Fabian Hörst

Fabian Hörst, Moritz Rempe, Lukas Heine et al.

Nuclei detection and segmentation in hematoxylin and eosin-stained (H&E) tissue images are important clinical tasks and crucial for a wide range of applications. However, it is a challenging task due to nuclei variances in staining and size, overlapping boundaries, and nuclei clustering. While convolutional neural networks have been extensively used for this task, we explore the potential of Transformer-based networks in this domain. Therefore, we introduce a new method for automated instance segmentation of cell nuclei in digitized tissue samples using a deep learning architecture based on Vision Transformer called CellViT. CellViT is trained and evaluated on the PanNuke dataset, which is one of the most challenging nuclei instance segmentation datasets, consisting of nearly 200,000 annotated Nuclei into 5 clinically important classes in 19 tissue types. We demonstrate the superiority of large-scale in-domain and out-of-domain pre-trained Vision Transformers by leveraging the recently published Segment Anything Model and a ViT-encoder pre-trained on 104 million histological image patches - achieving state-of-the-art nuclei detection and instance segmentation performance on the PanNuke dataset with a mean panoptic quality of 0.50 and an F1-detection score of 0.83. The code is publicly available at https://github.com/TIO-IKIM/CellViT

Jianning Li, Zongwei Zhou, Jiancheng Yang et al.

Prior to the deep learning era, shape was commonly used to describe the objects. Nowadays, state-of-the-art (SOTA) algorithms in medical imaging are predominantly diverging from computer vision, where voxel grids, meshes, point clouds, and implicit surface models are used. This is seen from numerous shape-related publications in premier vision conferences as well as the growing popularity of ShapeNet (about 51,300 models) and Princeton ModelNet (127,915 models). For the medical domain, we present a large collection of anatomical shapes (e.g., bones, organs, vessels) and 3D models of surgical instrument, called MedShapeNet, created to facilitate the translation of data-driven vision algorithms to medical applications and to adapt SOTA vision algorithms to medical problems. As a unique feature, we directly model the majority of shapes on the imaging data of real patients. As of today, MedShapeNet includes 23 dataset with more than 100,000 shapes that are paired with annotations (ground truth). Our data is freely accessible via a web interface and a Python application programming interface (API) and can be used for discriminative, reconstructive, and variational benchmarks as well as various applications in virtual, augmented, or mixed reality, and 3D printing. Exemplary, we present use cases in the fields of classification of brain tumors, facial and skull reconstructions, multi-class anatomy completion, education, and 3D printing. In future, we will extend the data and improve the interfaces. The project pages are: https://medshapenet.ikim.nrw/ and https://github.com/Jianningli/medshapenet-feedback

Oliver Ester, Fabian Hörst, Constantin Seibold et al.

The segmentation of histopathological whole slide images into tumourous and non-tumourous types of tissue is a challenging task that requires the consideration of both local and global spatial contexts to classify tumourous regions precisely. The identification of subtypes of tumour tissue complicates the issue as the sharpness of separation decreases and the pathologist's reasoning is even more guided by spatial context. However, the identification of detailed types of tissue is crucial for providing personalized cancer therapies. Due to the high resolution of whole slide images, existing semantic segmentation methods, restricted to isolated image sections, are incapable of processing context information beyond. To take a step towards better context comprehension, we propose a patch neighbour attention mechanism to query the neighbouring tissue context from a patch embedding memory bank and infuse context embeddings into bottleneck hidden feature maps. Our memory attention framework (MAF) mimics a pathologist's annotation procedure -- zooming out and considering surrounding tissue context. The framework can be integrated into any encoder-decoder segmentation method. We evaluate the MAF on a public breast cancer and an internal kidney cancer data set using famous segmentation models (U-Net, DeeplabV3) and demonstrate the superiority over other context-integrating algorithms -- achieving a substantial improvement of up to $17\%$ on Dice score. The code is publicly available at: https://github.com/tio-ikim/valuing-vicinity

Hamza Kalisch, Fabian Hörst, Ken Herrmann et al.

Lesion segmentation in PET/CT imaging is essential for precise tumor characterization, which supports personalized treatment planning and enhances diagnostic precision in oncology. However, accurate manual segmentation of lesions is time-consuming and prone to inter-observer variability. Given the rising demand and clinical use of PET/CT, automated segmentation methods, particularly deep-learning-based approaches, have become increasingly more relevant. The autoPET III Challenge focuses on advancing automated segmentation of tumor lesions in PET/CT images in a multitracer multicenter setting, addressing the clinical need for quantitative, robust, and generalizable solutions. Building on previous challenges, the third iteration of the autoPET challenge introduces a more diverse dataset featuring two different tracers (FDG and PSMA) from two clinical centers. To this extent, we developed a classifier that identifies the tracer of the given PET/CT based on the Maximum Intensity Projection of the PET scan. We trained two individual nnUNet-ensembles for each tracer where anatomical labels are included as a multi-label task to enhance the model's performance. Our final submission achieves cross-validation Dice scores of 76.90% and 61.33% for the publicly available FDG and PSMA datasets, respectively. The code is available at https://github.com/hakal104/autoPETIII/ .

Lukas Heine, Fabian Hörst, Jana Fragemann et al.

In industries such as healthcare, finance, and manufacturing, analysis of unstructured textual data presents significant challenges for analysis and decision making. Uncovering patterns within large-scale corpora and understanding their semantic impact is critical, but depends on domain experts or resource-intensive manual reviews. In response, we introduce Spacewalker in this system demonstration paper, an interactive tool designed to analyze, explore, and annotate data across multiple modalities. It allows users to extract data representations, visualize them in low-dimensional spaces and traverse large datasets either exploratory or by querying regions of interest. We evaluated Spacewalker through extensive experiments and annotation studies, assessing its efficacy in improving data integrity verification and annotation. We show that Spacewalker reduces time and effort compared to traditional methods. The code of this work is open-source and can be found at: https://github.com/code-lukas/Spacewalker

Fabian Hörst, Moritz Rempe, Helmut Becker et al.

Digital Pathology is a cornerstone in the diagnosis and treatment of diseases. A key task in this field is the identification and segmentation of cells in hematoxylin and eosin-stained images. Existing methods for cell segmentation often require extensive annotated datasets for training and are limited to a predefined cell classification scheme. To overcome these limitations, we propose $\text{CellViT}^{\scriptscriptstyle ++}$, a framework for generalized cell segmentation in digital pathology. $\text{CellViT}^{\scriptscriptstyle ++}$ utilizes Vision Transformers with foundation models as encoders to compute deep cell features and segmentation masks simultaneously. To adapt to unseen cell types, we rely on a computationally efficient approach. It requires minimal data for training and leads to a drastically reduced carbon footprint. We demonstrate excellent performance on seven different datasets, covering a broad spectrum of cell types, organs, and clinical settings. The framework achieves remarkable zero-shot segmentation and data-efficient cell-type classification. Furthermore, we show that $\text{CellViT}^{\scriptscriptstyle ++}$ can leverage immunofluorescence stainings to generate training datasets without the need for pathologist annotations. The automated dataset generation approach surpasses the performance of networks trained on manually labeled data, demonstrating its effectiveness in creating high-quality training datasets without expert annotations. To advance digital pathology, $\text{CellViT}^{\scriptscriptstyle ++}$ is available as an open-source framework featuring a user-friendly, web-based interface for visualization and annotation. The code is available under https://github.com/TIO-IKIM/CellViT-plus-plus.

Moritz Rempe, Lukas Heine, Constantin Seibold et al.

Medical data employed in research frequently comprises sensitive patient health information (PHI), which is subject to rigorous legal frameworks such as the General Data Protection Regulation (GDPR) or the Health Insurance Portability and Accountability Act (HIPAA). Consequently, these types of data must be pseudonymized prior to utilisation, which presents a significant challenge for many researchers. Given the vast array of medical data, it is necessary to employ a variety of de-identification techniques. To facilitate the anonymization process for medical imaging data, we have developed an open-source tool that can be used to de-identify DICOM magnetic resonance images, computer tomography images, whole slide images and magnetic resonance twix raw data. Furthermore, the implementation of a neural network enables the removal of text within the images. The proposed tool automates an elaborate anonymization pipeline for multiple types of inputs, reducing the need for additional tools used for de-identification of imaging data. We make our code publicly available at https://github.com/code-lukas/medical_image_deidentification.

Hamza Kalisch, Fabian Hörst, Jens Kleesiek et al.

As medical imaging is central to diagnostic processes, automating the generation of radiology reports has become increasingly relevant to assist radiologists with their heavy workloads. Most current methods rely solely on global image features, failing to capture fine-grained organ relationships crucial for accurate reporting. To this end, we propose CT-GRAPH, a hierarchical graph attention network that explicitly models radiological knowledge by structuring anatomical regions into a graph, linking fine-grained organ features to coarser anatomical systems and a global patient context. Our method leverages pretrained 3D medical feature encoders to obtain global and organ-level features by utilizing anatomical masks. These features are further refined within the graph and then integrated into a large language model to generate detailed medical reports. We evaluate our approach for the task of report generation on the large-scale chest CT dataset CT-RATE. We provide an in-depth analysis of pretrained feature encoders for CT report generation and show that our method achieves a substantial improvement of absolute 7.9\% in F1 score over current state-of-the-art methods. The code is publicly available at https://github.com/hakal104/CT-GRAPH.

Moritz Rempe, Lukas T. Rotkopf, Marco Schlimbach et al.

Deep learning applications in Magnetic Resonance Imaging (MRI) predominantly operate on reconstructed magnitude images, a process that discards phase information and requires computationally expensive transforms. Standard neural network architectures rely on local operations (convolutions or grid-patches) that are ill-suited for the global, non-local nature of raw frequency-domain (k-Space) data. In this work, we propose a novel complex-valued Vision Transformer (kViT) designed to perform classification directly on k-Space data. To bridge the geometric disconnect between current architectures and MRI physics, we introduce a radial k-Space patching strategy that respects the spectral energy distribution of the frequency-domain. Extensive experiments on the fastMRI and in-house datasets demonstrate that our approach achieves classification performance competitive with state-of-the-art image-domain baselines (ResNet, EfficientNet, ViT). Crucially, kViT exhibits superior robustness to high acceleration factors and offers a paradigm shift in computational efficiency, reducing VRAM consumption during training by up to 68$\times$ compared to standard methods. This establishes a pathway for resource-efficient, direct-from-scanner AI analysis.

Moritz Rempe, Fabian Hörst, Helmut Becker et al.

Magnetic resonance imaging (MRI) raw data, or k-Space data, is complex-valued, containing both magnitude and phase information. However, clinical and existing Artificial Intelligence (AI)-based methods focus only on magnitude images, discarding the phase data despite its potential for downstream tasks, such as tumor segmentation and classification. In this work, we introduce $\textit{PhaseGen}$, a novel complex-valued diffusion model for generating synthetic MRI raw data conditioned on magnitude images, commonly used in clinical practice. This enables the creation of artificial complex-valued raw data, allowing pretraining for models that require k-Space information. We evaluate PhaseGen on two tasks: skull-stripping directly in k-Space and MRI reconstruction using the publicly available FastMRI dataset. Our results show that training with synthetic phase data significantly improves generalization for skull-stripping on real-world data, with an increased segmentation accuracy from $41.1\%$ to $80.1\%$, and enhances MRI reconstruction when combined with limited real-world data. This work presents a step forward in utilizing generative AI to bridge the gap between magnitude-based datasets and the complex-valued nature of MRI raw data. This approach allows researchers to leverage the vast amount of avaliable image domain data in combination with the information-rich k-Space data for more accurate and efficient diagnostic tasks. We make our code publicly $\href{https://github.com/TIO-IKIM/PhaseGen}{\text{available here}}$.

Negar Shahamiri, Moritz Rempe, Lukas Heine et al.

Automatic tissue segmentation and nuclei detection is an important task in pathology, aiding in biomarker extraction and discovery. The panoptic segmentation of nuclei and tissue in advanced melanoma (PUMA) challenge aims to improve tissue segmentation and nuclei detection in melanoma histopathology. Unlike many challenge submissions focusing on extensive model tuning, our approach emphasizes delivering a deployable solution within a 24-hour development timeframe, using out-of-the-box frameworks. The pipeline combines two models, namely CellViT++ for nuclei detection and nnU-Net for tissue segmentation. Our results demonstrate a significant improvement in tissue segmentation, achieving a Dice score of 0.750, surpassing the baseline score of 0.629. For nuclei detection, we obtained results comparable to the baseline in both challenge tracks. The code is publicly available at https://github.com/TIO-IKIM/PUMA.

Johannes Raufeisen, Kunpeng Xie, Fabian Hörst et al.

Background: Cell segmentation in bright-field histological slides is a crucial topic in medical image analysis. Having access to accurate segmentation allows researchers to examine the relationship between cellular morphology and clinical observations. Unfortunately, most segmentation methods known today are limited to nuclei and cannot segmentate the cytoplasm. Material & Methods: We present a new network architecture Cyto R-CNN that is able to accurately segment whole cells (with both the nucleus and the cytoplasm) in bright-field images. We also present a new dataset CytoNuke, consisting of multiple thousand manual annotations of head and neck squamous cell carcinoma cells. Utilizing this dataset, we compared the performance of Cyto R-CNN to other popular cell segmentation algorithms, including QuPath's built-in algorithm, StarDist and Cellpose. To evaluate segmentation performance, we calculated AP50, AP75 and measured 17 morphological and staining-related features for all detected cells. We compared these measurements to the gold standard of manual segmentation using the Kolmogorov-Smirnov test. Results: Cyto R-CNN achieved an AP50 of 58.65% and an AP75 of 11.56% in whole-cell segmentation, outperforming all other methods (QuPath $19.46/0.91\%$; StarDist $45.33/2.32\%$; Cellpose $31.85/5.61\%$). Cell features derived from Cyto R-CNN showed the best agreement to the gold standard ($\bar{D} = 0.15$) outperforming QuPath ($\bar{D} = 0.22$), StarDist ($\bar{D} = 0.25$) and Cellpose ($\bar{D} = 0.23$). Conclusion: Our newly proposed Cyto R-CNN architecture outperforms current algorithms in whole-cell segmentation while providing more reliable cell measurements than any other model. This could improve digital pathology workflows, potentially leading to improved diagnosis. Moreover, our published dataset can be used to develop further models in the future.