| Sumario: | Purpose: This study aims to develop and evaluate deep learning models for the detection and classification of hypermetabolic lung lesions into four categories: benign, lung cancer, pulmonary lymphoma, and metastasis. These categories are defined by their pathological origin, clinical relevance, and therapeutic implications. Methods: A lesion localisation model was first developed using manually annotated PET/CT images. For classification, a multi-dimensional joint network was employed, incorporating both image patches and two-dimensional projections. Classification performance was quantified by metrics like accuracy, and compared to that of a radiomics model. Additionally, false-positive segmentations were manually reviewed and analysed for clinical evaluation. Results: The study retrospectively included 647 cases (409 males/238 females) over more than 8 years from five centres, divided into an internal dataset (426 cases from Shanghai Ruijin Hospital), an external test set I (151 cases from four other institutions), and an external test set II (70 cases from a new imaging device). The localisation model achieved detection rates of 81.19%, 75.48%, and 77.59% on the internal, external test set I, and external test set II, respectively. The classification model outperformed the radiomics approach, with area-under-curves of 88.4%, 80.7%, and 66.6%, respectively. Most false-positive segmentations were clinically acceptable, corresponding to suspicious lesions in adjacent regions, particularly lymph nodes. Conclusion: Deep learning models based on PET/CT imaging can effectively detect, segment, and classify hypermetabolic lung lesions, and identify suspicious adjacent lesions. These results highlight the potential of artificial intelligence in clinical decision-making and lung disease diagnosis.
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