Unleashing the Strengths of Unlabeled Data in Pan-cancer Abdominal Organ Quantification: the FLARE22 Challenge

Quantitative organ assessment is an essential step in automated abdominal disease diagnosis and treatment planning. Artificial intelligence (AI) has shown great potential to automatize this process. However, most existing AI algorithms rely on many expert annotations and lack a comprehensive evaluation of accuracy and efficiency in real-world multinational settings. To overcome these limitations, we organized the FLARE 2022 Challenge, the largest abdominal organ analysis challenge to date, to benchmark fast, low-resource, accurate, annotation-efficient, and generalized AI algorithms. We constructed an intercontinental and multinational dataset from more than 50 medical groups, including Computed Tomography (CT) scans with different races, diseases, phases, and manufacturers. We independently validated that a set of AI algorithms achieved a median Dice Similarity Coefficient (DSC) of 90.0\% by using 50 labeled scans and 2000 unlabeled scans, which can significantly reduce annotation requirements. The best-performing algorithms successfully generalized to holdout external validation sets, achieving a median DSC of 89.5\%, 90.9\%, and 88.3\% on North American, European, and Asian cohorts, respectively. They also enabled automatic extraction of key organ biology features, which was labor-intensive with traditional manual measurements. This opens the potential to use unlabeled data to boost performance and alleviate annotation shortages for modern AI models.

Medical diffusion on a budget: textual inversion for medical image generation

Diffusion-based models for text-to-image generation have gained immense popularity due to recent advancements in efficiency, accessibility, and quality. Although it is becoming increasingly feasible to perform inference with these systems using consumer-grade GPUs, training them from scratch still requires access to large datasets and significant computational resources. In the case of medical image generation, the availability of large, publicly accessible datasets that include text reports is limited due to legal and ethical concerns. While training a diffusion model on a private dataset may address this issue, it is not always feasible for institutions lacking the necessary computational resources. This work demonstrates that pre-trained Stable Diffusion models, originally trained on natural images, can be adapted to various medical imaging modalities by training text embeddings with textual inversion. In this study, we conducted experiments using medical datasets comprising only 100 samples from three medical modalities. Embeddings were trained in a matter of hours, while still retaining diagnostic relevance in image generation. Experiments were designed to achieve several objectives. Firstly, we fine-tuned the training and inference processes of textual inversion, revealing that larger embeddings and more examples are required. Secondly, we validated our approach by demonstrating a 2\% increase in the diagnostic accuracy (AUC) for detecting prostate cancer on MRI, which is a challenging multi-modal imaging modality, from 0.78 to 0.80. Thirdly, we performed simulations by interpolating between healthy and diseased states, combining multiple pathologies, and inpainting to show embedding flexibility and control of disease appearance. Finally, the embeddings trained in this study are small (less than 1 MB), which facilitates easy sharing of medical data with reduced privacy concerns.

Cine-MRI detection of abdominal adhesions with spatio-temporal deep learning

Adhesions are an important cause of chronic pain following abdominal surgery. Recent developments in abdominal cine-MRI have enabled the non-invasive diagnosis of adhesions. Adhesions are identified on cine-MRI by the absence of sliding motion during movement. Diagnosis and mapping of adhesions improves the management of patients with pain. Detection of abdominal adhesions on cine-MRI is challenging from both a radiological and deep learning perspective. We focus on classifying presence or absence of adhesions in sagittal abdominal cine-MRI series. We experimented with spatio-temporal deep learning architectures centered around a ConvGRU architecture. A hybrid architecture comprising a ResNet followed by a ConvGRU model allows to classify a whole time-series. Compared to a stand-alone ResNet with a two time-point (inspiration/expiration) input, we show an increase in classification performance (AUROC) from 0.74 to 0.83 ($p<0.05$). Our full temporal classification approach adds only a small amount (5%) of parameters to the entire architecture, which may be useful for other medical imaging problems with a temporal dimension.