Kathinka Dæhli Kurz

Luca Tomasetti, Mahdieh Khanmohammadi, Kjersti Engan et al.

Time is a fundamental factor during stroke treatments. A fast, automatic approach that segments the ischemic regions helps treatment decisions. In clinical use today, a set of color-coded parametric maps generated from computed tomography perfusion (CTP) images are investigated manually to decide a treatment plan. We propose an automatic method based on a neural network using a set of parametric maps to segment the two ischemic regions (core and penumbra) in patients affected by acute ischemic stroke. Our model is based on a convolution-deconvolution bottleneck structure with multi-input and slow fusion. A loss function based on the focal Tversky index addresses the data imbalance issue. The proposed architecture demonstrates effective performance and results comparable to the ground truth annotated by neuroradiologists. A Dice coefficient of 0.81 for penumbra and 0.52 for core over the large vessel occlusion test set is achieved. The full implementation is available at: https://git.io/JtFGb.

Luca Tomasetti, Kjersti Engan, Liv Jorunn Høllesli et al.

Precise and fast prediction methods for ischemic areas comprised of dead tissue, core, and salvageable tissue, penumbra, in acute ischemic stroke (AIS) patients are of significant clinical interest. They play an essential role in improving diagnosis and treatment planning. Computed Tomography (CT) scan is one of the primary modalities for early assessment in patients with suspected AIS. CT Perfusion (CTP) is often used as a primary assessment to determine stroke location, severity, and volume of ischemic lesions. Current automatic segmentation methods for CTP mostly use already processed 3D parametric maps conventionally used for clinical interpretation by radiologists as input. Alternatively, the raw CTP data is used on a slice-by-slice basis as 2D+time input, where the spatial information over the volume is ignored. In addition, these methods are only interested in segmenting core regions, while predicting penumbra can be essential for treatment planning. This paper investigates different methods to utilize the entire 4D CTP as input to fully exploit the spatio-temporal information, leading us to propose a novel 4D convolution layer. Our comprehensive experiments on a local dataset of 152 patients divided into three groups show that our proposed models generate more precise results than other methods explored. Adopting the proposed 4D mJ-Net, a Dice Coefficient of 0.53 and 0.23 is achieved for segmenting penumbra and core areas, respectively. The code is available on https://github.com/Biomedical-Data-Analysis-Laboratory/4D-mJ-Net.git.

Luca Tomasetti, Stine Hansen, Mahdieh Khanmohammadi et al.

Precise ischemic lesion segmentation plays an essential role in improving diagnosis and treatment planning for ischemic stroke, one of the prevalent diseases with the highest mortality rate. While numerous deep neural network approaches have recently been proposed to tackle this problem, these methods require large amounts of annotated regions during training, which can be impractical in the medical domain where annotated data is scarce. As a remedy, we present a prototypical few-shot segmentation approach for ischemic lesion segmentation using only one annotated sample during training. The proposed approach leverages a novel self-supervised training mechanism that is tailored to the task of ischemic stroke lesion segmentation by exploiting color-coded parametric maps generated from Computed Tomography Perfusion scans. We illustrate the benefits of our proposed training mechanism, leading to considerable improvements in performance in the few-shot setting. Given a single annotated patient, an average Dice score of 0.58 is achieved for the segmentation of ischemic lesions.

Sam Narimani, Solveig Roth Hoff, Kathinka Dæhli Kurz et al.

Purpose: Annotation of medical breast images is an essential step toward better diagnostic but a time consuming task. This research aims to focus on different selecting sample strategies within deep active learning on Breast Region Segmentation (BRS) to lessen computational cost of training and effective use of resources. Methods: The Stavanger breast MRI dataset containing 59 patients was used in this study, with FCN-ResNet50 adopted as a sustainable deep learning (DL) model. A novel sample selection approach based on Breast Anatomy Geometry (BAG) analysis was introduced to group data with similar informative features for DL. Patient positioning and Breast Size were considered the key selection criteria in this process. Four selection strategies including Random Selection, Nearest Point, Breast Size, and a hybrid of all three strategies were evaluated using an active learning framework. Four training data proportions of 10%, 20%, 30%, and 40% were used for model training, with the remaining data reserved for testing. Model performance was assessed using Dice score, Intersection over Union, precision, and recall, along with 5-fold cross-validation to enhance generalizability. Results: Increasing the training data proportion from 10% to 40% improved segmentation performance for nearly all strategies, except for Random Selection. The Nearest Point strategy consistently achieved the lowest carbon footprint at 30% and 40% data proportions. Overall, combining the Nearest Point strategy with 30% of the training data provided the best balance between segmentation performance, efficiency, and environmental sustainability. Keywords: Deep Active Learning, Breast Region Segmentation, Human-center analysis

Luca Tomasetti, Kjersti Engan, Mahdieh Khanmohammadi et al.

More than 13 million people suffer from ischemic cerebral stroke worldwide each year. Thrombolytic treatment can reduce brain damage but has a narrow treatment window. Computed Tomography Perfusion imaging is a commonly used primary assessment tool for stroke patients, and typically the radiologists will evaluate resulting parametric maps to estimate the affected areas, dead tissue (core), and the surrounding tissue at risk (penumbra), to decide further treatments. Different work has been reported, suggesting thresholds, and semi-automated methods, and in later years deep neural networks, for segmenting infarction areas based on the parametric maps. However, there is no consensus in terms of which thresholds to use, or how to combine the information from the parametric maps, and the presented methods all have limitations in terms of both accuracy and reproducibility. We propose a fully automated convolutional neural network based segmentation method that uses the full four-dimensional computed tomography perfusion dataset as input, rather than the pre-filtered parametric maps. The suggested network is tested on an available dataset as a proof-of-concept, with very encouraging results. Cross-validated results show averaged Dice score of 0.78 and 0.53, and an area under the receiver operating characteristic curve of 0.97 and 0.94 for penumbra and core respectively