Xuxin Chen

Xuxin Chen, Ke Zhang, Neman Abdoli et al.

Deep convolutional neural networks (CNNs) have been widely used in various medical imaging tasks. However, due to the intrinsic locality of convolution operation, CNNs generally cannot model long-range dependencies well, which are important for accurately identifying or mapping corresponding breast lesion features computed from unregistered multiple mammograms. This motivates us to leverage the architecture of Multi-view Vision Transformers to capture long-range relationships of multiple mammograms from the same patient in one examination. For this purpose, we employ local Transformer blocks to separately learn patch relationships within four mammograms acquired from two-view (CC/MLO) of two-side (right/left) breasts. The outputs from different views and sides are concatenated and fed into global Transformer blocks, to jointly learn patch relationships between four images representing two different views of the left and right breasts. To evaluate the proposed model, we retrospectively assembled a dataset involving 949 sets of mammograms, which include 470 malignant cases and 479 normal or benign cases. We trained and evaluated the model using a five-fold cross-validation method. Without any arduous preprocessing steps (e.g., optimal window cropping, chest wall or pectoral muscle removal, two-view image registration, etc.), our four-image (two-view-two-side) Transformer-based model achieves case classification performance with an area under ROC curve (AUC = 0.818), which significantly outperforms AUC = 0.784 achieved by the state-of-the-art multi-view CNNs (p = 0.009). It also outperforms two one-view-two-side models that achieve AUC of 0.724 (CC view) and 0.769 (MLO view), respectively. The study demonstrates the potential of using Transformers to develop high-performing computer-aided diagnosis schemes that combine four mammograms.

Neman Abdoli, Ke Zhang, Patrik Gilley et al.

2D and 3D tumor features are widely used in a variety of medical image analysis tasks. However, for chemotherapy response prediction, the effectiveness between different kinds of 2D and 3D features are not comprehensively assessed, especially in ovarian cancer-related applications. This investigation aims to accomplish such a comprehensive evaluation. For this purpose, CT images were collected retrospectively from 188 advanced-stage ovarian cancer patients. All the metastatic tumors that occurred in each patient were segmented and then processed by a set of six filters. Next, three categories of features, namely geometric, density, and texture features, were calculated from both the filtered results and the original segmented tumors, generating a total of 1595 and 1403 features for the 3D and 2D tumors, respectively. In addition to the conventional single-slice 2D and full-volume 3D tumor features, we also computed the incomplete-3D tumor features, which were achieved by sequentially adding one individual CT slice and calculating the corresponding features. Support vector machine (SVM) based prediction models were developed and optimized for each feature set. 5-fold cross-validation was used to assess the performance of each individual model. The results show that the 2D feature-based model achieved an AUC (area under the ROC curve [receiver operating characteristic]) of 0.84+-0.02. When adding more slices, the AUC first increased to reach the maximum and then gradually decreased to 0.86+-0.02. The maximum AUC was yielded when adding two adjacent slices, with a value of 0.91+-0.01. This initial result provides meaningful information for optimizing machine learning-based decision-making support tools in the future.

Ke Zhang, Neman Abdoli, Patrik Gilley et al.

Objective Neoadjuvant chemotherapy (NACT) is one kind of treatment for advanced stage ovarian cancer patients. However, due to the nature of tumor heterogeneity, the clinical outcomes to NACT vary significantly among different subgroups. Partial responses to NACT may lead to suboptimal debulking surgery, which will result in adverse prognosis. To address this clinical challenge, the purpose of this study is to develop a novel image marker to achieve high accuracy prognosis prediction of NACT at an early stage. Methods For this purpose, we first computed a total of 1373 radiomics features to quantify the tumor characteristics, which can be grouped into three categories: geometric, intensity, and texture features. Second, all these features were optimized by principal component analysis algorithm to generate a compact and informative feature cluster. This cluster was used as input for developing and optimizing support vector machine (SVM) based classifiers, which indicated the likelihood of receiving suboptimal cytoreduction after the NACT treatment. Two different kernels for SVM algorithm were explored and compared. A total of 42 ovarian cancer cases were retrospectively collected to validate the scheme. A nested leave-one-out cross-validation framework was adopted for model performance assessment. Results The results demonstrated that the model with a Gaussian radial basis function kernel SVM yielded an AUC (area under the ROC [receiver characteristic operation] curve) of 0.806. Meanwhile, this model achieved overall accuracy (ACC) of 83.3%, positive predictive value (PPV) of 81.8%, and negative predictive value (NPV) of 83.9%. Conclusion This study provides meaningful information for the development of radiomics based image markers in NACT treatment outcome prediction.

Xuxin Chen, Yuheng Li, Mingzhe Hu et al.

Although fusion of information from multiple views of mammograms plays an important role to increase accuracy of breast cancer detection, developing multi-view mammograms-based computer-aided diagnosis (CAD) schemes still faces challenges and no such CAD schemes have been used in clinical practice. To overcome the challenges, we investigate a new approach based on Contrastive Language-Image Pre-training (CLIP), which has sparked interest across various medical imaging tasks. By solving the challenges in (1) effectively adapting the single-view CLIP for multi-view feature fusion and (2) efficiently fine-tuning this parameter-dense model with limited samples and computational resources, we introduce Mammo-CLIP, the first multi-modal framework to process multi-view mammograms and corresponding simple texts. Mammo-CLIP uses an early feature fusion strategy to learn multi-view relationships in four mammograms acquired from the CC and MLO views of the left and right breasts. To enhance learning efficiency, plug-and-play adapters are added into CLIP image and text encoders for fine-tuning parameters and limiting updates to about 1% of the parameters. For framework evaluation, we assembled two datasets retrospectively. The first dataset, comprising 470 malignant and 479 benign cases, was used for few-shot fine-tuning and internal evaluation of the proposed Mammo-CLIP via 5-fold cross-validation. The second dataset, including 60 malignant and 294 benign cases, was used to test generalizability of Mammo-CLIP. Study results show that Mammo-CLIP outperforms the state-of-art cross-view transformer in AUC (0.841 vs. 0.817, 0.837 vs. 0.807) on both datasets. It also surpasses previous two CLIP-based methods by 20.3% and 14.3%. This study highlights the potential of applying the finetuned vision-language models for developing next-generation, image-text-based CAD schemes of breast cancer.

Xuxin Chen, Ximin Wang, Ke Zhang et al.

This study aims to develop a novel computer-aided diagnosis (CAD) scheme for mammographic breast mass classification using semi-supervised learning. Although supervised deep learning has achieved huge success across various medical image analysis tasks, its success relies on large amounts of high-quality annotations, which can be challenging to acquire in practice. To overcome this limitation, we propose employing a semi-supervised method, i.e., virtual adversarial training (VAT), to leverage and learn useful information underlying in unlabeled data for better classification of breast masses. Accordingly, our VAT-based models have two types of losses, namely supervised and virtual adversarial losses. The former loss acts as in supervised classification, while the latter loss aims at enhancing model robustness against virtual adversarial perturbation, thus improving model generalizability. To evaluate the performance of our VAT-based CAD scheme, we retrospectively assembled a total of 1024 breast mass images, with equal number of benign and malignant masses. A large CNN and a small CNN were used in this investigation, and both were trained with and without the adversarial loss. When the labeled ratios were 40% and 80%, VAT-based CNNs delivered the highest classification accuracy of 0.740 and 0.760, respectively. The experimental results suggest that the VAT-based CAD scheme can effectively utilize meaningful knowledge from unlabeled data to better classify mammographic breast mass images.

Xuxin Chen, Ximin Wang, Ke Zhang et al.

Deep learning has received extensive research interest in developing new medical image processing algorithms, and deep learning based models have been remarkably successful in a variety of medical imaging tasks to support disease detection and diagnosis. Despite the success, the further improvement of deep learning models in medical image analysis is majorly bottlenecked by the lack of large-sized and well-annotated datasets. In the past five years, many studies have focused on addressing this challenge. In this paper, we reviewed and summarized these recent studies to provide a comprehensive overview of applying deep learning methods in various medical image analysis tasks. Especially, we emphasize the latest progress and contributions of state-of-the-art unsupervised and semi-supervised deep learning in medical image analysis, which are summarized based on different application scenarios, including classification, segmentation, detection, and image registration. We also discuss the major technical challenges and suggest the possible solutions in future research efforts.