Fully automated quantification of in vivo viscoelasticity of prostate zones using magnetic resonance elastography with Dense U-net segmentation.

Magnetic resonance elastography (MRE) for measuring viscoelasticity heavily depends on proper tissue segmentation, especially in heterogeneous organs such as the prostate. Using trained network-based image segmentation, we investigated if MRE data suffice to extract anatomical and viscoelastic information for automatic tabulation of zonal mechanical properties of the prostate. Overall, 40 patients with benign prostatic hyperplasia (BPH) or prostate cancer (PCa) were examined with three magnetic resonance imaging (MRI) sequences: T2-weighted MRI (T2w), diffusion-weighted imaging (DWI), and MRE-based tomoelastography yielding six independent sets of imaging data per patient (T2w, DWI, apparent diffusion coefficient (ADC), MRE magnitude, shear wave speed, and loss angle maps). Combinations of these data were used to train Dense U-nets with manually segmented masks of the entire prostate gland (PG), central zone (CZ), and peripheral zone (PZ) in 30 patients and to validate them in 10 patients. Dice score (DS), sensitivity, specificity, and Hausdorff distance were determined. We found that segmentation based on MRE magnitude maps alone (DS, PG: 0.93$\pm$0.04, CZ: 0.95$\pm$0.03, PZ: 0.77$\pm$0.05) was more accurate than magnitude maps combined with T2w and DWI_b (DS, PG: 0.91$\pm$0.04, CZ: 0.91$\pm$0.06, PZ: 0.63$\pm$0.16) or T2w alone (DS, PG: 0.92$\pm$0.03, CZ: 0.91$\pm$0.04, PZ: 0.65$\pm$0.08). Automatically tabulated MRE values were not different from ground-truth values (P>0.05). In conclusion: MRE combined with Dense U-net segmentation allows tabulation of quantitative imaging markers without manual analysis and independent of other MRI sequences and can thus contribute to PCa detection and classification.