Alexander Valentinitsch

Anjany Sekuboyina, Malek E. Husseini, Amirhossein Bayat et al.

Vertebral labelling and segmentation are two fundamental tasks in an automated spine processing pipeline. Reliable and accurate processing of spine images is expected to benefit clinical decision-support systems for diagnosis, surgery planning, and population-based analysis on spine and bone health. However, designing automated algorithms for spine processing is challenging predominantly due to considerable variations in anatomy and acquisition protocols and due to a severe shortage of publicly available data. Addressing these limitations, the Large Scale Vertebrae Segmentation Challenge (VerSe) was organised in conjunction with the International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) in 2019 and 2020, with a call for algorithms towards labelling and segmentation of vertebrae. Two datasets containing a total of 374 multi-detector CT scans from 355 patients were prepared and 4505 vertebrae have individually been annotated at voxel-level by a human-machine hybrid algorithm (https://osf.io/nqjyw/, https://osf.io/t98fz/). A total of 25 algorithms were benchmarked on these datasets. In this work, we present the the results of this evaluation and further investigate the performance-variation at vertebra-level, scan-level, and at different fields-of-view. We also evaluate the generalisability of the approaches to an implicit domain shift in data by evaluating the top performing algorithms of one challenge iteration on data from the other iteration. The principal takeaway from VerSe: the performance of an algorithm in labelling and segmenting a spine scan hinges on its ability to correctly identify vertebrae in cases of rare anatomical variations. The content and code concerning VerSe can be accessed at: https://github.com/anjany/verse.

Mohit Kumar, Alexander Valentinitsch, Magdalena Fuchs et al.

This paper develops a novel mathematical framework for collaborative learning by means of geometrically inspired kernel machines which includes statements on the bounds of generalisation and approximation errors, and sample complexity. For classification problems, this approach allows us to learn bounded geometric structures around given data points and hence solve the global model learning problem in an efficient way by exploiting convexity properties of the related optimisation problem in a Reproducing Kernel Hilbert Space (RKHS). In this way, we can reduce classification problems to determining the closest bounded geometric structure from a given data point. Further advantages that come with our solution is that our approach does not require clients to perform multiple epochs of local optimisation using stochastic gradient descent, nor require rounds of communication between client/server for optimising the global model. We highlight that numerous experiments have shown that the proposed method is a competitive alternative to the state-of-the-art.

Mohit Kumar, Mathias Brucker, Alexander Valentinitsch et al.

Federated learning must address heterogeneity, strict communication and computation limits, and privacy while ensuring performance. We propose an operator-theoretic framework that maps the $L^2$-optimal solution into a reproducing kernel Hilbert space (RKHS) via a forward operator, approximates it using available data, and maps back with the inverse operator, yielding a gradient-free scheme. Finite-sample bounds are derived using concentration inequalities over operator norms, and the framework identifies a data-dependent hypothesis space with guarantees on risk, error, robustness, and approximation. Within this space we design efficient kernel machines leveraging the space folding property of Kernel Affine Hull Machines. Clients transfer knowledge via a scalar space folding measure, reducing communication and enabling a simple differentially private protocol: summaries are computed from noise-perturbed data matrices in one step, avoiding per-round clipping and privacy accounting. The induced global rule requires only integer minimum and equality-comparison operations per test point, making it compatible with fully homomorphic encryption (FHE). Across four benchmarks, the gradient-free FL method with fixed encoder embeddings matches or outperforms strong gradient-based fine-tuning, with gains up to 23.7 points. In differentially private experiments, kernel smoothing mitigates accuracy loss in high-privacy regimes. The global rule admits an FHE realization using $Q \times C$ encrypted minimum and $C$ equality-comparison operations per test point, with operation-level benchmarks showing practical latencies. Overall, the framework provides provable guarantees with low communication, supports private knowledge transfer via scalar summaries, and yields an FHE-compatible prediction rule offering a mathematically grounded alternative to gradient-based federated learning under heterogeneity.

Anjany Sekuboyina, Markus Rempfler, Alexander Valentinitsch et al.

We propose an auto-encoding network architecture for point clouds (PC) capable of extracting shape signatures without supervision. Building on this, we (i) design a loss function capable of modelling data variance on PCs which are unstructured, and (ii) regularise the latent space as in a variational auto-encoder, both of which increase the auto-encoders' descriptive capacity while making them probabilistic. Evaluating the reconstruction quality of our architectures, we employ them for detecting vertebral fractures without any supervision. By learning to efficiently reconstruct only healthy vertebrae, fractures are detected as anomalous reconstructions. Evaluating on a dataset containing $\sim$1500 vertebrae, we achieve area-under-ROC curve of $>$75%, without using intensity-based features.

Anjany Sekuboyina, Markus Rempfler, Alexander Valentinitsch et al.

Purpose: To use and test a labelling algorithm that operates on two-dimensional (2D) reformations, rather than three-dimensional (3D) data to locate and identify vertebrae. Methods: We improved the Btrfly Net (described by Sekuboyina et al) that works on sagittal and coronal maximum intensity projections (MIP) and augmented it with two additional components: spine-localization and adversarial a priori-learning. Furthermore, we explored two variants of adversarial training schemes that incorporated the anatomical a priori knowledge into the Btrfly Net. We investigated the superiority of the proposed approach for labelling vertebrae on three datasets: a public benchmarking dataset of 302 CT scans and two in-house datasets with a total of 238 CT scans. We employed Wilcoxon signed-rank test to compute the statistical significance of the improvement in performance observed due to various architectural components in our approach. Results: On the public dataset, our approach using the described Btrfly(pe-eb) network performed on par with current state-of-the-art methods achieving a statistically significant (p < .001) vertebrae identification rate of 88.5+/-0.2 % and localization distances of less than 7-mm. On the in-house datasets that had a higher inter-scan data variability, we obtained an identification rate of 85.1+/-1.2%. Conclusion: An identification performance comparable to existing 3D approaches was achieved when labelling vertebrae on 2D MIPs. The performance was further improved using the proposed adversarial training regime that effectively enforced local spine a priori knowledge during training. Lastly, spine-localization increased the generalizability of our approach by homogenizing the content in the MIPs.

Anjany Sekuboyina, Markus Rempfler, Jan Kukačka et al.

Robust localisation and identification of vertebrae is essential for automated spine analysis. The contribution of this work to the task is two-fold: (1) Inspired by the human expert, we hypothesise that a sagittal and coronal reformation of the spine contain sufficient information for labelling the vertebrae. Thereby, we propose a butterfly-shaped network architecture (termed Btrfly Net) that efficiently combines the information across reformations. (2) Underpinning the Btrfly net, we present an energy-based adversarial training regime that encodes local spine structure as an anatomical prior into the network, thereby enabling it to achieve state-of-art performance in all standard metrics on a benchmark dataset of 302 scans without any post-processing during inference.

Anjany Sekuboyina, Alexander Valentinitsch, Jan S. Kirschke et al.

Multi-class segmentation of vertebrae is a non-trivial task mainly due to the high correlation in the appearance of adjacent vertebrae. Hence, such a task calls for the consideration of both global and local context. Based on this motivation, we propose a two-staged approach that, given a computed tomography dataset of the spine, segments the five lumbar vertebrae and simultaneously labels them. The first stage employs a multi-layered perceptron performing non-linear regression for locating the lumbar region using the global context. The second stage, comprised of a fully-convolutional deep network, exploits the local context in the localised lumbar region to segment and label the lumbar vertebrae in one go. Aided with practical data augmentation for training, our approach is highly generalisable, capable of successfully segmenting both healthy and abnormal vertebrae (fractured and scoliotic spines). We consistently achieve an average Dice coefficient of over 90 percent on a publicly available dataset of the xVertSeg segmentation challenge of MICCAI 2016. This is particularly noteworthy because the xVertSeg dataset is beset with severe deformities in the form of vertebral fractures and scoliosis.

Patrick Ferdinand Christ, Florian Ettlinger, Georgios Kaissis et al.

Automatic non-invasive assessment of hepatocellular carcinoma (HCC) malignancy has the potential to substantially enhance tumor treatment strategies for HCC patients. In this work we present a novel framework to automatically characterize the malignancy of HCC lesions from DWI images. We predict HCC malignancy in two steps: As a first step we automatically segment HCC tumor lesions using cascaded fully convolutional neural networks (CFCN). A 3D neural network (SurvivalNet) then predicts the HCC lesions' malignancy from the HCC tumor segmentation. We formulate this task as a classification problem with classes being "low risk" and "high risk" represented by longer or shorter survival times than the median survival. We evaluated our method on DWI of 31 HCC patients. Our proposed framework achieves an end-to-end accuracy of 65% with a Dice score for the automatic lesion segmentation of 69% and an accuracy of 68% for tumor malignancy classification based on expert annotations. We compared the SurvivalNet to classical handcrafted features such as Histogram and Haralick and show experimentally that SurvivalNet outperforms the handcrafted features in HCC malignancy classification. End-to-end assessment of tumor malignancy based on our proposed fully automatic framework corresponds to assessment based on expert annotations with high significance (p>0.95).