Terence J. O’Brien

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.

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.

Khansa Rasheed, Junaid Qadir, Terence J. O'Brien et al.

Prediction of seizure before they occur is vital for bringing normalcy to the lives of patients. Researchers employed machine learning methods using hand-crafted features for seizure prediction. However, ML methods are too complicated to select the best ML model or best features. Deep Learning methods are beneficial in the sense of automatic feature extraction. One of the roadblocks for accurate seizure prediction is scarcity of epileptic seizure data. This paper addresses this problem by proposing a deep convolutional generative adversarial network to generate synthetic EEG samples. We use two methods to validate synthesized data namely, one-class SVM and a new proposal which we refer to as convolutional epileptic seizure predictor (CESP). Another objective of our study is to evaluate performance of well-known deep learning models (e.g., VGG16, VGG19, ResNet50, and Inceptionv3) by training models on augmented data using transfer learning with average time of 10 min between true prediction and seizure onset. Our results show that CESP model achieves sensitivity of 78.11% and 88.21%, and FPR of 0.27/h and 0.14/h for training on synthesized and testing on real Epilepsyecosystem and CHB-MIT datasets, respectively. Effective results of CESP trained on synthesized data shows that synthetic data acquired the correlation between features and labels very well. We also show that employment of idea of transfer learning and data augmentation in patient-specific manner provides highest accuracy with sensitivity of 90.03% and 0.03 FPR/h which was achieved using Inceptionv3, and that augmenting data with samples generated from DCGAN increased prediction results of our CESP model and Inceptionv3 by 4-5% as compared to state-of-the-art traditional augmentation techniques. Finally, we note that prediction results of CESP achieved by using augmented data are better than chance level for both datasets.

Khansa Rasheed, Adnan Qayyum, Junaid Qadir et al.

With the advancement in artificial intelligence (AI) and machine learning (ML) techniques, researchers are striving towards employing these techniques for advancing clinical practice. One of the key objectives in healthcare is the early detection and prediction of disease to timely provide preventive interventions. This is especially the case for epilepsy, which is characterized by recurrent and unpredictable seizures. Patients can be relieved from the adverse consequences of epileptic seizures if it could somehow be predicted in advance. Despite decades of research, seizure prediction remains an unsolved problem. This is likely to remain at least partly because of the inadequate amount of data to resolve the problem. There have been exciting new developments in ML-based algorithms that have the potential to deliver a paradigm shift in the early and accurate prediction of epileptic seizures. Here we provide a comprehensive review of state-of-the-art ML techniques in early prediction of seizures using EEG signals. We will identify the gaps, challenges, and pitfalls in the current research and recommend future directions.