A mechanism is provided to implement a trained machine learning computer model for determining z-wise lesion connectivity. The mechanism identifies, for a given slice in a three-dimensional medical image, a first lesion in the given slice and a second lesion in an adjacent slice in the three-dimensional medical image. The mechanism determines a first intersect value between the first lesion and the second lesion with respect to the first lesion and determines a second intersect value between the first lesion and the second lesion with respect to the second lesion. The mechanism determines whether the first lesion and the second lesion belong to the same three-dimensional lesion based on the first and second intersect values.