Su Ruan

Aghiles Kebaili, Jérôme Lapuyade-Lahorgue, Su Ruan

Deep learning has become a popular tool for medical image analysis, but the limited availability of training data remains a major challenge, particularly in the medical field where data acquisition can be costly and subject to privacy regulations. Data augmentation techniques offer a solution by artificially increasing the number of training samples, but these techniques often produce limited and unconvincing results. To address this issue, a growing number of studies have proposed the use of deep generative models to generate more realistic and diverse data that conform to the true distribution of the data. In this review, we focus on three types of deep generative models for medical image augmentation: variational autoencoders, generative adversarial networks, and diffusion models. We provide an overview of the current state of the art in each of these models and discuss their potential for use in different downstream tasks in medical imaging, including classification, segmentation, and cross-modal translation. We also evaluate the strengths and limitations of each model and suggest directions for future research in this field. Our goal is to provide a comprehensive review about the use of deep generative models for medical image augmentation and to highlight the potential of these models for improving the performance of deep learning algorithms in medical image analysis.

Ling Huang, Thierry Denoeux, Pierre Vera et al.

As information sources are usually imperfect, it is necessary to take into account their reliability in multi-source information fusion tasks. In this paper, we propose a new deep framework allowing us to merge multi-MR image segmentation results using the formalism of Dempster-Shafer theory while taking into account the reliability of different modalities relative to different classes. The framework is composed of an encoder-decoder feature extraction module, an evidential segmentation module that computes a belief function at each voxel for each modality, and a multi-modality evidence fusion module, which assigns a vector of discount rates to each modality evidence and combines the discounted evidence using Dempster's rule. The whole framework is trained by minimizing a new loss function based on a discounted Dice index to increase segmentation accuracy and reliability. The method was evaluated on the BraTs 2021 database of 1251 patients with brain tumors. Quantitative and qualitative results show that our method outperforms the state of the art, and implements an effective new idea for merging multi-information within deep neural networks.

Ling Huang, Su Ruan, Thierry Denoeux

The investigation of uncertainty is of major importance in risk-critical applications, such as medical image segmentation. Belief function theory, a formal framework for uncertainty analysis and multiple evidence fusion, has made significant contributions to medical image segmentation, especially since the development of deep learning. In this paper, we provide an introduction to the topic of medical image segmentation methods using belief function theory. We classify the methods according to the fusion step and explain how information with uncertainty or imprecision is modeled and fused with belief function theory. In addition, we discuss the challenges and limitations of present belief function-based medical image segmentation and propose orientations for future research. Future research could investigate both belief function theory and deep learning to achieve more promising and reliable segmentation results.

Tongxue Zhou, Alexandra Noeuveglise, Romain Modzelewski et al.

Brain tumor is one of the leading causes of cancer death. The high-grade brain tumors are easier to recurrent even after standard treatment. Therefore, developing a method to predict brain tumor recurrence location plays an important role in the treatment planning and it can potentially prolong patient's survival time. There is still little work to deal with this issue. In this paper, we present a deep learning-based brain tumor recurrence location prediction network. Since the dataset is usually small, we propose to use transfer learning to improve the prediction. We first train a multi-modal brain tumor segmentation network on the public dataset BraTS 2021. Then, the pre-trained encoder is transferred to our private dataset for extracting the rich semantic features. Following that, a multi-scale multi-channel feature fusion model and a nonlinear correlation learning module are developed to learn the effective features. The correlation between multi-channel features is modeled by a nonlinear equation. To measure the similarity between the distributions of original features of one modality and the estimated correlated features of another modality, we propose to use Kullback-Leibler divergence. Based on this divergence, a correlation loss function is designed to maximize the similarity between the two feature distributions. Finally, two decoders are constructed to jointly segment the present brain tumor and predict its future tumor recurrence location. To the best of our knowledge, this is the first work that can segment the present tumor and at the same time predict future tumor recurrence location, making the treatment planning more efficient and precise. The experimental results demonstrated the effectiveness of our proposed method to predict the brain tumor recurrence location from the limited dataset.

Amine Amyar, Romain Modzelewski, Pierre Vera et al.

Background and Objectives: Predicting patient response to treatment and survival in oncology is a prominent way towards precision medicine. To that end, radiomics was proposed as a field of study where images are used instead of invasive methods. The first step in radiomic analysis is the segmentation of the lesion. However, this task is time consuming and can be physician subjective. Automated tools based on supervised deep learning have made great progress to assist physicians. However, they are data hungry, and annotated data remains a major issue in the medical field where only a small subset of annotated images is available. Methods: In this work, we propose a multi-task learning framework to predict patient's survival and response. We show that the encoder can leverage multiple tasks to extract meaningful and powerful features that improve radiomics performance. We show also that subsidiary tasks serve as an inductive bias so that the model can better generalize. Results: Our model was tested and validated for treatment response and survival in lung and esophageal cancers, with an area under the ROC curve of 77% and 71% respectively, outperforming single task learning methods. Conclusions: We show that, by using a multi-task learning approach, we can boost the performance of radiomic analysis by extracting rich information of intratumoral and peritumoral regions.

Thibaud Brochet, Jérôme Lapuyade-Lahorgue, Pierre Vera et al.

In this paper, we propose to quantitatively compare loss functions based on parameterized Tsallis-Havrda-Charvat entropy and classical Shannon entropy for the training of a deep network in the case of small datasets which are usually encountered in medical applications. Shannon cross-entropy is widely used as a loss function for most neural networks applied to the segmentation, classification and detection of images. Shannon entropy is a particular case of Tsallis-Havrda-Charvat entropy. In this work, we compare these two entropies through a medical application for predicting recurrence in patients with head-neck and lung cancers after treatment. Based on both CT images and patient information, a multitask deep neural network is proposed to perform a recurrence prediction task using cross-entropy as a loss function and an image reconstruction task. Tsallis-Havrda-Charvat cross-entropy is a parameterized cross entropy with the parameter $α$. Shannon entropy is a particular case of Tsallis-Havrda-Charvat entropy for $α$ = 1. The influence of this parameter on the final prediction results is studied. In this paper, the experiments are conducted on two datasets including in total 580 patients, of whom 434 suffered from head-neck cancers and 146 from lung cancers. The results show that Tsallis-Havrda-Charvat entropy can achieve better performance in terms of prediction accuracy with some values of $α$.

Zong Fan, Xiaohui Zhang, Jacob A. Gasienica et al.

Deep learning (DL) techniques have been extensively utilized for medical image classification. Most DL-based classification networks are generally structured hierarchically and optimized through the minimization of a single loss function measured at the end of the networks. However, such a single loss design could potentially lead to optimization of one specific value of interest but fail to leverage informative features from intermediate layers that might benefit classification performance and reduce the risk of overfitting. Recently, auxiliary convolutional neural networks (AuxCNNs) have been employed on top of traditional classification networks to facilitate the training of intermediate layers to improve classification performance and robustness. In this study, we proposed an adversarial learning-based AuxCNN to support the training of deep neural networks for medical image classification. Two main innovations were adopted in our AuxCNN classification framework. First, the proposed AuxCNN architecture includes an image generator and an image discriminator for extracting more informative image features for medical image classification, motivated by the concept of generative adversarial network (GAN) and its impressive ability in approximating target data distribution. Second, a hybrid loss function is designed to guide the model training by incorporating different objectives of the classification network and AuxCNN to reduce overfitting. Comprehensive experimental studies demonstrated the superior classification performance of the proposed model. The effect of the network-related factors on classification performance was investigated.

Zexin Ji, Beiji Zou, Xiaoyan Kui et al.

In this paper, we propose a new architecture, called Deform-Mamba, for MR image super-resolution. Unlike conventional CNN or Transformer-based super-resolution approaches which encounter challenges related to the local respective field or heavy computational cost, our approach aims to effectively explore the local and global information of images. Specifically, we develop a Deform-Mamba encoder which is composed of two branches, modulated deform block and vision Mamba block. We also design a multi-view context module in the bottleneck layer to explore the multi-view contextual content. Thanks to the extracted features of the encoder, which include content-adaptive local and efficient global information, the vision Mamba decoder finally generates high-quality MR images. Moreover, we introduce a contrastive edge loss to promote the reconstruction of edge and contrast related content. Quantitative and qualitative experimental results indicate that our approach on IXI and fastMRI datasets achieves competitive performance.

Zacharia Mesbah, Léo Mottay, Romain Modzelewski et al.

For the last three years, the AutoPET competition gathered the medical imaging community around a hot topic: lesion segmentation on Positron Emitting Tomography (PET) scans. Each year a different aspect of the problem is presented; in 2024 the multiplicity of existing and used tracers was at the core of the challenge. Specifically, this year's edition aims to develop a fully automatic algorithm capable of performing lesion segmentation on a PET/CT scan, without knowing the tracer, which can either be a FDG or PSMA-based tracer. In this paper we describe how we used the nnUNetv2 framework to train two sets of 6 fold ensembles of models to perform fully automatic PET/CT lesion segmentation as well as a MIP-CNN to choose which set of models to use for segmentation.

Ling Huang, Su Ruan, Pierre Decazes et al.

Single-modality medical images generally do not contain enough information to reach an accurate and reliable diagnosis. For this reason, physicians generally diagnose diseases based on multimodal medical images such as, e.g., PET/CT. The effective fusion of multimodal information is essential to reach a reliable decision and explain how the decision is made as well. In this paper, we propose a fusion framework for multimodal medical image segmentation based on deep learning and the Dempster-Shafer theory of evidence. In this framework, the reliability of each single modality image when segmenting different objects is taken into account by a contextual discounting operation. The discounted pieces of evidence from each modality are then combined by Dempster's rule to reach a final decision. Experimental results with a PET-CT dataset with lymphomas and a multi-MRI dataset with brain tumors show that our method outperforms the state-of-the-art methods in accuracy and reliability.

Zexin Ji, Beiji Zou, Xiaoyan Kui et al.

In this paper, we propose a self-prior guided Mamba-UNet network (SMamba-UNet) for medical image super-resolution. Existing methods are primarily based on convolutional neural networks (CNNs) or Transformers. CNNs-based methods fail to capture long-range dependencies, while Transformer-based approaches face heavy calculation challenges due to their quadratic computational complexity. Recently, State Space Models (SSMs) especially Mamba have emerged, capable of modeling long-range dependencies with linear computational complexity. Inspired by Mamba, our approach aims to learn the self-prior multi-scale contextual features under Mamba-UNet networks, which may help to super-resolve low-resolution medical images in an efficient way. Specifically, we obtain self-priors by perturbing the brightness inpainting of the input image during network training, which can learn detailed texture and brightness information that is beneficial for super-resolution. Furthermore, we combine Mamba with Unet network to mine global features at different levels. We also design an improved 2D-Selective-Scan (ISS2D) module to divide image features into different directional sequences to learn long-range dependencies in multiple directions, and adaptively fuse sequence information to enhance super-resolved feature representation. Both qualitative and quantitative experimental results demonstrate that our approach outperforms current state-of-the-art methods on two public medical datasets: the IXI and fastMRI.

Ling Huang, Su Ruan, Yucheng Xing et al.

The comprehensive integration of machine learning healthcare models within clinical practice remains suboptimal, notwithstanding the proliferation of high-performing solutions reported in the literature. A predominant factor hindering widespread adoption pertains to an insufficiency of evidence affirming the reliability of the aforementioned models. Recently, uncertainty quantification methods have been proposed as a potential solution to quantify the reliability of machine learning models and thus increase the interpretability and acceptability of the result. In this review, we offer a comprehensive overview of prevailing methods proposed to quantify uncertainty inherent in machine learning models developed for various medical image tasks. Contrary to earlier reviews that exclusively focused on probabilistic methods, this review also explores non-probabilistic approaches, thereby furnishing a more holistic survey of research pertaining to uncertainty quantification for machine learning models. Analysis of medical images with the summary and discussion on medical applications and the corresponding uncertainty evaluation protocols are presented, which focus on the specific challenges of uncertainty in medical image analysis. We also highlight some potential future research work at the end. Generally, this review aims to allow researchers from both clinical and technical backgrounds to gain a quick and yet in-depth understanding of the research in uncertainty quantification for medical image analysis machine learning models.

Aghiles Kebaili, Jérôme Lapuyade-Lahorgue, Pierre Vera et al.

Despite the increasing use of deep learning in medical image segmentation, acquiring sufficient training data remains a challenge in the medical field. In response, data augmentation techniques have been proposed; however, the generation of diverse and realistic medical images and their corresponding masks remains a difficult task, especially when working with insufficient training sets. To address these limitations, we present an end-to-end architecture based on the Hamiltonian Variational Autoencoder (HVAE). This approach yields an improved posterior distribution approximation compared to traditional Variational Autoencoders (VAE), resulting in higher image generation quality. Our method outperforms generative adversarial architectures under data-scarce conditions, showcasing enhancements in image quality and precise tumor mask synthesis. We conduct experiments on two publicly available datasets, MICCAI's Brain Tumor Segmentation Challenge (BRATS), and Head and Neck Tumor Segmentation Challenge (HECKTOR), demonstrating the effectiveness of our method on different medical imaging modalities.

Aghiles Kebaili, Jérôme Lapuyade-Lahorgue, Pierre Vera et al.

In clinical practice, full imaging is not always feasible, often due to complex acquisition protocols, stringent privacy regulations, or specific clinical needs. However, missing MR modalities pose significant challenges for tasks like brain tumor segmentation, especially in deep learning-based segmentation, as each modality provides complementary information crucial for improving accuracy. A promising solution is missing data imputation, where absent modalities are generated from available ones. While generative models have been widely used for this purpose, most state-of-the-art approaches are limited to single or dual target translations, lacking the adaptability to generate missing modalities based on varying input configurations. To address this, we propose an Adaptive Multi-Modality Diffusion Network (AMM-Diff), a novel diffusion-based generative model capable of handling any number of input modalities and generating the missing ones. We designed an Image-Frequency Fusion Network (IFFN) that learns a unified feature representation through a self-supervised pretext task across the full input modalities and their selected high-frequency Fourier components. The proposed diffusion model leverages this representation, encapsulating prior knowledge of the complete modalities, and combines it with an adaptive reconstruction strategy to achieve missing modality completion. Experimental results on the BraTS 2021 dataset demonstrate the effectiveness of our approach.

Ling Huang, Yucheng Xing, Qika Lin et al.

Multimodal survival analysis aims to combine heterogeneous data sources (e.g., clinical, imaging, text, genomics) to improve the prediction quality of survival outcomes. However, this task is particularly challenging due to high heterogeneity and noise across data sources, which vary in structure, distribution, and context. Additionally, the ground truth is often censored (uncertain) due to incomplete follow-up data. In this paper, we propose a novel evidential multimodal survival fusion model, EsurvFusion, designed to combine multimodal data at the decision level through an evidence-based decision fusion layer that jointly addresses both data and model uncertainty while incorporating modality-level reliability. Specifically, EsurvFusion first models unimodal data with newly introduced Gaussian random fuzzy numbers, producing unimodal survival predictions along with corresponding aleatoric and epistemic uncertainties. It then estimates modality-level reliability through a reliability discounting layer to correct the misleading impact of noisy data modalities. Finally, a multimodal evidence-based fusion layer is introduced to combine the discounted predictions to form a unified, interpretable multimodal survival analysis model, revealing each modality's influence based on the learned reliability coefficients. This is the first work that studies multimodal survival analysis with both uncertainty and reliability. Extensive experiments on four multimodal survival datasets demonstrate the effectiveness of our model in handling high heterogeneity data, establishing new state-of-the-art on several benchmarks.

Aghiles Kebaili, Romain Modzelewski, Jérôme Lapuyade-Lahorgue et al.

Glioma, an aggressive brain malignancy characterized by rapid progression and its poor prognosis, poses significant challenges for accurate evolution prediction. These challenges are exacerbated by sparse, irregularly acquired longitudinal MRI data in clinical practice, where incomplete follow-up sequences create data imbalances and make reliable modeling difficult. In this paper, we present a multitask diffusion framework for time-agnostic, pixel-wise prediction of glioma progression. The model simultaneously generates future FLAIR sequences at any chosen time point and estimates spatial probabilistic tumor evolution maps derived using signed distance fields (SDFs), allowing uncertainty quantification. To capture temporal dynamics of tumor evolution across arbitrary intervals, we integrate a pretrained deformation module that models inter-scan changes using deformation fields. Regarding the common clinical limitation of data scarcity, we implement a targeted augmentation pipeline that synthesizes complete sequences of three follow-up scans and imputes missing MRI modalities from available patient studies, improving the stability and accuracy of predictive models. Based on merely two follow-up scans at earlier timepoints, our framework produces flexible time-depending probability maps, enabling clinicians to interrogate tumor progression risks at any future temporal milestone. We further introduce a radiotherapy-weighted focal loss term that leverages radiation dose maps, as these highlight regions of greater clinical importance during model training. The proposed method was trained on a public dataset and evaluated on an internal private dataset, achieving promising results in both cases

Numan Saeed, Salma Hassan, Shahad Hardan et al.

We present a publicly available multimodal dataset for head and neck cancer research, comprising 1123 annotated Positron Emission Tomography/Computed Tomography (PET/CT) studies from patients with histologically confirmed disease, acquired from 10 international medical centers. All studies contain co-registered PET/CT scans with varying acquisition protocols, reflecting real-world clinical diversity from a long-term, multi-institution retrospective collection. Primary gross tumor volumes (GTVp) and involved lymph nodes (GTVn) were manually segmented by experienced radiation oncologists and radiologists following established guidelines. We provide anonymized NifTi files, expert-annotated segmentation masks, comprehensive clinical metadata, and radiotherapy dose distributions for a patient subset. The metadata include TNM staging, HPV status, demographics, long-term follow-up outcomes, survival times, censoring indicators, and treatment information. To demonstrate its utility, we benchmark three key clinical tasks: automated tumor segmentation, recurrence-free survival prediction, and HPV status classification, using state-of-the-art deep learning models like UNet, SegResNet, and multimodal prognostic frameworks.

Zexin Ji, Beiji Zou, Xiaoyan Kui et al.

Multi-modal 3D medical image segmentation aims to accurately identify tumor regions across different modalities, facing challenges from variations in image intensity and tumor morphology. Traditional convolutional neural network (CNN)-based methods struggle with capturing global features, while Transformers-based methods, despite effectively capturing global context, encounter high computational costs in 3D medical image segmentation. The Mamba model combines linear scalability with long-distance modeling, making it a promising approach for visual representation learning. However, Mamba-based 3D multi-modal segmentation still struggles to leverage modality-specific features and fuse complementary information effectively. In this paper, we propose a Mamba based feature extraction and adaptive multilevel feature fusion for 3D tumor segmentation using multi-modal medical image. We first develop the specific modality Mamba encoder to efficiently extract long-range relevant features that represent anatomical and pathological structures present in each modality. Moreover, we design an bi-level synergistic integration block that dynamically merges multi-modal and multi-level complementary features by the modality attention and channel attention learning. Lastly, the decoder combines deep semantic information with fine-grained details to generate the tumor segmentation map. Experimental results on medical image datasets (PET/CT and MRI multi-sequence) show that our approach achieve competitive performance compared to the state-of-the-art CNN, Transformer, and Mamba-based approaches.

Zexin Ji, Beiji Zou, Xiaoyan Kui et al.

Convolutional neural networks and Transformer have made significant progresses in multi-modality medical image super-resolution. However, these methods either have a fixed receptive field for local learning or significant computational burdens for global learning, limiting the super-resolution performance. To solve this problem, State Space Models, notably Mamba, is introduced to efficiently model long-range dependencies in images with linear computational complexity. Relying on the Mamba and the fact that low-resolution images rely on global information to compensate for missing details, while high-resolution reference images need to provide more local details for accurate super-resolution, we propose a global and local Mamba network (GLMamba) for multi-modality medical image super-resolution. To be specific, our GLMamba is a two-branch network equipped with a global Mamba branch and a local Mamba branch. The global Mamba branch captures long-range relationships in low-resolution inputs, and the local Mamba branch focuses more on short-range details in high-resolution reference images. We also use the deform block to adaptively extract features of both branches to enhance the representation ability. A modulator is designed to further enhance deformable features in both global and local Mamba blocks. To fully integrate the reference image for low-resolution image super-resolution, we further develop a multi-modality feature fusion block to adaptively fuse features by considering similarities, differences, and complementary aspects between modalities. In addition, a contrastive edge loss (CELoss) is developed for sufficient enhancement of edge textures and contrast in medical images.

Aghiles Kebaili, Jérôme Lapuyade-Lahorgue, Pierre Vera et al.

Deep learning has gained significant attention in medical image segmentation. However, the limited availability of annotated training data presents a challenge to achieving accurate results. In efforts to overcome this challenge, data augmentation techniques have been proposed. However, the majority of these approaches primarily focus on image generation. For segmentation tasks, providing both images and their corresponding target masks is crucial, and the generation of diverse and realistic samples remains a complex task, especially when working with limited training datasets. To this end, we propose a new end-to-end hybrid architecture based on Hamiltonian Variational Autoencoders (HVAE) and a discriminative regularization to improve the quality of generated images. Our method provides an accuracte estimation of the joint distribution of the images and masks, resulting in the generation of realistic medical images with reduced artifacts and off-distribution instances. As generating 3D volumes requires substantial time and memory, our architecture operates on a slice-by-slice basis to segment 3D volumes, capitilizing on the richly augmented dataset. Experiments conducted on two public datasets, BRATS (MRI modality) and HECKTOR (PET modality), demonstrate the efficacy of our proposed method on different medical imaging modalities with limited data.

Aghiles Kebaili, Jérôme Lapuyade-Lahorgue, Pierre Vera et al.

Despite the increasing use of deep learning in medical image segmentation, the limited availability of annotated training data remains a major challenge due to the time-consuming data acquisition and privacy regulations. In the context of segmentation tasks, providing both medical images and their corresponding target masks is essential. However, conventional data augmentation approaches mainly focus on image synthesis. In this study, we propose a novel slice-based latent diffusion architecture designed to address the complexities of volumetric data generation in a slice-by-slice fashion. This approach extends the joint distribution modeling of medical images and their associated masks, allowing a simultaneous generation of both under data-scarce regimes. Our approach mitigates the computational complexity and memory expensiveness typically associated with diffusion models. Furthermore, our architecture can be conditioned by tumor characteristics, including size, shape, and relative position, thereby providing a diverse range of tumor variations. Experiments on a segmentation task using the BRATS2022 confirm the effectiveness of the synthesized volumes and masks for data augmentation.

Ling Huang, Su Ruan, Pierre Decazes et al.

An automatic evidential segmentation method based on Dempster-Shafer theory and deep learning is proposed to segment lymphomas from three-dimensional Positron Emission Tomography (PET) and Computed Tomography (CT) images. The architecture is composed of a deep feature-extraction module and an evidential layer. The feature extraction module uses an encoder-decoder framework to extract semantic feature vectors from 3D inputs. The evidential layer then uses prototypes in the feature space to compute a belief function at each voxel quantifying the uncertainty about the presence or absence of a lymphoma at this location. Two evidential layers are compared, based on different ways of using distances to prototypes for computing mass functions. The whole model is trained end-to-end by minimizing the Dice loss function. The proposed combination of deep feature extraction and evidential segmentation is shown to outperform the baseline UNet model as well as three other state-of-the-art models on a dataset of 173 patients.

Haigen Hu, Leizhao Shen, Qiu Guan et al.

Due to the irregular shapes,various sizes and indistinguishable boundaries between the normal and infected tissues, it is still a challenging task to accurately segment the infected lesions of COVID-19 on CT images. In this paper, a novel segmentation scheme is proposed for the infections of COVID-19 by enhancing supervised information and fusing multi-scale feature maps of different levels based on the encoder-decoder architecture. To this end, a deep collaborative supervision (Co-supervision) scheme is proposed to guide the network learning the features of edges and semantics. More specifically, an Edge Supervised Module (ESM) is firstly designed to highlight low-level boundary features by incorporating the edge supervised information into the initial stage of down-sampling. Meanwhile, an Auxiliary Semantic Supervised Module (ASSM) is proposed to strengthen high-level semantic information by integrating mask supervised information into the later stage. Then an Attention Fusion Module (AFM) is developed to fuse multiple scale feature maps of different levels by using an attention mechanism to reduce the semantic gaps between high-level and low-level feature maps. Finally, the effectiveness of the proposed scheme is demonstrated on four various COVID-19 CT datasets. The results show that the proposed three modules are all promising. Based on the baseline (ResUnet), using ESM, ASSM, or AFM alone can respectively increase Dice metric by 1.12\%, 1.95\%,1.63\% in our dataset, while the integration by incorporating three models together can rise 3.97\%. Compared with the existing approaches in various datasets, the proposed method can obtain better segmentation performance in some main metrics, and can achieve the best generalization and comprehensive performance.

Tongxue Zhou, Stéphane Canu, Pierre Vera et al.

Using multimodal Magnetic Resonance Imaging (MRI) is necessary for accurate brain tumor segmentation. The main problem is that not all types of MRIs are always available in clinical exams. Based on the fact that there is a strong correlation between MR modalities of the same patient, in this work, we propose a novel brain tumor segmentation network in the case of missing one or more modalities. The proposed network consists of three sub-networks: a feature-enhanced generator, a correlation constraint block and a segmentation network. The feature-enhanced generator utilizes the available modalities to generate 3D feature-enhanced image representing the missing modality. The correlation constraint block can exploit the multi-source correlation between the modalities and also constrain the generator to synthesize a feature-enhanced modality which must have a coherent correlation with the available modalities. The segmentation network is a multi-encoder based U-Net to achieve the final brain tumor segmentation. The proposed method is evaluated on BraTS 2018 dataset. Experimental results demonstrate the effectiveness of the proposed method which achieves the average Dice Score of 82.9, 74.9 and 59.1 on whole tumor, tumor core and enhancing tumor, respectively across all the situations, and outperforms the best method by 3.5%, 17% and 18.2%.

Tongxue Zhou, Su Ruan, Pierre Vera et al.

In the field of multimodal segmentation, the correlation between different modalities can be considered for improving the segmentation results. Considering the correlation between different MR modalities, in this paper, we propose a multi-modality segmentation network guided by a novel tri-attention fusion. Our network includes N model-independent encoding paths with N image sources, a tri-attention fusion block, a dual-attention fusion block, and a decoding path. The model independent encoding paths can capture modality-specific features from the N modalities. Considering that not all the features extracted from the encoders are useful for segmentation, we propose to use dual attention based fusion to re-weight the features along the modality and space paths, which can suppress less informative features and emphasize the useful ones for each modality at different positions. Since there exists a strong correlation between different modalities, based on the dual attention fusion block, we propose a correlation attention module to form the tri-attention fusion block. In the correlation attention module, a correlation description block is first used to learn the correlation between modalities and then a constraint based on the correlation is used to guide the network to learn the latent correlated features which are more relevant for segmentation. Finally, the obtained fused feature representation is projected by the decoder to obtain the segmentation results. Our experiment results tested on BraTS 2018 dataset for brain tumor segmentation demonstrate the effectiveness of our proposed method.

Fereshteh Yousefirizi, Pierre Decazes, Amine Amyar et al.

Artificial intelligence (AI) techniques have significant potential to enable effective, robust and automated image phenotyping including identification of subtle patterns. AI-based detection searches the image space to find the regions of interest based on patterns and features. There is a spectrum of tumor histologies from benign to malignant that can be identified by AI-based classification approaches using image features. The extraction of minable information from images gives way to the field of radiomics and can be explored via explicit (handcrafted/engineered) and deep radiomics frameworks. Radiomics analysis has the potential to be utilized as a noninvasive technique for the accurate characterization of tumors to improve diagnosis and treatment monitoring. This work reviews AI-based techniques, with a special focus on oncological PET and PET/CT imaging, for different detection, classification, and prediction/prognosis tasks. We also discuss needed efforts to enable the translation of AI techniques to routine clinical workflows, and potential improvements and complementary techniques such as the use of natural language processing on electronic health records and neuro-symbolic AI techniques.

Ling Huang, Thierry Denoeux, David Tonnelet et al.

Lymphoma detection and segmentation from whole-body Positron Emission Tomography/Computed Tomography (PET/CT) volumes are crucial for surgical indication and radiotherapy. Designing automatic segmentation methods capable of effectively exploiting the information from PET and CT as well as resolving their uncertainty remain a challenge. In this paper, we propose an lymphoma segmentation model using an UNet with an evidential PET/CT fusion layer. Single-modality volumes are trained separately to get initial segmentation maps and an evidential fusion layer is proposed to fuse the two pieces of evidence using Dempster-Shafer theory (DST). Moreover, a multi-task loss function is proposed: in addition to the use of the Dice loss for PET and CT segmentation, a loss function based on the concordance between the two segmentation is added to constrain the final segmentation. We evaluate our proposal on a database of polycentric PET/CT volumes of patients treated for lymphoma, delineated by the experts. Our method get accurate segmentation results with Dice score of 0.726, without any user interaction. Quantitative results show that our method is superior to the state-of-the-art methods.

Ling Huang, Su Ruan, Pierre Decazes et al.

PET and CT are two modalities widely used in medical image analysis. Accurately detecting and segmenting lymphomas from these two imaging modalities are critical tasks for cancer staging and radiotherapy planning. However, this task is still challenging due to the complexity of PET/CT images, and the computation cost to process 3D data. In this paper, a segmentation method based on belief functions is proposed to segment lymphomas in 3D PET/CT images. The architecture is composed of a feature extraction module and an evidential segmentation (ES) module. The ES module outputs not only segmentation results (binary maps indicating the presence or absence of lymphoma in each voxel) but also uncertainty maps quantifying the classification uncertainty. The whole model is optimized by minimizing Dice and uncertainty loss functions to increase segmentation accuracy. The method was evaluated on a database of 173 patients with diffuse large b-cell lymphoma. Quantitative and qualitative results show that our method outperforms the state-of-the-art methods.

Tongxue Zhou, Stéphane Canu, Pierre Vera et al.

Magnetic Resonance Imaging (MRI) is a widely used imaging technique to assess brain tumor. Accurately segmenting brain tumor from MR images is the key to clinical diagnostics and treatment planning. In addition, multi-modal MR images can provide complementary information for accurate brain tumor segmentation. However, it's common to miss some imaging modalities in clinical practice. In this paper, we present a novel brain tumor segmentation algorithm with missing modalities. Since it exists a strong correlation between multi-modalities, a correlation model is proposed to specially represent the latent multi-source correlation. Thanks to the obtained correlation representation, the segmentation becomes more robust in the case of missing modality. First, the individual representation produced by each encoder is used to estimate the modality independent parameter. Then, the correlation model transforms all the individual representations to the latent multi-source correlation representations. Finally, the correlation representations across modalities are fused via attention mechanism into a shared representation to emphasize the most important features for segmentation. We evaluate our model on BraTS 2018 and BraTS 2019 dataset, it outperforms the current state-of-the-art methods and produces robust results when one or more modalities are missing.

Thibaud Brochet, Jerome Lapuyade-Lahorgue, Sebastien Bougleux et al.

Pulmonary optical endomicroscopy (POE) is an imaging technology in real time. It allows to examine pulmonary alveoli at a microscopic level. Acquired in clinical settings, a POE image sequence can have as much as 25% of the sequence being uninformative frames (i.e. pure-noise and motion artefacts). For future data analysis, these uninformative frames must be first removed from the sequence. Therefore, the objective of our work is to develop an automatic detection method of uninformative images in endomicroscopy images. We propose to take the detection problem as a classification one. Considering advantages of deep learning methods, a classifier based on CNN (Convolutional Neural Network) is designed with a new loss function based on Havrda-Charvat entropy which is a parametrical generalization of the Shannon entropy. We propose to use this formula to get a better hold on all sorts of data since it provides a model more stable than the Shannon entropy. Our method is tested on one POE dataset including 2947 distinct images, is showing better results than using Shannon entropy and behaves better with regard to the problem of overfitting. Keywords: Deep Learning, CNN, Shannon entropy, Havrda-Charvat entropy, Pulmonary optical endomicroscopy.

Tongxue Zhou, Stéphane Canu, Pierre Vera et al.

In the field of multimodal segmentation, the correlation between different modalities can be considered for improving the segmentation results. In this paper, we propose a multi-modality segmentation network with a correlation constraint. Our network includes N model-independent encoding paths with N image sources, a correlation constraint block, a feature fusion block, and a decoding path. The model independent encoding path can capture modality-specific features from the N modalities. Since there exists a strong correlation between different modalities, we first propose a linear correlation block to learn the correlation between modalities, then a loss function is used to guide the network to learn the correlated features based on the linear correlation block. This block forces the network to learn the latent correlated features which are more relevant for segmentation. Considering that not all the features extracted from the encoders are useful for segmentation, we propose to use dual attention based fusion block to recalibrate the features along the modality and spatial paths, which can suppress less informative features and emphasize the useful ones. The fused feature representation is finally projected by the decoder to obtain the segmentation result. Our experiment results tested on BraTS-2018 dataset for brain tumor segmentation demonstrate the effectiveness of our proposed method.

Ling Huang, Su Ruan, Thierry Denoeux

Precise segmentation of a lesion area is important for optimizing its treatment. Deep learning makes it possible to detect and segment a lesion field using annotated data. However, obtaining precisely annotated data is very challenging in the medical domain. Moreover, labeling uncertainty and imprecision make segmentation results unreliable. In this paper, we address the uncertain boundary problem by a new evidential neural network with an information fusion strategy, and the scarcity of annotated data by semi-supervised learning. Experimental results show that our proposal has better performance than state-of-the-art methods.

Ling Huang, Su Ruan, Thierry Denoeux

Computed tomography (CT) image provides useful information for radiologists to diagnose Covid-19. However, visual analysis of CT scans is time-consuming. Thus, it is necessary to develop algorithms for automatic Covid-19 detection from CT images. In this paper, we propose a belief function-based convolutional neural network with semi-supervised training to detect Covid-19 cases. Our method first extracts deep features, maps them into belief degree maps and makes the final classification decision. Our results are more reliable and explainable than those of traditional deep learning-based classification models. Experimental results show that our approach is able to achieve a good performance with an accuracy of 0.81, an F1 of 0.812 and an AUC of 0.875.

Tongxue Zhou, Su Ruan, Stéphane Canu

Multi-modality is widely used in medical imaging, because it can provide multiinformation about a target (tumor, organ or tissue). Segmentation using multimodality consists of fusing multi-information to improve the segmentation. Recently, deep learning-based approaches have presented the state-of-the-art performance in image classification, segmentation, object detection and tracking tasks. Due to their self-learning and generalization ability over large amounts of data, deep learning recently has also gained great interest in multi-modal medical image segmentation. In this paper, we give an overview of deep learning-based approaches for multi-modal medical image segmentation task. Firstly, we introduce the general principle of deep learning and multi-modal medical image segmentation. Secondly, we present different deep learning network architectures, then analyze their fusion strategies and compare their results. The earlier fusion is commonly used, since it's simple and it focuses on the subsequent segmentation network architecture. However, the later fusion gives more attention on fusion strategy to learn the complex relationship between different modalities. In general, compared to the earlier fusion, the later fusion can give more accurate result if the fusion method is effective enough. We also discuss some common problems in medical image segmentation. Finally, we summarize and provide some perspectives on the future research.

Tongxue Zhou, Stéphane Canu, Su Ruan

The coronavirus disease (COVID-19) pandemic has led to a devastating effect on the global public health. Computed Tomography (CT) is an effective tool in the screening of COVID-19. It is of great importance to rapidly and accurately segment COVID-19 from CT to help diagnostic and patient monitoring. In this paper, we propose a U-Net based segmentation network using attention mechanism. As not all the features extracted from the encoders are useful for segmentation, we propose to incorporate an attention mechanism including a spatial and a channel attention, to a U-Net architecture to re-weight the feature representation spatially and channel-wise to capture rich contextual relationships for better feature representation. In addition, the focal tversky loss is introduced to deal with small lesion segmentation. The experiment results, evaluated on a COVID-19 CT segmentation dataset where 473 CT slices are available, demonstrate the proposed method can achieve an accurate and rapid segmentation on COVID-19 segmentation. The method takes only 0.29 second to segment a single CT slice. The obtained Dice Score, Sensitivity and Specificity are 83.1%, 86.7% and 99.3%, respectively.

Tongxue Zhou, Stéphane Canu, Pierre Vera et al.

Multimodal MR images can provide complementary information for accurate brain tumor segmentation. However, it's common to have missing imaging modalities in clinical practice. Since there exists a strong correlation between multi modalities, a novel correlation representation block is proposed to specially discover the latent multi-source correlation. Thanks to the obtained correlation representation, the segmentation becomes more robust in the case of missing modalities. The model parameter estimation module first maps the individual representation produced by each encoder to obtain independent parameters, then, under these parameters, the correlation expression module transforms all the individual representations to form a latent multi-source correlation representation. Finally, the correlation representations across modalities are fused via the attention mechanism into a shared representation to emphasize the most important features for segmentation. We evaluate our model on BraTS 2018 datasets, it outperforms the current state-of-the-art method and produces robust results when one or more modalities are missing.

Amine Amyar, Su Ruan, Pierre Vera et al.

One of the most challenges in medical imaging is the lack of data. It is proven that classical data augmentation methods are useful but still limited due to the huge variation in images. Using generative adversarial networks (GAN) is a promising way to address this problem, however, it is challenging to train one model to generate different classes of lesions. In this paper, we propose a deep convolutional conditional generative adversarial network to generate MIP positron emission tomography image (PET) which is a 2D image that represents a 3D volume for fast interpretation, according to different lesions or non lesion (normal). The advantage of our proposed method consists of one model that is capable of generating different classes of lesions trained on a small sample size for each class of lesion, and showing a very promising results. In addition, we show that a walk through a latent space can be used as a tool to evaluate the images generated.

Amine Amyar, Romain Modzelewski, Pierre Vera et al.

One of the most challenges in medical imaging is the lack of data and annotated data. It is proven that classical segmentation methods such as U-NET are useful but still limited due to the lack of annotated data. Using a weakly supervised learning is a promising way to address this problem, however, it is challenging to train one model to detect and locate efficiently different type of lesions due to the huge variation in images. In this paper, we present a novel approach to locate different type of lesions in positron emission tomography (PET) images using only a class label at the image-level. First, a simple convolutional neural network classifier is trained to predict the type of cancer on two 2D MIP images. Then, a pseudo-localization of the tumor is generated using class activation maps, back-propagated and corrected in a multitask learning approach with prior knowledge, resulting in a tumor detection mask. Finally, we use the mask generated from the two 2D images to detect the tumor in the 3D image. The advantage of our proposed method consists of detecting the whole tumor volume in 3D images, using only two 2D images of PET image, and showing a very promising results. It can be used as a tool to locate very efficiently tumors in a PET scan, which is a time-consuming task for physicians. In addition, we show that our proposed method can be used to conduct a radiomics study with state of the art results.

Yuan Liu, Stéphane Canu, Paul Honeine et al.

Sparse representation learning has recently gained a great success in signal and image processing, thanks to recent advances in dictionary learning. To this end, the $\ell_0$-norm is often used to control the sparsity level. Nevertheless, optimization problems based on the $\ell_0$-norm are non-convex and NP-hard. For these reasons, relaxation techniques have been attracting much attention of researchers, by priorly targeting approximation solutions (e.g. $\ell_1$-norm, pursuit strategies). On the contrary, this paper considers the exact $\ell_0$-norm optimization problem and proves that it can be solved effectively, despite of its complexity. The proposed method reformulates the problem as a Mixed-Integer Quadratic Program (MIQP) and gets the global optimal solution by applying existing optimization software. Because the main difficulty of this approach is its computational time, two techniques are introduced that improve the computational speed. Finally, our method is applied to image denoising which shows its feasibility and relevance compared to the state-of-the-art.

Dong Nie, Roger Trullo, Caroline Petitjean et al.

Computed tomography (CT) is critical for various clinical applications, e.g., radiotherapy treatment planning and also PET attenuation correction. However, CT exposes radiation during acquisition, which may cause side effects to patients. Compared to CT, magnetic resonance imaging (MRI) is much safer and does not involve any radiations. Therefore, recently, researchers are greatly motivated to estimate CT image from its corresponding MR image of the same subject for the case of radiotherapy planning. In this paper, we propose a data-driven approach to address this challenging problem. Specifically, we train a fully convolutional network to generate CT given an MR image. To better model the nonlinear relationship from MRI to CT and to produce more realistic images, we propose to use the adversarial training strategy and an image gradient difference loss function. We further apply AutoContext Model to implement a context-aware generative adversarial network. Experimental results show that our method is accurate and robust for predicting CT images from MRI images, and also outperforms three state-of-the-art methods under comparison.