Pierre-Marc Jodoin

Thierry Judge, Nicolas Duchateau, Andreas Østvik et al.

Speckle tracking echocardiography (STE) is the clinical standard for myocardial strain estimation. Despite good performance on global strain (GLS), its accuracy for regional strain remains limited, even though this biomarker is highly relevant for early diagnosis and the characterization of subtle abnormalities. from clinical data. Deep learning is a promising alternative, but its development is constrained by the lack of reliable motion references. Existing solutions rely either on STE-derived labels or on simulations generated by physics-based models, but these synthetic sequences still have limited realism compared with clinical data.In this paper, we propose a novel simulation strategy that incorporates speckle decorrelation measures from real videos and uses an iterative refinement process to improve the motion realism in the simulations. We created an open-source photorealistic dataset of 1,478 videos with reference motion, which was used to train an echocardiographic motion estimation algorithm. The proposed method achieves unmatched performance on global and regional strain, notably reaching a GLS variability of 1.42% in an inter-expert setting compared to 1.78% for the clinical reference.

Audrey Duran, Gaspard Dussert, Olivier Rouvière et al.

Multiparametric magnetic resonance imaging (mp-MRI) has shown excellent results in the detection of prostate cancer (PCa). However, characterizing prostate lesions aggressiveness in mp-MRI sequences is impossible in clinical practice, and biopsy remains the reference to determine the Gleason score (GS). In this work, we propose a novel end-to-end multi-class network that jointly segments the prostate gland and cancer lesions with GS group grading. After encoding the information on a latent space, the network is separated in two branches: 1) the first branch performs prostate segmentation 2) the second branch uses this zonal prior as an attention gate for the detection and grading of prostate lesions. The model was trained and validated with a 5-fold cross-validation on an heterogeneous series of 219 MRI exams acquired on three different scanners prior prostatectomy. In the free-response receiver operating characteristics (FROC) analysis for clinically significant lesions (defined as GS > 6) detection, our model achieves 69.0% $\pm$14.5% sensitivity at 2.9 false positive per patient on the whole prostate and 70.8% $\pm$14.4% sensitivity at 1.5 false positive when considering the peripheral zone (PZ) only. Regarding the automatic GS group

Félix Dumais, Jon Haitz Legarreta, Carl Lemaire et al.

White matter bundle segmentation is a cornerstone of modern tractography to study the brain's structural connectivity in domains such as neurological disorders, neurosurgery, and aging. In this study, we present FIESTA (FIbEr Segmentation in Tractography using Autoencoders), a reliable and robust, fully automated, and easily semi-automatically calibrated pipeline based on deep autoencoders that can dissect and fully populate white matter bundles. This pipeline is built upon previous works that demonstrated how autoencoders can be used successfully for streamline filtering, bundle segmentation, and streamline generation in tractography. Our proposed method improves bundle segmentation coverage by recovering hard-to-track bundles with generative sampling through the latent space seeding of the subject bundle and the atlas bundle. A latent space of streamlines is learned using autoencoder-based modeling combined with contrastive learning. Using an atlas of bundles in standard space (MNI), our proposed method segments new tractograms using the autoencoder latent distance between each tractogram streamline and its closest neighbor bundle in the atlas of bundles. Intra-subject bundle reliability is improved by recovering hard-to-track streamlines, using the autoencoder to generate new streamlines that increase the spatial coverage of each bundle while remaining anatomically correct. Results show that our method is more reliable than state-of-the-art automated virtual dissection methods such as RecoBundles, RecoBundlesX, TractSeg, White Matter Analysis and XTRACT. Our framework allows for the transition from one anatomical bundle definition to another with marginal calibration efforts. Overall, these results show that our framework improves the practicality and usability of current state-of-the-art bundle segmentation framework.

Jon Haitz Legarreta, Laurent Petit, Pierre-Marc Jodoin et al.

Current tractography methods use the local orientation information to propagate streamlines from seed locations. Many such seeds provide streamlines that stop prematurely or fail to map the true white matter pathways because some bundles are "harder-to-track" than others. This results in tractography reconstructions with poor white and gray matter spatial coverage. In this work, we propose a generative, autoencoder-based method, named GESTA (Generative Sampling in Bundle Tractography using Autoencoders), that produces streamlines achieving better spatial coverage. Compared to other deep learning methods, our autoencoder-based framework uses a single model to generate streamlines in a bundle-wise fashion, and does not require to propagate local orientations. GESTA produces new and complete streamlines for any given white matter bundle, including hard-to-track bundles. Applied on top of a given tractogram, GESTA is shown to be effective in improving the white matter volume coverage in poorly populated bundles, both on synthetic and human brain in vivo data. Our streamline evaluation framework ensures that the streamlines produced by GESTA are anatomically plausible and fit well to the local diffusion signal. The streamline evaluation criteria assess anatomy (white matter coverage), local orientation alignment (direction), and geometry features of streamlines, and optionally, gray matter connectivity. GESTA is thus a novel deep generative bundle tractography method that can be used to improve the tractography reconstruction of the white matter.

Thierry Judge, Olivier Bernard, Mihaela Porumb et al.

Accurate uncertainty estimation is a critical need for the medical imaging community. A variety of methods have been proposed, all direct extensions of classification uncertainty estimations techniques. The independent pixel-wise uncertainty estimates, often based on the probabilistic interpretation of neural networks, do not take into account anatomical prior knowledge and consequently provide sub-optimal results to many segmentation tasks. For this reason, we propose CRISP a ContRastive Image Segmentation for uncertainty Prediction method. At its core, CRISP implements a contrastive method to learn a joint latent space which encodes a distribution of valid segmentations and their corresponding images. We use this joint latent space to compare predictions to thousands of latent vectors and provide anatomically consistent uncertainty maps. Comprehensive studies performed on four medical image databases involving different modalities and organs underlines the superiority of our method compared to state-of-the-art approaches.

Daniel Jörgens, Pierre-Marc Jodoin, Maxime Descoteaux et al.

One of the main issues of the current tractography methods is their high false-positive rate. Tractogram filtering is an option to remove false-positive streamlines from tractography data in a post-processing step. In this paper, we train a deep neural network for filtering tractography data in which every streamline of a tractogram is classified as {\em plausible, implausible}, or {\em inconclusive}. For this, we use four different tractogram filtering strategies as supervisors: TractQuerier, RecobundlesX, TractSeg, and an anatomy-inspired filter. Their outputs are combined to obtain the classification labels for the streamlines. We assessed the importance of different types of information along the streamlines for performing this classification task, including the coordinates of the streamlines, diffusion data, landmarks, T1-weighted information, and a brain parcellation. We found that the streamline coordinates are the most relevant followed by the diffusion data in this particular classification task.

Yoan David, Pierre-Marc Jodoin, Alzheimer's Disease Neuroimaging Initiative et al.

Harmonization methods such as ComBat and its variants are widely used to mitigate diffusion MRI (dMRI) site-specific biases. However, ComBat assumes that subject distributions exhibit a Gaussian profile. In practice, patients with neurological disorders often present diffusion metrics that deviate markedly from those of healthy controls, introducing pathological outliers that distort site-effect estimation. This problem is particularly challenging in clinical practice as most patients undergoing brain imaging have an underlying and yet undiagnosed condition, making it difficult to exclude them from harmonization cohorts, as their scans were precisely prescribed to establish a diagnosis. In this paper, we show that harmonizing data to a normative reference population with ComBat while including pathological cases induces significant distortions. Across 7 neurological conditions, we evaluated 10 outlier rejection methods with 4 ComBat variants over a wide range of scenarios, revealing that many filtering strategies fail in the presence of pathology. In contrast, a simple MLP provides robust outlier compensation enabling reliable harmonization while preserving disease-related signal. Experiments on both control and real multi-site cohorts, comprising up to 80% of subjects with neurological disorders, demonstrate that Robust-ComBat consistently outperforms conventional statistical baselines with lower harmonization error across all ComBat variants.

Anders Austlid Taskén, Thierry Judge, Erik Andreas Rye Berg et al.

Segmental longitudinal strain (SLS) of the left ventricle (LV) is an important prognostic indicator for evaluating regional LV dysfunction, in particular for diagnosing and managing myocardial ischemia. Current techniques for strain estimation require significant manual intervention and expertise, limiting their efficiency and making them too resource-intensive for monitoring purposes. This study introduces the first automated pipeline, autoStrain, for SLS estimation in transesophageal echocardiography (TEE) using deep learning (DL) methods for motion estimation. We present a comparative analysis of two DL approaches: TeeFlow, based on the RAFT optical flow model for dense frame-to-frame predictions, and TeeTracker, based on the CoTracker point trajectory model for sparse long-sequence predictions. As ground truth motion data from real echocardiographic sequences are hardly accessible, we took advantage of a unique simulation pipeline (SIMUS) to generate a highly realistic synthetic TEE (synTEE) dataset of 80 patients with ground truth myocardial motion to train and evaluate both models. Our evaluation shows that TeeTracker outperforms TeeFlow in accuracy, achieving a mean distance error in motion estimation of 0.65 mm on a synTEE test dataset. Clinical validation on 16 patients further demonstrated that SLS estimation with our autoStrain pipeline aligned with clinical references, achieving a mean difference (95\% limits of agreement) of 1.09% (-8.90% to 11.09%). Incorporation of simulated ischemia in the synTEE data improved the accuracy of the models in quantifying abnormal deformation. Our findings indicate that integrating AI-driven motion estimation with TEE can significantly enhance the precision and efficiency of cardiac function assessment in clinical settings.

Gabriel Girard, Manon Edde, Félix Dumais et al.

Diffusion-weighted magnetic resonance imaging (DW-MRI) derived scalar maps are effective for assessing neurodegenerative diseases and microstructural properties of white matter in large number of brain conditions. However, DW-MRI inherently limits the combination of data from multiple acquisition sites without harmonization to mitigate scanner-specific biases. While the widely used ComBAT method reduces site effects in research, its reliance on linear covariate relationships, homogeneous populations, fixed site numbers, and well populated sites constrains its clinical use. To overcome these limitations, we propose Clinical-ComBAT, a method designed for real-world clinical scenarios. Clinical-ComBAT harmonizes each site independently, enabling flexibility as new data and clinics are introduced. It incorporates a non-linear polynomial data model, site-specific harmonization referenced to a normative site, and variance priors adaptable to small cohorts. It further includes hyperparameter tuning and a goodness-of-fit metric for harmonization assessment. We demonstrate its effectiveness on simulated and real data, showing improved alignment of diffusion metrics and enhanced applicability for normative modeling.

Nathan Painchaud, Jérémie Stym-Popper, Pierre-Yves Courand et al.

Deep learning enables automatic and robust extraction of cardiac function descriptors from echocardiographic sequences, such as ejection fraction or strain. These descriptors provide fine-grained information that physicians consider, in conjunction with more global variables from the clinical record, to assess patients' condition. Drawing on novel Transformer models applied to tabular data, we propose a method that considers all descriptors extracted from medical records and echocardiograms to learn the representation of a cardiovascular pathology with a difficult-to-characterize continuum, namely hypertension. Our method first projects each variable into its own representation space using modality-specific approaches. These standardized representations of multimodal data are then fed to a Transformer encoder, which learns to merge them into a comprehensive representation of the patient through the task of predicting a clinical rating. This stratification task is formulated as an ordinal classification to enforce a pathological continuum in the representation space. We observe the major trends along this continuum on a cohort of 239 hypertensive patients, providing unprecedented details in the description of hypertension's impact on various cardiac function descriptors. Our analysis shows that i) the XTab foundation model's architecture allows to reach outstanding performance (96.8% AUROC) even with limited data (less than 200 training samples), ii) stratification across the population is reproducible between trainings (within 5.7% mean absolute error), and iii) patterns emerge in descriptors, some of which align with established physiological knowledge about hypertension, while others could pave the way for a more comprehensive understanding of this pathology. Code is available at https://github.com/creatis-myriad/didactic.

Arnaud Judge, Nicolas Duchateau, Thierry Judge et al.

Domain adaptation methods aim to bridge the gap between datasets by enabling knowledge transfer across domains, reducing the need for additional expert annotations. However, many approaches struggle with reliability in the target domain, an issue particularly critical in medical image segmentation, where accuracy and anatomical validity are essential. This challenge is further exacerbated in spatio-temporal data, where the lack of temporal consistency can significantly degrade segmentation quality, and particularly in echocardiography, where the presence of artifacts and noise can further hinder segmentation performance. To address these issues, we present RL4Seg3D, an unsupervised domain adaptation framework for 2D + time echocardiography segmentation. RL4Seg3D integrates novel reward functions and a fusion scheme to enhance key landmark precision in its segmentations while processing full-sized input videos. By leveraging reinforcement learning for image segmentation, our approach improves accuracy, anatomical validity, and temporal consistency while also providing, as a beneficial side effect, a robust uncertainty estimator, which can be used at test time to further enhance segmentation performance. We demonstrate the effectiveness of our framework on over 30,000 echocardiographic videos, showing that it outperforms standard domain adaptation techniques without the need for any labels on the target domain. Code is available at https://github.com/arnaudjudge/RL4Seg3D.

Thierry Judge, Olivier Bernard, Woo-Jin Cho Kim et al.

Echocardiography plays a fundamental role in the extraction of important clinical parameters (e.g. left ventricular volume and ejection fraction) required to determine the presence and severity of heart-related conditions. When deploying automated techniques for computing these parameters, uncertainty estimation is crucial for assessing their utility. Since clinical parameters are usually derived from segmentation maps, there is no clear path for converting pixel-wise uncertainty values into uncertainty estimates in the downstream clinical metric calculation. In this work, we propose a novel uncertainty estimation method based on contouring rather than segmentation. Our method explicitly predicts contour location uncertainty from which contour samples can be drawn. Finally, the sampled contours can be used to propagate uncertainty to clinical metrics. Our proposed method not only provides accurate uncertainty estimations for the task of contouring but also for the downstream clinical metrics on two cardiac ultrasound datasets. Code is available at: https://github.com/ThierryJudge/contouring-uncertainty.

Antoine Théberge, Christian Desrosiers, Maxime Descoteaux et al.

Recently, deep reinforcement learning (RL) has been proposed to learn the tractography procedure and train agents to reconstruct the structure of the white matter without manually curated reference streamlines. While the performances reported were competitive, the proposed framework is complex, and little is still known about the role and impact of its multiple parts. In this work, we thoroughly explore the different components of the proposed framework, such as the choice of the RL algorithm, seeding strategy, the input signal and reward function, and shed light on their impact. Approximately 7,400 models were trained for this work, totalling nearly 41,000 hours of GPU time. Our goal is to guide researchers eager to explore the possibilities of deep RL for tractography by exposing what works and what does not work with the category of approach. As such, we ultimately propose a series of recommendations concerning the choice of RL algorithm, the input to the agents, the reward function and more to help future work using reinforcement learning for tractography. We also release the open source codebase, trained models, and datasets for users and researchers wanting to explore reinforcement learning for tractography.

Marco Armenta, Thierry Judge, Nathan Painchaud et al.

In this paper, we explore a process called neural teleportation, a mathematical consequence of applying quiver representation theory to neural networks. Neural teleportation "teleports" a network to a new position in the weight space and preserves its function. This phenomenon comes directly from the definitions of representation theory applied to neural networks and it turns out to be a very simple operation that has remarkable properties. We shed light on surprising and counter-intuitive consequences neural teleportation has on the loss landscape. In particular, we show that teleportation can be used to explore loss level curves, that it changes the local loss landscape, sharpens global minima and boosts back-propagated gradients at any moment during the learning process. Our results can be reproduced with the code available here: https://github.com/vitalab/neuralteleportation

Antoine Théberge, Maxime Descoteaux, Pierre-Marc Jodoin

Reinforcement learning (RL)-based tractography is a competitive alternative to machine learning and classical tractography algorithms due to its high anatomical accuracy obtained without the need for any annotated data. However, the reward functions so far used to train RL agents do not encapsulate anatomical knowledge which causes agents to generate spurious false positives tracts. In this paper, we propose a new RL tractography system, TractOracle, which relies on a reward network trained for streamline classification. This network is used both as a reward function during training as well as a mean for stopping the tracking process early and thus reduce the number of false positive streamlines. This makes our system a unique method that evaluates and reconstructs WM streamlines at the same time. We report an improvement of true positive ratios by almost 20\% and a reduction of 3x of false positive ratios on one dataset and an increase between 2x and 7x in the number true positive streamlines on another dataset.

Jeremi Levesque, Antoine Théberge, Maxime Descoteaux et al.

Tractography algorithms leverage diffusion MRI to reconstruct the fibrous architecture of the brain's white matter. Among machine learning approaches, reinforcement learning (RL) has emerged as a promising framework for tractography, outperforming traditional methods in several key aspects. TractOracle-RL, a recent RL-based approach, reduces false positives by incorporating anatomical priors into the training process via a reward-based mechanism. In this paper, we investigate four extensions of the original TractOracle-RL framework by integrating recent advances in RL, and we evaluate their performance across five diverse diffusion MRI datasets. Results demonstrate that combining an oracle with the RL framework consistently leads to robust and reliable tractography, regardless of the specific method or dataset used. We also introduce a novel RL training scheme called Iterative Reward Training (IRT), inspired by the Reinforcement Learning from Human Feedback (RLHF) paradigm. Instead of relying on human input, IRT leverages bundle filtering methods to iteratively refine the oracle's guidance throughout training. Experimental results show that RL methods trained with oracle feedback significantly outperform widely used tractography techniques in terms of accuracy and anatomical validity.

Pierre-Marc Jodoin, Manon Edde, Gabriel Girard et al.

Over the years, ComBAT has become the standard method for harmonizing MRI-derived measurements, with its ability to compensate for site-related additive and multiplicative biases while preserving biological variability. However, ComBAT relies on a set of assumptions that, when violated, can result in flawed harmonization. In this paper, we thoroughly review ComBAT's mathematical foundation, outlining these assumptions, and exploring their implications for the demographic composition necessary for optimal results. Through a series of experiments involving a slightly modified version of ComBAT called Pairwise-ComBAT tailored for normative modeling applications, we assess the impact of various population characteristics, including population size, age distribution, the absence of certain covariates, and the magnitude of additive and multiplicative factors. Based on these experiments, we present five essential recommendations that should be carefully considered to enhance consistency and supporting reproducibility, two essential factors for open science, collaborative research, and real-life clinical deployment.

Arnaud Judge, Thierry Judge, Nicolas Duchateau et al.

Performance of deep learning segmentation models is significantly challenged in its transferability across different medical imaging domains, particularly when aiming to adapt these models to a target domain with insufficient annotated data for effective fine-tuning. While existing domain adaptation (DA) methods propose strategies to alleviate this problem, these methods do not explicitly incorporate human-verified segmentation priors, compromising the potential of a model to produce anatomically plausible segmentations. We introduce RL4Seg, an innovative reinforcement learning framework that reduces the need to otherwise incorporate large expertly annotated datasets in the target domain, and eliminates the need for lengthy manual human review. Using a target dataset of 10,000 unannotated 2D echocardiographic images, RL4Seg not only outperforms existing state-of-the-art DA methods in accuracy but also achieves 99% anatomical validity on a subset of 220 expert-validated subjects from the target domain. Furthermore, our framework's reward network offers uncertainty estimates comparable with dedicated state-of-the-art uncertainty methods, demonstrating the utility and effectiveness of RL4Seg in overcoming domain adaptation challenges in medical image segmentation.

Bach Kim, Jose Dolz, Pierre-Marc Jodoin et al.

Privacy protection in medical data is a legitimate obstacle for centralized machine learning applications. Here, we propose a client-server image segmentation system which allows for the analysis of multi-centric medical images while preserving patient privacy. In this approach, the client protects the to-be-segmented patient image by mixing it to a reference image. As shown in our work, it is challenging to separate the image mixture to exact original content, thus making the data unworkable and unrecognizable for an unauthorized person. This proxy image is sent to a server for processing. The server then returns the mixture of segmentation maps, which the client can revert to a correct target segmentation. Our system has two components: 1) a segmentation network on the server side which processes the image mixture, and 2) a segmentation unmixing network which recovers the correct segmentation map from the segmentation mixture. Furthermore, the whole system is trained end-to-end. The proposed method is validated on the task of MRI brain segmentation using images from two different datasets. Results show that the segmentation accuracy of our method is comparable to a system trained on raw images, and outperforms other privacy-preserving methods with little computational overhead.

Hang Jung Ling, Nathan Painchaud, Pierre-Yves Courand et al.

Deep learning-based methods have spearheaded the automatic analysis of echocardiographic images, taking advantage of the publication of multiple open access datasets annotated by experts (CAMUS being one of the largest public databases). However, these models are still considered unreliable by clinicians due to unresolved issues concerning i) the temporal consistency of their predictions, and ii) their ability to generalize across datasets. In this context, we propose a comprehensive comparison between the current best performing methods in medical/echocardiographic image segmentation, with a particular focus on temporal consistency and cross-dataset aspects. We introduce a new private dataset, named CARDINAL, of apical two-chamber and apical four-chamber sequences, with reference segmentation over the full cardiac cycle. We show that the proposed 3D nnU-Net outperforms alternative 2D and recurrent segmentation methods. We also report that the best models trained on CARDINAL, when tested on CAMUS without any fine-tuning, still manage to perform competitively with respect to prior methods. Overall, the experimental results suggest that with sufficient training data, 3D nnU-Net could become the first automated tool to finally meet the standards of an everyday clinical device.

Nathan Painchaud, Nicolas Duchateau, Olivier Bernard et al.

Convolutional neural networks (CNN) have demonstrated their ability to segment 2D cardiac ultrasound images. However, despite recent successes according to which the intra-observer variability on end-diastole and end-systole images has been reached, CNNs still struggle to leverage temporal information to provide accurate and temporally consistent segmentation maps across the whole cycle. Such consistency is required to accurately describe the cardiac function, a necessary step in diagnosing many cardiovascular diseases. In this paper, we propose a framework to learn the 2D+time apical long-axis cardiac shape such that the segmented sequences can benefit from temporal and anatomical consistency constraints. Our method is a post-processing that takes as input segmented echocardiographic sequences produced by any state-of-the-art method and processes it in two steps to (i) identify spatio-temporal inconsistencies according to the overall dynamics of the cardiac sequence and (ii) correct the inconsistencies. The identification and correction of cardiac inconsistencies relies on a constrained autoencoder trained to learn a physiologically interpretable embedding of cardiac shapes, where we can both detect and fix anomalies. We tested our framework on 98 full-cycle sequences from the CAMUS dataset, which are available alongside this paper. Our temporal regularization method not only improves the accuracy of the segmentation across the whole sequences, but also enforces temporal and anatomical consistency.

Benoit Anctil-Robitaille, Antoine Théberge, Pierre-Marc Jodoin et al.

The physical and clinical constraints surrounding diffusion-weighted imaging (DWI) often limit the spatial resolution of the produced images to voxels up to 8 times larger than those of T1w images. Thus, the detailed information contained in T1w imagescould help in the synthesis of diffusion images in higher resolution. However, the non-Euclidean nature of diffusion imaging hinders current deep generative models from synthesizing physically plausible images. In this work, we propose the first Riemannian network architecture for the direct generation of diffusion tensors (DT) and diffusion orientation distribution functions (dODFs) from high-resolution T1w images. Our integration of the Log-Euclidean Metric into a learning objective guarantees, unlike standard Euclidean networks, the mathematically-valid synthesis of diffusion. Furthermore, our approach improves the fractional anisotropy mean squared error (FA MSE) between the synthesized diffusion and the ground-truth by more than 23% and the cosine similarity between principal directions by almost 5% when compared to our baselines. We validate our generated diffusion by comparing the resulting tractograms to our expected real data. We observe similar fiber bundles with streamlines having less than 3% difference in length, less than 1% difference in volume, and a visually close shape. While our method is able to generate high-resolution diffusion images from structural inputs in less than 15 seconds, we acknowledge and discuss the limits of diffusion inference solely relying on T1w images. Our results nonetheless suggest a relationship between the high-level geometry of the brain and the overall white matter architecture.

Youssef Skandarani, Pierre-Marc Jodoin, Alain Lalande

Deep learning methods are the de-facto solutions to a multitude of medical image analysis tasks. Cardiac MRI segmentation is one such application which, like many others, requires a large number of annotated data so a trained network can generalize well. Unfortunately, the process of having a large number of manually curated images by medical experts is both slow and utterly expensive. In this paper, we set out to explore whether expert knowledge is a strict requirement for the creation of annotated datasets that machine learning can successfully train on. To do so, we gauged the performance of three segmentation models, namely U-Net, Attention U-Net, and ENet, trained with different loss functions on expert and non-expert groundtruth for cardiac cine-MRI segmentation. Evaluation was done with classic segmentation metrics (Dice index and Hausdorff distance) as well as clinical measurements, such as the ventricular ejection fractions and the myocardial mass. Results reveal that generalization performances of a segmentation neural network trained on non-expert groundtruth data is, to all practical purposes, as good as on expert groundtruth data, in particular when the non-expert gets a decent level of training, highlighting an opportunity for the efficient and cheap creation of annotations for cardiac datasets.

Youssef Skandarani, Pierre-Marc Jodoin, Alain Lalande

Generative Adversarial Networks (GANs) have become increasingly powerful, generating mind-blowing photorealistic images that mimic the content of datasets they were trained to replicate. One recurrent theme in medical imaging is whether GANs can also be effective at generating workable medical data as they are for generating realistic RGB images. In this paper, we perform a multi-GAN and multi-application study to gauge the benefits of GANs in medical imaging. We tested various GAN architectures from basic DCGAN to more sophisticated style-based GANs on three medical imaging modalities and organs namely : cardiac cine-MRI, liver CT and RGB retina images. GANs were trained on well-known and widely utilized datasets from which their FID score were computed to measure the visual acuity of their generated images. We further tested their usefulness by measuring the segmentation accuracy of a U-Net trained on these generated images. Results reveal that GANs are far from being equal as some are ill-suited for medical imaging applications while others are much better off. The top-performing GANs are capable of generating realistic-looking medical images by FID standards that can fool trained experts in a visual Turing test and comply to some metrics. However, segmentation results suggests that no GAN is capable of reproducing the full richness of a medical datasets.

Bach Ngoc Kim, Jose Dolz, Christian Desrosiers et al.

We propose a client-server system which allows for the analysis of multi-centric medical images while preserving patient identity. In our approach, the client protects the patient identity by applying a pseudo-random non-linear deformation to the input image. This results into a proxy image which is sent to the server for processing. The server then returns back the deformed processed image which the client reverts to a canonical form. Our system has three components: 1) a flow-field generator which produces a pseudo-random deformation function, 2) a Siamese discriminator that learns the patient identity from the processed image, 3) a medical image processing network that analyzes the content of the proxy images. The system is trained end-to-end in an adversarial manner. By fooling the discriminator, the flow-field generator learns to produce a bi-directional non-linear deformation which allows to remove and recover the identity of the subject from both the input image and output result. After end-to-end training, the flow-field generator is deployed on the client side and the segmentation network is deployed on the server side. The proposed method is validated on the task of MRI brain segmentation using images from two different datasets. Results show that the segmentation accuracy of our method is similar to a system trained on non-encoded images, while considerably reducing the ability to recover subject identity.

Jon Haitz Legarreta, Laurent Petit, François Rheault et al.

Current brain white matter fiber tracking techniques show a number of problems, including: generating large proportions of streamlines that do not accurately describe the underlying anatomy; extracting streamlines that are not supported by the underlying diffusion signal; and under-representing some fiber populations, among others. In this paper, we describe a novel autoencoder-based learning method to filter streamlines from diffusion MRI tractography, and hence, to obtain more reliable tractograms. Our method, dubbed FINTA (Filtering in Tractography using Autoencoders) uses raw, unlabeled tractograms to train the autoencoder, and to learn a robust representation of brain streamlines. Such an embedding is then used to filter undesired streamline samples using a nearest neighbor algorithm. Our experiments on both synthetic and in vivo human brain diffusion MRI tractography data obtain accuracy scores exceeding the 90\% threshold on the test set. Results reveal that FINTA has a superior filtering performance compared to conventional, anatomy-based methods, and the RecoBundles state-of-the-art method. Additionally, we demonstrate that FINTA can be applied to partial tractograms without requiring changes to the framework. We also show that the proposed method generalizes well across different tracking methods and datasets, and shortens significantly the computation time for large (>1 M streamlines) tractograms. Together, this work brings forward a new deep learning framework in tractography based on autoencoders, which offers a flexible and powerful method for white matter filtering and bundling that could enhance tractometry and connectivity analyses.

Marco Antonio Armenta, Pierre-Marc Jodoin

In this work, we show that neural networks can be represented via the mathematical theory of quiver representations. More specifically, we prove that a neural network is a quiver representation with activation functions, a mathematical object that we represent using a network quiver. Also, we show that network quivers gently adapt to common neural network concepts such as fully-connected layers, convolution operations, residual connections, batch normalization, pooling operations and even randomly wired neural networks. We show that this mathematical representation is by no means an approximation of what neural networks are as it exactly matches reality. This interpretation is algebraic and can be studied with algebraic methods. We also provide a quiver representation model to understand how a neural network creates representations from the data. We show that a neural network saves the data as quiver representations, and maps it to a geometrical space called the moduli space, which is given in terms of the underlying oriented graph of the network, i.e., its quiver. This results as a consequence of our defined objects and of understanding how the neural network computes a prediction in a combinatorial and algebraic way. Overall, representing neural networks through the quiver representation theory leads to 9 consequences and 4 inquiries for future research that we believe are of great interest to better understand what neural networks are and how they work.

Nathan Painchaud, Youssef Skandarani, Thierry Judge et al.

Convolutional neural networks (CNN) have had unprecedented success in medical imaging and, in particular, in medical image segmentation. However, despite the fact that segmentation results are closer than ever to the inter-expert variability, CNNs are not immune to producing anatomically inaccurate segmentations, even when built upon a shape prior. In this paper, we present a framework for producing cardiac image segmentation maps that are guaranteed to respect pre-defined anatomical criteria, while remaining within the inter-expert variability. The idea behind our method is to use a well-trained CNN, have it process cardiac images, identify the anatomically implausible results and warp these results toward the closest anatomically valid cardiac shape. This warping procedure is carried out with a constrained variational autoencoder (cVAE) trained to learn a representation of valid cardiac shapes through a smooth, yet constrained, latent space. With this cVAE, we can project any implausible shape into the cardiac latent space and steer it toward the closest correct shape. We tested our framework on short-axis MRI as well as apical two and four-chamber view ultrasound images, two modalities for which cardiac shapes are drastically different. With our method, CNNs can now produce results that are both within the inter-expert variability and always anatomically plausible without having to rely on a shape prior.

Youssef Skandarani, Nathan Painchaud, Pierre-Marc Jodoin et al.

In this work, we propose a Variational Autoencoder (VAE) - Generative Adversarial Networks (GAN) model that can produce highly realistic MRI together with its pixel accurate groundtruth for the application of cine-MR image cardiac segmentation. On one side of our model is a Variational Autoencoder (VAE) trained to learn the latent representations of cardiac shapes. On the other side is a GAN that uses "SPatially-Adaptive (DE)Normalization" (SPADE) modules to generate realistic MR images tailored to a given anatomical map. At test time, the sampling of the VAE latent space allows to generate an arbitrary large number of cardiac shapes, which are fed to the GAN that subsequently generates MR images whose cardiac structure fits that of the cardiac shapes. In other words, our system can generate a large volume of realistic yet labeled cardiac MR images. We show that segmentation with CNNs trained with our synthetic annotated images gets competitive results compared to traditional techniques. We also show that combining data augmentation with our GAN-generated images lead to an improvement in the Dice score of up to 12 percent while allowing for better generalization capabilities on other datasets.

Sarah Leclerc, Erik Smistad, Andreas Østvik et al.

Segmentation of cardiac structures is one of the fundamental steps to estimate volumetric indices of the heart. This step is still performed semi-automatically in clinical routine, and is thus prone to inter- and intra-observer variability. Recent studies have shown that deep learning has the potential to perform fully automatic segmentation. However, the current best solutions still suffer from a lack of robustness. In this work, we introduce an end-to-end multi-task network designed to improve the overall accuracy of cardiac segmentation while enhancing the estimation of clinical indices and reducing the number of outliers. Results obtained on a large open access dataset show that our method outperforms the current best performing deep learning solution and achieved an overall segmentation accuracy lower than the intra-observer variability for the epicardial border (i.e. on average a mean absolute error of 1.5mm and a Hausdorff distance of 5.1mm) with 11% of outliers. Moreover, we demonstrate that our method can closely reproduce the expert analysis for the end-diastolic and end-systolic left ventricular volumes, with a mean correlation of 0.96 and a mean absolute error of 7.6ml. Concerning the ejection fraction of the left ventricle, results are more contrasted with a mean correlation coefficient of 0.83 and an absolute mean error of 5.0%, producing scores that are slightly below the intra-observer margin. Based on this observation, areas for improvement are suggested.

Bach Ngoc Kim, Jose Dolz, Pierre-Marc Jodoin et al.

This paper presents a client/server privacy-preserving network in the context of multicentric medical image analysis. Our approach is based on adversarial learning which encodes images to obfuscate the patient identity while preserving enough information for a target task. Our novel architecture is composed of three components: 1) an encoder network which removes identity-specific features from input medical images, 2) a discriminator network that attempts to identify the subject from the encoded images, 3) a medical image analysis network which analyzes the content of the encoded images (segmentation in our case). By simultaneously fooling the discriminator and optimizing the medical analysis network, the encoder learns to remove privacy-specific features while keeping those essentials for the target task. Our approach is illustrated on the problem of segmenting brain MRI from the large-scale Parkinson Progression Marker Initiative (PPMI) dataset. Using longitudinal data from PPMI, we show that the discriminator learns to heavily distort input images while allowing for highly accurate segmentation results.

Nathan Painchaud, Youssef Skandarani, Thierry Judge et al.

Recent publications have shown that the segmentation accuracy of modern-day convolutional neural networks (CNN) applied on cardiac MRI can reach the inter-expert variability, a great achievement in this area of research. However, despite these successes, CNNs still produce anatomically inaccurate segmentations as they provide no guarantee on the anatomical plausibility of their outcome, even when using a shape prior. In this paper, we propose a cardiac MRI segmentation method which always produces anatomically plausible results. At the core of the method is an adversarial variational autoencoder (aVAE) whose latent space encodes a smooth manifold on which lies a large spectrum of valid cardiac shapes. This aVAE is used to automatically warp anatomically inaccurate cardiac shapes towards a close but correct shape. Our method can accommodate any cardiac segmentation method and convert its anatomically implausible results to plausible ones without affecting its overall geometric and clinical metrics. With our method, CNNs can now produce results that are both within the inter-expert variability and always anatomically plausible.

Frederic Branchaud-Charron, Andrew Achkar, Pierre-Marc Jodoin

In this paper, we propose a new measure to gauge the complexity of image classification problems. Given an annotated image dataset, our method computes a complexity measure called the cumulative spectral gradient (CSG) which strongly correlates with the test accuracy of convolutional neural networks (CNN). The CSG measure is derived from the probabilistic divergence between classes in a spectral clustering framework. We show that this metric correlates with the overall separability of the dataset and thus its inherent complexity. As will be shown, our metric can be used for dataset reduction, to assess which classes are more difficult to disentangle, and approximate the accuracy one could expect to get with a CNN. Results obtained on 11 datasets and three CNN models reveal that our method is more accurate and faster than previous complexity measures.

Philippe Poulin, Daniel Jörgens, Pierre-Marc Jodoin et al.

Supervised machine learning (ML) algorithms have recently been proposed as an alternative to traditional tractography methods in order to address some of their weaknesses. They can be path-based and local-model-free, and easily incorporate anatomical priors to make contextual and non-local decisions that should help the tracking process. ML-based techniques have thus shown promising reconstructions of larger spatial extent of existing white matter bundles, promising reconstructions of less false positives, and promising robustness to known position and shape biases of current tractography techniques. But as of today, none of these ML-based methods have shown conclusive performances or have been adopted as a de facto solution to tractography. One reason for this might be the lack of well-defined and extensive frameworks to train, evaluate, and compare these methods. In this paper, we describe several datasets and evaluation tools that contain useful features for ML algorithms, along with the various methods proposed in the recent years. We then discuss the strategies that are used to evaluate and compare those methods, as well as their shortcomings. Finally, we describe the particular needs of ML tractography methods and discuss tangible solutions for future works.

Carl Lemaire, Andrew Achkar, Pierre-Marc Jodoin

Pruning methods have shown to be effective at reducing the size of deep neural networks while keeping accuracy almost intact. Among the most effective methods are those that prune a network while training it with a sparsity prior loss and learnable dropout parameters. A shortcoming of these approaches however is that neither the size nor the inference speed of the pruned network can be controlled directly; yet this is a key feature for targeting deployment of CNNs on low-power hardware. To overcome this, we introduce a budgeted regularized pruning framework for deep CNNs. Our approach naturally fits into traditional neural network training as it consists of a learnable masking layer, a novel budget-aware objective function, and the use of knowledge distillation. We also provide insights on how to prune a residual network and how this can lead to new architectures. Experimental results reveal that CNNs pruned with our method are more accurate and less compute-hungry than state-of-the-art methods. Also, our approach is more effective at preventing accuracy collapse in case of severe pruning; this allows us to attain pruning factors up to 16x without significant accuracy drop.

Clement Zotti, Zhiming Luo, Alain Lalande et al.

In this paper, we propose a fully automatic MRI cardiac segmentation method based on a novel deep convolutional neural network (CNN) designed for the 2017 ACDC MICCAI challenge. The novelty of our network comes with its embedded shape prior and its loss function tailored to the cardiac anatomy. Our model includes a cardiac centerof-mass regression module which allows for an automatic shape prior registration. Also, since our method processes raw MR images without any manual preprocessing and/or image cropping, our CNN learns both high-level features (useful to distinguish the heart from other organs with a similar shape) and low-level features (useful to get accurate segmentation results). Those features are learned with a multi-resolution conv-deconv "grid" architecture which can be seen as an extension of the U-Net. Experimental results reveal that our method can segment the left and right ventricles as well as the myocardium from a 3D MRI cardiac volume in 0.4 second with an average Dice coefficient of 0.90 and an average Hausdorff distance of 10.4 mm.

Mohammad Havaei, Nicolas Guizard, Hugo Larochelle et al.

Segmentation of focal (localized) brain pathologies such as brain tumors and brain lesions caused by multiple sclerosis and ischemic strokes are necessary for medical diagnosis, surgical planning and disease development as well as other applications such as tractography. Over the years, attempts have been made to automate this process for both clinical and research reasons. In this regard, machine learning methods have long been a focus of attention. Over the past two years, the medical imaging field has seen a rise in the use of a particular branch of machine learning commonly known as deep learning. In the non-medical computer vision world, deep learning based methods have obtained state-of-the-art results on many datasets. Recent studies in computer aided diagnostics have shown deep learning methods (and especially convolutional neural networks - CNN) to yield promising results. In this chapter, we provide a survey of CNN methods applied to medical imaging with a focus on brain pathology segmentation. In particular, we discuss their characteristic peculiarities and their specific configuration and adjustments that are best suited to segment medical images. We also underline the intrinsic differences deep learning methods have with other machine learning methods.

Mohammad Havaei, Hugo Larochelle, Philippe Poulin et al.

Purpose: In this paper, we investigate a framework for interactive brain tumor segmentation which, at its core, treats the problem of interactive brain tumor segmentation as a machine learning problem. Methods: This method has an advantage over typical machine learning methods for this task where generalization is made across brains. The problem with these methods is that they need to deal with intensity bias correction and other MRI-specific noise. In this paper, we avoid these issues by approaching the problem as one of within brain generalization. Specifically, we propose a semi-automatic method that segments a brain tumor by training and generalizing within that brain only, based on some minimum user interaction. Conclusion: We investigate how adding spatial feature coordinates (i.e. $i$, $j$, $k$) to the intensity features can significantly improve the performance of different classification methods such as SVM, kNN and random forests. This would only be possible within an interactive framework. We also investigate the use of a more appropriate kernel and the adaptation of hyper-parameters specifically for each brain. Results: As a result of these experiments, we obtain an interactive method whose results reported on the MICCAI-BRATS 2013 dataset are the second most accurate compared to published methods, while using significantly less memory and processing power than most state-of-the-art methods.

Mohammad Havaei, Axel Davy, David Warde-Farley et al.

In this paper, we present a fully automatic brain tumor segmentation method based on Deep Neural Networks (DNNs). The proposed networks are tailored to glioblastomas (both low and high grade) pictured in MR images. By their very nature, these tumors can appear anywhere in the brain and have almost any kind of shape, size, and contrast. These reasons motivate our exploration of a machine learning solution that exploits a flexible, high capacity DNN while being extremely efficient. Here, we give a description of different model choices that we've found to be necessary for obtaining competitive performance. We explore in particular different architectures based on Convolutional Neural Networks (CNN), i.e. DNNs specifically adapted to image data. We present a novel CNN architecture which differs from those traditionally used in computer vision. Our CNN exploits both local features as well as more global contextual features simultaneously. Also, different from most traditional uses of CNNs, our networks use a final layer that is a convolutional implementation of a fully connected layer which allows a 40 fold speed up. We also describe a 2-phase training procedure that allows us to tackle difficulties related to the imbalance of tumor labels. Finally, we explore a cascade architecture in which the output of a basic CNN is treated as an additional source of information for a subsequent CNN. Results reported on the 2013 BRATS test dataset reveal that our architecture improves over the currently published state-of-the-art while being over 30 times faster.

Greg Castanon, Mohamed Elgharib, Venkatesh Saligrama et al.

We present a content-based retrieval method for long surveillance videos both for wide-area (Airborne) as well as near-field imagery (CCTV). Our goal is to retrieve video segments, with a focus on detecting objects moving on routes, that match user-defined events of interest. The sheer size and remote locations where surveillance videos are acquired, necessitates highly compressed representations that are also meaningful for supporting user-defined queries. To address these challenges we archive long-surveillance video through lightweight processing based on low-level local spatio-temporal extraction of motion and object features. These are then hashed into an inverted index using locality-sensitive hashing (LSH). This local approach allows for query flexibility as well as leads to significant gains in compression. Our second task is to extract partial matches to the user-created query and assembles them into full matches using Dynamic Programming (DP). DP exploits causality to assemble the indexed low level features into a video segment which matches the query route. We examine CCTV and Airborne footage, whose low contrast makes motion extraction more difficult. We generate robust motion estimates for Airborne data using a tracklets generation algorithm while we use Horn and Schunck approach to generate motion estimates for CCTV. Our approach handles long routes, low contrasts and occlusion. We derive bounds on the rate of false positives and demonstrate the effectiveness of the approach for counting, motion pattern recognition and abandoned object applications.