A weakly-supervised deep learning model for fast localisation and delineation of the skeleton, internal organs, and spinal canal on Whole-Body Diffusion-Weighted MRI (WB-DWI)

Background: Apparent Diffusion Coefficient (ADC) values and Total Diffusion Volume (TDV) from Whole-body diffusion-weighted MRI (WB-DWI) are recognized cancer imaging biomarkers. However, manual disease delineation for ADC and TDV measurements is unfeasible in clinical practice, demanding automation. As a first step, we propose an algorithm to generate fast and reproducible probability maps of the skeleton, adjacent internal organs (liver, spleen, urinary bladder, and kidneys), and spinal canal. Methods: We developed an automated deep-learning pipeline based on a 3D patch-based Residual U-Net architecture that localises and delineates these anatomical structures on WB-DWI. The algorithm was trained using "soft labels" (non-binary segmentations) derived from a computationally intensive atlas-based approach. For training and validation, we employed a multi-centre WB-DWI dataset comprising 532 scans from patients with Advanced Prostate Cancer (APC) or Multiple Myeloma (MM), with testing on 45 patients. Results: Our weakly-supervised deep learning model achieved an average dice score of 0.67 for whole skeletal delineation, 0.76 when excluding ribcage, 0.83 for internal organs, and 0.86 for spinal canal, with average surface distances below 3mm. Relative median ADC differences between automated and manual full-body delineations were below 10%. The model was 12x faster than the atlas-based registration algorithm (25 sec vs. 5 min). Two experienced radiologists rated the model's outputs as either "good" or "excellent" on test scans, with inter-reader agreement from fair to substantial (Gwet's AC1 = 0.27-0.72). Conclusion: The model offers fast, reproducible probability maps for localising and delineating body regions on WB-DWI, potentially enabling non-invasive imaging biomarker quantification to support disease staging and treatment response assessment.