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Volumetric medical image segmentation is pivotal in enhancing disease diagnosis, treatment planning, and advancing medical research. While existing volumetric foundation models for medical image segmentation, such as SAM-Med3D and SegVol, have shown remarkable performance on general organs and tumors, their ability to segment certain categories in clinical downstream tasks remains limited. Supervised Finetuning (SFT) serves as an effective way to adapt such foundation models for task-specific downstream tasks but at the cost of degrading the general knowledge previously stored in the original foundation model.To address this, we propose SAM-Med3D-MoE, a novel framework that seamlessly integrates task-specific finetuned models with the foundational model, creating a unified model at minimal additional training expense for an extra gating network. This gating network, in conjunction with a selection strategy, allows the unified model to achieve comparable performance of the original models in their respective tasks both general and specialized without updating any parameters of them.Our comprehensive experiments demonstrate the efficacy of SAM-Med3D-MoE, with an average Dice performance increase from 53 to 56.4 on 15 specific classes. It especially gets remarkable gains of 29.6, 8.5, 11.2 on the spinal cord, esophagus, and right hip, respectively. Additionally, it achieves 48.9 Dice on the challenging SPPIN2023 Challenge, significantly surpassing the general expert's performance of 32.3. We anticipate that SAM-Med3D-MoE can serve as a new framework for adapting the foundation model to specific areas in medical image analysis. Codes and datasets will be publicly available.

Motion artifacts in Magnetic Resonance Imaging (MRI) are one of the frequently occurring artifacts due to patient movements during scanning. Motion is estimated to be present in approximately 30% of clinical MRI scans; however, motion has not been explicitly modeled within deep learning image reconstruction models. Deep learning (DL) algorithms have been demonstrated to be effective for both the image reconstruction task and the motion correction task, but the two tasks are considered separately. The image reconstruction task involves removing undersampling artifacts such as noise and aliasing artifacts, whereas motion correction involves removing artifacts including blurring, ghosting, and ringing. In this work, we propose a novel method to simultaneously accelerate imaging and correct motion. This is achieved by integrating a motion module into the deep learning-based MRI reconstruction process, enabling real-time detection and correction of motion. We model motion as a tightly integrated auxiliary layer in the deep learning model during training, making the deep learning model 'motion-informed'. During inference, image reconstruction is performed from undersampled raw k-space data using a trained motion-informed DL model. Experimental results demonstrate that the proposed motion-informed deep learning image reconstruction network outperformed the conventional image reconstruction network for motion-degraded MRI datasets., Comment: 22 pages, 7 figures, 4 tables

Perivascular spaces(PVSs) form a central component of the brain\'s waste clearance system, the glymphatic system. These structures are visible on MRI images, and their morphology is associated with aging and neurological disease. Manual quantification of PVS is time consuming and subjective. Numerous deep learning methods for PVS segmentation have been developed, however the majority have been developed and evaluated on homogenous datasets and high resolution scans, perhaps limiting their applicability for the wide range of image qualities acquired in clinic and research. In this work we train a nnUNet, a top-performing biomedical image segmentation algorithm, on a heterogenous training sample of manually segmented MRI images of a range of different qualities and resolutions from 6 different datasets. These are compared to publicly available deep learning methods for 3D segmentation of PVS. The resulting model, PINGU (Perivascular space Identification Nnunet for Generalised Usage), achieved voxel and cluster level dice scores of 0.50(SD=0.15), 0.63(0.17) in the white matter(WM), and 0.54(0.11), 0.66(0.17) in the basal ganglia(BG). Performance on data from unseen sites was substantially lower for both PINGU(0.20-0.38(WM, voxel), 0.29-0.58(WM, cluster), 0.22-0.36(BG, voxel), 0.46-0.60(BG, cluster)) and the publicly available algorithms(0.18-0.30(WM, voxel), 0.29-0.38(WM cluster), 0.10-0.20(BG, voxel), 0.15-0.37(BG, cluster)), but PINGU strongly outperformed the publicly available algorithms, particularly in the BG. Finally, training PINGU on manual segmentations from a single site with homogenous scan properties gave marginally lower performances on internal cross-validation, but in some cases gave higher performance on external validation. PINGU stands out as broad-use PVS segmentation tool, with particular strength in the BG, an area of PVS related to vascular disease and pathology.

In Magnetic Resonance Imaging (MRI), image acquisitions are often undersampled in the measurement domain to accelerate the scanning process, at the expense of image quality. However, image quality is a crucial factor that influences the accuracy of clinical diagnosis; hence, high-quality image reconstruction from undersampled measurements has been a key area of research. Recently, deep learning (DL) methods have emerged as the state-of-the-art for MRI reconstruction, typically involving deep neural networks to transform undersampled MRI images into high-quality MRI images through data-driven processes. Nevertheless, there is clear and significant room for improvement in undersampled DL MRI reconstruction to meet the high standards required for clinical diagnosis, in terms of eliminating aliasing artifacts and reducing image noise. In this paper, we introduce a self-supervised pretraining procedure using contrastive learning to improve the accuracy of undersampled DL MRI reconstruction. We use contrastive learning to transform the MRI image representations into a latent space that maximizes mutual information among different undersampled representations and optimizes the information content at the input of the downstream DL reconstruction models. Our experiments demonstrate improved reconstruction accuracy across a range of acceleration factors and datasets, both quantitatively and qualitatively. Furthermore, our extended experiments validate the proposed framework's robustness under adversarial conditions, such as measurement noise, different k-space sampling patterns, and pathological abnormalities, and also prove the transfer learning capabilities on MRI datasets with completely different anatomy. Additionally, we conducted experiments to visualize and analyze the properties of the proposed MRI contrastive learning latent space.

Deep learning (DL) models are capable of successfully exploiting latent representations in MR data and have become state-of-the-art for accelerated MRI reconstruction. However, undersampling the measurements in k-space as well as the over- or under-parameterized and non-transparent nature of DL make these models exposed to uncertainty. Consequently, uncertainty estimation has become a major issue in DL MRI reconstruction. To estimate uncertainty, Monte Carlo (MC) inference techniques have become a common practice where multiple reconstructions are utilized to compute the variance in reconstruction as a measurement of uncertainty. However, these methods demand high computational costs as they require multiple inferences through the DL model. To this end, we introduce a method to estimate uncertainty during MRI reconstruction using a pixel classification framework. The proposed method, PixCUE (stands for Pixel Classification Uncertainty Estimation) produces the reconstructed image along with an uncertainty map during a single forward pass through the DL model. We demonstrate that this approach generates uncertainty maps that highly correlate with the reconstruction errors with respect to various MR imaging sequences and under numerous adversarial conditions. We also show that the estimated uncertainties are correlated to that of the conventional MC method. We further provide an empirical relationship between the uncertainty estimations using PixCUE and well-established reconstruction metrics such as NMSE, PSNR, and SSIM. We conclude that PixCUE is capable of reliably estimating the uncertainty in MRI reconstruction with a minimum additional computational cost., Comment: 19 pages, 7 figures, 1 table

As intensities of MRI volumes are inconsistent across institutes, it is essential to extract universal features of multi-modal MRIs to precisely segment brain tumors. In this concept, we propose a volumetric vision transformer that follows two windowing strategies in attention for extracting fine features and local distributional smoothness (LDS) during model training inspired by virtual adversarial training (VAT) to make the model robust. We trained and evaluated network architecture on the FeTS Challenge 2022 dataset. Our performance on the online validation dataset is as follows: Dice Similarity Score of 81.71%, 91.38% and 85.40%; Hausdorff Distance (95%) of 14.81 mm, 3.93 mm, 11.18 mm for the enhancing tumor, whole tumor, and tumor core, respectively. Overall, the experimental results verify our method's effectiveness by yielding better performance in segmentation accuracy for each tumor sub-region. Our code implementation is publicly available : https://github.com/himashi92/vizviva_fets_2022

Global correlations are widely seen in human anatomical structures due to similarity across tissues and bones. These correlations are reflected in magnetic resonance imaging (MRI) scans as a result of close-range proton density and T1/T2 parameters. Furthermore, to achieve accelerated MRI, k-space data are undersampled which causes global aliasing artifacts. Convolutional neural network (CNN) models are widely utilized for accelerated MRI reconstruction, but those models are limited in capturing global correlations due to the intrinsic locality of the convolution operation. The self-attention-based transformer models are capable of capturing global correlations among image features, however, the current contributions of transformer models for MRI reconstruction are minute. The existing contributions mostly provide CNN-transformer hybrid solutions and rarely leverage the physics of MRI. In this paper, we propose a physics-based stand-alone (convolution free) transformer model titled, the Multi-head Cascaded Swin Transformers (McSTRA) for accelerated MRI reconstruction. McSTRA combines several interconnected MRI physics-related concepts with the transformer networks: it exploits global MR features via the shifted window self-attention mechanism; it extracts MR features belonging to different spectral components separately using a multi-head setup; it iterates between intermediate de-aliasing and k-space correction via a cascaded network with data consistency in k-space and intermediate loss computations; furthermore, we propose a novel positional embedding generation mechanism to guide self-attention utilizing the point spread function corresponding to the undersampling mask. Our model significantly outperforms state-of-the-art MRI reconstruction methods both visually and quantitatively while depicting improved resolution and removal of aliasing artifacts.

This paper proposes an adversarial learning based training approach for brain tumor segmentation task. In this concept, the 3D segmentation network learns from dual reciprocal adversarial learning approaches. To enhance the generalization across the segmentation predictions and to make the segmentation network robust, we adhere to the Virtual Adversarial Training approach by generating more adversarial examples via adding some noise on original patient data. By incorporating a critic that acts as a quantitative subjective referee, the segmentation network learns from the uncertainty information associated with segmentation results. We trained and evaluated network architecture on the RSNA-ASNR-MICCAI BraTS 2021 dataset. Our performance on the online validation dataset is as follows: Dice Similarity Score of 81.38%, 90.77% and 85.39%; Hausdorff Distance (95\%) of 21.83 mm, 5.37 mm, 8.56 mm for the enhancing tumor, whole tumor and tumor core, respectively. Similarly, our approach achieved a Dice Similarity Score of 84.55%, 90.46% and 85.30%, as well as Hausdorff Distance (95\%) of 13.48 mm, 6.32 mm and 16.98 mm on the final test dataset. Overall, our proposed approach yielded better performance in segmentation accuracy for each tumor sub-region. Our code implementation is publicly available at https://github.com/himashi92/vizviva_brats_2021

We propose a Transformer architecture for volumetric segmentation, a challenging task that requires keeping a complex balance in encoding local and global spatial cues, and preserving information along all axes of the volume. Encoder of the proposed design benefits from self-attention mechanism to simultaneously encode local and global cues, while the decoder employs a parallel self and cross attention formulation to capture fine details for boundary refinement. Empirically, we show that the proposed design choices result in a computationally efficient model, with competitive and promising results on the Medical Segmentation Decathlon (MSD) brain tumor segmentation (BraTS) Task. We further show that the representations learned by our model are robust against data corruptions. \href{https://github.com/himashi92/VT-UNet}{Our code implementation is publicly available}.

Segmentation of images is a long-standing challenge in medical AI. This is mainly due to the fact that training a neural network to perform image segmentation requires a significant number of pixel-level annotated data, which is often unavailable. To address this issue, we propose a semi-supervised image segmentation technique based on the concept of multi-view learning. In contrast to the previous art, we introduce an adversarial form of dual-view training and employ a critic to formulate the learning problem in multi-view training as a min-max problem. Thorough quantitative and qualitative evaluations on several datasets indicate that our proposed method outperforms state-of-the-art medical image segmentation algorithms consistently and comfortably. The code is publicly available at https://github.com/himashi92/Duo-SegNet

Radiation exposure in positron emission tomography (PET) imaging limits its usage in the studies of radiation-sensitive populations, e.g., pregnant women, children, and adults that require longitudinal imaging. Reducing the PET radiotracer dose or acquisition time reduces photon counts, which can deteriorate image quality. Recent deep-neural-network (DNN) based methods for image-to-image translation enable the mapping of low-quality PET images (acquired using substantially reduced dose), coupled with the associated magnetic resonance imaging (MRI) images, to high-quality PET images. However, such DNN methods focus on applications involving test data that match the statistical characteristics of the training data very closely and give little attention to evaluating the performance of these DNNs on new out-of-distribution (OOD) acquisitions. We propose a novel DNN formulation that models the (i) underlying sinogram-based physics of the PET imaging system and (ii) the uncertainty in the DNN output through the per-voxel heteroscedasticity of the residuals between the predicted and the high-quality reference images. Our sinogram-based uncertainty-aware DNN framework, namely, suDNN, estimates a standard-dose PET image using multimodal input in the form of (i) a low-dose/low-count PET image and (ii) the corresponding multi-contrast MRI images, leading to improved robustness of suDNN to OOD acquisitions. Results on in vivo simultaneous PET-MRI, and various forms of OOD data in PET-MRI, show the benefits of suDNN over the current state of the art, quantitatively and qualitatively., Comment: Accepted at Medical Image Analysis

Gliomas are the most common primary brain malignancies, with different degrees of aggressiveness, variable prognosis and various heterogeneous histologic sub-regions, i.e., peritumoral edematous/invaded tissue, necrotic core, active and non-enhancing core. This intrinsic heterogeneity is also portrayed in their radio-phenotype, as their sub-regions are depicted by varying intensity profiles disseminated across multi-parametric magnetic resonance imaging (mpMRI) scans, reflecting varying biological properties. Their heterogeneous shape, extent, and location are some of the factors that make these tumors difficult to resect, and in some cases inoperable. The amount of resected tumor is a factor also considered in longitudinal scans, when evaluating the apparent tumor for potential diagnosis of progression. Furthermore, there is mounting evidence that accurate segmentation of the various tumor sub-regions can offer the basis for quantitative image analysis towards prediction of patient overall survival. This study assesses the state-of-the-art machine learning (ML) methods used for brain tumor image analysis in mpMRI scans, during the last seven instances of the International Brain Tumor Segmentation (BraTS) challenge, i.e., 2012-2018. Specifically, we focus on i) evaluating segmentations of the various glioma sub-regions in pre-operative mpMRI scans, ii) assessing potential tumor progression by virtue of longitudinal growth of tumor sub-regions, beyond use of the RECIST/RANO criteria, and iii) predicting the overall survival from pre-operative mpMRI scans of patients that underwent gross total resection. Finally, we investigate the challenge of identifying the best ML algorithms for each of these tasks, considering that apart from being diverse on each instance of the challenge, the multi-institutional mpMRI BraTS dataset has also been a continuously evolving/growing dataset., Comment: The International Multimodal Brain Tumor Segmentation (BraTS) Challenge

Purpose: The suppression of motion artefacts from MR images is a challenging task. The purpose of this paper is to develop a standalone novel technique to suppress motion artefacts from MR images using a data-driven deep learning approach. Methods: A deep learning convolutional neural network (CNN) was developed to remove motion artefacts in brain MR images. A CNN was trained on simulated motion corrupted images to identify and suppress artefacts due to the motion. The network was an encoder-decoder CNN architecture where the encoder decomposed the motion corrupted images into a set of feature maps. The feature maps were then combined by the decoder network to generate a motion-corrected image. The network was tested on an unseen simulated dataset and an experimental, motion corrupted in vivo brain dataset. Results: The trained network was able to suppress the motion artefacts in the simulated motion corrupted images, and the mean percentage error in the motion corrected images was 2.69 % with a standard deviation of 0.95 %. The network was able to effectively suppress the motion artefacts from the experimental dataset, demonstrating the generalisation capability of the trained network. Conclusion: A novel and generic motion correction technique has been developed that can suppress motion artefacts from motion corrupted MR images. The proposed technique is a standalone post-processing method that does not interfere with data acquisition or reconstruction parameters, thus making it suitable for a multitude of MR sequences.