VoxelPrompt: A Vision-Language Agent for Grounded Medical Image Analysis

We present VoxelPrompt, an agent-driven vision-language framework that tackles diverse radiological tasks through joint modeling of natural language, image volumes, and analytical metrics. VoxelPrompt is multi-modal and versatile, leveraging the flexibility of language interaction while providing quantitatively grounded image analysis. Given a variable number of 3D medical volumes, such as MRI and CT scans, VoxelPrompt employs a language agent that iteratively predicts executable instructions to solve a task specified by an input prompt. These instructions communicate with a vision network to encode image features and generate volumetric outputs (e.g., segmentations). VoxelPrompt interprets the results of intermediate instructions and plans further actions to compute discrete measures (e.g., tumor growth across a series of scans) and present relevant outputs to the user. We evaluate this framework in a sandbox of diverse neuroimaging tasks, and we show that the single VoxelPrompt model can delineate hundreds of anatomical and pathological features, measure many complex morphological properties, and perform open-language analysis of lesion characteristics. VoxelPrompt carries out these objectives with accuracy similar to that of fine-tuned, single-task models for segmentation and visual question-answering, while facilitating a much larger range of tasks. Therefore, by supporting accurate image processing with language interaction, VoxelPrompt provides comprehensive utility for numerous imaging tasks that traditionally require specialized models to address.

Anatomy-aware and acquisition-agnostic joint registration with SynthMorph

Affine image registration is a cornerstone of medical-image processing and analysis. While classical algorithms can achieve excellent accuracy, they solve a time-consuming optimization for every new image pair. Deep-learning (DL) methods learn a function that maps an image pair to an output transform. Evaluating the functions is fast, but capturing large transforms can be challenging, and networks tend to struggle if a test-image characteristic shifts from the training domain, such as the contrast or resolution. A majority of affine methods are also agnostic to the anatomy the user wishes to align; the registration will be inaccurate if algorithms consider all structures in the image. We address these shortcomings with a fast, robust, and easy-to-use DL tool for affine and deformable registration of any brain image without preprocessing, right off the MRI scanner. First, we rigorously analyze how competing architectures learn affine transforms across a diverse set of neuroimaging data, aiming to truly capture the behavior of methods in the real world. Second, we leverage a recent strategy to train networks with wildly varying images synthesized from label maps, yielding robust performance across acquisition specifics. Third, we optimize the spatial overlap of select anatomical labels, which enables networks to distinguish between anatomy of interest and irrelevant structures, removing the need for preprocessing that excludes content that would otherwise reduce the accuracy of anatomy-specific registration. We combine the affine model with prior work on deformable registration and test brain-specific registration across a landscape of MRI protocols unseen at training, demonstrating consistent and improved accuracy compared to existing tools. We distribute our code and tool at https://w3id.org/synthmorph, providing a single complete end-to-end solution for registration of brain MRI.

An Open-Source Tool for Longitudinal Whole-Brain and White Matter Lesion Segmentation

In this paper we describe and validate a longitudinal method for whole-brain segmentation of longitudinal MRI scans. It builds upon an existing whole-brain segmentation method that can handle multi-contrast data and robustly analyze images with white matter lesions. This method is here extended with subject-specific latent variables that encourage temporal consistency between its segmentation results, enabling it to better track subtle morphological changes in dozens of neuroanatomical structures and white matter lesions. We validate the proposed method on multiple datasets of control subjects and patients suffering from Alzheimer's disease and multiple sclerosis, and compare its results against those obtained with its original cross-sectional formulation and two benchmark longitudinal methods. The results indicate that the method attains a higher test-retest reliability, while being more sensitive to longitudinal disease effect differences between patient groups. An implementation is publicly available as part of the open-source neuroimaging package FreeSurfer.

Learning the Effect of Registration Hyperparameters with HyperMorph

We introduce HyperMorph, a framework that facilitates efficient hyperparameter tuning in learning-based deformable image registration. Classical registration algorithms perform an iterative pair-wise optimization to compute a deformation field that aligns two images. Recent learning-based approaches leverage large image datasets to learn a function that rapidly estimates a deformation for a given image pair. In both strategies, the accuracy of the resulting spatial correspondences is strongly influenced by the choice of certain hyperparameter values. However, an effective hyperparameter search consumes substantial time and human effort as it often involves training multiple models for different fixed hyperparameter values and may lead to suboptimal registration. We propose an amortized hyperparameter learning strategy to alleviate this burden by learning the impact of hyperparameters on deformation fields. We design a meta network, or hypernetwork, that predicts the parameters of a registration network for input hyperparameters, thereby comprising a single model that generates the optimal deformation field corresponding to given hyperparameter values. This strategy enables fast, high-resolution hyperparameter search at test-time, reducing the inefficiency of traditional approaches while increasing flexibility. We also demonstrate additional benefits of HyperMorph, including enhanced robustness to model initialization and the ability to rapidly identify optimal hyperparameter values specific to a dataset, image contrast, task, or even anatomical region, all without the need to retrain models. We make our code publicly available at http://hypermorph.voxelmorph.net.

SynthStrip: Skull-Stripping for Any Brain Image

The removal of non-brain signal from magnetic resonance imaging (MRI) data, known as skull-stripping, is an integral component of many neuroimage analysis streams. Despite their abundance, popular classical skull-stripping methods are usually tailored to images with specific acquisition properties, namely near-isotropic resolution and T1-weighted (T1w) MRI contrast, which are prevalent in research settings. As a result, existing tools tend to adapt poorly to other image types, such as stacks of thick slices acquired with fast spin-echo (FSE) MRI that are common in the clinic. While learning-based approaches for brain extraction have gained traction in recent years, these methods face a similar burden, as they are only effective for image types seen during the training procedure. To achieve robust skull-stripping across a landscape of protocols, we introduce SynthStrip, a rapid, learning-based brain-extraction tool. By leveraging anatomical segmentations to generate an entirely synthetic training dataset with anatomies, intensity distributions, and artifacts that far exceed the realistic range of medical images, SynthStrip learns to successfully generalize to a variety of real acquired brain images, removing the need for training data with target contrasts. We demonstrate the efficacy of SynthStrip for a diverse set of image acquisitions and resolutions across subject populations, ranging from newborn to adult. We show substantial improvements in accuracy over popular skull-stripping baselines - all with a single trained model. Our method and labeled evaluation data are available at https://w3id.org/synthstrip.

Learn2Reg: comprehensive multi-task medical image registration challenge, dataset and evaluation in the era of deep learning

Image registration is a fundamental medical image analysis task, and a wide variety of approaches have been proposed. However, only a few studies have comprehensively compared medical image registration approaches on a wide range of clinically relevant tasks, in part because of the lack of availability of such diverse data. This limits the development of registration methods, the adoption of research advances into practice, and a fair benchmark across competing approaches. The Learn2Reg challenge addresses these limitations by providing a multi-task medical image registration benchmark for comprehensive characterisation of deformable registration algorithms. A continuous evaluation will be possible at https://learn2reg.grand-challenge.org. Learn2Reg covers a wide range of anatomies (brain, abdomen, and thorax), modalities (ultrasound, CT, MR), availability of annotations, as well as intra- and inter-patient registration evaluation. We established an easily accessible framework for training and validation of 3D registration methods, which enabled the compilation of results of over 65 individual method submissions from more than 20 unique teams. We used a complementary set of metrics, including robustness, accuracy, plausibility, and runtime, enabling unique insight into the current state-of-the-art of medical image registration. This paper describes datasets, tasks, evaluation methods and results of the challenge, and the results of further analysis of transferability to new datasets, the importance of label supervision, and resulting bias.

Hypernet-Ensemble Learning of Segmentation Probability for Medical Image Segmentation with Ambiguous Labels

Despite the superior performance of Deep Learning (DL) on numerous segmentation tasks, the DL-based approaches are notoriously overconfident about their prediction with highly polarized label probability. This is often not desirable for many applications with the inherent label ambiguity even in human annotations. This challenge has been addressed by leveraging multiple annotations per image and the segmentation uncertainty. However, multiple per-image annotations are often not available in a real-world application and the uncertainty does not provide full control on segmentation results to users. In this paper, we propose novel methods to improve the segmentation probability estimation without sacrificing performance in a real-world scenario that we have only one ambiguous annotation per image. We marginalize the estimated segmentation probability maps of networks that are encouraged to under-/over-segment with the varying Tversky loss without penalizing balanced segmentation. Moreover, we propose a unified hypernetwork ensemble method to alleviate the computational burden of training multiple networks. Our approaches successfully estimated the segmentation probability maps that reflected the underlying structures and provided the intuitive control on segmentation for the challenging 3D medical image segmentation. Although the main focus of our proposed methods is not to improve the binary segmentation performance, our approaches marginally outperformed the state-of-the-arts. The codes are available at \url{https://github.com/sh4174/HypernetEnsemble}.

HyperMorph: Amortized Hyperparameter Learning for Image Registration

We present HyperMorph, a learning-based strategy for deformable image registration that removes the need to tune important registration hyperparameters during training. Classical registration methods solve an optimization problem to find a set of spatial correspondences between two images, while learning-based methods leverage a training dataset to learn a function that generates these correspondences. The quality of the results for both types of techniques depends greatly on the choice of hyperparameters. Unfortunately, hyperparameter tuning is time-consuming and typically involves training many separate models with various hyperparameter values, potentially leading to suboptimal results. To address this inefficiency, we introduce amortized hyperparameter learning for image registration, a novel strategy to learn the effects of hyperparameters on deformation fields. The proposed framework learns a hypernetwork that takes in an input hyperparameter and modulates a registration network to produce the optimal deformation field for that hyperparameter value. In effect, this strategy trains a single, rich model that enables rapid, fine-grained discovery of hyperparameter values from a continuous interval at test-time. We demonstrate that this approach can be used to optimize multiple hyperparameters considerably faster than existing search strategies, leading to a reduced computational and human burden and increased flexibility. We also show that this has several important benefits, including increased robustness to initialization and the ability to rapidly identify optimal hyperparameter values specific to a registration task, dataset, or even a single anatomical region - all without retraining the HyperMorph model. Our code is publicly available at http://voxelmorph.mit.edu.

A Longitudinal Method for Simultaneous Whole-Brain and Lesion Segmentation in Multiple Sclerosis

In this paper we propose a novel method for the segmentation of longitudinal brain MRI scans of patients suffering from Multiple Sclerosis. The method builds upon an existing cross-sectional method for simultaneous whole-brain and lesion segmentation, introducing subject-specific latent variables to encourage temporal consistency between longitudinal scans. It is very generally applicable, as it does not make any prior assumptions on the scanner, the MRI protocol, or the number and timing of longitudinal follow-up scans. Preliminary experiments on three longitudinal datasets indicate that the proposed method produces more reliable segmentations and detects disease effects better than the cross-sectional method it is based upon.

PSACNN: Pulse Sequence Adaptive Fast Whole Brain Segmentation

With the advent of convolutional neural networks~(CNN), supervised learning methods are increasingly being used for whole brain segmentation. However, a large, manually annotated training dataset of labeled brain images required to train such supervised methods is frequently difficult to obtain or create. In addition, existing training datasets are generally acquired with a homogeneous magnetic resonance imaging~(MRI) acquisition protocol. CNNs trained on such datasets are unable to generalize on test data with different acquisition protocols. Modern neuroimaging studies and clinical trials are necessarily multi-center initiatives with a wide variety of acquisition protocols. Despite stringent protocol harmonization practices, it is very difficult to standardize the gamut of MRI imaging parameters across scanners, field strengths, receive coils etc., that affect image contrast. In this paper we propose a CNN-based segmentation algorithm that, in addition to being highly accurate and fast, is also resilient to variation in the input acquisition. Our approach relies on building approximate forward models of pulse sequences that produce a typical test image. For a given pulse sequence, we use its forward model to generate plausible, synthetic training examples that appear as if they were acquired in a scanner with that pulse sequence. Sampling over a wide variety of pulse sequences results in a wide variety of augmented training examples that help build an image contrast invariant model. Our method trains a single CNN that can segment input MRI images with acquisition parameters as disparate as $T_1$-weighted and $T_2$-weighted contrasts with only $T_1$-weighted training data. The segmentations generated are highly accurate with state-of-the-art results~(overall Dice overlap$=0.94$), with a fast run time~($\approx$ 45 seconds), and consistent across a wide range of acquisition protocols.