Alexandre Bône

Emma Sarfati, Alexandre Bône, Marc-Michel Rohé et al.

Large medical imaging datasets can be cheaply and quickly annotated with low-confidence, weak labels (e.g., radiological scores). Access to high-confidence labels, such as histology-based diagnoses, is rare and costly. Pretraining strategies, like contrastive learning (CL) methods, can leverage unlabeled or weakly-annotated datasets. These methods typically require large batch sizes, which poses a difficulty in the case of large 3D images at full resolution, due to limited GPU memory. Nevertheless, volumetric positional information about the spatial context of each 2D slice can be very important for some medical applications. In this work, we propose an efficient weakly-supervised positional (WSP) contrastive learning strategy where we integrate both the spatial context of each 2D slice and a weak label via a generic kernel-based loss function. We illustrate our method on cirrhosis prediction using a large volume of weakly-labeled images, namely radiological low-confidence annotations, and small strongly-labeled (i.e., high-confidence) datasets. The proposed model improves the classification AUC by 5% with respect to a baseline model on our internal dataset, and by 26% on the public LIHC dataset from the Cancer Genome Atlas. The code is available at: https://github.com/Guerbet-AI/wsp-contrastive.

Rebeca Vétil, Clément Abi-Nader, Alexandre Bône et al.

We address the problem of learning Deep Learning Radiomics (DLR) that are not redundant with Hand-Crafted Radiomics (HCR). To do so, we extract DLR features using a VAE while enforcing their independence with HCR features by minimizing their mutual information. The resulting DLR features can be combined with hand-crafted ones and leveraged by a classifier to predict early markers of cancer. We illustrate our method on four early markers of pancreatic cancer and validate it on a large independent test set. Our results highlight the value of combining non-redundant DLR and HCR features, as evidenced by an improvement in the Area Under the Curve compared to baseline methods that do not address redundancy or solely rely on HCR features.

Emma Sarfati, Alexandre Bone, Marc-Michel Rohe et al.

Identifying cirrhosis is key to correctly assess the health of the liver. However, the gold standard diagnosis of the cirrhosis needs a medical intervention to obtain the histological confirmation, e.g. the METAVIR score, as the radiological presentation can be equivocal. In this work, we propose to leverage transfer learning from large datasets annotated by radiologists, which we consider as a weak annotation, to predict the histological score available on a small annex dataset. To this end, we propose to compare different pretraining methods, namely weakly-supervised and self-supervised ones, to improve the prediction of the cirrhosis. Finally, we introduce a loss function combining both supervised and self-supervised frameworks for pretraining. This method outperforms the baseline classification of the METAVIR score, reaching an AUC of 0.84 and a balanced accuracy of 0.75, compared to 0.77 and 0.72 for a baseline classifier.

Omar Ali, Alexandre Bone, Caterina Accardo et al.

Surgical resections are the most prevalent curative treatment for primary liver cancer. Tumors located in critical positions are known to complexify liver resections (LR). While experienced surgeons in specialized medical centers may have the necessary expertise to accurately anticipate LR complexity, and prepare accordingly, an objective method able to reproduce this behavior would have the potential to improve the standard routine of care, and avoid intra- and postoperative complications. In this article, we propose CoRe, an automated medical image processing pipeline for the prediction of postoperative LR complexity from preoperative CT scans, using imaging biomarkers. The CoRe pipeline first segments the liver, lesions, and vessels with two deep learning networks. The liver vasculature is then pruned based on a topological criterion to define the hepatic central zone (HCZ), a convex volume circumscribing the major liver vessels, from which a new imaging biomarker, BHCZ is derived. Additional biomarkers are extracted and leveraged to train and evaluate a LR complexity prediction model. An ablation study shows the HCZ-based biomarker as the central feature in predicting LR complexity. The best predictive model reaches an accuracy, F1, and AUC of 77.3, 75.4, and 84.1% respectively.

Anupama Goparaju, Alexandre Bone, Nan Hu et al.

Statistical shape modeling (SSM) is widely used in biology and medicine as a new generation of morphometric approaches for the quantitative analysis of anatomical shapes. Technological advancements of in vivo imaging have led to the development of open-source computational tools that automate the modeling of anatomical shapes and their population-level variability. However, little work has been done on the evaluation and validation of such tools in clinical applications that rely on morphometric quantifications (e.g., implant design and lesion screening). Here, we systematically assess the outcome of widely used, state-of-the-art SSM tools, namely ShapeWorks, Deformetrica, and SPHARM-PDM. We use both quantitative and qualitative metrics to evaluate shape models from different tools. We propose validation frameworks for anatomical landmark/measurement inference and lesion screening. We also present a lesion screening method to objectively characterize subtle abnormal shape changes with respect to learned population-level statistics of controls. Results demonstrate that SSM tools display different levels of consistencies, where ShapeWorks and Deformetrica models are more consistent compared to models from SPHARM-PDM due to the groupwise approach of estimating surface correspondences. Furthermore, ShapeWorks and Deformetrica shape models are found to capture clinically relevant population-level variability compared to SPHARM-PDM models.

E. Sarfati, A. Bône, M-M. Rohé et al.

Hepatocellular carcinoma is the most spread primary liver cancer across the world ($\sim$80\% of the liver tumors). The gold standard for HCC diagnosis is liver biopsy. However, in the clinical routine, expert radiologists provide a visual diagnosis by interpreting hepatic CT-scans according to a standardized protocol, the LI-RADS, which uses five radiological criteria with an associated decision tree. In this paper, we propose an automatic approach to predict histology-proven HCC from CT images in order to reduce radiologists' inter-variability. We first show that standard deep learning methods fail to accurately predict HCC from CT-scans on a challenging database, and propose a two-step approach inspired by the LI-RADS system to improve the performance. We achieve improvements from 6 to 18 points of AUC with respect to deep learning baselines trained with different architectures. We also provide clinical validation of our method, achieving results that outperform non-expert radiologists and are on par with expert ones.

Pierre Fayolle, Alexandre Bône, Noëlie Debs et al.

Gadolinium-based contrast agents (GBCAs) are widely used in magnetic resonance imaging (MRI) to enhance lesion detection and characterisation, particularly in the field of neuro-oncology. Nevertheless, concerns regarding gadolinium retention and accumulation in brain and body tissues, most notably for diseases that require close monitoring and frequent GBCA injection, have led to the need for strategies to reduce dosage. In this study, a deep learning framework is proposed for the virtual contrast enhancement of full-dose post-contrast T1-weighted MRI images from corresponding low-dose acquisitions. The contribution of the presented model is its utilisation of longitudinal information, which is achieved by incorporating a prior full-dose MRI examination from the same patient. A comparative evaluation against a non-longitudinal single session model demonstrated that the longitudinal approach significantly improves image quality across multiple reconstruction metrics. Furthermore, experiments with varying simulated contrast doses confirmed the robustness of the proposed method. These results emphasize the potential of integrating prior imaging history into deep learning-based virtual contrast enhancement pipelines to reduce GBCA usage without compromising diagnostic utility, thus paving the way for safer, more sustainable longitudinal monitoring in clinical MRI practice.

Alexandre Bône, Olivier Colliot, Stanley Durrleman

We propose a method to learn a distribution of shape trajectories from longitudinal data, i.e. the collection of individual objects repeatedly observed at multiple time-points. The method allows to compute an average spatiotemporal trajectory of shape changes at the group level, and the individual variations of this trajectory both in terms of geometry and time dynamics. First, we formulate a non-linear mixed-effects statistical model as the combination of a generic statistical model for manifold-valued longitudinal data, a deformation model defining shape trajectories via the action of a finite-dimensional set of diffeomorphisms with a manifold structure, and an efficient numerical scheme to compute parallel transport on this manifold. Second, we introduce a MCMC-SAEM algorithm with a specific approach to shape sampling, an adaptive scheme for proposal variances, and a log-likelihood tempering strategy to estimate our model. Third, we validate our algorithm on 2D simulated data, and then estimate a scenario of alteration of the shape of the hippocampus 3D brain structure during the course of Alzheimer's disease. The method shows for instance that hippocampal atrophy progresses more quickly in female subjects, and occurs earlier in APOE4 mutation carriers. We finally illustrate the potential of our method for classifying pathological trajectories versus normal ageing.

Maxime Louis, Alexandre Bône, Benjamin Charlier et al.

The analysis of manifold-valued data requires efficient tools from Riemannian geometry to cope with the computational complexity at stake. This complexity arises from the always-increasing dimension of the data, and the absence of closed-form expressions to basic operations such as the Riemannian logarithm. In this paper, we adapt a generic numerical scheme recently introduced for computing parallel transport along geodesics in a Riemannian manifold to finite-dimensional manifolds of diffeomorphisms. We provide a qualitative and quantitative analysis of its behavior on high-dimensional manifolds, and investigate an application with the prediction of brain structures progression.

Alexandre Bône, Maxime Louis, Alexandre Routier et al.

We propose a method to predict the subject-specific longitudinal progression of brain structures extracted from baseline MRI, and evaluate its performance on Alzheimer's disease data. The disease progression is modeled as a trajectory on a group of diffeomorphisms in the context of large deformation diffeomorphic metric mapping (LDDMM). We first exhibit the limited predictive abilities of geodesic regression extrapolation on this group. Building on the recent concept of parallel curves in shape manifolds, we then introduce a second predictive protocol which personalizes previously learned trajectories to new subjects, and investigate the relative performances of two parallel shifting paradigms. This design only requires the baseline imaging data. Finally, coefficients encoding the disease dynamics are obtained from longitudinal cognitive measurements for each subject, and exploited to refine our methodology which is demonstrated to successfully predict the follow-up visits.