Medical image computing and computer-assisted intervention : MICCAI ... International Conference on Medical Image Computing and Computer-Assisted Intervention最新文献

The accuracy of predictive models for solitary pulmonary nodule (SPN) diagnosis can be greatly increased by incorporating repeat imaging and medical context, such as electronic health records (EHRs). However, clinically routine modalities such as imaging and diagnostic codes can be asynchronous and irregularly sampled over different time scales which are obstacles to longitudinal multimodal learning. In this work, we propose a transformer-based multimodal strategy to integrate repeat imaging with longitudinal clinical signatures from routinely collected EHRs for SPN classification. We perform unsupervised disentanglement of latent clinical signatures and leverage time-distance scaled self-attention to jointly learn from clinical signatures expressions and chest computed tomography (CT) scans. Our classifier is pretrained on 2,668 scans from a public dataset and 1,149 subjects with longitudinal chest CTs, billing codes, medications, and laboratory tests from EHRs of our home institution. Evaluation on 227 subjects with challenging SPNs revealed a significant AUC improvement over a longitudinal multimodal baseline (0.824 vs 0.752 AUC), as well as improvements over a single cross-section multimodal scenario (0.809 AUC) and a longitudinal imaging-only scenario (0.741 AUC). This work demonstrates significant advantages with a novel approach for co-learning longitudinal imaging and non-imaging phenotypes with transformers. Code available at https://github.com/MASILab/lmsignatures.

Brain structural MRI has been widely used for assessing future progression of cognitive impairment (CI) based on learning-based methods. Previous studies generally suffer from the limited number of labeled training data, while there exists a huge amount of MRIs in large-scale public databases. Even without task-specific label information, brain anatomical structures provided by these MRIs can be used to boost learning performance intuitively. Unfortunately, existing research seldom takes advantage of such brain anatomy prior. To this end, this paper proposes a brain anatomy-guided representation (BAR) learning framework for assessing the clinical progression of cognitive impairment with T1-weighted MRIs. The BAR consists of a pretext model and a downstream model, with a shared brain anatomy-guided encoder for MRI feature extraction. The pretext model also contains a decoder for brain tissue segmentation, while the downstream model relies on a predictor for classification. We first train the pretext model through a brain tissue segmentation task on 9,544 auxiliary T1-weighted MRIs, yielding a generalizable encoder. The downstream model with the learned encoder is further fine-tuned on target MRIs for prediction tasks. We validate the proposed BAR on two CI-related studies with a total of 391 subjects with T1-weighted MRIs. Experimental results suggest that the BAR outperforms several state-of-the-art (SOTA) methods. The source code and pre-trained models are available at https://github.com/goodaycoder/BAR.

The fiber orientation distribution function (FOD) is an advanced model for high angular resolution diffusion MRI representing complex fiber geometry. However, the complicated mathematical structures of the FOD function pose challenges for FOD image processing tasks such as interpolation, which plays a critical role in the propagation of fiber tracts in tractography. In FOD-based tractography, linear interpolation is commonly used for numerical efficiency, but it is prone to generate false artificial information, leading to anatomically incorrect fiber tracts. To overcome this difficulty, we propose a flowbased and geometrically consistent interpolation framework that considers peak-wise rotations of FODs within the neighborhood of each location. Our method decomposes a FOD function into multiple components and uses a smooth vector field to model the flows of each peak in its neighborhood. To generate the interpolated result along the flow of each vector field, we develop a closed-form and efficient method to rotate FOD peaks in neighboring voxels and realize geometrically consistent interpolation of FOD components. By combining the interpolation results from each peak, we obtain the final interpolation of FODs. Experimental results on Human Connectome Project (HCP) data demonstrate that our method produces anatomically more meaningful FOD interpolations and significantly enhances tractography performance.

The thickness of the cortical band is linked to various neurological and psychiatric conditions, and is often estimated through surface-based methods such as Freesurfer in MRI studies. The DiReCT method, which calculates cortical thickness using a diffeomorphic deformation of the gray-white matter interface towards the pial surface, offers an alternative to surface-based methods. Recent studies using a synthetic cortical thickness phantom have demonstrated that the combination of DiReCT and deep-learning-based segmentation is more sensitive to subvoxel cortical thinning than Freesurfer. While anatomical segmentation of a T1-weighted image now takes seconds, existing implementations of DiReCT rely on iterative image registration methods which can take up to an hour per volume. On the other hand, learning-based deformable image registration methods like VoxelMorph have been shown to be faster than classical methods while improving registration accuracy. This paper proposes CortexMorph, a new method that employs unsupervised deep learning to directly regress the deformation field needed for DiReCT. By combining CortexMorph with a deep-learning-based segmentation model, it is possible to estimate region-wise thickness in seconds from a T1-weighted image, while maintaining the ability to detect cortical atrophy. We validate this claim on the OASIS-3 dataset and the synthetic cortical thickness phantom of Rusak et al.

Deep learning nowadays offers expert-level and sometimes even super-expert-level performance, but achieving such performance demands massive annotated data for training (e.g., Google's proprietary CXR Foundation Model (CXR-FM) was trained on 821,544 labeled and mostly private chest X-rays (CXRs)). Numerous datasets are publicly available in medical imaging but individually small and heterogeneous in expert labels. We envision a powerful and robust foundation model that can be trained by aggregating numerous small public datasets. To realize this vision, we have developed Ark, a framework that accrues and reuses knowledge from heterogeneous expert annotations in various datasets. As a proof of concept, we have trained two Ark models on 335,484 and 704,363 CXRs, respectively, by merging several datasets including ChestX-ray14, CheXpert, MIMIC-II, and VinDr-CXR, evaluated them on a wide range of imaging tasks covering both classification and segmentation via fine-tuning, linear-probing, and gender-bias analysis, and demonstrated our Ark's superior and robust performance over the state-of-the-art (SOTA) fully/self-supervised baselines and Google's proprietary CXR-FM. This enhanced performance is attributed to our simple yet powerful observation that aggregating numerous public datasets diversifies patient populations and accrues knowledge from diverse experts, yielding unprecedented performance yet saving annotation cost. With all codes and pretrained models released at GitHub.com/JLiangLab/Ark, we hope that Ark exerts an important impact on open science, as accruing and reusing knowledge from expert annotations in public datasets can potentially surpass the performance of proprietary models trained on unusually large data, inspiring many more researchers worldwide to share codes and datasets to build open foundation models, accelerate open science, and democratize deep learning for medical imaging.

One of the hallmark symptoms of Parkinson's Disease (PD) is the progressive loss of postural reflexes, which eventually leads to gait difficulties and balance problems. Identifying disruptions in brain function associated with gait impairment could be crucial in better understanding PD motor progression, thus advancing the development of more effective and personalized therapeutics. In this work, we present an explainable, geometric, weighted-graph attention neural network (xGW-GAT) to identify functional networks predictive of the progression of gait difficulties in individuals with PD. xGW-GAT predicts the multi-class gait impairment on the MDS-Unified PD Rating Scale (MDS-UPDRS). Our computational- and data-efficient model represents functional connectomes as symmetric positive definite (SPD) matrices on a Riemannian manifold to explicitly encode pairwise interactions of entire connectomes, based on which we learn an attention mask yielding individual- and group-level explainability. Applied to our resting-state functional MRI (rs-fMRI) dataset of individuals with PD, xGW-GAT identifies functional connectivity patterns associated with gait impairment in PD and offers interpretable explanations of functional subnetworks associated with motor impairment. Our model successfully outperforms several existing methods while simultaneously revealing clinically-relevant connectivity patterns. The source code is available at https://github.com/favour-nerrise/xGW-GAT.

Interpretability is a key issue when applying deep learning models to longitudinal brain MRIs. One way to address this issue is by visualizing the high-dimensional latent spaces generated by deep learning via self-organizing maps (SOM). SOM separates the latent space into clusters and then maps the cluster centers to a discrete (typically 2D) grid preserving the high-dimensional relationship between clusters. However, learning SOM in a high-dimensional latent space tends to be unstable, especially in a self-supervision setting. Furthermore, the learned SOM grid does not necessarily capture clinically interesting information, such as brain age. To resolve these issues, we propose the first self-supervised SOM approach that derives a high-dimensional, interpretable representation stratified by brain age solely based on longitudinal brain MRIs (i.e., without demographic or cognitive information). Called Longitudinally-consistent Self-Organized Representation learning (LSOR), the method is stable during training as it relies on soft clustering (vs. the hard cluster assignments used by existing SOM). Furthermore, our approach generates a latent space stratified according to brain age by aligning trajectories inferred from longitudinal MRIs to the reference vector associated with the corresponding SOM cluster. When applied to longitudinal MRIs of the Alzheimer's Disease Neuroimaging Initiative (ADNI, $N=632$), LSOR generates an interpretable latent space and achieves comparable or higher accuracy than the state-of-the-art representations with respect to the downstream tasks of classification (static vs. progressive mild cognitive impairment) and regression (determining ADAS-Cog score of all subjects). The code is available at https://github.com/ouyangjiahong/longitudinal-som-single-modality.

Surgical phase recognition (SPR) is a crucial element in the digital transformation of the modern operating theater. While SPR based on video sources is well-established, incorporation of interventional X-ray sequences has not yet been explored. This paper presents Pelphix, a first approach to SPR for X-ray-guided percutaneous pelvic fracture fixation, which models the procedure at four levels of granularity - corridor, activity, view, and frame value - simulating the pelvic fracture fixation workflow as a Markov process to provide fully annotated training data. Using added supervision from detection of bony corridors, tools, and anatomy, we learn image representations that are fed into a transformer model to regress surgical phases at the four granularity levels. Our approach demonstrates the feasibility of X-ray-based SPR, achieving an average accuracy of 99.2% on simulated sequences and 71.7% in cadaver across all granularity levels, with up to 84% accuracy for the target corridor in real data. This work constitutes the first step toward SPR for the X-ray domain, establishing an approach to categorizing phases in X-ray-guided surgery, simulating realistic image sequences to enable machine learning model development, and demonstrating that this approach is feasible for the analysis of real procedures. As X-ray-based SPR continues to mature, it will benefit procedures in orthopedic surgery, angiography, and interventional radiology by equipping intelligent surgical systems with situational awareness in the operating room.

Mitigating the effects of image appearance due to variations in computed tomography (CT) acquisition and reconstruction parameters is a challenging inverse problem. We present CTFlow, a normalizing flows-based method for harmonizing CT scans acquired and reconstructed using different doses and kernels to a target scan. Unlike existing state-of-the-art image harmonization approaches that only generate a single output, flow-based methods learn the explicit conditional density and output the entire spectrum of plausible reconstruction, reflecting the underlying uncertainty of the problem. We demonstrate how normalizing flows reduces variability in image quality and the performance of a machine learning algorithm for lung nodule detection. We evaluate the performance of CTFlow by 1) comparing it with other techniques on a denoising task using the AAPM-Mayo Clinical Low-Dose CT Grand Challenge dataset, and 2) demonstrating consistency in nodule detection performance across 186 real-world low-dose CT chest scans acquired at our institution. CTFlow performs better in the denoising task for both peak signal-to-noise ratio and perceptual quality metrics. Moreover, CTFlow produces more consistent predictions across all dose and kernel conditions than generative adversarial network (GAN)-based image harmonization on a lung nodule detection task. The code is available at https://github.com/hsu-lab/ctflow.

Integrating high-level semantically correlated contents and low-level anatomical features is of central importance in medical image segmentation. Towards this end, recent deep learning-based medical segmentation methods have shown great promise in better modeling such information. However, convolution operators for medical segmentation typically operate on regular grids, which inherently blur the high-frequency regions, i.e., boundary regions. In this work, we propose MORSE, a generic implicit neural rendering framework designed at an anatomical level to assist learning in medical image segmentation. Our method is motivated by the fact that implicit neural representation has been shown to be more effective in fitting complex signals and solving computer graphics problems than discrete grid-based representation. The core of our approach is to formulate medical image segmentation as a rendering problem in an end-to-end manner. Specifically, we continuously align the coarse segmentation prediction with the ambiguous coordinate-based point representations and aggregate these features to adaptively refine the boundary region. To parallelly optimize multi-scale pixel-level features, we leverage the idea from Mixture-of-Expert (MoE) to design and train our MORSE with a stochastic gating mechanism. Our experiments demonstrate that MORSE can work well with different medical segmentation backbones, consistently achieving competitive performance improvements in both 2D and 3D supervised medical segmentation methods. We also theoretically analyze the superiority of MORSE.