Improving Pediatric Low-Grade Neuroepithelial Tumors Molecular Subtype Identification Using a Novel AUROC Loss Function for Convolutional Neural Networks

Pediatric Low-Grade Neuroepithelial Tumors (PLGNT) are the most common pediatric cancer type, accounting for 40% of brain tumors in children, and identifying PLGNT molecular subtype is crucial for treatment planning. However, the gold standard to determine the PLGNT subtype is biopsy, which can be impractical or dangerous for patients. This research improves the performance of Convolutional Neural Networks (CNNs) in classifying PLGNT subtypes through MRI scans by introducing a loss function that specifically improves the model's Area Under the Receiver Operating Characteristic (ROC) Curve (AUROC), offering a non-invasive diagnostic alternative. In this study, a retrospective dataset of 339 children with PLGNT (143 BRAF fusion, 71 with BRAF V600E mutation, and 125 non-BRAF) was curated. We employed a CNN model with Monte Carlo random data splitting. The baseline model was trained using binary cross entropy (BCE), and achieved an AUROC of 86.11% for differentiating BRAF fusion and BRAF V600E mutations, which was improved to 87.71% using our proposed AUROC loss function (p-value 0.045). With multiclass classification, the AUROC improved from 74.42% to 76. 59% (p-value 0.0016).

Generating 3D Brain Tumor Regions in MRI using Vector-Quantization Generative Adversarial Networks

Medical image analysis has significantly benefited from advancements in deep learning, particularly in the application of Generative Adversarial Networks (GANs) for generating realistic and diverse images that can augment training datasets. However, the effectiveness of such approaches is often limited by the amount of available data in clinical settings. Additionally, the common GAN-based approach is to generate entire image volumes, rather than solely the region of interest (ROI). Research on deep learning-based brain tumor classification using MRI has shown that it is easier to classify the tumor ROIs compared to the entire image volumes. In this work, we present a novel framework that uses vector-quantization GAN and a transformer incorporating masked token modeling to generate high-resolution and diverse 3D brain tumor ROIs that can be directly used as augmented data for the classification of brain tumor ROI. We apply our method to two imbalanced datasets where we augment the minority class: (1) the Multimodal Brain Tumor Segmentation Challenge (BraTS) 2019 dataset to generate new low-grade glioma (LGG) ROIs to balance with high-grade glioma (HGG) class; (2) the internal pediatric LGG (pLGG) dataset tumor ROIs with BRAF V600E Mutation genetic marker to balance with BRAF Fusion genetic marker class. We show that the proposed method outperforms various baseline models in both qualitative and quantitative measurements. The generated data was used to balance the data in the brain tumor types classification task. Using the augmented data, our approach surpasses baseline models by 6.4% in AUC on the BraTS 2019 dataset and 4.3% in AUC on our internal pLGG dataset. The results indicate the generated tumor ROIs can effectively address the imbalanced data problem. Our proposed method has the potential to facilitate an accurate diagnosis of rare brain tumors using MRI scans.

Using Large Text-to-Image Models with Structured Prompts for Skin Disease Identification: A Case Study

This paper investigates the potential usage of large text-to-image (LTI) models for the automated diagnosis of a few skin conditions with rarity or a serious lack of annotated datasets. As the input to the LTI model, we provide the targeted instantiation of a generic but succinct prompt structure designed upon careful observations of the conditional narratives from the standard medical textbooks. In this regard, we pave the path to utilizing accessible textbook descriptions for automated diagnosis of conditions with data scarcity through the lens of LTI models. Experiments show the efficacy of the proposed framework, including much better localization of the infected regions. Moreover, it has the immense possibility for generalization across the medical sub-domains, not only to mitigate the data scarcity issue but also to debias automated diagnostics from the all-pervasive racial biases.

A Comprehensive Study of Radiomics-based Machine Learning for Fibrosis Detection

Objectives: Early detection of liver fibrosis can help cure the disease or prevent disease progression. We perform a comprehensive study of machine learning-based fibrosis detection in CT images using radiomic features to develop a non-invasive approach to fibrosis detection. Methods: Two sets of radiomic features were extracted from spherical ROIs in CT images of 182 patients who underwent simultaneous liver biopsy and CT examinations, one set corresponding to biopsy locations and another distant from biopsy locations. Combinations of contrast, normalization, machine learning model, feature selection method, bin width, and kernel radius were investigated, each of which were trained and evaluated 100 times with randomized development and test cohorts. The best settings were evaluated based on their mean test AUC and the best features were determined based on their frequency among the best settings. Results: Logistic regression models with NC images normalized using Gamma correction with $\gamma = 1.5$ performed best for fibrosis detection. Boruta was the best for radiomic feature selection method. Training a model using these optimal settings and features consisting of first order energy, first order kurtosis, and first order skewness, resulted in a model that achieved mean test AUCs of 0.7549 and 0.7166 on biopsy-based and non-biopsy ROIs respectively, outperforming a baseline and best models found during the initial study. Conclusions: Logistic regression models trained on radiomic features from NC images normalized using Gamma correction with $\gamma = 1.5$ that underwent Boruta feature selection are effective for liver fibrosis detection. Energy, kurtosis, and skewness are particularly effective features for fibrosis detection.

Automating Cobb Angle Measurement for Adolescent Idiopathic Scoliosis using Instance Segmentation

Scoliosis is a three-dimensional deformity of the spine, most often diagnosed in childhood. It affects 2-3% of the population, which is approximately seven million people in North America. Currently, the reference standard for assessing scoliosis is based on the manual assignment of Cobb angles at the site of the curvature center. This manual process is time consuming and unreliable as it is affected by inter- and intra-observer variance. To overcome these inaccuracies, machine learning (ML) methods can be used to automate the Cobb angle measurement process. This paper proposes to address the Cobb angle measurement task using YOLACT, an instance segmentation model. The proposed method first segments the vertebrae in an X-Ray image using YOLACT, then it tracks the important landmarks using the minimum bounding box approach. Lastly, the extracted landmarks are used to calculate the corresponding Cobb angles. The model achieved a Symmetric Mean Absolute Percentage Error (SMAPE) score of 10.76%, demonstrating the reliability of this process in both vertebra localization and Cobb angle measurement.

A novel GAN-based paradigm for weakly supervised brain tumor segmentation of MR images

Segmentation of regions of interest (ROIs) for identifying abnormalities is a leading problem in medical imaging. Using Machine Learning (ML) for this problem generally requires manually annotated ground-truth segmentations, demanding extensive time and resources from radiologists. This work presents a novel weakly supervised approach that utilizes binary image-level labels, which are much simpler to acquire, to effectively segment anomalies in medical Magnetic Resonance (MR) images without ground truth annotations. We train a binary classifier using these labels and use it to derive seeds indicating regions likely and unlikely to contain tumors. These seeds are used to train a generative adversarial network (GAN) that converts cancerous images to healthy variants, which are then used in conjunction with the seeds to train a ML model that generates effective segmentations. This method produces segmentations that achieve Dice coefficients of 0.7903, 0.7868, and 0.7712 on the MICCAI Brain Tumor Segmentation (BraTS) 2020 dataset for the training, validation, and test cohorts respectively. We also propose a weakly supervised means of filtering the segmentations, removing a small subset of poorer segmentations to acquire a large subset of high quality segmentations. The proposed filtering further improves the Dice coefficients to up to 0.8374, 0.8232, and 0.8136 for training, validation, and test, respectively.

Optimized Global Perturbation Attacks For Brain Tumour ROI Extraction From Binary Classification Models

Deep learning techniques have greatly benefited computer-aided diagnostic systems. However, unlike other fields, in medical imaging, acquiring large fine-grained annotated datasets such as 3D tumour segmentation is challenging due to the high cost of manual annotation and privacy regulations. This has given interest to weakly-supervise methods to utilize the weakly labelled data for tumour segmentation. In this work, we propose a weakly supervised approach to obtain regions of interest using binary class labels. Furthermore, we propose a novel objective function to train the generator model based on a pretrained binary classification model. Finally, we apply our method to the brain tumour segmentation problem in MRI.

Tumor-location-guided CNNs for Pediatric Low-grade Glioma Molecular Biomarker Classification Using MRI

Pediatric low-grade glioma (pLGG) is the most common type of brain cancer among children, and the identification of molecular markers for pLGG is crucial for successful treatment planning. Current standard care is biopsy, which is invasive. Thus, the non-invasive imaging-based approaches, where Machine Learning (ML) has a high potential, are impactful. Recently, we developed a tumor-location-based algorithm and demonstrated its potential to differentiate pLGG molecular subtypes. In this work, we first reevaluated the performance of the location-based algorithm on a larger pLGG dataset, which includes 214 patients and achieved an area under the receiver operating characteristic curve (AUROC) of 77.90. A Convolutional Neural Network (CNN) based algorithm increased the average AUROC to 86.11. Ultimately, we designed and implemented a tumor-location-guided CNN algorithm and achieved average AUROC of 88.64. Using a repeated experiment approach with 100 runs, we ensured the results were reproducible and the improvement was statistically significant.

Introducing Vision Transformer for Alzheimer's Disease classification task with 3D input

Many high-performance classification models utilize complex CNN-based architectures for Alzheimer's Disease classification. We aim to investigate two relevant questions regarding classification of Alzheimer's Disease using MRI: "Do Vision Transformer-based models perform better than CNN-based models?" and "Is it possible to use a shallow 3D CNN-based model to obtain satisfying results?" To achieve these goals, we propose two models that can take in and process 3D MRI scans: Convolutional Voxel Vision Transformer (CVVT) architecture, and ConvNet3D-4, a shallow 4-block 3D CNN-based model. Our results indicate that the shallow 3D CNN-based models are sufficient to achieve good classification results for Alzheimer's Disease using MRI scans.

Superpixel Generation and Clustering for Weakly Supervised Brain Tumor Segmentation in MR Images

Training Machine Learning (ML) models to segment tumors and other anomalies in medical images is an increasingly popular area of research but generally requires manually annotated ground truth segmentations which necessitates significant time and resources to create. This work proposes a pipeline of ML models that utilize binary classification labels, which can be easily acquired, to segment ROIs without requiring ground truth annotations. We used 2D slices of Magnetic Resonance Imaging (MRI) brain scans from the Multimodal Brain Tumor Segmentation Challenge (BraTS) 2020 dataset and labels indicating the presence of high-grade glioma (HGG) tumors to train the pipeline. Our pipeline also introduces a novel variation of deep learning-based superpixel generation, which enables training guided by clustered superpixels and simultaneously trains a superpixel clustering model. On our test set, our pipeline's segmentations achieved a Dice coefficient of 61.7%, which is a substantial improvement over the 42.8% Dice coefficient acquired when the popular Local Interpretable Model-Agnostic Explanations (LIME) method was used.