Sachin Jambawalikar

Hongyi Pan, Gorkem Durak, Elif Keles et al.

Pancreatic cancer is projected to be the second-deadliest cancer by 2030, making early detection critical. Intraductal papillary mucinous neoplasms (IPMNs), key cancer precursors, present a clinical dilemma, as current guidelines struggle to stratify malignancy risk, leading to unnecessary surgeries or missed diagnoses. Here, we developed Cyst-X, an AI framework for IPMN risk prediction trained on a unique, multi-center dataset of 1,461 MRI scans from 764 patients. Cyst-X achieves significantly higher accuracy (AUC = 0.82) than both the established Kyoto guidelines (AUC = 0.75) and expert radiologists, particularly in correct identification of high-risk lesions. Clinically, this translates to a 20% increase in cancer detection sensitivity (87.8% vs. 64.1%) for high-risk lesions. We demonstrate that this performance is maintained in a federated learning setting, allowing for collaborative model training without compromising patient privacy. To accelerate research in early pancreatic cancer detection, we publicly release the Cyst-X dataset and models, providing the first large-scale, multi-center MRI resource for pancreatic cyst analysis.

Wanying Dou, Gorkem Durak, Koushik Biswas et al.

While the acute phase of the COVID-19 pandemic has subsided, its long-term effects persist through Post-Acute Sequelae of COVID-19 (PASC), commonly known as Long COVID. There remains substantial uncertainty regarding both its duration and optimal management strategies. PASC manifests as a diverse array of persistent or newly emerging symptoms--ranging from fatigue, dyspnea, and neurologic impairments (e.g., brain fog), to cardiovascular, pulmonary, and musculoskeletal abnormalities--that extend beyond the acute infection phase. This heterogeneous presentation poses substantial challenges for clinical assessment, diagnosis, and treatment planning. In this paper, we focus on imaging findings that may suggest fibrotic damage in the lungs, a critical manifestation characterized by scarring of lung tissue, which can potentially affect long-term respiratory function in patients with PASC. This study introduces a novel multi-center chest CT analysis framework that combines deep learning and radiomics for fibrosis prediction. Our approach leverages convolutional neural networks (CNNs) and interpretable feature extraction, achieving 82.2% accuracy and 85.5% AUC in classification tasks. We demonstrate the effectiveness of Grad-CAM visualization and radiomics-based feature analysis in providing clinically relevant insights for PASC-related lung fibrosis prediction. Our findings highlight the potential of deep learning-driven computational methods for early detection and risk assessment of PASC-related lung fibrosis--presented for the first time in the literature.

Ugur Demir, Ismail Irmakci, Elif Keles et al.

Visual explanation methods have an important role in the prognosis of the patients where the annotated data is limited or unavailable. There have been several attempts to use gradient-based attribution methods to localize pathology from medical scans without using segmentation labels. This research direction has been impeded by the lack of robustness and reliability. These methods are highly sensitive to the network parameters. In this study, we introduce a robust visual explanation method to address this problem for medical applications. We provide an innovative visual explanation algorithm for general purpose and as an example application, we demonstrate its effectiveness for quantifying lesions in the lungs caused by the Covid-19 with high accuracy and robustness without using dense segmentation labels. This approach overcomes the drawbacks of commonly used Grad-CAM and its extended versions. The premise behind our proposed strategy is that the information flow is minimized while ensuring the classifier prediction stays similar. Our findings indicate that the bottleneck condition provides a more stable severity estimation than the similar attribution methods.

Arjun D. Desai, Francesco Caliva, Claudia Iriondo et al.

Purpose: To organize a knee MRI segmentation challenge for characterizing the semantic and clinical efficacy of automatic segmentation methods relevant for monitoring osteoarthritis progression. Methods: A dataset partition consisting of 3D knee MRI from 88 subjects at two timepoints with ground-truth articular (femoral, tibial, patellar) cartilage and meniscus segmentations was standardized. Challenge submissions and a majority-vote ensemble were evaluated using Dice score, average symmetric surface distance, volumetric overlap error, and coefficient of variation on a hold-out test set. Similarities in network segmentations were evaluated using pairwise Dice correlations. Articular cartilage thickness was computed per-scan and longitudinally. Correlation between thickness error and segmentation metrics was measured using Pearson's coefficient. Two empirical upper bounds for ensemble performance were computed using combinations of model outputs that consolidated true positives and true negatives. Results: Six teams (T1-T6) submitted entries for the challenge. No significant differences were observed across all segmentation metrics for all tissues (p=1.0) among the four top-performing networks (T2, T3, T4, T6). Dice correlations between network pairs were high (>0.85). Per-scan thickness errors were negligible among T1-T4 (p=0.99) and longitudinal changes showed minimal bias (<0.03mm). Low correlations (<0.41) were observed between segmentation metrics and thickness error. The majority-vote ensemble was comparable to top performing networks (p=1.0). Empirical upper bound performances were similar for both combinations (p=1.0). Conclusion: Diverse networks learned to segment the knee similarly where high segmentation accuracy did not correlate to cartilage thickness accuracy. Voting ensembles did not outperform individual networks but may help regularize individual models.

Yucheng Liu, Naji Khosravan, Yulin Liu et al.

Creating large scale high-quality annotations is a known challenge in medical imaging. In this work, based on the CycleGAN algorithm, we propose leveraging annotations from one modality to be useful in other modalities. More specifically, the proposed algorithm creates highly realistic synthetic CT images (SynCT) from prostate MR images using unpaired data sets. By using SynCT images (without segmentation labels) and MR images (with segmentation labels available), we have trained a deep segmentation network for precise delineation of prostate from real CT scans. For the generator in our CycleGAN, the cycle consistency term is used to guarantee that SynCT shares the identical manually-drawn, high-quality masks originally delineated on MR images. Further, we introduce a cost function based on structural similarity index (SSIM) to improve the anatomical similarity between real and synthetic images. For segmentation followed by the SynCT generation from CycleGAN, automatic delineation is achieved through a 2.5D Residual U-Net. Quantitative evaluation demonstrates comparable segmentation results between our SynCT and radiologist drawn masks for real CT images, solving an important problem in medical image segmentation field when ground truth annotations are not available for the modality of interest.