Brainomaly: Unsupervised Neurologic Disease Detection Utilizing Unannotated T1-weighted Brain MR Images

Deep neural networks have revolutionized the field of supervised learning by enabling accurate predictions through learning from large annotated datasets. However, acquiring large annotated medical imaging datasets is a challenging task, especially for rare diseases, due to the high cost, time, and effort required for annotation. In these scenarios, unsupervised disease detection methods, such as anomaly detection, can save significant human effort. A typically used approach for anomaly detection is to learn the images from healthy subjects only, assuming the model will detect the images from diseased subjects as outliers. However, in many real-world scenarios, unannotated datasets with a mix of healthy and diseased individuals are available. Recent studies have shown improvement in unsupervised disease/anomaly detection using such datasets of unannotated images from healthy and diseased individuals compared to datasets that only include images from healthy individuals. A major issue remains unaddressed in these studies, which is selecting the best model for inference from a set of trained models without annotated samples. To address this issue, we propose Brainomaly, a GAN-based image-to-image translation method for neurologic disease detection using unannotated T1-weighted brain MRIs of individuals with neurologic diseases and healthy subjects. Brainomaly is trained to remove the diseased regions from the input brain MRIs and generate MRIs of corresponding healthy brains. Instead of generating the healthy images directly, Brainomaly generates an additive map where each voxel indicates the amount of changes required to make the input image look healthy. In addition, Brainomaly uses a pseudo-AUC metric for inference model selection, which further improves the detection performance. Our Brainomaly outperforms existing state-of-the-art methods by large margins.