Elliot K. Fishman

Tianwei Ni, Lingxi Xie, Huangjie Zheng et al.

We focus on an important yet challenging problem: using a 2D deep network to deal with 3D segmentation for medical image analysis. Existing approaches either applied multi-view planar (2D) networks or directly used volumetric (3D) networks for this purpose, but both of them are not ideal: 2D networks cannot capture 3D contexts effectively, and 3D networks are both memory-consuming and less stable arguably due to the lack of pre-trained models. In this paper, we bridge the gap between 2D and 3D using a novel approach named Elastic Boundary Projection (EBP). The key observation is that, although the object is a 3D volume, what we really need in segmentation is to find its boundary which is a 2D surface. Therefore, we place a number of pivot points in the 3D space, and for each pivot, we determine its distance to the object boundary along a dense set of directions. This creates an elastic shell around each pivot which is initialized as a perfect sphere. We train a 2D deep network to determine whether each ending point falls within the object, and gradually adjust the shell so that it gradually converges to the actual shape of the boundary and thus achieves the goal of segmentation. EBP allows boundary-based segmentation without cutting a 3D volume into slices or patches, which stands out from conventional 2D and 3D approaches. EBP achieves promising accuracy in abdominal organ segmentation. Our code has been open-sourced https://github.com/twni2016/Elastic-Boundary-Projection.

Mintong Kang, Bowen Li, Zengle Zhu et al.

The success of deep learning relies heavily on large labeled datasets, but we often only have access to several small datasets associated with partial labels. To address this problem, we propose a new initiative, "Label-Assemble", that aims to unleash the full potential of partial labels from an assembly of public datasets. We discovered that learning from negative examples facilitates both computer-aided disease diagnosis and detection. This discovery will be particularly crucial in novel disease diagnosis, where positive examples are hard to collect, yet negative examples are relatively easier to assemble. For example, assembling existing labels from NIH ChestX-ray14 (available since 2017) significantly improves the accuracy of COVID-19 diagnosis from 96.3% to 99.3%. In addition to diagnosis, assembling labels can also improve disease detection, e.g., the detection of pancreatic ductal adenocarcinoma (PDAC) can greatly benefit from leveraging the labels of Cysts and PanNets (two other types of pancreatic abnormalities), increasing sensitivity from 52.1% to 84.0% while maintaining a high specificity of 98.0%.

Yan Wang, Peng Tang, Yuyin Zhou et al.

Pancreatic ductal adenocarcinoma (PDAC) is the third most common cause of cancer death in the United States. Predicting tumors like PDACs (including both classification and segmentation) from medical images by deep learning is becoming a growing trend, but usually a large number of annotated data are required for training, which is very labor-intensive and time-consuming. In this paper, we consider a partially supervised setting, where cheap image-level annotations are provided for all the training data, and the costly per-voxel annotations are only available for a subset of them. We propose an Inductive Attention Guidance Network (IAG-Net) to jointly learn a global image-level classifier for normal/PDAC classification and a local voxel-level classifier for semi-supervised PDAC segmentation. We instantiate both the global and the local classifiers by multiple instance learning (MIL), where the attention guidance, indicating roughly where the PDAC regions are, is the key to bridging them: For global MIL based normal/PDAC classification, attention serves as a weight for each instance (voxel) during MIL pooling, which eliminates the distraction from the background; For local MIL based semi-supervised PDAC segmentation, the attention guidance is inductive, which not only provides bag-level pseudo-labels to training data without per-voxel annotations for MIL training, but also acts as a proxy of an instance-level classifier. Experimental results show that our IAG-Net boosts PDAC segmentation accuracy by more than 5% compared with the state-of-the-arts.

Seyoun Park, Elliot K. Fishman, Alan L. Yuille

Human body is a complex dynamic system composed of various sub-dynamic parts. Especially, thoracic and abdominal organs have complex internal shape variations with different frequencies by various reasons such as respiration with fast motion and peristalsis with slower motion. CT protocols for abdominal lesions are multi-phase scans for various tumor detection to use different vascular contrast, however, they are not aligned well enough to visually check the same area. In this paper, we propose a time-efficient and accurate deformable registration algorithm for multi-phase CT scans considering abdominal organ motions, which can be applied for differentiable or non-differentiable motions of abdominal organs. Experimental results shows the registration accuracy as 0.85 +/- 0.45mm (mean +/- STD) for pancreas within 1 minute for the whole abdominal region.

Yingwei Li, Zhuotun Zhu, Yuyin Zhou et al.

Although deep neural networks have been a dominant method for many 2D vision tasks, it is still challenging to apply them to 3D tasks, such as medical image segmentation, due to the limited amount of annotated 3D data and limited computational resources. In this chapter, by rethinking the strategy to apply 3D Convolutional Neural Networks to segment medical images, we propose a novel 3D-based coarse-to-fine framework to efficiently tackle these challenges. The proposed 3D-based framework outperforms their 2D counterparts by a large margin since it can leverage the rich spatial information along all three axes. We further analyze the threat of adversarial attacks on the proposed framework and show how to defense against the attack. We conduct experiments on three datasets, the NIH pancreas dataset, the JHMI pancreas dataset and the JHMI pathological cyst dataset, where the first two and the last one contain healthy and pathological pancreases respectively, and achieve the current state-of-the-art in terms of Dice-Sorensen Coefficient (DSC) on all of them. Especially, on the NIH pancreas segmentation dataset, we outperform the previous best by an average of over $2\%$, and the worst case is improved by $7\%$ to reach almost $70\%$, which indicates the reliability of our framework in clinical applications.

Zhuotun Zhu, Yongyi Lu, Wei Shen et al.

This work presents comprehensive results to detect in the early stage the pancreatic neuroendocrine tumors (PNETs), a group of endocrine tumors arising in the pancreas, which are the second common type of pancreatic cancer, by checking the abdominal CT scans. To the best of our knowledge, this task has not been studied before as a computational task. To provide radiologists with tumor locations, we adopt a segmentation framework to classify CT volumes by checking if at least a sufficient number of voxels is segmented as tumors. To quantitatively analyze our method, we collect and voxelwisely label a new abdominal CT dataset containing $376$ cases with both arterial and venous phases available for each case, in which $228$ cases were diagnosed with PNETs while the remaining $148$ cases are normal, which is currently the largest dataset for PNETs to the best of our knowledge. In order to incorporate rich knowledge of radiologists to our framework, we annotate dilated pancreatic duct as well, which is regarded as the sign of high risk for pancreatic cancer. Quantitatively, our approach outperforms state-of-the-art segmentation networks and achieves a sensitivity of $89.47\%$ at a specificity of $81.08\%$, which indicates a potential direction to achieve a clinical impact related to cancer diagnosis by earlier tumor detection.

Yingda Xia, Qihang Yu, Wei Shen et al.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers among the population. Screening for PDACs in dynamic contrast-enhanced CT is beneficial for early diagnosis. In this paper, we investigate the problem of automated detecting PDACs in multi-phase (arterial and venous) CT scans. Multiple phases provide more information than single phase, but they are unaligned and inhomogeneous in texture, making it difficult to combine cross-phase information seamlessly. We study multiple phase alignment strategies, i.e., early alignment (image registration), late alignment (high-level feature registration), and slow alignment (multi-level feature registration), and suggest an ensemble of all these alignments as a promising way to boost the performance of PDAC detection. We provide an extensive empirical evaluation on two PDAC datasets and show that the proposed alignment ensemble significantly outperforms previous state-of-the-art approaches, illustrating the strong potential for clinical use.

Yan Wang, Xu Wei, Fengze Liu et al.

Tubular structure segmentation in medical images, e.g., segmenting vessels in CT scans, serves as a vital step in the use of computers to aid in screening early stages of related diseases. But automatic tubular structure segmentation in CT scans is a challenging problem, due to issues such as poor contrast, noise and complicated background. A tubular structure usually has a cylinder-like shape which can be well represented by its skeleton and cross-sectional radii (scales). Inspired by this, we propose a geometry-aware tubular structure segmentation method, Deep Distance Transform (DDT), which combines intuitions from the classical distance transform for skeletonization and modern deep segmentation networks. DDT first learns a multi-task network to predict a segmentation mask for a tubular structure and a distance map. Each value in the map represents the distance from each tubular structure voxel to the tubular structure surface. Then the segmentation mask is refined by leveraging the shape prior reconstructed from the distance map. We apply our DDT on six medical image datasets. The experiments show that (1) DDT can boost tubular structure segmentation performance significantly (e.g., over 13% improvement measured by DSC for pancreatic duct segmentation), and (2) DDT additionally provides a geometrical measurement for a tubular structure, which is important for clinical diagnosis (e.g., the cross-sectional scale of a pancreatic duct can be an indicator for pancreatic cancer).

Qihang Yu, Yingda Xia, Lingxi Xie et al.

There has been a debate in 3D medical image segmentation on whether to use 2D or 3D networks, where both pipelines have advantages and disadvantages. 2D methods enjoy a low inference time and greater transfer-ability while 3D methods are superior in performance for hard targets requiring contextual information. This paper investigates efficient 3D segmentation from another perspective, which uses 2D networks to mimic 3D segmentation. To compensate the lack of contextual information in 2D manner, we propose to thicken the 2D network inputs by feeding multiple slices as multiple channels into 2D networks and thus 3D contextual information is incorporated. We also put forward to use early-stage multiplexing and slice sensitive attention to solve the confusion problem of information loss which occurs when 2D networks face thickened inputs. With this design, we achieve a higher performance while maintaining a lower inference latency on a few abdominal organs from CT scans, in particular when the organ has a peculiar 3D shape and thus strongly requires contextual information, demonstrating our method's effectiveness and ability in capturing 3D information. We also point out that "thickened" 2D inputs pave a new method of 3D segmentation, and look forward to more efforts in this direction. Experiments on segmenting a few abdominal targets in particular blood vessels which require strong 3D contexts demonstrate the advantages of our approach.

Xutong Ren, Lingxi Xie, Chen Wei et al.

Computer vision is difficult, partly because the desired mathematical function connecting input and output data is often complex, fuzzy and thus hard to learn. Coarse-to-fine (C2F) learning is a promising direction, but it remains unclear how it is applied to a wide range of vision problems. This paper presents a generalized C2F framework by making two technical contributions. First, we provide a unified way of C2F propagation, in which the coarse prediction (a class vector, a detected box, a segmentation mask, etc.) is encoded into a dense (pixel-level) matrix and concatenated to the original input, so that the fine model takes the same design of the coarse model but sees additional information. Second, we present a progressive training strategy which starts with feeding the ground-truth instead of the coarse output into the fine model, and gradually increases the fraction of coarse output, so that at the end of training the fine model is ready for testing. We also relate our approach to curriculum learning by showing that data difficulty keeps increasing during the training process. We apply our framework to three vision tasks including image classification, object localization and semantic segmentation, and demonstrate consistent accuracy gain compared to the baseline training strategy.

Huangjie Zheng, Lingxi Xie, Tianwei Ni et al.

In real-world practice, medical images acquired in different phases possess complementary information, {\em e.g.}, radiologists often refer to both arterial and venous scans in order to make the diagnosis. However, in medical image analysis, fusing prediction from two phases is often difficult, because (i) there is a domain gap between two phases, and (ii) the semantic labels are not pixel-wise corresponded even for images scanned from the same patient. This paper studies organ segmentation in two-phase CT scans. We propose Phase Collaborative Network (PCN), an end-to-end framework that contains both generative and discriminative modules. PCN can be mathematically explained to formulate phase-to-phase and data-to-label relations jointly. Experiments are performed on a two-phase CT dataset, on which PCN outperforms the baselines working with one-phase data by a large margin, and we empirically verify that the gain comes from inter-phase collaboration. Besides, PCN transfers well to two public single-phase datasets, demonstrating its potential applications.

Zhuotun Zhu, Yingda Xia, Lingxi Xie et al.

We propose an intuitive approach of detecting pancreatic ductal adenocarcinoma (PDAC), the most common type of pancreatic cancer, by checking abdominal CT scans. Our idea is named multi-scale segmentation-for-classification, which classifies volumes by checking if at least a sufficient number of voxels is segmented as tumors, by which we can provide radiologists with tumor locations. In order to deal with tumors with different scales, we train and test our volumetric segmentation networks with multi-scale inputs in a coarse-to-fine flowchart. A post-processing module is used to filter out outliers and reduce false alarms. We collect a new dataset containing 439 CT scans, in which 136 cases were diagnosed with PDAC and 303 cases are normal, which is the largest set for PDAC tumors to the best of our knowledge. To offer the best trade-off between sensitivity and specificity, our proposed framework reports a sensitivity of 94.1% at a specificity of 98.5%, which demonstrates the potential to make a clinical impact.

Fengze Liu, Lingxi Xie, Yingda Xia et al.

We aim to detect pancreatic ductal adenocarcinoma (PDAC) in abdominal CT scans, which sheds light on early diagnosis of pancreatic cancer. This is a 3D volume classification task with little training data. We propose a two-stage framework, which first segments the pancreas into a binary mask, then compresses the mask into a shape vector and performs abnormality classification. Shape representation and classification are performed in a joint manner, both to exploit the knowledge that PDAC often changes the shape of the pancreas and to prevent over-fitting. Experiments are performed on 300 normal scans and 136 PDAC cases. We achieve a specificity of 90.2% (false alarm occurs on less than 1/10 normal cases) at a sensitivity of 80.2% (less than 1/5 PDAC cases are not detected), which show promise for clinical applications.

Yan Wang, Yuyin Zhou, Wei Shen et al.

Accurate and robust segmentation of abdominal organs on CT is essential for many clinical applications such as computer-aided diagnosis and computer-aided surgery. But this task is challenging due to the weak boundaries of organs, the complexity of the background, and the variable sizes of different organs. To address these challenges, we introduce a novel framework for multi-organ segmentation by using organ-attention networks with reverse connections (OAN-RCs) which are applied to 2D views, of the 3D CT volume, and output estimates which are combined by statistical fusion exploiting structural similarity. OAN is a two-stage deep convolutional network, where deep network features from the first stage are combined with the original image, in a second stage, to reduce the complex background and enhance the discriminative information for the target organs. RCs are added to the first stage to give the lower layers semantic information thereby enabling them to adapt to the sizes of different organs. Our networks are trained on 2D views enabling us to use holistic information and allowing efficient computation. To compensate for the limited cross-sectional information of the original 3D volumetric CT, multi-sectional images are reconstructed from the three different 2D view directions. Then we combine the segmentation results from the different views using statistical fusion, with a novel term relating the structural similarity of the 2D views to the original 3D structure. To train the network and evaluate results, 13 structures were manually annotated by four human raters and confirmed by a senior expert on 236 normal cases. We tested our algorithm and computed Dice-Sorensen similarity coefficients and surface distances for evaluating our estimates of the 13 structures. Our experiments show that the proposed approach outperforms 2D- and 3D-patch based state-of-the-art methods.

Yan Wang, Yuyin Zhou, Peng Tang et al.

Deep convolutional neural networks (CNNs), especially fully convolutional networks, have been widely applied to automatic medical image segmentation problems, e.g., multi-organ segmentation. Existing CNN-based segmentation methods mainly focus on looking for increasingly powerful network architectures, but pay less attention to data sampling strategies for training networks more effectively. In this paper, we present a simple but effective sample selection method for training multi-organ segmentation networks. Sample selection exhibits an exploitation-exploration strategy, i.e., exploiting hard samples and exploring less frequently visited samples. Based on the fact that very hard samples might have annotation errors, we propose a new sample selection policy, named Relaxed Upper Confident Bound (RUCB). Compared with other sample selection policies, e.g., Upper Confident Bound (UCB), it exploits a range of hard samples rather than being stuck with a small set of very hard ones, which mitigates the influence of annotation errors during training. We apply this new sample selection policy to training a multi-organ segmentation network on a dataset containing 120 abdominal CT scans and show that it boosts segmentation performance significantly.

Yuyin Zhou, Yan Wang, Peng Tang et al.

In multi-organ segmentation of abdominal CT scans, most existing fully supervised deep learning algorithms require lots of voxel-wise annotations, which are usually difficult, expensive, and slow to obtain. In comparison, massive unlabeled 3D CT volumes are usually easily accessible. Current mainstream works to address the semi-supervised biomedical image segmentation problem are mostly graph-based. By contrast, deep network based semi-supervised learning methods have not drawn much attention in this field. In this work, we propose Deep Multi-Planar Co-Training (DMPCT), whose contributions can be divided into two folds: 1) The deep model is learned in a co-training style which can mine consensus information from multiple planes like the sagittal, coronal, and axial planes; 2) Multi-planar fusion is applied to generate more reliable pseudo-labels, which alleviates the errors occurring in the pseudo-labels and thus can help to train better segmentation networks. Experiments are done on our newly collected large dataset with 100 unlabeled cases as well as 210 labeled cases where 16 anatomical structures are manually annotated by four radiologists and confirmed by a senior expert. The results suggest that DMPCT significantly outperforms the fully supervised method by more than 4% especially when only a small set of annotations is used.

Yingda Xia, Lingxi Xie, Fengze Liu et al.

There has been a debate on whether to use 2D or 3D deep neural networks for volumetric organ segmentation. Both 2D and 3D models have their advantages and disadvantages. In this paper, we present an alternative framework, which trains 2D networks on different viewpoints for segmentation, and builds a 3D Volumetric Fusion Net (VFN) to fuse the 2D segmentation results. VFN is relatively shallow and contains much fewer parameters than most 3D networks, making our framework more efficient at integrating 3D information for segmentation. We train and test the segmentation and fusion modules individually, and propose a novel strategy, named cross-cross-augmentation, to make full use of the limited training data. We evaluate our framework on several challenging abdominal organs, and verify its superiority in segmentation accuracy and stability over existing 2D and 3D approaches.

Zhuotun Zhu, Yingda Xia, Wei Shen et al.

In this paper, we adopt 3D Convolutional Neural Networks to segment volumetric medical images. Although deep neural networks have been proven to be very effective on many 2D vision tasks, it is still challenging to apply them to 3D tasks due to the limited amount of annotated 3D data and limited computational resources. We propose a novel 3D-based coarse-to-fine framework to effectively and efficiently tackle these challenges. The proposed 3D-based framework outperforms the 2D counterpart to a large margin since it can leverage the rich spatial infor- mation along all three axes. We conduct experiments on two datasets which include healthy and pathological pancreases respectively, and achieve the current state-of-the-art in terms of Dice-Sørensen Coefficient (DSC). On the NIH pancreas segmentation dataset, we outperform the previous best by an average of over 2%, and the worst case is improved by 7% to reach almost 70%, which indicates the reliability of our framework in clinical applications.

Qihang Yu, Lingxi Xie, Yan Wang et al.

We aim at segmenting small organs (e.g., the pancreas) from abdominal CT scans. As the target often occupies a relatively small region in the input image, deep neural networks can be easily confused by the complex and variable background. To alleviate this, researchers proposed a coarse-to-fine approach, which used prediction from the first (coarse) stage to indicate a smaller input region for the second (fine) stage. Despite its effectiveness, this algorithm dealt with two stages individually, which lacked optimizing a global energy function, and limited its ability to incorporate multi-stage visual cues. Missing contextual information led to unsatisfying convergence in iterations, and that the fine stage sometimes produced even lower segmentation accuracy than the coarse stage. This paper presents a Recurrent Saliency Transformation Network. The key innovation is a saliency transformation module, which repeatedly converts the segmentation probability map from the previous iteration as spatial weights and applies these weights to the current iteration. This brings us two-fold benefits. In training, it allows joint optimization over the deep networks dealing with different input scales. In testing, it propagates multi-stage visual information throughout iterations to improve segmentation accuracy. Experiments in the NIH pancreas segmentation dataset demonstrate the state-of-the-art accuracy, which outperforms the previous best by an average of over 2%. Much higher accuracies are also reported on several small organs in a larger dataset collected by ourselves. In addition, our approach enjoys better convergence properties, making it more efficient and reliable in practice.

Yuyin Zhou, Lingxi Xie, Elliot K. Fishman et al.

Automatic segmentation of an organ and its cystic region is a prerequisite of computer-aided diagnosis. In this paper, we focus on pancreatic cyst segmentation in abdominal CT scan. This task is important and very useful in clinical practice yet challenging due to the low contrast in boundary, the variability in location, shape and the different stages of the pancreatic cancer. Inspired by the high relevance between the location of a pancreas and its cystic region, we introduce extra deep supervision into the segmentation network, so that cyst segmentation can be improved with the help of relatively easier pancreas segmentation. Under a reasonable transformation function, our approach can be factorized into two stages, and each stage can be efficiently optimized via gradient back-propagation throughout the deep networks. We collect a new dataset with 131 pathological samples, which, to the best of our knowledge, is the largest set for pancreatic cyst segmentation. Without human assistance, our approach reports a 63.44% average accuracy, measured by the Dice-Sørensen coefficient (DSC), which is higher than the number (60.46%) without deep supervision.

Yuyin Zhou, Lingxi Xie, Wei Shen et al.

Deep neural networks have been widely adopted for automatic organ segmentation from abdominal CT scans. However, the segmentation accuracy of some small organs (e.g., the pancreas) is sometimes below satisfaction, arguably because deep networks are easily disrupted by the complex and variable background regions which occupies a large fraction of the input volume. In this paper, we formulate this problem into a fixed-point model which uses a predicted segmentation mask to shrink the input region. This is motivated by the fact that a smaller input region often leads to more accurate segmentation. In the training process, we use the ground-truth annotation to generate accurate input regions and optimize network weights. On the testing stage, we fix the network parameters and update the segmentation results in an iterative manner. We evaluate our approach on the NIH pancreas segmentation dataset, and outperform the state-of-the-art by more than 4%, measured by the average Dice-Sørensen Coefficient (DSC). In addition, we report 62.43% DSC in the worst case, which guarantees the reliability of our approach in clinical applications.