Segmentation of pelvic structures in T2 MRI via MR-to-CT synthesis

Segmentation of multiple pelvic structures in MRI volumes is a prerequisite for many clinical applications, such as sarcopenia assessment, bone density measurement, and muscle-to-fat volume ratio estimation. While many CT-specific datasets and automated CT-based multi-structure pelvis segmentation methods exist, there are few MRI-specific multi-structure segmentation methods in literature. In this pilot work, we propose a lightweight and annotation-free pipeline to synthetically translate T2 MRI volumes of the pelvis to CT, and subsequently leverage an existing CT-only tool called TotalSegmentator to segment 8 pelvic structures in the generated CT volumes. The predicted masks were then mapped back to the original MR volumes as segmentation masks. We compared the predicted masks against the expert annotations of the public TCGA-UCEC dataset and an internal dataset. Experiments demonstrated that the proposed pipeline achieved Dice measures >= 65% for 8 pelvic structures in T2 MRI. The proposed pipeline is an alternative method to obtain multi-organ and structure segmentations without being encumbered by time-consuming manual annotations. By exploiting the significant research progress in CTs, it is possible to extend the proposed pipeline to other MRI sequences in principle. Our research bridges the chasm between the current CT-based multi-structure segmentation and MRI-based segmentation. The manually segmented structures in the TCGA-UCEC dataset are publicly available.