Sebastien Tourbier

Jagruti Patel, Thomas A. W. Bolton, Mikkel Schöttner et al.

Small sample sizes in neuroimaging in general, and in structural connectome (SC) studies in particular limit the development of reliable biomarkers for neurological and psychiatric disorders - such as Alzheimer's disease and schizophrenia - by reducing statistical power, reliability, and generalizability. Large-scale multi-site studies have exist, but they have acquisition-related biases due to scanner heterogeneity, compromising imaging consistency and downstream analyses. While existing SC harmonization methods - such as linear regression (LR), ComBat, and deep learning techniques - mitigate these biases, they often rely on detailed metadata, traveling subjects (TS), or overlook the graph-topology of SCs. To address these limitations, we propose a site-conditioned deep harmonization framework that harmonizes SCs across diverse acquisition sites without requiring metadata or TS that we test in a simulated scenario based on the Human Connectome Dataset. Within this framework, we benchmark three deep architectures - a fully connected autoencoder (AE), a convolutional AE, and a graph convolutional AE - against a top-performing LR baseline. While non-graph models excel in edge-weight prediction and edge existence detection, the graph AE demonstrates superior preservation of topological structure and subject-level individuality, as reflected by graph metrics and fingerprinting accuracy, respectively. Although the LR baseline achieves the highest numerical performance by explicitly modeling acquisition parameters, it lacks applicability to real-world multi-site use cases as detailed acquisition metadata is often unavailable. Our results highlight the critical role of model architecture in SC harmonization performance and demonstrate that graph-based approaches are particularly well-suited for structure-aware, domain-generalizable SC harmonization in large-scale multi-site SC studies.

Tommaso Di Noto, Sofyan Jankowski, Francesco Puccinelli et al.

Despite the plethora of AI-based algorithms developed for anomaly detection in radiology, subsequent integration into clinical setting is rarely evaluated. In this work, we assess the applicability and utility of an AI-based model for brain aneurysm detection comparing the performance of two readers with different levels of experience (2 and 13 years). We aim to answer the following questions: 1) Do the readers improve their performance when assisted by the AI algorithm? 2) How much does the AI algorithm impact routine clinical workflow? We reuse and enlarge our open-access, Time-Of-Flight Magnetic Resonance Angiography dataset (N=460). We use 360 subjects for training/validating our algorithm and 100 as unseen test set for the reading session. Even though our model reaches state-of-the-art results on the test set (sensitivity=74%, false positive rate=1.6), we show that neither the junior nor the senior reader significantly increase their sensitivity (p=0.59, p=1, respectively). In addition, we find that reading time for both readers is significantly higher in the "AI-assisted" setting than in the "Unassisted" (+15 seconds, on average; p=3x10^(-4) junior, p=3x10^(-5) senior). The confidence reported by the readers is unchanged across the two settings, indicating that the AI assistance does not influence the certainty of the diagnosis. Our findings highlight the importance of clinical validation of AI algorithms in a clinical setting involving radiologists. This study should serve as a reminder to the community to always examine the real-word effectiveness and workflow impact of proposed algorithms.

Tommaso Di Noto, Guillaume Marie, Sebastien Tourbier et al.

Brain aneurysm detection in Time-Of-Flight Magnetic Resonance Angiography (TOF-MRA) has undergone drastic improvements with the advent of Deep Learning (DL). However, performances of supervised DL models heavily rely on the quantity of labeled samples, which are extremely costly to obtain. Here, we present a DL model for aneurysm detection that overcomes the issue with ''weak'' labels: oversized annotations which are considerably faster to create. Our weak labels resulted to be four times faster to generate than their voxel-wise counterparts. In addition, our model leverages prior anatomical knowledge by focusing only on plausible locations for aneurysm occurrence. We frst train and evaluate our model through cross-validation on an in-house TOF-MRA dataset comprising 284 subjects (170 females / 127 healthy controls / 157 patients with 198 aneurysms). On this dataset, our best model achieved a sensitivity of 83%, with False Positive (FP) rate of 0.8 per patient. To assess model generalizability, we then participated in a challenge for aneurysm detection with TOF-MRA data (93 patients, 20 controls, 125 aneurysms). On the public challenge, sensitivity was 68% (FP rate=2.5), ranking 4th/18 on the open leaderboard. We found no signifcant diference in sensitivity between aneurysm risk-of-rupture groups (p=0.75), locations (p=0.72), or sizes (p=0.15). Data, code and model weights are released under permissive licenses. We demonstrate that weak labels and anatomical knowledge can alleviate the necessity for prohibitively expensive voxel-wise annotations.