Rajesh N. Keswani

Nikhil Kumar Tomar, Debesh Jha, Koushik Biswas et al.

Colorectal cancer (CRC) is the third most common cause of cancer diagnosed in the United States and the second leading cause of cancer-related death among both genders. Notably, CRC is the leading cause of cancer in younger men less than 50 years old. Colonoscopy is considered the gold standard for the early diagnosis of CRC. Skills vary significantly among endoscopists, and a high miss rate is reported. Automated polyp segmentation can reduce the missed rates, and timely treatment is possible in the early stage. To address this challenge, we introduce \textit{\textbf{\ac{FANetv2}}}, an advanced encoder-decoder network designed to accurately segment polyps from colonoscopy images. Leveraging an initial input mask generated by Otsu thresholding, FANetv2 iteratively refines its binary segmentation masks through a novel feedback attention mechanism informed by the mask predictions of previous epochs. Additionally, it employs a text-guided approach that integrates essential information about the number (one or many) and size (small, medium, large) of polyps to further enhance its feature representation capabilities. This dual-task approach facilitates accurate polyp segmentation and aids in the auxiliary classification of polyp attributes, significantly boosting the model's performance. Our comprehensive evaluations on the publicly available BKAI-IGH and CVC-ClinicDB datasets demonstrate the superior performance of FANetv2, evidenced by high dice similarity coefficients (DSC) of 0.9186 and 0.9481, along with low Hausdorff distances of 2.83 and 3.19, respectively. The source code for FANetv2 is available at https://github.com/xxxxx/FANetv2.

Lanhong Yao, Zheyuan Zhang, Ugur Demir et al.

Intraductal Papillary Mucinous Neoplasm (IPMN) cysts are pre-malignant pancreas lesions, and they can progress into pancreatic cancer. Therefore, detecting and stratifying their risk level is of ultimate importance for effective treatment planning and disease control. However, this is a highly challenging task because of the diverse and irregular shape, texture, and size of the IPMN cysts as well as the pancreas. In this study, we propose a novel computer-aided diagnosis pipeline for IPMN risk classification from multi-contrast MRI scans. Our proposed analysis framework includes an efficient volumetric self-adapting segmentation strategy for pancreas delineation, followed by a newly designed deep learning-based classification scheme with a radiomics-based predictive approach. We test our proposed decision-fusion model in multi-center data sets of 246 multi-contrast MRI scans and obtain superior performance to the state of the art (SOTA) in this field. Our ablation studies demonstrate the significance of both radiomics and deep learning modules for achieving the new SOTA performance compared to international guidelines and published studies (81.9\% vs 61.3\% in accuracy). Our findings have important implications for clinical decision-making. In a series of rigorous experiments on multi-center data sets (246 MRI scans from five centers), we achieved unprecedented performance (81.9\% accuracy).

Zheyuan Zhang, Elif Keles, Gorkem Durak et al.

Automated volumetric segmentation of the pancreas on cross-sectional imaging is needed for diagnosis and follow-up of pancreatic diseases. While CT-based pancreatic segmentation is more established, MRI-based segmentation methods are understudied, largely due to a lack of publicly available datasets, benchmarking research efforts, and domain-specific deep learning methods. In this retrospective study, we collected a large dataset (767 scans from 499 participants) of T1-weighted (T1W) and T2-weighted (T2W) abdominal MRI series from five centers between March 2004 and November 2022. We also collected CT scans of 1,350 patients from publicly available sources for benchmarking purposes. We developed a new pancreas segmentation method, called PanSegNet, combining the strengths of nnUNet and a Transformer network with a new linear attention module enabling volumetric computation. We tested PanSegNet's accuracy in cross-modality (a total of 2,117 scans) and cross-center settings with Dice and Hausdorff distance (HD95) evaluation metrics. We used Cohen's kappa statistics for intra and inter-rater agreement evaluation and paired t-tests for volume and Dice comparisons, respectively. For segmentation accuracy, we achieved Dice coefficients of 88.3% (std: 7.2%, at case level) with CT, 85.0% (std: 7.9%) with T1W MRI, and 86.3% (std: 6.4%) with T2W MRI. There was a high correlation for pancreas volume prediction with R^2 of 0.91, 0.84, and 0.85 for CT, T1W, and T2W, respectively. We found moderate inter-observer (0.624 and 0.638 for T1W and T2W MRI, respectively) and high intra-observer agreement scores. All MRI data is made available at https://osf.io/kysnj/. Our source code is available at https://github.com/NUBagciLab/PaNSegNet.

Hongyi Pan, Ziliang Hong, Gorkem Durak et al.

Accurate classification of Intraductal Papillary Mucinous Neoplasms (IPMN) is essential for identifying high-risk cases that require timely intervention. In this study, we develop a federated learning framework for multi-center IPMN classification utilizing a comprehensive pancreas MRI dataset. This dataset includes 652 T1-weighted and 655 T2-weighted MRI images, accompanied by corresponding IPMN risk scores from 7 leading medical institutions, making it the largest and most diverse dataset for IPMN classification to date. We assess the performance of DenseNet-121 in both centralized and federated settings for training on distributed data. Our results demonstrate that the federated learning approach achieves high classification accuracy comparable to centralized learning while ensuring data privacy across institutions. This work marks a significant advancement in collaborative IPMN classification, facilitating secure and high-accuracy model training across multiple centers.

Hongyi Pan, Gorkem Durak, Zheyuan Zhang et al.

Federated learning (FL) enables collaborative model training across institutions without sharing sensitive data, making it an attractive solution for medical imaging tasks. However, traditional FL methods, such as Federated Averaging (FedAvg), face difficulties in generalizing across domains due to variations in imaging protocols and patient demographics across institutions. This challenge is particularly evident in pancreas MRI segmentation, where anatomical variability and imaging artifacts significantly impact performance. In this paper, we conduct a comprehensive evaluation of FL algorithms for pancreas MRI segmentation and introduce a novel approach that incorporates adaptive aggregation weights. By dynamically adjusting the contribution of each client during model aggregation, our method accounts for domain-specific differences and improves generalization across heterogeneous datasets. Experimental results demonstrate that our approach enhances segmentation accuracy and reduces the impact of domain shift compared to conventional FL methods while maintaining privacy-preserving capabilities. Significant performance improvements are observed across multiple hospitals (centers).

Evandros Kaklamanos, Kristjana Kristinsdottir, Jonathan Huang et al.

Endoscopic procedures such as esophagogastroduodenoscopy (EGD) and colonoscopy play a critical role in diagnosing and managing gastrointestinal (GI) disorders. However, the documentation burden associated with these procedures place significant strain on gastroenterologists, contributing to inefficiencies in clinical workflows and physician burnout. To address this challenge, we propose a novel automated report generation model that leverages a transformer-based vision encoder and text decoder within a two-stage training framework. In the first stage, both components are pre-trained on image/text caption pairs to capture generalized vision-language features, followed by fine-tuning on images/report pairs to generate clinically meaningful findings. Our approach not only streamlines the documentation process but also holds promise for reducing physician workload and improving patient care.

Ziliang Hong, Halil Ertugrul Aktas, Andrea Mia Bejar et al.

We present the first federated learning (FL) approach for pancreas part(head, body and tail) segmentation in MRI, addressing a critical clinical challenge as a significant innovation. Pancreatic diseases exhibit marked regional heterogeneity cancers predominantly occur in the head region while chronic pancreatitis causes tissue loss in the tail, making accurate segmentation of the organ into head, body, and tail regions essential for precise diagnosis and treatment planning. This segmentation task remains exceptionally challenging in MRI due to variable morphology, poor soft-tissue contrast, and anatomical variations across patients. Our novel contribution tackles two fundamental challenges: first, the technical complexity of pancreas part delineation in MRI, and second the data scarcity problem that has hindered prior approaches. We introduce a privacy-preserving FL framework that enables collaborative model training across seven medical institutions without direct data sharing, leveraging a diverse dataset of 711 T1W and 726 T2W MRI scans. Our key innovations include: (1) a systematic evaluation of three state-of-the-art segmentation architectures (U-Net, Attention U-Net,Swin UNETR) paired with two FL algorithms (FedAvg, FedProx), revealing Attention U-Net with FedAvg as optimal for pancreatic heterogeneity, which was never been done before; (2) a novel anatomically-informed loss function prioritizing region-specific texture contrasts in MRI. Comprehensive evaluation demonstrates that our approach achieves clinically viable performance despite training on distributed, heterogeneous datasets.