Xiaoping Yang

Bingxue Wang, Liwen Zou, Jun Chen et al.

The presence of tertiary lymphoid structures (TLSs) on pancreatic pathological images is an important prognostic indicator of pancreatic tumors. Therefore, TLSs detection on pancreatic pathological images plays a crucial role in diagnosis and treatment for patients with pancreatic tumors. However, fully supervised detection algorithms based on deep learning usually require a large number of manual annotations, which is time-consuming and labor-intensive. In this paper, we aim to detect the TLSs in a manner of few-shot learning by proposing a weakly supervised segmentation network. We firstly obtain the lymphocyte density maps by combining a pretrained model for nuclei segmentation and a domain adversarial network for lymphocyte nuclei recognition. Then, we establish a cross-scale attention guidance mechanism by jointly learning the coarse-scale features from the original histopathology images and fine-scale features from our designed lymphocyte density attention. A noise-sensitive constraint is introduced by an embedding signed distance function loss in the training procedure to reduce tiny prediction errors. Experimental results on two collected datasets demonstrate that our proposed method significantly outperforms the state-of-the-art segmentation-based algorithms in terms of TLSs detection accuracy. Additionally, we apply our method to study the congruent relationship between the density of TLSs and peripancreatic vascular invasion and obtain some clinically statistical results.

Liwen Zou, Zhenghua Cai, Yudong Qiu et al.

Pancreatic duct dilation indicates a high risk of various pancreatic diseases. Segmentation of dilated pancreatic ducts on computed tomography (CT) images shows the potential to assist the early diagnosis, surgical planning and prognosis. Because of the ducts' tiny sizes, slender tubular structures and the surrounding distractions, most current researches on pancreatic duct segmentation achieve low accuracy and always have segmentation errors on the terminal parts of the ducts. To address these problems, we propose a terminal guidance mechanism called cascaded terminal guidance network (CTG-Net). Firstly, a terminal attention mechanism is established on the skeletons extracted from the coarse predictions. Then, to get fine terminal segmentation, a subnetwork is designed for jointly learning the local intensity from the original images, feature cues from coarse predictions and global anatomy information from the pancreas distance transform maps. Finally, a terminal distraction attention module which explicitly learns the distribution of the terminal distraction is proposed to reduce the false positive and false negative predictions. We also propose a new metric called tDice to measure the terminal segmentation accuracy for targets with tubular structures and two segmentation metrics for distractions. We collect our dilated pancreatic duct segmentation dataset with 150 CT scans from patients with 5 types of pancreatic tumors. Experimental results on our dataset show that our proposed approach boosts dilated pancreatic duct segmentation accuracy by nearly 20% compared with the existing results, and achieves more than 9% improvement for the terminal segmentation accuracy compared with the state-of-the-art methods.

Liwen Zou, Zhenghua Cai, Liang Mao et al.

Peripancreatic vessel segmentation and anatomical labeling play extremely important roles to assist the early diagnosis, surgery planning and prognosis for patients with pancreatic tumors. However, most current techniques cannot achieve satisfactory segmentation performance for peripancreatic veins and usually make predictions with poor integrity and connectivity. Besides, unsupervised labeling algorithms cannot deal with complex anatomical variation while fully supervised methods require a large number of voxel-wise annotations for training, which is very labor-intensive and time-consuming. To address these problems, we propose our Automated Peripancreatic vEssel Segmentation and lAbeling (APESA) framework, to not only highly improve the segmentation performance for peripancreatic veins, but also efficiently identify the peripancreatic artery branches. There are two core modules in our proposed APESA framework: iterative trunk growth module (ITGM) for vein segmentation and weakly supervised labeling mechanism (WSLM) for artery branch identification. Our proposed ITGM is composed of a series of trunk growth modules, each of which chooses the most reliable trunk of a basic vessel prediction by the largest connected constraint, and seeks for the possible growth branches by branch proposal network. Our designed iterative process guides the raw trunk to be more complete and fully connected. Our proposed WSLM consists of an unsupervised rule-based preprocessing for generating pseudo branch annotations, and an anatomical labeling network to learn the branch distribution voxel by voxel. We achieve Dice of 94.01% for vein segmentation on our collected dataset, which boosts the accuracy by nearly 10% compared with the state-of-the-art methods. Additionally, we also achieve Dice of 97.01% on segmentation and competitive performance on anatomical labeling for peripancreatic arteries.

Yuntao Zhu, Yuxuan Qiao, Xiaoping Yang

There are many unsolved problems in vascular image segmentation, including vascular structural connectivity, scarce branches and missing small vessels. Obtaining vessels that preserve their correct topological structures is currently a crucial research issue, as it provides an overall view of one vascular system. In order to preserve the topology and accuracy of vessel segmentation, we proposed a novel Morphology Edge Attention Network (MEA-Net) for the segmentation of vessel-like structures, and an Optimal Geometric Matching Connection (OGMC) model to connect the broken vessel segments. The MEA-Net has an edge attention module that improves the segmentation of edges and small objects by morphology operation extracting boundary voxels on multi-scale. The OGMC model uses the concept of curve touching from differential geometry to filter out fragmented vessel endpoints, and then employs minimal surfaces to determine the optimal connection order between blood vessels. Finally, we calculate the geodesic to repair missing vessels under a given Riemannian metric. Our method achieves superior or competitive results compared to state-of-the-art methods on four datasets of 3D vascular segmentation tasks, both effectively reducing vessel broken and increasing vessel branch richness, yielding blood vessels with a more precise topological structure.

Jun Ma, Yao Zhang, Song Gu et al.

With the unprecedented developments in deep learning, automatic segmentation of main abdominal organs seems to be a solved problem as state-of-the-art (SOTA) methods have achieved comparable results with inter-rater variability on many benchmark datasets. However, most of the existing abdominal datasets only contain single-center, single-phase, single-vendor, or single-disease cases, and it is unclear whether the excellent performance can generalize on diverse datasets. This paper presents a large and diverse abdominal CT organ segmentation dataset, termed AbdomenCT-1K, with more than 1000 (1K) CT scans from 12 medical centers, including multi-phase, multi-vendor, and multi-disease cases. Furthermore, we conduct a large-scale study for liver, kidney, spleen, and pancreas segmentation and reveal the unsolved segmentation problems of the SOTA methods, such as the limited generalization ability on distinct medical centers, phases, and unseen diseases. To advance the unsolved problems, we further build four organ segmentation benchmarks for fully supervised, semi-supervised, weakly supervised, and continual learning, which are currently challenging and active research topics. Accordingly, we develop a simple and effective method for each benchmark, which can be used as out-of-the-box methods and strong baselines. We believe the AbdomenCT-1K dataset will promote future in-depth research towards clinical applicable abdominal organ segmentation methods. The datasets, codes, and trained models are publicly available at https://github.com/JunMa11/AbdomenCT-1K.

Pengxu Wen, Tingting Yu, Ziwei Nie et al.

Intracranial pressure (ICP) elevation poses severe threats to cerebral function, thus necessitating monitoring for timely intervention. While lumbar puncture is the gold standard for ICP measurement, its invasiveness and associated risks drive the need for non-invasive alternatives. Optic nerve sheath diameter (ONSD) has emerged as a promising biomarker, as elevated ICP directly correlates with increased ONSD. However, current clinical practices for ONSD measurement suffer from inconsistency in manual operation, subjectivity in optimal view selection, and variability in thresholding, limiting their reliability. To address these challenges, we introduce a fully automatic two-stage framework for ICP grading, integrating keyframe identification, ONSD measurement and clinical data. Specifically, the fundus ultrasound video processing stage performs frame-level anatomical segmentation, rule-based keyframe identification guided by an international consensus statement, and precise ONSD measurement. The intracranial pressure grading stage then fuses ONSD metrics with clinical features to enable the prediction of ICP grades, thereby demonstrating an innovative blend of interpretable ultrasound analysis and multi-source data integration for objective clinical evaluation. Experimental results demonstrate that our method achieves a validation accuracy of $0.845 \pm 0.071$ (with standard deviation from five-fold cross-validation) and an independent test accuracy of 0.786, significantly outperforming conventional threshold-based method ($0.637 \pm 0.111$ validation accuracy, $0.429$ test accuracy). Through effectively reducing operator variability and integrating multi-source information, our framework establishes a reliable non-invasive approach for clinical ICP evaluation, holding promise for improving patient management in acute neurological conditions.

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/).

Jun Ma, Xiaoping Yang

Automatic segmentation of head and neck tumors plays an important role in radiomics analysis. In this short paper, we propose an automatic segmentation method for head and neck tumors from PET and CT images based on the combination of convolutional neural networks (CNNs) and hybrid active contours. Specifically, we first introduce a multi-channel 3D U-Net to segment the tumor with the concatenated PET and CT images. Then, we estimate the segmentation uncertainty by model ensembles and define a segmentation quality score to select the cases with high uncertainties. Finally, we develop a hybrid active contour model to refine the high uncertainty cases. Our method ranked second place in the MICCAI 2020 HECKTOR challenge with average Dice Similarity Coefficient, precision, and recall of 0.752, 0.838, and 0.717, respectively.

Yue Sun, Kun Gao, Zhengwang Wu et al.

To better understand early brain growth patterns in health and disorder, it is critical to accurately segment infant brain magnetic resonance (MR) images into white matter (WM), gray matter (GM), and cerebrospinal fluid (CSF). Deep learning-based methods have achieved state-of-the-art performance; however, one of major limitations is that the learning-based methods may suffer from the multi-site issue, that is, the models trained on a dataset from one site may not be applicable to the datasets acquired from other sites with different imaging protocols/scanners. To promote methodological development in the community, iSeg-2019 challenge (http://iseg2019.web.unc.edu) provides a set of 6-month infant subjects from multiple sites with different protocols/scanners for the participating methods. Training/validation subjects are from UNC (MAP) and testing subjects are from UNC/UMN (BCP), Stanford University, and Emory University. By the time of writing, there are 30 automatic segmentation methods participating in iSeg-2019. We review the 8 top-ranked teams by detailing their pipelines/implementations, presenting experimental results and evaluating performance in terms of the whole brain, regions of interest, and gyral landmark curves. We also discuss their limitations and possible future directions for the multi-site issue. We hope that the multi-site dataset in iSeg-2019 and this review article will attract more researchers on the multi-site issue.

Jun Ma, Dong Wang, Xiao-Ping Wang et al.

Active contour models have been widely used in image segmentation, and the level set method (LSM) is the most popular approach for solving the models, via implicitly representing the contour by a level set function. However, the LSM suffers from high computational burden and numerical instability, requiring additional regularization terms or re-initialization techniques. In this paper, we use characteristic functions to implicitly represent the contours, propose a new representation to the geodesic active contours and derive an efficient algorithm termed as the iterative convolution-thresholding method (ICTM). Compared to the LSM, the ICTM is simpler and much more efficient. In addition, the ICTM enjoys most desired features of the level set-based methods. Extensive experiments, on 2D synthetic, 2D ultrasound, 3D CT, and 3D MR images for nodule, organ and lesion segmentation, demonstrate that the proposed method not only obtains comparable or even better segmentation results (compared to the LSM) but also achieves significant acceleration.

Jun Ma, Yixin Wang, Xingle An et al.

Purpose: Accurate segmentation of lung and infection in COVID-19 CT scans plays an important role in the quantitative management of patients. Most of the existing studies are based on large and private annotated datasets that are impractical to obtain from a single institution, especially when radiologists are busy fighting the coronavirus disease. Furthermore, it is hard to compare current COVID-19 CT segmentation methods as they are developed on different datasets, trained in different settings, and evaluated with different metrics. Methods: To promote the development of data-efficient deep learning methods, in this paper, we built three benchmarks for lung and infection segmentation based on 70 annotated COVID-19 cases, which contain current active research areas, e.g., few-shot learning, domain generalization, and knowledge transfer. For a fair comparison among different segmentation methods, we also provide standard training, validation and testing splits, evaluation metrics and, the corresponding code. Results: Based on the state-of-the-art network, we provide more than 40 pre-trained baseline models, which not only serve as out-of-the-box segmentation tools but also save computational time for researchers who are interested in COVID-19 lung and infection segmentation. We achieve average Dice Similarity Coefficient (DSC) scores of 97.3\%, 97.7\%, and 67.3\% and average Normalized Surface Dice (NSD) scores of 90.6\%, 91.4\%, and 70.0\% for left lung, right lung, and infection, respectively. Conclusions: To the best of our knowledge, this work presents the first data-efficient learning benchmark for medical image segmentation and the largest number of pre-trained models up to now. All these resources are publicly available, and our work lays the foundation for promoting the development of deep learning methods for efficient COVID-19 CT segmentation with limited data.

Patrick Bilic, Patrick Christ, Hongwei Bran Li et al.

In this work, we report the set-up and results of the Liver Tumor Segmentation Benchmark (LiTS), which was organized in conjunction with the IEEE International Symposium on Biomedical Imaging (ISBI) 2017 and the International Conferences on Medical Image Computing and Computer-Assisted Intervention (MICCAI) 2017 and 2018. The image dataset is diverse and contains primary and secondary tumors with varied sizes and appearances with various lesion-to-background levels (hyper-/hypo-dense), created in collaboration with seven hospitals and research institutions. Seventy-five submitted liver and liver tumor segmentation algorithms were trained on a set of 131 computed tomography (CT) volumes and were tested on 70 unseen test images acquired from different patients. We found that not a single algorithm performed best for both liver and liver tumors in the three events. The best liver segmentation algorithm achieved a Dice score of 0.963, whereas, for tumor segmentation, the best algorithms achieved Dices scores of 0.674 (ISBI 2017), 0.702 (MICCAI 2017), and 0.739 (MICCAI 2018). Retrospectively, we performed additional analysis on liver tumor detection and revealed that not all top-performing segmentation algorithms worked well for tumor detection. The best liver tumor detection method achieved a lesion-wise recall of 0.458 (ISBI 2017), 0.515 (MICCAI 2017), and 0.554 (MICCAI 2018), indicating the need for further research. LiTS remains an active benchmark and resource for research, e.g., contributing the liver-related segmentation tasks in \url{http://medicaldecathlon.com/}. In addition, both data and online evaluation are accessible via \url{www.lits-challenge.com}.

Spyridon Bakas, Mauricio Reyes, Andras Jakab et al.

Gliomas are the most common primary brain malignancies, with different degrees of aggressiveness, variable prognosis and various heterogeneous histologic sub-regions, i.e., peritumoral edematous/invaded tissue, necrotic core, active and non-enhancing core. This intrinsic heterogeneity is also portrayed in their radio-phenotype, as their sub-regions are depicted by varying intensity profiles disseminated across multi-parametric magnetic resonance imaging (mpMRI) scans, reflecting varying biological properties. Their heterogeneous shape, extent, and location are some of the factors that make these tumors difficult to resect, and in some cases inoperable. The amount of resected tumor is a factor also considered in longitudinal scans, when evaluating the apparent tumor for potential diagnosis of progression. Furthermore, there is mounting evidence that accurate segmentation of the various tumor sub-regions can offer the basis for quantitative image analysis towards prediction of patient overall survival. This study assesses the state-of-the-art machine learning (ML) methods used for brain tumor image analysis in mpMRI scans, during the last seven instances of the International Brain Tumor Segmentation (BraTS) challenge, i.e., 2012-2018. Specifically, we focus on i) evaluating segmentations of the various glioma sub-regions in pre-operative mpMRI scans, ii) assessing potential tumor progression by virtue of longitudinal growth of tumor sub-regions, beyond use of the RECIST/RANO criteria, and iii) predicting the overall survival from pre-operative mpMRI scans of patients that underwent gross total resection. Finally, we investigate the challenge of identifying the best ML algorithms for each of these tasks, considering that apart from being diverse on each instance of the challenge, the multi-institutional mpMRI BraTS dataset has also been a continuously evolving/growing dataset.