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Meningeal lymphatic vessels (MLVs) are responsible for the drainage of waste products from the human brain. An impairment in their functionality has been associated with aging as well as brain disorders like multiple sclerosis and Alzheimer's disease. However, MLVs have only recently been described for the first time in magnetic resonance imaging (MRI), and their ramified structure renders manual segmentation particularly difficult. Further, as there is no consistent notion of their appearance, human-annotated MLV structures contain a high inter-rater variability that most automatic segmentation methods cannot take into account. In this work, we propose a new rater-aware training scheme for the popular nnU-Net model, and we explore rater-based ensembling strategies for accurate and consistent segmentation of MLVs. This enables us to boost nnU-Net's performance while obtaining explicit predictions in different annotation styles and a rater-based uncertainty estimation. Our final model, MLV$^2$-Net, achieves a Dice similarity coefficient of 0.806 with respect to the human reference standard. The model further matches the human inter-rater reliability and replicates age-related associations with MLV volume., Comment: ML4H 2024

Diagnosing dementia, particularly for Alzheimer's Disease (AD) and frontotemporal dementia (FTD), is complex due to overlapping symptoms. While magnetic resonance imaging (MRI) and positron emission tomography (PET) data are critical for the diagnosis, integrating these modalities in deep learning faces challenges, often resulting in suboptimal performance compared to using single modalities. Moreover, the potential of multi-modal approaches in differential diagnosis, which holds significant clinical importance, remains largely unexplored. We propose a novel framework, DiaMond, to address these issues with vision Transformers to effectively integrate MRI and PET. DiaMond is equipped with self-attention and a novel bi-attention mechanism that synergistically combine MRI and PET, alongside a multi-modal normalization to reduce redundant dependency, thereby boosting the performance. DiaMond significantly outperforms existing multi-modal methods across various datasets, achieving a balanced accuracy of 92.4% in AD diagnosis, 65.2% for AD-MCI-CN classification, and 76.5% in differential diagnosis of AD and FTD. We also validated the robustness of DiaMond in a comprehensive ablation study. The code is available at https://github.com/ai-med/DiaMond., Comment: Accepted by IEEE/CVF Winter Conference on Applications of Computer Vision (WACV) 2025

Our findings indicate that adopting "advanced" computational elements fails to significantly improve registration accuracy. Instead, well-established registration-specific designs offer fair improvements, enhancing results by a marginal 1.5\% over the baseline. Our findings emphasize the importance of rigorous, unbiased evaluation and contribution disentanglement of all low- and high-level registration components, rather than simply following the computer vision trends with "more advanced" computational blocks. We advocate for simpler yet effective solutions and novel evaluation metrics that go beyond conventional registration accuracy, warranting further research across diverse organs and modalities. The code is available at \url{https://github.com/BailiangJ/rethink-reg}., Comment: WBIR 2024 Workshop on Biomedical Imaging Registration

Controllable text-to-image (T2I) diffusion models have shown impressive performance in generating high-quality visual content through the incorporation of various conditions. Current methods, however, exhibit limited performance when guided by skeleton human poses, especially in complex pose conditions such as side or rear perspectives of human figures. To address this issue, we present Stable-Pose, a novel adapter model that introduces a coarse-to-fine attention masking strategy into a vision Transformer (ViT) to gain accurate pose guidance for T2I models. Stable-Pose is designed to adeptly handle pose conditions within pre-trained Stable Diffusion, providing a refined and efficient way of aligning pose representation during image synthesis. We leverage the query-key self-attention mechanism of ViTs to explore the interconnections among different anatomical parts in human pose skeletons. Masked pose images are used to smoothly refine the attention maps based on target pose-related features in a hierarchical manner, transitioning from coarse to fine levels. Additionally, our loss function is formulated to allocate increased emphasis to the pose region, thereby augmenting the model's precision in capturing intricate pose details. We assessed the performance of Stable-Pose across five public datasets under a wide range of indoor and outdoor human pose scenarios. Stable-Pose achieved an AP score of 57.1 in the LAION-Human dataset, marking around 13% improvement over the established technique ControlNet. The project link and code is available at https://github.com/ai-med/StablePose., Comment: Accepted by NeurIPS 2024

Positron emission tomography (PET) is a well-established functional imaging technique for diagnosing brain disorders. However, PET's high costs and radiation exposure limit its widespread use. In contrast, magnetic resonance imaging (MRI) does not have these limitations. Although it also captures neurodegenerative changes, MRI is a less sensitive diagnostic tool than PET. To close this gap, we aim to generate synthetic PET from MRI. Herewith, we introduce PASTA, a novel pathology-aware image translation framework based on conditional diffusion models. Compared to the state-of-the-art methods, PASTA excels in preserving both structural and pathological details in the target modality, which is achieved through its highly interactive dual-arm architecture and multi-modal condition integration. A cycle exchange consistency and volumetric generation strategy elevate PASTA's capability to produce high-quality 3D PET scans. Our qualitative and quantitative results confirm that the synthesized PET scans from PASTA not only reach the best quantitative scores but also preserve the pathology correctly. For Alzheimer's classification, the performance of synthesized scans improves over MRI by 4%, almost reaching the performance of actual PET. Code is available at https://github.com/ai-med/PASTA.

Differential diagnosis of dementia is challenging due to overlapping symptoms, with structural magnetic resonance imaging (MRI) being the primary method for diagnosis. Despite the clinical value of computer-aided differential diagnosis, research has been limited, mainly due to the absence of public datasets that contain diverse types of dementia. This leaves researchers with small in-house datasets that are insufficient for training deep neural networks (DNNs). Self-supervised learning shows promise for utilizing unlabeled MRI scans in training, but small batch sizes for volumetric brain scans make its application challenging. To address these issues, we propose Triplet Training for differential diagnosis with limited target data. It consists of three key stages: (i) self-supervised pre-training on unlabeled data with Barlow Twins, (ii) self-distillation on task-related data, and (iii) fine-tuning on the target dataset. Our approach significantly outperforms traditional training strategies, achieving a balanced accuracy of 75.6%. We further provide insights into the training process by visualizing changes in the latent space after each step. Finally, we validate the robustness of Triplet Training in terms of its individual components in a comprehensive ablation study. Our code is available at https://github.com/ai-med/TripletTraining., Comment: Accepted for presentation at MIDL 2024

Magnetic resonance imaging (MRI) is critical for diagnosing neurodegenerative diseases, yet accurately assessing mild cortical atrophy remains a challenge due to its subtlety. Automated cortex reconstruction, paired with healthy reference ranges, aids in pinpointing pathological atrophy, yet their generalization is limited by biases from image acquisition and processing. We introduce the concept of stochastic cortical self-reconstruction (SCSR) that creates a subject-specific healthy reference by taking MRI-derived thicknesses as input and, therefore, implicitly accounting for potential confounders. SCSR randomly corrupts parts of the cortex and self-reconstructs them from the remaining information. Trained exclusively on healthy individuals, repeated self-reconstruction generates a stochastic reference cortex for assessing deviations from the norm. We present three implementations of this concept: XGBoost applied on parcels, and two autoencoders on vertex level -- one based on a multilayer perceptron and the other using a spherical U-Net. These models were trained on healthy subjects from the UK Biobank and subsequently evaluated across four public Alzheimer's datasets. Finally, we deploy the model on clinical in-house data, where deviation maps' high spatial resolution aids in discriminating between four types of dementia.

Reconstructing the cortex from longitudinal MRI is indispensable for analyzing morphological changes in the human brain. Despite the recent disruption of cortical surface reconstruction with deep learning, challenges arising from longitudinal data are still persistent. Especially the lack of strong spatiotemporal point correspondence hinders downstream analyses due to the introduced noise. To address this issue, we present V2C-Long, the first dedicated deep learning-based cortex reconstruction method for longitudinal MRI. In contrast to existing methods, V2C-Long surfaces are directly comparable in a cross-sectional and longitudinal manner. We establish strong inherent spatiotemporal correspondences via a novel composition of two deep mesh deformation networks and fast aggregation of feature-enhanced within-subject templates. The results on internal and external test data demonstrate that V2C-Long yields cortical surfaces with improved accuracy and consistency compared to previous methods. Finally, this improvement manifests in higher sensitivity to regional cortical atrophy in Alzheimer's disease., Comment: Preprint

The reconstruction of cortical surfaces is a prerequisite for quantitative analyses of the cerebral cortex in magnetic resonance imaging (MRI). Existing segmentation-based methods separate the surface registration from the surface extraction, which is computationally inefficient and prone to distortions. We introduce Vox2Cortex-Flow (V2C-Flow), a deep mesh-deformation technique that learns a deformation field from a brain template to the cortical surfaces of an MRI scan. To this end, we present a geometric neural network that models the deformation-describing ordinary differential equation in a continuous manner. The network architecture comprises convolutional and graph-convolutional layers, which allows it to work with images and meshes at the same time. V2C-Flow is not only very fast, requiring less than two seconds to infer all four cortical surfaces, but also establishes vertex-wise correspondences to the template during reconstruction. In addition, V2C-Flow is the first approach for cortex reconstruction that models white matter and pial surfaces jointly, therefore avoiding intersections between them. Our comprehensive experiments on internal and external test data demonstrate that V2C-Flow results in cortical surfaces that are state-of-the-art in terms of accuracy. Moreover, we show that the established correspondences are more consistent than in FreeSurfer and that they can directly be utilized for cortex parcellation and group analyses of cortical thickness., Comment: To appear in Medical Image Analysis

Explaining predictions of black-box neural networks is crucial when applied to decision-critical tasks. Thus, attribution maps are commonly used to identify important image regions, despite prior work showing that humans prefer explanations based on similar examples. To this end, ProtoPNet learns a set of class-representative feature vectors (prototypes) for case-based reasoning. During inference, similarities of latent features to prototypes are linearly classified to form predictions and attribution maps are provided to explain the similarity. In this work, we evaluate whether architectures for case-based reasoning fulfill established axioms required for faithful explanations using the example of ProtoPNet. We show that such architectures allow the extraction of faithful explanations. However, we prove that the attribution maps used to explain the similarities violate the axioms. We propose a new procedure to extract explanations for trained ProtoPNets, named ProtoPFaith. Conceptually, these explanations are Shapley values, calculated on the similarity scores of each prototype. They allow to faithfully answer which prototypes are present in an unseen image and quantify each pixel's contribution to that presence, thereby complying with all axioms. The theoretical violations of ProtoPNet manifest in our experiments on three datasets (CUB-200-2011, Stanford Dogs, RSNA) and five architectures (ConvNet, ResNet, ResNet50, WideResNet50, ResNeXt50). Our experiments show a qualitative difference between the explanations given by ProtoPNet and ProtoPFaith. Additionally, we quantify the explanations with the Area Over the Perturbation Curve, on which ProtoPFaith outperforms ProtoPNet on all experiments by a factor $>10^3$., Comment: To be published in proceedings of AAAI Conference on Artificial Intelligence

Recent years have witnessed a surge of interest in integrating high-dimensional data captured by multisource sensors, driven by the impressive success of neural networks in the integration of multimodal data. However, the integration of heterogeneous multimodal data poses a significant challenge, as confounding effects and dependencies among such heterogeneous data sources introduce unwanted variability and bias, leading to suboptimal performance of multimodal models. Therefore, it becomes crucial to normalize the low- or high-level features extracted from data modalities before their fusion takes place. This paper introduces a novel approach for the normalization of multimodal data, called RegBN, that incorporates regularization. RegBN uses the Frobenius norm as a regularizer term to address the side effects of confounders and underlying dependencies among different data sources. The proposed method generalizes well across multiple modalities and eliminates the need for learnable parameters, simplifying training and inference. We validate the effectiveness of RegBN on eight databases from five research areas, encompassing diverse modalities such as language, audio, image, video, depth, tabular, and 3D MRI. The proposed method demonstrates broad applicability across different architectures such as multilayer perceptrons, convolutional neural networks, and vision transformers, enabling effective normalization of both low- and high-level features in multimodal neural networks. RegBN is available at \url{https://github.com/mogvision/regbn}.

Prior to the deep learning era, shape was commonly used to describe the objects. Nowadays, state-of-the-art (SOTA) algorithms in medical imaging are predominantly diverging from computer vision, where voxel grids, meshes, point clouds, and implicit surface models are used. This is seen from numerous shape-related publications in premier vision conferences as well as the growing popularity of ShapeNet (about 51,300 models) and Princeton ModelNet (127,915 models). For the medical domain, we present a large collection of anatomical shapes (e.g., bones, organs, vessels) and 3D models of surgical instrument, called MedShapeNet, created to facilitate the translation of data-driven vision algorithms to medical applications and to adapt SOTA vision algorithms to medical problems. As a unique feature, we directly model the majority of shapes on the imaging data of real patients. As of today, MedShapeNet includes 23 dataset with more than 100,000 shapes that are paired with annotations (ground truth). Our data is freely accessible via a web interface and a Python application programming interface (API) and can be used for discriminative, reconstructive, and variational benchmarks as well as various applications in virtual, augmented, or mixed reality, and 3D printing. Exemplary, we present use cases in the fields of classification of brain tumors, facial and skull reconstructions, multi-class anatomy completion, education, and 3D printing. In future, we will extend the data and improve the interfaces. The project pages are: https://medshapenet.ikim.nrw/ and https://github.com/Jianningli/medshapenet-feedback, Comment: 16 pages

Abdominal organ segmentation from CT and MRI is an essential prerequisite for surgical planning and computer-aided navigation systems. It is challenging due to the high variability in the shape, size, and position of abdominal organs. Three-dimensional numeric representations of abdominal shapes with point-wise correspondence to a template are further important for quantitative and statistical analyses thereof. Recently, template-based surface extraction methods have shown promising advances for direct mesh reconstruction from volumetric scans. However, the generalization of these deep learning-based approaches to different organs and datasets, a crucial property for deployment in clinical environments, has not yet been assessed. We close this gap and employ template-based mesh reconstruction methods for joint liver, kidney, pancreas, and spleen segmentation. Our experiments on manually annotated CT and MRI data reveal limited generalization capabilities of previous methods to organs of different geometry and weak performance on small datasets. We alleviate these issues with a novel deep diffeomorphic mesh-deformation architecture and an improved training scheme. The resulting method, UNetFlow, generalizes well to all four organs and can be easily fine-tuned on new data. Moreover, we propose a simple registration-based post-processing that aligns voxel and mesh outputs to boost segmentation accuracy., Comment: Scientific Reports

The wide range of research in deep learning-based medical image segmentation pushed the boundaries in a multitude of applications. A clinically relevant problem that received less attention is the handling of scans with irregular anatomy, e.g., after organ resection. State-of-the-art segmentation models often lead to organ hallucinations, i.e., false-positive predictions of organs, which cannot be alleviated by oversampling or post-processing. Motivated by the increasing need to develop robust deep learning models, we propose HALOS for abdominal organ segmentation in MR images that handles cases after organ resection surgery. To this end, we combine missing organ classification and multi-organ segmentation tasks into a multi-task model, yielding a classification-assisted segmentation pipeline. The segmentation network learns to incorporate knowledge about organ existence via feature fusion modules. Extensive experiments on a small labeled test set and large-scale UK Biobank data demonstrate the effectiveness of our approach in terms of higher segmentation Dice scores and near-to-zero false positive prediction rate., Comment: To be published in proceedings of Information Processing In Medical Imaging (IPMI) 2023

Alzheimer's disease (AD) has a complex and multifactorial etiology, which requires integrating information about neuroanatomy, genetics, and cerebrospinal fluid biomarkers for accurate diagnosis. Hence, recent deep learning approaches combined image and tabular information to improve diagnostic performance. However, the black-box nature of such neural networks is still a barrier for clinical applications, in which understanding the decision of a heterogeneous model is integral. We propose PANIC, a prototypical additive neural network for interpretable AD classification that integrates 3D image and tabular data. It is interpretable by design and, thus, avoids the need for post-hoc explanations that try to approximate the decision of a network. Our results demonstrate that PANIC achieves state-of-the-art performance in AD classification, while directly providing local and global explanations. Finally, we show that PANIC extracts biologically meaningful signatures of AD, and satisfies a set of desirable desiderata for trustworthy machine learning. Our implementation is available at https://github.com/ai-med/PANIC ., Comment: To be published in proceedings of Information Processing In Medical Imaging 2023

The reconstruction of cerebral cortex surfaces from brain MRI scans is instrumental for the analysis of brain morphology and the detection of cortical thinning in neurodegenerative diseases like Alzheimer's disease (AD). Moreover, for a fine-grained analysis of atrophy patterns, the parcellation of the cortical surfaces into individual brain regions is required. For the former task, powerful deep learning approaches, which provide highly accurate brain surfaces of tissue boundaries from input MRI scans in seconds, have recently been proposed. However, these methods do not come with the ability to provide a parcellation of the reconstructed surfaces. Instead, separate brain-parcellation methods have been developed, which typically consider the cortical surfaces as given, often computed beforehand with FreeSurfer. In this work, we propose two options, one based on a graph classification branch and another based on a novel generic 3D reconstruction loss, to augment template-deformation algorithms such that the surface meshes directly come with an atlas-based brain parcellation. By combining both options with two of the latest cortical surface reconstruction algorithms, we attain highly accurate parcellations with a Dice score of 90.2 (graph classification branch) and 90.4 (novel reconstruction loss) together with state-of-the-art surfaces., Comment: accepted at MLCN workshop 2022

Alzheimer's Disease (AD) is the most common form of dementia and often difficult to diagnose due to the multifactorial etiology of dementia. Recent works on neuroimaging-based computer-aided diagnosis with deep neural networks (DNNs) showed that fusing structural magnetic resonance images (sMRI) and fluorodeoxyglucose positron emission tomography (FDG-PET) leads to improved accuracy in a study population of healthy controls and subjects with AD. However, this result conflicts with the established clinical knowledge that FDG-PET better captures AD-specific pathologies than sMRI. Therefore, we propose a framework for the systematic evaluation of multi-modal DNNs and critically re-evaluate single- and multi-modal DNNs based on FDG-PET and sMRI for binary healthy vs. AD, and three-way healthy/mild cognitive impairment/AD classification. Our experiments demonstrate that a single-modality network using FDG-PET performs better than MRI (accuracy 0.91 vs 0.87) and does not show improvement when combined. This conforms with the established clinical knowledge on AD biomarkers, but raises questions about the true benefit of multi-modal DNNs. We argue that future work on multi-modal fusion should systematically assess the contribution of individual modalities following our proposed evaluation framework. Finally, we encourage the community to go beyond healthy vs. AD classification and focus on differential diagnosis of dementia, where fusing multi-modal image information conforms with a clinical need.

Modeling temporal changes in subcortical structures is crucial for a better understanding of the progression of Alzheimer's disease (AD). Given their flexibility to adapt to heterogeneous sequence lengths, mesh-based transformer architectures have been proposed in the past for predicting hippocampus deformations across time. However, one of the main limitations of transformers is the large amount of trainable parameters, which makes the application on small datasets very challenging. In addition, current methods do not include relevant non-image information that can help to identify AD-related patterns in the progression. To this end, we introduce CASHformer, a transformer-based framework to model longitudinal shape trajectories in AD. CASHformer incorporates the idea of pre-trained transformers as universal compute engines that generalize across a wide range of tasks by freezing most layers during fine-tuning. This reduces the number of parameters by over 90% with respect to the original model and therefore enables the application of large models on small datasets without overfitting. In addition, CASHformer models cognitive decline to reveal AD atrophy patterns in the temporal sequence. Our results show that CASHformer reduces the reconstruction error by 73% compared to previously proposed methods. Moreover, the accuracy of detecting patients progressing to AD increases by 3% with imputing missing longitudinal shape data.

The reconstruction of cortical surfaces from brain magnetic resonance imaging (MRI) scans is essential for quantitative analyses of cortical thickness and sulcal morphology. Although traditional and deep learning-based algorithmic pipelines exist for this purpose, they have two major drawbacks: lengthy runtimes of multiple hours (traditional) or intricate post-processing, such as mesh extraction and topology correction (deep learning-based). In this work, we address both of these issues and propose Vox2Cortex, a deep learning-based algorithm that directly yields topologically correct, three-dimensional meshes of the boundaries of the cortex. Vox2Cortex leverages convolutional and graph convolutional neural networks to deform an initial template to the densely folded geometry of the cortex represented by an input MRI scan. We show in extensive experiments on three brain MRI datasets that our meshes are as accurate as the ones reconstructed by state-of-the-art methods in the field, without the need for time- and resource-intensive post-processing. To accurately reconstruct the tightly folded cortex, we work with meshes containing about 168,000 vertices at test time, scaling deep explicit reconstruction methods to a new level., Comment: Accepted at CVPR 2022

The longitudinal modeling of neuroanatomical changes related to Alzheimer's disease (AD) is crucial for studying the progression of the disease. To this end, we introduce TransforMesh, a spatio-temporal network based on transformers that models longitudinal shape changes on 3D anatomical meshes. While transformer and mesh networks have recently shown impressive performances in natural language processing and computer vision, their application to medical image analysis has been very limited. To the best of our knowledge, this is the first work that combines transformer and mesh networks. Our results show that TransforMesh can model shape trajectories better than other baseline architectures that do not capture temporal dependencies. Moreover, we also explore the capabilities of TransforMesh in detecting structural anomalies of the hippocampus in patients developing AD.

The current state-of-the-art deep neural networks (DNNs) for Alzheimer's Disease diagnosis use different biomarker combinations to classify patients, but do not allow extracting knowledge about the interactions of biomarkers. However, to improve our understanding of the disease, it is paramount to extract such knowledge from the learned model. In this paper, we propose a Deep Factorization Machine model that combines the ability of DNNs to learn complex relationships and the ease of interpretability of a linear model. The proposed model has three parts: (i) an embedding layer to deal with sparse categorical data, (ii) a Factorization Machine to efficiently learn pairwise interactions, and (iii) a DNN to implicitly model higher order interactions. In our experiments on data from the Alzheimer's Disease Neuroimaging Initiative, we demonstrate that our proposed model classifies cognitive normal, mild cognitive impaired, and demented patients more accurately than competing models. In addition, we show that valuable knowledge about the interactions among biomarkers can be obtained., Comment: Accepted at International Workshop on Machine Learning in Medical Imaging (MLMI) 2021

Deep Neural Networks (DNNs) have an enormous potential to learn from complex biomedical data. In particular, DNNs have been used to seamlessly fuse heterogeneous information from neuroanatomy, genetics, biomarkers, and neuropsychological tests for highly accurate Alzheimer's disease diagnosis. On the other hand, their black-box nature is still a barrier for the adoption of such a system in the clinic, where interpretability is absolutely essential. We propose Shapley Value Explanation of Heterogeneous Neural Networks (SVEHNN) for explaining the Alzheimer's diagnosis made by a DNN from the 3D point cloud of the neuroanatomy and tabular biomarkers. Our explanations are based on the Shapley value, which is the unique method that satisfies all fundamental axioms for local explanations previously established in the literature. Thus, SVEHNN has many desirable characteristics that previous work on interpretability for medical decision making is lacking. To avoid the exponential time complexity of the Shapley value, we propose to transform a given DNN into a Lightweight Probabilistic Deep Network without re-training, thus achieving a complexity only quadratic in the number of features. In our experiments on synthetic and real data, we show that we can closely approximate the exact Shapley value with a dramatically reduced runtime and can reveal the hidden knowledge the network has learned from the data., Comment: Accepted at 2021 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI)

Prior work on diagnosing Alzheimer's disease from magnetic resonance images of the brain established that convolutional neural networks (CNNs) can leverage the high-dimensional image information for classifying patients. However, little research focused on how these models can utilize the usually low-dimensional tabular information, such as patient demographics or laboratory measurements. We introduce the Dynamic Affine Feature Map Transform (DAFT), a general-purpose module for CNNs that dynamically rescales and shifts the feature maps of a convolutional layer, conditional on a patient's tabular clinical information. We show that DAFT is highly effective in combining 3D image and tabular information for diagnosis and time-to-dementia prediction, where it outperforms competing CNNs with a mean balanced accuracy of 0.622 and mean c-index of 0.748, respectively. Our extensive ablation study provides valuable insights into the architectural properties of DAFT. Our implementation is available at https://github.com/ai-med/DAFT., Comment: Accepted at 2021 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI)

International challenges have become the de facto standard for comparative assessment of image analysis algorithms given a specific task. Segmentation is so far the most widely investigated medical image processing task, but the various segmentation challenges have typically been organized in isolation, such that algorithm development was driven by the need to tackle a single specific clinical problem. We hypothesized that a method capable of performing well on multiple tasks will generalize well to a previously unseen task and potentially outperform a custom-designed solution. To investigate the hypothesis, we organized the Medical Segmentation Decathlon (MSD) - a biomedical image analysis challenge, in which algorithms compete in a multitude of both tasks and modalities. The underlying data set was designed to explore the axis of difficulties typically encountered when dealing with medical images, such as small data sets, unbalanced labels, multi-site data and small objects. The MSD challenge confirmed that algorithms with a consistent good performance on a set of tasks preserved their good average performance on a different set of previously unseen tasks. Moreover, by monitoring the MSD winner for two years, we found that this algorithm continued generalizing well to a wide range of other clinical problems, further confirming our hypothesis. Three main conclusions can be drawn from this study: (1) state-of-the-art image segmentation algorithms are mature, accurate, and generalize well when retrained on unseen tasks; (2) consistent algorithmic performance across multiple tasks is a strong surrogate of algorithmic generalizability; (3) the training of accurate AI segmentation models is now commoditized to non AI experts.

We propose an unsupervised domain adaptation (UDA) approach for white matter hyperintensity (WMH) segmentation, which uses Self-Training with Uncertainty DEpendent Label refinement (STRUDEL). Self-training has recently been introduced as a highly effective method for UDA, which is based on self-generated pseudo labels. However, pseudo labels can be very noisy and therefore deteriorate model performance. We propose to predict the uncertainty of pseudo labels and integrate it in the training process with an uncertainty-guided loss function to highlight labels with high certainty. STRUDEL is further improved by incorporating the segmentation output of an existing method in the pseudo label generation that showed high robustness for WMH segmentation. In our experiments, we evaluate STRUDEL with a standard U-Net and a modified network with a higher receptive field. Our results on WMH segmentation across datasets demonstrate the significant improvement of STRUDEL with respect to standard self-training., Comment: accepted at Machine Learning in Medical Imaging (MLMI 2021)

Geometric deep learning can find representations that are optimal for a given task and therefore improve the performance over pre-defined representations. While current work has mainly focused on point representations, meshes also contain connectivity information and are therefore a more comprehensive characterization of the underlying anatomical surface. In this work, we evaluate four recent geometric deep learning approaches that operate on mesh representations. These approaches can be grouped into template-free and template-based approaches, where the template-based methods need a more elaborate pre-processing step with the definition of a common reference template and correspondences. We compare the different networks for the prediction of Alzheimer's disease based on the meshes of the hippocampus. Our results show advantages for template-based methods in terms of accuracy, number of learnable parameters, and training speed. While the template creation may be limiting for some applications, neuroimaging has a long history of building templates with automated tools readily available. Overall, working with meshes is more involved than working with simplistic point clouds, but they also offer new avenues for designing geometric deep learning architectures.

Spatial and channel re-calibration have become powerful concepts in computer vision. Their ability to capture long-range dependencies is especially useful for those networks that extract local features, such as CNNs. While re-calibration has been widely studied for image analysis, it has not yet been used on shape representations. In this work, we introduce re-calibration modules on deep neural networks for 3D point clouds. We propose a set of re-calibration blocks that extend Squeeze and Excitation blocks and that can be added to any network for 3D point cloud analysis that builds a global descriptor by hierarchically combining features from multiple local neighborhoods. We run two sets of experiments to validate our approach. First, we demonstrate the benefit and versatility of our proposed modules by incorporating them into three state-of-the-art networks for 3D point cloud analysis: PointNet++, DGCNN, and RSCNN. We evaluate each network on two tasks: object classification on ModelNet40, and object part segmentation on ShapeNet. Our results show an improvement of up to 1% in accuracy for ModelNet40 compared to the baseline method. In the second set of experiments, we investigate the benefits of re-calibration blocks on Alzheimer's Disease (AD) diagnosis. Our results demonstrate that our proposed methods yield a 2% increase in accuracy for diagnosing AD and a 2.3% increase in concordance index for predicting AD onset with time-to-event analysis. Concluding, re-calibration improves the accuracy of point cloud architectures, while only minimally increasing the number of parameters.

We propose a versatile framework for survival analysis that combines advanced concepts from statistics with deep learning. The presented framework is based on piecewise exponential models and thereby supports various survival tasks, such as competing risks and multi-state modeling, and further allows for estimation of time-varying effects and time-varying features. To also include multiple data sources and higher-order interaction effects into the model, we embed the model class in a neural network and thereby enable the simultaneous estimation of both inherently interpretable structured regression inputs as well as deep neural network components which can potentially process additional unstructured data sources. A proof of concept is provided by using the framework to predict Alzheimer's disease progression based on tabular and 3D point cloud data and applying it to synthetic data., Comment: 8 pages, 3 figures, Accepted at the AAAI spring symposium: Survival Prediction

We introduce deep neural networks for the analysis of anatomical shapes that learn a low-dimensional shape representation from the given task, instead of relying on hand-engineered representations. Our framework is modular and consists of several computing blocks that perform fundamental shape processing tasks. The networks operate on unordered point clouds and provide invariance to similarity transformations, avoiding the need to identify point correspondences between shapes. Based on the framework, we assemble a discriminative model for disease classification and age regression, as well as a generative model for the accruate reconstruction of shapes. In particular, we propose a conditional generative model, where the condition vector provides a mechanism to control the generative process. instance, it enables to assess shape variations specific to a particular diagnosis, when passing it as side information. Next to working on single shapes, we introduce an extension for the joint analysis of multiple anatomical structures, where the simultaneous modeling of multiple structures can lead to a more compact encoding and a better understanding of disorders. We demonstrate the advantages of our framework in comprehensive experiments on real and synthetic data. The key insights are that (i) learning a shape representation specific to the given task yields higher performance than alternative shape descriptors, (ii) multi-structure analysis is both more efficient and more accurate than single-structure analysis, and (iii) point clouds generated by our model capture morphological differences associated to Alzheimers disease, to the point that they can be used to train a discriminative model for disease classification. Our framework naturally scales to the analysis of large datasets, giving it the potential to learn characteristic variations in large populations., Comment: Accepted for publication in the Medical Image Analysis journal

Studying the relationship between neuroanatomy and cognitive decline due to Alzheimer's has been a major research focus in the last decade. However, to infer cause-effect relationships rather than simple associations from observational data, we need to (i) express the causal relationships leading to cognitive decline in a graphical model, and (ii) ensure the causal effect of interest is identifiable from the collected data. We derive a causal graph from the current clinical knowledge on cause and effect in the Alzheimer's disease continuum, and show that identifiability of the causal effect requires all confounders to be known and measured. However, in complex neuroimaging studies, we neither know all potential confounders nor do we have data on them. To alleviate this requirement, we leverage the dependencies among multiple causes by deriving a substitute confounder via a probabilistic latent factor model. In our theoretical analysis, we prove that using the substitute confounder enables identifiability of the causal effect of neuroanatomy on cognition. We quantitatively evaluate the effectiveness of our approach on semi-synthetic data, where we know the true causal effects, and illustrate its use on real data on the Alzheimer's disease continuum, where it reveals important causes that otherwise would have been missed., Comment: Accepted as oral presentation at 2021 International Conference on Information Processing in Medical Imaging (IPMI)

The ability of neural networks to continuously learn and adapt to new tasks while retaining prior knowledge is crucial for many applications. However, current neural networks tend to forget previously learned tasks when trained on new ones, i.e., they suffer from Catastrophic Forgetting (CF). The objective of Continual Learning (CL) is to alleviate this problem, which is particularly relevant for medical applications, where it may not be feasible to store and access previously used sensitive patient data. In this work, we propose a Continual Learning approach for brain segmentation, where a single network is consecutively trained on samples from different domains. We build upon an importance driven approach and adapt it for medical image segmentation. Particularly, we introduce learning rate regularization to prevent the loss of the network's knowledge. Our results demonstrate that directly restricting the adaptation of important network parameters clearly reduces Catastrophic Forgetting for segmentation across domains.

Fully Convolutional Neural Networks (F-CNNs) achieve state-of-the-art performance for segmentation tasks in computer vision and medical imaging. Recently, computational blocks termed squeeze and excitation (SE) have been introduced to recalibrate F-CNN feature maps both channel- and spatial-wise, boosting segmentation performance while only minimally increasing the model complexity. So far, the development of SE blocks has focused on 2D architectures. For volumetric medical images, however, 3D F-CNNs are a natural choice. In this article, we extend existing 2D recalibration methods to 3D and propose a generic compress-process-recalibrate pipeline for easy comparison of such blocks. We further introduce Project & Excite (PE) modules, customized for 3D networks. In contrast to existing modules, Project \& Excite does not perform global average pooling but compresses feature maps along different spatial dimensions of the tensor separately to retain more spatial information that is subsequently used in the excitation step. We evaluate the modules on two challenging tasks, whole-brain segmentation of MRI scans and whole-body segmentation of CT scans. We demonstrate that PE modules can be easily integrated into 3D F-CNNs, boosting performance up to 0.3 in Dice Score and outperforming 3D extensions of other recalibration blocks, while only marginally increasing the model complexity. Our code is publicly available on https://github.com/ai-med/squeeze_and_excitation ., Comment: Accepted for publication at IEEE Transactions on Medical Imaging

The desire to train complex machine learning algorithms and to increase the statistical power in association studies drives neuroimaging research to use ever-larger datasets. The most obvious way to increase sample size is by pooling scans from independent studies. However, simple pooling is often ill-advised as selection, measurement, and confounding biases may creep in and yield spurious correlations. In this work, we combine 35,320 magnetic resonance images of the brain from 17 studies to examine bias in neuroimaging. In the first experiment, Name That Dataset, we provide empirical evidence for the presence of bias by showing that scans can be correctly assigned to their respective dataset with 71.5% accuracy. Given such evidence, we take a closer look at confounding bias, which is often viewed as the main shortcoming in observational studies. In practice, we neither know all potential confounders nor do we have data on them. Hence, we model confounders as unknown, latent variables. Kolmogorov complexity is then used to decide whether the confounded or the causal model provides the simplest factorization of the graphical model. Finally, we present methods for dataset harmonization and study their ability to remove bias in imaging features. In particular, we propose an extension of the recently introduced ComBat algorithm to control for global variation across image features, inspired by adjusting for population stratification in genetics. Our results demonstrate that harmonization can reduce dataset-specific information in image features. Further, confounding bias can be reduced and even turned into a causal relationship. However, harmonziation also requires caution as it can easily remove relevant subject-specific information. Code is available at https://github.com/ai-med/Dataset-Bias.

We introduce a wide and deep neural network for prediction of progression from patients with mild cognitive impairment to Alzheimer's disease. Information from anatomical shape and tabular clinical data (demographics, biomarkers) are fused in a single neural network. The network is invariant to shape transformations and avoids the need to identify point correspondences between shapes. To account for right censored time-to-event data, i.e., when it is only known that a patient did not develop Alzheimer's disease up to a particular time point, we employ a loss commonly used in survival analysis. Our network is trained end-to-end to combine information from a patient's hippocampus shape and clinical biomarkers. Our experiments on data from the Alzheimer's Disease Neuroimaging Initiative demonstrate that our proposed model is able to learn a shape descriptor that augments clinical biomarkers and outperforms a deep neural network on shape alone and a linear model on common clinical biomarkers., Comment: Data and Machine Learning Advances with Multiple Views Workshop, ECML-PKDD 2019

Neuroimaging datasets keep growing in size to address increasingly complex medical questions. However, even the largest datasets today alone are too small for training complex machine learning models. A potential solution is to increase sample size by pooling scans from several datasets. In this work, we combine 12,207 MRI scans from 15 studies and show that simple pooling is often ill-advised due to introducing various types of biases in the training data. First, we systematically define these biases. Second, we detect bias by experimentally showing that scans can be correctly assigned to their respective dataset with 73.3% accuracy. Finally, we propose to tell causal from confounding factors by quantifying the extent of confounding and causality in a single dataset using causal inference. We achieve this by finding the simplest graphical model in terms of Kolmogorov complexity. As Kolmogorov complexity is not directly computable, we employ the minimum description length to approximate it. We empirically show that our approach is able to estimate plausible causal relationships from real neuroimaging data., Comment: MICCAI 2019

Fully Convolutional Neural Networks (F-CNNs) achieve state-of-the-art performance for image segmentation in medical imaging. Recently, squeeze and excitation (SE) modules and variations thereof have been introduced to recalibrate feature maps channel- and spatial-wise, which can boost performance while only minimally increasing model complexity. So far, the development of SE has focused on 2D images. In this paper, we propose `Project & Excite' (PE) modules that base upon the ideas of SE and extend them to operating on 3D volumetric images. `Project & Excite' does not perform global average pooling, but squeezes feature maps along different slices of a tensor separately to retain more spatial information that is subsequently used in the excitation step. We demonstrate that PE modules can be easily integrated in 3D U-Net, boosting performance by 5% Dice points, while only increasing the model complexity by 2%. We evaluate the PE module on two challenging tasks, whole-brain segmentation of MRI scans and whole-body segmentation of CT scans. Code: https://github.com/ai-med/squeeze_and_excitation, Comment: Accepted for International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) 2019

Recent methods for generating novel molecules use graph representations of molecules and employ various forms of graph convolutional neural networks for inference. However, training requires solving an expensive graph isomorphism problem, which previous approaches do not address or solve only approximately. In this work, we propose ALMGIG, a likelihood-free adversarial learning framework for inference and de novo molecule generation that avoids explicitly computing a reconstruction loss. Our approach extends generative adversarial networks by including an adversarial cycle-consistency loss to implicitly enforce the reconstruction property. To capture properties unique to molecules, such as valence, we extend the Graph Isomorphism Network to multi-graphs. To quantify the performance of models, we propose to compute the distance between distributions of physicochemical properties with the 1-Wasserstein distance. We demonstrate that ALMGIG more accurately learns the distribution over the space of molecules than all baselines. Moreover, it can be utilized for drug discovery by efficiently searching the space of molecules using molecules' continuous latent representation. Our code is available at https://github.com/ai-med/almgig, Comment: Accepted at The European Conference on Machine Learning and Principles and Practice of Knowledge Discovery in Databases (ECML PKDD); Code at https://github.com/ai-med/almgig

Access to sufficient annotated data is a common challenge in training deep neural networks on medical images. As annotating data is expensive and time-consuming, it is difficult for an individual medical center to reach large enough sample sizes to build their own, personalized models. As an alternative, data from all centers could be pooled to train a centralized model that everyone can use. However, such a strategy is often infeasible due to the privacy-sensitive nature of medical data. Recently, federated learning (FL) has been introduced to collaboratively learn a shared prediction model across centers without the need for sharing data. In FL, clients are locally training models on site-specific datasets for a few epochs and then sharing their model weights with a central server, which orchestrates the overall training process. Importantly, the sharing of models does not compromise patient privacy. A disadvantage of FL is the dependence on a central server, which requires all clients to agree on one trusted central body, and whose failure would disrupt the training process of all clients. In this paper, we introduce BrainTorrent, a new FL framework without a central server, particularly targeted towards medical applications. BrainTorrent presents a highly dynamic peer-to-peer environment, where all centers directly interact with each other without depending on a central body. We demonstrate the overall effectiveness of FL for the challenging task of whole brain segmentation and observe that the proposed server-less BrainTorrent approach does not only outperform the traditional server-based one but reaches a similar performance to a model trained on pooled data.

Deep neural networks enable highly accurate image segmentation, but require large amounts of manually annotated data for supervised training. Few-shot learning aims to address this shortcoming by learning a new class from a few annotated support examples. We introduce, a novel few-shot framework, for the segmentation of volumetric medical images with only a few annotated slices. Compared to other related works in computer vision, the major challenges are the absence of pre-trained networks and the volumetric nature of medical scans. We address these challenges by proposing a new architecture for few-shot segmentation that incorporates 'squeeze & excite' blocks. Our two-armed architecture consists of a conditioner arm, which processes the annotated support input and generates a task-specific representation. This representation is passed on to the segmenter arm that uses this information to segment the new query image. To facilitate efficient interaction between the conditioner and the segmenter arm, we propose to use 'channel squeeze & spatial excitation' blocks - a light-weight computational module - that enables heavy interaction between both the arms with negligible increase in model complexity. This contribution allows us to perform image segmentation without relying on a pre-trained model, which generally is unavailable for medical scans. Furthermore, we propose an efficient strategy for volumetric segmentation by optimally pairing a few slices of the support volume to all the slices of the query volume. We perform experiments for organ segmentation on whole-body contrast-enhanced CT scans from the Visceral Dataset. Our proposed model outperforms multiple baselines and existing approaches with respect to the segmentation accuracy by a significant margin. The source code is available at https://github.com/abhi4ssj/few-shot-segmentation., Comment: Accepted for publication at Medical Image Analysis

In this paper we propose a novel augmentation technique that improves not only the performance of deep neural networks on clean test data, but also significantly increases their robustness to random transformations, both affine and projective. Inspired by ManiFool, the augmentation is performed by a line-search manifold-exploration method that learns affine geometric transformations that lead to the misclassification on an image, while ensuring that it remains on the same manifold as the training data. This augmentation method populates any training dataset with images that lie on the border of the manifolds between two-classes and maximizes the variance the network is exposed to during training. Our method was thoroughly evaluated on the challenging tasks of fine-grained skin lesion classification from limited data, and breast tumor classification of mammograms. Compared with traditional augmentation methods, and with images synthesized by Generative Adversarial Networks our method not only achieves state-of-the-art performance but also significantly improves the network's robustness., Comment: Under Review for the 26th International Conference on Information Processing in Medical Imaging (IPMI) 2019

In this work, we report the set-up and results of the Liver Tumor Segmentation Benchmark (LiTS), which was organized in conjunction with the IEEE International Symposium on Biomedical Imaging (ISBI) 2017 and the International Conferences on Medical Image Computing and Computer-Assisted Intervention (MICCAI) 2017 and 2018. The image dataset is diverse and contains primary and secondary tumors with varied sizes and appearances with various lesion-to-background levels (hyper-/hypo-dense), created in collaboration with seven hospitals and research institutions. Seventy-five submitted liver and liver tumor segmentation algorithms were trained on a set of 131 computed tomography (CT) volumes and were tested on 70 unseen test images acquired from different patients. We found that not a single algorithm performed best for both liver and liver tumors in the three events. The best liver segmentation algorithm achieved a Dice score of 0.963, whereas, for tumor segmentation, the best algorithms achieved Dices scores of 0.674 (ISBI 2017), 0.702 (MICCAI 2017), and 0.739 (MICCAI 2018). Retrospectively, we performed additional analysis on liver tumor detection and revealed that not all top-performing segmentation algorithms worked well for tumor detection. The best liver tumor detection method achieved a lesion-wise recall of 0.458 (ISBI 2017), 0.515 (MICCAI 2017), and 0.554 (MICCAI 2018), indicating the need for further research. LiTS remains an active benchmark and resource for research, e.g., contributing the liver-related segmentation tasks in \url{http://medicaldecathlon.com/}. In addition, both data and online evaluation are accessible via \url{www.lits-challenge.com}., Comment: Patrick Bilic, Patrick Christ, Hongwei Bran Li, and Eugene Vorontsov made equal contributions to this work. Published in Medical Image Analysis

We introduce Bayesian QuickNAT for the automated quality control of whole-brain segmentation on MRI T1 scans. Next to the Bayesian fully convolutional neural network, we also present inherent measures of segmentation uncertainty that allow for quality control per brain structure. For estimating model uncertainty, we follow a Bayesian approach, wherein, Monte Carlo (MC) samples from the posterior distribution are generated by keeping the dropout layers active at test time. Entropy over the MC samples provides a voxel-wise model uncertainty map, whereas expectation over the MC predictions provides the final segmentation. Next to voxel-wise uncertainty, we introduce four metrics to quantify structure-wise uncertainty in segmentation for quality control. We report experiments on four out-of-sample datasets comprising of diverse age range, pathology and imaging artifacts. The proposed structure-wise uncertainty metrics are highly correlated with the Dice score estimated with manual annotation and therefore present an inherent measure of segmentation quality. In particular, the intersection over union over all the MC samples is a suitable proxy for the Dice score. In addition to quality control at scan-level, we propose to incorporate the structure-wise uncertainty as a measure of confidence to do reliable group analysis on large data repositories. We envisage that the introduced uncertainty metrics would help assess the fidelity of automated deep learning based segmentation methods for large-scale population studies, as they enable automated quality control and group analyses in processing large data repositories., Comment: Under Review in NeuroImage

We present a novel, parameter-efficient and practical fully convolutional neural network architecture, termed InfiNet, aimed at voxel-wise semantic segmentation of infant brain MRI images at iso-intense stage, which can be easily extended for other segmentation tasks involving multi-modalities. InfiNet consists of double encoder arms for T1 and T2 input scans that feed into a joint-decoder arm that terminates in the classification layer. The novelty of InfiNet lies in the manner in which the decoder upsamples lower resolution input feature map(s) from multiple encoder arms. Specifically, the pooled indices computed in the max-pooling layers of each of the encoder blocks are related to the corresponding decoder block to perform non-linear learning-free upsampling. The sparse maps are concatenated with intermediate encoder representations (skip connections) and convolved with trainable filters to produce dense feature maps. InfiNet is trained end-to-end to optimize for the Generalized Dice Loss, which is well-suited for high class imbalance. InfiNet achieves the whole-volume segmentation in under 50 seconds and we demonstrate competitive performance against multiple state-of-the art deep architectures and their multi-modal variants., Comment: 4 pages, 3 figures, conference, IEEE ISBI, 2018