Out-of-distribution multi-view auto-encoders for prostate cancer lesion detection

Traditional deep learning (DL) approaches based on supervised learning paradigms require large amounts of annotated data that are rarely available in the medical domain. Unsupervised Out-of-distribution (OOD) detection is an alternative that requires less annotated data. Further, OOD applications exploit the class skewness commonly present in medical data. Magnetic resonance imaging (MRI) has proven to be useful for prostate cancer (PCa) diagnosis and management, but current DL approaches rely on T2w axial MRI, which suffers from low out-of-plane resolution. We propose a multi-stream approach to accommodate different T2w directions to improve the performance of PCa lesion detection in an OOD approach. We evaluate our approach on a publicly available data-set, obtaining better detection results in terms of AUC when compared to a single direction approach (73.1 vs 82.3). Our results show the potential of OOD approaches for PCa lesion detection based on MRI.

Prostate Age Gap (PAG): An MRI surrogate marker of aging for prostate cancer detection

Background: Prostate cancer (PC) MRI-based risk calculators are commonly based on biological (e.g. PSA), MRI markers (e.g. volume), and patient age. Whilst patient age measures the amount of years an individual has existed, biological age (BA) might better reflect the physiology of an individual. However, surrogates from prostate MRI and linkage with clinically significant PC (csPC) remain to be explored. Purpose: To obtain and evaluate Prostate Age Gap (PAG) as an MRI marker tool for csPC risk. Study type: Retrospective. Population: A total of 7243 prostate MRI slices from 468 participants who had undergone prostate biopsies. A deep learning model was trained on 3223 MRI slices cropped around the gland from 81 low-grade PC (ncsPC, Gleason score <=6) and 131 negative cases and tested on the remaining 256 participants. Assessment: Chronological age was defined as the age of the participant at the time of the visit and used to train the deep learning model to predict the age of the patient. Following, we obtained PAG, defined as the model predicted age minus the patient's chronological age. Multivariate logistic regression models were used to estimate the association through odds ratio (OR) and predictive value of PAG and compared against PSA levels and PI-RADS>=3. Statistical tests: T-test, Mann-Whitney U test, Permutation test and ROC curve analysis. Results: The multivariate adjusted model showed a significant difference in the odds of clinically significant PC (csPC, Gleason score >=7) (OR =3.78, 95% confidence interval (CI):2.32-6.16, P <.001). PAG showed a better predictive ability when compared to PI-RADS>=3 and adjusted by other risk factors, including PSA levels: AUC =0.981 vs AUC =0.704, p<.001. Conclusion: PAG was significantly associated with the risk of clinically significant PC and outperformed other well-established PC risk factors.

3D Masked Modelling Advances Lesion Classification in Axial T2w Prostate MRI

Masked Image Modelling (MIM) has been shown to be an efficient self-supervised learning (SSL) pre-training paradigm when paired with transformer architectures and in the presence of a large amount of unlabelled natural images. The combination of the difficulties in accessing and obtaining large amounts of labeled data and the availability of unlabelled data in the medical imaging domain makes MIM an interesting approach to advance deep learning (DL) applications based on 3D medical imaging data. Nevertheless, SSL and, in particular, MIM applications with medical imaging data are rather scarce and there is still uncertainty. around the potential of such a learning paradigm in the medical domain. We study MIM in the context of Prostate Cancer (PCa) lesion classification with T2 weighted (T2w) axial magnetic resonance imaging (MRI) data. In particular, we explore the effect of using MIM when coupled with convolutional neural networks (CNNs) under different conditions such as different masking strategies, obtaining better results in terms of AUC than other pre-training strategies like ImageNet weight initialization.

Self-transfer learning via patches: A prostate cancer triage approach based on bi-parametric MRI

Prostate cancer (PCa) is the second most common cancer diagnosed among men worldwide. The current PCa diagnostic pathway comes at the cost of substantial overdiagnosis, leading to unnecessary treatment and further testing. Bi-parametric magnetic resonance imaging (bp-MRI) based on apparent diffusion coefficient maps (ADC) and T2-weighted (T2w) sequences has been proposed as a triage test to differentiate between clinically significant (cS) and non-clinically significant (ncS) prostate lesions. However, analysis of the sequences relies on expertise, requires specialized training, and suffers from inter-observer variability. Deep learning (DL) techniques hold promise in tasks such as classification and detection. Nevertheless, they rely on large amounts of annotated data which is not common in the medical field. In order to palliate such issues, existing works rely on transfer learning (TL) and ImageNet pre-training, which has been proven to be sub-optimal for the medical imaging domain. In this paper, we present a patch-based pre-training strategy to distinguish between cS and ncS lesions which exploit the region of interest (ROI) of the patched source domain to efficiently train a classifier in the full-slice target domain which does not require annotations by making use of transfer learning (TL). We provide a comprehensive comparison between several CNNs architectures and different settings which are presented as a baseline. Moreover, we explore cross-domain TL which exploits both MRI modalities and improves single modality results. Finally, we show how our approaches outperform the standard approaches by a considerable margin

Improving prostate whole gland segmentation in t2-weighted MRI with synthetically generated data

Whole gland (WG) segmentation of the prostate plays a crucial role in detection, staging and treatment planning of prostate cancer (PCa). Despite promise shown by deep learning (DL) methods, they rely on the availability of a considerable amount of annotated data. Augmentation techniques such as translation and rotation of images present an alternative to increase data availability. Nevertheless, the amount of information provided by the transformed data is limited due to the correlation between the generated data and the original. Based on the recent success of generative adversarial networks (GAN) in producing synthetic images for other domains as well as in the medical domain, we present a pipeline to generate WG segmentation masks and synthesize T2-weighted MRI of the prostate based on a publicly available multi-center dataset. Following, we use the generated data as a form of data augmentation. Results show an improvement in the quality of the WG segmentation when compared to standard augmentation techniques.