Inês Machado

Fryderyk Kögl, Anna Reithmeir, Vasiliki Sideri-Lampretsa et al.

General vision encoders like DINOv2 and SAM have recently transformed computer vision. Even though they are trained on natural images, such encoder models have excelled in medical imaging, e.g., in classification, segmentation, and registration. However, no in-depth comparison of different state-of-the-art general vision encoders for medical registration is available. In this work, we investigate how well general vision encoder features can be used in the dissimilarity metrics for medical image registration. We explore two encoders that were trained on natural images as well as one that was fine-tuned on medical data. We apply the features within the well-established B-spline FFD registration framework. In extensive experiments on cardiac cine MRI data, we find that using features as additional guidance for conventional metrics improves the registration quality. The code is available at github.com/compai-lab/2024-miccai-koegl.

Inês P. Machado, Esther Puyol-Antón, Kerstin Hammernik et al.

Cine cardiac magnetic resonance (CMR) imaging is considered the gold standard for cardiac function evaluation. However, cine CMR acquisition is inherently slow and in recent decades considerable effort has been put into accelerating scan times without compromising image quality or the accuracy of derived results. In this paper, we present a fully-automated, quality-controlled integrated framework for reconstruction, segmentation and downstream analysis of undersampled cine CMR data. The framework enables active acquisition of radial k-space data, in which acquisition can be stopped as soon as acquired data are sufficient to produce high quality reconstructions and segmentations. This results in reduced scan times and automated analysis, enabling robust and accurate estimation of functional biomarkers. To demonstrate the feasibility of the proposed approach, we perform realistic simulations of radial k-space acquisitions on a dataset of subjects from the UK Biobank and present results on in-vivo cine CMR k-space data collected from healthy subjects. The results demonstrate that our method can produce quality-controlled images in a mean scan time reduced from 12 to 4 seconds per slice, and that image quality is sufficient to allow clinically relevant parameters to be automatically estimated to within 5% mean absolute difference.

Francesca Fati, Felipe Coutinho, Marika Reinius et al.

Purpose. High-grade serous ovarian carcinoma (HGSOC) is characterized by pronounced biological and spatial heterogeneity and is frequently diagnosed at an advanced stage. Neoadjuvant chemotherapy (NACT) followed by delayed primary surgery is commonly employed in patients unsuitable for primary cytoreduction. The Chemotherapy Response Score (CRS) is a validated histopathological biomarker of response to NACT, but it is only available postoperatively. In this study, we investigate whether pre-treatment computed tomography (CT) imaging and clinical data can be used to predict CRS as an investigational decision-support adjunct to inform multidisciplinary team (MDT) discussions regarding expected treatment response. Methods. We proposed a 2.5D multimodal deep learning framework that processes lesion-dense omental slices using a pre-trained Vision Transformer encoder and integrates the resulting visual representations with clinical variables through an intermediate fusion module to predict CRS. Results. Our multimodal model, integrating imaging and clinical data, achieved a ROC-AUC of 0.95 alongside 95% accuracy and 80% precision on the internal test cohort (IEO, n=41 patients). On the external test set (OV04, n=70 patients), it achieved a ROC-AUC of 0.68, alongside 67% accuracy and 75% precision. Conclusion. These preliminary results demonstrate the feasibility of transformer-based deep learning for preoperative prediction of CRS in HGSOC using routine clinical data and CT imaging. As an investigational, pre-treatment decision-support tool, this approach may assist MDT discussions by providing early, non-invasive estimates of treatment response.

Tiago Assis, Colin P. Galvin, Joshua P. Castillo et al.

Accurate compensation of brain deformation is critical for reliable image-guided neurosurgery. Surgical manipulation and tumor resection induce tissue motion, causing preoperative planning images to become misaligned with the intraoperative anatomy. In this review, we examine methods developed between 2020 and 2025 for modeling and correcting brain deformation, with a particular focus on learning-based approaches. A comprehensive literature search was conducted in PubMed, IEEE Xplore, Scopus, and Web of Science, with predefined inclusion and exclusion criteria focused on computational methods applied to brain deformation compensation for neurosurgical imaging, resulting in $46$ studies meeting these criteria. We provide a unified analysis of methodological strategies, including deep learning-based image registration, direct deformation field regression, synthesis-driven multimodal alignment, resection-aware architectures addressing missing correspondences, and hybrid models that integrate biomechanical priors. We also examine dataset utilization, reported evaluation metrics, validation protocols, and how uncertainty and generalization have been assessed across studies. While learning-based deformation models demonstrate promising performance and computational efficiency, current approaches exhibit limitations in out-of-distribution robustness, standardized benchmarking, interpretability, and readiness for clinical deployment. Our review highlights these gaps and outlines opportunities for future research aimed at achieving more robust, generalizable, and clinically translatable deformation compensation solutions for neurosurgical guidance. By organizing recent advances and critically assessing evaluation practices, this work offers a comprehensive reference for researchers and clinicians working on data-driven brain deformation modeling and correction.

Tiago Assis, Ines P. Machado, Benjamin Zwick et al.

Accurate compensation of brain shift is critical for maintaining the reliability of neuronavigation during neurosurgery. While keypoint-based registration methods offer robustness to large deformations and topological changes, they typically rely on simple geometric interpolators that ignore tissue biomechanics to create dense displacement fields. In this work, we propose a novel deep learning framework that estimates dense, physically plausible brain deformations from sparse matched keypoints. We first generate a large dataset of synthetic brain deformations using biomechanical simulations. Then, a residual 3D U-Net is trained to refine standard interpolation estimates into biomechanically guided deformations. Experiments on a large set of simulated displacement fields demonstrate that our method significantly outperforms classical interpolators, reducing by half the mean square error while introducing negligible computational overhead at inference time. Code available at: \href{https://github.com/tiago-assis/Deep-Biomechanical-Interpolator}{https://github.com/tiago-assis/Deep-Biomechanical-Interpolator}.

Jean-Baptiste Carluer, Laurent Chauvin, Jie Luo et al.

This work details a highly efficient implementation of the 3D scale-invariant feature transform (SIFT) algorithm, for the purpose of machine learning from large sets of volumetric medical image data. The primary operations of the 3D SIFT code are implemented on a graphics processing unit (GPU), including convolution, sub-sampling, and 4D peak detection from scale-space pyramids. The performance improvements are quantified in keypoint detection and image-to-image matching experiments, using 3D MRI human brain volumes of different people. Computationally efficient 3D keypoint descriptors are proposed based on the Binary Robust Independent Elementary Feature (BRIEF) code, including a novel descriptor we call Ranked Robust Independent Elementary Features (RRIEF), and compared to the original 3D SIFT-Rank method\citep{toews2013efficient}. The GPU implementation affords a speedup of approximately 7X beyond an optimised CPU implementation, where computation time is reduced from 1.4 seconds to 0.2 seconds for 3D volumes of size (145, 174, 145) voxels with approximately 3000 keypoints. Notable speedups include the convolution operation (20X), 4D peak detection (3X), sub-sampling (3X), and difference-of-Gaussian pyramid construction (2X). Efficient descriptors offer a speedup of 2X and a memory savings of 6X compared to standard SIFT-Rank descriptors, at a cost of reduced numbers of keypoint correspondences, revealing a trade-off between computational efficiency and algorithmic performance. The speedups gained by our implementation will allow for a more efficient analysis on larger data sets. Our optimized GPU implementation of the 3D SIFT-Rank extractor is available at https://github.com/CarluerJB/3D_SIFT_CUDA.

Daniël Boeke, Cedrik Blommestijn, Rebecca N. Wray et al.

Recurrence risk estimation in clear cell renal cell carcinoma (ccRCC) is essential for guiding postoperative surveillance and treatment. The Leibovich score remains widely used for stratifying distant recurrence risk but offers limited patient-level resolution and excludes imaging information. This study evaluates multimodal recurrence prediction by integrating preoperative computed tomography (CT) and postoperative histopathology whole-slide images (WSIs). A modular deep learning framework with pretrained encoders and Cox-based survival modeling was tested across unimodal, late fusion, and intermediate fusion setups. In a real-world ccRCC cohort, WSI-based models consistently outperformed CT-only models, underscoring the prognostic strength of pathology. Intermediate fusion further improved performance, with the best model (TITAN-CONCH with ResNet-18) approaching the adjusted Leibovich score. Random tie-breaking narrowed the gap between the clinical baseline and learned models, suggesting discretization may overstate individualized performance. Using simple embedding concatenation, radiology added value primarily through fusion. These findings demonstrate the feasibility of foundation model-based multimodal integration for personalized ccRCC risk prediction. Future work should explore more expressive fusion strategies, larger multimodal datasets, and general-purpose CT encoders to better match pathology modeling capacity.

Devran Ugurlu, Esther Puyol-Anton, Bram Ruijsink et al.

Domain shift refers to the difference in the data distribution of two datasets, normally between the training set and the test set for machine learning algorithms. Domain shift is a serious problem for generalization of machine learning models and it is well-established that a domain shift between the training and test sets may cause a drastic drop in the model's performance. In medical imaging, there can be many sources of domain shift such as different scanners or scan protocols, different pathologies in the patient population, anatomical differences in the patient population (e.g. men vs women) etc. Therefore, in order to train models that have good generalization performance, it is important to be aware of the domain shift problem, its potential causes and to devise ways to address it. In this paper, we study the effect of domain shift on left and right ventricle blood pool segmentation in short axis cardiac MR images. Our dataset contains short axis images from 4 different MR scanners and 3 different pathology groups. The training is performed with nnUNet. The results show that scanner differences cause a greater drop in performance compared to changing the pathology group, and that the impact of domain shift is greater on right ventricle segmentation compared to left ventricle segmentation. Increasing the number of training subjects increased cross-scanner performance more than in-scanner performance at small training set sizes, but this difference in improvement decreased with larger training set sizes. Training models using data from multiple scanners improved cross-domain performance.

Ines Machado, Esther Puyol-Anton, Kerstin Hammernik et al.

Cine cardiac MRI is routinely acquired for the assessment of cardiac health, but the imaging process is slow and typically requires several breath-holds to acquire sufficient k-space profiles to ensure good image quality. Several undersampling-based reconstruction techniques have been proposed during the last decades to speed up cine cardiac MRI acquisition. However, the undersampling factor is commonly fixed to conservative values before acquisition to ensure diagnostic image quality, potentially leading to unnecessarily long scan times. In this paper, we propose an end-to-end quality-aware cine short-axis cardiac MRI framework that combines image acquisition and reconstruction with downstream tasks such as segmentation, volume curve analysis and estimation of cardiac functional parameters. The goal is to reduce scan time by acquiring only a fraction of k-space data to enable the reconstruction of images that can pass quality control checks and produce reliable estimates of cardiac functional parameters. The framework consists of a deep learning model for the reconstruction of 2D+t cardiac cine MRI images from undersampled data, an image quality-control step to detect good quality reconstructions, followed by a deep learning model for bi-ventricular segmentation, a quality-control step to detect good quality segmentations and automated calculation of cardiac functional parameters. To demonstrate the feasibility of the proposed approach, we perform simulations using a cohort of selected participants from the UK Biobank (n=270), 200 healthy subjects and 70 patients with cardiomyopathies. Our results show that we can produce quality-controlled images in a scan time reduced from 12 to 4 seconds per slice, enabling reliable estimates of cardiac functional parameters such as ejection fraction within 5% mean absolute error.

Jie Luo, Matt Toews, Ines Machado et al.

A reliable Ultrasound (US)-to-US registration method to compensate for brain shift would substantially improve Image-Guided Neurological Surgery. Developing such a registration method is very challenging, due to factors such as missing correspondence in images, the complexity of brain pathology and the demand for fast computation. We propose a novel feature-driven active framework. Here, landmarks and their displacement are first estimated from a pair of US images using corresponding local image features. Subsequently, a Gaussian Process (GP) model is used to interpolate a dense deformation field from the sparse landmarks. Kernels of the GP are estimated by using variograms and a discrete grid search method. If necessary, the user can actively add new landmarks based on the image context and visualization of the uncertainty measure provided by the GP to further improve the result. We retrospectively demonstrate our registration framework as a robust and accurate brain shift compensation solution on clinical data acquired during neurosurgery.