Application of artificial intelligence in head and neck tumor segmentation: a comparative systematic review and meta-analysis between PET and PET/CT modalities
Abstract
Background: For the effective treatment planning of head and neck cancers, precise tumor segmentation is vital. The combination of artificial intelligence (AI) technology with imaging systems like positron emission tomography (PET) and PET/ computed tomography (PET/CT) has made attempts to automate these processes. Despite these attempts, the usefulness of AI segmentation with PET imaging compared to PET/CT still lacks clarity.
Methods: A comprehensive search was performed on Scopus, Embase, PubMed, Cochrane, Web of Science, and Google Scholar for studies published before Dec 2024, with an update in March 2025. Included studies utilized AI algorithms to segment head and neck tumors via PET or PET/CT and provided quantitative performance measures. Pooled estimates of Dice Similarity Coefficient (DSC) sensitivity, precision, and Hausdorff Distance (HD95) were calculated using a random-effects model. Also, sensitivity analyses were performed to find the potential source of heterogeneity. Additionally, subgroup analyses were conducted for overall and primary tumor segmentation. Publication bias was assessed using weighted Egger's test, followed by presentation of funnel plots for different metrics. Risk of bias (RoB) was evaluated using the QUADAS-C tool. Also, CLAIM was used to assess methodological quality and robustness of the included studies.
Results: Eleven studies were included. All included studies were rated as having a low risk of bias. Also, CLAIM scores showed a high…
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