The accurate segmentation of prostate cancer (PCa) from multiparametric MRI is crucial in clinical practice for guiding biopsy and treatment planning. Existing automated methods often lack the necessary accuracy and robustness in localizing PCa, whereas interactive segmentation methods, although more accurate, require user intervention on each input image, thereby limiting the cost-effectiveness of the segmentation workflow. Our innovative framework addresses the limitations of current methods by combining a coarse segmentation network, a rejection network, and an interactive deep network known as Segment Anything Model (SAM). The coarse segmentation network automatically generates initial segmentation results, which are evaluated by the rejection network to estimate their quality. Low-quality results are flagged for user interaction, with the user providing a region of interest (ROI) enclosing the lesions, whereas for high-quality results, ROIs were cropped from the automatic segmentation. Both manually and automatically defined ROIs are fed into SAM to produce the final fine segmentation. This approach significantly reduces the annotation burden and achieves substantial improvements by flagging approximately 20% of the images with the lowest quality scores for manual annotation. With only half of the images manually annotated, the final segmentation accuracy is statistically indistinguishable from that achieved using full manual annotation. Although this paper focuses on prostate lesion segmentation from multimodality MRI, the framework can be adapted to other medical image segmentation applications to improve segmentation efficiency while maintaining high accuracy standards.

BACKGROUND AND OBJECTIVE:Image-guided clinical diagnosis can be achieved by automatically and accurately segmenting prostate and prostatic cancer in male pelvic magnetic resonance imaging (MRI) images. For accurate tumor removal, the location, number, and size of prostate cancer are crucial, especially in surgical patients. The morphological differences between the prostate and tumor regions are small, the size of the tumor is uncertain, the boundary between the tumor and surrounding tissue is blurred, and the classification that separates the normal region from the tumor is uneven. Therefore, segmenting prostate and tumor on MRI images is challenging. METHODS:This study offers a new prostate and prostatic cancer segmentation network based on double branch attention driven multi-scale learning for MRI. To begin, the dual branch structure provides two input images with different scales for feature coding, as well as a multi-scale attention module that collects details from different scales. The features of the double branch structure are then entered into the built feature fusion module to get more complete context information. Finally, to give a more precise learning representation, each stage is built using a deep supervision mechanism. RESULTS:The results of our proposed network's prostate and tumor segmentation on a variety of male pelvic MRI data sets show that it outperforms existing techniques. For prostate and prostatic cancer MRI segmentation, the dice similarity coefficient (DSC) values were 91.65% and 84.39%, respectively. CONCLUSIONS:Our method maintains high correlation and consistency between automatic segmentation results and expert manual segmentation results. Accurate automatic segmentation of prostate and prostate cancer has important clinical significance.

Prostate cancer is one of the deadest cancers among human beings. To better diagnose the prostate cancer, prostate lesion segmentation becomes a very important work, but its progress is very slow due to the prostate lesions small in size, irregular in shape, and blurred in contour. Therefore, automatic prostate lesion segmentation from mp-MRI is a great significant work and a challenging task. However, the most existing multi-step segmentation methods based on voxel-level classification are time-consuming, may introduce errors in different steps and lead to error accumulation. To decrease the computation time, harness richer 3D spatial features, and fuse the multi-level contextual information of mp-MRI, we present an automatic segmentation method in which all steps are optimized conjointly as one step to form our end-to-end convolutional neural network. The proposed end-to-end network DMSA-V-Net consists of two parts: (1) a 3D V-Net is used as the backbone network, it is the first attempt in employing 3D convolutional neural network for CS prostate lesion segmentation, (2) a deep multi-scale attention mechanism is introduced into the 3D V-Net which can highly focus on the ROI while suppressing the redundant background. As a merit, the attention can adaptively re-align the context information between the feature maps at different scales and the saliency maps in high-levels. We performed experiments based on five cross-fold validation with data including 97 patients. The results show that the Dice and sensitivity are 0.7014 and 0.8652 respectively, which demonstrates that our segmentation approach is more significant and accurate compared to other methods.