Fuping Wu

Zheyao Gao, Lei Li, Fuping Wu et al.

Distributed learning has shown great potential in medical image analysis. It allows to use multi-center training data with privacy protection. However, data distributions in local centers can vary from each other due to different imaging vendors, and annotation protocols. Such variation degrades the performance of learning-based methods. To mitigate the influence, two groups of methods have been proposed for different aims, i.e., the global methods and the personalized methods. The former are aimed to improve the performance of a single global model for all test data from unseen centers (known as generic data); while the latter target multiple models for each center (denoted as local data). However, little has been researched to achieve both goals simultaneously. In this work, we propose a new framework of distributed learning that bridges the gap between two groups, and improves the performance for both generic and local data. Specifically, our method decouples the predictions for generic data and local data, via distribution-conditioned adaptation matrices. Results on multi-center left atrial (LA) MRI segmentation showed that our method demonstrated superior performance over existing methods on both generic and local data. Our code is available at https://github.com/key1589745/decouple_predict

Zheyao Gao, Yuanye Liu, Fuping Wu et al.

Staging of liver fibrosis is important in the diagnosis and treatment planning of patients suffering from liver diseases. Current deep learning-based methods using abdominal magnetic resonance imaging (MRI) usually take a sub-region of the liver as an input, which nevertheless could miss critical information. To explore richer representations, we formulate this task as a multi-view learning problem and employ multiple sub-regions of the liver. Previously, features or predictions are usually combined in an implicit manner, and uncertainty-aware methods have been proposed. However, these methods could be challenged to capture cross-view representations, which can be important in the accurate prediction of staging. Therefore, we propose a reliable multi-view learning method with interpretable combination rules, which can model global representations to improve the accuracy of predictions. Specifically, the proposed method estimates uncertainties based on subjective logic to improve reliability, and an explicit combination rule is applied based on Dempster-Shafer's evidence theory with good power of interpretability. Moreover, a data-efficient transformer is introduced to capture representations in the global view. Results evaluated on enhanced MRI data show that our method delivers superior performance over existing multi-view learning methods.

Kaiwen Wan, Lei Li, Dengqiang Jia et al.

Medical images are generally acquired with limited field-of-view (FOV), which could lead to incomplete regions of interest (ROI), and thus impose a great challenge on medical image analysis. This is particularly evident for the learning-based multi-target landmark detection, where algorithms could be misleading to learn primarily the variation of background due to the varying FOV, failing the detection of targets. Based on learning a navigation policy, instead of predicting targets directly, reinforcement learning (RL)-based methods have the potential totackle this challenge in an efficient manner. Inspired by this, in this work we propose a multi-agent RL framework for simultaneous multi-target landmark detection. This framework is aimed to learn from incomplete or (and) complete images to form an implicit knowledge of global structure, which is consolidated during the training stage for the detection of targets from either complete or incomplete test images. To further explicitly exploit the global structural information from incomplete images, we propose to embed a shape model into the RL process. With this prior knowledge, the proposed RL model can not only localize dozens of targetssimultaneously, but also work effectively and robustly in the presence of incomplete images. We validated the applicability and efficacy of the proposed method on various multi-target detection tasks with incomplete images from practical clinics, using body dual-energy X-ray absorptiometry (DXA), cardiac MRI and head CT datasets. Results showed that our method could predict whole set of landmarks with incomplete training images up to 80% missing proportion (average distance error 2.29 cm on body DXA), and could detect unseen landmarks in regions with missing image information outside FOV of target images (average distance error 6.84 mm on 3D half-head CT).

Sihan Wang, Fuping Wu, Lei Li et al.

Cardiac segmentation is in great demand for clinical practice. Due to the enormous labor of manual delineation, unsupervised segmentation is desired. The ill-posed optimization problem of this task is inherently challenging, requiring well-designed constraints. In this work, we propose an unsupervised framework for multi-class segmentation with both intensity and shape constraints. Firstly, we extend a conventional non-convex energy function as an intensity constraint and implement it with U-Net. For shape constraint, synthetic images are generated from anatomical labels via image-to-image translation, as shape supervision for the segmentation network. Moreover, augmentation invariance is applied to facilitate the segmentation network to learn the latent features in terms of shape. We evaluated the proposed framework using the public datasets from MICCAI2019 MSCMR Challenge and achieved promising results on cardiac MRIs with Dice scores of 0.5737, 0.7796, and 0.6287 in Myo, LV, and RV, respectively.

Yuhan Zheng, Fuping Wu, Bartłomiej W. Papież

Diabetic retinopathy (DR) is a complication of diabetes, and one of the major causes of vision impairment in the global population. As the early-stage manifestation of DR is usually very mild and hard to detect, an accurate diagnosis via eye-screening is clinically important to prevent vision loss at later stages. In this work, we propose an ensemble method to automatically grade DR using ultra-wide optical coherence tomography angiography (UW-OCTA) images available from Diabetic Retinopathy Analysis Challenge (DRAC) 2022. First, we adopt the state-of-the-art classification networks, i.e., ResNet, DenseNet, EfficientNet, and VGG, and train them to grade UW-OCTA images with different splits of the available dataset. Ultimately, we obtain 25 models, of which, the top 16 models are selected and ensembled to generate the final predictions. During the training process, we also investigate the multi-task learning strategy, and add an auxiliary classification task, the Image Quality Assessment, to improve the model performance. Our final ensemble model achieved a quadratic weighted kappa (QWK) of 0.9346 and an Area Under Curve (AUC) of 0.9766 on the internal testing dataset, and the QWK of 0.839 and the AUC of 0.8978 on the DRAC challenge testing dataset.

Yuanye Liu, Zheyao Gao, Nannan Shi et al.

Accurate staging of liver fibrosis from magnetic resonance imaging (MRI) is crucial in clinical practice. While conventional methods often focus on a specific sub-region, multi-view learning captures more information by analyzing multiple patches simultaneously. However, previous multi-view approaches could not typically calculate uncertainty by nature, and they generally integrate features from different views in a black-box fashion, hence compromising reliability as well as interpretability of the resulting models. In this work, we propose a new multi-view method based on evidential learning, referred to as MERIT, which tackles the two challenges in a unified framework. MERIT enables uncertainty quantification of the predictions to enhance reliability, and employs a logic-based combination rule to improve interpretability. Specifically, MERIT models the prediction from each sub-view as an opinion with quantified uncertainty under the guidance of the subjective logic theory. Furthermore, a distribution-aware base rate is introduced to enhance performance, particularly in scenarios involving class distribution shifts. Finally, MERIT adopts a feature-specific combination rule to explicitly fuse multi-view predictions, thereby enhancing interpretability. Results have showcased the effectiveness of the proposed MERIT, highlighting the reliability and offering both ad-hoc and post-hoc interpretability. They also illustrate that MERIT can elucidate the significance of each view in the decision-making process for liver fibrosis staging. Our code has be released via https://github.com/HenryLau7/MERIT.

Jian-Qing Zheng, Yuanhan Mo, Yang Sun et al.

In medical imaging, the diffusion models have shown great potential for synthetic image generation tasks. However, these approaches often lack the interpretable connections between the generated and real images and can create anatomically implausible structures or illusions. To address these limitations, we propose the Deformation-Recovery Diffusion Model (DRDM), a novel diffusion-based generative model that emphasises morphological transformation through deformation fields rather than direct image synthesis. DRDM introduces a topology-preserving deformation field generation strategy, which randomly samples and integrates multi-scale Deformation Velocity Fields (DVFs). DRDM is trained to learn to recover unrealistic deformation components, thus restoring randomly deformed images to a realistic distribution. This formulation enables the generation of diverse yet anatomically plausible deformations that preserve structural integrity, thereby improving data augmentation and synthesis for downstream tasks such as few-shot learning and image registration. Experiments on cardiac Magnetic Resonance Imaging and pulmonary Computed Tomography show that DRDM is capable of creating diverse, large-scale deformations, while maintaining anatomical plausibility of deformation fields. Additional evaluations on 2D image segmentation and 3D image registration tasks indicate notable performance gains, underscoring DRDM's potential to enhance both image manipulation and generative modelling in medical imaging applications. Project page: https://jianqingzheng.github.io/def_diff_rec/

Fuping Wu, Le Zhang, Yang Sun et al.

Multi-task learning (MTL) has shown great potential in medical image analysis, improving the generalizability of the learned features and the performance in individual tasks. However, most of the work on MTL focuses on either architecture design or gradient manipulation, while in both scenarios, features are learned in a competitive manner. In this work, we propose to formulate MTL as a multi/bi-level optimization problem, and therefore force features to learn from each task in a cooperative approach. Specifically, we update the sub-model for each task alternatively taking advantage of the learned sub-models of the other tasks. To alleviate the negative transfer problem during the optimization, we search for flat minima for the current objective function with regard to features from other tasks. To demonstrate the effectiveness of the proposed approach, we validate our method on three publicly available datasets. The proposed method shows the advantage of cooperative learning, and yields promising results when compared with the state-of-the-art MTL approaches. The code will be available online.

An Sui, Yuzhu Li, Gunter Schumann et al.

Uncertainty quantification complements model predictions by characterizing their reliability, which is essential for high-stakes decision making such as medical image segmentation. However, most existing methods reduce uncertainty to a scalar confidence estimate, leaving its spatial distribution semantically underconstrained. In this work, we focus on uncertainty interpretability, namely, whether estimated uncertainty behaves in a human-understandable manner with respect to sources of ambiguity. We identify three perception-aligned principles requiring the spatial distribution of uncertainty to reflect: (1) image contrast between structures, (2) severity of image corruption, and (3) geometric complexity in anatomical structures. Accordingly, we develop a principle-guided uncertainty supervision framework (PriUS) based on evidential learning, in which the corresponding supervision objectives are explicitly enforced during training. We further introduce quantitative metrics to measure the consistency between predicted uncertainty and image attributes that induce ambiguity. Experiments on ACDC, ISIC, and WHS datasets showed that, compared with state-of-the-art methods, PriUS produced more consistent uncertainty estimates while maintaining competitive segmentation performance.

Yuzhu Li, An Sui, Fuping Wu et al.

Uncertainty estimation has been widely studied in medical image segmentation as a tool to provide reliability, particularly in deep learning approaches. However, previous methods generally lack effective supervision in uncertainty estimation, leading to low interpretability and robustness of the predictions. In this work, we propose a self-supervised approach to guide the learning of uncertainty. Specifically, we introduce three principles about the relationships between the uncertainty and the image gradients around boundaries and noise. Based on these principles, two uncertainty supervision losses are designed. These losses enhance the alignment between model predictions and human interpretation. Accordingly, we introduce novel quantitative metrics for evaluating the interpretability and robustness of uncertainty. Experimental results demonstrate that compared to state-of-the-art approaches, the proposed method can achieve competitive segmentation performance and superior results in out-of-distribution (OOD) scenarios while significantly improving the interpretability and robustness of uncertainty estimation. Code is available via https://github.com/suiannaius/SURE.

Fuping Wu, Bartlomiej W. Papiez

Foundation models are widely employed in medical image analysis, due to their high adaptability and generalizability for downstream tasks. With the increasing number of foundation models being released, model selection has become an important issue. In this work, we study the capabilities of foundation models in medical image classification tasks by conducting a benchmark study on the MedMNIST dataset. Specifically, we adopt various foundation models ranging from convolutional to Transformer-based models and implement both end-to-end training and linear probing for all classification tasks. The results demonstrate the significant potential of these pre-trained models when transferred for medical image classification. We further conduct experiments with different image sizes and various sizes of training data. By analyzing all the results, we provide preliminary, yet useful insights and conclusions on this topic.

Le Zhang, Fuping Wu, Arun Thirunavukarasu et al.

Large annotated datasets are vital for training segmentation models, but pixel-level labeling is time-consuming, error-prone, and often requires scarce expert annotators, especially in medical imaging. In contrast, coarse annotations are quicker, cheaper, and easier to produce, even by non-experts. In this paper, we propose to use coarse drawings from both positive (target) and negative (background) classes in the image, even with noisy pixels, to train a convolutional neural network (CNN) for semantic segmentation. We present a method for learning the true segmentation label distributions from purely noisy coarse annotations using two coupled CNNs. The separation of the two CNNs is achieved by high fidelity with the characters of the noisy training annotations. We propose to add a complementary label learning that encourages estimating negative label distribution. To illustrate the properties of our method, we first use a toy segmentation dataset based on MNIST. We then present the quantitative results of experiments using publicly available datasets: Cityscapes dataset for multi-class segmentation, and retinal images for medical applications. In all experiments, our method outperforms state-of-the-art methods, particularly in the cases where the ratio of coarse annotations is small compared to the given dense annotations.

Sihan Wang, Shangqi Gao, Fuping Wu et al.

Image decomposition aims to analyze an image into elementary components, which is essential for numerous downstream tasks and also by nature provides certain interpretability to the analysis. Deep learning can be powerful for such tasks, but surprisingly their combination with a focus on interpretability and generalizability is rarely explored. In this work, we introduce a novel framework for interpretable deep image decomposition, combining hierarchical Bayesian modeling and deep learning to create an architecture-modularized and model-generalizable deep neural network (DNN). The proposed framework includes three steps: (1) hierarchical Bayesian modeling of image decomposition, (2) transforming the inference problem into optimization tasks, and (3) deep inference via a modularized Bayesian DNN. We further establish a theoretical connection between the loss function and the generalization error bound, which inspires a new test-time adaptation approach for out-of-distribution scenarios. We instantiated the application using two downstream tasks, \textit{i.e.}, image denoising, and unsupervised anomaly detection, and the results demonstrated improved generalizability as well as interpretability of our methods. The source code will be released upon the acceptance of this paper.

Nicharee Srikijkasemwat, Soumya Snigdha Kundu, Fuping Wu et al.

Knee osteoarthritis (OA) is the most common joint disorder and a leading cause of disability. Diagnosing OA severity typically requires expert assessment of X-ray images and is commonly based on the Kellgren-Lawrence grading system, a time-intensive process. This study aimed to develop an automated deep learning model to classify knee OA severity, reducing the need for expert evaluation. First, we evaluated ten state-of-the-art deep learning models, achieving a top accuracy of 0.69 with individual models. To address class imbalance, we employed weighted sampling, improving accuracy to 0.70. We further applied Smooth-GradCAM++ to visualize decision-influencing regions, enhancing the explainability of the best-performing model. Finally, we developed ensemble models using majority voting and a shallow neural network. Our ensemble model, KneeXNet, achieved the highest accuracy of 0.72, demonstrating its potential as an automated tool for knee OA assessment.

Lei Li, Fuping Wu, Sihan Wang et al.

Assessment of myocardial viability is essential in diagnosis and treatment management of patients suffering from myocardial infarction, and classification of pathology on myocardium is the key to this assessment. This work defines a new task of medical image analysis, i.e., to perform myocardial pathology segmentation (MyoPS) combining three-sequence cardiac magnetic resonance (CMR) images, which was first proposed in the MyoPS challenge, in conjunction with MICCAI 2020. The challenge provided 45 paired and pre-aligned CMR images, allowing algorithms to combine the complementary information from the three CMR sequences for pathology segmentation. In this article, we provide details of the challenge, survey the works from fifteen participants and interpret their methods according to five aspects, i.e., preprocessing, data augmentation, learning strategy, model architecture and post-processing. In addition, we analyze the results with respect to different factors, in order to examine the key obstacles and explore potential of solutions, as well as to provide a benchmark for future research. We conclude that while promising results have been reported, the research is still in the early stage, and more in-depth exploration is needed before a successful application to the clinics. Note that MyoPS data and evaluation tool continue to be publicly available upon registration via its homepage (www.sdspeople.fudan.edu.cn/zhuangxiahai/0/myops20/).

Lei Li, Fuping Wu, Sihang Wang et al.

Accurate cardiac computing, analysis and modeling from multi-modality images are important for the diagnosis and treatment of cardiac disease. Late gadolinium enhancement magnetic resonance imaging (LGE MRI) is a promising technique to visualize and quantify myocardial infarction (MI) and atrial scars. Automating quantification of MI and atrial scars can be challenging due to the low image quality and complex enhancement patterns of LGE MRI. Moreover, compared with the other sequences LGE MRIs with gold standard labels are particularly limited, which represents another obstacle for developing novel algorithms for automatic segmentation and quantification of LGE MRIs. This chapter aims to summarize the state-of-the-art and our recent advanced contributions on deep learning based multi-modality cardiac image analysis. Firstly, we introduce two benchmark works for multi-sequence cardiac MRI based myocardial and pathology segmentation. Secondly, two novel frameworks for left atrial scar segmentation and quantification from LGE MRI were presented. Thirdly, we present three unsupervised domain adaptation techniques for cross-modality cardiac image segmentation.

Fuping Wu, Xiahai Zhuang

Unsupervised domain adaptation is useful in medical image segmentation. Particularly, when ground truths of the target images are not available, domain adaptation can train a target-specific model by utilizing the existing labeled images from other modalities. Most of the reported works mapped images of both the source and target domains into a common latent feature space, and then reduced their discrepancy either implicitly with adversarial training or explicitly by directly minimizing a discrepancy metric. In this work, we propose a new framework, where the latent features of both domains are driven towards a common and parameterized variational form, whose conditional distribution given the image is Gaussian. This is achieved by two networks based on variational auto-encoders (VAEs) and a regularization for this variational approximation. Both of the VAEs, each for one domain, contain a segmentation module, where the source segmentation is trained in a supervised manner, while the target one is trained unsupervisedly. We validated the proposed domain adaptation method using two cardiac segmentation tasks, i.e., the cross-modality (CT and MR) whole heart segmentation and the cross-sequence cardiac MR segmentation. Results show that the proposed method achieved better accuracies compared to two state-of-the-art approaches and demonstrated good potential for cardiac segmentation. Furthermore, the proposed explicit regularization was shown to be effective and efficient in narrowing down the distribution gap between domains, which is useful for unsupervised domain adaptation. Our code and data has been released via https://zmiclab.github.io/projects.html.

Lei Li, Veronika A. Zimmer, Wangbin Ding et al.

Deep learning (DL)-based models have demonstrated good performance in medical image segmentation. However, the models trained on a known dataset often fail when performed on an unseen dataset collected from different centers, vendors and disease populations. In this work, we present a random style transfer network to tackle the domain generalization problem for multi-vendor and center cardiac image segmentation. Style transfer is used to generate training data with a wider distribution/ heterogeneity, namely domain augmentation. As the target domain could be unknown, we randomly generate a modality vector for the target modality in the style transfer stage, to simulate the domain shift for unknown domains. The model can be trained in a semi-supervised manner by simultaneously optimizing a supervised segmentation and an unsupervised style translation objective. Besides, the framework incorporates the spatial information and shape prior of the target by introducing two regularization terms. We evaluated the proposed framework on 40 subjects from the M\&Ms challenge2020, and obtained promising performance in the segmentation for data from unknown vendors and centers.

Lei Li, Fuping Wu, Guang Yang et al.

Late gadolinium enhancement magnetic resonance imaging (LGE MRI) appears to be a promising alternative for scar assessment in patients with atrial fibrillation (AF). Automating the quantification and analysis of atrial scars can be challenging due to the low image quality. In this work, we propose a fully automated method based on the graph-cuts framework, where the potentials of the graph are learned on a surface mesh of the left atrium (LA) using a multi-scale convolutional neural network (MS-CNN). For validation, we have employed fifty-eight images with manual delineations. MS-CNN, which can efficiently incorporate both the local and global texture information of the images, has been shown to evidently improve the segmentation accuracy of the proposed graph-cuts based method. The segmentation could be further improved when the contribution between the t-link and n-link weights of the graph is balanced. The proposed method achieves a mean accuracy of 0.856 +- 0.033 and mean Dice score of 0.702 +- 0.071 for LA scar quantification. Compared with the conventional methods, which are based on the manual delineation of LA for initialization, our method is fully automatic and has demonstrated significantly better Dice score and accuracy (p < 0.01). The method is promising and can be useful in diagnosis and prognosis of AF.

Lei Li, Fuping Wu, Guang Yang et al.

Late Gadolinium Enhancement Magnetic Resonance Imaging (LGE MRI) emerged as a routine scan for patients with atrial fibrillation (AF). However, due to the low image quality automating the quantification and analysis of the atrial scars is challenging. In this study, we pro-posed a fully automated method based on the graph-cuts framework, where the potential of the graph is learned on a surface mesh of the left atrium (LA) using an equidistant projection and a Deep Neural Network (DNN). For validation, we employed 100 datasets with manual delineation. The results showed that the performance of the proposed method improved and converged with respect to the increased size of training patches, which provide important features of the structural and texture information learned by the DNN. The segmentation could be further improved when the contribution from the t-link and n-link is balanced, thanks to inter-relationship learned by the DNN for the graph-cuts algorithm. Compared with the published methods which mostly acquired manual delineation of the LA or LA wall, our method is fully automatic and demonstrated evidently better results with statistical significance. Finally, the accuracy of quantifying the scars assessed by the Dice score was 0.570. The results are promising and the method can be useful in diagnosis and prognosis of AF.

Fuping Wu, Lei Li, Guang Yang et al.

We present a fully-automated segmentation and quantification of the left atrial (LA) fibrosis and scars combining two cardiac MRIs, one is the target late gadolinium-enhanced (LGE) image, and the other is an anatomical MRI from the same acquisition session. We formulate the joint distribution of images using a multivariate mixture model (MvMM), and employ the maximum likelihood estimator (MLE) for texture classification of the images simultaneously. The MvMM can also embed transformations assigned to the images to correct the misregistration. The iterated conditional mode algorithm is adopted for optimization. This method first extracts the anatomical shape of the LA, and then estimates a prior probability map. It projects the resulting segmentation onto the LA surface, for quantification and analysis of scarring. We applied the proposed method to 36 clinical data sets and obtained promising results (Accuracy: $0.809\pm .150$, Dice: $0.556\pm.187$). We compared the method with the conventional algorithms and showed an evidently and statistically better performance ($p<0.03$).