Mark Klemens

Farnaz Khun Jush, Grit Werner, Mark Klemens et al.

Reliable identification of anatomical body regions is a prerequisite for many automated medical imaging workflows, yet existing solutions remain heavily dependent on unreliable DICOM metadata. Current solutions mainly use supervised learning, which limits their applicability in many real-world scenarios. In this work, we investigate whether body region detection in volumetric CT and MR images can be achieved in a fully zero-shot manner by using knowledge embedded in large pre-trained foundation models. We propose and systematically evaluate three training-free pipelines: (1) a segmentation-driven rule-based system leveraging pre-trained multi-organ segmentation models, (2) a Multimodal Large Language Model (MLLM) guided by radiologist-defined rules, and (3) a segmentation-aware MLLM that combines visual input with explicit anatomical evidence. All methods are evaluated on 887 heterogeneous CT and MR scans with manually verified anatomical region labels. The segmentation-driven rule-based approach achieves the strongest and most consistent performance, with weighted F1-scores of 0.947 (CT) and 0.914 (MR), demonstrating robustness across modalities and atypical scan coverage. The MLLM performs competitively in visually distinctive regions, while the segmentation-aware MLLM reveals fundamental limitations.

Melanie Dohmen, Mark A. Klemens, Ivo M. Baltruschat et al.

Image-to-image translation can create large impact in medical imaging, as images can be synthetically transformed to other modalities, sequence types, higher resolutions or lower noise levels. To ensure patient safety, these methods should be validated by human readers, which requires a considerable amount of time and costs. Quantitative metrics can effectively complement such studies and provide reproducible and objective assessment of synthetic images. If a reference is available, the similarity of MR images is frequently evaluated by SSIM and PSNR metrics, even though these metrics are not or too sensitive regarding specific distortions. When reference images to compare with are not available, non-reference quality metrics can reliably detect specific distortions, such as blurriness. To provide an overview on distortion sensitivity, we quantitatively analyze 11 similarity (reference) and 12 quality (non-reference) metrics for assessing synthetic images. We additionally include a metric on a downstream segmentation task. We investigate the sensitivity regarding 11 kinds of distortions and typical MR artifacts, and analyze the influence of different normalization methods on each metric and distortion. Finally, we derive recommendations for effective usage of the analyzed similarity and quality metrics for evaluation of image-to-image translation models.

Tuan Truong, Ivo M. Baltruschat, Mark Klemens et al.

De-identification of medical images is a critical step to ensure privacy during data sharing in research and clinical settings. The initial step in this process involves detecting Protected Health Information (PHI), which can be found in image metadata or imprinted within image pixels. Despite the importance of such systems, there has been limited evaluation of existing AI-based solutions, creating barriers to the development of reliable and robust tools. In this study, we present an AI-based pipeline for PHI detection, comprising three key modules: text detection, text extraction, and text analysis. We benchmark three models - YOLOv11, EasyOCR, and GPT-4o - across different setups corresponding to these modules, evaluating their performance on two different datasets encompassing multiple imaging modalities and PHI categories. Our findings indicate that the optimal setup involves utilizing dedicated vision and language models for each module, which achieves a commendable balance in performance, latency, and cost associated with the usage of Large Language Models (LLMs). Additionally, we show that the application of LLMs not only involves identifying PHI content but also enhances OCR tasks and facilitates an end-to-end PHI detection pipeline, showcasing promising outcomes through our analysis.

Jens Hooge, Gerard Sanroma-Guell, Faidra Stavropoulou et al.

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) plays a crucial role in the detection and characterization of focal liver lesions, with the hepatobiliary phase (HBP) providing essential diagnostic information. However, acquiring HBP images requires prolonged scan times, which may compromise patient comfort and scanner throughput. In this study, we propose a deep learning based approach for synthesizing HBP images from earlier contrast phases (precontrast and transitional) and compare three generative models: a perceptual U-Net, a perceptual GAN (pGAN), and a denoising diffusion probabilistic model (DDPM). We curated a multi-site DCE-MRI dataset from diverse clinical settings and introduced a contrast evolution score (CES) to assess training data quality, enhancing model performance. Quantitative evaluation using pixel-wise and perceptual metrics, combined with qualitative assessment through blinded radiologist reviews, showed that pGAN achieved the best quantitative performance but introduced heterogeneous contrast in out-of-distribution cases. In contrast, the U-Net produced consistent liver enhancement with fewer artifacts, while DDPM underperformed due to limited preservation of fine structural details. These findings demonstrate the feasibility of synthetic HBP image generation as a means to reduce scan time without compromising diagnostic utility, highlighting the clinical potential of deep learning for dynamic contrast enhancement in liver MRI. A project demo is available at: https://jhooge.github.io/hepatogen