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Purpose: The main purpose of this study was to assess the reliability ofshape and heterogeneity features in both Positron Emission Tomography (PET) andlow-dose Computed Tomography (CT) components of PET/CT. A secondary objectivewas to investigate the impact of image quantization.Material and methods: AHealth Insurance Portability and Accountability Act -compliant secondaryanalysis of deidentified prospectively acquired PET/CT test-retest datasets of74 patients from multi-center Merck and ACRIN trials was performed.Metabolically active volumes were automatically delineated on PET with FuzzyLocally Adaptive Bayesian algorithm. 3DSlicerTM was used to semi-automaticallydelineate the anatomical volumes on low-dose CT components. Two quantizationmethods were considered: a quantization into a set number of bins(quantizationB) and an alternative quantization with bins of fixed width(quantizationW). Four shape descriptors, ten first-order metrics and 26textural features were computed. Bland-Altman analysis was used to quantifyrepeatability. Features were subsequently categorized as very reliable,reliable, moderately reliable and poorly reliable with respect to thecorresponding volume variability. Results: Repeatability was highly variableamongst features. Numerous metrics were identified as poorly or moderatelyreliable. Others were (very) reliable in both modalities, and in all categories(shape, 1st-, 2nd- and 3rd-order metrics). Image quantization played a majorrole in the features repeatability. Features were more reliable in PET withquantizationB, whereas quantizationW showed better results in CT.Conclusion:The test-retest repeatability of shape and heterogeneity features in PET andlow-dose CT varied greatly amongst metrics. The level of repeatability alsodepended strongly on the quantization step, with different optimal choices foreach modality. The repeatability of PET and low-dose CT features should becarefully taken into account when selecting metrics to build multiparametricmodels.

Reliability of PET/CT shape and heterogeneity features in functional and  morphological components of Non-Small Cell Lung Cancer tumors: a  repeatability analysis in a prospective multi-center cohort