Weakly Supervised MR-TRUS Image Synthesis for Brachytherapy of Prostate Cancer

Prostate magnetic resonance imaging (MRI) offers accurate details of structures and tumors for prostate cancer brachytherapy. However, it is unsuitable for routine treatment since MR images differ significantly from trans-rectal ultrasound (TRUS) images conventionally used for radioactive seed implants in brachytherapy. TRUS imaging is fast, convenient, and widely available in the operation room but is known for its low soft-tissue contrast and tumor visualization capability in the prostate area. Conventionally, practitioners usually rely on prostate segmentation to fuse the two imaging modalities with non-rigid registration. However, prostate delineation is often not available on diagnostic MR images. Besides, the high non-linear intensity relationship between two imaging modalities poses a challenge to non-rigid registration. Hence, we propose a method to generate a TRUS-styled image from a prostate MR image to replace the role of the TRUS image in radiation therapy dose pre-planning. We propose a structural constraint to handle non-linear projections of anatomical structures between MR and TRUS images. We further include an adversarial mechanism to enforce the model to preserve anatomical features in an MR image (such as prostate boundary and dominant intraprostatic lesion (DIL)) while synthesizing the TRUS-styled counterpart image. The proposed method is compared with other state-of-art methods with real TRUS images as the reference. The results demonstrate that the TRUS images synthesized by our method can be used for brachytherapy treatment planning for prostate cancer.