Interactive Cascaded Network for Prostate Cancer Segmentation from Multimodality MRI with Automated Quality Assessment

The accurate segmentation of prostate cancer (PCa) from multiparametric MRI is crucial in clinical practice for guiding biopsy and treatment planning. Existing automated methods often lack the necessary accuracy and robustness in localizing PCa, whereas interactive segmentation methods, although more accurate, require user intervention on each input image, thereby limiting the cost-effectiveness of the segmentation workflow. Our innovative framework addresses the limitations of current methods by combining a coarse segmentation network, a rejection network, and an interactive deep network known as Segment Anything Model (SAM). The coarse segmentation network automatically generates initial segmentation results, which are evaluated by the rejection network to estimate their quality. Low-quality results are flagged for user interaction, with the user providing a region of interest (ROI) enclosing the lesions, whereas for high-quality results, ROIs were cropped from the automatic segmentation. Both manually and automatically defined ROIs are fed into SAM to produce the final fine segmentation. This approach significantly reduces the annotation burden and achieves substantial improvements by flagging approximately 20% of the images with the lowest quality scores for manual annotation. With only half of the images manually annotated, the final segmentation accuracy is statistically indistinguishable from that achieved using full manual annotation. Although this paper focuses on prostate lesion segmentation from multimodality MRI, the framework can be adapted to other medical image segmentation applications to improve segmentation efficiency while maintaining high accuracy standards. © 2024 by the authors.