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Objective  To identify the impact of segmentation methods and intensity discretization on radiomic features (RFs) extraction from  68 Ga-DOTA-TOC PET images in patients with neuroendocrine tumors.    Methods  Forty-nine patients were retrospectively analyzed. Tumor contouring was performed manually by four different operators and with a semi-automatic edge-based segmentation (SAEB) algorithm. Three SUV max  fixed thresholds (20, 30, 40%) were applied. Fifty-one RFs were extracted applying two different intensity rescale factors for gray-level discretization: one absolute (AR60 = SUV from 0 to 60) and one relative (RR = min-max of the VOI SUV). Dice similarity coefficient (DSC) was calculated to quantify segmentation agreement between different segmentation methods. The impact of segmentation and discretization on RFs was assessed by intra-class correlation coefficients (ICC) and the coefficient of variance (COV  L  ). The RFs’ correlation with volume and SUV max  was analyzed by calculating Pearson’s correlation coefficients.    Results  DSC mean value was 0.75 ± 0.11 (0.45–0.92) between SAEB and operators and 0.78 ± 0.09 (0.36–0.97), among the four manual segmentations. The study showed high robustness (ICC > 0.9): (a) in 64.7% of RFs for segmentation methods using AR60, improved by applying SUV max  threshold of 40% (86.5%); (b) in 50.9% of RFs for different SUV max  thresholds using AR60; and (c) in 37% of RFs for discretization settings using different segmentation methods. Several RFs were not correlated with volume and SUV max .    Conclusions  RFs robustness to manual segmentation resulted higher in NET  68 Ga-DOTA-TOC images compared to  18 F-FDG PET/CT images. Forty percent SUV max  thresholds yield superior RFs stability among operators, however leading to a possible loss of biological information. SAEB segmentation appears to be an optimal alternative to manual segmentation, but further validations are needed. Finally, discretization settings highly impacted on RFs robustness and should always be stated.    Supplementary Information  The online version contains supplementary material available at 10.1186/s40658-021-00367-6.

Impact of segmentation and discretization on radiomic features in 68Ga-DOTA-TOC PET/CT images of neuroendocrine tumor