Pierre Croisille

Morgane des Ligneris, Nathan Painchaud, Allan Serva et al.

Pulmonary embolism, the obstruction of a pulmonary artery by a blood clot, is one of the leading causes of acute cardiovascular syndrome. In clinical practice, therapeutic decisions after diagnosis via computed tomography pulmonary angiography rely on risk stratification, which categorizes 30-day mortality risk into three categories. This stratification depends on the right-to-left ventricular diameter ratio and blood levels of two cardiac enzymes. However, blood biomarkers are not always available in emergency settings, and manual calculation of established severity scores - such as Qanadli and Mastora - is time-consuming and rarely performed in clinical routine practice. This study introduces an automated pipeline that models a directed graph representation of the pulmonary arterial tree, labeling its hierarchical structure and characterizing pulmonary embolism. The pipeline derives image-based biomarkers, including local artery-level features (morphological information, hierarchical position, clot volume, and resulting obstruction) and global patient-level biomarkers such as automatically calculated severity scores (Qanadli and Mastora) and the total embolic volume distribution by lobes and hierarchical levels. Using artificial-intelligence-generated binary masks of arteries, emboli, lungs, and lobes, it creates a patient digital twin of the arterial structure. Validation of the pipeline through comparison to an existing pipeline, anatomical expectations, and manual severity score calculations demonstrates the pipeline's ability to automatically generate anatomically accurate digital twins and severity scores with strong agreement. This supports the potential of these image-derived biomarkers to automatically provide rapid, precise information on thrombotic burden and spatial clot distribution.

Nathan Painchaud, Tristan Habémont, Morgane des Ligneris et al.

Risk stratification for pulmonary embolism (PE) is critical for clinical decision-making. Stratification guidelines are based on patient medical records, parameters measured from computed tomography pulmonary angiography (CTPA), and blood tests. However, blood tests are often missing in routine practice. This work studies whether state-of-the-art models can accurately classify risk stratification from only medical records and biomarkers extracted from CTPA images. We benchmark different approaches to combine medical records and cardiac biomarkers with rich pulmonary vascular information; we add vascular biomarkers to tabular models and apply graph neural networks (GNNs) on the vascular tree's intrinsic graph representation. We use a private dataset (n=353) with uniquely complete data for PE risk stratification. Our results show that, among global features, medical records and cardiac biomarkers are the most significant predictors, while vascular biomarkers do not further improve stratification. Even more surprising, even GNNs on vascular graphs fail to outperform strong tabular baseline on global features. We consider hypotheses, on both models and data, that could explain this suboptimal performance. Our investigation suggests that, counter-intuitively, vascular graphs might hold no discriminative information for PE risk stratification. Code is available from https://github.com/creatis-myriad/GENESIS.

Kaifeng Zou, Sylvain Faisan, Fabrice Heitz et al.

By highlighting the regions of the input image that contribute the most to the decision, saliency maps have become a popular method to make neural networks interpretable. In medical imaging, they are particularly well-suited to explain neural networks in the context of abnormality localization. However, from our experiments, they are less suited to classification problems where the features that allow to distinguish between the different classes are spatially correlated, scattered and definitely non-trivial. In this paper we thus propose a new paradigm for better interpretability. To this end we provide the user with relevant and easily interpretable information so that he can form his own opinion. We use Disentangled Variational Auto-Encoders which latent representation is divided into two components: the non-interpretable part and the disentangled part. The latter accounts for the categorical variables explicitly representing the different classes of interest. In addition to providing the class of a given input sample, such a model offers the possibility to transform the sample from a given class to a sample of another class, by modifying the value of the categorical variables in the latent representation. This paves the way to easier interpretation of class differences. We illustrate the relevance of this approach in the context of automatic sex determination from hip bones in forensic medicine. The features encoded by the model, that distinguish the different classes were found to be consistent with expert knowledge.