Brain tumor segmentation using synthetic MR images -- A comparison of GANs and diffusion models

Large annotated datasets are required for training deep learning models, but in medical imaging data sharing is often complicated due to ethics, anonymization and data protection legislation (e.g. the general data protection regulation (GDPR)). Generative AI models, such as generative adversarial networks (GANs) and diffusion models, can today produce very realistic synthetic images, and can potentially facilitate data sharing as GDPR should not apply for medical images which do not belong to a specific person. However, in order to share synthetic images it must first be demonstrated that they can be used for training different networks with acceptable performance. Here, we therefore comprehensively evaluate four GANs (progressive GAN, StyleGAN 1-3) and a diffusion model for the task of brain tumor segmentation. Our results show that segmentation networks trained on synthetic images reach Dice scores that are 80\% - 90\% of Dice scores when training with real images, but that memorization of the training images can be a problem for diffusion models if the original dataset is too small. Furthermore, we demonstrate that common metrics for evaluating synthetic images, Fr\'echet inception distance (FID) and inception score (IS), do not correlate well with the obtained performance when using the synthetic images for training segmentation networks.