Automatic zonal segmentation of the prostate from 2D and 3D T2-weighted MRI and evaluation for clinical use

Purpose: An accurate zonal segmentation of the prostate is required for prostate cancer (PCa) management with MRI. Approach: The aim of this work is to present UFNet, a deep learning-based method for automatic zonal segmentation of the prostate from T2-weighted (T2w) MRI. It takes into account the image anisotropy, includes both spatial and channelwise attention mechanisms and uses loss functions to enforce prostate partition. The method was applied on a private multicentric three-dimensional T2w MRI dataset and on the public two-dimensional T2w MRI dataset ProstateX. To assess the model performance, the structures segmented by the algorithm on the private dataset were compared with those obtained by seven radiologists of various experience levels. Results: On the private dataset, we obtained a Dice score (DSC) of $$ for the whole gland (WG), $$ for the transition zone (TZ), and $$ for the peripheral zone (PZ). Results were significantly better than other compared networks' ( $$ ). On ProstateX, we obtained a DSC of $$ for WG, $$ for TZ, and $$ for PZ. These results are similar to state-of-the art results and, on the private dataset, are coherent with those obtained by radiologists. Zonal locations and sectorial positions of lesions annotated by radiologists were also preserved. Conclusions: Deep learning-based methods can provide an accurate zonal segmentation of the prostate leading to a consistent zonal location and sectorial position of lesions, and therefore can be used as a helping tool for PCa diagnosis.