Multimodal MRI-Ultrasound AI for Prostate Cancer Detection Outperforms Radiologist MRI Interpretation: A Multi-Center Study

TL;DR

This study presents a multimodal AI framework combining MRI and TRUS images that outperforms unimodal models and radiologists in detecting clinically significant prostate cancer, potentially improving biopsy accuracy and patient outcomes.

Contribution

The paper introduces a novel multimodal AI model integrating MRI and TRUS data, demonstrating superior performance over existing unimodal models and radiologists in prostate cancer detection.

Findings

Multimodal AI achieved 80% sensitivity, outperforming unimodal models.

The model showed higher specificity (88%) than radiologists.

Lesion Dice score was improved with the multimodal approach.

Abstract

Pre-biopsy magnetic resonance imaging (MRI) is increasingly used to target suspicious prostate lesions. This has led to artificial intelligence (AI) applications improving MRI-based detection of clinically significant prostate cancer (CsPCa). However, MRI-detected lesions must still be mapped to transrectal ultrasound (TRUS) images during biopsy, which results in missing CsPCa. This study systematically evaluates a multimodal AI framework integrating MRI and TRUS image sequences to enhance CsPCa identification. The study included 3110 patients from three cohorts across two institutions who underwent prostate biopsy. The proposed framework, based on the 3D UNet architecture, was evaluated on 1700 test cases, comparing performance to unimodal AI models that use either MRI or TRUS alone. Additionally, the proposed model was compared to radiologists in a cohort of 110 patients. The multimodal AI approach achieved superior sensitivity (80%) and Lesion Dice (42%) compared to unimodal MRI (73%, 30%) and TRUS models (49%, 27%). Compared to radiologists, the multimodal model showed higher specificity (88% vs. 78%) and Lesion Dice (38% vs. 33%), with equivalent sensitivity (79%). Our findings demonstrate the potential of multimodal AI to improve CsPCa lesion targeting during biopsy and treatment planning, surpassing current unimodal models and radiologists; ultimately improving outcomes for prostate cancer patients.