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Hu L, Guo X, Zhou D, Wang Z, Dai L, Li L, Li Y, Zhang T, Long H, Yu C, Shi ZW, Han C, Lu C, Zhao J, Li Y, Zha Y, Liu Z. Development and Validation of a Deep Learning Model to Reduce the Interference of Rectal Artifacts in MRI-based Prostate Cancer Diagnosis. Radiol Artif Intell 2024; 6:e230362. [PMID: 38446042 PMCID: PMC10985636 DOI: 10.1148/ryai.230362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/31/2024] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
Purpose To develop an MRI-based model for clinically significant prostate cancer (csPCa) diagnosis that can resist rectal artifact interference. Materials and Methods This retrospective study included 2203 male patients with prostate lesions who underwent biparametric MRI and biopsy between January 2019 and June 2023. Targeted adversarial training with proprietary adversarial samples (TPAS) strategy was proposed to enhance model resistance against rectal artifacts. The automated csPCa diagnostic models trained with and without TPAS were compared using multicenter validation datasets. The impact of rectal artifacts on the diagnostic performance of each model at the patient and lesion levels was compared using the area under the receiver operating characteristic curve (AUC) and the area under the precision-recall curve (AUPRC). The AUC between models was compared using the DeLong test, and the AUPRC was compared using the bootstrap method. Results The TPAS model exhibited diagnostic performance improvements of 6% at the patient level (AUC: 0.87 vs 0.81, P < .001) and 7% at the lesion level (AUPRC: 0.84 vs 0.77, P = .007) compared with the control model. The TPAS model demonstrated less performance decline in the presence of rectal artifact-pattern adversarial noise than the control model (ΔAUC: -17% vs -19%, ΔAUPRC: -18% vs -21%). The TPAS model performed better than the control model in patients with moderate (AUC: 0.79 vs 0.73, AUPRC: 0.68 vs 0.61) and severe (AUC: 0.75 vs 0.57, AUPRC: 0.69 vs 0.59) artifacts. Conclusion This study demonstrates that the TPAS model can reduce rectal artifact interference in MRI-based csPCa diagnosis, thereby improving its performance in clinical applications. Keywords: MR-Diffusion-weighted Imaging, Urinary, Prostate, Comparative Studies, Diagnosis, Transfer Learning Clinical trial registration no. ChiCTR23000069832 Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
| | | | - Dawei Zhou
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Zhen Wang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Lisong Dai
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Liang Li
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Ying Li
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Tian Zhang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Haining Long
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Chengxin Yu
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Zhen-wei Shi
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Chu Han
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Cheng Lu
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Jungong Zhao
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Yuehua Li
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Yunfei Zha
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
| | - Zaiyi Liu
- From the Guangdong Cardiovascular Institute, Guangdong Provincial
People’s Hospital, Guangdong Academy of Sciences, Guangzhou, China
(L.H.); Department of Radiology, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University, No. 106
Zhongshan Er Road, Guangzhou 510080, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image
Analysis and Application, Guangzhou, China (L.H., Z.W.S., C.H., C.L., Z.L.);
Department of TPS Algorithm, Xi’an OUR United Corporation, Xi’an,
China (X.G.); State Key Laboratory of Integrated Services Networks, School of
Telecommunications Engineering, Xidian University, Xi’an, China (D.Z.);
Department of Radiology, Yichang Central People’s Hospital Affiliated to
the First Clinical Medical College of Three Gorges University, Yichang, China
(Z.W., C.Y.); Institute of Diagnostic and Interventional Radiology, Shanghai
Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China (L.D., H.L., J.Z., Yuehua Li); and
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
(L.L., Ying Li, T.Z., Y.Z.)
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