Detection of subclinical atherosclerosis by image-based deep learning on chest x-ray

Aims. To develop a deep-learning based system for recognition of subclinical atherosclerosis on a plain frontal chest x-ray. Methods and Results. A deep-learning algorithm to predict coronary artery calcium (CAC) score (the AI-CAC model) was developed on 460 chest x-ray (80% training cohort, 20% internal validation cohort) of primary prevention patients (58.4% male, median age 63 [51-74] years) with available paired chest x-ray and chest computed tomography (CT) indicated for any clinical reason and performed within 3 months. The CAC score calculated on chest CT was used as ground truth. The model was validated on an temporally-independent cohort of 90 patients from the same institution (external validation). The diagnostic accuracy of the AI-CAC model assessed by the area under the curve (AUC) was the primary outcome. Overall, median AI-CAC score was 35 (0-388) and 28.9% patients had no AI-CAC. AUC of the AI-CAC model to identify a CAC>0 was 0.90 in the internal validation cohort and 0.77 in the external validation cohort. Sensitivity was consistently above 92% in both cohorts. In the overall cohort (n=540), among patients with AI-CAC=0, a single ASCVD event occurred, after 4.3 years. Patients with AI-CAC>0 had significantly higher Kaplan Meier estimates for ASCVD events (13.5% vs. 3.4%, log-rank=0.013). Conclusion. The AI-CAC model seems to accurately detect subclinical atherosclerosis on chest x-ray with elevated sensitivity, and to predict ASCVD events with elevated negative predictive value. Adoption of the AI-CAC model to refine CV risk stratification or as an opportunistic screening tool requires prospective evaluation.

Contrastive learning for regression in multi-site brain age prediction

Building accurate Deep Learning (DL) models for brain age prediction is a very relevant topic in neuroimaging, as it could help better understand neurodegenerative disorders and find new biomarkers. To estimate accurate and generalizable models, large datasets have been collected, which are often multi-site and multi-scanner. This large heterogeneity negatively affects the generalization performance of DL models since they are prone to overfit site-related noise. Recently, contrastive learning approaches have been shown to be more robust against noise in data or labels. For this reason, we propose a novel contrastive learning regression loss for robust brain age prediction using MRI scans. Our method achieves state-of-the-art performance on the OpenBHB challenge, yielding the best generalization capability and robustness to site-related noise.

Unbiased Supervised Contrastive Learning

Many datasets are biased, namely they contain easy-to-learn features that are highly correlated with the target class only in the dataset but not in the true underlying distribution of the data. For this reason, learning unbiased models from biased data has become a very relevant research topic in the last years. In this work, we tackle the problem of learning representations that are robust to biases. We first present a margin-based theoretical framework that allows us to clarify why recent contrastive losses (InfoNCE, SupCon, etc.) can fail when dealing with biased data. Based on that, we derive a novel formulation of the supervised contrastive loss (epsilon-SupInfoNCE), providing more accurate control of the minimal distance between positive and negative samples. Furthermore, thanks to our theoretical framework, we also propose FairKL, a new debiasing regularization loss, that works well even with extremely biased data. We validate the proposed losses on standard vision datasets including CIFAR10, CIFAR100, and ImageNet, and we assess the debiasing capability of FairKL with epsilon-SupInfoNCE, reaching state-of-the-art performance on a number of biased datasets, including real instances of biases in the wild.

Rethinking Positive Sampling for Contrastive Learning with Kernel

Data augmentation is a crucial component in unsupervised contrastive learning (CL). It determines how positive samples are defined and, ultimately, the quality of the representation. While efficient augmentations have been found for standard vision datasets, such as ImageNet, it is still an open problem in other applications, such as medical imaging, or in datasets with easy-to-learn but irrelevant imaging features. In this work, we propose a new way to define positive samples using kernel theory along with a novel loss called decoupled uniformity. We propose to integrate prior information, learnt from generative models or given as auxiliary attributes, into contrastive learning, to make it less dependent on data augmentation. We draw a connection between contrastive learning and the conditional mean embedding theory to derive tight bounds on the downstream classification loss. In an unsupervised setting, we empirically demonstrate that CL benefits from generative models, such as VAE and GAN, to less rely on data augmentations. We validate our framework on vision datasets including CIFAR10, CIFAR100, STL10 and ImageNet100 and a brain MRI dataset. In the weakly supervised setting, we demonstrate that our formulation provides state-of-the-art results.

Unsupervised Learning of Unbiased Visual Representations

Deep neural networks are known for their inability to learn robust representations when biases exist in the dataset. This results in a poor generalization to unbiased datasets, as the predictions strongly rely on peripheral and confounding factors, which are erroneously learned by the network. Many existing works deal with this issue by either employing an explicit supervision on the bias attributes, or assuming prior knowledge about the bias. In this work we study this problem in a more difficult scenario, in which no explicit annotation about the bias is available, and without any prior knowledge about its nature. We propose a fully unsupervised debiasing framework, consisting of three steps: first, we exploit the natural preference for learning malignant biases, obtaining a bias-capturing model; then, we perform a pseudo-labelling step to obtain bias labels; finally we employ state-of-the-art supervised debiasing techniques to obtain an unbiased model. We also propose a theoretical framework to assess the biasness of a model, and provide a detailed analysis on how biases affect the training of neural networks. We perform experiments on synthetic and real-world datasets, showing that our method achieves state-of-the-art performance in a variety of settings, sometimes even higher than fully supervised debiasing approaches.

EnD: Entangling and Disentangling deep representations for bias correction

Artificial neural networks perform state-of-the-art in an ever-growing number of tasks, and nowadays they are used to solve an incredibly large variety of tasks. There are problems, like the presence of biases in the training data, which question the generalization capability of these models. In this work we propose EnD, a regularization strategy whose aim is to prevent deep models from learning unwanted biases. In particular, we insert an "information bottleneck" at a certain point of the deep neural network, where we disentangle the information about the bias, still letting the useful information for the training task forward-propagating in the rest of the model. One big advantage of EnD is that we do not require additional training complexity (like decoders or extra layers in the model), since it is a regularizer directly applied on the trained model. Our experiments show that EnD effectively improves the generalization on unbiased test sets, and it can be effectively applied on real-case scenarios, like removing hidden biases in the COVID-19 detection from radiographic images.

UniToPatho, a labeled histopathological dataset for colorectal polyps classification and adenoma dysplasia grading

Histopathological characterization of colorectal polyps allows to tailor patients' management and follow up with the ultimate aim of avoiding or promptly detecting an invasive carcinoma. Colorectal polyps characterization relies on the histological analysis of tissue samples to determine the polyps malignancy and dysplasia grade. Deep neural networks achieve outstanding accuracy in medical patterns recognition, however they require large sets of annotated training images. We introduce UniToPatho, an annotated dataset of 9536 hematoxylin and eosin (H&E) stained patches extracted from 292 whole-slide images, meant for training deep neural networks for colorectal polyps classification and adenomas grading. We present our dataset and provide insights on how to tackle the problem of automatic colorectal polyps characterization.

A two-step explainable approach for COVID-19 computer-aided diagnosis from chest x-ray images

Early screening of patients is a critical issue in order to assess immediate and fast responses against the spread of COVID-19. The use of nasopharyngeal swabs has been considered the most viable approach; however, the result is not immediate or, in the case of fast exams, sufficiently accurate. Using Chest X-Ray (CXR) imaging for early screening potentially provides faster and more accurate response; however, diagnosing COVID from CXRs is hard and we should rely on deep learning support, whose decision process is, on the other hand, "black-boxed" and, for such reason, untrustworthy. We propose an explainable two-step diagnostic approach, where we first detect known pathologies (anomalies) in the lungs, on top of which we diagnose the illness. Our approach achieves promising performance in COVID detection, compatible with expert human radiologists. All of our experiments have been carried out bearing in mind that, especially for clinical applications, explainability plays a major role for building trust in machine learning algorithms.

Unveiling COVID-19 from Chest X-ray with deep learning: a hurdles race with small data

The possibility to use widespread and simple chest X-ray (CXR) imaging for early screening of COVID-19 patients is attracting much interest from both the clinical and the AI community. In this study we provide insights and also raise warnings on what is reasonable to expect by applying deep-learning to COVID classification of CXR images. We provide a methodological guide and critical reading of an extensive set of statistical results that can be obtained using currently available datasets. In particular, we take the challenge posed by current small size COVID data and show how significant can be the bias introduced by transfer-learning using larger public non-COVID CXR datasets. We also contribute by providing results on a medium size COVID CXR dataset, just collected by one of the major emergency hospitals in Northern Italy during the peak of the COVID pandemic. These novel data allow us to contribute to validate the generalization capacity of preliminary results circulating in the scientific community. Our conclusions shed some light into the possibility to effectively discriminate COVID using CXR.