Deep Learning Network for Segmentation of the Prostate Gland With Median Lobe Enlargement in T2-weighted MR Images: Comparison With Manual Segmentation Method

Deep Learning Prostate MRI Segmentation Accuracy and Robustness: A Systematic Review

Purpose To investigate the accuracy and robustness of prostate segmentation using deep learning across various training data sizes, MRI vendors, prostate zones, and testing methods relative to fellowship-trained diagnostic radiologists. Materials and Methods In this systematic review, Embase, PubMed, Scopus, and Web of Science databases were queried for English-language articles using keywords and related terms for prostate MRI segmentation and deep learning algorithms dated to July 31, 2022. A total of 691 articles from the search query were collected and subsequently filtered to 48 on the basis of predefined inclusion and exclusion criteria. Multiple characteristics were extracted from selected studies, such as deep learning algorithm performance, MRI vendor, and training dataset features. The primary outcome was comparison of mean Dice similarity coefficient (DSC) for prostate segmentation for deep learning algorithms versus diagnostic radiologists. Results Forty-eight studies were included. Most published deep learning algorithms for whole prostate gland segmentation (39 of 42 [93%]) had a DSC at or above expert level (DSC ≥ 0.86). The mean DSC was 0.79 ± 0.06 (SD) for peripheral zone, 0.87 ± 0.05 for transition zone, and 0.90 ± 0.04 for whole prostate gland segmentation. For selected studies that used one major MRI vendor, the mean DSCs of each were as follows: General Electric (three of 48 studies), 0.92 ± 0.03; Philips (four of 48 studies), 0.92 ± 0.02; and Siemens (six of 48 studies), 0.91 ± 0.03. Conclusion Deep learning algorithms for prostate MRI segmentation demonstrated accuracy similar to that of expert radiologists despite varying parameters; therefore, future research should shift toward evaluating segmentation robustness and patient outcomes across diverse clinical settings. Keywords: MRI, Genital/Reproductive, Prostate Segmentation, Deep Learning Systematic review registration link: osf.io/nxaev © RSNA, 2024.

PSMA-positive prostatic volume prediction with deep learning based on T2-weighted MRI

PURPOSE

High PSMA expression might be correlated with structural characteristics such as growth patterns on histopathology, not recognized by the human eye on MRI images. Deep structural image analysis might be able to detect such differences and therefore predict if a lesion would be PSMA positive. Therefore, we aimed to train a neural network based on PSMA PET/MRI scans to predict increased prostatic PSMA uptake based on the axial T2-weighted sequence alone.

MATERIAL AND METHODS

All patients undergoing simultaneous PSMA PET/MRI for PCa staging or biopsy guidance between April 2016 and December 2020 at our institution were selected. To increase the specificity of our model, the prostatic beds on PSMA PET scans were dichotomized in positive and negative regions using an SUV threshold greater than 4 to generate a PSMA PET map. Then, a C-ENet was trained on the T2 images of the training cohort to generate a predictive prostatic PSMA PET map.

RESULTS

One hundred and fifty-four PSMA PET/MRI scans were available (133 [68Ga]Ga-PSMA-11 and 21 [18F]PSMA-1007). Significant cancer was present in 127 of them. The whole dataset was divided into a training cohort (n = 124) and a test cohort (n = 30). The C-ENet was able to predict the PSMA PET map with a dice similarity coefficient of 69.5 ± 15.6%.

CONCLUSION

Increased prostatic PSMA uptake on PET might be estimated based on T2 MRI alone. Further investigation with larger cohorts and external validation is needed to assess whether PSMA uptake can be predicted accurately enough to help in the interpretation of mpMRI.

A Critical Analysis of the Robustness of Radiomics to Variations in Segmentation Methods in 18F-PSMA-1007 PET Images of Patients Affected by Prostate Cancer

BACKGROUND

Radiomics shows promising results in supporting the clinical decision process, and much effort has been put into its standardization, thus leading to the Imaging Biomarker Standardization Initiative (IBSI), that established how radiomics features should be computed. However, radiomics still lacks standardization and many factors, such as segmentation methods, limit study reproducibility and robustness.

AIM

We investigated the impact that three different segmentation methods (manual, thresholding and region growing) have on radiomics features extracted from 18F-PSMA-1007 Positron Emission Tomography (PET) images of 78 patients (43 Low Risk, 35 High Risk). Segmentation was repeated for each patient, thus leading to three datasets of segmentations. Then, feature extraction was performed for each dataset, and 1781 features (107 original, 930 Laplacian of Gaussian (LoG) features, 744 wavelet features) were extracted. Feature robustness and reproducibility were assessed through the intra class correlation coefficient (ICC) to measure agreement between the three segmentation methods. To assess the impact that the three methods had on machine learning models, feature selection was performed through a hybrid descriptive-inferential method, and selected features were given as input to three classifiers, K-Nearest Neighbors (KNN), Support Vector Machines (SVM), Linear Discriminant Analysis (LDA), Random Forest (RF), AdaBoost and Neural Networks (NN), whose performance in discriminating between low-risk and high-risk patients have been validated through 30 times repeated five-fold cross validation.

CONCLUSIONS

Our study showed that segmentation methods influence radiomics features and that Shape features were the least reproducible (average ICC: 0.27), while GLCM features the most reproducible. Moreover, feature reproducibility changed depending on segmentation type, resulting in 51.18% of LoG features exhibiting excellent reproducibility (range average ICC: 0.68-0.87) and 47.85% of wavelet features exhibiting poor reproducibility that varied between wavelet sub-bands (range average ICC: 0.34-0.80) and resulted in the LLL band showing the highest average ICC (0.80). Finally, model performance showed that region growing led to the highest accuracy (74.49%), improved sensitivity (84.38%) and AUC (79.20%) in contrast with manual segmentation.

Prostate volume analysis in image registration for prostate cancer care: a verification study

Combined magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) may enhance diagnosis, aid surgical planning and intra-operative orientation for prostate biopsy and radical prostatectomy. Although PET-MRI may provide these benefits, PET-MRI machines are not widely available. Image fusion of Prostate specific membrane antigen PET/CT and MRI acquired separately may be a suitable clinical alternative. This study compares CT-MR registration algorithms for urological prostate cancer care. Paired whole-pelvis MR and CT scan data were used (n = 20). A manual prostate CTV contour was performed independently on each patients MR and CT image. A semi-automated rigid-, automated rigid- and automated non-rigid registration technique was applied to align the MR and CT data. Dice Similarity Index (DSI), 95% Hausdorff distance (95%HD) and average surface distance (ASD) measures were used to assess the closeness of the manual and registered contours. The automated non-rigid approach had a significantly improved performance compared to the automated rigid- and semi-automated rigid-registration, having better average scores and decreased spread for the DSI, 95%HD and ASD (all p < 0.001). Additionally, the automated rigid approach had similar significantly improved performance compared to the semi-automated rigid registration across all accuracy metrics observed (all p < 0.001). Overall, all registration techniques studied here demonstrated sufficient accuracy for exploring their clinical use. While the fully automated non-rigid registration algorithm in the present study provided the most accurate registration, the semi-automated rigid registration is a quick, feasible, and accessible method to perform image registration for prostate cancer care by urologists and radiation oncologists now.

A semiautomatic segmentation method framework for pelvic bone tumors based on CT-MR multimodal images

The pelvic structure is complex and the tumor is poorly defined from the surrounding tissues. Finding the exact tumor resection margin based on the surgeon's clinical experience alone is a time-consuming and difficult task, which is a major factor leading to surgical failure. An accurate method for segmenting pelvic bone tumors is needed. In this paper, a semiautomatic segmentation method for pelvic bone tumors based on CT-MR multimodal images is presented. The method combines multiple medical prior knowledge and image segmentation algorithms. Finally, the segmentation results are visualized in three dimensions. We tested the proposed method on a collection of 10 cases (97 tumor MR images in total). The segmentation results were compared with the manual annotation of the physicians. On average, our method has an accuracy of 0.9358, a recall of 0.9278, an IOU value of 0.8697, a Dice value of 0.9280, and an AUC value of 0.9632. The average error of the 3D model was within the allowable range of the surgery. The proposed algorithm can accurately segment bone tumors in pelvic MR images regardless of tumor location, size, and other factors. It provides the possibility to assist pelvic bone tumor preservation surgery.

Deep learning algorithm performs similarly to radiologists in the assessment of prostate volume on MRI

OBJECTIVES

Prostate volume (PV) in combination with prostate specific antigen (PSA) yields PSA density which is an increasingly important biomarker. Calculating PV from MRI is a time-consuming, radiologist-dependent task. The aim of this study was to assess whether a deep learning algorithm can replace PI-RADS 2.1 based ellipsoid formula (EF) for calculating PV.

METHODS

Eight different measures of PV were retrospectively collected for each of 124 patients who underwent radical prostatectomy and preoperative MRI of the prostate (multicenter and multi-scanner MRI's 1.5 and 3 T). Agreement between volumes obtained from the deep learning algorithm (PV_DL) and ellipsoid formula by two radiologists (PV_EF1 and PV_EF2) was evaluated against the reference standard PV obtained by manual planimetry by an expert radiologist (PV_MPE). A sensitivity analysis was performed using a prostatectomy specimen as the reference standard. Inter-reader agreement was evaluated between the radiologists using the ellipsoid formula and between the expert and inexperienced radiologists performing manual planimetry.

RESULTS

PV_DL showed better agreement and precision than PV_EF1 and PV_EF2 using the reference standard PV_MPE (mean difference [95% limits of agreement] PV_DL: -0.33 [-10.80; 10.14], PV_EF1: -3.83 [-19.55; 11.89], PV_EF2: -3.05 [-18.55; 12.45]) or the PV determined based on specimen weight (PV_DL: -4.22 [-22.52; 14.07], PV_EF1: -7.89 [-30.50; 14.73], PV_EF2: -6.97 [-30.13; 16.18]). Inter-reader agreement was excellent between the two experienced radiologists using the ellipsoid formula and was good between expert and inexperienced radiologists performing manual planimetry.

CONCLUSION

Deep learning algorithm performs similarly to radiologists in the assessment of prostate volume on MRI.

KEY POINTS

• A commercially available deep learning algorithm performs similarly to radiologists in the assessment of prostate volume on MRI. • The deep-learning algorithm was previously untrained on this heterogenous multicenter day-to-day practice MRI data set.

Deep Learning Networks for Automatic Retroperitoneal Sarcoma Segmentation in Computerized Tomography

The volume estimation of retroperitoneal sarcoma (RPS) is often difficult due to its huge dimensions and irregular shape; thus, it often requires manual segmentation, which is time-consuming and operator-dependent. This study aimed to evaluate two fully automated deep learning networks (ENet and ERFNet) for RPS segmentation. This retrospective study included 20 patients with RPS who received an abdominal computed tomography (CT) examination. Forty-nine CT examinations, with a total of 72 lesions, were included. Manual segmentation was performed by two radiologists in consensus, and automatic segmentation was performed using ENet and ERFNet. Significant differences between manual and automatic segmentation were tested using the analysis of variance (ANOVA). A set of performance indicators for the shape comparison (namely sensitivity), positive predictive value (PPV), dice similarity coefficient (DSC), volume overlap error (VOE), and volumetric differences (VD) were calculated. There were no significant differences found between the RPS volumes obtained using manual segmentation and ENet (p-value = 0.935), manual segmentation and ERFNet (p-value = 0.544), or ENet and ERFNet (p-value = 0.119). The sensitivity, PPV, DSC, VOE, and VD for ENet and ERFNet were 91.54% and 72.21%, 89.85% and 87.00%, 90.52% and 74.85%, 16.87% and 36.85%, and 2.11% and -14.80%, respectively. By using a dedicated GPU, ENet took around 15 s for segmentation versus 13 s for ERFNet. In the case of CPU, ENet took around 2 min versus 1 min for ERFNet. The manual approach required approximately one hour per segmentation. In conclusion, fully automatic deep learning networks are reliable methods for RPS volume assessment. ENet performs better than ERFNet for automatic segmentation, though it requires more time.