Image and Video Processing (eess.IV)

Abstract: Over the past few years, surgical data science has attracted substantial interest from the machine learning (ML) community. Various studies have demonstrated the efficacy of emerging ML techniques in analysing surgical data, particularly recordings of procedures, for digitizing clinical and non-clinical functions like preoperative planning, context-aware decision-making, and operating skill assessment. However, this field is still in its infancy and lacks representative, well-annotated datasets for training robust models in intermediate ML tasks. Also, existing datasets suffer from inaccurate labels, hindering the development of reliable models. In this paper, we propose a systematic methodology for developing robust models for surgical tool detection using noisy data. Our methodology introduces two key innovations: (1) an intelligent active learning strategy for minimal dataset identification and label correction by human experts; and (2) an assembling strategy for a student-teacher model-based self-training framework to achieve the robust classification of 14 surgical tools in a semi-supervised fashion. Furthermore, we employ weighted data loaders to handle difficult class labels and address class imbalance issues. The proposed methodology achieves an average F1-score of 85.88\% for the ensemble model-based self-training with class weights, and 80.88\% without class weights for noisy labels. Also, our proposed method significantly outperforms existing approaches, which effectively demonstrates its effectiveness.

Abstract: Low-rank higher-order tensor approximation has been used successfully to extract discrete directions for tractography from continuous fiber orientation density functions (fODFs). However, while it accounts for fiber crossings, it has so far ignored fanning, which has led to incomplete reconstructions. In this work, we integrate an anisotropic model of fanning based on the Bingham distribution into a recently proposed tractography method that performs low-rank approximation with an Unscented Kalman Filter. Our technical contributions include an initialization scheme for the new parameters, which is based on the Hessian of the low-rank approximation, pre-integration of the required convolution integrals to reduce the computational effort, and representation of the required 3D rotations with quaternions. Results on 12 subjects from the Human Connectome Project confirm that, in almost all considered tracts, our extended model significantly increases completeness of the reconstruction, while reducing excess, at acceptable additional computational cost. Its results are also more accurate than those from a simpler, isotropic fanning model that is based on Watson distributions.

Abstract: Knee Osteoarthritis (KOA) is a highly prevalent chronic musculoskeletal condition with no currently available treatment. The manifestation of KOA is heterogeneous and prediction of its progression is challenging. Current literature suggests that the use of multi-modal data and advanced modeling methods, such as the ones based on Deep Learning, has promise in tackling this challenge. To date, however, the evidence on the efficacy of this approach is limited. In this study, we leveraged recent advances in Deep Learning and, using a Transformer approach, developed a unified framework for the multi-modal fusion of knee imaging data. Subsequently, we analyzed its performance across a range of scenarios by investigating multiple progression horizons -- from short-term to long-term. We report our findings using a large cohort (n=2421-3967) derived from the Osteoarthritis Initiative dataset. We show that structural knee MRI allows identifying radiographic KOA progressors on par with multi-modal fusion approaches, achieving an area under the ROC curve (ROC AUC) of 0.70-0.76 and Average Precision (AP) of 0.15-0.54 in 2-8 year horizons. Progression within 1 year was better predicted with a multi-modal method using X-ray, structural, and compositional MR images -- ROC AUC of 0.76(0.04), AP of 0.13(0.04) -- or via clinical data. Our follow-up analysis generally shows that prediction from the imaging data is more accurate for post-traumatic subjects, and we further investigate which subject subgroups may benefit the most. The present study provides novel insights into multi-modal imaging of KOA and brings a unified data-driven framework for studying its progression in an end-to-end manner, providing new tools for the design of more efficient clinical trials. The source code of our framework and the pre-trained models are made publicly available.

Abstract: Multi-sequence MRI is valuable in clinical settings for reliable diagnosis and treatment prognosis, but some sequences may be unusable or missing for various reasons. To address this issue, MRI synthesis is a potential solution. Recent deep learning-based methods have achieved good performance in combining multiple available sequences for missing sequence synthesis. Despite their success, these methods lack the ability to quantify the contributions of different input sequences and estimate the quality of generated images, making it hard to be practical. Hence, we propose an explainable task-specific synthesis network, which adapts weights automatically for specific sequence generation tasks and provides interpretability and reliability from two sides: (1) visualize the contribution of each input sequence in the fusion stage by a trainable task-specific weighted average module; (2) highlight the area the network tried to refine during synthesizing by a task-specific attention module. We conduct experiments on the BraTS2021 dataset of 1251 subjects, and results on arbitrary sequence synthesis indicate that the proposed method achieves better performance than the state-of-the-art methods. Our code is available at \url{https://github.com/fiy2W/mri_seq2seq}.

Abstract: Magnetic resonance imaging (MRI) is the most sensitive technique for breast cancer detection among current clinical imaging modalities. Contrast-enhanced MRI (CE-MRI) provides superior differentiation between tumors and invaded healthy tissue, and has become an indispensable technique in the detection and evaluation of cancer. However, the use of gadolinium-based contrast agents (GBCA) to obtain CE-MRI may be associated with nephrogenic systemic fibrosis and may lead to bioaccumulation in the brain, posing a potential risk to human health. Moreover, and likely more important, the use of gadolinium-based contrast agents requires the cannulation of a vein, and the injection of the contrast media which is cumbersome and places a burden on the patient. To reduce the use of contrast agents, diffusion-weighted imaging (DWI) is emerging as a key imaging technique, although currently usually complementing breast CE-MRI. In this study, we develop a multi-sequence fusion network to synthesize CE-MRI based on T1-weighted MRI and DWIs. DWIs with different b-values are fused to efficiently utilize the difference features of DWIs. Rather than proposing a pure data-driven approach, we invent a multi-sequence attention module to obtain refined feature maps, and leverage hierarchical representation information fused at different scales while utilizing the contributions from different sequences from a model-driven approach by introducing the weighted difference module. The results show that the multi-b-value DWI-based fusion model can potentially be used to synthesize CE-MRI, thus theoretically reducing or avoiding the use of GBCA, thereby minimizing the burden to patients. Our code is available at \url{https://github.com/Netherlands-Cancer-Institute/CE-MRI}.

Abstract: Retinal vascular phenotypes, derived from low-cost, non-invasive retinal imaging, have been linked to systemic conditions such as cardio-, neuro- and reno-vascular disease. Recent high-resolution optical coherence tomography (OCT) allows imaging of the choroidal microvasculature which could provide more information about vascular health that complements the superficial retinal vessels, which current vascular phenotypes are based on. Segmentation of the choroid in OCT is a key step in quantifying choroidal parameters like thickness and area. Gaussian Process Edge Tracing (GPET) is a promising, clinically validated method for this. However, GPET is semi-automatic and thus requires time-consuming manual interventions by specifically trained personnel which introduces subjectivity and limits the potential for analysing larger datasets or deploying GPET into clinical practice. We introduce DeepGPET, which distils GPET into a neural network to yield a fully-automatic and efficient choroidal segmentation method. DeepGPET achieves excellent agreement with GPET on data from 3 clinical studies (AUC=0.9994, Dice=0.9664; Pearson correlation of 0.8908 for choroidal thickness and 0.9082 for choroidal area), while reducing the mean processing time per image from 34.49s ($\pm$15.09) to 1.25s ($\pm$0.10) on a standard laptop CPU and removing all manual interventions. DeepGPET will be made available for researchers upon publication.

Abstract: According to the 2021 World Health Organization (WHO) Classification scheme for gliomas, glioma segmentation is a very important basis for diagnosis and genotype prediction. In general, 3D multimodal brain MRI is an effective diagnostic tool. In the past decade, there has been an increase in the use of machine learning, particularly deep learning, for medical images processing. Thanks to the development of foundation models, models pre-trained with large-scale datasets have achieved better results on a variety of tasks. However, for medical images with small dataset sizes, deep learning methods struggle to achieve better results on real-world image datasets. In this paper, we propose a cross-modality attention adapter based on multimodal fusion to fine-tune the foundation model to accomplish the task of glioma segmentation in multimodal MRI brain images with better results. The effectiveness of the proposed method is validated via our private glioma data set from the First Affiliated Hospital of Zhengzhou University (FHZU) in Zhengzhou, China. Our proposed method is superior to current state-of-the-art methods with a Dice of 88.38% and Hausdorff distance of 10.64, thereby exhibiting a 4% increase in Dice to segment the glioma region for glioma treatment.