Improving Representation of High-frequency Components for Medical Foundation Models

Foundation models have recently attracted significant attention for their impressive generalizability across diverse downstream tasks. However, these models are demonstrated to exhibit great limitations in representing high-frequency components and fine-grained details. In many medical imaging tasks, the precise representation of such information is crucial due to the inherently intricate anatomical structures, sub-visual features, and complex boundaries involved. Consequently, the limited representation of prevalent foundation models can result in significant performance degradation or even failure in these tasks. To address these challenges, we propose a novel pretraining strategy, named Frequency-advanced Representation Autoencoder (Frepa). Through high-frequency masking and low-frequency perturbation combined with adversarial learning, Frepa encourages the encoder to effectively represent and preserve high-frequency components in the image embeddings. Additionally, we introduce an innovative histogram-equalized image masking strategy, extending the Masked Autoencoder approach beyond ViT to other architectures such as Swin Transformer and convolutional networks. We develop Frepa across nine medical modalities and validate it on 32 downstream tasks for both 2D images and 3D volume data. Without fine-tuning, Frepa can outperform other self-supervised pretraining methods and, in some cases, even surpasses task-specific trained models. This improvement is particularly significant for tasks involving fine-grained details, such as achieving up to a +15% increase in DSC for retina vessel segmentation and a +7% increase in IoU for lung nodule detection. Further experiments quantitatively reveal that Frepa enables superior high-frequency representations and preservation in the embeddings, underscoring its potential for developing more generalized and universal medical image foundation models.

Deep learning-driven pulmonary arteries and veins segmentation reveals demography-associated pulmonary vasculature anatomy

Pulmonary artery-vein segmentation is crucial for diagnosing pulmonary diseases and surgical planning, and is traditionally achieved by Computed Tomography Pulmonary Angiography (CTPA). However, concerns regarding adverse health effects from contrast agents used in CTPA have constrained its clinical utility. In contrast, identifying arteries and veins using non-contrast CT, a conventional and low-cost clinical examination routine, has long been considered impossible. Here we propose a High-abundant Pulmonary Artery-vein Segmentation (HiPaS) framework achieving accurate artery-vein segmentation on both non-contrast CT and CTPA across various spatial resolutions. HiPaS first performs spatial normalization on raw CT scans via a super-resolution module, and then iteratively achieves segmentation results at different branch levels by utilizing the low-level vessel segmentation as a prior for high-level vessel segmentation. We trained and validated HiPaS on our established multi-centric dataset comprising 1,073 CT volumes with meticulous manual annotation. Both quantitative experiments and clinical evaluation demonstrated the superior performance of HiPaS, achieving a dice score of 91.8% and a sensitivity of 98.0%. Further experiments demonstrated the non-inferiority of HiPaS segmentation on non-contrast CT compared to segmentation on CTPA. Employing HiPaS, we have conducted an anatomical study of pulmonary vasculature on 10,613 participants in China (five sites), discovering a new association between pulmonary vessel abundance and sex and age: vessel abundance is significantly higher in females than in males, and slightly decreases with age, under the controlling of lung volumes (p < 0.0001). HiPaS realizing accurate artery-vein segmentation delineates a promising avenue for clinical diagnosis and understanding pulmonary physiology in a non-invasive manner.

Unsupervised Decomposition Networks for Bias Field Correction in MR Image

Bias field, which is caused by imperfect MR devices or imaged objects, introduces intensity inhomogeneity into MR images and degrades the performance of MR image analysis methods. Many retrospective algorithms were developed to facilitate the bias correction, to which the deep learning-based methods outperformed. However, in the training phase, the supervised deep learning-based methods heavily rely on the synthesized bias field. As the formation of the bias field is extremely complex, it is difficult to mimic the true physical property of MR images by synthesized data. While bias field correction and image segmentation are strongly related, the segmentation map is precisely obtained by decoupling the bias field from the original MR image, and the bias value is indicated by the segmentation map in reverse. Thus, we proposed novel unsupervised decomposition networks that are trained only with biased data to obtain the bias-free MR images. Networks are made up of: a segmentation part to predict the probability of every pixel belonging to each class, and an estimation part to calculate the bias field, which are optimized alternately. Furthermore, loss functions based on the combination of fuzzy clustering and the multiplicative bias field are also devised. The proposed loss functions introduce the smoothness of bias field and construct the soft relationships among different classes under intra-consistency constraints. Extensive experiments demonstrate that the proposed method can accurately estimate bias fields and produce better bias correction results. The code is available on the link: https://github.com/LeongDong/Bias-Decomposition-Networks.

Efficient automatic segmentation for multi-level pulmonary arteries: The PARSE challenge

Efficient automatic segmentation of multi-level (i.e. main and branch) pulmonary arteries (PA) in CTPA images plays a significant role in clinical applications. However, most existing methods concentrate only on main PA or branch PA segmentation separately and ignore segmentation efficiency. Besides, there is no public large-scale dataset focused on PA segmentation, which makes it highly challenging to compare the different methods. To benchmark multi-level PA segmentation algorithms, we organized the first \textbf{P}ulmonary \textbf{AR}tery \textbf{SE}gmentation (PARSE) challenge. On the one hand, we focus on both the main PA and the branch PA segmentation. On the other hand, for better clinical application, we assign the same score weight to segmentation efficiency (mainly running time and GPU memory consumption during inference) while ensuring PA segmentation accuracy. We present a summary of the top algorithms and offer some suggestions for efficient and accurate multi-level PA automatic segmentation. We provide the PARSE challenge as open-access for the community to benchmark future algorithm developments at \url{https://parse2022.grand-challenge.org/Parse2022/}.

The state-of-the-art 3D anisotropic intracranial hemorrhage segmentation on non-contrast head CT: The INSTANCE challenge

Automatic intracranial hemorrhage segmentation in 3D non-contrast head CT (NCCT) scans is significant in clinical practice. Existing hemorrhage segmentation methods usually ignores the anisotropic nature of the NCCT, and are evaluated on different in-house datasets with distinct metrics, making it highly challenging to improve segmentation performance and perform objective comparisons among different methods. The INSTANCE 2022 was a grand challenge held in conjunction with the 2022 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI). It is intended to resolve the above-mentioned problems and promote the development of both intracranial hemorrhage segmentation and anisotropic data processing. The INSTANCE released a training set of 100 cases with ground-truth and a validation set with 30 cases without ground-truth labels that were available to the participants. A held-out testing set with 70 cases is utilized for the final evaluation and ranking. The methods from different participants are ranked based on four metrics, including Dice Similarity Coefficient (DSC), Hausdorff Distance (HD), Relative Volume Difference (RVD) and Normalized Surface Dice (NSD). A total of 13 teams submitted distinct solutions to resolve the challenges, making several baseline models, pre-processing strategies and anisotropic data processing techniques available to future researchers. The winner method achieved an average DSC of 0.6925, demonstrating a significant growth over our proposed baseline method. To the best of our knowledge, the proposed INSTANCE challenge releases the first intracranial hemorrhage segmentation benchmark, and is also the first challenge that intended to resolve the anisotropic problem in 3D medical image segmentation, which provides new alternatives in these research fields.

Position-prior Clustering-based Self-attention Module for Knee Cartilage Segmentation

The morphological changes in knee cartilage (especially femoral and tibial cartilages) are closely related to the progression of knee osteoarthritis, which is expressed by magnetic resonance (MR) images and assessed on the cartilage segmentation results. Thus, it is necessary to propose an effective automatic cartilage segmentation model for longitudinal research on osteoarthritis. In this research, to relieve the problem of inaccurate discontinuous segmentation caused by the limited receptive field in convolutional neural networks, we proposed a novel position-prior clustering-based self-attention module (PCAM). In PCAM, long-range dependency between each class center and feature point is captured by self-attention allowing contextual information re-allocated to strengthen the relative features and ensure the continuity of segmentation result. The clutsering-based method is used to estimate class centers, which fosters intra-class consistency and further improves the accuracy of segmentation results. The position-prior excludes the false positives from side-output and makes center estimation more precise. Sufficient experiments are conducted on OAI-ZIB dataset. The experimental results show that the segmentation performance of combination of segmentation network and PCAM obtains an evident improvement compared to original model, which proves the potential application of PCAM in medical segmentation tasks. The source code is publicly available from link: https://github.com/LeongDong/PCAMNet

ULTRA: Uncertainty-aware Label Distribution Learning for Breast Tumor Cellularity Assessment

Neoadjuvant therapy (NAT) for breast cancer is a common treatment option in clinical practice. Tumor cellularity (TC), which represents the percentage of invasive tumors in the tumor bed, has been widely used to quantify the response of breast cancer to NAT. Therefore, automatic TC estimation is significant in clinical practice. However, existing state-of-the-art methods usually take it as a TC score regression problem, which ignores the ambiguity of TC labels caused by subjective assessment or multiple raters. In this paper, to efficiently leverage the label ambiguities, we proposed an Uncertainty-aware Label disTRibution leArning (ULTRA) framework for automatic TC estimation. The proposed ULTRA first converted the single-value TC labels to discrete label distributions, which effectively models the ambiguity among all possible TC labels. Furthermore, the network learned TC label distributions by minimizing the Kullback-Leibler (KL) divergence between the predicted and ground-truth TC label distributions, which better supervised the model to leverage the ambiguity of TC labels. Moreover, the ULTRA mimicked the multi-rater fusion process in clinical practice with a multi-branch feature fusion module to further explore the uncertainties of TC labels. We evaluated the ULTRA on the public BreastPathQ dataset. The experimental results demonstrate that the ULTRA outperformed the regression-based methods for a large margin and achieved state-of-the-art results. The code will be available from https://github.com/PerceptionComputingLab/ULTRA

Transformer Network for Significant Stenosis Detection in CCTA of Coronary Arteries

Coronary artery disease (CAD) has posed a leading threat to the lives of cardiovascular disease patients worldwide for a long time. Therefore, automated diagnosis of CAD has indispensable significance in clinical medicine. However, the complexity of coronary artery plaques that cause CAD makes the automatic detection of coronary artery stenosis in Coronary CT angiography (CCTA) a difficult task. In this paper, we propose a Transformer network (TR-Net) for the automatic detection of significant stenosis (i.e. luminal narrowing > 50%) while practically completing the computer-assisted diagnosis of CAD. The proposed TR-Net introduces a novel Transformer, and tightly combines convolutional layers and Transformer encoders, allowing their advantages to be demonstrated in the task. By analyzing semantic information sequences, TR-Net can fully understand the relationship between image information in each position of a multiplanar reformatted (MPR) image, and accurately detect significant stenosis based on both local and global information. We evaluate our TR-Net on a dataset of 76 patients from different patients annotated by experienced radiologists. Experimental results illustrate that our TR-Net has achieved better results in ACC (0.92), Spec (0.96), PPV (0.84), F1 (0.79) and MCC (0.74) indicators compared with the state-of-the-art methods. The source code is publicly available from the link (https://github.com/XinghuaMa/TR-Net).

The SARAS Endoscopic Surgeon Action Detection (ESAD) dataset: Challenges and methods

For an autonomous robotic system, monitoring surgeon actions and assisting the main surgeon during a procedure can be very challenging. The challenges come from the peculiar structure of the surgical scene, the greater similarity in appearance of actions performed via tools in a cavity compared to, say, human actions in unconstrained environments, as well as from the motion of the endoscopic camera. This paper presents ESAD, the first large-scale dataset designed to tackle the problem of surgeon action detection in endoscopic minimally invasive surgery. ESAD aims at contributing to increase the effectiveness and reliability of surgical assistant robots by realistically testing their awareness of the actions performed by a surgeon. The dataset provides bounding box annotation for 21 action classes on real endoscopic video frames captured during prostatectomy, and was used as the basis of a recent MIDL 2020 challenge. We also present an analysis of the dataset conducted using the baseline model which was released as part of the challenge, and a description of the top performing models submitted to the challenge together with the results they obtained. This study provides significant insight into what approaches can be effective and can be extended further. We believe that ESAD will serve in the future as a useful benchmark for all researchers active in surgeon action detection and assistive robotics at large.

Cardiac Segmentation on Late Gadolinium Enhancement MRI: A Benchmark Study from Multi-Sequence Cardiac MR Segmentation Challenge

Accurate computing, analysis and modeling of the ventricles and myocardium from medical images are important, especially in the diagnosis and treatment management for patients suffering from myocardial infarction (MI). Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) provides an important protocol to visualize MI. However, automated segmentation of LGE CMR is still challenging, due to the indistinguishable boundaries, heterogeneous intensity distribution and complex enhancement patterns of pathological myocardium from LGE CMR. Furthermore, compared with the other sequences LGE CMR images with gold standard labels are particularly limited, which represents another obstacle for developing novel algorithms for automatic segmentation of LGE CMR. This paper presents the selective results from the Multi-Sequence Cardiac MR (MS-CMR) Segmentation challenge, in conjunction with MICCAI 2019. The challenge offered a data set of paired MS-CMR images, including auxiliary CMR sequences as well as LGE CMR, from 45 patients who underwent cardiomyopathy. It was aimed to develop new algorithms, as well as benchmark existing ones for LGE CMR segmentation and compare them objectively. In addition, the paired MS-CMR images could enable algorithms to combine the complementary information from the other sequences for the segmentation of LGE CMR. Nine representative works were selected for evaluation and comparisons, among which three methods are unsupervised methods and the other six are supervised. The results showed that the average performance of the nine methods was comparable to the inter-observer variations. The success of these methods was mainly attributed to the inclusion of the auxiliary sequences from the MS-CMR images, which provide important label information for the training of deep neural networks.