# Male pelvic synthetic CT generation from T1-weighted MRI using 2D and 3D convolutional neural networks

## TL;DR

This study compares 2D and 3D convolutional neural networks for generating synthetic CT images from T1-weighted MRI in prostate cancer patients, aiming to improve MR-only radiotherapy planning.

## Contribution

It introduces and evaluates both 2D and 3D CNN models for pelvic sCT generation, demonstrating the 3D model's superior accuracy over the 2D model.

## Key findings

- 3D CNN achieved lower mean absolute error than 2D CNN.
- Both models produced accurate pelvic sCTs with high dice similarity for bones.
- Statistical tests favored the 3D CNN in key accuracy metrics.

## Abstract

To achieve magnetic resonance (MR)-only radiotherapy, a method needs to be employed to estimate a synthetic CT (sCT) for generating electron density maps and patient positioning reference images. We investigated 2D and 3D convolutional neural network (CNN) methods to generate a male pelvic sCT using a T1-weighted MR image. A retrospective study was performed using CTs and T1-weighted MR images of 20 prostate cancer patients. The proposed 2D CNN model, which contained 27 convolutional layers, was modified from the SegNet for better performance. 3D version of the CNN model was also developed. Both CNN models were trained from scratch to map intensities of T1-weighted MR images to CT Hounsfield Unit (HU) values. Each sCT was generated in a five-fold-cross-validation framework and compared with the corresponding CT using voxel-wise mean absolute error (MAE), and dice similarity coefficient (DSC), recall, and precision for bony structures. Wilcoxon signed-rank tests were performed to evaluate the differences between the both models. The MAE averaged across all patients were 40.5 $\pm$ 5.4 HU and 37.6 $\pm$ 5.1 HU for the 2D and 3D CNN models, respectively. The DSC, recall, and precision of the bony structures were 0.81 $\pm$ 0.04, 0.85 $\pm$ 0.04, and 0.77 $\pm$ 0.09 for the 2D CNN model, and 0.82 $\pm$ 0.04, 0.84 $\pm$ 0.04, and 0.80 $\pm$ 0.08 for the 3D CNN model, respectively. P values of the Wilcoxon signed-rank tests were less than 0.05 except for recall, which was 0.6. The 2D and 3D CNN models generated accurate pelvic sCTs for the 20 patients using T1-weighted MR images. The evaluation metrics and statistical tests indicated that the 3D model was able to generate sCTs with better MAE, bone DSC, and bone precision. The accuracy of the dose calculation and patient positioning using generated sCTs will be tested and compared for the two models in the future.