A Multiphase CT-Based Integrated Deep Learning Framework for Rectal Cancer Detection, Segmentation, and Staging: Performance Comparison with Radiologist Assessment

Abstract

Accurate staging of rectal cancer is crucial for treatment planning; however, computed tomography (CT) interpretation remains challenging and highly dependent on radiologist expertise. This study aimed to develop and evaluate an AI-assisted system for rectal cancer detection and staging using CT images. The proposed framework integrates three components-a convolutional neural network (RCD-CNN) for lesion detection, a U-Net model for rectal contour delineation and tumor localization, and a 3D convolutional network (RCS-3DCNN) for staging prediction. CT scans from 223 rectal cancer patients at Kaohsiung Medical University Chung-Ho Memorial Hospital were retrospectively analyzed, including both non-contrast and contrast-enhanced studies. RCD-CNN achieved an accuracy of 0.976, recall of 0.975, and precision of 0.976. U-Net yielded Dice scores of 0.897 (rectal contours) and 0.856 (tumor localization). Radiologist-based clinical staging had 82.6% concordance with pathology, while AI-based staging achieved 80.4%. McNemar's test showed no significant difference between the AI and radiologist staging results (<i>p</i> = 1.0). The proposed AI-assisted system achieved staging accuracy comparable to that of radiologists and demonstrated feasibility as a decision-support tool in rectal cancer management. This study introduces a novel three-stage, dual-phase CT-based AI framework that integrates lesion detection, segmentation, and staging within a unified workflow.

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