Computer-Aided Detection and diagnosis for prostate cancer based on mono and multi-parametric MRI: A review

International audienceProstate cancer is the second most diagnosed cancer of men all over the world. In the last decades, new imaging techniques based on Magnetic Resonance Imaging (MRI) have been developed improving diagnosis.In practise, diagnosis can be affected by multiple factors such as observer variability and visibility and complexity of the lesions. In this regard, computer-aided detection and computer-aided diagnosis systemshave been designed to help radiologists in their clinical practice. Research on computer-aided systems specifically focused for prostate cancer is a young technology and has been part of a dynamic field ofresearch for the last ten years. This survey aims to provide a comprehensive review of the state of the art in this lapse of time, focusing on the different stages composing the work-flow of a computer-aidedsystem. We also provide a comparison between studies and a discussion about the potential avenues for future research. In addition, this paper presents a new public online dataset which is made available to theresearch community with the aim of providing a common evaluation framework to overcome some of the current limitations identified in this survey

Computer-Assisted Characterization of Prostate Cancer on Magnetic Resonance Imaging

Prostate cancer (PCa) is one of the most prevalent cancers among men. Early diagnosis can improve survival and reduce treatment costs. Current inter-radiologist variability for detection of PCa is high. The use of multi-parametric magnetic resonance imaging (mpMRI) with machine learning algorithms has been investigated both for improving PCa detection and for PCa diagnosis. Widespread clinical implementation of computer-assisted PCa lesion characterization remains elusive; critically needed is a model that is validated against a histologic reference standard that is densely sampled in an unbiased fashion. We address this using our technique for highly accurate fusion of mpMRI with whole-mount digitized histology of the surgical specimen. In this thesis, we present models for characterization of malignant, benign and confounding tissue and aggressiveness of PCa. Further validation on a larger dataset could enable improved characterization performance, improving survival rates and enabling a more personalized treatment plan

Domain Adaptation for Novel Imaging Modalities with Application to Prostate MRI

The need for training data can impede the adoption of novel imaging modalities for deep learning-based medical image analysis. Domain adaptation can mitigate this problem by exploiting training samples from an existing, densely-annotated source domain within a novel, sparsely-annotated target domain, by bridging the differences between the two domains. In this thesis we present methods for adapting between diffusion-weighed (DW)-MRI data from multiparametric (mp)-MRI acquisitions and VERDICT (Vascular, Extracellular and Restricted Diffusion for Cytometry in Tumors) MRI, a richer DW-MRI technique involving an optimized acquisition protocol for cancer characterization. We also show that the proposed methods are general and their applicability extends beyond medical imaging. First, we propose a semi-supervised domain adaptation method for prostate lesion segmentation on VERDICT MRI. Our approach relies on stochastic generative modelling to translate across two heterogeneous domains at pixel-space and exploits the inherent uncertainty in the cross-domain mapping to generate multiple outputs conditioned on a single input. We further extend this approach to the unsupervised scenario where there is no labeled data for the target domain. We rely on stochastic generative modelling to translate across the two domains at pixel space and introduce two loss functions that promote semantic consistency. Finally we demonstrate that the proposed approaches extend beyond medical image analysis and focus on unsupervised domain adaptation for semantic segmentation of urban scenes. We show that relying on stochastic generative modelling allows us to train more accurate target networks and achieve state-of-the-art performance on two challenging semantic segmentation benchmarks

Development and validation of novel and quantitative MRI methods for cancer evaluation

Quantitative imaging biomarkers (QIB) offer the opportunity to further the evaluation of cancer at presentation as well as predict response to anti-cancer therapies before and early during treatment with the ultimate goal of truly personalised medical care and the mitigation of futile, often detrimental, therapy. Few QIBs are successfully translated into clinical practice and there is increasing recognition that rigorous methodologies and standardisation of research pipelines and techniques are required to move a theoretically useful biomarker into the clinic. To this end, I have aimed to give an overview of what I believe to be some of key elements within the research field beginning with the concept of imaging biomarkers, introducing concepts in development and validation, before providing a summary of the current and future utility of a range of quantitative MR imaging biomarkers techniques within the oncological imaging field. The original, prospective, research moves from the technical and analytical validation of a novel QIB use (T1 mapping in cancer), first in vivo qualification of this biomarker in cancer patient response assessment and prediction (sarcoma and breast cancer as well as prostate cancer separately), and then moving on to application of more established QIBs in cancer evaluation (R2*/BOLD imaging in head and neck cancer) as well as how existing MR data can be post-processed to improved cancer evaluation (further metrics derived from diffusion weighted imaging in head and neck cancer and textural analysis of existing clinical MR images utility in prostate cancer detection)

New Technology and Techniques for Needle-Based Magnetic Resonance Image-Guided Prostate Focal Therapy

The most common diagnosis of prostate cancer is that of localized disease, and unfortunately the optimal type of treatment for these men is not yet certain. Magnetic resonance image (MRI)-guided focal laser ablation (FLA) therapy is a promising potential treatment option for select men with localized prostate cancer, and may result in fewer side effects than whole-gland therapies, while still achieving oncologic control. The objective of this thesis was to develop methods of accurately guiding needles to the prostate within the bore of a clinical MRI scanner for MRI-guided FLA therapy. To achieve this goal, a mechatronic needle guidance system was developed. The system enables precise targeting of prostate tumours through angulated trajectories and insertion of needles with the patient in the bore of a clinical MRI scanner. After confirming sufficient accuracy in phantoms, and good MRI-compatibility, the system was used to guide needles for MRI-guided FLA therapy in eight patients. Results from this case series demonstrated an improvement in needle guidance time and ease of needle delivery compared to conventional approaches. Methods of more reliable treatment planning were sought, leading to the development of a systematic treatment planning method, and Monte Carlo simulations of needle placement uncertainty. The result was an estimate of the maximum size of focal target that can be confidently ablated using the mechatronic needle guidance system, leading to better guidelines for patient eligibility. These results also quantified the benefit that could be gained with improved techniques for needle guidance

Development and application of quantitative image analysis for preclinical MRI research

The aim of this thesis is to develop quantitative analysis methods to validate MRI and improve the detection of tumour infiltration. The major components include a description of the development the quantitative methods to better validate imaging biomarkers and detect of infiltration of tumour cells into normal tissue, which were then applied to a mouse model of glioblastoma invasion. To do this, a new histology model, called Stacked In-plane Histology (SIH), was developed to allow a quantitative analysis of MRI. Validating imaging biomarkers for glioblastoma infiltration Cancer can be defined as a disease in which a group of abnormal cells grow uncontrollably, often with fatal outcomes. According to (Cancer research UK, 2019), there are more than 363,000 new cancer cases in the UK every year, an increase from the 990 cases reported daily in 2014-2016, with only half of all patients recovering. Glioblastoma (GB) is the most frequent and malignant form of primary brain tumours with a very poor prognosis. Even with the development of modern diagnostic strategies and new therapies, the five-year survival rate is just 5%, with the median survival time only 14 months. Unfortunately, glioblastoma can affect patients at any age, including young children, but has a peak occurrence between the ages of 65 and 75 years. The standard treatment for GB consists of surgical resection, followed by radiotherapy and chemotherapy. However, the infiltration of GB cells into healthy adjacent brain tissue is a major obstacle for successful treatment, making complete removal of a tumour by surgery a difficult task, with the potential for tumour recurrence. Magnetic Resonance Imaging (MRI) is a non-invasive, multipurpose imaging tool used for the diagnosis and monitoring of cancerous tumours. It can provide morphological, physiological, and metabolic information about the tumour. Currently, MRI is the standard diagnostic tool for GB before the pathological examination of tissue from surgical resection or biopsy specimens. The standard MRI sequences used for diagnosis of GB include T2-Weighted (T2W), T1-Weighted (T1W), Fluid-Attenuated Inversion Recovery (FLAIR), and Contrast Enhance T1 gadolinium (CE-T1) scans. These conventional scans are used to localize the tumour, in addition to associated oedema and necrosis. Although these scans can identify the bulk of the tumour, it is known that they do not detect regions infiltrated by GB cells. The MRI signal depends upon many physical parameters including water content, local structure, tumbling rates, diffusion, and hypoxia (Dominietto, 2014). There has been considerable interest in identifying whether such biologically indirect image contrasts can be used as non-invasive imaging biomarkers, either for normal biological functions, pathogenic processes or pharmacological responses to therapeutic interventions (Atkinson et al., 2001). In fact, when new MRI methods are proposed as imaging biomarkers of particular diseases, it is crucial that they are validated against histopathology. In humans, such validation is limited to a biopsy, which is the gold standard of diagnosis for most types of cancer. Some types of biopsies can take an image-guided approach using MRI, Computed Tomography (CT) or Ultrasound (US). However, a biopsy may miss the most malignant region of the tumour and is difficult to repeat. Biomarker validation can be performed in preclinical disease models, where the animal can be terminated immediately after imaging for histological analysis. Here, in principle, co-registration of the biomarker images with the histopathology would allow for direct validation. However, in practice, most preclinical validation studies have been limited to using simple visual comparisons to assess the correlation between the imaging biomarker and underlying histopathology. First objective (Chapter 5): Histopathology is the gold standard for assessing non-invasive imaging biomarkers, with most validation approaches involving a qualitative visual inspection. To allow a more quantitative analysis, previous studies have attempted to co-register MRI with histology. However, these studies have focused on developing better algorithms to deal with the distortions common in histology sections. By contrast, we have taken an approach to improve the quality of the histological processing and analysis, for example, by taking into account the imaging slice orientation and thickness. Multiple histology sections were cut in the MR imaging plane to produce a Stacked In-plane Histology (SIH) map. This approach, which is applied to the next two objectives, creates a histopathology map which can be used as the gold standard to quantitatively validate imaging biomarkers. Second objective (Chapter 6): Glioblastoma is the most malignant form of primary brain tumour and recurrence following treatment is common. Non-invasive MR imaging is an important component of brain tumour diagnosis and treatment planning. Unfortunately, clinic MRI (T1W, T2W, CE-T1, and FLAIR) fails to detect regions of glioblastoma cell infiltration beyond the solid tumour region identified by contrast enhanced T1 scans. However, advanced MRI techniques such as Arterial Spin Labelling (ASL) could provide us with extra information (perfusion) which may allow better detection of infiltration. In order to assess whether local perfusion perturbation could provide a useful biomarker for glioblastoma cell infiltration, we quantitatively analysed the correlation between perfusion MRI (ASL) and stacked in-plane histology. This work used a mouse model of glioblastoma that mimics the infiltrative behaviour found in human patients. The results demonstrate the ability of perfusion imaging to probe regions of low tumour cell infiltration, while confirming the sensitivity limitations of clinic imaging modalities. Third objective (Chapter 7): It is widely hypothesised that Multiparametric MRI (mpMRI), can extract more information than is obtained from the constituent individual MR images, by reconstructing a single map that contains complementary information. Using the MRI and histology dataset from objective 2, we used a multi-regression algorithm to reconstruct a single map which was highly correlated (r>0.6) with histology. The results are promising, showing that mpMRI can better predict the whole tumour region, including the region of tumour cell infiltration