Nazim Haouchine

Reuben Dorent, Nazim Haouchine, Fryderyk Kögl et al. · harvard

We introduce MHVAE, a deep hierarchical variational auto-encoder (VAE) that synthesizes missing images from various modalities. Extending multi-modal VAEs with a hierarchical latent structure, we introduce a probabilistic formulation for fusing multi-modal images in a common latent representation while having the flexibility to handle incomplete image sets as input. Moreover, adversarial learning is employed to generate sharper images. Extensive experiments are performed on the challenging problem of joint intra-operative ultrasound (iUS) and Magnetic Resonance (MR) synthesis. Our model outperformed multi-modal VAEs, conditional GANs, and the current state-of-the-art unified method (ResViT) for synthesizing missing images, demonstrating the advantage of using a hierarchical latent representation and a principled probabilistic fusion operation. Our code is publicly available \url{https://github.com/ReubenDo/MHVAE}.

Nazim Haouchine, Reuben Dorent, Parikshit Juvekar et al. · harvard

We present a novel method for intraoperative patient-to-image registration by learning Expected Appearances. Our method uses preoperative imaging to synthesize patient-specific expected views through a surgical microscope for a predicted range of transformations. Our method estimates the camera pose by minimizing the dissimilarity between the intraoperative 2D view through the optical microscope and the synthesized expected texture. In contrast to conventional methods, our approach transfers the processing tasks to the preoperative stage, reducing thereby the impact of low-resolution, distorted, and noisy intraoperative images, that often degrade the registration accuracy. We applied our method in the context of neuronavigation during brain surgery. We evaluated our approach on synthetic data and on retrospective data from 6 clinical cases. Our method outperformed state-of-the-art methods and achieved accuracies that met current clinical standards.

Sidaty El Hadramy, Nazim Haouchine, Michael Wehrli et al.

This paper presents NOIR, a framework that reframes core medical imaging tasks as operator learning between continuous function spaces, challenging the prevailing paradigm of discrete grid-based deep learning. Instead of operating on fixed pixel or voxel grids, NOIR embeds discrete medical signals into shared Implicit Neural Representations and learns a Neural Operator that maps between their latent modulations, enabling resolution-independent function-to-function transformations. We evaluate NOIR across multiple 2D and 3D downstream tasks, including segmentation, shape completion, image-to-image translation, and image synthesis, on several public datasets such as Shenzhen, OASIS-4, SkullBreak, fastMRI, as well as an in-house clinical dataset. It achieves competitive performance at native resolution while demonstrating strong robustness to unseen discretizations, and empirically satisfies key theoretical properties of neural operators. The project page is available here: https://github.com/Sidaty1/NOIR-io.

Maximilian Fehrentz, Mohammad Farid Azampour, Reuben Dorent et al.

We present in this paper a novel approach for 3D/2D intraoperative registration during neurosurgery via cross-modal inverse neural rendering. Our approach separates implicit neural representation into two components, handling anatomical structure preoperatively and appearance intraoperatively. This disentanglement is achieved by controlling a Neural Radiance Field's appearance with a multi-style hypernetwork. Once trained, the implicit neural representation serves as a differentiable rendering engine, which can be used to estimate the surgical camera pose by minimizing the dissimilarity between its rendered images and the target intraoperative image. We tested our method on retrospective patients' data from clinical cases, showing that our method outperforms state-of-the-art while meeting current clinical standards for registration. Code and additional resources can be found at https://maxfehrentz.github.io/style-ngp/.

Hassan Rasheed, Reuben Dorent, Maximilian Fehrentz et al.

We propose in this paper a texture-invariant 2D keypoints descriptor specifically designed for matching preoperative Magnetic Resonance (MR) images with intraoperative Ultrasound (US) images. We introduce a matching-by-synthesis strategy, where intraoperative US images are synthesized from MR images accounting for multiple MR modalities and intraoperative US variability. We build our training set by enforcing keypoints localization over all images then train a patient-specific descriptor network that learns texture-invariant discriminant features in a supervised contrastive manner, leading to robust keypoints descriptors. Our experiments on real cases with ground truth show the effectiveness of the proposed approach, outperforming the state-of-the-art methods and achieving 80.35% matching precision on average.

Alberto Neri, Veronica Penza, Nazim Haouchine et al.

Unsafe surgical care is a critical health concern, often linked to limitations in surgeon experience, skills, and situational awareness. Integrating patient-specific 3D models into the surgical field can enhance visualization, provide real-time anatomical guidance, and reduce intraoperative complications. However, reliably registering these models in general surgery remains challenging due to mismatches between preoperative and intraoperative organ surfaces, such as deformations and noise. To overcome these challenges, we introduce the first patient-specific non-rigid point cloud registration method, which leverages a novel data generation strategy to optimize outcomes for individual patients. Our approach combines a Transformer encoder-decoder architecture with overlap estimation and a dedicated matching module to predict dense correspondences, followed by a physics-based algorithm for registration. Experimental results on both synthetic and real data demonstrate that our patient-specific method significantly outperforms traditional agnostic approaches, achieving 45% Matching Score with 92% Inlier Ratio on synthetic data, highlighting its potential to improve surgical care.

Reuben Dorent, Erickson Torio, Nazim Haouchine et al.

Intraoperative ultrasound (iUS) imaging has the potential to improve surgical outcomes in brain surgery. However, its interpretation is challenging, even for expert neurosurgeons. In this work, we designed the first patient-specific framework that performs brain tumor segmentation in trackerless iUS. To disambiguate ultrasound imaging and adapt to the neurosurgeon's surgical objective, a patient-specific real-time network is trained using synthetic ultrasound data generated by simulating virtual iUS sweep acquisitions in pre-operative MR data. Extensive experiments performed in real ultrasound data demonstrate the effectiveness of the proposed approach, allowing for adapting to the surgeon's definition of surgical targets and outperforming non-patient-specific models, neurosurgeon experts, and high-end tracking systems. Our code is available at: \url{https://github.com/ReubenDo/MHVAE-Seg}.

Teng Zhou, Jax Luo, Yuping Sun et al.

Accurate MRI-to-CT translation promises the integration of complementary imaging information without the need for additional imaging sessions. Given the practical challenges associated with acquiring paired MRI and CT scans, the development of robust methods capable of leveraging unpaired datasets is essential for advancing the MRI-to-CT translation. Current unpaired MRI-to-CT translation methods, which predominantly rely on cycle consistency and contrastive learning frameworks, frequently encounter challenges in accurately translating anatomical features that are highly discernible on CT but less distinguishable on MRI, such as bone structures. This limitation renders these approaches less suitable for applications in radiation therapy, where precise bone representation is essential for accurate treatment planning. To address this challenge, we propose a path- and bone-contour regularized approach for unpaired MRI-to-CT translation. In our method, MRI and CT images are projected to a shared latent space, where the MRI-to-CT mapping is modeled as a continuous flow governed by neural ordinary differential equations. The optimal mapping is obtained by minimizing the transition path length of the flow. To enhance the accuracy of translated bone structures, we introduce a trainable neural network to generate bone contours from MRI and implement mechanisms to directly and indirectly encourage the model to focus on bone contours and their adjacent regions. Evaluations conducted on three datasets demonstrate that our method outperforms existing unpaired MRI-to-CT translation approaches, achieving lower overall error rates. Moreover, in a downstream bone segmentation task, our approach exhibits superior performance in preserving the fidelity of bone structures. Our code is available at: https://github.com/kennysyp/PaBoT.

Daniil Morozov, Reuben Dorent, Nazim Haouchine

Intraoperative registration of real-time ultrasound (iUS) to preoperative Magnetic Resonance Imaging (MRI) remains an unsolved problem due to severe modality-specific differences in appearance, resolution, and field-of-view. To address this, we propose a novel 3D cross-modal keypoint descriptor for MRI-iUS matching and registration. Our approach employs a patient-specific matching-by-synthesis approach, generating synthetic iUS volumes from preoperative MRI. This enables supervised contrastive training to learn a shared descriptor space. A probabilistic keypoint detection strategy is then employed to identify anatomically salient and modality-consistent locations. During training, a curriculum-based triplet loss with dynamic hard negative mining is used to learn descriptors that are i) robust to iUS artifacts such as speckle noise and limited coverage, and ii) rotation-invariant . At inference, the method detects keypoints in MR and real iUS images and identifies sparse matches, which are then used to perform rigid registration. Our approach is evaluated using 3D MRI-iUS pairs from the ReMIND dataset. Experiments show that our approach outperforms state-of-the-art keypoint matching methods across 11 patients, with an average precision of $69.8\%$. For image registration, our method achieves a competitive mean Target Registration Error of 2.39 mm on the ReMIND2Reg benchmark. Compared to existing iUS-MR registration approach, our framework is interpretable, requires no manual initialization, and shows robustness to iUS field-of-view variation. Code is available at https://github.com/morozovdd/CrossKEY.

Taewoong Lee, Sarah Frisken, Nazim Haouchine

We present a method for 3D/2D registration of Digital Subtraction Angiography (DSA) images to provide valuable insight into brain hemodynamics and angioarchitecture. Our approach formulates the registration as a pose estimation problem, leveraging both anteroposterior and lateral DSA views and employing differentiable rendering. Preliminary experiments on real and synthetic datasets demonstrate the effectiveness of our method, with both qualitative and quantitative evaluations highlighting its potential for clinical applications. The code is available at https://github.com/taewoonglee17/TwoViewsDSAReg.

Reuben Dorent, Nazim Haouchine, Alexandra Golby et al.

We propose a deep mixture of multimodal hierarchical variational auto-encoders called MMHVAE that synthesizes missing images from observed images in different modalities. MMHVAE's design focuses on tackling four challenges: (i) creating a complex latent representation of multimodal data to generate high-resolution images; (ii) encouraging the variational distributions to estimate the missing information needed for cross-modal image synthesis; (iii) learning to fuse multimodal information in the context of missing data; (iv) leveraging dataset-level information to handle incomplete data sets at training time. Extensive experiments are performed on the challenging problem of pre-operative brain multi-parametric magnetic resonance and intra-operative ultrasound imaging.

Alberto Neri, Maximilan Fehrentz, Veronica Penza et al.

Purpose: Neural Radiance Fields (NeRF) offer exceptional capabilities for 3D reconstruction and view synthesis, yet their reliance on extensive multi-view data limits their application in surgical intraoperative settings where only limited data is available. In particular, collecting such extensive data intraoperatively is impractical due to time constraints. This work addresses this challenge by leveraging a single intraoperative image and preoperative data to train NeRF efficiently for surgical scenarios. Methods: We leverage preoperative MRI data to define the set of camera viewpoints and images needed for robust and unobstructed training. Intraoperatively, the appearance of the surgical image is transferred to the pre-constructed training set through neural style transfer, specifically combining WTC2 and STROTSS to prevent over-stylization. This process enables the creation of a dataset for instant and fast single-image NeRF training. Results: The method is evaluated with four clinical neurosurgical cases. Quantitative comparisons to NeRF models trained on real surgical microscope images demonstrate strong synthesis agreement, with similarity metrics indicating high reconstruction fidelity and stylistic alignment. When compared with ground truth, our method demonstrates high structural similarity, confirming good reconstruction quality and texture preservation. Conclusion: Our approach demonstrates the feasibility of single-image NeRF training in surgical settings, overcoming the limitations of traditional multi-view methods.

Kathleen Baur, Xin Xiong, Erickson Torio et al. · harvard

Although Digital Subtraction Angiography (DSA) is the most important imaging for visualizing cerebrovascular anatomy, its interpretation by clinicians remains difficult. This is particularly true when treating arteriovenous malformations (AVMs), where entangled vasculature connecting arteries and veins needs to be carefully identified.The presented method aims to enhance DSA image series by highlighting critical information via automatic classification of vessels using a combination of two learning models: An unsupervised machine learning method based on Independent Component Analysis that decomposes the phases of flow and a convolutional neural network that automatically delineates the vessels in image space. The proposed method was tested on clinical DSA images series and demonstrated efficient differentiation between arteries and veins that provides a viable solution to enhance visualizations for clinical use.

Malika Sanhinova, Nazim Haouchine, Steve D. Pieper et al.

Accurate and reliable registration of longitudinal spine images is essential for assessment of disease progression and surgical outcome. Implementing a fully automatic and robust registration is crucial for clinical use, however, it is challenging due to substantial change in shape and appearance due to lesions. In this paper we present a novel method to automatically align longitudinal spine CTs and accurately assess lesion progression. Our method follows a two-step pipeline where vertebrae are first automatically localized, labeled and 3D surfaces are generated using a deep learning model, then longitudinally aligned using a Gaussian mixture model surface registration. We tested our approach on 37 vertebrae, from 5 patients, with baseline CTs and 3, 6, and 12 months follow-ups leading to 111 registrations. Our experiment showed accurate registration with an average Hausdorff distance of 0.65 mm and average Dice score of 0.92.

Maximilian Fehrentz, Alexander Winkler, Thomas Heiliger et al.

We introduce BridgeSplat, a novel approach for deformable surgical navigation that couples intraoperative 3D reconstruction with preoperative CT data to bridge the gap between surgical video and volumetric patient data. Our method rigs 3D Gaussians to a CT mesh, enabling joint optimization of Gaussian parameters and mesh deformation through photometric supervision. By parametrizing each Gaussian relative to its parent mesh triangle, we enforce alignment between Gaussians and mesh and obtain deformations that can be propagated back to update the CT. We demonstrate BridgeSplat's effectiveness on visceral pig surgeries and synthetic data of a human liver under simulation, showing sensible deformations of the preoperative CT on monocular RGB data. Code, data, and additional resources can be found at https://maxfehrentz.github.io/ct-informed-splatting/ .

Lasse Hansen, Wiebke Heyer, Christoph Großbröhmer et al.

Medical image registration is critical for clinical applications, and fair benchmarking of different methods is essential for monitoring ongoing progress. To date, the Learn2Reg 2020-2023 challenges have released several complementary datasets and established metrics for evaluations. However, these editions did not capture all aspects of the registration problem, particularly in terms of modality diversity and task complexity. To address these limitations, the 2024 edition introduces three new tasks, including large-scale multi-modal registration and unsupervised inter-subject brain registration, as well as the first microscopy-focused benchmark within Learn2Reg. The new datasets also inspired new method developments, including invertibility constraints, pyramid features, keypoints alignment and instance optimisation.

Jie Luo, Guangshen Ma, Sarah Frisken et al.

With the increasing availability of new image registration approaches, an unbiased evaluation is becoming more needed so that clinicians can choose the most suitable approaches for their applications. Current evaluations typically use landmarks in manually annotated datasets. As a result, the quality of annotations is crucial for unbiased comparisons. Even though most data providers claim to have quality control over their datasets, an objective third-party screening can be reassuring for intended users. In this study, we use the variogram to screen the manually annotated landmarks in two datasets used to benchmark registration in image-guided neurosurgeries. The variogram provides an intuitive 2D representation of the spatial characteristics of annotated landmarks. Using variograms, we identified potentially problematic cases and had them examined by experienced radiologists. We found that (1) a small number of annotations may have fiducial localization errors; (2) the landmark distribution for some cases is not ideal to offer fair comparisons. If unresolved, both findings could incur bias in registration evaluation.

Nazim Haouchine, Frederick Roy, Hadrien Courtecuisse et al.

We present Calipso, an interactive method for editing images and videos in a physically-coherent manner. Our main idea is to realize physics-based manipulations by running a full physics simulation on proxy geometries given by non-rigidly aligned CAD models. Running these simulations allows us to apply new, unseen forces to move or deform selected objects, change physical parameters such as mass or elasticity, or even add entire new objects that interact with the rest of the underlying scene. In Calipso, the user makes edits directly in 3D; these edits are processed by the simulation and then transfered to the target 2D content using shape-to-image correspondences in a photo-realistic rendering process. To align the CAD models, we introduce an efficient CAD-to-image alignment procedure that jointly minimizes for rigid and non-rigid alignment while preserving the high-level structure of the input shape. Moreover, the user can choose to exploit image flow to estimate scene motion, producing coherent physical behavior with ambient dynamics. We demonstrate Calipso's physics-based editing on a wide range of examples producing myriad physical behavior while preserving geometric and visual consistency.