Mitigating 3D Prostate Biparametric MRI Data Scarcity through Domain Adaptation using Locally-Trained Latent Diffusion Models for Prostate Cancer Detection

Objective: Latent diffusion models (LDMs) could mitigate data scarcity challenges affecting machine learning development for medical image interpretation. The recent CCELLA LDM improved prostate cancer detection performance using synthetic MRI for classifier training but was limited to the axial T2-weighted (AxT2) sequence, did not investigate inter-institutional domain shift, and prioritized PI-RADS over histopathology outcomes. Methods: We propose CCELLA++, a novel LDM pipeline for simultaneous 3D biparametric prostate MRI (bpMRI) generation, including the AxT2, high b-value diffusion series (HighB) and apparent diffusion coefficient map (ADC), to overcome these limitations. We investigated source-free domain adaptation with classifiers pretrained on single institution real or LDM-generated synthetic data prior to fine-tuning on fractions of an out-of-distribution, external dataset. Results: CCELLA++ achieved comparable AxT2 Kernel Inception Distance to CCELLA (0.0128, 0.0131 respectively). CCELLA++ synthetic bpMRI pretraining outperformed real bpMRI in AP and AUC up to 12.5% (n<=166) external dataset volume (p<0.01 all), no pretraining in AUC up to 25% external volume (n=332, p<0.05 all), and CCELLA AxT2-only pretraining in both data-scarce (n=83, p<0.001 AP and AUC) and full data (n=1329, p<0.05 AP and AUC) scenarios. Conclusion: CCELLA++ synthetic bpMRI can improve downstream classifier generalization and performance beyond real bpMRI or CCELLA-generated AxT2-only images. Future work should quantify medical image quality, balance bpMRI LDM training, and condition the LDM with additional information. Significance: CCELLA++ can generate synthetic bpMRI that outperforms real data for domain adaptation with data-scarce external institutions, advancing machine learning development for medical imaging. Our code is available at https://github.com/grabkeem/CCELLA-plus-plus