Abstract

ObjectiveTo establish and evaluate the 3D U-Net model for automated segmentation and detection of pelvic bone metastases in patients with prostate cancer (PCa) using diffusion-weighted imaging (DWI) and T1 weighted imaging (T1WI) images.MethodsThe model consisted of two 3D U-Net algorithms. A total of 859 patients with clinically suspected or confirmed PCa between January 2017 and December 2020 were enrolled for the first 3D U-Net development of pelvic bony structure segmentation. Then, 334 PCa patients were selected for the model development of bone metastases segmentation. Additionally, 63 patients from January to May 2021 were recruited for the external evaluation of the network. The network was developed using DWI and T1WI images as input. Dice similarity coefficient (DSC), volumetric similarity (VS), and Hausdorff distance (HD) were used to evaluate the segmentation performance. Sensitivity, specificity, and area under the curve (AUC) were used to evaluate the detection performance at the patient level; recall, precision, and F1-score were assessed at the lesion level.ResultsThe pelvic bony structures segmentation on DWI and T1WI images had mean DSC and VS values above 0.85, and the HD values were <15 mm. In the testing set, the AUC of the metastases detection at the patient level were 0.85 and 0.80 on DWI and T1WI images. At the lesion level, the F1-score achieved 87.6% and 87.8% concerning metastases detection on DWI and T1WI images, respectively. In the external dataset, the AUC of the model for M-staging was 0.94 and 0.89 on DWI and T1WI images.ConclusionThe deep learning-based 3D U-Net network yields accurate detection and segmentation of pelvic bone metastases for PCa patients on DWI and T1WI images, which lays a foundation for the whole-body skeletal metastases assessment.

Highlights

  • The nature of bone marrow makes it a favorite fertile soil into which prostate tumors incline to colonize and grow [1, 2]; up to 84% of patients with advanced prostate cancer (PCa) experience bone metastases [3], and more than 80% PCa patients developed relapse in the bone following treatment of the primary site [4]

  • Bone scintigraphy (BS) and computed tomography (CT) scans were endorsed as the standard imaging method in the staging and follow-up of metastatic PCa [6], while it is gradually clear that the reduced accuracy of BS and CT in the detection and therapeutic response evaluation of bone metastases reduces their effectiveness in therapy management [7]

  • As detailed in the Supplementary materials (Supplementary Tables S1–S4), no significant difference was found among the patients from different datasets and different scanners (3.0 T Discovery vs. 3.0 T Achieva vs. 3.0 T Intera) on both diffusion-weighted imaging (DWI) and T1 weighted imaging (T1WI)-IP images

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Summary

Introduction

The nature of bone marrow makes it a favorite fertile soil into which prostate tumors incline to colonize and grow [1, 2]; up to 84% of patients with advanced prostate cancer (PCa) experience bone metastases [3], and more than 80% PCa patients developed relapse in the bone following treatment of the primary site [4]. Bone scintigraphy (BS) and computed tomography (CT) scans were endorsed as the standard imaging method in the staging and follow-up of metastatic PCa [6], while it is gradually clear that the reduced accuracy of BS and CT in the detection and therapeutic response evaluation of bone metastases reduces their effectiveness in therapy management [7]. The value of volumetric measurements for assessing treatment response has been increasingly discussed, and the measurements of lesion volume on mpMRI should be undertaken on high-quality T1WI images according to the METastasis Reporting and Data System (MET-RADS) for PCa [9]. The detection and delineation of metastases and evaluation of volume change concerning disease progression or therapy on DWI and T1WI images are key tasks as part of optimal patient management

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