Jennifer Alvén

Xixi Liu, Jorge Lazo, Andreas Hallqvist et al.

Accurate prognostication and risk estimation are essential for guiding clinical decision-making and optimizing patient management. While radiologist-assessed features from CT scans provide valuable indicators of disease severity and outcomes, interpreting such images requires expert knowledge, and translating rich visual information into textual summaries inevitably leads to information loss. In this work, we propose a vision-language framework for 3D CT image understanding that leverages large-scale open-sourced CT images paired with radiology reports through visual instruction tuning. This pre-training enables the model to learn clinically meaningful visual-textual representations, which can then be adapted to downstream survival prediction tasks. By incorporating a survival prediction head on top of the pre-trained model, our approach improves survival prediction from CT images and clinical data while generating clinically meaningful language responses to predefined questions. Experimental results demonstrate that our method outperforms baseline methods in survival prediction, particularly, when clinical data alone is less predictive. The code will be released upon acceptance.

Victor Wåhlstrand Skärström, Lisa Johansson, Jennifer Alvén et al.

We present a novel method for explainable vertebral fracture assessment (XVFA) in low-dose radiographs using deep neural networks, incorporating vertebra detection and keypoint localization with uncertainty estimates. We incorporate Genant's semi-quantitative criteria as a differentiable rule-based means of classifying both vertebra fracture grade and morphology. Unlike previous work, XVFA provides explainable classifications relatable to current clinical methodology, as well as uncertainty estimations, while at the same time surpassing state-of-the art methods with a vertebra-level sensitivity of 93% and end-to-end AUC of 97% in a challenging setting. Moreover, we compare intra-reader agreement with model uncertainty estimates, with model reliability on par with human annotators.

Roman Naeem, David Hagerman, Jennifer Alvén et al.

Tubular tree structures, such as blood vessels and airways, are essential in human anatomy and accurately tracking them while preserving their topology is crucial for various downstream tasks. Trexplorer is a recurrent model designed for centerline tracking in 3D medical images but it struggles with predicting duplicate branches and terminating tracking prematurely. To address these issues, we present Trexplorer Super, an enhanced version that notably improves performance through novel advancements. However, evaluating centerline tracking models is challenging due to the lack of public datasets. To enable thorough evaluation, we develop three centerline datasets, one synthetic and two real, each with increasing difficulty. Using these datasets, we conduct a comprehensive evaluation of existing state-of-the-art (SOTA) models and compare them with our approach. Trexplorer Super outperforms previous SOTA models on every dataset. Our results also highlight that strong performance on synthetic data does not necessarily translate to real datasets. The code and datasets are available at https://github.com/RomStriker/Trexplorer-Super.

Roman Naeem, David Hagerman, Jennifer Alvén et al.

Tubular trees, such as blood vessels and lung airways, are essential for material transport within the human body. Accurately detecting their centerlines with correct tree topology is critical for clinical tasks such as diagnosis, treatment planning, and surgical navigation. In these applications, maintaining high recall is crucial, as missing small branches can result in fatal mistakes caused by incomplete assessments or undetected abnormalities. We present RefTr, a 3D image-to-graph model for centerline generation of vascular trees via recurrent refinement of confluent trajectories. RefTr uses a Producer-Refiner architecture based on a Transformer decoder, where the Producer proposes a set of initial confluent trajectories that are recurrently refined by the Refiner to produce final trajectories, which forms the centerline graph. The confluent trajectory representation enables refinement of complete trajectories while explicitly enforcing a valid tree topology. The recurrent refinement scheme improves precision and reuses the same Refiner block across multiple steps, yielding a 2.4x reduction in decoder parameters compared to previous SOTA. We also introduce an efficient non-maximum suppression algorithm for spatial tree graphs to merge duplicate branches and boost precision. Across multiple public centerline datasets, RefTr achieves superior recall and comparable precision to previous SOTA, while offering faster inference and substantially fewer parameters, demonstrating its potential as a new state-of-the-art framework for vascular tree analysis in 3D medical imaging.