With increasing reliance on medical imaging in clinical practices, automated report generation from medical images is in great demand. Existing report generation methods typically adopt an encoder-decoder deep learning framework to build a uni-directional image-to-report mapping. However, such a framework ignores the bi-directional mutual associations between images and reports, thus incurring difficulties in associating the intrinsic medical meanings between them. Recent generative representation learning methods have demonstrated the benefits of dual-modal learning from both image and text modalities. However, these methods exhibit two major drawbacks for medical report generation: 1) they tend to capture morphological information and have difficulties in capturing subtle pathological semantic information, and 2) they predict masked text rely on both unmasked images and text, inevitably degrading performance when inference is based solely on images. In this study, we propose a new report generation framework with dual-modal dynamic traceback learning (DTrace) to overcome the two identified drawbacks and enable dual-modal learning for medical report generation. To achieve this, our DTrace introduces a traceback mechanism to control the semantic validity of generated content via self-assessment. Further, our DTrace introduces a dynamic learning strategy to adapt to various proportions of image and text input, enabling report generation without reliance on textual input during inference. Extensive experiments on two well-benchmarked datasets (IU-Xray and MIMIC-CXR) show that our DTrace outperforms state-of-the-art medical report generation methods.
Dense prediction is a fundamental requirement for many medical vision tasks such as medical image restoration, registration, and segmentation. The most popular vision model, Convolutional Neural Networks (CNNs), has reached bottlenecks due to the intrinsic locality of convolution operations. Recently, transformers have been widely adopted for dense prediction for their capability to capture long-range visual dependence. However, due to the high computational complexity and large memory consumption of self-attention operations, transformers are usually used at downsampled feature resolutions. Such usage cannot effectively leverage the tissue-level textural information available only at the full image resolution. This textural information is crucial for medical dense prediction as it can differentiate the subtle human anatomy in medical images. In this study, we hypothesize that Multi-layer Perceptrons (MLPs) are superior alternatives to transformers in medical dense prediction where tissue-level details dominate the performance, as MLPs enable long-range dependence at the full image resolution. To validate our hypothesis, we develop a full-resolution hierarchical MLP framework that uses MLPs beginning from the full image resolution. We evaluate this framework with various MLP blocks on a wide range of medical dense prediction tasks including restoration, registration, and segmentation. Extensive experiments on six public well-benchmarked datasets show that, by simply using MLPs at full resolution, our framework outperforms its CNN and transformer counterparts and achieves state-of-the-art performance on various medical dense prediction tasks.
Deformable image registration aims to find a dense non-linear spatial correspondence between a pair of images, which is a crucial step for many medical tasks such as tumor growth monitoring and population analysis. Recently, Deep Neural Networks (DNNs) have been widely recognized for their ability to perform fast end-to-end registration. However, DNN-based registration needs to explore the spatial information of each image and fuse this information to characterize spatial correspondence. This raises an essential question: what is the optimal fusion strategy to characterize spatial correspondence? Existing fusion strategies (e.g., early fusion, late fusion) were empirically designed to fuse information by manually defined prior knowledge, which inevitably constrains the registration performance within the limits of empirical designs. In this study, we depart from existing empirically-designed fusion strategies and develop a data-driven fusion strategy for deformable image registration. To achieve this, we propose an Automatic Fusion network (AutoFuse) that provides flexibility to fuse information at many potential locations within the network. A Fusion Gate (FG) module is also proposed to control how to fuse information at each potential network location based on training data. Our AutoFuse can automatically optimize its fusion strategy during training and can be generalizable to both unsupervised registration (without any labels) and semi-supervised registration (with weak labels provided for partial training data). Extensive experiments on two well-benchmarked medical registration tasks (inter- and intra-patient registration) with eight public datasets show that our AutoFuse outperforms state-of-the-art unsupervised and semi-supervised registration methods.
Survival prediction is crucial for cancer patients as it provides early prognostic information for treatment planning. Recently, deep survival models based on deep learning and medical images have shown promising performance for survival prediction. However, existing deep survival models are not well developed in utilizing multi-modality images (e.g., PET-CT) and in extracting region-specific information (e.g., the prognostic information in Primary Tumor (PT) and Metastatic Lymph Node (MLN) regions). In view of this, we propose a merging-diverging learning framework for survival prediction from multi-modality images. This framework has a merging encoder to fuse multi-modality information and a diverging decoder to extract region-specific information. In the merging encoder, we propose a Hybrid Parallel Cross-Attention (HPCA) block to effectively fuse multi-modality features via parallel convolutional layers and cross-attention transformers. In the diverging decoder, we propose a Region-specific Attention Gate (RAG) block to screen out the features related to lesion regions. Our framework is demonstrated on survival prediction from PET-CT images in Head and Neck (H&N) cancer, by designing an X-shape merging-diverging hybrid transformer network (named XSurv). Our XSurv combines the complementary information in PET and CT images and extracts the region-specific prognostic information in PT and MLN regions. Extensive experiments on the public dataset of HEad and neCK TumOR segmentation and outcome prediction challenge (HECKTOR 2022) demonstrate that our XSurv outperforms state-of-the-art survival prediction methods.
* Early Accepted at International Conference on Medical Image Computing
and Computer Assisted Intervention (MICCAI 2023)
Image registration is a fundamental requirement for medical image analysis. Deep registration methods based on deep learning have been widely recognized for their capabilities to perform fast end-to-end registration. Many deep registration methods achieved state-of-the-art performance by performing coarse-to-fine registration, where multiple registration steps were iterated with cascaded networks. Recently, Non-Iterative Coarse-to-finE (NICE) registration methods have been proposed to perform coarse-to-fine registration in a single network and showed advantages in both registration accuracy and runtime. However, existing NICE registration methods mainly focus on deformable registration, while affine registration, a common prerequisite, is still reliant on time-consuming traditional optimization-based methods or extra affine registration networks. In addition, existing NICE registration methods are limited by the intrinsic locality of convolution operations. Transformers may address this limitation for their capabilities to capture long-range dependency, but the benefits of using transformers for NICE registration have not been explored. In this study, we propose a Non-Iterative Coarse-to-finE Transformer network (NICE-Trans) for image registration. Our NICE-Trans is the first deep registration method that (i) performs joint affine and deformable coarse-to-fine registration within a single network, and (ii) embeds transformers into a NICE registration framework to model long-range relevance between images. Extensive experiments with seven public datasets show that our NICE-Trans outperforms state-of-the-art registration methods on both registration accuracy and runtime.
* Accepted at International Conference on Medical Image Computing and
Computer Assisted Intervention (MICCAI 2023)
Survival prediction is a major concern for cancer management. Deep survival models based on deep learning have been widely adopted to perform end-to-end survival prediction from medical images. Recent deep survival models achieved promising performance by jointly performing tumor segmentation with survival prediction, where the models were guided to extract tumor-related information through Multi-Task Learning (MTL). However, existing deep survival models have difficulties in exploring out-of-tumor prognostic information (e.g., local lymph node metastasis and adjacent tissue invasions). In addition, existing deep survival models are underdeveloped in utilizing multi-modality images. Empirically-designed strategies were commonly adopted to fuse multi-modality information via fixed pre-designed networks. In this study, we propose a Deep Multi-modality Segmentation-to-Survival model (DeepMSS) for survival prediction from PET/CT images. Instead of adopting MTL, we propose a novel Segmentation-to-Survival Learning (SSL) strategy, where our DeepMSS is trained for tumor segmentation and survival prediction sequentially. This strategy enables the DeepMSS to initially focus on tumor regions and gradually expand its focus to include other prognosis-related regions. We also propose a data-driven strategy to fuse multi-modality image information, which realizes automatic optimization of fusion strategies based on training data during training and also improves the adaptability of DeepMSS to different training targets. Our DeepMSS is also capable of incorporating conventional radiomics features as an enhancement, where handcrafted features can be extracted from the DeepMSS-segmented tumor regions and cooperatively integrated into the DeepMSS's training and inference. Extensive experiments with two large clinical datasets show that our DeepMSS outperforms state-of-the-art survival prediction methods.
Positron emission tomography (PET) is the most sensitive molecular imaging modality routinely applied in our modern healthcare. High radioactivity caused by the injected tracer dose is a major concern in PET imaging and limits its clinical applications. However, reducing the dose leads to inadequate image quality for diagnostic practice. Motivated by the need to produce high quality images with minimum low-dose, Convolutional Neural Networks (CNNs) based methods have been developed for high quality PET synthesis from its low-dose counterparts. Previous CNNs-based studies usually directly map low-dose PET into features space without consideration of different dose reduction level. In this study, a novel approach named CG-3DSRGAN (Classification-Guided Generative Adversarial Network with Super Resolution Refinement) is presented. Specifically, a multi-tasking coarse generator, guided by a classification head, allows for a more comprehensive understanding of the noise-level features present in the low-dose data, resulting in improved image synthesis. Moreover, to recover spatial details of standard PET, an auxiliary super resolution network - Contextual-Net - is proposed as a second-stage training to narrow the gap between coarse prediction and standard PET. We compared our method to the state-of-the-art methods on whole-body PET with different dose reduction factors (DRFs). Experiments demonstrate our method can outperform others on all DRF.
Over the last decade, supervised deep learning on manually annotated big data has been progressing significantly on computer vision tasks. But the application of deep learning in medical image analysis was limited by the scarcity of high-quality annotated medical imaging data. An emerging solution is self-supervised learning (SSL), among which contrastive SSL is the most successful approach to rivalling or outperforming supervised learning. This review investigates several state-of-the-art contrastive SSL algorithms originally on natural images as well as their adaptations for medical images, and concludes by discussing recent advances, current limitations, and future directions in applying contrastive SSL in the medical domain.
Prostate cancer (PCa) is one of the most prevalent cancers in men and many people around the world die from clinically significant PCa (csPCa). Early diagnosis of csPCa in bi-parametric MRI (bpMRI), which is non-invasive, cost-effective, and more efficient compared to multiparametric MRI (mpMRI), can contribute to precision care for PCa. The rapid rise in artificial intelligence (AI) algorithms are enabling unprecedented improvements in providing decision support systems that can aid in csPCa diagnosis and understanding. However, existing state of the art AI algorithms which are based on deep learning technology are often limited to 2D images that fails to capture inter-slice correlations in 3D volumetric images. The use of 3D convolutional neural networks (CNNs) partly overcomes this limitation, but it does not adapt to the anisotropy of images, resulting in sub-optimal semantic representation and poor generalization. Furthermore, due to the limitation of the amount of labelled data of bpMRI and the difficulty of labelling, existing CNNs are built on relatively small datasets, leading to a poor performance. To address the limitations identified above, we propose a new Zonal-aware Self-supervised Mesh Network (Z-SSMNet) that adaptatively fuses multiple 2D, 2.5D and 3D CNNs to effectively balance representation for sparse inter-slice information and dense intra-slice information in bpMRI. A self-supervised learning (SSL) technique is further introduced to pre-train our network using unlabelled data to learn the generalizable image features. Furthermore, we constrained our network to understand the zonal specific domain knowledge to improve the diagnosis precision of csPCa. Experiments on the PI-CAI Challenge dataset demonstrate our proposed method achieves better performance for csPCa detection and diagnosis in bpMRI.
In this study, we focus on brain tumor sequence registration between pre-operative and follow-up Magnetic Resonance Imaging (MRI) scans of brain glioma patients, in the context of Brain Tumor Sequence Registration challenge (BraTS-Reg 2022). Brain tumor registration is a fundamental requirement in brain image analysis for quantifying tumor changes. This is a challenging task due to large deformations and missing correspondences between pre-operative and follow-up scans. For this task, we adopt our recently proposed Non-Iterative Coarse-to-finE registration Networks (NICE-Net) - a deep learning-based method for coarse-to-fine registering images with large deformations. To overcome missing correspondences, we extend the NICE-Net by introducing dual deep supervision, where a deep self-supervised loss based on image similarity and a deep weakly-supervised loss based on manually annotated landmarks are deeply embedded into the NICE-Net. At the BraTS-Reg 2022, our method achieved a competitive result on the validation set (mean absolute error: 3.387) and placed 4th in the final testing phase (Score: 0.3544).