was delineated based on 18F-DOPA uptake avidity (tumoral areas with increased uptake compared to normal background reference region).
• For each patient, 18F-DOPA uniformity, defined as the percentage of the MRI tumor volume at admission (as delineated on FLAIR images) demonstrating increased 18F-DOPA PET uptake, was also calculated
• PET tumor volume was delineated on 18F-DOPA PET studies by including all voxels with standardized uptake value (SUV) above the maximum (max) SUV of the normal background reference tissue. For the normal (N) background reference tissue, a VOI (diameter 20 mm) was drawn in the normal cerebral hemisphere at the level of the left centrum semiovale, including cortical and white matter. For each case, the radiotracer concentration in the tumoral VOI was normalized to the injected dose per patient body weight, and the SUV max was obtained for each lesion [maximum pixel value (kBq/mL) within the VOI/ injected dose (kBq)/patient weight (g)]. An additional VOI was drawn over the left striatum including the entire putamen (S). Ratios of tumor to normal tissue uptake were also generated by dividing the tumor SUVmax by the SUVmax of the striatum (T/S)
• In case of absence of increased 18F-DOPA uptake, a VOI including the tumor on MRI FLAIR images was delineated on co-registered 18F-DOPA PET images to generate T/S and T/N ratios.

Is it possible to automatically perform all aforementioned steps through your platflorm?
thank you so much in advance,
Rosella Trò