Realistic High-Resolution Body Computed Tomography Image Synthesis by Using Progressive Growing Generative Adversarial Network: Visual Turing Test

Abstract

BackgroundGenerative adversarial network (GAN)–based synthetic images can be viable solutions to current supervised deep learning challenges. However, generating highly realistic images is a prerequisite for these approaches. ObjectiveThe aim of this study was to investigate and validate the unsupervised synthesis of highly realistic body computed tomography (CT) images by using a progressive growing GAN (PGGAN) trained to learn the probability distribution of normal data. MethodsWe trained the PGGAN by using 11,755 body CT scans. Ten radiologists (4 radiologists with 10 years of experience [Group III]) evaluated the results in a binary approach by using an independent validation set of 300 images (150 real and 150 synthetic) to judge the authenticity of each image. ResultsThe mean accuracy of the 10 readers in the entire image set was higher than random guessing (1781/3000, 59.4% vs 1500/3000, 50.0%, respectively; P<.001). However, in terms of identifying synthetic images as fake, there was no significant difference in the specificity between the visual Turing test and random guessing (779/1500, 51.9% vs 750/1500, 50.0%, respectively; P=.29). The accuracy between the 3 reader groups with different experience levels was not significantly different (Group I, 696/1200, 58.0%; Group II, 726/1200, 60.5%; and Group III, 359/600, 59.8%; P=.36). Interreader agreements were poor (κ=0.11) for the entire image set. In subgroup analysis, the discrepancies between real and synthetic CT images occurred mainly in the thoracoabdominal junction and in the anatomical details. ConclusionsThe GAN can synthesize highly realistic high-resolution body CT images that are indistinguishable from real images; however, it has limitations in generating body images of the thoracoabdominal junction and lacks accuracy in the anatomical details.