Learn-Morph-Infer: a new way of solving the inverse problem for brain tumor modeling

Current treatment planning of patients diagnosed with brain tumor could significantly benefit by accessing the spatial distribution of tumor cell concentration. Existing diagnostic modalities, such as magnetic-resonance imaging (MRI), contrast sufficiently well areas of high cell density. However, they do not portray areas of low concentration, which can often serve as a source for the secondary appearance of the tumor after treatment. Numerical simulations of tumor growth could complement imaging information by providing estimates of full spatial distributions of tumor cells. Over recent years a corpus of literature on medical image-based tumor modeling was published. It includes different mathematical formalisms describing the forward tumor growth model. Alongside, various parametric inference schemes were developed to perform an efficient tumor model personalization, i.e. solving the inverse problem. However, the unifying drawback of all existing approaches is the time complexity of the model personalization that prohibits a potential integration of the modeling into clinical settings. In this work, we introduce a methodology for inferring patient-specific spatial distribution of brain tumor from T1Gd and FLAIR MRI medical scans. Coined as \textit{Learn-Morph-Infer} the method achieves real-time performance in the order of minutes on widely available hardware and the compute time is stable across tumor models of different complexity, such as reaction-diffusion and reaction-advection-diffusion models. We believe the proposed inverse solution approach not only bridges the way for clinical translation of brain tumor personalization but can also be adopted to other scientific and engineering domains.

The RSNA-ASNR-MICCAI BraTS 2021 Benchmark on Brain Tumor Segmentation and Radiogenomic Classification

The BraTS 2021 challenge celebrates its 10th anniversary and is jointly organized by the Radiological Society of North America (RSNA), the American Society of Neuroradiology (ASNR), and the Medical Image Computing and Computer Assisted Interventions (MICCAI) society. Since its inception, BraTS has been focusing on being a common benchmarking venue for brain glioma segmentation algorithms, with well-curated multi-institutional multi-parametric magnetic resonance imaging (mpMRI) data. Gliomas are the most common primary malignancies of the central nervous system, with varying degrees of aggressiveness and prognosis. The RSNA-ASNR-MICCAI BraTS 2021 challenge targets the evaluation of computational algorithms assessing the same tumor compartmentalization, as well as the underlying tumor's molecular characterization, in pre-operative baseline mpMRI data from 2,000 patients. Specifically, the two tasks that BraTS 2021 focuses on are: a) the segmentation of the histologically distinct brain tumor sub-regions, and b) the classification of the tumor's O[6]-methylguanine-DNA methyltransferase (MGMT) promoter methylation status. The performance evaluation of all participating algorithms in BraTS 2021 will be conducted through the Sage Bionetworks Synapse platform (Task 1) and Kaggle (Task 2), concluding in distributing to the top ranked participants monetary awards of $60,000 collectively.

The Medical Segmentation Decathlon

International challenges have become the de facto standard for comparative assessment of image analysis algorithms given a specific task. Segmentation is so far the most widely investigated medical image processing task, but the various segmentation challenges have typically been organized in isolation, such that algorithm development was driven by the need to tackle a single specific clinical problem. We hypothesized that a method capable of performing well on multiple tasks will generalize well to a previously unseen task and potentially outperform a custom-designed solution. To investigate the hypothesis, we organized the Medical Segmentation Decathlon (MSD) - a biomedical image analysis challenge, in which algorithms compete in a multitude of both tasks and modalities. The underlying data set was designed to explore the axis of difficulties typically encountered when dealing with medical images, such as small data sets, unbalanced labels, multi-site data and small objects. The MSD challenge confirmed that algorithms with a consistent good performance on a set of tasks preserved their good average performance on a different set of previously unseen tasks. Moreover, by monitoring the MSD winner for two years, we found that this algorithm continued generalizing well to a wide range of other clinical problems, further confirming our hypothesis. Three main conclusions can be drawn from this study: (1) state-of-the-art image segmentation algorithms are mature, accurate, and generalize well when retrained on unseen tasks; (2) consistent algorithmic performance across multiple tasks is a strong surrogate of algorithmic generalizability; (3) the training of accurate AI segmentation models is now commoditized to non AI experts.

The Federated Tumor Segmentation (FeTS) Challenge

This manuscript describes the first challenge on Federated Learning, namely the Federated Tumor Segmentation (FeTS) challenge 2021. International challenges have become the standard for validation of biomedical image analysis methods. However, the actual performance of participating (even the winning) algorithms on "real-world" clinical data often remains unclear, as the data included in challenges are usually acquired in very controlled settings at few institutions. The seemingly obvious solution of just collecting increasingly more data from more institutions in such challenges does not scale well due to privacy and ownership hurdles. Towards alleviating these concerns, we are proposing the FeTS challenge 2021 to cater towards both the development and the evaluation of models for the segmentation of intrinsically heterogeneous (in appearance, shape, and histology) brain tumors, namely gliomas. Specifically, the FeTS 2021 challenge uses clinically acquired, multi-institutional magnetic resonance imaging (MRI) scans from the BraTS 2020 challenge, as well as from various remote independent institutions included in the collaborative network of a real-world federation (https://www.fets.ai/). The goals of the FeTS challenge are directly represented by the two included tasks: 1) the identification of the optimal weight aggregation approach towards the training of a consensus model that has gained knowledge via federated learning from multiple geographically distinct institutions, while their data are always retained within each institution, and 2) the federated evaluation of the generalizability of brain tumor segmentation models "in the wild", i.e. on data from institutional distributions that were not part of the training datasets.

Common Limitations of Image Processing Metrics: A Picture Story

While the importance of automatic image analysis is increasing at an enormous pace, recent meta-research revealed major flaws with respect to algorithm validation. Specifically, performance metrics are key for objective, transparent and comparative performance assessment, but relatively little attention has been given to the practical pitfalls when using specific metrics for a given image analysis task. A common mission of several international initiatives is therefore to provide researchers with guidelines and tools to choose the performance metrics in a problem-aware manner. This dynamically updated document has the purpose to illustrate important limitations of performance metrics commonly applied in the field of image analysis. The current version is based on a Delphi process on metrics conducted by an international consortium of image analysis experts.

$\textbf{MyoMapNet}$: Accelerated Modified Look-Locker Inversion Recovery Myocardial T1 Mapping via Neural Networks

Purpose: To develop and evaluate MyoMapNet, a rapid myocardial T1 mapping approach that uses neural networks (NN) to estimate voxel-wise myocardial T1 and extracellular (ECV) from T1-weighted images collected after a single inversion pulse over 4-5 heartbeats. Method: MyoMapNet utilizes a simple fully-connected NN to estimate T1 values from 5 (native) or 4 (post-contrast) T1-weighted images. Native MOLLI-5(3)3 T1 was collected in 717 subjects (386 males, 55$\pm$16.5 years) and post-contrast MOLLI-4(1)3(1)2 in 535 subjects (232 male, 56.5$\pm$15 years). The dataset was divided into training (80%) and testing (20%), where 20% of the training set was used to optimize MyoMapNet architecture (size and loss functions). We used MyoMapNet to estimate T1 and ECV maps with the first 5 (native) or 4 (post-contrast) T1-weighted images from the corresponding MOLLI sequence compared to the conventional and an abbreviated MOLLI using similar number of T1-weighted images with 3-parameter curve-fitting. Results: In our preliminary optimizaiton step, we determined that a 5-layers NN trained using mean-absolute-error loss yields lower estimation errors and was used subsequently in independent testing study. The myocardial T1 by MyoMapNet was similar to MOLLI (1200$\pm$45ms vs. 1199$\pm$46ms; P=0.3 for native T1, and 27.3$\pm$3.5% vs. 27.1$\pm$4%; P=0.4 for ECV). MyoMapNet had significantly smaller errors in T1 estimations compared to abbreviated-MOLLI (1$\pm$17ms vs. 31$\pm$34ms, P<0.01 for in native T1, and 0.1$\pm$1.3% vs. 1.9$\pm$2.5%, P<0.01 for ECV). The duration of T1 estimation was approximately 2 ms per slice using MyoMapNet. Conclusion: MyoMapNet T1 mapping enables myocardial T1 quantification in 4-5 heartbeats with near-instantaneous map estimation time with similar accuracy and precision as MOLLI. Keywords: Myocardial T1 mapping, MOLLI, T1 reconstruction, Neural network, Deep Learning.

Differentiable Deconvolution for Improved Stroke Perfusion Analysis

Perfusion imaging is the current gold standard for acute ischemic stroke analysis. It allows quantification of the salvageable and non-salvageable tissue regions (penumbra and core areas respectively). In clinical settings, the singular value decomposition (SVD) deconvolution is one of the most accepted and used approaches for generating interpretable and physically meaningful maps. Though this method has been widely validated in experimental and clinical settings, it might produce suboptimal results because the chosen inputs to the model cannot guarantee optimal performance. For the most critical input, the arterial input function (AIF), it is still controversial how and where it should be chosen even though the method is very sensitive to this input. In this work we propose an AIF selection approach that is optimized for maximal core lesion segmentation performance. The AIF is regressed by a neural network optimized through a differentiable SVD deconvolution, aiming to maximize core lesion segmentation agreement with ground truth data. To our knowledge, this is the first work exploiting a differentiable deconvolution model with neural networks. We show that our approach is able to generate AIFs without any manual annotation, and hence avoiding manual rater's influences. The method achieves manual expert performance in the ISLES18 dataset. We conclude that the methodology opens new possibilities for improving perfusion imaging quantification with deep neural networks.

A Computed Tomography Vertebral Segmentation Dataset with Anatomical Variations and Multi-Vendor Scanner Data

With the advent of deep learning algorithms, fully automated radiological image analysis is within reach. In spine imaging, several atlas- and shape-based as well as deep learning segmentation algorithms have been proposed, allowing for subsequent automated analysis of morphology and pathology. The first Large Scale Vertebrae Segmentation Challenge (VerSe 2019) showed that these perform well on normal anatomy, but fail in variants not frequently present in the training dataset. Building on that experience, we report on the largely increased VerSe 2020 dataset and results from the second iteration of the VerSe challenge (MICCAI 2020, Lima, Peru). VerSe 2020 comprises annotated spine computed tomography (CT) images from 300 subjects with 4142 fully visualized and annotated vertebrae, collected across multiple centres from four different scanner manufacturers, enriched with cases that exhibit anatomical variants such as enumeration abnormalities (n=77) and transitional vertebrae (n=161). Metadata includes vertebral labelling information, voxel-level segmentation masks obtained with a human-machine hybrid algorithm and anatomical ratings, to enable the development and benchmarking of robust and accurate segmentation algorithms.