V2C-Long: Longitudinal Cortex Reconstruction with Spatiotemporal Correspondence

Reconstructing the cortex from longitudinal MRI is indispensable for analyzing morphological changes in the human brain. Despite the recent disruption of cortical surface reconstruction with deep learning, challenges arising from longitudinal data are still persistent. Especially the lack of strong spatiotemporal point correspondence hinders downstream analyses due to the introduced noise. To address this issue, we present V2C-Long, the first dedicated deep learning-based cortex reconstruction method for longitudinal MRI. In contrast to existing methods, V2C-Long surfaces are directly comparable in a cross-sectional and longitudinal manner. We establish strong inherent spatiotemporal correspondences via a novel composition of two deep mesh deformation networks and fast aggregation of feature-enhanced within-subject templates. The results on internal and external test data demonstrate that V2C-Long yields cortical surfaces with improved accuracy and consistency compared to previous methods. Finally, this improvement manifests in higher sensitivity to regional cortical atrophy in Alzheimer's disease.

Neural deformation fields for template-based reconstruction of cortical surfaces from MRI

The reconstruction of cortical surfaces is a prerequisite for quantitative analyses of the cerebral cortex in magnetic resonance imaging (MRI). Existing segmentation-based methods separate the surface registration from the surface extraction, which is computationally inefficient and prone to distortions. We introduce Vox2Cortex-Flow (V2C-Flow), a deep mesh-deformation technique that learns a deformation field from a brain template to the cortical surfaces of an MRI scan. To this end, we present a geometric neural network that models the deformation-describing ordinary differential equation in a continuous manner. The network architecture comprises convolutional and graph-convolutional layers, which allows it to work with images and meshes at the same time. V2C-Flow is not only very fast, requiring less than two seconds to infer all four cortical surfaces, but also establishes vertex-wise correspondences to the template during reconstruction. In addition, V2C-Flow is the first approach for cortex reconstruction that models white matter and pial surfaces jointly, therefore avoiding intersections between them. Our comprehensive experiments on internal and external test data demonstrate that V2C-Flow results in cortical surfaces that are state-of-the-art in terms of accuracy. Moreover, we show that the established correspondences are more consistent than in FreeSurfer and that they can directly be utilized for cortex parcellation and group analyses of cortical thickness.

Keep the Faith: Faithful Explanations in Convolutional Neural Networks for Case-Based Reasoning

Explaining predictions of black-box neural networks is crucial when applied to decision-critical tasks. Thus, attribution maps are commonly used to identify important image regions, despite prior work showing that humans prefer explanations based on similar examples. To this end, ProtoPNet learns a set of class-representative feature vectors (prototypes) for case-based reasoning. During inference, similarities of latent features to prototypes are linearly classified to form predictions and attribution maps are provided to explain the similarity. In this work, we evaluate whether architectures for case-based reasoning fulfill established axioms required for faithful explanations using the example of ProtoPNet. We show that such architectures allow the extraction of faithful explanations. However, we prove that the attribution maps used to explain the similarities violate the axioms. We propose a new procedure to extract explanations for trained ProtoPNets, named ProtoPFaith. Conceptually, these explanations are Shapley values, calculated on the similarity scores of each prototype. They allow to faithfully answer which prototypes are present in an unseen image and quantify each pixel's contribution to that presence, thereby complying with all axioms. The theoretical violations of ProtoPNet manifest in our experiments on three datasets (CUB-200-2011, Stanford Dogs, RSNA) and five architectures (ConvNet, ResNet, ResNet50, WideResNet50, ResNeXt50). Our experiments show a qualitative difference between the explanations given by ProtoPNet and ProtoPFaith. Additionally, we quantify the explanations with the Area Over the Perturbation Curve, on which ProtoPFaith outperforms ProtoPNet on all experiments by a factor $>10^3$.

Meshes Meet Voxels: Abdominal Organ Segmentation via Diffeomorphic Deformations

Abdominal multi-organ segmentation from CT and MRI is an essential prerequisite for surgical planning and computer-aided navigation systems. Three-dimensional numeric representations of abdominal shapes are further important for quantitative and statistical analyses thereof. Existing methods in the field, however, are unable to extract highly accurate 3D representations that are smooth, topologically correct, and match points on a template. In this work, we present UNetFlow, a novel diffeomorphic shape deformation approach for abdominal organs. UNetFlow combines the advantages of voxel-based and mesh-based approaches for 3D shape extraction. Our results demonstrate high accuracy with respect to manually annotated CT data and better topological correctness compared to previous methods. In addition, we show the generalization of UNetFlow to MRI.

HALOS: Hallucination-free Organ Segmentation after Organ Resection Surgery

The wide range of research in deep learning-based medical image segmentation pushed the boundaries in a multitude of applications. A clinically relevant problem that received less attention is the handling of scans with irregular anatomy, e.g., after organ resection. State-of-the-art segmentation models often lead to organ hallucinations, i.e., false-positive predictions of organs, which cannot be alleviated by oversampling or post-processing. Motivated by the increasing need to develop robust deep learning models, we propose HALOS for abdominal organ segmentation in MR images that handles cases after organ resection surgery. To this end, we combine missing organ classification and multi-organ segmentation tasks into a multi-task model, yielding a classification-assisted segmentation pipeline. The segmentation network learns to incorporate knowledge about organ existence via feature fusion modules. Extensive experiments on a small labeled test set and large-scale UK Biobank data demonstrate the effectiveness of our approach in terms of higher segmentation Dice scores and near-to-zero false positive prediction rate.

Joint Reconstruction and Parcellation of Cortical Surfaces

The reconstruction of cerebral cortex surfaces from brain MRI scans is instrumental for the analysis of brain morphology and the detection of cortical thinning in neurodegenerative diseases like Alzheimer's disease (AD). Moreover, for a fine-grained analysis of atrophy patterns, the parcellation of the cortical surfaces into individual brain regions is required. For the former task, powerful deep learning approaches, which provide highly accurate brain surfaces of tissue boundaries from input MRI scans in seconds, have recently been proposed. However, these methods do not come with the ability to provide a parcellation of the reconstructed surfaces. Instead, separate brain-parcellation methods have been developed, which typically consider the cortical surfaces as given, often computed beforehand with FreeSurfer. In this work, we propose two options, one based on a graph classification branch and another based on a novel generic 3D reconstruction loss, to augment template-deformation algorithms such that the surface meshes directly come with an atlas-based brain parcellation. By combining both options with two of the latest cortical surface reconstruction algorithms, we attain highly accurate parcellations with a Dice score of 90.2 (graph classification branch) and 90.4 (novel reconstruction loss) together with state-of-the-art surfaces.

Vox2Cortex: Fast Explicit Reconstruction of Cortical Surfaces from 3D MRI Scans with Geometric Deep Neural Networks

The reconstruction of cortical surfaces from brain magnetic resonance imaging (MRI) scans is essential for quantitative analyses of cortical thickness and sulcal morphology. Although traditional and deep learning-based algorithmic pipelines exist for this purpose, they have two major drawbacks: lengthy runtimes of multiple hours (traditional) or intricate post-processing, such as mesh extraction and topology correction (deep learning-based). In this work, we address both of these issues and propose Vox2Cortex, a deep learning-based algorithm that directly yields topologically correct, three-dimensional meshes of the boundaries of the cortex. Vox2Cortex leverages convolutional and graph convolutional neural networks to deform an initial template to the densely folded geometry of the cortex represented by an input MRI scan. We show in extensive experiments on three brain MRI datasets that our meshes are as accurate as the ones reconstructed by state-of-the-art methods in the field, without the need for time- and resource-intensive post-processing. To accurately reconstruct the tightly folded cortex, we work with meshes containing about 168,000 vertices at test time, scaling deep explicit reconstruction methods to a new level.

STRUDEL: Self-Training with Uncertainty Dependent Label Refinement across Domains

We propose an unsupervised domain adaptation (UDA) approach for white matter hyperintensity (WMH) segmentation, which uses Self-Training with Uncertainty DEpendent Label refinement (STRUDEL). Self-training has recently been introduced as a highly effective method for UDA, which is based on self-generated pseudo labels. However, pseudo labels can be very noisy and therefore deteriorate model performance. We propose to predict the uncertainty of pseudo labels and integrate it in the training process with an uncertainty-guided loss function to highlight labels with high certainty. STRUDEL is further improved by incorporating the segmentation output of an existing method in the pseudo label generation that showed high robustness for WMH segmentation. In our experiments, we evaluate STRUDEL with a standard U-Net and a modified network with a higher receptive field. Our results on WMH segmentation across datasets demonstrate the significant improvement of STRUDEL with respect to standard self-training.

Importance Driven Continual Learning for Segmentation Across Domains

The ability of neural networks to continuously learn and adapt to new tasks while retaining prior knowledge is crucial for many applications. However, current neural networks tend to forget previously learned tasks when trained on new ones, i.e., they suffer from Catastrophic Forgetting (CF). The objective of Continual Learning (CL) is to alleviate this problem, which is particularly relevant for medical applications, where it may not be feasible to store and access previously used sensitive patient data. In this work, we propose a Continual Learning approach for brain segmentation, where a single network is consecutively trained on samples from different domains. We build upon an importance driven approach and adapt it for medical image segmentation. Particularly, we introduce learning rate regularization to prevent the loss of the network's knowledge. Our results demonstrate that directly restricting the adaptation of important network parameters clearly reduces Catastrophic Forgetting for segmentation across domains.

Recalibrating 3D ConvNets with Project & Excite

Fully Convolutional Neural Networks (F-CNNs) achieve state-of-the-art performance for segmentation tasks in computer vision and medical imaging. Recently, computational blocks termed squeeze and excitation (SE) have been introduced to recalibrate F-CNN feature maps both channel- and spatial-wise, boosting segmentation performance while only minimally increasing the model complexity. So far, the development of SE blocks has focused on 2D architectures. For volumetric medical images, however, 3D F-CNNs are a natural choice. In this article, we extend existing 2D recalibration methods to 3D and propose a generic compress-process-recalibrate pipeline for easy comparison of such blocks. We further introduce Project & Excite (PE) modules, customized for 3D networks. In contrast to existing modules, Project \& Excite does not perform global average pooling but compresses feature maps along different spatial dimensions of the tensor separately to retain more spatial information that is subsequently used in the excitation step. We evaluate the modules on two challenging tasks, whole-brain segmentation of MRI scans and whole-body segmentation of CT scans. We demonstrate that PE modules can be easily integrated into 3D F-CNNs, boosting performance up to 0.3 in Dice Score and outperforming 3D extensions of other recalibration blocks, while only marginally increasing the model complexity. Our code is publicly available on https://github.com/ai-med/squeeze_and_excitation .