Sanjay P. Prabhu

Anahita Fathi Kazerooni, Nastaran Khalili, Xinyang Liu et al.

Pediatric central nervous system tumors are the leading cause of cancer-related deaths in children. The five-year survival rate for high-grade glioma in children is less than 20%. The development of new treatments is dependent upon multi-institutional collaborative clinical trials requiring reproducible and accurate centralized response assessment. We present the results of the BraTS-PEDs 2023 challenge, the first Brain Tumor Segmentation (BraTS) challenge focused on pediatric brain tumors. This challenge utilized data acquired from multiple international consortia dedicated to pediatric neuro-oncology and clinical trials. BraTS-PEDs 2023 aimed to evaluate volumetric segmentation algorithms for pediatric brain gliomas from magnetic resonance imaging using standardized quantitative performance evaluation metrics employed across the BraTS 2023 challenges. The top-performing AI approaches for pediatric tumor analysis included ensembles of nnU-Net and Swin UNETR, Auto3DSeg, or nnU-Net with a self-supervised framework. The BraTSPEDs 2023 challenge fostered collaboration between clinicians (neuro-oncologists, neuroradiologists) and AI/imaging scientists, promoting faster data sharing and the development of automated volumetric analysis techniques. These advancements could significantly benefit clinical trials and improve the care of children with brain tumors.

Anahita Fathi Kazerooni, Nastaran Khalili, Xinyang Liu et al.

Pediatric tumors of the central nervous system are the most common cause of cancer-related death in children. The five-year survival rate for high-grade gliomas in children is less than 20%. Due to their rarity, the diagnosis of these entities is often delayed, their treatment is mainly based on historic treatment concepts, and clinical trials require multi-institutional collaborations. Here we present the CBTN-CONNECT-DIPGR-ASNR-MICCAI BraTS-PEDs challenge, focused on pediatric brain tumors with data acquired across multiple international consortia dedicated to pediatric neuro-oncology and clinical trials. The CBTN-CONNECT-DIPGR-ASNR-MICCAI BraTS-PEDs challenge brings together clinicians and AI/imaging scientists to lead to faster development of automated segmentation techniques that could benefit clinical trials, and ultimately the care of children with brain tumors.

Sheng He, Randy L. Gollub, Shawn N. Murphy et al.

Brain age prediction based on children's brain MRI is an important biomarker for brain health and brain development analysis. In this paper, we consider the 3D brain MRI volume as a sequence of 2D images and propose a new framework using the recurrent neural network for brain age estimation. The proposed method is named as 2D-ResNet18+Long short-term memory (LSTM), which consists of four parts: 2D ResNet18 for feature extraction on 2D images, a pooling layer for feature reduction over the sequences, an LSTM layer, and a final regression layer. We apply the proposed method on a public multisite NIH-PD dataset and evaluate generalization on a second multisite dataset, which shows that the proposed 2D-ResNet18+LSTM method provides better results than traditional 3D based neural network for brain age estimation.

Seyed Raein Hashemi, Sanjay P. Prabhu, Simon K. Warfield et al.

The most recent fast and accurate image segmentation methods are built upon fully convolutional deep neural networks. In this paper, we propose new deep learning strategies for DenseNets to improve segmenting images with subtle differences in intensity values and features. We aim to segment brain tissue on infant brain MRI at about 6 months of age where white matter and gray matter of the developing brain show similar T1 and T2 relaxation times, thus appear to have similar intensity values on both T1- and T2-weighted MRI scans. Brain tissue segmentation at this age is, therefore, very challenging. To this end, we propose an exclusive multi-label training strategy to segment the mutually exclusive brain tissues with similarity loss functions that automatically balance the training based on class prevalence. Using our proposed training strategy based on similarity loss functions and patch prediction fusion we decrease the number of parameters in the network, reduce the complexity of the training process focusing the attention on less number of tasks, while mitigating the effects of data imbalance between labels and inaccuracies near patch borders. By taking advantage of these strategies we were able to perform fast image segmentation (90 seconds per 3D volume), using a network with less parameters than many state-of-the-art networks, overcoming issues such as 3Dvs2D training and large vs small patch size selection, while achieving the top performance in segmenting brain tissue among all methods tested in first and second round submissions of the isointense infant brain MRI segmentation (iSeg) challenge according to the official challenge test results. Our proposed strategy improves the training process through balanced training and by reducing its complexity while providing a trained model that works for any size input image and is fast and more accurate than many state-of-the-art methods.

Seyed Raein Hashemi, Seyed Sadegh Mohseni Salehi, Deniz Erdogmus et al.

Fully convolutional deep neural networks have been asserted to be fast and precise frameworks with great potential in image segmentation. One of the major challenges in training such networks raises when data is unbalanced, which is common in many medical imaging applications such as lesion segmentation where lesion class voxels are often much lower in numbers than non-lesion voxels. A trained network with unbalanced data may make predictions with high precision and low recall, being severely biased towards the non-lesion class which is particularly undesired in most medical applications where FNs are more important than FPs. Various methods have been proposed to address this problem, more recently similarity loss functions and focal loss. In this work we trained fully convolutional deep neural networks using an asymmetric similarity loss function to mitigate the issue of data imbalance and achieve much better tradeoff between precision and recall. To this end, we developed a 3D FC-DenseNet with large overlapping image patches as input and an asymmetric similarity loss layer based on Tversky index (using Fbeta scores). We used large overlapping image patches as inputs for intrinsic and extrinsic data augmentation, a patch selection algorithm, and a patch prediction fusion strategy using B-spline weighted soft voting to account for the uncertainty of prediction in patch borders. We applied this method to MS lesion segmentation based on two different datasets of MSSEG and ISBI longitudinal MS lesion segmentation challenge, where we achieved top performance in both challenges. Our network trained with focal loss ranked first according to the ISBI challenge overall score and resulted in the lowest reported lesion false positive rate among all submitted methods. Our network trained with the asymmetric similarity loss led to the lowest surface distance and the best lesion true positive rate.