Zhaolin Chen

Himashi Peiris, Munawar Hayat, Zhaolin Chen et al.

As intensities of MRI volumes are inconsistent across institutes, it is essential to extract universal features of multi-modal MRIs to precisely segment brain tumors. In this concept, we propose a volumetric vision transformer that follows two windowing strategies in attention for extracting fine features and local distributional smoothness (LDS) during model training inspired by virtual adversarial training (VAT) to make the model robust. We trained and evaluated network architecture on the FeTS Challenge 2022 dataset. Our performance on the online validation dataset is as follows: Dice Similarity Score of 81.71%, 91.38% and 85.40%; Hausdorff Distance (95%) of 14.81 mm, 3.93 mm, 11.18 mm for the enhancing tumor, whole tumor, and tumor core, respectively. Overall, the experimental results verify our method's effectiveness by yielding better performance in segmentation accuracy for each tumor sub-region. Our code implementation is publicly available : https://github.com/himashi92/vizviva_fets_2022

Mahboobeh Jafari, Delaram Sadeghi, Afshin Shoeibi et al.

Schizophrenia (SZ) is a prevalent mental disorder characterized by cognitive, emotional, and behavioral changes. Symptoms of SZ include hallucinations, illusions, delusions, lack of motivation, and difficulties in concentration. Diagnosing SZ involves employing various tools, including clinical interviews, physical examinations, psychological evaluations, the Diagnostic and Statistical Manual of Mental Disorders (DSM), and neuroimaging techniques. Electroencephalography (EEG) recording is a significant functional neuroimaging modality that provides valuable insights into brain function during SZ. However, EEG signal analysis poses challenges for neurologists and scientists due to the presence of artifacts, long-term recordings, and the utilization of multiple channels. To address these challenges, researchers have introduced artificial intelligence (AI) techniques, encompassing conventional machine learning (ML) and deep learning (DL) methods, to aid in SZ diagnosis. This study reviews papers focused on SZ diagnosis utilizing EEG signals and AI methods. The introduction section provides a comprehensive explanation of SZ diagnosis methods and intervention techniques. Subsequently, review papers in this field are discussed, followed by an introduction to the AI methods employed for SZ diagnosis and a summary of relevant papers presented in tabular form. Additionally, this study reports on the most significant challenges encountered in SZ diagnosis, as identified through a review of papers in this field. Future directions to overcome these challenges are also addressed. The discussion section examines the specific details of each paper, culminating in the presentation of conclusions and findings.

Mevan Ekanayake, Zhifeng Chen, Mehrtash Harandi et al.

In Magnetic Resonance Imaging (MRI), image acquisitions are often undersampled in the measurement domain to accelerate the scanning process, at the expense of image quality. However, image quality is a crucial factor that influences the accuracy of clinical diagnosis; hence, high-quality image reconstruction from undersampled measurements has been a key area of research. Recently, deep learning (DL) methods have emerged as the state-of-the-art for MRI reconstruction, typically involving deep neural networks to transform undersampled MRI images into high-quality MRI images through data-driven processes. Nevertheless, there is clear and significant room for improvement in undersampled DL MRI reconstruction to meet the high standards required for clinical diagnosis, in terms of eliminating aliasing artifacts and reducing image noise. In this paper, we introduce a self-supervised pretraining procedure using contrastive learning to improve the accuracy of undersampled DL MRI reconstruction. We use contrastive learning to transform the MRI image representations into a latent space that maximizes mutual information among different undersampled representations and optimizes the information content at the input of the downstream DL reconstruction models. Our experiments demonstrate improved reconstruction accuracy across a range of acceleration factors and datasets, both quantitatively and qualitatively. Furthermore, our extended experiments validate the proposed framework's robustness under adversarial conditions, such as measurement noise, different k-space sampling patterns, and pathological abnormalities, and also prove the transfer learning capabilities on MRI datasets with completely different anatomy. Additionally, we conducted experiments to visualize and analyze the properties of the proposed MRI contrastive learning latent space.

Guoan Wang, Jin Ye, Junlong Cheng et al.

Volumetric medical image segmentation is pivotal in enhancing disease diagnosis, treatment planning, and advancing medical research. While existing volumetric foundation models for medical image segmentation, such as SAM-Med3D and SegVol, have shown remarkable performance on general organs and tumors, their ability to segment certain categories in clinical downstream tasks remains limited. Supervised Finetuning (SFT) serves as an effective way to adapt such foundation models for task-specific downstream tasks but at the cost of degrading the general knowledge previously stored in the original foundation model.To address this, we propose SAM-Med3D-MoE, a novel framework that seamlessly integrates task-specific finetuned models with the foundational model, creating a unified model at minimal additional training expense for an extra gating network. This gating network, in conjunction with a selection strategy, allows the unified model to achieve comparable performance of the original models in their respective tasks both general and specialized without updating any parameters of them.Our comprehensive experiments demonstrate the efficacy of SAM-Med3D-MoE, with an average Dice performance increase from 53 to 56.4 on 15 specific classes. It especially gets remarkable gains of 29.6, 8.5, 11.2 on the spinal cord, esophagus, and right hip, respectively. Additionally, it achieves 48.9 Dice on the challenging SPPIN2023 Challenge, significantly surpassing the general expert's performance of 32.3. We anticipate that SAM-Med3D-MoE can serve as a new framework for adapting the foundation model to specific areas in medical image analysis. Codes and datasets will be publicly available.

Sanuwani Dayarathna, Kh Tohidul Islam, Bohan Zhuang et al.

Magnetic Resonance Imaging (MRI) is instrumental in clinical diagnosis, offering diverse contrasts that provide comprehensive diagnostic information. However, acquiring multiple MRI contrasts is often constrained by high costs, long scanning durations, and patient discomfort. Current synthesis methods, typically focused on single-image contrasts, fall short in capturing the collective nuances across various contrasts. Moreover, existing methods for multi-contrast MRI synthesis often fail to accurately map feature-level information across multiple imaging contrasts. We introduce McCaD (Multi-Contrast MRI Conditioned Adaptive Adversarial Diffusion), a novel framework leveraging an adversarial diffusion model conditioned on multiple contrasts for high-fidelity MRI synthesis. McCaD significantly enhances synthesis accuracy by employing a multi-scale, feature-guided mechanism, incorporating denoising and semantic encoders. An adaptive feature maximization strategy and a spatial feature-attentive loss have been introduced to capture more intrinsic features across multiple contrasts. This facilitates a precise and comprehensive feature-guided denoising process. Extensive experiments on tumor and healthy multi-contrast MRI datasets demonstrated that the McCaD outperforms state-of-the-art baselines quantitively and qualitatively. The code is provided with supplementary materials.

Mevan Ekanayake, Kamlesh Pawar, Mehrtash Harandi et al.

Global correlations are widely seen in human anatomical structures due to similarity across tissues and bones. These correlations are reflected in magnetic resonance imaging (MRI) scans as a result of close-range proton density and T1/T2 parameters. Furthermore, to achieve accelerated MRI, k-space data are undersampled which causes global aliasing artifacts. Convolutional neural network (CNN) models are widely utilized for accelerated MRI reconstruction, but those models are limited in capturing global correlations due to the intrinsic locality of the convolution operation. The self-attention-based transformer models are capable of capturing global correlations among image features, however, the current contributions of transformer models for MRI reconstruction are minute. The existing contributions mostly provide CNN-transformer hybrid solutions and rarely leverage the physics of MRI. In this paper, we propose a physics-based stand-alone (convolution free) transformer model titled, the Multi-head Cascaded Swin Transformers (McSTRA) for accelerated MRI reconstruction. McSTRA combines several interconnected MRI physics-related concepts with the transformer networks: it exploits global MR features via the shifted window self-attention mechanism; it extracts MR features belonging to different spectral components separately using a multi-head setup; it iterates between intermediate de-aliasing and k-space correction via a cascaded network with data consistency in k-space and intermediate loss computations; furthermore, we propose a novel positional embedding generation mechanism to guide self-attention utilizing the point spread function corresponding to the undersampling mask. Our model significantly outperforms state-of-the-art MRI reconstruction methods both visually and quantitatively while depicting improved resolution and removal of aliasing artifacts.

Mevan Ekanayake, Zhifeng Chen, Gary Egan et al.

Implicit Neural Representations (INRs) have recently advanced the field of deep learning due to their ability to learn continuous representations of signals without the need for large training datasets. Although INR methods have been studied for medical image super-resolution, their adaptability to localized priors in medical images has not been extensively explored. Medical images contain rich anatomical divisions that could provide valuable local prior information to enhance the accuracy and robustness of INRs. In this work, we propose a novel framework, referred to as the Semantically Conditioned INR (SeCo-INR), that conditions an INR using local priors from a medical image, enabling accurate model fitting and interpolation capabilities to achieve super-resolution. Our framework learns a continuous representation of the semantic segmentation features of a medical image and utilizes it to derive the optimal INR for each semantic region of the image. We tested our framework using several medical imaging modalities and achieved higher quantitative scores and more realistic super-resolution outputs compared to state-of-the-art methods.

Mevan Ekanayake, Kamlesh Pawar, Gary Egan et al.

Deep learning (DL) models are capable of successfully exploiting latent representations in MR data and have become state-of-the-art for accelerated MRI reconstruction. However, undersampling the measurements in k-space as well as the over- or under-parameterized and non-transparent nature of DL make these models exposed to uncertainty. Consequently, uncertainty estimation has become a major issue in DL MRI reconstruction. To estimate uncertainty, Monte Carlo (MC) inference techniques have become a common practice where multiple reconstructions are utilized to compute the variance in reconstruction as a measurement of uncertainty. However, these methods demand high computational costs as they require multiple inferences through the DL model. To this end, we introduce a method to estimate uncertainty during MRI reconstruction using a pixel classification framework. The proposed method, PixCUE (stands for Pixel Classification Uncertainty Estimation) produces the reconstructed image along with an uncertainty map during a single forward pass through the DL model. We demonstrate that this approach generates uncertainty maps that highly correlate with the reconstruction errors with respect to various MR imaging sequences and under numerous adversarial conditions. We also show that the estimated uncertainties are correlated to that of the conventional MC method. We further provide an empirical relationship between the uncertainty estimations using PixCUE and well-established reconstruction metrics such as NMSE, PSNR, and SSIM. We conclude that PixCUE is capable of reliably estimating the uncertainty in MRI reconstruction with a minimum additional computational cost.

Jinlong He, Pengfei Li, Gang Liu et al.

Multimodal large language models (MLLMs) represent an evolutionary expansion in the capabilities of traditional large language models, enabling them to tackle challenges that surpass the scope of purely text-based applications. It leverages the knowledge previously encoded within these language models, thereby enhancing their applicability and functionality in the reign of multimodal contexts. Recent works investigate the adaptation of MLLMs as a universal solution to address medical multi-modal problems as a generative task. In this paper, we propose a parameter efficient framework for fine-tuning MLLMs, specifically validated on medical visual question answering (Med-VQA) and medical report generation (MRG) tasks, using public benchmark datasets. We also introduce an evaluation metric using the 5-point Likert scale and its weighted average value to measure the quality of the generated reports for MRG tasks, where the scale ratings are labelled by both humans manually and the GPT-4 model. We further assess the consistency of performance metrics across traditional measures, GPT-4, and human ratings for both VQA and MRG tasks. The results indicate that semantic similarity assessments using GPT-4 align closely with human annotators and provide greater stability, yet they reveal a discrepancy when compared to conventional lexical similarity measurements. This questions the reliability of lexical similarity metrics for evaluating the performance of generative models in Med-VQA and report generation tasks. Besides, our fine-tuned model significantly outperforms GPT-4v. This indicates that without additional fine-tuning, multi-modal models like GPT-4v do not perform effectively on medical imaging tasks. The code will be available here: https://github.com/jinlHe/PeFoMed.

Cameron Dennis Pain, Yasmeen George, Alex Fornito et al.

Low-dose positron emission tomography (PET) image reconstruction methods have potential to significantly improve PET as an imaging modality. Deep learning provides a promising means of incorporating prior information into the image reconstruction problem to produce quantitatively accurate images from compromised signal. Deep learning-based methods for low-dose PET are generally poorly conditioned and perform unreliably on images with features not present in the training distribution. We present a method which explicitly models deep latent space features using a robust kernel representation, providing robust performance on previously unseen dose reduction factors. Additional constraints on the information content of deep latent features allow for tuning in-distribution accuracy and generalisability. Tests with out-of-distribution dose reduction factors ranging from $\times 10$ to $\times 1000$ and with both paired and unpaired MR, demonstrate significantly improved performance relative to conventional deep-learning methods trained using the same data. Code:https://github.com/cameronPain

Zhenxuan Zhang, Peiyuan Jing, Ruicheng Yuan et al.

Low-field to high-field MRI synthesis has emerged as a cost-effective strategy to enhance image quality under hardware and acquisition constraints, particularly in scenarios where access to high-field scanners is limited or impractical. Despite recent progress in diffusion models, diffusion-based approaches often struggle to balance fine-detail recovery and structural fidelity. In particular, the uncontrolled generation of high-resolution details in structurally ambiguous regions may introduce anatomically inconsistent patterns, such as spurious edges or artificial texture variations. These artifacts can bias downstream quantitative analysis. For example, they may cause inaccurate tissue boundary delineation or erroneous volumetric estimation, ultimately reducing clinical trust in synthesized images. These limitations highlight the need for generative models that are not only visually accurate but also spatially reliable and anatomically consistent. To address this issue, we propose a reliability-aware diffusion framework (ReDiff) that improves synthesis robustness at both the sampling and post-generation stages. Specifically, we introduce a reliability-guided sampling strategy to suppress unreliable responses during the denoising process. We further develop an uncertainty-aware multi-candidate selection scheme to enhance the reliability of the final prediction. Experiments on multi-center MRI datasets demonstrate improved structural fidelity and reduced artifacts compared with state-of-the-art methods.

Zhiqiang Shen, Peng Cao, Jinzhu Yang et al.

Due to domain shifts across diverse medical imaging modalities, learned segmentation models often suffer significant performance degradation during deployment. We posit that these domain shifts can generally be categorized into two main components: 1) "style" shifts, referring to global disparities in image properties such as illumination, contrast, and color; and 2) "content" shifts, which involve local discrepancies in anatomical structures. To address the domain shifts in medical image segmentation, we first factorize an image into style codes and content maps, explicitly modeling the "style" and "content" components. Building on this, we introduce a Style-Content decomposition-based data augmentation algorithm (StyCona), which performs augmentation on both the global style and local content of source-domain images, enabling the training of a well-generalized model for domain generalizable medical image segmentation. StyCona is a simple yet effective plug-and-play module that substantially improves model generalization without requiring additional training parameters or modifications to segmentation model architectures. Experiments on cardiac magnetic resonance imaging and fundus photography segmentation tasks, with single and multiple target domains respectively, demonstrate the effectiveness of StyCona and its superiority over state-of-the-art domain generalization methods. The code is available at https://github.com/Senyh/StyCona.

Yicheng Wu, Tao Song, Zhonghua Wu et al.

Unified MRI imputation, which can adapt to diverse imputation scenarios, is highly desirable as it reduces scanning costs and provides comprehensive MRI information for improved clinical diagnosis. Existing unified MRI imputation methods either rely on specific prompts to guide their transformation network or require multiple modality-specific modules. However, these approaches struggle to capture large modality and instance variations or become too complex to generalize effectively. To address these limitations, we propose CodeBrain, a fundamentally different pipeline for unified brain MRI imputation. Our key idea is to reframe various inter-modality transformations as a full-modality code prediction task via a two-stage framework. In the first stage, CodeBrain reconstructs a target modality from any other modalities by learning a compact scalar-quantized code for each instance and modality. Any target modality can then be reconstructed with high fidelity by combining the corresponding code with shared features extracted from any available modality. In the second stage, a projection encoder is trained to predict full-modality compact codes from any incomplete MRI samples, effectively simulating various imputation scenarios. We evaluate our CodeBrain on two public brain MRI datasets (i.e., IXI and BraTS 2023). Extensive experiments demonstrate that CodeBrain outperforms state-of-the-art methods, setting a new benchmark for unified brain MRI imputation. Our code will be released.

Himashi Peiris, Zhaolin Chen

Accurate hippocampus segmentation in brain MRI is critical for studying cognitive and memory functions and diagnosing neurodevelopmental disorders. While high-field MRIs provide detailed imaging, low-field MRIs are more accessible and cost-effective, which eliminates the need for sedation in children, though they often suffer from lower image quality. In this paper, we present a novel deep-learning approach for the automatic segmentation of bilateral hippocampi in low-field MRIs. Extending recent advancements in infant brain segmentation to underserved communities through the use of low-field MRIs ensures broader access to essential diagnostic tools, thereby supporting better healthcare outcomes for all children. Inspired by our previous work, Co-BioNet, the proposed model employs a dual-view structure to enable mutual feature learning via high-frequency masking, enhancing segmentation accuracy by leveraging complementary information from different perspectives. Extensive experiments demonstrate that our method provides reliable segmentation outcomes for hippocampal analysis in low-resource settings. The code is publicly available at: https://github.com/himashi92/LoFiHippSeg.

Himashi Peiris, Zhaolin Chen, Gary Egan et al.

This paper proposes an adversarial learning based training approach for brain tumor segmentation task. In this concept, the 3D segmentation network learns from dual reciprocal adversarial learning approaches. To enhance the generalization across the segmentation predictions and to make the segmentation network robust, we adhere to the Virtual Adversarial Training approach by generating more adversarial examples via adding some noise on original patient data. By incorporating a critic that acts as a quantitative subjective referee, the segmentation network learns from the uncertainty information associated with segmentation results. We trained and evaluated network architecture on the RSNA-ASNR-MICCAI BraTS 2021 dataset. Our performance on the online validation dataset is as follows: Dice Similarity Score of 81.38%, 90.77% and 85.39%; Hausdorff Distance (95\%) of 21.83 mm, 5.37 mm, 8.56 mm for the enhancing tumor, whole tumor and tumor core, respectively. Similarly, our approach achieved a Dice Similarity Score of 84.55%, 90.46% and 85.30%, as well as Hausdorff Distance (95\%) of 13.48 mm, 6.32 mm and 16.98 mm on the final test dataset. Overall, our proposed approach yielded better performance in segmentation accuracy for each tumor sub-region. Our code implementation is publicly available at https://github.com/himashi92/vizviva_brats_2021

Himashi Peiris, Munawar Hayat, Zhaolin Chen et al.

We propose a Transformer architecture for volumetric segmentation, a challenging task that requires keeping a complex balance in encoding local and global spatial cues, and preserving information along all axes of the volume. Encoder of the proposed design benefits from self-attention mechanism to simultaneously encode local and global cues, while the decoder employs a parallel self and cross attention formulation to capture fine details for boundary refinement. Empirically, we show that the proposed design choices result in a computationally efficient model, with competitive and promising results on the Medical Segmentation Decathlon (MSD) brain tumor segmentation (BraTS) Task. We further show that the representations learned by our model are robust against data corruptions. \href{https://github.com/himashi92/VT-UNet}{Our code implementation is publicly available}.

Himashi Peiris, Zhaolin Chen, Gary Egan et al.

Segmentation of images is a long-standing challenge in medical AI. This is mainly due to the fact that training a neural network to perform image segmentation requires a significant number of pixel-level annotated data, which is often unavailable. To address this issue, we propose a semi-supervised image segmentation technique based on the concept of multi-view learning. In contrast to the previous art, we introduce an adversarial form of dual-view training and employ a critic to formulate the learning problem in multi-view training as a min-max problem. Thorough quantitative and qualitative evaluations on several datasets indicate that our proposed method outperforms state-of-the-art medical image segmentation algorithms consistently and comfortably. The code is publicly available at https://github.com/himashi92/Duo-SegNet

Benjamin Sinclair, Lucy Vivash, Jasmine Moses et al.

Perivascular spaces(PVSs) form a central component of the brainś waste clearance system, the glymphatic system. These structures are visible on MRI images, and their morphology is associated with aging and neurological disease. Manual quantification of PVS is time consuming and subjective. Numerous deep learning methods for PVS segmentation have been developed, however the majority have been developed and evaluated on homogenous datasets and high resolution scans, perhaps limiting their applicability for the wide range of image qualities acquired in clinic and research. In this work we train a nnUNet, a top-performing biomedical image segmentation algorithm, on a heterogenous training sample of manually segmented MRI images of a range of different qualities and resolutions from 6 different datasets. These are compared to publicly available deep learning methods for 3D segmentation of PVS. The resulting model, PINGU (Perivascular space Identification Nnunet for Generalised Usage), achieved voxel and cluster level dice scores of 0.50(SD=0.15), 0.63(0.17) in the white matter(WM), and 0.54(0.11), 0.66(0.17) in the basal ganglia(BG). Performance on data from unseen sites was substantially lower for both PINGU(0.20-0.38(WM, voxel), 0.29-0.58(WM, cluster), 0.22-0.36(BG, voxel), 0.46-0.60(BG, cluster)) and the publicly available algorithms(0.18-0.30(WM, voxel), 0.29-0.38(WM cluster), 0.10-0.20(BG, voxel), 0.15-0.37(BG, cluster)), but PINGU strongly outperformed the publicly available algorithms, particularly in the BG. Finally, training PINGU on manual segmentations from a single site with homogenous scan properties gave marginally lower performances on internal cross-validation, but in some cases gave higher performance on external validation. PINGU stands out as broad-use PVS segmentation tool, with particular strength in the BG, an area of PVS related to vascular disease and pathology.

Shenjun Zhong, Zhifeng Chen, Zhaolin Chen

Magnetic Resonance Fingerprinting (MRF) leverages transient-state signal dynamics generated by the tunable acquisition parameters, making the design of an optimal, robust sequence a complex, high-dimensional sequential decision problem, such as optimizing one of the key parameters, flip angle. Reinforcement learning (RL) offers a promising approach to automate parameter selection, to optimize pulse sequences that maximize the distinguishability of fingerprints across the parameter space. In this work, we introduce an RL framework for optimizing the flip-angle schedule in MRF and demonstrate a learned schedule exhibiting non-periodic patterns that enhances fingerprint separability. Additionally, an interesting observation is that the RL-optimized schedule may enable a reduction in the number of repetition time, potentially accelerate MRF acquisitions.

Zhenxuan Zhang, Peiyuan Jing, Zi Wang et al.

Synthesizing high-quality images from low-field MRI holds significant potential. Low-field MRI is cheaper, more accessible, and safer, but suffers from low resolution and poor signal-to-noise ratio. This synthesis process can reduce reliance on costly acquisitions and expand data availability. However, synthesizing high-field MRI still suffers from a clinical fidelity gap. There is a need to preserve anatomical fidelity, enhance fine-grained structural details, and bridge domain gaps in image contrast. To address these issues, we propose a \emph{cyclic self-supervised diffusion (CSS-Diff)} framework for high-field MRI synthesis from real low-field MRI data. Our core idea is to reformulate diffusion-based synthesis under a cycle-consistent constraint. It enforces anatomical preservation throughout the generative process rather than just relying on paired pixel-level supervision. The CSS-Diff framework further incorporates two novel processes. The slice-wise gap perception network aligns inter-slice inconsistencies via contrastive learning. The local structure correction network enhances local feature restoration through self-reconstruction of masked and perturbed patches. Extensive experiments on cross-field synthesis tasks demonstrate the effectiveness of our method, achieving state-of-the-art performance (e.g., 31.80 $\pm$ 2.70 dB in PSNR, 0.943 $\pm$ 0.102 in SSIM, and 0.0864 $\pm$ 0.0689 in LPIPS). Beyond pixel-wise fidelity, our method also preserves fine-grained anatomical structures compared with the original low-field MRI (e.g., left cerebral white matter error drops from 12.1$\%$ to 2.1$\%$, cortex from 4.2$\%$ to 3.7$\%$). To conclude, our CSS-Diff can synthesize images that are both quantitatively reliable and anatomically consistent.

Zhen Xuen Brandon Low, Rory Zhang, Hang Min et al.

Enlarged perivascular spaces (PVS) are increasingly recognized as biomarkers of cerebral small vessel disease, Alzheimer's disease, stroke, and aging-related neurodegeneration. However, manual segmentation of PVS is time-consuming and subject to moderate inter-rater reliability, while existing automated deep learning models have moderate performance and typically fail to generalize across diverse clinical and research MRI datasets. We adapted MedNeXt-L-k5, a Transformer-inspired 3D encoder-decoder convolutional network, for automated PVS segmentation. Two models were trained: one using a homogeneous dataset of 200 T2-weighted (T2w) MRI scans from the Human Connectome Project-Aging (HCP-Aging) dataset and another using 40 heterogeneous T1-weighted (T1w) MRI volumes from seven studies across six scanners. Model performance was evaluated using internal 5-fold cross validation (5FCV) and leave-one-site-out cross validation (LOSOCV). MedNeXt-L-k5 models trained on the T2w images of the HCP-Aging dataset achieved voxel-level Dice scores of 0.88+/-0.06 (white matter, WM), comparable to the reported inter-rater reliability of that dataset, and the highest yet reported in the literature. The same models trained on the T1w images of the HCP-Aging dataset achieved a substantially lower Dice score of 0.58+/-0.09 (WM). Under LOSOCV, the model had voxel-level Dice scores of 0.38+/-0.16 (WM) and 0.35+/-0.12 (BG), and cluster-level Dice scores of 0.61+/-0.19 (WM) and 0.62+/-0.21 (BG). MedNeXt-L-k5 provides an efficient solution for automated PVS segmentation across diverse T1w and T2w MRI datasets. MedNeXt-L-k5 did not outperform the nnU-Net, indicating that the attention-based mechanisms present in transformer-inspired models to provide global context are not required for high accuracy in PVS segmentation.

Viswanath P. Sudarshan, Uddeshya Upadhyay, Gary F. Egan et al.

Radiation exposure in positron emission tomography (PET) imaging limits its usage in the studies of radiation-sensitive populations, e.g., pregnant women, children, and adults that require longitudinal imaging. Reducing the PET radiotracer dose or acquisition time reduces photon counts, which can deteriorate image quality. Recent deep-neural-network (DNN) based methods for image-to-image translation enable the mapping of low-quality PET images (acquired using substantially reduced dose), coupled with the associated magnetic resonance imaging (MRI) images, to high-quality PET images. However, such DNN methods focus on applications involving test data that match the statistical characteristics of the training data very closely and give little attention to evaluating the performance of these DNNs on new out-of-distribution (OOD) acquisitions. We propose a novel DNN formulation that models the (i) underlying sinogram-based physics of the PET imaging system and (ii) the uncertainty in the DNN output through the per-voxel heteroscedasticity of the residuals between the predicted and the high-quality reference images. Our sinogram-based uncertainty-aware DNN framework, namely, suDNN, estimates a standard-dose PET image using multimodal input in the form of (i) a low-dose/low-count PET image and (ii) the corresponding multi-contrast MRI images, leading to improved robustness of suDNN to OOD acquisitions. Results on in vivo simultaneous PET-MRI, and various forms of OOD data in PET-MRI, show the benefits of suDNN over the current state of the art, quantitatively and qualitatively.

Spyridon Bakas, Mauricio Reyes, Andras Jakab et al.

Gliomas are the most common primary brain malignancies, with different degrees of aggressiveness, variable prognosis and various heterogeneous histologic sub-regions, i.e., peritumoral edematous/invaded tissue, necrotic core, active and non-enhancing core. This intrinsic heterogeneity is also portrayed in their radio-phenotype, as their sub-regions are depicted by varying intensity profiles disseminated across multi-parametric magnetic resonance imaging (mpMRI) scans, reflecting varying biological properties. Their heterogeneous shape, extent, and location are some of the factors that make these tumors difficult to resect, and in some cases inoperable. The amount of resected tumor is a factor also considered in longitudinal scans, when evaluating the apparent tumor for potential diagnosis of progression. Furthermore, there is mounting evidence that accurate segmentation of the various tumor sub-regions can offer the basis for quantitative image analysis towards prediction of patient overall survival. This study assesses the state-of-the-art machine learning (ML) methods used for brain tumor image analysis in mpMRI scans, during the last seven instances of the International Brain Tumor Segmentation (BraTS) challenge, i.e., 2012-2018. Specifically, we focus on i) evaluating segmentations of the various glioma sub-regions in pre-operative mpMRI scans, ii) assessing potential tumor progression by virtue of longitudinal growth of tumor sub-regions, beyond use of the RECIST/RANO criteria, and iii) predicting the overall survival from pre-operative mpMRI scans of patients that underwent gross total resection. Finally, we investigate the challenge of identifying the best ML algorithms for each of these tasks, considering that apart from being diverse on each instance of the challenge, the multi-institutional mpMRI BraTS dataset has also been a continuously evolving/growing dataset.

Kamlesh Pawar, Zhaolin Chen, N. Jon Shah et al.

Purpose: The suppression of motion artefacts from MR images is a challenging task. The purpose of this paper is to develop a standalone novel technique to suppress motion artefacts from MR images using a data-driven deep learning approach. Methods: A deep learning convolutional neural network (CNN) was developed to remove motion artefacts in brain MR images. A CNN was trained on simulated motion corrupted images to identify and suppress artefacts due to the motion. The network was an encoder-decoder CNN architecture where the encoder decomposed the motion corrupted images into a set of feature maps. The feature maps were then combined by the decoder network to generate a motion-corrected image. The network was tested on an unseen simulated dataset and an experimental, motion corrupted in vivo brain dataset. Results: The trained network was able to suppress the motion artefacts in the simulated motion corrupted images, and the mean percentage error in the motion corrected images was 2.69 % with a standard deviation of 0.95 %. The network was able to effectively suppress the motion artefacts from the experimental dataset, demonstrating the generalisation capability of the trained network. Conclusion: A novel and generic motion correction technique has been developed that can suppress motion artefacts from motion corrupted MR images. The proposed technique is a standalone post-processing method that does not interfere with data acquisition or reconstruction parameters, thus making it suitable for a multitude of MR sequences.