Qian Wang

Honglin Xiong, Sheng Wang, Yitao Zhu et al.

The recent progress of large language models (LLMs), including ChatGPT and GPT-4, in comprehending and responding to human instructions has been remarkable. Nevertheless, these models typically perform better in English and have not been explicitly trained for the medical domain, resulting in suboptimal precision in diagnoses, drug recommendations, and other medical advice. Additionally, training and deploying a dialogue model is still believed to be impossible for hospitals, hindering the promotion of LLMs. To tackle these challenges, we have collected databases of medical dialogues in Chinese with ChatGPT's help and adopted several techniques to train an easy-deploy LLM. Remarkably, we were able to fine-tune the ChatGLM-6B on a single A100 80G in 13 hours, which means having a healthcare-purpose LLM can be very affordable. DoctorGLM is currently an early-stage engineering attempt and contain various mistakes. We are sharing it with the broader community to invite feedback and suggestions to improve its healthcare-focused capabilities: https://github.com/xionghonglin/DoctorGLM.

Xiangyu Zhao, Zengxin Qi, Sheng Wang et al.

Medical image segmentation methods are generally designed as fully-supervised to guarantee model performance, which require a significant amount of expert annotated samples that are high-cost and laborious. Semi-supervised image segmentation can alleviate the problem by utilizing a large number of unlabeled images along with limited labeled images. However, learning a robust representation from numerous unlabeled images remains challenging due to potential noise in pseudo labels and insufficient class separability in feature space, which undermines the performance of current semi-supervised segmentation approaches. To address the issues above, we propose a novel semi-supervised segmentation method named as Rectified Contrastive Pseudo Supervision (RCPS), which combines a rectified pseudo supervision and voxel-level contrastive learning to improve the effectiveness of semi-supervised segmentation. Particularly, we design a novel rectification strategy for the pseudo supervision method based on uncertainty estimation and consistency regularization to reduce the noise influence in pseudo labels. Furthermore, we introduce a bidirectional voxel contrastive loss to the network to ensure intra-class consistency and inter-class contrast in feature space, which increases class separability in the segmentation. The proposed RCPS segmentation method has been validated on two public datasets and an in-house clinical dataset. Experimental results reveal that the proposed method yields better segmentation performance compared with the state-of-the-art methods in semi-supervised medical image segmentation. The source code is available at https://github.com/hsiangyuzhao/RCPS.

Sheng Wang, Zihao Zhao, Xi Ouyang et al.

Large language models (LLMs) have recently demonstrated their potential in clinical applications, providing valuable medical knowledge and advice. For example, a large dialog LLM like ChatGPT has successfully passed part of the US medical licensing exam. However, LLMs currently have difficulty processing images, making it challenging to interpret information from medical images, which are rich in information that supports clinical decisions. On the other hand, computer-aided diagnosis (CAD) networks for medical images have seen significant success in the medical field by using advanced deep-learning algorithms to support clinical decision-making. This paper presents a method for integrating LLMs into medical-image CAD networks. The proposed framework uses LLMs to enhance the output of multiple CAD networks, such as diagnosis networks, lesion segmentation networks, and report generation networks, by summarizing and reorganizing the information presented in natural language text format. The goal is to merge the strengths of LLMs' medical domain knowledge and logical reasoning with the vision understanding capability of existing medical-image CAD models to create a more user-friendly and understandable system for patients compared to conventional CAD systems. In the future, LLM's medical knowledge can be also used to improve the performance of vision-based medical-image CAD models.

Zhenrong Shen, Xi Ouyang, Bin Xiao et al.

Lung nodule detection in chest X-ray (CXR) images is common to early screening of lung cancers. Deep-learning-based Computer-Assisted Diagnosis (CAD) systems can support radiologists for nodule screening in CXR. However, it requires large-scale and diverse medical data with high-quality annotations to train such robust and accurate CADs. To alleviate the limited availability of such datasets, lung nodule synthesis methods are proposed for the sake of data augmentation. Nevertheless, previous methods lack the ability to generate nodules that are realistic with the size attribute desired by the detector. To address this issue, we introduce a novel lung nodule synthesis framework in this paper, which decomposes nodule attributes into three main aspects including shape, size, and texture, respectively. A GAN-based Shape Generator firstly models nodule shapes by generating diverse shape masks. The following Size Modulation then enables quantitative control on the diameters of the generated nodule shapes in pixel-level granularity. A coarse-to-fine gated convolutional Texture Generator finally synthesizes visually plausible nodule textures conditioned on the modulated shape masks. Moreover, we propose to synthesize nodule CXR images by controlling the disentangled nodule attributes for data augmentation, in order to better compensate for the nodules that are easily missed in the detection task. Our experiments demonstrate the enhanced image quality, diversity, and controllability of the proposed lung nodule synthesis framework. We also validate the effectiveness of our data augmentation on greatly improving nodule detection performance.

Mianxin Liu, Jingyang Zhang, Yao Wang et al.

Brain disorders in the early and late life of humans potentially share pathological alterations in brain functions. However, the key evidence from neuroimaging data for pathological commonness remains unrevealed. To explore this hypothesis, we build a deep learning model, using multi-site functional magnetic resonance imaging data (N=4,410, 6 sites), for classifying 5 different brain disorders from healthy controls, with a set of common features. Our model achieves 62.6(1.9)% overall classification accuracy on data from the 6 investigated sites and detects a set of commonly affected functional subnetworks at different spatial scales, including default mode, executive control, visual, and limbic networks. In the deep-layer feature representation for individual data, we observe young and aging patients with disorders are continuously distributed, which is in line with the clinical concept of the "spectrum of disorders". The revealed spectrum underlying early- and late-life brain disorders promotes the understanding of disorder comorbidities in the lifespan.

Zhenrong Shen, Maosong Cao, Sheng Wang et al.

Automatic examination of thin-prep cytologic test (TCT) slides can assist pathologists in finding cervical abnormality for accurate and efficient cancer screening. Current solutions mostly need to localize suspicious cells and classify abnormality based on local patches, concerning the fact that whole slide images of TCT are extremely large. It thus requires many annotations of normal and abnormal cervical cells, to supervise the training of the patch-level classifier for promising performance. In this paper, we propose CellGAN to synthesize cytopathological images of various cervical cell types for augmenting patch-level cell classification. Built upon a lightweight backbone, CellGAN is equipped with a non-linear class mapping network to effectively incorporate cell type information into image generation. We also propose the Skip-layer Global Context module to model the complex spatial relationship of the cells, and attain high fidelity of the synthesized images through adversarial learning. Our experiments demonstrate that CellGAN can produce visually plausible TCT cytopathological images for different cell types. We also validate the effectiveness of using CellGAN to greatly augment patch-level cell classification performance.

Zhiyun Song, Zengxin Qi, Xin Wang et al.

Cross-modality synthesis (CMS), super-resolution (SR), and their combination (CMSR) have been extensively studied for magnetic resonance imaging (MRI). Their primary goals are to enhance the imaging quality by synthesizing the desired modality and reducing the slice thickness. Despite the promising synthetic results, these techniques are often tailored to specific tasks, thereby limiting their adaptability to complex clinical scenarios. Therefore, it is crucial to build a unified network that can handle various image synthesis tasks with arbitrary requirements of modality and resolution settings, so that the resources for training and deploying the models can be greatly reduced. However, none of the previous works is capable of performing CMS, SR, and CMSR using a unified network. Moreover, these MRI reconstruction methods often treat alias frequencies improperly, resulting in suboptimal detail restoration. In this paper, we propose a Unified Co-Modulated Alias-free framework (Uni-COAL) to accomplish the aforementioned tasks with a single network. The co-modulation design of the image-conditioned and stochastic attribute representations ensures the consistency between CMS and SR, while simultaneously accommodating arbitrary combinations of input/output modalities and thickness. The generator of Uni-COAL is also designed to be alias-free based on the Shannon-Nyquist signal processing framework, ensuring effective suppression of alias frequencies. Additionally, we leverage the semantic prior of Segment Anything Model (SAM) to guide Uni-COAL, ensuring a more authentic preservation of anatomical structures during synthesis. Experiments on three datasets demonstrate that Uni-COAL outperforms the alternatives in CMS, SR, and CMSR tasks for MR images, which highlights its generalizability to wide-range applications.

Xiangyu Zhao, Di Zang, Sheng Wang et al.

Brain network analysis for traumatic brain injury (TBI) patients is critical for its consciousness level assessment and prognosis evaluation, which requires the segmentation of certain consciousness-related brain regions. However, it is difficult to construct a TBI segmentation model as manually annotated MR scans of TBI patients are hard to collect. Data augmentation techniques can be applied to alleviate the issue of data scarcity. However, conventional data augmentation strategies such as spatial and intensity transformation are unable to mimic the deformation and lesions in traumatic brains, which limits the performance of the subsequent segmentation task. To address these issues, we propose a novel medical image inpainting model named TBI-GAN to synthesize TBI MR scans with paired brain label maps. The main strength of our TBI-GAN method is that it can generate TBI images and corresponding label maps simultaneously, which has not been achieved in the previous inpainting methods for medical images. We first generate the inpainted image under the guidance of edge information following a coarse-to-fine manner, and then the synthesized intensity image is used as the prior for label inpainting. Furthermore, we introduce a registration-based template augmentation pipeline to increase the diversity of the synthesized image pairs and enhance the capacity of data augmentation. Experimental results show that the proposed TBI-GAN method can produce sufficient synthesized TBI images with high quality and valid label maps, which can greatly improve the 2D and 3D traumatic brain segmentation performance compared with the alternatives.

Zihao Zhao, Yuxiao Liu, Han Wu et al.

Contrastive Language-Image Pre-training (CLIP), a simple yet effective pre-training paradigm, successfully introduces text supervision to vision models. It has shown promising results across various tasks due to its generalizability and interpretability. The use of CLIP has recently gained increasing interest in the medical imaging domain, serving as a pre-training paradigm for image-text alignment, or a critical component in diverse clinical tasks. With the aim of facilitating a deeper understanding of this promising direction, this survey offers an in-depth exploration of the CLIP within the domain of medical imaging, regarding both refined CLIP pre-training and CLIP-driven applications. In this paper, we (1) first start with a brief introduction to the fundamentals of CLIP methodology; (2) then investigate the adaptation of CLIP pre-training in the medical imaging domain, focusing on how to optimize CLIP given characteristics of medical images and reports; (3) further explore practical utilization of CLIP pre-trained models in various tasks, including classification, dense prediction, and cross-modal tasks; and (4) finally discuss existing limitations of CLIP in the context of medical imaging, and propose forward-looking directions to address the demands of medical imaging domain. Studies featuring technical and practical value are both investigated. We expect this survey will provide researchers with a holistic understanding of the CLIP paradigm and its potential implications. The project page of this survey can also be found on https://github.com/zhaozh10/Awesome-CLIP-in-Medical-Imaging.

Xiangyu Zhao, Sheng Wang, Zhiyun Song et al.

Accurate automatic segmentation of medical images typically requires large datasets with high-quality annotations, making it less applicable in clinical settings due to limited training data. One-shot segmentation based on learned transformations (OSSLT) has shown promise when labeled data is extremely limited, typically including unsupervised deformable registration, data augmentation with learned registration, and segmentation learned from augmented data. However, current one-shot segmentation methods are challenged by limited data diversity during augmentation, and potential label errors caused by imperfect registration. To address these issues, we propose a novel one-shot medical image segmentation method with adversarial training and label error rectification (AdLER), with the aim of improving the diversity of generated data and correcting label errors to enhance segmentation performance. Specifically, we implement a novel dual consistency constraint to ensure anatomy-aligned registration that lessens registration errors. Furthermore, we develop an adversarial training strategy to augment the atlas image, which ensures both generation diversity and segmentation robustness. We also propose to rectify potential label errors in the augmented atlas images by estimating segmentation uncertainty, which can compensate for the imperfect nature of deformable registration and improve segmentation authenticity. Experiments on the CANDI and ABIDE datasets demonstrate that the proposed AdLER outperforms previous state-of-the-art methods by 0.7% (CANDI), 3.6% (ABIDE "seen"), and 4.9% (ABIDE "unseen") in segmentation based on Dice scores, respectively. The source code will be available at https://github.com/hsiangyuzhao/AdLER.

Xi Ouyang, Srikrishna Karanam, Ziyan Wu et al.

We consider the problem of abnormality localization for clinical applications. While deep learning has driven much recent progress in medical imaging, many clinical challenges are not fully addressed, limiting its broader usage. While recent methods report high diagnostic accuracies, physicians have concerns trusting these algorithm results for diagnostic decision-making purposes because of a general lack of algorithm decision reasoning and interpretability. One potential way to address this problem is to further train these models to localize abnormalities in addition to just classifying them. However, doing this accurately will require a large amount of disease localization annotations by clinical experts, a task that is prohibitively expensive to accomplish for most applications. In this work, we take a step towards addressing these issues by means of a new attention-driven weakly supervised algorithm comprising a hierarchical attention mining framework that unifies activation- and gradient-based visual attention in a holistic manner. Our key algorithmic innovations include the design of explicit ordinal attention constraints, enabling principled model training in a weakly-supervised fashion, while also facilitating the generation of visual-attention-driven model explanations by means of localization cues. On two large-scale chest X-ray datasets (NIH ChestX-ray14 and CheXpert), we demonstrate significant localization performance improvements over the current state of the art while also achieving competitive classification performance. Our code is available on https://github.com/oyxhust/HAM.

Kai Xuan, Lei Xiang, Xiaoqian Huang et al.

In clinical practice, multi-modal magnetic resonance imaging (MRI) with different contrasts is usually acquired in a single study to assess different properties of the same region of interest in the human body. The whole acquisition process can be accelerated by having one or more modalities under-sampled in the $k$-space. Recent research has shown that, considering the redundancy between different modalities, a target MRI modality under-sampled in the $k$-space can be more efficiently reconstructed with a fully-sampled reference MRI modality. However, we find that the performance of the aforementioned multi-modal reconstruction can be negatively affected by subtle spatial misalignment between different modalities, which is actually common in clinical practice. In this paper, we improve the quality of multi-modal reconstruction by compensating for such spatial misalignment with a spatial alignment network. First, our spatial alignment network estimates the displacement between the fully-sampled reference and the under-sampled target images, and warps the reference image accordingly. Then, the aligned fully-sampled reference image joins the multi-modal reconstruction of the under-sampled target image. Also, considering the contrast difference between the target and reference images, we have designed a cross-modality-synthesis-based registration loss in combination with the reconstruction loss, to jointly train the spatial alignment network and the reconstruction network. The experiments on both clinical MRI and multi-coil $k$-space raw data demonstrate the superiority and robustness of the multi-modal MRI reconstruction empowered with our spatial alignment network. Our code is publicly available at \url{https://github.com/woxuankai/SpatialAlignmentNetwork}.

Nuo Chen, Zhiyuan Hu, Qingyun Zou et al.

Large Language Models (LLMs) are increasingly adopted as evaluators, offering a scalable alternative to human annotation. However, existing supervised fine-tuning (SFT) approaches often fall short in domains that demand complex reasoning. Judgment is inherently reasoning-intensive: beyond surface-level scoring, it requires verifying evidence, identifying errors, and justifying decisions. Through the analysis of evaluation tasks, we find a negative correlation between SFT performance gains and the proportion of reasoning-demanding samples, revealing the limits of SFT in such scenarios. To address this, we introduce JudgeLRM, a family of judgment-oriented LLMs, trained using reinforcement learning (RL) with judge-wise, outcome-driven rewards to activate reasoning capabilities. JudgeLRM consistently outperform SFT-tuned baselines in the same size, as well as other RL and SFT variants, and even surpass state-of-the-art reasoning models: notably, JudgeLRM-3B/4B exceeds GPT-4, while JudgeLRM-7B/8B/14B outperforms DeepSeek-R1 by over 2% in F1 score, with particularly strong gains on reasoning-heavy tasks. Our findings underscore the value of RL in unlocking reasoning-aligned LLM judges.

Yingce Xia, Peiran Jin, Shufang Xie et al. · microsoft-research

Foundation models have revolutionized natural language processing and artificial intelligence, significantly enhancing how machines comprehend and generate human languages. Inspired by the success of these foundation models, researchers have developed foundation models for individual scientific domains, including small molecules, materials, proteins, DNA, RNA and even cells. However, these models are typically trained in isolation, lacking the ability to integrate across different scientific domains. Recognizing that entities within these domains can all be represented as sequences, which together form the "language of nature", we introduce Nature Language Model (NatureLM), a sequence-based science foundation model designed for scientific discovery. Pre-trained with data from multiple scientific domains, NatureLM offers a unified, versatile model that enables various applications including: (i) generating and optimizing small molecules, proteins, RNA, and materials using text instructions; (ii) cross-domain generation/design, such as protein-to-molecule and protein-to-RNA generation; and (iii) top performance across different domains, matching or surpassing state-of-the-art specialist models. NatureLM offers a promising generalist approach for various scientific tasks, including drug discovery (hit generation/optimization, ADMET optimization, synthesis), novel material design, and the development of therapeutic proteins or nucleotides. We have developed NatureLM models in different sizes (1 billion, 8 billion, and 46.7 billion parameters) and observed a clear improvement in performance as the model size increases.

Shuyu Wang, Weiqi Li, Qian Wang et al.

Recent advances in AI-generated content (AIGC) have significantly accelerated image editing techniques, driving increasing demand for diverse and fine-grained edits. Despite these advances, existing image editing methods still face challenges in achieving high precision and semantic accuracy in complex scenarios. Recent studies address this issue by incorporating multimodal large language models (MLLMs) into image editing pipelines. However, current MLLM-based methods mainly rely on interpreting textual instructions, leaving the intrinsic visual understanding of large models largely unexplored, thus resulting in insufficient alignment between textual semantics and visual outcomes. To overcome these limitations, we propose MIND-Edit, an end-to-end image-editing framework integrating pretrained diffusion model with MLLM. MIND-Edit introduces two complementary strategies: (1) a text instruction optimization strategy that clarifies ambiguous user instructions based on semantic reasoning from the MLLM, and (2) an MLLM insight-driven editing strategy that explicitly leverages the intrinsic visual understanding capability of the MLLM to infer editing intent and guide the diffusion process via generated visual embeddings. Furthermore, we propose a joint training approach to effectively integrate both strategies, allowing them to reinforce each other for more accurate instruction interpretation and visually coherent edits aligned with user intent. Extensive experiments demonstrate that MIND-Edit outperforms state-of-the-art image editing methods in both quantitative metrics and visual quality, particularly under complex and challenging scenarios.

Zhenrong Shen, Manman Fei, Xin Wang et al.

Automatic thin-prep cytologic test (TCT) screening can assist pathologists in finding cervical abnormality towards accurate and efficient cervical cancer diagnosis. Current automatic TCT screening systems mostly involve abnormal cervical cell detection, which generally requires large-scale and diverse training data with high-quality annotations to achieve promising performance. Pathological image synthesis is naturally raised to minimize the efforts in data collection and annotation. However, it is challenging to generate realistic large-size cytopathological images while simultaneously synthesizing visually plausible appearances for small-size abnormal cervical cells. In this paper, we propose a two-stage image synthesis framework to create synthetic data for augmenting cervical abnormality screening. In the first Global Image Generation stage, a Normal Image Generator is designed to generate cytopathological images full of normal cervical cells. In the second Local Cell Editing stage, normal cells are randomly selected from the generated images and then are converted to different types of abnormal cells using the proposed Abnormal Cell Synthesizer. Both Normal Image Generator and Abnormal Cell Synthesizer are built upon Stable Diffusion, a pre-trained foundation model for image synthesis, via parameter-efficient fine-tuning methods for customizing cytopathological image contents and extending spatial layout controllability, respectively. Our experiments demonstrate the synthetic image quality, diversity, and controllability of the proposed synthesis framework, and validate its data augmentation effectiveness in enhancing the performance of abnormal cervical cell detection.

Jiexuan Zhang, Yiheng Du, Qian Wang et al.

Despite their generative power, diffusion models struggle to maintain style consistency across images conditioned on the same style prompt, hindering their practical deployment in creative workflows. While several training-free methods attempt to solve this, they are constrained to the U-Net architecture, which not only leads to low-quality results and artifacts like object repetition but also renders them incompatible with superior Diffusion Transformer (DiT). To address these issues, we introduce AlignedGen, a novel training-free framework that enhances style consistency across images generated by DiT models. Our work first reveals a critical insight: naive attention sharing fails in DiT due to conflicting positional signals from improper position embeddings. We introduce Shifted Position Embedding (ShiftPE), an effective solution that resolves this conflict by allocating a non-overlapping set of positional indices to each image. Building on this foundation, we develop Advanced Attention Sharing (AAS), a suite of three techniques meticulously designed to fully unleash the potential of attention sharing within the DiT. Furthermore, to broaden the applicability of our method, we present an efficient query, key, and value feature extraction algorithm, enabling our method to seamlessly incorporate external images as style references. Extensive experimental results validate that our method effectively enhances style consistency across generated images while maintaining precise text-to-image alignment.

Yuyu Guo, Lei Bi, Zhengbin Zhu et al.

Automated segmentation of left ventricular cavity (LVC) in temporal cardiac image sequences (multiple time points) is a fundamental requirement for quantitative analysis of its structural and functional changes. Deep learning based methods for the segmentation of LVC are the state of the art; however, these methods are generally formulated to work on single time points, and fails to exploit the complementary information from the temporal image sequences that can aid in segmentation accuracy and consistency among the images across the time points. Furthermore, these segmentation methods perform poorly in segmenting the end-systole (ES) phase images, where the left ventricle deforms to the smallest irregular shape, and the boundary between the blood chamber and myocardium becomes inconspicuous. To overcome these limitations, we propose a new method to automatically segment temporal cardiac images where we introduce a spatial sequential (SS) network to learn the deformation and motion characteristics of the LVC in an unsupervised manner; these characteristics were then integrated with sequential context information derived from bi-directional learning (BL) where both chronological and reverse-chronological directions of the image sequence were used. Our experimental results on a cardiac computed tomography (CT) dataset demonstrated that our spatial-sequential network with bi-directional learning (SS-BL) method outperformed existing methods for LVC segmentation. Our method was also applied to MRI cardiac dataset and the results demonstrated the generalizability of our method.

Xin Wang, Zhiyun Song, Yitao Zhu et al.

In clinical practice, 2D magnetic resonance (MR) sequences are widely adopted. While individual 2D slices can be stacked to form a 3D volume, the relatively large slice spacing can pose challenges for both image visualization and subsequent analysis tasks, which often require isotropic voxel spacing. To reduce slice spacing, deep-learning-based super-resolution techniques are widely investigated. However, most current solutions require a substantial number of paired high-resolution and low-resolution images for supervised training, which are typically unavailable in real-world scenarios. In this work, we propose a self-supervised super-resolution framework for inter-slice super-resolution of MR images. Our framework is first featured by pre-training on video dataset, as temporal correlation of videos is found beneficial for modeling the spatial relation among MR slices. Then, we use public high-quality MR dataset to fine-tune our pre-trained model, for enhancing awareness of our model to medical data. Finally, given a target dataset at hand, we utilize self-supervised fine-tuning to further ensure our model works well with user-specific super-resolution tasks. The proposed method demonstrates superior performance compared to other self-supervised methods and also holds the potential to benefit various downstream applications.

Kelei He, Chen Gan, Zhuoyuan Li et al.

Transformers have dominated the field of natural language processing, and recently impacted the computer vision area. In the field of medical image analysis, Transformers have also been successfully applied to full-stack clinical applications, including image synthesis/reconstruction, registration, segmentation, detection, and diagnosis. Our paper aims to promote awareness and application of Transformers in the field of medical image analysis. Specifically, we first overview the core concepts of the attention mechanism built into Transformers and other basic components. Second, we review various Transformer architectures tailored for medical image applications and discuss their limitations. Within this review, we investigate key challenges revolving around the use of Transformers in different learning paradigms, improving the model efficiency, and their coupling with other techniques. We hope this review can give a comprehensive picture of Transformers to the readers in the field of medical image analysis.

Xi Ouyang, Jiayu Huo, Liming Xia et al.

The coronavirus disease (COVID-19) is rapidly spreading all over the world, and has infected more than 1,436,000 people in more than 200 countries and territories as of April 9, 2020. Detecting COVID-19 at early stage is essential to deliver proper healthcare to the patients and also to protect the uninfected population. To this end, we develop a dual-sampling attention network to automatically diagnose COVID- 19 from the community acquired pneumonia (CAP) in chest computed tomography (CT). In particular, we propose a novel online attention module with a 3D convolutional network (CNN) to focus on the infection regions in lungs when making decisions of diagnoses. Note that there exists imbalanced distribution of the sizes of the infection regions between COVID-19 and CAP, partially due to fast progress of COVID-19 after symptom onset. Therefore, we develop a dual-sampling strategy to mitigate the imbalanced learning. Our method is evaluated (to our best knowledge) upon the largest multi-center CT data for COVID-19 from 8 hospitals. In the training-validation stage, we collect 2186 CT scans from 1588 patients for a 5-fold cross-validation. In the testing stage, we employ another independent large-scale testing dataset including 2796 CT scans from 2057 patients. Results show that our algorithm can identify the COVID-19 images with the area under the receiver operating characteristic curve (AUC) value of 0.944, accuracy of 87.5%, sensitivity of 86.9%, specificity of 90.1%, and F1-score of 82.0%. With this performance, the proposed algorithm could potentially aid radiologists with COVID-19 diagnosis from CAP, especially in the early stage of the COVID-19 outbreak.

Xuhua Ren, Jiayu Huo, Kai Xuan et al.

Brain magnetic resonance (MR) segmentation for hydrocephalus patients is considered as a challenging work. Encoding the variation of the brain anatomical structures from different individuals cannot be easily achieved. The task becomes even more difficult especially when the image data from hydrocephalus patients are considered, which often have large deformations and differ significantly from the normal subjects. Here, we propose a novel strategy with hard and soft attention modules to solve the segmentation problems for hydrocephalus MR images. Our main contributions are three-fold: 1) the hard-attention module generates coarse segmentation map using multi-atlas-based method and the VoxelMorph tool, which guides subsequent segmentation process and improves its robustness; 2) the soft-attention module incorporates position attention to capture precise context information, which further improves the segmentation accuracy; 3) we validate our method by segmenting insula, thalamus and many other regions-of-interests (ROIs) that are critical to quantify brain MR images of hydrocephalus patients in real clinical scenario. The proposed method achieves much improved robustness and accuracy when segmenting all 17 consciousness-related ROIs with high variations for different subjects. To the best of our knowledge, this is the first work to employ deep learning for solving the brain segmentation problems of hydrocephalus patients.

Dong Nie, Lei Xiang, Qian Wang et al.

Medical imaging plays a critical role in various clinical applications. However, due to multiple considerations such as cost and risk, the acquisition of certain image modalities could be limited. To address this issue, many cross-modality medical image synthesis methods have been proposed. However, the current methods cannot well model the hard-to-synthesis regions (e.g., tumor or lesion regions). To address this issue, we propose a simple but effective strategy, that is, we propose a dual-discriminator (dual-D) adversarial learning system, in which, a global-D is used to make an overall evaluation for the synthetic image, and a local-D is proposed to densely evaluate the local regions of the synthetic image. More importantly, we build an adversarial attention mechanism which targets at better modeling hard-to-synthesize regions (e.g., tumor or lesion regions) based on the local-D. Experimental results show the robustness and accuracy of our method in synthesizing fine-grained target images from the corresponding source images. In particular, we evaluate our method on two datasets, i.e., to address the tasks of generating T2 MRI from T1 MRI for the brain tumor images and generating MRI from CT. Our method outperforms the state-of-the-art methods under comparison in all datasets and tasks. And the proposed difficult-region-aware attention mechanism is also proved to be able to help generate more realistic images, especially for the hard-to-synthesize regions.

Lei Bi, Yuyu Guo, Qian Wang et al.

Automated segmentation of the optic cup and disk on retinal fundus images is fundamental for the automated detection / analysis of glaucoma. Traditional segmentation approaches depend heavily upon hand-crafted features and a priori knowledge of the user. As such, these methods are difficult to be adapt to the clinical environment. Recently, deep learning methods based on fully convolutional networks (FCNs) have been successful in resolving segmentation problems. However, the reliance on large annotated training data is problematic when dealing with medical images. If a sufficient amount of annotated training data to cover all possible variations is not available, FCNs do not provide accurate segmentation. In addition, FCNs have a large receptive field in the convolutional layers, and hence produce coarse outputs of boundaries. Hence, we propose a new fully automated method that we refer to as a dual-stage fully convolutional networks (DSFCN). Our approach leverages deep residual architectures and FCNs and learns and infers the location of the optic cup and disk in a step-wise manner with fine-grained details. During training, our approach learns from the training data and the estimated results derived from the previous iteration. The ability to learn from the previous iteration optimizes the learning of the optic cup and the disk boundaries. During testing (prediction), DSFCN uses test (input) images and the estimated probability map derived from previous iterations to gradually improve the segmentation accuracy. Our method achieved an average Dice co-efficient of 0.8488 and 0.9441 for optic cup and disk segmentation and an area under curve (AUC) of 0.9513 for glaucoma detection.

Dongming Wei, Zhengwang Wu, Gang Li et al.

Objective: Deformable brain MR image registration is challenging due to large inter-subject anatomical variation. For example, the highly complex cortical folding pattern makes it hard to accurately align corresponding cortical structures of individual images. In this paper, we propose a novel deep learning way to simplify the difficult registration problem of brain MR images. Methods: We train a morphological simplification network (MS-Net), which can generate a "simple" image with less anatomical details based on the "complex" input. With MS-Net, the complexity of the fixed image or the moving image under registration can be reduced gradually, thus building an individual (simplification) trajectory represented by MS-Net outputs. Since the generated images at the ends of the two trajectories (of the fixed and moving images) are so simple and very similar in appearance, they are easy to register. Thus, the two trajectories can act as a bridge to link the fixed and the moving images, and guide their registration. Results: Our experiments show that the proposed method can achieve highly accurate registration performance on different datasets (i.e., NIREP, LPBA, IBSR, CUMC, and MGH). Moreover, the method can be also easily transferred across diverse image datasets and obtain superior accuracy on surface alignment. Conclusion and Significance: We propose MS-Net as a powerful and flexible tool to simplify brain MR images and their registration. To our knowledge, this is the first work to simplify brain MR image registration by deep learning, instead of estimating deformation field directly.

Xiaohuan Cao, Jianhua Yang, Li Wang et al.

Non-rigid inter-modality registration can facilitate accurate information fusion from different modalities, but it is challenging due to the very different image appearances across modalities. In this paper, we propose to train a non-rigid inter-modality image registration network, which can directly predict the transformation field from the input multimodal images, such as CT and MR images. In particular, the training of our inter-modality registration network is supervised by intra-modality similarity metric based on the available paired data, which is derived from a pre-aligned CT and MR dataset. Specifically, in the training stage, to register the input CT and MR images, their similarity is evaluated on the warped MR image and the MR image that is paired with the input CT. So that, the intra-modality similarity metric can be directly applied to measure whether the input CT and MR images are well registered. Moreover, we use the idea of dual-modality fashion, in which we measure the similarity on both CT modality and MR modality. In this way, the complementary anatomies in both modalities can be jointly considered to more accurately train the inter-modality registration network. In the testing stage, the trained inter-modality registration network can be directly applied to register the new multimodal images without any paired data. Experimental results have shown that, the proposed method can achieve promising accuracy and efficiency for the challenging non-rigid inter-modality registration task and also outperforms the state-of-the-art approaches.