Many renal cancers are incidentally found on non-contrast CT (NCCT) images. On contrast-enhanced CT (CECT) images, most kidney tumors, especially renal cancers, have different intensity values compared to normal tissues. However, on NCCT images, some tumors called isodensity tumors, have similar intensity values to the surrounding normal tissues, and can only be detected through a change in organ shape. Several deep learning methods which segment kidney tumors from CECT images have been proposed and showed promising results. However, these methods fail to capture such changes in organ shape on NCCT images. In this paper, we present a novel framework, which can explicitly capture protruded regions in kidneys to enable a better segmentation of kidney tumors. We created a synthetic mask dataset that simulates a protuberance, and trained a segmentation network to separate the protruded regions from the normal kidney regions. To achieve the segmentation of whole tumors, our framework consists of three networks. The first network is a conventional semantic segmentation network which extracts a kidney region mask and an initial tumor region mask. The second network, which we name protuberance detection network, identifies the protruded regions from the kidney region mask. Given the initial tumor region mask and the protruded region mask, the last network fuses them and predicts the final kidney tumor mask accurately. The proposed method was evaluated on a publicly available KiTS19 dataset, which contains 108 NCCT images, and showed that our method achieved a higher dice score of 0.615 (+0.097) and sensitivity of 0.721 (+0.103) compared to 3D-UNet. To the best of our knowledge, this is the first deep learning method that is specifically designed for kidney tumor segmentation on NCCT images.

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