SALT: Introducing a Framework for Hierarchical Segmentations in Medical Imaging using Softmax for Arbitrary Label Trees

Traditional segmentation networks approach anatomical structures as standalone elements, overlooking the intrinsic hierarchical connections among them. This study introduces Softmax for Arbitrary Label Trees (SALT), a novel approach designed to leverage the hierarchical relationships between labels, improving the efficiency and interpretability of the segmentations. This study introduces a novel segmentation technique for CT imaging, which leverages conditional probabilities to map the hierarchical structure of anatomical landmarks, such as the spine's division into lumbar, thoracic, and cervical regions and further into individual vertebrae. The model was developed using the SAROS dataset from The Cancer Imaging Archive (TCIA), comprising 900 body region segmentations from 883 patients. The dataset was further enhanced by generating additional segmentations with the TotalSegmentator, for a total of 113 labels. The model was trained on 600 scans, while validation and testing were conducted on 150 CT scans. Performance was assessed using the Dice score across various datasets, including SAROS, CT-ORG, FLARE22, LCTSC, LUNA16, and WORD. Among the evaluated datasets, SALT achieved its best results on the LUNA16 and SAROS datasets, with Dice scores of 0.93 and 0.929 respectively. The model demonstrated reliable accuracy across other datasets, scoring 0.891 on CT-ORG and 0.849 on FLARE22. The LCTSC dataset showed a score of 0.908 and the WORD dataset also showed good performance with a score of 0.844. SALT used the hierarchical structures inherent in the human body to achieve whole-body segmentations with an average of 35 seconds for 100 slices. This rapid processing underscores its potential for integration into clinical workflows, facilitating the automatic and efficient computation of full-body segmentations with each CT scan, thus enhancing diagnostic processes and patient care.

MOMO -- Deep Learning-driven classification of external DICOM studies for PACS archivation

Patients regularly continue assessment or treatment in other facilities than they began them in, receiving their previous imaging studies as a CD-ROM and requiring clinical staff at the new hospital to import these studies into their local database. However, between different facilities, standards for nomenclature, contents, or even medical procedures may vary, often requiring human intervention to accurately classify the received studies in the context of the recipient hospital's standards. In this study, the authors present MOMO (MOdality Mapping and Orchestration), a deep learning-based approach to automate this mapping process utilizing metadata substring matching and a neural network ensemble, which is trained to recognize the 76 most common imaging studies across seven different modalities. A retrospective study is performed to measure the accuracy that this algorithm can provide. To this end, a set of 11,934 imaging series with existing labels was retrieved from the local hospital's PACS database to train the neural networks. A set of 843 completely anonymized external studies was hand-labeled to assess the performance of our algorithm. Additionally, an ablation study was performed to measure the performance impact of the network ensemble in the algorithm, and a comparative performance test with a commercial product was conducted. In comparison to a commercial product (96.20% predictive power, 82.86% accuracy, 1.36% minor errors), a neural network ensemble alone performs the classification task with less accuracy (99.05% predictive power, 72.69% accuracy, 10.3% minor errors). However, MOMO outperforms either by a large margin in accuracy and with increased predictive power (99.29% predictive power, 92.71% accuracy, 2.63% minor errors).

An Uncertainty-Aware, Shareable and Transparent Neural Network Architecture for Brain-Age Modeling

The deviation between chronological age and age predicted from neuroimaging data has been identified as a sensitive risk-marker of cross-disorder brain changes, growing into a cornerstone of biological age-research. However, Machine Learning models underlying the field do not consider uncertainty, thereby confounding results with training data density and variability. Also, existing models are commonly based on homogeneous training sets, often not independently validated, and cannot be shared due to data protection issues. Here, we introduce an uncertainty-aware, shareable, and transparent Monte-Carlo Dropout Composite-Quantile-Regression (MCCQR) Neural Network trained on N=10,691 datasets from the German National Cohort. The MCCQR model provides robust, distribution-free uncertainty quantification in high-dimensional neuroimaging data, achieving lower error rates compared to existing models across ten recruitment centers and in three independent validation samples (N=4,004). In two examples, we demonstrate that it prevents spurious associations and increases power to detect accelerated brain-aging. We make the pre-trained model publicly available.

Predicting brain-age from raw T 1 -weighted Magnetic Resonance Imaging data using 3D Convolutional Neural Networks

Age prediction based on Magnetic Resonance Imaging (MRI) data of the brain is a biomarker to quantify the progress of brain diseases and aging. Current approaches rely on preparing the data with multiple preprocessing steps, such as registering voxels to a standardized brain atlas, which yields a significant computational overhead, hampers widespread usage and results in the predicted brain-age to be sensitive to preprocessing parameters. Here we describe a 3D Convolutional Neural Network (CNN) based on the ResNet architecture being trained on raw, non-registered T$_ 1$-weighted MRI data of N=10,691 samples from the German National Cohort and additionally applied and validated in N=2,173 samples from three independent studies using transfer learning. For comparison, state-of-the-art models using preprocessed neuroimaging data are trained and validated on the same samples. The 3D CNN using raw neuroimaging data predicts age with a mean average deviation of 2.84 years, outperforming the state-of-the-art brain-age models using preprocessed data. Since our approach is invariant to preprocessing software and parameter choices, it enables faster, more robust and more accurate brain-age modeling.