Revisiting registration-based synthesis: A focus on unsupervised MR image synthesis

Deep learning (DL) has led to significant improvements in medical image synthesis, enabling advanced image-to-image translation to generate synthetic images. However, DL methods face challenges such as domain shift and high demands for training data, limiting their generalizability and applicability. Historically, image synthesis was also carried out using deformable image registration (DIR), a method that warps moving images of a desired modality to match the anatomy of a fixed image. However, concerns about its speed and accuracy led to its decline in popularity. With the recent advances of DL-based DIR, we now revisit and reinvigorate this line of research. In this paper, we propose a fast and accurate synthesis method based on DIR. We use the task of synthesizing a rare magnetic resonance (MR) sequence, white matter nulled (WMn) T1-weighted (T1-w) images, to demonstrate the potential of our approach. During training, our method learns a DIR model based on the widely available MPRAGE sequence, which is a cerebrospinal fluid nulled (CSFn) T1-w inversion recovery gradient echo pulse sequence. During testing, the trained DIR model is first applied to estimate the deformation between moving and fixed CSFn images. Subsequently, this estimated deformation is applied to align the paired WMn counterpart of the moving CSFn image, yielding a synthetic WMn image for the fixed CSFn image. Our experiments demonstrate promising results for unsupervised image synthesis using DIR. These findings highlight the potential of our technique in contexts where supervised synthesis methods are constrained by limited training data.

Efficient Annotation for Medical Image Analysis: A One-Pass Selective Annotation Approach

Annotating biomedical images for supervised learning is a complex and labor-intensive task due to data diversity and its intricate nature. In this paper, we propose an innovative method, the efficient one-pass selective annotation (EPOSA), that significantly reduces the annotation burden while maintaining robust model performance. Our approach employs a variational autoencoder (VAE) to extract salient features from unannotated images, which are subsequently clustered using the DBSCAN algorithm. This process groups similar images together, forming distinct clusters. We then use a two-stage sample selection algorithm, called representative selection (RepSel), to form a selected dataset. The first stage is a Markov Chain Monte Carlo (MCMC) sampling technique to select representative samples from each cluster for annotations. This selection process is the second stage, which is guided by the principle of maximizing intra-cluster mutual information and minimizing inter-cluster mutual information. This ensures a diverse set of features for model training and minimizes outlier inclusion. The selected samples are used to train a VGG-16 network for image classification. Experimental results on the Med-MNIST dataset demonstrate that our proposed EPOSA outperforms random selection and other state-of-the-art methods under the same annotation budget, presenting a promising direction for efficient and effective annotation in medical image analysis.

Automated Artifact Detection in Ultra-widefield Fundus Photography of Patients with Sickle Cell Disease

Importance: Ultra-widefield fundus photography (UWF-FP) has shown utility in sickle cell retinopathy screening; however, image artifact may diminish quality and gradeability of images. Objective: To create an automated algorithm for UWF-FP artifact classification. Design: A neural network based automated artifact detection algorithm was designed to identify commonly encountered UWF-FP artifacts in a cross section of patient UWF-FP. A pre-trained ResNet-50 neural network was trained on a subset of the images and the classification accuracy, sensitivity, and specificity were quantified on the hold out test set. Setting: The study is based on patients from a tertiary care hospital site. Participants: There were 243 UWF-FP acquired from patients with sickle cell disease (SCD), and artifact labelling in the following categories was performed: Eyelash Present, Lower Eyelid Obstructing, Upper Eyelid Obstructing, Image Too Dark, Dark Artifact, and Image Not Centered. Results: Overall, the accuracy for each class was Eyelash Present at 83.7%, Lower Eyelid Obstructing at 83.7%, Upper Eyelid Obstructing at 98.0%, Image Too Dark at 77.6%, Dark Artifact at 93.9%, and Image Not Centered at 91.8%. Conclusions and Relevance: This automated algorithm shows promise in identifying common imaging artifacts on a subset of Optos UWF-FP in SCD patients. Further refinement is ongoing with the goal of improving efficiency of tele-retinal screening in sickle cell retinopathy (SCR) by providing a photographer real-time feedback as to the types of artifacts present, and the need for image re-acquisition. This algorithm also may have potential future applicability in other retinal diseases by improving quality and efficiency of image acquisition of UWF-FP.

Label Propagation via Random Walk for Training Robust Thalamus Nuclei Parcellation Model from Noisy Annotations

Data-driven thalamic nuclei parcellation depends on high-quality manual annotations. However, the small size and low contrast changes among thalamic nuclei, yield annotations that are often incomplete, noisy, or ambiguously labelled. To train a robust thalamic nuclei parcellation model with noisy annotations, we propose a label propagation algorithm based on random walker to refine the annotations before model training. A two-step model was trained to generate first the whole thalamus and then the nuclei masks. We conducted experiments on a mild traumatic brain injury~(mTBI) dataset with noisy thalamic nuclei annotations. Our model outperforms current state-of-the-art thalamic nuclei parcellations by a clear margin. We believe our method can also facilitate the training of other parcellation models with noisy labels.

Automated Ventricle Parcellation and Evan's Ratio Computation in Pre- and Post-Surgical Ventriculomegaly

Normal pressure hydrocephalus~(NPH) is a brain disorder associated with enlarged ventricles and multiple cognitive and motor symptoms. The degree of ventricular enlargement can be measured using magnetic resonance images~(MRIs) and characterized quantitatively using the Evan's ratio (ER). Automatic computation of ER is desired to avoid the extra time and variations associated with manual measurements on MRI. Because shunt surgery is often used to treat NPH, it is necessary that this process be robust to image artifacts caused by the shunt and related implants. In this paper, we propose a 3D regions-of-interest aware (ROI-aware) network for segmenting the ventricles. The method achieves state-of-the-art performance on both pre-surgery MRIs and post-surgery MRIs with artifacts. Based on our segmentation results, we also describe an automated approach to compute ER from these results. Experimental results on multiple datasets demonstrate the potential of the proposed method to assist clinicians in the diagnosis and management of NPH.

Segmenting thalamic nuclei from manifold projections of multi-contrast MRI

The thalamus is a subcortical gray matter structure that plays a key role in relaying sensory and motor signals within the brain. Its nuclei can atrophy or otherwise be affected by neurological disease and injuries including mild traumatic brain injury. Segmenting both the thalamus and its nuclei is challenging because of the relatively low contrast within and around the thalamus in conventional magnetic resonance (MR) images. This paper explores imaging features to determine key tissue signatures that naturally cluster, from which we can parcellate thalamic nuclei. Tissue contrasts include T1-weighted and T2-weighted images, MR diffusion measurements including FA, mean diffusivity, Knutsson coefficients that represent fiber orientation, and synthetic multi-TI images derived from FGATIR and T1-weighted images. After registration of these contrasts and isolation of the thalamus, we use the uniform manifold approximation and projection (UMAP) method for dimensionality reduction to produce a low-dimensional representation of the data within the thalamus. Manual labeling of the thalamus provides labels for our UMAP embedding from which k nearest neighbors can be used to label new unseen voxels in that same UMAP embedding. N -fold cross-validation of the method reveals comparable performance to state-of-the-art methods for thalamic parcellation.