Stephen T.C. Wong

Haomiao Ni, Yuan Xue, Kelvin Wong et al.

Accurate infarct segmentation in non-contrast CT (NCCT) images is a crucial step toward computer-aided acute ischemic stroke (AIS) assessment. In clinical practice, bilateral symmetric comparison of brain hemispheres is usually used to locate pathological abnormalities. Recent research has explored asymmetries to assist with AIS segmentation. However, most previous symmetry-based work mixed different types of asymmetries when evaluating their contribution to AIS. In this paper, we propose a novel Asymmetry Disentanglement Network (ADN) to automatically separate pathological asymmetries and intrinsic anatomical asymmetries in NCCTs for more effective and interpretable AIS segmentation. ADN first performs asymmetry disentanglement based on input NCCTs, which produces different types of 3D asymmetry maps. Then a synthetic, intrinsic-asymmetry-compensated and pathology-asymmetry-salient NCCT volume is generated and later used as input to a segmentation network. The training of ADN incorporates domain knowledge and adopts a tissue-type aware regularization loss function to encourage clinically-meaningful pathological asymmetry extraction. Coupled with an unsupervised 3D transformation network, ADN achieves state-of-the-art AIS segmentation performance on a public NCCT dataset. In addition to the superior performance, we believe the learned clinically-interpretable asymmetry maps can also provide insights towards a better understanding of AIS assessment. Our code is available at https://github.com/nihaomiao/MICCAI22_ADN.

Yanglan Ou, Ye Yuan, Xiaolei Huang et al. · cmu

We present a new encoder-decoder Vision Transformer architecture, Patcher, for medical image segmentation. Unlike standard Vision Transformers, it employs Patcher blocks that segment an image into large patches, each of which is further divided into small patches. Transformers are applied to the small patches within a large patch, which constrains the receptive field of each pixel. We intentionally make the large patches overlap to enhance intra-patch communication. The encoder employs a cascade of Patcher blocks with increasing receptive fields to extract features from local to global levels. This design allows Patcher to benefit from both the coarse-to-fine feature extraction common in CNNs and the superior spatial relationship modeling of Transformers. We also propose a new mixture-of-experts (MoE) based decoder, which treats the feature maps from the encoder as experts and selects a suitable set of expert features to predict the label for each pixel. The use of MoE enables better specializations of the expert features and reduces interference between them during inference. Extensive experiments demonstrate that Patcher outperforms state-of-the-art Transformer- and CNN-based approaches significantly on stroke lesion segmentation and polyp segmentation. Code for Patcher is released with publication to facilitate future research.

Michael Livanos, Ian Davidson, Stephen Wong

Knowledge distillation is a simple but powerful way to transfer knowledge between a teacher model to a student model. Existing work suffers from at least one of the following key limitations in terms of direction and scope of transfer which restrict its use: all knowledge is transferred from teacher to student regardless of whether or not that knowledge is useful, the student is the only one learning in this exchange, and typically distillation transfers knowledge only from a single teacher to a single student. We formulate a novel form of knowledge distillation in which many models can act as both students and teachers which we call cooperative distillation. The models cooperate as follows: a model (the student) identifies specific deficiencies in it's performance and searches for another model (the teacher) who encodes learned knowledge into instructional virtual instances via counterfactual instance generation. Because different models may have different strengths and weaknesses, all models can act as either students or teachers (cooperation) when appropriate and only distill knowledge in areas specific to their strengths (focus). Since counterfactuals as a paradigm are not tied to any specific algorithm, we can use this method to distill knowledge between learners of different architectures, algorithms, and even feature spaces. We demonstrate that our approach not only outperforms baselines such as transfer learning, self-supervised learning, and multiple knowledge distillation algorithms on several datasets, but it can also be used in settings where the aforementioned techniques cannot.

Jiahao Huang, Weiping Ding, Jun Lv et al.

In clinical medicine, magnetic resonance imaging (MRI) is one of the most important tools for diagnosis, triage, prognosis, and treatment planning. However, MRI suffers from an inherent slow data acquisition process because data is collected sequentially in k-space. In recent years, most MRI reconstruction methods proposed in the literature focus on holistic image reconstruction rather than enhancing the edge information. This work steps aside this general trend by elaborating on the enhancement of edge information. Specifically, we introduce a novel parallel imaging coupled dual discriminator generative adversarial network (PIDD-GAN) for fast multi-channel MRI reconstruction by incorporating multi-view information. The dual discriminator design aims to improve the edge information in MRI reconstruction. One discriminator is used for holistic image reconstruction, whereas the other one is responsible for enhancing edge information. An improved U-Net with local and global residual learning is proposed for the generator. Frequency channel attention blocks (FCA Blocks) are embedded in the generator for incorporating attention mechanisms. Content loss is introduced to train the generator for better reconstruction quality. We performed comprehensive experiments on Calgary-Campinas public brain MR dataset and compared our method with state-of-the-art MRI reconstruction methods. Ablation studies of residual learning were conducted on the MICCAI13 dataset to validate the proposed modules. Results show that our PIDD-GAN provides high-quality reconstructed MR images, with well-preserved edge information. The time of single-image reconstruction is below 5ms, which meets the demand of faster processing.

Tongan Cai, Haomiao Ni, Mingli Yu et al.

In an emergency room (ER) setting, stroke triage or screening is a common challenge. A quick CT is usually done instead of MRI due to MRI's slow throughput and high cost. Clinical tests are commonly referred to during the process, but the misdiagnosis rate remains high. We propose a novel multimodal deep learning framework, DeepStroke, to achieve computer-aided stroke presence assessment by recognizing patterns of minor facial muscles incoordination and speech inability for patients with suspicion of stroke in an acute setting. Our proposed DeepStroke takes one-minute facial video data and audio data readily available during stroke triage for local facial paralysis detection and global speech disorder analysis. Transfer learning was adopted to reduce face-attribute biases and improve generalizability. We leverage a multi-modal lateral fusion to combine the low- and high-level features and provide mutual regularization for joint training. Novel adversarial training is introduced to obtain identity-free and stroke-discriminative features. Experiments on our video-audio dataset with actual ER patients show that DeepStroke outperforms state-of-the-art models and achieves better performance than both a triage team and ER doctors, attaining a 10.94% higher sensitivity and maintaining 7.37% higher accuracy than traditional stroke triage when specificity is aligned. Meanwhile, each assessment can be completed in less than six minutes, demonstrating the framework's great potential for clinical translation.

Yanglan Ou, Ye Yuan, Xiaolei Huang et al.

Diffusion-weighted (DW) magnetic resonance imaging is essential for the diagnosis and treatment of ischemic stroke. DW images (DWIs) are usually acquired in multi-slice settings where lesion areas in two consecutive 2D slices are highly discontinuous due to large slice thickness and sometimes even slice gaps. Therefore, although DWIs contain rich 3D information, they cannot be treated as regular 3D or 2D images. Instead, DWIs are somewhere in-between (or 2.5D) due to the volumetric nature but inter-slice discontinuities. Thus, it is not ideal to apply most existing segmentation methods as they are designed for either 2D or 3D images. To tackle this problem, we propose a new neural network architecture tailored for segmenting highly-discontinuous 2.5D data such as DWIs. Our network, termed LambdaUNet, extends UNet by replacing convolutional layers with our proposed Lambda+ layers. In particular, Lambda+ layers transform both intra-slice and inter-slice context around a pixel into linear functions, called lambdas, which are then applied to the pixel to produce informative 2.5D features. LambdaUNet is simple yet effective in combining sparse inter-slice information from adjacent slices while also capturing dense contextual features within a single slice. Experiments on a unique clinical dataset demonstrate that LambdaUNet outperforms existing 3D/2D image segmentation methods including recent variants of UNet. Code for LambdaUNet is released with the publication to facilitate future research.

Maoqiang Wu, Xinyue Zhang, Jiahao Ding et al.

Deep learning has attracted broad interest in healthcare and medical communities. However, there has been little research into the privacy issues created by deep networks trained for medical applications. Recently developed inference attack algorithms indicate that images and text records can be reconstructed by malicious parties that have the ability to query deep networks. This gives rise to the concern that medical images and electronic health records containing sensitive patient information are vulnerable to these attacks. This paper aims to attract interest from researchers in the medical deep learning community to this important problem. We evaluate two prominent inference attack models, namely, attribute inference attack and model inversion attack. We show that they can reconstruct real-world medical images and clinical reports with high fidelity. We then investigate how to protect patients' privacy using defense mechanisms, such as label perturbation and model perturbation. We provide a comparison of attack results between the original and the medical deep learning models with defenses. The experimental evaluations show that our proposed defense approaches can effectively reduce the potential privacy leakage of medical deep learning from the inference attacks.