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.