Karoline Skogen

Qinghui Liu, Bradley J MacIntosh, Till Schellhorn et al.

We propose a novel and flexible attention based U-Net architecture referred to as "Voxels-Intersecting Along Orthogonal Levels Attention U-Net" (viola-Unet), for intracranial hemorrhage (ICH) segmentation task in the INSTANCE 2022 Data Challenge on non-contrast computed tomography (CT). The performance of ICH segmentation was improved by efficiently incorporating fused spatially orthogonal and cross-channel features via our proposed Viola attention plugged into the U-Net decoding branches. The viola-Unet outperformed the strong baseline nnU-Net models during both 5-fold cross validation and online validation. Our solution was the winner of the challenge validation phase in terms of all four performance metrics (i.e., DSC, HD, NSD, and RVD). The code base, pretrained weights, and docker image of the viola-Unet AI tool are publicly available at \url{https://github.com/samleoqh/Viola-Unet}.

Qinghui Liu, Elies Fuster-Garcia, Ivar Thokle Hovden et al.

Diffuse gliomas are malignant brain tumors that grow widespread through the brain. The complex interactions between neoplastic cells and normal tissue, as well as the treatment-induced changes often encountered, make glioma tumor growth modeling challenging. In this paper, we present a novel end-to-end network capable of future predictions of tumor masks and multi-parametric magnetic resonance images (MRI) of how the tumor will look at any future time points for different treatment plans. Our approach is based on cutting-edge diffusion probabilistic models and deep-segmentation neural networks. We included sequential multi-parametric MRI and treatment information as conditioning inputs to guide the generative diffusion process as well as a joint segmentation process. This allows for tumor growth estimates and realistic MRI generation at any given treatment and time point. We trained the model using real-world postoperative longitudinal MRI data with glioma tumor growth trajectories represented as tumor segmentation maps over time. The model demonstrates promising performance across various tasks, including generating high-quality multi-parametric MRI with tumor masks, performing time-series tumor segmentations, and providing uncertainty estimates. Combined with the treatment-aware generated MRI, the tumor growth predictions with uncertainty estimates can provide useful information for clinical decision-making.

Jon André Ottesen, Tryggve Storas, Svein Are Sirirud Vatnehol et al.

Purpose: To evaluate the quality of deep learning reconstruction for prospectively accelerated intraoperative magnetic resonance imaging (iMRI) during resective brain tumor surgery. Materials and Methods: Accelerated iMRI was performed during brain surgery using dual surface coils positioned around the area of resection. A deep learning (DL) model was trained on the fastMRI neuro dataset to mimic the data from the iMRI protocol. Evaluation was performed on imaging material from 40 patients imaged between 01.11.2021 - 01.06.2023 that underwent iMRI during tumor resection surgery. A comparative analysis was conducted between the conventional compressed sense (CS) method and the trained DL reconstruction method. Blinded evaluation of multiple image quality metrics was performed by two working neuro-radiologists and a working neurosurgeon on a 1 to 5 Likert scale (1=non diagnostic, 2=poor, 3=acceptable, 4=good, 5=excellent), and the favored reconstruction variant. Results: The DL reconstruction was strongly favored or favored over the CS reconstruction for 33/40, 39/40, and 8/40 of cases for reader 1, 2, and 3, respectively. Two of three readers consistently assigned higher ratings for the DL reconstructions, and the DL reconstructions had a higher score than their respective CS counterparts for 72%, 72%, and 14% of the cases for reader 1, 2, and 3, respectively. Still, the DL reconstructions exhibited shortcomings such as a striping artifact and reduced signal. Conclusion: DL shows promise to allow for high-quality reconstructions of intraoperative MRI with equal to or improved perceived spatial resolution, signal-to-noise ratio, diagnostic confidence, diagnostic conspicuity, and spatial resolution compared to compressed sense.

Qinghui Liu, Jon E. Nesvold, Hanna Raaum et al.

Background: There are many challenges and opportunities in the clinical deployment of AI tools in radiology. The current study describes a radiology software platform called NeoMedSys that can enable efficient deployment and refinements of AI models. We evaluated the feasibility and effectiveness of running NeoMedSys for three months in real-world clinical settings and focused on improvement performance of an in-house developed AI model (VIOLA-AI) designed for intracranial hemorrhage (ICH) detection. Methods: NeoMedSys integrates tools for deploying, testing, and optimizing AI models with a web-based medical image viewer, annotation system, and hospital-wide radiology information systems. A prospective pragmatic investigation was deployed using clinical cases of patients presenting to the largest Emergency Department in Norway (site-1) with suspected traumatic brain injury (TBI) or patients with suspected stroke (site-2). We assessed ICH classification performance as VIOLA-AI encountered new data and underwent pre-planned model retraining. Performance metrics included sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve (AUC). Results: NeoMedSys facilitated iterative improvements in the AI model, significantly enhancing its diagnostic accuracy. Automated bleed detection and segmentation were reviewed in near real-time to facilitate re-training VIOLA-AI. The iterative refinement process yielded a marked improvement in classification sensitivity, rising to 90.3% (from 79.2%), and specificity that reached 89.3% (from 80.7%). The bleed detection ROC analysis for the entire sample demonstrated a high area-under-the-curve (AUC) of 0.949 (from 0.873). Model refinement stages were associated with notable gains, highlighting the value of real-time radiologist feedback.