GRN+: A Simplified Generative Reinforcement Network for Tissue Layer Analysis in 3D Ultrasound Images for Chronic Low-back Pain

3D ultrasound delivers high-resolution, real-time images of soft tissues, which is essential for pain research. However, manually distinguishing various tissues for quantitative analysis is labor-intensive. To streamline this process, we developed and validated GRN+, a novel multi-model framework that automates layer segmentation with minimal annotated data. GRN+ combines a ResNet-based generator and a U-Net segmentation model. Through a method called Segmentation-guided Enhancement (SGE), the generator produces new images and matching masks under the guidance of the segmentation model, with its weights adjusted according to the segmentation loss gradient. To prevent gradient explosion and secure stable training, a two-stage backpropagation strategy was implemented: the first stage propagates the segmentation loss through both the generator and segmentation model, while the second stage concentrates on optimizing the segmentation model alone, thereby refining mask prediction using the generated images. Tested on 69 fully annotated 3D ultrasound scans from 29 subjects with six manually labeled tissue layers, GRN+ outperformed all other semi-supervised methods in terms of the Dice coefficient using only 5% labeled data, despite not using unlabeled data for unsupervised training. Additionally, when applied to fully annotated datasets, GRN+ with SGE achieved a 2.16% higher Dice coefficient while incurring lower computational costs compared to other models. Overall, GRN+ provides accurate tissue segmentation while reducing both computational expenses and the dependency on extensive annotations, making it an effective tool for 3D ultrasound analysis in cLBP patients.

InterSliceBoost: Identifying Tissue Layers in Three-dimensional Ultrasound Images for Chronic Lower Back Pain (cLBP) Assessment

Available studies on chronic lower back pain (cLBP) typically focus on one or a few specific tissues rather than conducting a comprehensive layer-by-layer analysis. Since three-dimensional (3-D) images often contain hundreds of slices, manual annotation of these anatomical structures is both time-consuming and error-prone. We aim to develop and validate a novel approach called InterSliceBoost to enable the training of a segmentation model on a partially annotated dataset without compromising segmentation performance. The architecture of InterSliceBoost includes two components: an inter-slice generator and a segmentation model. The generator utilizes residual block-based encoders to extract features from adjacent image-mask pairs (IMPs). Differential features are calculated and input into a decoder to generate inter-slice IMPs. The segmentation model is trained on partially annotated datasets (e.g., skipping 1, 2, 3, or 7 images) and the generated inter-slice IMPs. To validate the performance of InterSliceBoost, we utilized a dataset of 76 B-mode ultrasound scans acquired on 29 subjects enrolled in an ongoing cLBP study. InterSliceBoost, trained on only 33% of the image slices, achieved a mean Dice coefficient of 80.84% across all six layers on the independent test set, with Dice coefficients of 73.48%, 61.11%, 81.87%, 95.74%, 83.52% and 88.74% for segmenting dermis, superficial fat, superficial fascial membrane, deep fat, deep fascial membrane, and muscle. This performance is significantly higher than the conventional model trained on fully annotated images (p<0.05). InterSliceBoost can effectively segment the six tissue layers depicted on 3-D B-model ultrasound images in settings with partial annotations.

Segmentation-Aware Generative Reinforcement Network (GRN) for Tissue Layer Segmentation in 3-D Ultrasound Images for Chronic Low-back Pain (cLBP) Assessment

We introduce a novel segmentation-aware joint training framework called generative reinforcement network (GRN) that integrates segmentation loss feedback to optimize both image generation and segmentation performance in a single stage. An image enhancement technique called segmentation-guided enhancement (SGE) is also developed, where the generator produces images tailored specifically for the segmentation model. Two variants of GRN were also developed, including GRN for sample-efficient learning (GRN-SEL) and GRN for semi-supervised learning (GRN-SSL). GRN's performance was evaluated using a dataset of 69 fully annotated 3D ultrasound scans from 29 subjects. The annotations included six anatomical structures: dermis, superficial fat, superficial fascial membrane (SFM), deep fat, deep fascial membrane (DFM), and muscle. Our results show that GRN-SEL with SGE reduces labeling efforts by up to 70% while achieving a 1.98% improvement in the Dice Similarity Coefficient (DSC) compared to models trained on fully labeled datasets. GRN-SEL alone reduces labeling efforts by 60%, GRN-SSL with SGE decreases labeling requirements by 70%, and GRN-SSL alone by 60%, all while maintaining performance comparable to fully supervised models. These findings suggest the effectiveness of the GRN framework in optimizing segmentation performance with significantly less labeled data, offering a scalable and efficient solution for ultrasound image analysis and reducing the burdens associated with data annotation.