Minghui Zhang

Minghui Zhang, Yangqian Wu, Hanxiao Zhang et al. · harvard

Open international challenges are becoming the de facto standard for assessing computer vision and image analysis algorithms. In recent years, new methods have extended the reach of pulmonary airway segmentation that is closer to the limit of image resolution. Since EXACT'09 pulmonary airway segmentation, limited effort has been directed to quantitative comparison of newly emerged algorithms driven by the maturity of deep learning based approaches and clinical drive for resolving finer details of distal airways for early intervention of pulmonary diseases. Thus far, public annotated datasets are extremely limited, hindering the development of data-driven methods and detailed performance evaluation of new algorithms. To provide a benchmark for the medical imaging community, we organized the Multi-site, Multi-domain Airway Tree Modeling (ATM'22), which was held as an official challenge event during the MICCAI 2022 conference. ATM'22 provides large-scale CT scans with detailed pulmonary airway annotation, including 500 CT scans (300 for training, 50 for validation, and 150 for testing). The dataset was collected from different sites and it further included a portion of noisy COVID-19 CTs with ground-glass opacity and consolidation. Twenty-three teams participated in the entire phase of the challenge and the algorithms for the top ten teams are reviewed in this paper. Quantitative and qualitative results revealed that deep learning models embedded with the topological continuity enhancement achieved superior performance in general. ATM'22 challenge holds as an open-call design, the training data and the gold standard evaluation are available upon successful registration via its homepage.

Hanxiao Zhang, Xiao Gu, Minghui Zhang et al. · oxford

The LIDC-IDRI database is the most popular benchmark for lung cancer prediction. However, with subjective assessment from radiologists, nodules in LIDC may have entirely different malignancy annotations from the pathological ground truth, introducing label assignment errors and subsequent supervision bias during training. The LIDC database thus requires more objective labels for learning-based cancer prediction. Based on an extra small dataset containing 180 nodules diagnosed by pathological examination, we propose to re-label LIDC data to mitigate the effect of original annotation bias verified on this robust benchmark. We demonstrate in this paper that providing new labels by similar nodule retrieval based on metric learning would be an effective re-labeling strategy. Training on these re-labeled LIDC nodules leads to improved model performance, which is enhanced when new labels of uncertain nodules are added. We further infer that re-labeling LIDC is current an expedient way for robust lung cancer prediction while building a large pathological-proven nodule database provides the long-term solution.

Reuben Dorent, Roya Khajavi, Tagwa Idris et al.

Accurate assessment of lymph node size in 3D CT scans is crucial for cancer staging, therapeutic management, and monitoring treatment response. Existing state-of-the-art segmentation frameworks in medical imaging often rely on fully annotated datasets. However, for lymph node segmentation, these datasets are typically small due to the extensive time and expertise required to annotate the numerous lymph nodes in 3D CT scans. Weakly-supervised learning, which leverages incomplete or noisy annotations, has recently gained interest in the medical imaging community as a potential solution. Despite the variety of weakly-supervised techniques proposed, most have been validated only on private datasets or small publicly available datasets. To address this limitation, the Mediastinal Lymph Node Quantification (LNQ) challenge was organized in conjunction with the 26th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2023). This challenge aimed to advance weakly-supervised segmentation methods by providing a new, partially annotated dataset and a robust evaluation framework. A total of 16 teams from 5 countries submitted predictions to the validation leaderboard, and 6 teams from 3 countries participated in the evaluation phase. The results highlighted both the potential and the current limitations of weakly-supervised approaches. On one hand, weakly-supervised approaches obtained relatively good performance with a median Dice score of $61.0\%$. On the other hand, top-ranked teams, with a median Dice score exceeding $70\%$, boosted their performance by leveraging smaller but fully annotated datasets to combine weak supervision and full supervision. This highlights both the promise of weakly-supervised methods and the ongoing need for high-quality, fully annotated data to achieve higher segmentation performance.

Puyang Wang, Dazhou Guo, Dandan Zheng et al.

Intrathoracic airway segmentation in computed tomography (CT) is a prerequisite for various respiratory disease analyses such as chronic obstructive pulmonary disease (COPD), asthma and lung cancer. Unlike other organs with simpler shapes or topology, the airway's complex tree structure imposes an unbearable burden to generate the "ground truth" label (up to 7 or 3 hours of manual or semi-automatic annotation on each case). Most of the existing airway datasets are incompletely labeled/annotated, thus limiting the completeness of computer-segmented airway. In this paper, we propose a new anatomy-aware multi-class airway segmentation method enhanced by topology-guided iterative self-learning. Based on the natural airway anatomy, we formulate a simple yet highly effective anatomy-aware multi-class segmentation task to intuitively handle the severe intra-class imbalance of the airway. To solve the incomplete labeling issue, we propose a tailored self-iterative learning scheme to segment toward the complete airway tree. For generating pseudo-labels to achieve higher sensitivity , we introduce a novel breakage attention map and design a topology-guided pseudo-label refinement method by iteratively connecting breaking branches commonly existed from initial pseudo-labels. Extensive experiments have been conducted on four datasets including two public challenges. The proposed method ranked 1st in both EXACT'09 challenge using average score and ATM'22 challenge on weighted average score. In a public BAS dataset and a private lung cancer dataset, our method significantly improves previous leading approaches by extracting at least (absolute) 7.5% more detected tree length and 4.0% more tree branches, while maintaining similar precision.

Minghui Zhang, Guang-Zhong Yang, Yun Gu

Detailed pulmonary airway segmentation is a clinically important task for endobronchial intervention and treatment of peripheral located lung cancer lesions. Convolutional Neural Networks (CNNs) are promising tools for medical image analysis but have been performing poorly for cases when existing a significant imbalanced feature distribution, which is true for the airway data as the trachea and principal bronchi dominate most of the voxels whereas the lobar bronchi and distal segmental bronchi occupy a small proportion. In this paper, we propose a Differentiable Topology-Preserved Distance Transform (DTPDT) framework to improve the performance of airway segmentation. A Topology-Preserved Surrogate (TPS) learning strategy is first proposed to balance the training progress within-class distribution. Furthermore, a Convolutional Distance Transform (CDT) is designed to identify the breakage phenomenon with superior sensitivity and minimize the variation of the distance map between the predictionand ground-truth. The proposed method is validated with the publically available reference airway segmentation datasets. The detected rate of branch and length on public EXACT'09 and BAS datasets are 82.1%/79.6% and 96.5%/91.5% respectively, demonstrating the reliability and efficiency of the method in terms of improving the topology completeness of the segmentation performance while maintaining the overall topology accuracy.

Hanxiao Zhang, Liang Chen, Xiao Gu et al.

Recent evolution in deep learning has proven its value for CT-based lung nodule classification. Most current techniques are intrinsically black-box systems, suffering from two generalizability issues in clinical practice. First, benign-malignant discrimination is often assessed by human observers without pathologic diagnoses at the nodule level. We termed these data as "unsure data". Second, a classifier does not necessarily acquire reliable nodule features for stable learning and robust prediction with patch-level labels during learning. In this study, we construct a sure dataset with pathologically-confirmed labels and propose a collaborative learning framework to facilitate sure nodule classification by integrating unsure data knowledge through nodule segmentation and malignancy score regression. A loss function is designed to learn reliable features by introducing interpretability constraints regulated with nodule segmentation maps. Furthermore, based on model inference results that reflect the understanding from both machine and experts, we explore a new nodule analysis method for similar historical nodule retrieval and interpretable diagnosis. Detailed experimental results demonstrate that our approach is beneficial for achieving improved performance coupled with faithful model reasoning for lung cancer prediction. Extensive cross-evaluation results further illustrate the effect of unsure data for deep-learning-based methods in lung nodule classification.

Yangqian Wu, Minghui Zhang, Weihao Yu et al.

Purpose: Bronchoscopic intervention is a widely-used clinical technique for pulmonary diseases, which requires an accurate and topological complete airway map for its localization and guidance. The airway map could be extracted from chest computed tomography (CT) scans automatically by airway segmentation methods. Due to the complex tree-like structure of the airway, preserving its topology completeness while maintaining the segmentation accuracy is a challenging task. Methods: In this paper, a long-term slice propagation (LTSP) method is proposed for accurate airway segmentation from pathological CT scans. We also design a two-stage end-to-end segmentation framework utilizing the LTSP method in the decoding process. Stage 1 is used to generate a coarse feature map by an encoder-decoder architecture. Stage 2 is to adopt the proposed LTSP method for exploiting the continuity information and enhancing the weak airway features in the coarse feature map. The final segmentation result is predicted from the refined feature map. Results: Extensive experiments were conducted to evaluate the performance of the proposed method on 70 clinical CT scans. The results demonstrate the considerable improvements of the proposed method compared to some state-of-the-art methods as most breakages are eliminated and more tiny bronchi are detected. The ablation studies further confirm the effectiveness of the constituents of the proposed method. Conclusion: Slice continuity information is beneficial to accurate airway segmentation. Furthermore, by propagating the long-term slice feature, the airway topology connectivity is preserved with overall segmentation accuracy maintained.

Weihao Yu, Hao Zheng, Minghui Zhang et al.

Airway segmentation is critical for virtual bronchoscopy and computer-aided pulmonary disease analysis. In recent years, convolutional neural networks (CNNs) have been widely used to delineate the bronchial tree. However, the segmentation results of the CNN-based methods usually include many discontinuous branches, which need manual repair in clinical use. A major reason for the breakages is that the appearance of the airway wall can be affected by the lung disease as well as the adjacency of the vessels, while the network tends to overfit to these special patterns in the training set. To learn robust features for these areas, we design a multi-branch framework that adopts the geodesic distance transform to capture the intensity changes between airway lumen and wall. Another reason for the breakages is the intra-class imbalance. Since the volume of the peripheral bronchi may be much smaller than the large branches in an input patch, the common segmentation loss is not sensitive to the breakages among the distal branches. Therefore, in this paper, a breakage-sensitive regularization term is designed and can be easily combined with other loss functions. Extensive experiments are conducted on publicly available datasets. Compared with state-of-the-art methods, our framework can detect more branches while maintaining competitive segmentation performance.

Minghui Zhang, Xin Yu, Hanxiao Zhang et al.

3D Convolutional Neural Networks (CNNs) have been widely adopted for airway segmentation. The performance of 3D CNNs is greatly influenced by the dataset while the public airway datasets are mainly clean CT scans with coarse annotation, thus difficult to be generalized to noisy CT scans (e.g. COVID-19 CT scans). In this work, we proposed a new dual-stream network to address the variability between the clean domain and noisy domain, which utilizes the clean CT scans and a small amount of labeled noisy CT scans for airway segmentation. We designed two different encoders to extract the transferable clean features and the unique noisy features separately, followed by two independent decoders. Further on, the transferable features are refined by the channel-wise feature recalibration and Signed Distance Map (SDM) regression. The feature recalibration module emphasizes critical features and the SDM pays more attention to the bronchi, which is beneficial to extracting the transferable topological features robust to the coarse labels. Extensive experimental results demonstrated the obvious improvement brought by our proposed method. Compared to other state-of-the-art transfer learning methods, our method accurately segmented more bronchi in the noisy CT scans.