Development and Validation of an Algorithm for Segmentation of the Prostate and its Zones from Three-dimensional Transrectal Multiparametric Ultrasound Images

We developed a deep learning algorithm for automated prostate and zonal segmentation of three-dimensional ultrasound images. This tool demonstrated high accuracy, closely matching expert assessments, and holds promise for improving prostate cancer diagnosis and streamlining imaging workflows in clinical practice. Multiparametric ultrasound (mpUS) is being investigated as an alternative to magnetic resonance imaging (MRI) for detection of prostate cancer (PC). Automated prostate segmentation facilitates workflows, and zonal segmentation can aid in PC diagnosis, accounting for differences in imaging characteristics and tumor incidence. Our aim was to develop a deep learning algorithm that can automatically segment the prostate and its zones on three-dimensional (3D) contrast-enhanced ultrasound (CEUS) and conventional brightness-mode (B-mode) images (NCT04605276). A total of 259 3D mpUS images were collected from men with suspicion for PC in a prospective multicenter trial to develop a computer-aided diagnosis system for PC. Manual segmentation was performed using a custom tool, and an algorithm was developed using a convolutional neural network based on the U-Net architecture. Cross-validation of the automated segmentation algorithm revealed Dice similarity coefficients (DSCs) of 0.91 (95% confidence interval [CI] 0.90–0.91) for CEUS and 0.94 (95% CI 0.93–0.94) for B-mode ultrasound for 3D prostate segmentation. Zonal segmentation was less accurate, with DSCs of 0.83 (95% CI 0.82–0.84) for CEUS and 0.86 (95% CI 0.85–0.87) for B-mode ultrasound. There was high agreement for prostate volume between automatic segmentation on CEUS and physician-estimated volumes on MRI (R 2 = 0.96). Qualitative assessment of prostate segmentation using a scale from 1 to 5 revealed a median grade of 5 (interquartile range [IQR] 4–5) for manual segmentation and 4 (IQR 4–5) for automated segmentation ( p = 0.10). Our deep learning algorithm demonstrated strong performance for automatic prostate and zonal segmentation from 3D CEUS and B-mode ultrasound images. We developed a computer tool to automatically identify the prostate in three-dimensional ultrasound images. The results show high accuracy and closely match manual assessments by urologists. This tool has potential for use in a computer-aided diagnostic system for prostate cancer.