arXiv:2502.00366eess.IVcs.CV2025-02被引 9

基于MRI和超声的前列腺专用大模型,显著提升癌症检测准确率并减少不必要的活检。

Prostate-Specific Foundation Models for Enhanced Detection of Clinically Significant Cancer

  • 采用病灶级对比学习训练前列腺影像专用基础模型
  • 多中心验证下AUC达0.875~0.966,优于放射科医生
  • 与PSA结合可将特异性从15%提升至38%,大幅减少误诊活检

前列腺癌诊断仍具挑战性。即使使用MRI,放射科医生的特异性较低且存在显著观察者间差异,导致临床显著癌症识别延迟或错误,引发大量不必要的活检并增加漏诊风险。本文提出前列腺视觉对比网络(ProViCNet),一种用于磁共振成像(MRI)和经直肠超声(TRUS)的前列腺器官特异性视觉基础模型,用于全面癌症检测。ProViCNet在六家机构共4,401名患者的数据上进行训练与验证,基于活检确诊的放射科标注,采用图像块级对比学习。在多个内部与外部验证队列中表现一致,MRI的ROC曲线下面积(AUC)为0.875至0.966,显著优于放射科医生(0.907对0.805,p<0.001);TRUS的AUC为0.670至0.740。此外,将ProViCNet与标准PSA结合,构建虚拟筛查测试,可在保持高敏感性的前提下,将特异性从15%提升至38%(p<0.001),显著减少不必要的活检。结果表明,ProViCNet有潜力提高前列腺癌诊断准确性,优化诊疗路径。

原文摘要 · Abstract (English)

Accurate prostate cancer diagnosis remains challenging. Even when using MRI, radiologists exhibit low specificity and significant inter-observer variability, leading to potential delays or inaccuracies in identifying clinically significant cancers. This leads to numerous unnecessary biopsies and risks of missing clinically significant cancers. Here we present prostate vision contrastive network (ProViCNet), prostate organ-specific vision foundation models for Magnetic Resonance Imaging (MRI) and Trans-Rectal Ultrasound imaging (TRUS) for comprehensive cancer detection. ProViCNet was trained and validated using 4,401 patients across six institutions, as a prostate cancer detection model on radiology images relying on patch-level contrastive learning guided by biopsy confirmed radiologist annotations. ProViCNet demonstrated consistent performance across multiple internal and external validation cohorts with area under the receiver operating curve values ranging from 0.875 to 0.966, significantly outperforming radiologists in the reader study (0.907 versus 0.805, p<0.001) for mpMRI, while achieving 0.670 to 0.740 for TRUS. We also integrated ProViCNet with standard PSA to develop a virtual screening test, and we showed that we can maintain the high sensitivity for detecting clinically significant cancers while more than doubling specificity from 15% to 38% (p<0.001), thereby substantially reducing unnecessary biopsies. These findings highlight that ProViCNet's potential for enhancing prostate cancer diagnosis accuracy and reduce unnecessary biopsies, thereby optimizing diagnostic pathways.

前列腺癌医学影像基础模型AI辅助诊断

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