REHRSeg: Unleashing the Power of Self-Supervised Super-Resolution for Resource-Efficient 3D MRI Segmentation

High-resolution (HR) 3D magnetic resonance imaging (MRI) can provide detailed anatomical structural information, enabling precise segmentation of regions of interest for various medical image analysis tasks. Due to the high demands of acquisition device, collection of HR images with their annotations is always impractical in clinical scenarios. Consequently, segmentation results based on low-resolution (LR) images with large slice thickness are often unsatisfactory for subsequent tasks. In this paper, we propose a novel Resource-Efficient High-Resolution Segmentation framework (REHRSeg) to address the above-mentioned challenges in real-world applications, which can achieve HR segmentation while only employing the LR images as input. REHRSeg is designed to leverage self-supervised super-resolution (self-SR) to provide pseudo supervision, therefore the relatively easier-to-acquire LR annotated images generated by 2D scanning protocols can be directly used for model training. The main contribution to ensure the effectiveness in self-SR for enhancing segmentation is three-fold: (1) We mitigate the data scarcity problem in the medical field by using pseudo-data for training the segmentation model. (2) We design an uncertainty-aware super-resolution (UASR) head in self-SR to raise the awareness of segmentation uncertainty as commonly appeared on the ROI boundaries. (3) We align the spatial features for self-SR and segmentation through structural knowledge distillation to enable a better capture of region correlations. Experimental results demonstrate that REHRSeg achieves high-quality HR segmentation without intensive supervision, while also significantly improving the baseline performance for LR segmentation.

Inter-slice Super-resolution of Magnetic Resonance Images by Pre-training and Self-supervised Fine-tuning

In clinical practice, 2D magnetic resonance (MR) sequences are widely adopted. While individual 2D slices can be stacked to form a 3D volume, the relatively large slice spacing can pose challenges for both image visualization and subsequent analysis tasks, which often require isotropic voxel spacing. To reduce slice spacing, deep-learning-based super-resolution techniques are widely investigated. However, most current solutions require a substantial number of paired high-resolution and low-resolution images for supervised training, which are typically unavailable in real-world scenarios. In this work, we propose a self-supervised super-resolution framework for inter-slice super-resolution of MR images. Our framework is first featured by pre-training on video dataset, as temporal correlation of videos is found beneficial for modeling the spatial relation among MR slices. Then, we use public high-quality MR dataset to fine-tune our pre-trained model, for enhancing awareness of our model to medical data. Finally, given a target dataset at hand, we utilize self-supervised fine-tuning to further ensure our model works well with user-specific super-resolution tasks. The proposed method demonstrates superior performance compared to other self-supervised methods and also holds the potential to benefit various downstream applications.

Two-stage Cytopathological Image Synthesis for Augmenting Cervical Abnormality Screening

Automatic thin-prep cytologic test (TCT) screening can assist pathologists in finding cervical abnormality towards accurate and efficient cervical cancer diagnosis. Current automatic TCT screening systems mostly involve abnormal cervical cell detection, which generally requires large-scale and diverse training data with high-quality annotations to achieve promising performance. Pathological image synthesis is naturally raised to minimize the efforts in data collection and annotation. However, it is challenging to generate realistic large-size cytopathological images while simultaneously synthesizing visually plausible appearances for small-size abnormal cervical cells. In this paper, we propose a two-stage image synthesis framework to create synthetic data for augmenting cervical abnormality screening. In the first Global Image Generation stage, a Normal Image Generator is designed to generate cytopathological images full of normal cervical cells. In the second Local Cell Editing stage, normal cells are randomly selected from the generated images and then are converted to different types of abnormal cells using the proposed Abnormal Cell Synthesizer. Both Normal Image Generator and Abnormal Cell Synthesizer are built upon Stable Diffusion, a pre-trained foundation model for image synthesis, via parameter-efficient fine-tuning methods for customizing cytopathological image contents and extending spatial layout controllability, respectively. Our experiments demonstrate the synthetic image quality, diversity, and controllability of the proposed synthesis framework, and validate its data augmentation effectiveness in enhancing the performance of abnormal cervical cell detection.

Uni-COAL: A Unified Framework for Cross-Modality Synthesis and Super-Resolution of MR Images

Cross-modality synthesis (CMS), super-resolution (SR), and their combination (CMSR) have been extensively studied for magnetic resonance imaging (MRI). Their primary goals are to enhance the imaging quality by synthesizing the desired modality and reducing the slice thickness. Despite the promising synthetic results, these techniques are often tailored to specific tasks, thereby limiting their adaptability to complex clinical scenarios. Therefore, it is crucial to build a unified network that can handle various image synthesis tasks with arbitrary requirements of modality and resolution settings, so that the resources for training and deploying the models can be greatly reduced. However, none of the previous works is capable of performing CMS, SR, and CMSR using a unified network. Moreover, these MRI reconstruction methods often treat alias frequencies improperly, resulting in suboptimal detail restoration. In this paper, we propose a Unified Co-Modulated Alias-free framework (Uni-COAL) to accomplish the aforementioned tasks with a single network. The co-modulation design of the image-conditioned and stochastic attribute representations ensures the consistency between CMS and SR, while simultaneously accommodating arbitrary combinations of input/output modalities and thickness. The generator of Uni-COAL is also designed to be alias-free based on the Shannon-Nyquist signal processing framework, ensuring effective suppression of alias frequencies. Additionally, we leverage the semantic prior of Segment Anything Model (SAM) to guide Uni-COAL, ensuring a more authentic preservation of anatomical structures during synthesis. Experiments on three datasets demonstrate that Uni-COAL outperforms the alternatives in CMS, SR, and CMSR tasks for MR images, which highlights its generalizability to wide-range applications.

Progressive Attention Guidance for Whole Slide Vulvovaginal Candidiasis Screening

Vulvovaginal candidiasis (VVC) is the most prevalent human candidal infection, estimated to afflict approximately 75% of all women at least once in their lifetime. It will lead to several symptoms including pruritus, vaginal soreness, and so on. Automatic whole slide image (WSI) classification is highly demanded, for the huge burden of disease control and prevention. However, the WSI-based computer-aided VCC screening method is still vacant due to the scarce labeled data and unique properties of candida. Candida in WSI is challenging to be captured by conventional classification models due to its distinctive elongated shape, the small proportion of their spatial distribution, and the style gap from WSIs. To make the model focus on the candida easier, we propose an attention-guided method, which can obtain a robust diagnosis classification model. Specifically, we first use a pre-trained detection model as prior instruction to initialize the classification model. Then we design a Skip Self-Attention module to refine the attention onto the fined-grained features of candida. Finally, we use a contrastive learning method to alleviate the overfitting caused by the style gap of WSIs and suppress the attention to false positive regions. Our experimental results demonstrate that our framework achieves state-of-the-art performance. Code and example data are available at https://github.com/cjdbehumble/MICCAI2023-VVC-Screening.

AdLER: Adversarial Training with Label Error Rectification for One-Shot Medical Image Segmentation

Accurate automatic segmentation of medical images typically requires large datasets with high-quality annotations, making it less applicable in clinical settings due to limited training data. One-shot segmentation based on learned transformations (OSSLT) has shown promise when labeled data is extremely limited, typically including unsupervised deformable registration, data augmentation with learned registration, and segmentation learned from augmented data. However, current one-shot segmentation methods are challenged by limited data diversity during augmentation, and potential label errors caused by imperfect registration. To address these issues, we propose a novel one-shot medical image segmentation method with adversarial training and label error rectification (AdLER), with the aim of improving the diversity of generated data and correcting label errors to enhance segmentation performance. Specifically, we implement a novel dual consistency constraint to ensure anatomy-aligned registration that lessens registration errors. Furthermore, we develop an adversarial training strategy to augment the atlas image, which ensures both generation diversity and segmentation robustness. We also propose to rectify potential label errors in the augmented atlas images by estimating segmentation uncertainty, which can compensate for the imperfect nature of deformable registration and improve segmentation authenticity. Experiments on the CANDI and ABIDE datasets demonstrate that the proposed AdLER outperforms previous state-of-the-art methods by 0.7% (CANDI), 3.6% (ABIDE "seen"), and 4.9% (ABIDE "unseen") in segmentation based on Dice scores, respectively. The source code will be available at https://github.com/hsiangyuzhao/AdLER.

CellGAN: Conditional Cervical Cell Synthesis for Augmenting Cytopathological Image Classification

Automatic examination of thin-prep cytologic test (TCT) slides can assist pathologists in finding cervical abnormality for accurate and efficient cancer screening. Current solutions mostly need to localize suspicious cells and classify abnormality based on local patches, concerning the fact that whole slide images of TCT are extremely large. It thus requires many annotations of normal and abnormal cervical cells, to supervise the training of the patch-level classifier for promising performance. In this paper, we propose CellGAN to synthesize cytopathological images of various cervical cell types for augmenting patch-level cell classification. Built upon a lightweight backbone, CellGAN is equipped with a non-linear class mapping network to effectively incorporate cell type information into image generation. We also propose the Skip-layer Global Context module to model the complex spatial relationship of the cells, and attain high fidelity of the synthesized images through adversarial learning. Our experiments demonstrate that CellGAN can produce visually plausible TCT cytopathological images for different cell types. We also validate the effectiveness of using CellGAN to greatly augment patch-level cell classification performance.

CT-based Subchondral Bone Microstructural Analysis in Knee Osteoarthritis via MR-Guided Distillation Learning

Background: MR-based subchondral bone effectively predicts knee osteoarthritis. However, its clinical application is limited by the cost and time of MR. Purpose: We aim to develop a novel distillation-learning-based method named SRRD for subchondral bone microstructural analysis using easily-acquired CT images, which leverages paired MR images to enhance the CT-based analysis model during training. Materials and Methods: Knee joint images of both CT and MR modalities were collected from October 2020 to May 2021. Firstly, we developed a GAN-based generative model to transform MR images into CT images, which was used to establish the anatomical correspondence between the two modalities. Next, we obtained numerous patches of subchondral bone regions of MR images, together with their trabecular parameters (BV / TV, Tb. Th, Tb. Sp, Tb. N) from the corresponding CT image patches via regression. The distillation-learning technique was used to train the regression model and transfer MR structural information to the CT-based model. The regressed trabecular parameters were further used for knee osteoarthritis classification. Results: A total of 80 participants were evaluated. CT-based regression results of trabecular parameters achieved intra-class correlation coefficients (ICCs) of 0.804, 0.773, 0.711, and 0.622 for BV / TV, Tb. Th, Tb. Sp, and Tb. N, respectively. The use of distillation learning significantly improved the performance of the CT-based knee osteoarthritis classification method using the CNN approach, yielding an AUC score of 0.767 (95% CI, 0.681-0.853) instead of 0.658 (95% CI, 0.574-0.742) (p<.001). Conclusions: The proposed SRRD method showed high reliability and validity in MR-CT registration, regression, and knee osteoarthritis classification, indicating the feasibility of subchondral bone microstructural analysis based on CT images.

Learning Better Contrastive View from Radiologist's Gaze

Recent self-supervised contrastive learning methods greatly benefit from the Siamese structure that aims to minimizing distances between positive pairs. These methods usually apply random data augmentation to input images, expecting the augmented views of the same images to be similar and positively paired. However, random augmentation may overlook image semantic information and degrade the quality of augmented views in contrastive learning. This issue becomes more challenging in medical images since the abnormalities related to diseases can be tiny, and are easy to be corrupted (e.g., being cropped out) in the current scheme of random augmentation. In this work, we first demonstrate that, for widely-used X-ray images, the conventional augmentation prevalent in contrastive pre-training can affect the performance of the downstream diagnosis or classification tasks. Then, we propose a novel augmentation method, i.e., FocusContrast, to learn from radiologists' gaze in diagnosis and generate contrastive views for medical images with guidance from radiologists' visual attention. Specifically, we track the gaze movement of radiologists and model their visual attention when reading to diagnose X-ray images. The learned model can predict visual attention of the radiologists given a new input image, and further guide the attention-aware augmentation that hardly neglects the disease-related abnormalities. As a plug-and-play and framework-agnostic module, FocusContrast consistently improves state-of-the-art contrastive learning methods of SimCLR, MoCo, and BYOL by 4.0~7.0% in classification accuracy on a knee X-ray dataset.

Domain Generalization for Mammographic Image Analysis via Contrastive Learning

Mammographic image analysis is a fundamental problem in the computer-aided diagnosis scheme, which has recently made remarkable progress with the advance of deep learning. However, the construction of a deep learning model requires training data that are large and sufficiently diverse in terms of image style and quality. In particular, the diversity of image style may be majorly attributed to the vendor factor. However, mammogram collection from vendors as many as possible is very expensive and sometimes impractical for laboratory-scale studies. Accordingly, to further augment the generalization capability of deep learning models to various vendors with limited resources, a new contrastive learning scheme is developed. Specifically, the backbone network is firstly trained with a multi-style and multi-view unsupervised self-learning scheme for the embedding of invariant features to various vendor styles. Afterward, the backbone network is then recalibrated to the downstream tasks of mass detection, multi-view mass matching, BI-RADS classification and breast density classification with specific supervised learning. The proposed method is evaluated with mammograms from four vendors and two unseen public datasets. The experimental results suggest that our approach can effectively improve analysis performance on both seen and unseen domains, and outperforms many state-of-the-art (SOTA) generalization methods.