Hyunjin Park

Inye Na, Jonghun Kim, Eun Sook Ko et al.

Motivated by the question, "Can we generate tumors with desired attributes?'' this study leverages radiomics features to explore the feasibility of generating synthetic tumor images. Characterized by its low-dimensional yet biologically meaningful markers, radiomics bridges the gap between complex medical imaging data and actionable clinical insights. We present RadiomicsFill-Mammo, the first of the RadiomicsFill series, an innovative technique that generates realistic mammogram mass images mirroring specific radiomics attributes using masked images and opposite breast images, leveraging a recent stable diffusion model. This approach also allows for the incorporation of essential clinical variables, such as BI-RADS and breast density, alongside radiomics features as conditions for mass generation. Results indicate that RadiomicsFill-Mammo effectively generates diverse and realistic tumor images based on various radiomics conditions. Results also demonstrate a significant improvement in mass detection capabilities, leveraging RadiomicsFill-Mammo as a strategy to generate simulated samples. Furthermore, RadiomicsFill-Mammo not only advances medical imaging research but also opens new avenues for enhancing treatment planning and tumor simulation. Our code is available at https://github.com/nainye/RadiomicsFill.

Jonghun Kim, Hyunjin Park

Multi-modal images play a crucial role in comprehensive evaluations in medical image analysis providing complementary information for identifying clinically important biomarkers. However, in clinical practice, acquiring multiple modalities can be challenging due to reasons such as scan cost, limited scan time, and safety considerations. In this paper, we propose a model based on the latent diffusion model (LDM) that leverages switchable blocks for image-to-image translation in 3D medical images without patch cropping. The 3D LDM combined with conditioning using the target modality allows generating high-quality target modality in 3D overcoming the shortcoming of the missing out-of-slice information in 2D generation methods. The switchable block, noted as multiple switchable spatially adaptive normalization (MS-SPADE), dynamically transforms source latents to the desired style of the target latents to help with the diffusion process. The MS-SPADE block allows us to have one single model to tackle many translation tasks of one source modality to various targets removing the need for many translation models for different scenarios. Our model exhibited successful image synthesis across different source-target modality scenarios and surpassed other models in quantitative evaluations tested on multi-modal brain magnetic resonance imaging datasets of four different modalities and an independent IXI dataset. Our model demonstrated successful image synthesis across various modalities even allowing for one-to-many modality translations. Furthermore, it outperformed other one-to-one translation models in quantitative evaluations.

Inye Na, Jonghun Kim, Hyunjin Park

We introduce RadiomicsFill, a synthetic tumor generator conditioned on radiomics features, enabling detailed control and individual manipulation of tumor subregions. This conditioning leverages conventional high-dimensional features of the tumor (i.e., radiomics features) and thus is biologically well-grounded. Our model combines generative adversarial networks, radiomics-feature conditioning, and multi-task learning. Through experiments with glioma patients, RadiomicsFill demonstrated its capability to generate diverse, realistic tumors and its fine-tuning ability for specific radiomics features like 'Pixel Surface' and 'Shape Sphericity'. The ability of RadiomicsFill to generate an unlimited number of realistic synthetic tumors offers notable prospects for both advancing medical imaging research and potential clinical applications.

Inye Na, Nejung Rue, Jiwon Chung et al.

Medical image retrieval is a valuable field for supporting clinical decision-making, yet current methods primarily support 2D images and require fully annotated queries, limiting clinical flexibility. To address this, we propose RadiomicsRetrieval, a 3D content-based retrieval framework bridging handcrafted radiomics descriptors with deep learning-based embeddings at the tumor level. Unlike existing 2D approaches, RadiomicsRetrieval fully exploits volumetric data to leverage richer spatial context in medical images. We employ a promptable segmentation model (e.g., SAM) to derive tumor-specific image embeddings, which are aligned with radiomics features extracted from the same tumor via contrastive learning. These representations are further enriched by anatomical positional embedding (APE). As a result, RadiomicsRetrieval enables flexible querying based on shape, location, or partial feature sets. Extensive experiments on both lung CT and brain MRI public datasets demonstrate that radiomics features significantly enhance retrieval specificity, while APE provides global anatomical context essential for location-based searches. Notably, our framework requires only minimal user prompts (e.g., a single point), minimizing segmentation overhead and supporting diverse clinical scenarios. The capability to query using either image embeddings or selected radiomics attributes highlights its adaptability, potentially benefiting diagnosis, treatment planning, and research on large-scale medical imaging repositories. Our code is available at https://github.com/nainye/RadiomicsRetrieval.

Kaiyuan Yang, Fabio Musio, Yihui Ma et al.

The Circle of Willis (CoW) is an important network of arteries connecting major circulations of the brain. Its vascular architecture is believed to affect the risk, severity, and clinical outcome of serious neurovascular diseases. However, characterizing the highly variable CoW anatomy is still a manual and time-consuming expert task. The CoW is usually imaged by two non-invasive angiographic imaging modalities, magnetic resonance angiography (MRA) and computed tomography angiography (CTA), but there exist limited datasets with annotations on CoW anatomy, especially for CTA. Therefore, we organized the TopCoW challenge with the release of an annotated CoW dataset. The TopCoW dataset is the first public dataset with voxel-level annotations for 13 CoW vessel components, enabled by virtual reality technology. It is also the first large dataset using 200 pairs of MRA and CTA from the same patients. As part of the benchmark, we invited submissions worldwide and attracted over 250 registered participants from six continents. The submissions were evaluated on both internal and external test datasets of 226 scans from over five centers. The top performing teams achieved over 90% Dice scores at segmenting the CoW components, over 80% F1 scores at detecting key CoW components, and over 70% balanced accuracy at classifying CoW variants for nearly all test sets. The best algorithms also showed clinical potential in classifying fetal-type posterior cerebral artery and locating aneurysms with CoW anatomy. TopCoW demonstrated the utility and versatility of CoW segmentation algorithms for a wide range of downstream clinical applications with explainability. The annotated datasets and best performing algorithms have been released as public Zenodo records to foster further methodological development and clinical tool building.

Jonghun Kim, Sinyoung Ra, Hyunjin Park

LLMs have demonstrated remarkable capabilities in linguistic reasoning and are increasingly adept at vision-language tasks. The integration of image tokens into transformers has enabled direct visual input and output, advancing research from image-to-text descriptions to text-to-image generation. However, simple text-to-image generation holds limited clinical utility. In medical imaging, tasks such as image segmentation for localizing pathologies or image translation for reconstructing missing sequences have much greater clinical importance. Despite this, integrating these diverse, clinically relevant tasks within a single, versatile language model remains unexplored. Our method, LLaBIT (Large Language Model for Brain Image Translation), extends the visual reasoning of LLMs to these clinically meaningful tasks in the brain MRI domain. To mitigate the spatial information loss inherent in image tokenization, we incorporate a mechanism to reuse feature maps from the image encoder, minimizing data degradation. We also generate text data using LLMs with strict predefined instructions to augment limited image-text paired data in brain MRI. We comprehensively evaluated our method on five brain MRI datasets across four distinct tasks: report generation, visual question answering, image segmentation, and image translation. Our model not only demonstrated superior performance across all tasks but also outperformed specialized, task-specific models in direct comparisons, highlighting its efficacy and versatility

Jonghun Kim, Inye Na, Eun Sook Ko et al.

Due to privacy concerns, obtaining large datasets is challenging in medical image analysis, especially with 3D modalities like Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Existing generative models, developed to address this issue, often face limitations in output diversity and thus cannot accurately represent 3D medical images. We propose a tumor-generation model that utilizes radiomics features as generative conditions. Radiomics features are high-dimensional handcrafted semantic features that are biologically well-grounded and thus are good candidates for conditioning. Our model employs a GAN-based model to generate tumor masks and a diffusion-based approach to generate tumor texture conditioned on radiomics features. Our method allows the user to generate tumor images according to user-specified radiomics features such as size, shape, and texture at an arbitrary location. This enables the physicians to easily visualize tumor images to better understand tumors according to changing radiomics features. Our approach allows for the removal, manipulation, and repositioning of tumors, generating various tumor types in different scenarios. The model has been tested on tumors in four different organs (kidney, lung, breast, and brain) across CT and MRI. The synthesized images are shown to effectively aid in training for downstream tasks and their authenticity was also evaluated through expert evaluations. Our method has potential usage in treatment planning with diverse synthesized tumors.

Jonghun Kim, Hyunjin Park

Neoadjuvant chemotherapy (NAC) is a common therapy option before the main surgery for breast cancer. Response to NAC is monitored using follow-up dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Accurate prediction of NAC response helps with treatment planning. Here, we adopt maximum intensity projection images from DCE-MRI to generate post-treatment images (i.e., 3 or 12 weeks after NAC) from pre-treatment images leveraging the emerging diffusion model. We introduce prompt tuning to account for the known clinical factors affecting response to NAC. Our model performed better than other generative models in image quality metrics. Our model was better at generating images that reflected changes in tumor size according to pCR compared to other models. Ablation study confirmed the design choices of our method. Our study has the potential to help with precision medicine.

Jonghun Kim, Gyeongdeok Jo, Sinyoung Ra et al.

Medical imaging data contain sensitive patient information requiring strong privacy protection. Many analytical setups require data to be sent to a server for inference purposes. Homomorphic encryption (HE) provides a solution by allowing computations to be performed on encrypted data without revealing the original information. However, HE inference is computationally expensive, particularly for large images (e.g., chest X-rays). In this study, we propose an HE inference framework for medical images that uses VQGAN to compress images into latent representations, thereby significantly reducing the computational burden while preserving image quality. We approximate the activation functions with lower-degree polynomials to balance the accuracy and efficiency in compliance with HE requirements. We observed that a downsampling factor of eight for compression achieved an optimal balance between performance and computational cost. We further adapted the squeeze and excitation module, which is known to improve traditional CNNs, to enhance the HE framework. Our method was tested on two chest X-ray datasets for multi-label classification tasks using vanilla CNN backbones. Although HE inference remains relatively slow and introduces minor performance differences compared with unencrypted inference, our approach shows strong potential for practical use in medical images

Jonghun Kim, Hyunjin Park

Breast cancer is the most prevalent cancer among women and predicting pathologic complete response (pCR) after anti-cancer treatment is crucial for patient prognosis and treatment customization. Deep learning has shown promise in medical imaging diagnosis, particularly when utilizing multiple imaging modalities to enhance accuracy. This study presents a model that predicts pCR in breast cancer patients using dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) maps. Radiomics features are established hand-crafted features of the tumor region and thus could be useful in medical image analysis. Our approach extracts features from both DCE MRI and ADC using an encoder with a self-attention mechanism, leveraging radiomics to guide feature extraction from tumor-related regions. Our experimental results demonstrate the superior performance of our model in predicting pCR compared to other baseline methods.

Hugo J. Kuijf, J. Matthijs Biesbroek, Jeroen de Bresser et al.

Quantification of cerebral white matter hyperintensities (WMH) of presumed vascular origin is of key importance in many neurological research studies. Currently, measurements are often still obtained from manual segmentations on brain MR images, which is a laborious procedure. Automatic WMH segmentation methods exist, but a standardized comparison of the performance of such methods is lacking. We organized a scientific challenge, in which developers could evaluate their method on a standardized multi-center/-scanner image dataset, giving an objective comparison: the WMH Segmentation Challenge (https://wmh.isi.uu.nl/). Sixty T1+FLAIR images from three MR scanners were released with manual WMH segmentations for training. A test set of 110 images from five MR scanners was used for evaluation. Segmentation methods had to be containerized and submitted to the challenge organizers. Five evaluation metrics were used to rank the methods: (1) Dice similarity coefficient, (2) modified Hausdorff distance (95th percentile), (3) absolute log-transformed volume difference, (4) sensitivity for detecting individual lesions, and (5) F1-score for individual lesions. Additionally, methods were ranked on their inter-scanner robustness. Twenty participants submitted their method for evaluation. This paper provides a detailed analysis of the results. In brief, there is a cluster of four methods that rank significantly better than the other methods, with one clear winner. The inter-scanner robustness ranking shows that not all methods generalize to unseen scanners. The challenge remains open for future submissions and provides a public platform for method evaluation.