Developing a Machine Learning-Based Clinical Decision Support Tool for Uterine Tumor Imaging

Uterine leiomyosarcoma (LMS) is a rare but aggressive malignancy. On imaging, it is difficult to differentiate LMS from, for example, degenerated leiomyoma (LM), a prevalent but benign condition. We curated a data set of 115 axial T2-weighted MRI images from 110 patients (mean [range] age=45 [17-81] years) with UTs that included five different tumor types. These data were randomly split stratifying on tumor volume into training (n=85) and test sets (n=30). An independent second reader (reader 2) provided manual segmentations for all test set images. To automate segmentation, we applied nnU-Net and explored the effect of training set size on performance by randomly generating subsets with 25, 45, 65 and 85 training set images. We evaluated the ability of radiomic features to distinguish between types of UT individually and when combined through feature selection and machine learning. Using the entire training set the mean [95% CI] fibroid DSC was measured as 0.87 [0.59-1.00] and the agreement between the two readers was 0.89 [0.77-1.0] on the test set. When classifying degenerated LM from LMS we achieve a test set F1-score of 0.80. Classifying UTs based on radiomic features we identify classifiers achieving F1-scores of 0.53 [0.45, 0.61] and 0.80 [0.80, 0.80] on the test set for the benign versus malignant, and degenerated LM versus LMS tasks. We show that it is possible to develop an automated method for 3D segmentation of the uterus and UT that is close to human-level performance with fewer than 150 annotated images. For distinguishing UT types, while we train models that merit further investigation with additional data, reliable automatic differentiation of UTs remains a challenge.

Role of Image Acquisition and Patient Phenotype Variations in Automatic Segmentation Model Generalization

Purpose: This study evaluated the out-of-domain performance and generalization capabilities of automated medical image segmentation models, with a particular focus on adaptation to new image acquisitions and disease type. Materials: Datasets from both non-contrast and contrast-enhanced abdominal CT scans of healthy patients and those with polycystic kidney disease (PKD) were used. A total of 400 images (100 non-contrast controls, 100 contrast controls, 100 non-contrast PKD, 100 contrast PKD) were utilized for training/validation of models to segment kidneys, livers, and spleens, and the final models were then tested on 100 non-contrast CT images of patients affected by PKD. Performance was evaluated using Dice, Jaccard, TPR, and Precision. Results: Models trained on a diverse range of data showed no worse performance than models trained exclusively on in-domain data when tested on in-domain data. For instance, the Dice similarity of the model trained on 25% from each dataset was found to be non-inferior to the model trained purely on in-domain data. Conclusions: The results indicate that broader training examples significantly enhances model generalization and out-of-domain performance, thereby improving automated segmentation tools' applicability in clinical settings. The study's findings provide a roadmap for future research to adopt a data-centric approach in medical image AI model development.

Realistic Ultrasound Image Synthesis for Improved Classification of Liver Disease

With the success of deep learning-based methods applied in medical image analysis, convolutional neural networks (CNNs) have been investigated for classifying liver disease from ultrasound (US) data. However, the scarcity of available large-scale labeled US data has hindered the success of CNNs for classifying liver disease from US data. In this work, we propose a novel generative adversarial network (GAN) architecture for realistic diseased and healthy liver US image synthesis. We adopt the concept of stacking to synthesize realistic liver US data. Quantitative and qualitative evaluation is performed on 550 in-vivo B-mode liver US images collected from 55 subjects. We also show that the synthesized images, together with real in vivo data, can be used to significantly improve the performance of traditional CNN architectures for Nonalcoholic fatty liver disease (NAFLD) classification.