Melissa Thalhammer

Fabian Bongratz, Markus Karmann, Adrian Holz et al.

Meningeal lymphatic vessels (MLVs) are responsible for the drainage of waste products from the human brain. An impairment in their functionality has been associated with aging as well as brain disorders like multiple sclerosis and Alzheimer's disease. However, MLVs have only recently been described for the first time in magnetic resonance imaging (MRI), and their ramified structure renders manual segmentation particularly difficult. Further, as there is no consistent notion of their appearance, human-annotated MLV structures contain a high inter-rater variability that most automatic segmentation methods cannot take into account. In this work, we propose a new rater-aware training scheme for the popular nnU-Net model, and we explore rater-based ensembling strategies for accurate and consistent segmentation of MLVs. This enables us to boost nnU-Net's performance while obtaining explicit predictions in different annotation styles and a rater-based uncertainty estimation. Our final model, MLV$^2$-Net, achieves a Dice similarity coefficient of 0.806 with respect to the human reference standard. The model further matches the human inter-rater reliability and replicates age-related associations with MLV volume.

Christian Wachinger, Dennis Hedderich, Melissa Thalhammer et al.

Understanding individual differences in cortical structure is key to advancing diagnostics in neurology and psychiatry. Reference models aid in detecting aberrant cortical thickness, yet site-specific biases limit their direct application to unseen data, and region-wise averages prevent the detection of localized cortical changes. To address these limitations, we developed the Stochastic Cortical Self-Reconstruction (SCSR), a novel method that leverages deep learning to reconstruct cortical thickness maps at the vertex level without needing additional subject information. Trained on over 25,000 healthy individuals, SCSR generates highly individualized cortical reconstructions that can detect subtle thickness deviations. Our evaluations on independent test sets demonstrated that SCSR achieved significantly lower reconstruction errors and identified atrophy patterns that enabled better disease discrimination than established methods. It also hints at cortical thinning in preterm infants that went undetected by existing models, showcasing its versatility. Finally, SCSR excelled in mapping highly resolved cortical deviations of dementia patients from clinical data, highlighting its potential for supporting diagnosis in clinical practice.