Reversing the Abnormal: Pseudo-Healthy Generative Networks for Anomaly Detection

Early and accurate disease detection is crucial for patient management and successful treatment outcomes. However, the automatic identification of anomalies in medical images can be challenging. Conventional methods rely on large labeled datasets which are difficult to obtain. To overcome these limitations, we introduce a novel unsupervised approach, called PHANES (Pseudo Healthy generative networks for ANomaly Segmentation). Our method has the capability of reversing anomalies, i.e., preserving healthy tissue and replacing anomalous regions with pseudo-healthy (PH) reconstructions. Unlike recent diffusion models, our method does not rely on a learned noise distribution nor does it introduce random alterations to the entire image. Instead, we use latent generative networks to create masks around possible anomalies, which are refined using inpainting generative networks. We demonstrate the effectiveness of PHANES in detecting stroke lesions in T1w brain MRI datasets and show significant improvements over state-of-the-art (SOTA) methods. We believe that our proposed framework will open new avenues for interpretable, fast, and accurate anomaly segmentation with the potential to support various clinical-oriented downstream tasks.

Robust Detection Outcome: A Metric for Pathology Detection in Medical Images

Detection of pathologies is a fundamental task in medical imaging and the evaluation of algorithms that can perform this task automatically is crucial. However, current object detection metrics for natural images do not reflect the specific clinical requirements in pathology detection sufficiently. To tackle this problem, we propose Robust Detection Outcome (RoDeO); a novel metric for evaluating algorithms for pathology detection in medical images, especially in chest X-rays. RoDeO evaluates different errors directly and individually, and reflects clinical needs better than current metrics. Extensive evaluation on the ChestX-ray8 dataset shows the superiority of our metrics compared to existing ones. We released the code at https://github.com/FeliMe/RoDeO and published RoDeO as pip package (rodeometric).

Unsupervised Pathology Detection: A Deep Dive Into the State of the Art

Deep unsupervised approaches are gathering increased attention for applications such as pathology detection and segmentation in medical images since they promise to alleviate the need for large labeled datasets and are more generalizable than their supervised counterparts in detecting any kind of rare pathology. As the Unsupervised Anomaly Detection (UAD) literature continuously grows and new paradigms emerge, it is vital to continuously evaluate and benchmark new methods in a common framework, in order to reassess the state-of-the-art (SOTA) and identify promising research directions. To this end, we evaluate a diverse selection of cutting-edge UAD methods on multiple medical datasets, comparing them against the established SOTA in UAD for brain MRI. Our experiments demonstrate that newly developed feature-modeling methods from the industrial and medical literature achieve increased performance compared to previous work and set the new SOTA in a variety of modalities and datasets. Additionally, we show that such methods are capable of benefiting from recently developed self-supervised pre-training algorithms, further increasing their performance. Finally, we perform a series of experiments in order to gain further insights into some unique characteristics of selected models and datasets. Our code can be found under https://github.com/iolag/UPD_study/.

Reconstruction-driven motion estimation for motion-compensated MR CINE imaging

In cardiac CINE, motion-compensated MR reconstruction (MCMR) is an effective approach to address highly undersampled acquisitions by incorporating motion information between frames. In this work, we propose a deep learning-based framework to address the MCMR problem efficiently. Contrary to state-of-the-art (SOTA) MCMR methods which break the original problem into two sub-optimization problems, i.e. motion estimation and reconstruction, we formulate this problem as a single entity with one single optimization. We discard the canonical motion-warping loss (similarity measurement between motion-warped images and target images) to estimate the motion, but drive the motion estimation process directly by the final reconstruction performance. The higher reconstruction quality is achieved without using any smoothness loss terms and without iterative processing between motion estimation and reconstruction. Therefore, we avoid non-trivial loss weighting factors tuning and time-consuming iterative processing. Experiments on 43 in-house acquired 2D CINE datasets indicate that the proposed MCMR framework can deliver artifact-free motion estimation and high-quality MR images even for imaging accelerations up to 20x. The proposed framework is compared to SOTA non-MCMR and MCMR methods and outperforms these methods qualitatively and quantitatively in all applied metrics across all experiments with different acceleration rates.

Private, fair and accurate: Training large-scale, privacy-preserving AI models in radiology

Artificial intelligence (AI) models are increasingly used in the medical domain. However, as medical data is highly sensitive, special precautions to ensure the protection of said data are required. The gold standard for privacy preservation is the introduction of differential privacy (DP) to model training. However, prior work has shown that DP has negative implications on model accuracy and fairness. Therefore, the purpose of this study is to demonstrate that the privacy-preserving training of AI models for chest radiograph diagnosis is possible with high accuracy and fairness compared to non-private training. N=193,311 high quality clinical chest radiographs were retrospectively collected and manually labeled by experienced radiologists, who assigned one or more of the following diagnoses: cardiomegaly, congestion, pleural effusion, pneumonic infiltration and atelectasis, to each side (where applicable). The non-private AI models were compared with privacy-preserving (DP) models with respect to privacy-utility trade-offs (measured as area under the receiver-operator-characteristic curve (AUROC)), and privacy-fairness trade-offs (measured as Pearson-R or Statistical Parity Difference). The non-private AI model achieved an average AUROC score of 0.90 over all labels, whereas the DP AI model with a privacy budget of epsilon=7.89 resulted in an AUROC of 0.87, i.e., a mere 2.6% performance decrease compared to non-private training. The privacy-preserving training of diagnostic AI models can achieve high performance with a small penalty on model accuracy and does not amplify discrimination against age, sex or co-morbidity. We thus encourage practitioners to integrate state-of-the-art privacy-preserving techniques into medical AI model development.

Equivariant Differentially Private Deep Learning

The formal privacy guarantee provided by Differential Privacy (DP) bounds the leakage of sensitive information from deep learning models. In practice, however, this comes at a severe computation and accuracy cost. The recently established state of the art (SOTA) results in image classification under DP are due to the use of heavy data augmentation and large batch sizes, leading to a drastically increased computation overhead. In this work, we propose to use more efficient models with improved feature quality by introducing steerable equivariant convolutional networks for DP training. We demonstrate that our models are able to outperform the current SOTA performance on CIFAR-10 by up to $9\%$ across different $\varepsilon$-values while reducing the number of model parameters by a factor of $35$ and decreasing the computation time by more than $90 \%$. Our results are a large step towards efficient model architectures that make optimal use of their parameters and bridge the privacy-utility gap between private and non-private deep learning for computer vision.

CHeart: A Conditional Spatio-Temporal Generative Model for Cardiac Anatomy

Two key questions in cardiac image analysis are to assess the anatomy and motion of the heart from images; and to understand how they are associated with non-imaging clinical factors such as gender, age and diseases. While the first question can often be addressed by image segmentation and motion tracking algorithms, our capability to model and to answer the second question is still limited. In this work, we propose a novel conditional generative model to describe the 4D spatio-temporal anatomy of the heart and its interaction with non-imaging clinical factors. The clinical factors are integrated as the conditions of the generative modelling, which allows us to investigate how these factors influence the cardiac anatomy. We evaluate the model performance in mainly two tasks, anatomical sequence completion and sequence generation. The model achieves a high performance in anatomical sequence completion, comparable to or outperforming other state-of-the-art generative models. In terms of sequence generation, given clinical conditions, the model can generate realistic synthetic 4D sequential anatomies that share similar distributions with the real data.

Clustering disease trajectories in contrastive feature space for biomarker discovery in age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly. Despite this, the exact dynamics of disease progression are poorly understood. There is a clear need for imaging biomarkers in retinal optical coherence tomography (OCT) that aid the diagnosis, prognosis and management of AMD. However, current grading systems, which coarsely group disease stage into broad categories describing early and intermediate AMD, have very limited prognostic value for the conversion to late AMD. In this paper, we are the first to analyse disease progression as clustered trajectories in a self-supervised feature space. Our method first pretrains an encoder with contrastive learning to project images from longitudinal time series to points in feature space. This enables the creation of disease trajectories, which are then denoised, partitioned and grouped into clusters. These clusters, found in two datasets containing time series of 7,912 patients imaged over eight years, were correlated with known OCT biomarkers. This reinforced efforts by four expert ophthalmologists to investigate clusters, during a clinical comparison and interpretation task, as candidates for time-dependent biomarkers that describe progression of AMD.

Approaching Peak Ground Truth

Machine learning models are typically evaluated by computing similarity with reference annotations and trained by maximizing similarity with such. Especially in the bio-medical domain, annotations are subjective and suffer from low inter- and intra-rater reliability. Since annotations only reflect the annotation entity's interpretation of the real world, this can lead to sub-optimal predictions even though the model achieves high similarity scores. Here, the theoretical concept of Peak Ground Truth (PGT) is introduced. PGT marks the point beyond which an increase in similarity with the reference annotation stops translating to better Real World Model Performance (RWMP). Additionally, a quantitative technique to approximate PGT by computing inter- and intra-rater reliability is proposed. Finally, three categories of PGT-aware strategies to evaluate and improve model performance are reviewed.

Neural Implicit k-Space for Binning-free Non-Cartesian Cardiac MR Imaging

In this work, we propose a novel image reconstruction framework that directly learns a neural implicit representation in k-space for ECG-triggered non-Cartesian Cardiac Magnetic Resonance Imaging (CMR). While existing methods bin acquired data from neighboring time points to reconstruct one phase of the cardiac motion, our framework allows for a continuous, binning-free, and subject-specific k-space representation.We assign a unique coordinate that consists of time, coil index, and frequency domain location to each sampled k-space point. We then learn the subject-specific mapping from these unique coordinates to k-space intensities using a multi-layer perceptron with frequency domain regularization. During inference, we obtain a complete k-space for Cartesian coordinates and an arbitrary temporal resolution. A simple inverse Fourier transform recovers the image, eliminating the need for density compensation and costly non-uniform Fourier transforms for non-Cartesian data. This novel imaging framework was tested on 42 radially sampled datasets from 6 subjects. The proposed method outperforms other techniques qualitatively and quantitatively using data from four and one heartbeat(s) and 30 cardiac phases. Our results for one heartbeat reconstruction of 50 cardiac phases show improved artifact removal and spatio-temporal resolution, leveraging the potential for real-time CMR.