External validation of a deep learning model for automatic segmentation of skeletal muscle and adipose tissue on abdominal CT images

David P J van Dijk*, Leroy F Volmer, Ralph Brecheisen, Bibi Martens, Ross D Dolan, Adam S Bryce, David K Chang, Donald C McMillan, Jan H M B Stoot, Malcolm A West, Sander S Rensen, Andre Dekker, Leonard Wee, Steven W M Olde Damink, Body Composition Collaborative

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives: Body composition assessment using CT images at the L3-level is increasingly applied in cancer research and has been shown to be strongly associated with long-term survival. Robust high-throughput automated segmentation is key to assess large patient cohorts and to support implementation of body composition analysis into routine clinical practice. We trained and externally validated a deep learning neural network (DLNN) to automatically segment L3-CT images. Methods: Expert-drawn segmentations of visceral and subcutaneous adipose tissue (VAT/SAT) and skeletal muscle (SM) of L3-CT-images of 3187 patients undergoing abdominal surgery were used to train a DLNN. The external validation cohort was comprised of 2535 patients with abdominal cancer. DLNN performance was evaluated with (geometric) dice similarity (DS) and Lin’s concordance correlation coefficient. Results: There was a strong concordance between automatic and manual segmentations with median DS for SM, VAT, and SAT of 0.97 (IQR: 0.95-0.98), 0.98 (IQR: 0.95-0.98), and 0.95 (IQR: 0.92-0.97), respectively. Concordance correlations were excellent: SM 0.964 (0.959-0.968), VAT 0.998 (0.998-0.998), and SAT 0.992 (0.991-0.993). Bland-Altman metrics indicated only small and clinically insignificant systematic offsets; SM radiodensity: 0.23 Hounsfield units (0.5%), SM: 1.26 cm 2.m 2 (2.8%), VAT: −1.02 cm 2.m 2 (1.7%), and SAT: 3.24 cm 2.m 2 (4.6%). Conclusion: A robustly-performing and independently externally validated DLNN for automated body composition analysis was developed. Advances in knowledge: This DLNN was successfully trained and externally validated on several large patient cohorts. The trained algorithm could facilitate large-scale population studies and implementation of body composition analysis into clinical practice.

Original languageEnglish
Pages (from-to)2015-2023
Number of pages9
JournalBritish Journal of Radiology
Volume97
Issue number1164
Early online date16 Sept 2024
DOIs
Publication statusPublished - 1 Dec 2024

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