José Ignacio Orlando

Duilio Deangeli, Emmanuel Iarussi, Juan Pablo Princich et al.

Although normal homologous brain structures are approximately symmetrical by definition, they also have shape differences due to e.g. natural ageing. On the other hand, neurodegenerative conditions induce their own changes in this asymmetry, making them more pronounced or altering their location. Identifying when these alterations are due to a pathological deterioration is still challenging. Current clinical tools rely either on subjective evaluations, basic volume measurements or disease-specific deep learning models. This paper introduces a novel method to learn normal asymmetry patterns in homologous brain structures based on anomaly detection and representation learning. Our framework uses a Siamese architecture to map 3D segmentations of left and right hemispherical sides of a brain structure to a normal asymmetry embedding space, learned using a support vector data description objective. Being trained using healthy samples only, it can quantify deviations-from-normal-asymmetry patterns in unseen samples by measuring the distance of their embeddings to the center of the learned normal space. We demonstrate in public and in-house sets that our method can accurately characterize normal asymmetries and detect pathological alterations due to Alzheimer's disease and hippocampal sclerosis, even though no diseased cases were accessed for training. Our source code is available at https://github.com/duiliod/DeepNORHA.

Eugenia Moris, Alicia Costábile, Sebastián Rey et al.

Plaque assays remain the gold standard readout of virus infectivity; however, plaque counting from plate images is labor-intensive and prone to inter-operator variability. We present an end-to-end, computer-aided workflow for cytopathic effect-based virus titration directly from laboratory plaque assay images. The proposed approach combines two models derived from the Segment Anything Model (SAM): a SAM2-based well-segmentation module that localizes assay wells across heterogeneous imaging conditions, and a SAM-based plaque-segmentation model that detects and enumerates plaques within each well. The method was evaluated on a mixed dataset comprising private plaque assay images of Mayaro virus and Coxsackievirus B3, together with public Vaccinia virus images from the VACVPlaque dataset. The pipeline outputs per-well plaque counts, automatically computes plaque-forming units per milliliter (PFU/mL), and is integrated into a web-based platform that allows users to review results and organize experiments. On held-out plates (17 from MAYV/CVB3 and 22 from VACV), the workflow generalized across two plate formats (6-well and 12-well) and showed strong agreement with manual annotations (Pearson correlation coefficients of 0.92 for MAYV/CVB3 and 0.88 for VACV). Automated plaque counts were further compared with annotations from four independent experts, demonstrating high concordance. The proposed system will be open sourced and publicly released upon acceptance of this manuscript to enable reproducible, scalable, and audit-ready plaque assay analysis while substantially reducing manual annotation effort.

Camila García, Yibin Fang, Jianmin Liu et al.

Segmentation of brain arterio-venous malformations (bAVMs) in 3D rotational angiographies (3DRA) is still an open problem in the literature, with high relevance for clinical practice. While deep learning models have been applied for segmenting the brain vasculature in these images, they have never been used in cases with bAVMs. This is likely caused by the difficulty to obtain sufficiently annotated data to train these approaches. In this paper we introduce a first deep learning model for blood vessel segmentation in 3DRA images of patients with bAVMs. To this end, we densely annotated 5 3DRA volumes of bAVM cases and used these to train two alternative 3DUNet-based architectures with different segmentation objectives. Our results show that the networks reach a comprehensive coverage of relevant structures for bAVM analysis, much better than what is obtained using standard methods. This is promising for achieving a better topological and morphological characterisation of the bAVM structures of interest. Furthermore, the models have the ability to segment venous structures even when missing in the ground truth labelling, which is relevant for planning interventional treatments. Ultimately, these results could be used as more reliable first initial guesses, alleviating the cumbersome task of creating manual labels.

Tomás Castilla, Marcela S. Martínez, Mercedes Leguía et al.

Deep learning is currently the state-of-the-art for automated detection of referable diabetic retinopathy (DR) from color fundus photographs (CFP). While the general interest is put on improving results through methodological innovations, it is not clear how good these approaches perform compared to standard deep classification models trained with the appropriate settings. In this paper we propose to model a strong baseline for this task based on a simple and standard ResNet-18 architecture. To this end, we built on top of prior art by training the model with a standard preprocessing strategy but using images from several public sources and an empirically calibrated data augmentation setting. To evaluate its performance, we covered multiple clinically relevant perspectives, including image and patient level DR screening, discriminating responses by input quality and DR grade, assessing model uncertainties and analyzing its results in a qualitative manner. With no other methodological innovation than a carefully designed training, our ResNet model achieved an AUC = 0.955 (0.953 - 0.956) on a combined test set of 61007 test images from different public datasets, which is in line or even better than what other more complex deep learning models reported in the literature. Similar AUC values were obtained in 480 images from two separate in-house databases specially prepared for this study, which emphasize its generalization ability. This confirms that standard networks can still be strong baselines for this task if properly trained.

Eugenia Moris, Nicolás Dazeo, Maria Paula Albina de Rueda et al.

Automated optic disc (OD) and optic cup (OC) segmentation in fundus images is relevant to efficiently measure the vertical cup-to-disc ratio (vCDR), a biomarker commonly used in ophthalmology to determine the degree of glaucomatous optic neuropathy. In general this is solved using coarse-to-fine deep learning algorithms in which a first stage approximates the OD and a second one uses a crop of this area to predict OD/OC masks. While this approach is widely applied in the literature, there are no studies analyzing its real contribution to the results. In this paper we present a comprehensive analysis of different coarse-to-fine designs for OD/OC segmentation using 5 public databases, both from a standard segmentation perspective and for estimating the vCDR for glaucoma assessment. Our analysis shows that these algorithms not necessarily outperfom standard multi-class single-stage models, especially when these are learned from sufficiently large and diverse training sets. Furthermore, we noticed that the coarse stage achieves better OD segmentation results than the fine one, and that providing OD supervision to the second stage is essential to ensure accurate OC masks. Moreover, both the single-stage and two-stage models trained on a multi-dataset setting showed results in pair or even better than other state-of-the-art alternatives, while ranking first in REFUGE for OD/OC segmentation. Finally, we evaluated the models for vCDR prediction in comparison with six ophthalmologists on a subset of AIROGS images, to understand them in the context of inter-observer variability. We noticed that vCDR estimates recovered both from single-stage and coarse-to-fine models can obtain good glaucoma detection results even when they are not highly correlated with manual measurements from experts.

Huihui Fang, Fei Li, Junde Wu et al.

With the rapid development of artificial intelligence (AI) in medical image processing, deep learning in color fundus photography (CFP) analysis is also evolving. Although there are some open-source, labeled datasets of CFPs in the ophthalmology community, large-scale datasets for screening only have labels of disease categories, and datasets with annotations of fundus structures are usually small in size. In addition, labeling standards are not uniform across datasets, and there is no clear information on the acquisition device. Here we release a multi-annotation, multi-quality, and multi-device color fundus image dataset for glaucoma analysis on an original challenge -- Retinal Fundus Glaucoma Challenge 2nd Edition (REFUGE2). The REFUGE2 dataset contains 2000 color fundus images with annotations of glaucoma classification, optic disc/cup segmentation, as well as fovea localization. Meanwhile, the REFUGE2 challenge sets three sub-tasks of automatic glaucoma diagnosis and fundus structure analysis and provides an online evaluation framework. Based on the characteristics of multi-device and multi-quality data, some methods with strong generalizations are provided in the challenge to make the predictions more robust. This shows that REFUGE2 brings attention to the characteristics of real-world multi-domain data, bridging the gap between scientific research and clinical application.

José Ignacio Orlando, Elena Prokofyeva, Mariana del Fresno et al.

Diabetic retinopathy is one of the leading causes of preventable blindness in the world. Its earliest sign are red lesions, a general term that groups both microaneurysms and hemorrhages. In daily clinical practice, these lesions are manually detected by physicians using fundus photographs. However, this task is tedious and time consuming, and requires an intensive effort due to the small size of the lesions and their lack of contrast. Computer-assisted diagnosis of DR based on red lesion detection is being actively explored due to its improvement effects both in clinicians consistency and accuracy. Several methods for detecting red lesions have been proposed in the literature, most of them based on characterizing lesion candidates using hand crafted features, and classifying them into true or false positive detections. Deep learning based approaches, by contrast, are scarce in this domain due to the high expense of annotating the lesions manually. In this paper we propose a novel method for red lesion detection based on combining both deep learned and domain knowledge. Features learned by a CNN are augmented by incorporating hand crafted features. Such ensemble vector of descriptors is used afterwards to identify true lesion candidates using a Random Forest classifier. We empirically observed that combining both sources of information significantly improve results with respect to using each approach separately. Furthermore, our method reported the highest performance on a per-lesion basis on DIARETDB1 and e-ophtha, and for screening and need for referral on MESSIDOR compared to a second human expert. Results highlight the fact that integrating manually engineered approaches with deep learned features is relevant to improve results when the networks are trained from lesion-level annotated data. An open source implementation of our system is publicly available online.

José Ignacio Orlando, Hugo Luis Manterola, Enzo Ferrante et al.

Arabidopsis thaliana is a plant species widely utilized by scientists to estimate the impact of genetic differences in root morphological features. For this purpose, images of this plant after genetic modifications are taken to study differences in the root architecture. This task requires manual segmentations of radicular structures, although this is a particularly tedious and time-consuming labor. In this work, we present an unsupervised method for Arabidopsis thaliana root segmentation based on morphological operations and fully-connected Conditional Random Fields. Although other approaches have been proposed to this purpose, all of them are based on more complex and expensive imaging modalities. Our results prove that our method can be easily applied over images taken using conventional scanners, with a minor user intervention. A first data set, our results and a fully open source implementation are available online.

Lucas Gabriel Telesco, Danila Nejamkin, Estefanía Mata et al.

Retinal image quality assessment (RIQA) supports computer-aided diagnosis of eye diseases. However, most tools classify only overall image quality, without indicating acquisition defects to guide recapture. This gap is mainly due to the high cost of detailed annotations. In this paper, we aim to mitigate this limitation by introducing a hybrid semi-supervised learning approach that combines manual labels for overall quality with pseudo-labels of quality details within a multi-task framework. Our objective is to obtain more interpretable RIQA models without requiring extensive manual labeling. Pseudo-labels are generated by a Teacher model trained on a small dataset and then used to fine-tune a pre-trained model in a multi-task setting. Using a ResNet-18 backbone, we show that these weak annotations improve quality assessment over single-task baselines (F1: 0.875 vs. 0.863 on EyeQ, and 0.778 vs. 0.763 on DeepDRiD), matching or surpassing existing methods. The multi-task model achieved performance statistically comparable to the Teacher for most detail prediction tasks (p > 0.05). In a newly annotated EyeQ subset released with this paper, our model performed similarly to experts, suggesting that pseudo-label noise aligns with expert variability. Our main finding is that the proposed semi-supervised approach not only improves overall quality assessment but also provides interpretable feedback on capture conditions (illumination, clarity, contrast). This enhances interpretability at no extra manual labeling cost and offers clinically actionable outputs to guide image recapture.

Franco Javier Arellano, José Ignacio Orlando

Diabetic Macular Edema (DME) is a leading cause of vision loss among patients with Diabetic Retinopathy (DR). While deep learning has shown promising results for automatically detecting this condition from fundus images, its application remains challenging due the limited availability of annotated data. Foundation Models (FM) have emerged as an alternative solution. However, it is unclear if they can cope with DME detection in particular. In this paper, we systematically compare different FM and standard transfer learning approaches for this task. Specifically, we compare the two most popular FM for retinal images--RETFound and FLAIR--and an EfficientNet-B0 backbone, across different training regimes and evaluation settings in IDRiD, MESSIDOR-2 and OCT-and-Eye-Fundus-Images (OEFI). Results show that despite their scale, FM do not consistently outperform fine-tuned CNNs in this task. In particular, an EfficientNet-B0 ranked first or second in terms of area under the ROC and precision/recall curves in most evaluation settings, with RETFound only showing promising results in OEFI. FLAIR, on the other hand, demonstrated competitive zero-shot performance, achieving notable AUC-PR scores when prompted appropriately. These findings reveal that FM might not be a good tool for fine-grained ophthalmic tasks such as DME detection even after fine-tuning, suggesting that lightweight CNNs remain strong baselines in data-scarce environments.

Huihui Fang, Fei Li, Junde Wu et al.

Pathologic myopia (PM) is a common blinding retinal degeneration suffered by highly myopic population. Early screening of this condition can reduce the damage caused by the associated fundus lesions and therefore prevent vision loss. Automated diagnostic tools based on artificial intelligence methods can benefit this process by aiding clinicians to identify disease signs or to screen mass populations using color fundus photographs as inputs. This paper provides insights about PALM, our open fundus imaging dataset for pathological myopia recognition and anatomical structure annotation. Our databases comprises 1200 images with associated labels for the pathologic myopia category and manual annotations of the optic disc, the position of the fovea and delineations of lesions such as patchy retinal atrophy (including peripapillary atrophy) and retinal detachment. In addition, this paper elaborates on other details such as the labeling process used to construct the database, the quality and characteristics of the samples and provides other relevant usage notes.

Huihui Fang, Fei Li, Huazhu Fu et al.

Age-related macular degeneration (AMD) is the leading cause of visual impairment among elderly in the world. Early detection of AMD is of great importance, as the vision loss caused by this disease is irreversible and permanent. Color fundus photography is the most cost-effective imaging modality to screen for retinal disorders. Cutting edge deep learning based algorithms have been recently developed for automatically detecting AMD from fundus images. However, there are still lack of a comprehensive annotated dataset and standard evaluation benchmarks. To deal with this issue, we set up the Automatic Detection challenge on Age-related Macular degeneration (ADAM), which was held as a satellite event of the ISBI 2020 conference. The ADAM challenge consisted of four tasks which cover the main aspects of detecting and characterizing AMD from fundus images, including detection of AMD, detection and segmentation of optic disc, localization of fovea, and detection and segmentation of lesions. As part of the challenge, we have released a comprehensive dataset of 1200 fundus images with AMD diagnostic labels, pixel-wise segmentation masks for both optic disc and AMD-related lesions (drusen, exudates, hemorrhages and scars, among others), as well as the coordinates corresponding to the location of the macular fovea. A uniform evaluation framework has been built to make a fair comparison of different models using this dataset. During the challenge, 610 results were submitted for online evaluation, with 11 teams finally participating in the onsite challenge. This paper introduces the challenge, the dataset and the evaluation methods, as well as summarizes the participating methods and analyzes their results for each task. In particular, we observed that the ensembling strategy and the incorporation of clinical domain knowledge were the key to improve the performance of the deep learning models.

Junde Wu, Huihui Fang, Fei Li et al.

Color fundus photography and Optical Coherence Tomography (OCT) are the two most cost-effective tools for glaucoma screening. Both two modalities of images have prominent biomarkers to indicate glaucoma suspected. Clinically, it is often recommended to take both of the screenings for a more accurate and reliable diagnosis. However, although numerous algorithms are proposed based on fundus images or OCT volumes in computer-aided diagnosis, there are still few methods leveraging both of the modalities for the glaucoma assessment. Inspired by the success of Retinal Fundus Glaucoma Challenge (REFUGE) we held previously, we set up the Glaucoma grAding from Multi-Modality imAges (GAMMA) Challenge to encourage the development of fundus \& OCT-based glaucoma grading. The primary task of the challenge is to grade glaucoma from both the 2D fundus images and 3D OCT scanning volumes. As part of GAMMA, we have publicly released a glaucoma annotated dataset with both 2D fundus color photography and 3D OCT volumes, which is the first multi-modality dataset for glaucoma grading. In addition, an evaluation framework is also established to evaluate the performance of the submitted methods. During the challenge, 1272 results were submitted, and finally, top-10 teams were selected to the final stage. We analysis their results and summarize their methods in the paper. Since all these teams submitted their source code in the challenge, a detailed ablation study is also conducted to verify the effectiveness of the particular modules proposed. We find many of the proposed techniques are practical for the clinical diagnosis of glaucoma. As the first in-depth study of fundus \& OCT multi-modality glaucoma grading, we believe the GAMMA Challenge will be an essential starting point for future research.

Pablo Navarro, José Ignacio Orlando, Claudio Delrieux et al.

Finding point-wise correspondences between images is a long-standing problem in image analysis. This becomes particularly challenging for sketch images, due to the varying nature of human drawing style, projection distortions and viewport changes. In this paper we present the first attempt to obtain a learned descriptor for dense registration in line drawings. Based on recent deep learning techniques for corresponding photographs, we designed descriptors to locally match image pairs where the object of interest belongs to the same semantic category, yet still differ drastically in shape, form, and projection angle. To this end, we have specifically crafted a data set of synthetic sketches using non-photorealistic rendering over a large collection of part-based registered 3D models. After training, a neural network generates descriptors for every pixel in an input image, which are shown to generalize correctly in unseen sketches hand-drawn by humans. We evaluate our method against a baseline of correspondences data collected from expert designers, in addition to comparisons with other descriptors that have been proven effective in sketches. Code, data and further resources will be publicly released by the time of publication.

José Ignacio Orlando, Huazhu Fu, João Barbossa Breda et al.

Glaucoma is one of the leading causes of irreversible but preventable blindness in working age populations. Color fundus photography (CFP) is the most cost-effective imaging modality to screen for retinal disorders. However, its application to glaucoma has been limited to the computation of a few related biomarkers such as the vertical cup-to-disc ratio. Deep learning approaches, although widely applied for medical image analysis, have not been extensively used for glaucoma assessment due to the limited size of the available data sets. Furthermore, the lack of a standardize benchmark strategy makes difficult to compare existing methods in a uniform way. In order to overcome these issues we set up the Retinal Fundus Glaucoma Challenge, REFUGE (\url{https://refuge.grand-challenge.org}), held in conjunction with MICCAI 2018. The challenge consisted of two primary tasks, namely optic disc/cup segmentation and glaucoma classification. As part of REFUGE, we have publicly released a data set of 1200 fundus images with ground truth segmentations and clinical glaucoma labels, currently the largest existing one. We have also built an evaluation framework to ease and ensure fairness in the comparison of different models, encouraging the development of novel techniques in the field. 12 teams qualified and participated in the online challenge. This paper summarizes their methods and analyzes their corresponding results. In particular, we observed that two of the top-ranked teams outperformed two human experts in the glaucoma classification task. Furthermore, the segmentation results were in general consistent with the ground truth annotations, with complementary outcomes that can be further exploited by ensembling the results.

José Ignacio Orlando, Anna Breger, Hrvoje Bogunović et al.

Segmenting anatomical structures such as the photoreceptor layer in retinal optical coherence tomography (OCT) scans is challenging in pathological scenarios. Supervised deep learning models trained with standard loss functions are usually able to characterize only the most common disease appeareance from a training set, resulting in suboptimal performance and poor generalization when dealing with unseen lesions. In this paper we propose to overcome this limitation by means of an augmented target loss function framework. We introduce a novel amplified-target loss that explicitly penalizes errors within the central area of the input images, based on the observation that most of the challenging disease appeareance is usually located in this area. We experimentally validated our approach using a data set with OCT scans of patients with macular diseases. We observe increased performance compared to the models that use only the standard losses. Our proposed loss function strongly supports the segmentation model to better distinguish photoreceptors in highly pathological scenarios.

Rhona Asgari, José Ignacio Orlando, Sebastian Waldstein et al.

Automated drusen segmentation in retinal optical coherence tomography (OCT) scans is relevant for understanding age-related macular degeneration (AMD) risk and progression. This task is usually performed by segmenting the top/bottom anatomical interfaces that define drusen, the outer boundary of the retinal pigment epithelium (OBRPE) and the Bruch's membrane (BM), respectively. In this paper we propose a novel multi-decoder architecture that tackles drusen segmentation as a multitask problem. Instead of training a multiclass model for OBRPE/BM segmentation, we use one decoder per target class and an extra one aiming for the area between the layers. We also introduce connections between each class-specific branch and the additional decoder to increase the regularization effect of this surrogate task. We validated our approach on private/public data sets with 166 early/intermediate AMD Spectralis, and 200 AMD and control Bioptigen OCT volumes, respectively. Our method consistently outperformed several baselines in both layer and drusen segmentation evaluations.

Philipp Seeböck, José Ignacio Orlando, Thomas Schlegl et al.

Diagnosis and treatment guidance are aided by detecting relevant biomarkers in medical images. Although supervised deep learning can perform accurate segmentation of pathological areas, it is limited by requiring a-priori definitions of these regions, large-scale annotations, and a representative patient cohort in the training set. In contrast, anomaly detection is not limited to specific definitions of pathologies and allows for training on healthy samples without annotation. Anomalous regions can then serve as candidates for biomarker discovery. Knowledge about normal anatomical structure brings implicit information for detecting anomalies. We propose to take advantage of this property using bayesian deep learning, based on the assumption that epistemic uncertainties will correlate with anatomical deviations from a normal training set. A Bayesian U-Net is trained on a well-defined healthy environment using weak labels of healthy anatomy produced by existing methods. At test time, we capture epistemic uncertainty estimates of our model using Monte Carlo dropout. A novel post-processing technique is then applied to exploit these estimates and transfer their layered appearance to smooth blob-shaped segmentations of the anomalies. We experimentally validated this approach in retinal optical coherence tomography (OCT) images, using weak labels of retinal layers. Our method achieved a Dice index of 0.789 in an independent anomaly test set of age-related macular degeneration (AMD) cases. The resulting segmentations allowed very high accuracy for separating healthy and diseased cases with late wet AMD, dry geographic atrophy (GA), diabetic macular edema (DME) and retinal vein occlusion (RVO). Finally, we qualitatively observed that our approach can also detect other deviations in normal scans such as cut edge artifacts.

Philipp Seeböck, David Romo-Bucheli, Sebastian Waldstein et al.

Optical coherence tomography (OCT) has become the most important imaging modality in ophthalmology. A substantial amount of research has recently been devoted to the development of machine learning (ML) models for the identification and quantification of pathological features in OCT images. Among the several sources of variability the ML models have to deal with, a major factor is the acquisition device, which can limit the ML model's generalizability. In this paper, we propose to reduce the image variability across different OCT devices (Spectralis and Cirrus) by using CycleGAN, an unsupervised unpaired image transformation algorithm. The usefulness of this approach is evaluated in the setting of retinal fluid segmentation, namely intraretinal cystoid fluid (IRC) and subretinal fluid (SRF). First, we train a segmentation model on images acquired with a source OCT device. Then we evaluate the model on (1) source, (2) target and (3) transformed versions of the target OCT images. The presented transformation strategy shows an F1 score of 0.4 (0.51) for IRC (SRF) segmentations. Compared with traditional transformation approaches, this means an F1 score gain of 0.2 (0.12).

José Ignacio Orlando, Philipp Seeböck, Hrvoje Bogunović et al.

In this paper, we introduce a Bayesian deep learning based model for segmenting the photoreceptor layer in pathological OCT scans. Our architecture provides accurate segmentations of the photoreceptor layer and produces pixel-wise epistemic uncertainty maps that highlight potential areas of pathologies or segmentation errors. We empirically evaluated this approach in two sets of pathological OCT scans of patients with age-related macular degeneration, retinal vein oclussion and diabetic macular edema, improving the performance of the baseline U-Net both in terms of the Dice index and the area under the precision/recall curve. We also observed that the uncertainty estimates were inversely correlated with the model performance, underlying its utility for highlighting areas where manual inspection/correction might be needed.

José Ignacio Orlando, João Barbosa Breda, Karel van Keer et al.

Glaucoma is the leading cause of irreversible but preventable blindness in the world. Its major treatable risk factor is the intra-ocular pressure, although other biomarkers are being explored to improve the understanding of the pathophysiology of the disease. It has been recently observed that glaucoma induces changes in the ocular hemodynamics. However, its effects on the functional behavior of the retinal arterioles have not been studied yet. In this paper we propose a first approach for characterizing those changes using computational hemodynamics. The retinal blood flow is simulated using a 0D model for a steady, incompressible non Newtonian fluid in rigid domains. The simulation is performed on patient-specific arterial trees extracted from fundus images. We also propose a novel feature representation technique to comprise the outcomes of the simulation stage into a fixed length feature vector that can be used for classification studies. Our experiments on a new database of fundus images show that our approach is able to capture representative changes in the hemodynamics of glaucomatous patients. Code and data are publicly available in https://ignaciorlando.github.io.