How To Segment in 3D Using 2D Models: Automated 3D Segmentation of Prostate Cancer Metastatic Lesions on PET Volumes Using Multi-Angle Maximum Intensity Projections and Diffusion Models

Prostate specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) imaging provides a tremendously exciting frontier in visualization of prostate cancer (PCa) metastatic lesions. However, accurate segmentation of metastatic lesions is challenging due to low signal-to-noise ratios and variable sizes, shapes, and locations of the lesions. This study proposes a novel approach for automated segmentation of metastatic lesions in PSMA PET/CT 3D volumetric images using 2D denoising diffusion probabilistic models (DDPMs). Instead of 2D trans-axial slices or 3D volumes, the proposed approach segments the lesions on generated multi-angle maximum intensity projections (MA-MIPs) of the PSMA PET images, then obtains the final 3D segmentation masks from 3D ordered subset expectation maximization (OSEM) reconstruction of 2D MA-MIPs segmentations. Our proposed method achieved superior performance compared to state-of-the-art 3D segmentation approaches in terms of accuracy and robustness in detecting and segmenting small metastatic PCa lesions. The proposed method has significant potential as a tool for quantitative analysis of metastatic burden in PCa patients.

Thyroidiomics: An Automated Pipeline for Segmentation and Classification of Thyroid Pathologies from Scintigraphy Images

The objective of this study was to develop an automated pipeline that enhances thyroid disease classification using thyroid scintigraphy images, aiming to decrease assessment time and increase diagnostic accuracy. Anterior thyroid scintigraphy images from 2,643 patients were collected and categorized into diffuse goiter (DG), multinodal goiter (MNG), and thyroiditis (TH) based on clinical reports, and then segmented by an expert. A ResUNet model was trained to perform auto-segmentation. Radiomic features were extracted from both physician (scenario 1) and ResUNet segmentations (scenario 2), followed by omitting highly correlated features using Spearman's correlation, and feature selection using Recursive Feature Elimination (RFE) with XGBoost as the core. All models were trained under leave-one-center-out cross-validation (LOCOCV) scheme, where nine instances of algorithms were iteratively trained and validated on data from eight centers and tested on the ninth for both scenarios separately. Segmentation performance was assessed using the Dice similarity coefficient (DSC), while classification performance was assessed using metrics, such as precision, recall, F1-score, accuracy, area under the Receiver Operating Characteristic (ROC AUC), and area under the precision-recall curve (PRC AUC). ResUNet achieved DSC values of 0.84$\pm$0.03, 0.71$\pm$0.06, and 0.86$\pm$0.02 for MNG, TH, and DG, respectively. Classification in scenario 1 achieved an accuracy of 0.76$\pm$0.04 and a ROC AUC of 0.92$\pm$0.02 while in scenario 2, classification yielded an accuracy of 0.74$\pm$0.05 and a ROC AUC of 0.90$\pm$0.02. The automated pipeline demonstrated comparable performance to physician segmentations on several classification metrics across different classes, effectively reducing assessment time while maintaining high diagnostic accuracy. Code available at: https://github.com/ahxmeds/thyroidiomics.git.

Deep Optimal Experimental Design for Parameter Estimation Problems

Optimal experimental design is a well studied field in applied science and engineering. Techniques for estimating such a design are commonly used within the framework of parameter estimation. Nonetheless, in recent years parameter estimation techniques are changing rapidly with the introduction of deep learning techniques to replace traditional estimation methods. This in turn requires the adaptation of optimal experimental design that is associated with these new techniques. In this paper we investigate a new experimental design methodology that uses deep learning. We show that the training of a network as a Likelihood Free Estimator can be used to significantly simplify the design process and circumvent the need for the computationally expensive bi-level optimization problem that is inherent in optimal experimental design for non-linear systems. Furthermore, deep design improves the quality of the recovery process for parameter estimation problems. As proof of concept we apply our methodology to two different systems of Ordinary Differential Equations.

Nuclear Medicine Artificial Intelligence in Action: The Bethesda Report (AI Summit 2024)

The 2nd SNMMI Artificial Intelligence (AI) Summit, organized by the SNMMI AI Task Force, took place in Bethesda, MD, on February 29 - March 1, 2024. Bringing together various community members and stakeholders, and following up on a prior successful 2022 AI Summit, the summit theme was: AI in Action. Six key topics included (i) an overview of prior and ongoing efforts by the AI task force, (ii) emerging needs and tools for computational nuclear oncology, (iii) new frontiers in large language and generative models, (iv) defining the value proposition for the use of AI in nuclear medicine, (v) open science including efforts for data and model repositories, and (vi) issues of reimbursement and funding. The primary efforts, findings, challenges, and next steps are summarized in this manuscript.

Beyond Conventional Parametric Modeling: Data-Driven Framework for Estimation and Prediction of Time Activity Curves in Dynamic PET Imaging

Dynamic Positron Emission Tomography (dPET) imaging and Time-Activity Curve (TAC) analyses are essential for understanding and quantifying the biodistribution of radiopharmaceuticals over time and space. Traditional compartmental modeling, while foundational, commonly struggles to fully capture the complexities of biological systems, including non-linear dynamics and variability. This study introduces an innovative data-driven neural network-based framework, inspired by Reaction Diffusion systems, designed to address these limitations. Our approach, which adaptively fits TACs from dPET, enables the direct calibration of diffusion coefficients and reaction terms from observed data, offering significant improvements in predictive accuracy and robustness over traditional methods, especially in complex biological scenarios. By more accurately modeling the spatio-temporal dynamics of radiopharmaceuticals, our method advances modeling of pharmacokinetic and pharmacodynamic processes, enabling new possibilities in quantitative nuclear medicine.

Segmentation-Free Outcome Prediction in Head and Neck Cancer: Deep Learning-based Feature Extraction from Multi-Angle Maximum Intensity Projections (MA-MIPs) of PET Images

We introduce an innovative, simple, effective segmentation-free approach for outcome prediction in head \& neck cancer (HNC) patients. By harnessing deep learning-based feature extraction techniques and multi-angle maximum intensity projections (MA-MIPs) applied to Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) volumes, our proposed method eliminates the need for manual segmentations of regions-of-interest (ROIs) such as primary tumors and involved lymph nodes. Instead, a state-of-the-art object detection model is trained to perform automatic cropping of the head and neck region on the PET volumes. A pre-trained deep convolutional neural network backbone is then utilized to extract deep features from MA-MIPs obtained from 72 multi-angel axial rotations of the cropped PET volumes. These deep features extracted from multiple projection views of the PET volumes are then aggregated and fused, and employed to perform recurrence-free survival analysis on a cohort of 489 HNC patients. The proposed approach outperforms the best performing method on the target dataset for the task of recurrence-free survival analysis. By circumventing the manual delineation of the malignancies on the FDG PET-CT images, our approach eliminates the dependency on subjective interpretations and highly enhances the reproducibility of the proposed survival analysis method.

IgCONDA-PET: Implicitly-Guided Counterfactual Diffusion for Detecting Anomalies in PET Images

Minimizing the need for pixel-level annotated data for training PET anomaly segmentation networks is crucial, particularly due to time and cost constraints related to expert annotations. Current un-/weakly-supervised anomaly detection methods rely on autoencoder or generative adversarial networks trained only on healthy data, although these are more challenging to train. In this work, we present a weakly supervised and Implicitly guided COuNterfactual diffusion model for Detecting Anomalies in PET images, branded as IgCONDA-PET. The training is conditioned on image class labels (healthy vs. unhealthy) along with implicit guidance to generate counterfactuals for an unhealthy image with anomalies. The counterfactual generation process synthesizes the healthy counterpart for a given unhealthy image, and the difference between the two facilitates the identification of anomaly locations. The code is available at: https://github.com/igcondapet/IgCONDA-PET.git

MEDDAP: Medical Dataset Enhancement via Diversified Augmentation Pipeline

The effectiveness of Deep Neural Networks (DNNs) heavily relies on the abundance and accuracy of available training data. However, collecting and annotating data on a large scale is often both costly and time-intensive, particularly in medical cases where practitioners are already occupied with their duties. Moreover, ensuring that the model remains robust across various scenarios of image capture is crucial in medical domains, especially when dealing with ultrasound images that vary based on the settings of different devices and the manual operation of the transducer. To address this challenge, we introduce a novel pipeline called MEDDAP, which leverages Stable Diffusion (SD) models to augment existing small datasets by automatically generating new informative labeled samples. Pretrained checkpoints for SD are typically based on natural images, and training them for medical images requires significant GPU resources due to their heavy parameters. To overcome this challenge, we introduce USLoRA (Ultrasound Low-Rank Adaptation), a novel fine-tuning method tailored specifically for ultrasound applications. USLoRA allows for selective fine-tuning of weights within SD, requiring fewer than 0.1\% of parameters compared to fully fine-tuning only the UNet portion of SD. To enhance dataset diversity, we incorporate different adjectives into the generation process prompts, thereby desensitizing the classifiers to intensity changes across different images. This approach is inspired by clinicians' decision-making processes regarding breast tumors, where tumor shape often plays a more crucial role than intensity. In conclusion, our pipeline not only outperforms classifiers trained on the original dataset but also demonstrates superior performance when encountering unseen datasets. The source code is available at https://github.com/yasamin-med/MEDDAP.

A cascaded deep network for automated tumor detection and segmentation in clinical PET imaging of diffuse large B-cell lymphoma

Accurate detection and segmentation of diffuse large B-cell lymphoma (DLBCL) from PET images has important implications for estimation of total metabolic tumor volume, radiomics analysis, surgical intervention and radiotherapy. Manual segmentation of tumors in whole-body PET images is time-consuming, labor-intensive and operator-dependent. In this work, we develop and validate a fast and efficient three-step cascaded deep learning model for automated detection and segmentation of DLBCL tumors from PET images. As compared to a single end-to-end network for segmentation of tumors in whole-body PET images, our three-step model is more effective (improves 3D Dice score from 58.9% to 78.1%) since each of its specialized modules, namely the slice classifier, the tumor detector and the tumor segmentor, can be trained independently to a high degree of skill to carry out a specific task, rather than a single network with suboptimal performance on overall segmentation.

A slice classification neural network for automated classification of axial PET/CT slices from a multi-centric lymphoma dataset

Automated slice classification is clinically relevant since it can be incorporated into medical image segmentation workflows as a preprocessing step that would flag slices with a higher probability of containing tumors, thereby directing physicians attention to the important slices. In this work, we train a ResNet-18 network to classify axial slices of lymphoma PET/CT images (collected from two institutions) depending on whether the slice intercepted a tumor (positive slice) in the 3D image or if the slice did not (negative slice). Various instances of the network were trained on 2D axial datasets created in different ways: (i) slice-level split and (ii) patient-level split; inputs of different types were used: (i) only PET slices and (ii) concatenated PET and CT slices; and different training strategies were employed: (i) center-aware (CAW) and (ii) center-agnostic (CAG). Model performances were compared using the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC), and various binary classification metrics. We observe and describe a performance overestimation in the case of slice-level split as compared to the patient-level split training. The model trained using patient-level split data with the network input containing only PET slices in the CAG training regime was the best performing/generalizing model on a majority of metrics. Our models were additionally more closely compared using the sensitivity metric on the positive slices from their respective test sets.