Oscar Esteban

Thomas Sanchez, Oscar Esteban, Yvan Gomez et al.

Fetal brain MRI is becoming an increasingly relevant complement to neurosonography for perinatal diagnosis, allowing fundamental insights into fetal brain development throughout gestation. However, uncontrolled fetal motion and heterogeneity in acquisition protocols lead to data of variable quality, potentially biasing the outcome of subsequent studies. We present FetMRQC, an open-source machine-learning framework for automated image quality assessment and quality control that is robust to domain shifts induced by the heterogeneity of clinical data. FetMRQC extracts an ensemble of quality metrics from unprocessed anatomical MRI and combines them to predict experts' ratings using random forests. We validate our framework on a pioneeringly large and diverse dataset of more than 1600 manually rated fetal brain T2-weighted images from four clinical centers and 13 different scanners. Our study shows that FetMRQC's predictions generalize well to unseen data while being interpretable. FetMRQC is a step towards more robust fetal brain neuroimaging, which has the potential to shed new insights on the developing human brain.

Thomas Sanchez, Oscar Esteban, Yvan Gomez et al.

Quality control (QC) has long been considered essential to guarantee the reliability of neuroimaging studies. It is particularly important for fetal brain MRI, where large and unpredictable fetal motion can lead to substantial artifacts in the acquired images. Existing methods for fetal brain quality assessment operate at the \textit{slice} level, and fail to get a comprehensive picture of the quality of an image, that can only be achieved by looking at the \textit{entire} brain volume. In this work, we propose FetMRQC, a machine learning framework for automated image quality assessment tailored to fetal brain MRI, which extracts an ensemble of quality metrics that are then used to predict experts' ratings. Based on the manual ratings of more than 1000 low-resolution stacks acquired across two different institutions, we show that, compared with existing quality metrics, FetMRQC is able to generalize out-of-domain, while being interpretable and data efficient. We also release a novel manual quality rating tool designed to facilitate and optimize quality rating of fetal brain images. Our tool, along with all the code to generate, train and evaluate the model is available at https://github.com/Medical-Image-Analysis-Laboratory/fetal_brain_qc/ .

Rastko Ciric, Armin W. Thomas, Oscar Esteban et al.

Mapping the functional connectome has the potential to uncover key insights into brain organisation. However, existing workflows for functional connectomics are limited in their adaptability to new data, and principled workflow design is a challenging combinatorial problem. We introduce a new analytic paradigm and software toolbox that implements common operations used in functional connectomics as fully differentiable processing blocks. Under this paradigm, workflow configurations exist as reparameterisations of a differentiable functional that interpolates them. The differentiable program that we envision occupies a niche midway between traditional pipelines and end-to-end neural networks, combining the glass-box tractability and domain knowledge of the former with the amenability to optimisation of the latter. In this preliminary work, we provide a proof of concept for differentiable connectomics, demonstrating the capacity of our processing blocks both to recapitulate canonical knowledge in neuroscience and to make new discoveries in an unsupervised setting. Our differentiable modules are competitive with state-of-the-art methods in problem domains including functional parcellation, denoising, and covariance modelling. Taken together, our results and software demonstrate the promise of differentiable programming for functional connectomics.

Tommaso Di Noto, Sofyan Jankowski, Francesco Puccinelli et al.

Despite the plethora of AI-based algorithms developed for anomaly detection in radiology, subsequent integration into clinical setting is rarely evaluated. In this work, we assess the applicability and utility of an AI-based model for brain aneurysm detection comparing the performance of two readers with different levels of experience (2 and 13 years). We aim to answer the following questions: 1) Do the readers improve their performance when assisted by the AI algorithm? 2) How much does the AI algorithm impact routine clinical workflow? We reuse and enlarge our open-access, Time-Of-Flight Magnetic Resonance Angiography dataset (N=460). We use 360 subjects for training/validating our algorithm and 100 as unseen test set for the reading session. Even though our model reaches state-of-the-art results on the test set (sensitivity=74%, false positive rate=1.6), we show that neither the junior nor the senior reader significantly increase their sensitivity (p=0.59, p=1, respectively). In addition, we find that reading time for both readers is significantly higher in the "AI-assisted" setting than in the "Unassisted" (+15 seconds, on average; p=3x10^(-4) junior, p=3x10^(-5) senior). The confidence reported by the readers is unchanged across the two settings, indicating that the AI assistance does not influence the certainty of the diagnosis. Our findings highlight the importance of clinical validation of AI algorithms in a clinical setting involving radiologists. This study should serve as a reminder to the community to always examine the real-word effectiveness and workflow impact of proposed algorithms.

Tommaso Di Noto, Guillaume Marie, Sebastien Tourbier et al.

Brain aneurysm detection in Time-Of-Flight Magnetic Resonance Angiography (TOF-MRA) has undergone drastic improvements with the advent of Deep Learning (DL). However, performances of supervised DL models heavily rely on the quantity of labeled samples, which are extremely costly to obtain. Here, we present a DL model for aneurysm detection that overcomes the issue with ''weak'' labels: oversized annotations which are considerably faster to create. Our weak labels resulted to be four times faster to generate than their voxel-wise counterparts. In addition, our model leverages prior anatomical knowledge by focusing only on plausible locations for aneurysm occurrence. We frst train and evaluate our model through cross-validation on an in-house TOF-MRA dataset comprising 284 subjects (170 females / 127 healthy controls / 157 patients with 198 aneurysms). On this dataset, our best model achieved a sensitivity of 83%, with False Positive (FP) rate of 0.8 per patient. To assess model generalizability, we then participated in a challenge for aneurysm detection with TOF-MRA data (93 patients, 20 controls, 125 aneurysms). On the public challenge, sensitivity was 68% (FP rate=2.5), ranking 4th/18 on the open leaderboard. We found no signifcant diference in sensitivity between aneurysm risk-of-rupture groups (p=0.75), locations (p=0.72), or sizes (p=0.15). Data, code and model weights are released under permissive licenses. We demonstrate that weak labels and anatomical knowledge can alleviate the necessity for prohibitively expensive voxel-wise annotations.

Oscar Esteban, Gert Wollny, Subrahmanyam Gorthi et al.

We present MBIS (Multivariate Bayesian Image Segmentation tool), a clustering tool based on the mixture of multivariate normal distributions model. MBIS supports multi-channel bias field correction based on a B-spline model. A second methodological novelty is the inclusion of graph-cuts optimization for the stationary anisotropic hidden Markov random field model. Along with MBIS, we release an evaluation framework that contains three different experiments on multi-site data. We first validate the accuracy of segmentation and the estimated bias field for each channel. MBIS outperforms a widely used segmentation tool in a cross-comparison evaluation. The second experiment demonstrates the robustness of results on atlas-free segmentation of two image sets from scan-rescan protocols on 21 healthy subjects. Multivariate segmentation is more replicable than the monospectral counterpart on T1-weighted images. Finally, we provide a third experiment to illustrate how MBIS can be used in a large-scale study of tissue volume change with increasing age in 584 healthy subjects. This last result is meaningful as multivariate segmentation performs robustly without the need for prior knowledge