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Background  The accurate definition of gross tumor volume (GTV) of esophageal squamous cell carcinoma (ESCC) can promote precise irradiation field determination, and further achieve the radiotherapy curative effect. This retrospective study is intended to assess the applicability of leveraging deep learning-based method to automatically define the GTV from 3D  18 F-FDG PET/CT images of patients diagnosed with ESCC.    Methods  We perform experiments on a clinical cohort with 164  18 F-FDG PET/CT scans. The state-of-the-art esophageal GTV segmentation deep neural net is first employed to delineate the lesion area on PET/CT images. Afterwards, we propose a novel equivalent truncated elliptical cone integral method (ETECIM) to estimate the GTV value. Indexes of Dice similarity coefficient (DSC), Hausdorff distance (HD), and mean surface distance (MSD) are used to evaluate the segmentation performance. Conformity index (CI), degree of inclusion (DI), and motion vector (MV) are used to assess the differences between predicted and ground truth tumors. Statistical differences in the GTV, DI, and position are also determined.    Results  We perform 4-fold cross-validation for evaluation, reporting the values of DSC, HD, and MSD as 0.72 ± 0.02, 11.87 ± 4.20 mm, and 2.43 ± 0.60 mm (mean ± standard deviation), respectively. Pearson correlations (R 2 ) achieve 0.8434, 0.8004, 0.9239, and 0.7119 for each fold cross-validation, and there is no significant difference ( t  = 1.193,  p  = 0.235) between the predicted and ground truth GTVs. For DI, a significant difference is found ( t  = −2.263,  p  = 0.009). For position assessment, there is no significant difference (left-right in x direction:  t  = 0.102,  p  = 0.919, anterior–posterior in y direction:  t  = 0.221,  p  = 0.826, and cranial–caudal in z direction:  t  = 0.569,  p  = 0.570) between the predicted and ground truth GTVs. The median of CI is 0.63, and the gotten MV is small.    Conclusions  The predicted tumors correspond well with the manual ground truth. The proposed GTV estimation approach ETECIM is more precise than the most commonly used voxel volume summation method. The ground truth GTVs can be solved out due to the good linear correlation with the predicted results. Deep learning-based method shows its promising in GTV definition and clinical radiotherapy application.

Gross Tumor Volume Definition and Comparative Assessment for Esophageal Squamous Cell Carcinoma From 3D 18F-FDG PET/CT by Deep Learning-Based Method