Benchmarking the CoW with the TopCoW Challenge: Topology-Aware Anatomical Segmentation of the Circle of Willis for CTA and MRA

The Circle of Willis (CoW) is an important network of arteries connecting major circulations of the brain. Its vascular architecture is believed to affect the risk, severity, and clinical outcome of serious neuro-vascular diseases. However, characterizing the highly variable CoW anatomy is still a manual and time-consuming expert task. The CoW is usually imaged by two angiographic imaging modalities, magnetic resonance angiography (MRA) and computed tomography angiography (CTA), but there exist limited public datasets with annotations on CoW anatomy, especially for CTA. Therefore we organized the TopCoW Challenge in 2023 with the release of an annotated CoW dataset and invited submissions worldwide for the CoW segmentation task, which attracted over 140 registered participants from four continents. TopCoW dataset was the first public dataset with voxel-level annotations for CoW's 13 vessel components, made possible by virtual-reality (VR) technology. It was also the first dataset with paired MRA and CTA from the same patients. TopCoW challenge aimed to tackle the CoW characterization problem as a multiclass anatomical segmentation task with an emphasis on topological metrics. The top performing teams managed to segment many CoW components to Dice scores around 90%, but with lower scores for communicating arteries and rare variants. There were also topological mistakes for predictions with high Dice scores. Additional topological analysis revealed further areas for improvement in detecting certain CoW components and matching CoW variant's topology accurately. TopCoW represented a first attempt at benchmarking the CoW anatomical segmentation task for MRA and CTA, both morphologically and topologically.

Synthetic Tumor Manipulation: With Radiomics Features

We introduce RadiomicsFill, a synthetic tumor generator conditioned on radiomics features, enabling detailed control and individual manipulation of tumor subregions. This conditioning leverages conventional high-dimensional features of the tumor (i.e., radiomics features) and thus is biologically well-grounded. Our model combines generative adversarial networks, radiomics-feature conditioning, and multi-task learning. Through experiments with glioma patients, RadiomicsFill demonstrated its capability to generate diverse, realistic tumors and its fine-tuning ability for specific radiomics features like 'Pixel Surface' and 'Shape Sphericity'. The ability of RadiomicsFill to generate an unlimited number of realistic synthetic tumors offers notable prospects for both advancing medical imaging research and potential clinical applications.

Adaptive Latent Diffusion Model for 3D Medical Image to Image Translation: Multi-modal Magnetic Resonance Imaging Study

Multi-modal images play a crucial role in comprehensive evaluations in medical image analysis providing complementary information for identifying clinically important biomarkers. However, in clinical practice, acquiring multiple modalities can be challenging due to reasons such as scan cost, limited scan time, and safety considerations. In this paper, we propose a model based on the latent diffusion model (LDM) that leverages switchable blocks for image-to-image translation in 3D medical images without patch cropping. The 3D LDM combined with conditioning using the target modality allows generating high-quality target modality in 3D overcoming the shortcoming of the missing out-of-slice information in 2D generation methods. The switchable block, noted as multiple switchable spatially adaptive normalization (MS-SPADE), dynamically transforms source latents to the desired style of the target latents to help with the diffusion process. The MS-SPADE block allows us to have one single model to tackle many translation tasks of one source modality to various targets removing the need for many translation models for different scenarios. Our model exhibited successful image synthesis across different source-target modality scenarios and surpassed other models in quantitative evaluations tested on multi-modal brain magnetic resonance imaging datasets of four different modalities and an independent IXI dataset. Our model demonstrated successful image synthesis across various modalities even allowing for one-to-many modality translations. Furthermore, it outperformed other one-to-one translation models in quantitative evaluations.

Standardized Assessment of Automatic Segmentation of White Matter Hyperintensities and Results of the WMH Segmentation Challenge

Quantification of cerebral white matter hyperintensities (WMH) of presumed vascular origin is of key importance in many neurological research studies. Currently, measurements are often still obtained from manual segmentations on brain MR images, which is a laborious procedure. Automatic WMH segmentation methods exist, but a standardized comparison of the performance of such methods is lacking. We organized a scientific challenge, in which developers could evaluate their method on a standardized multi-center/-scanner image dataset, giving an objective comparison: the WMH Segmentation Challenge (https://wmh.isi.uu.nl/). Sixty T1+FLAIR images from three MR scanners were released with manual WMH segmentations for training. A test set of 110 images from five MR scanners was used for evaluation. Segmentation methods had to be containerized and submitted to the challenge organizers. Five evaluation metrics were used to rank the methods: (1) Dice similarity coefficient, (2) modified Hausdorff distance (95th percentile), (3) absolute log-transformed volume difference, (4) sensitivity for detecting individual lesions, and (5) F1-score for individual lesions. Additionally, methods were ranked on their inter-scanner robustness. Twenty participants submitted their method for evaluation. This paper provides a detailed analysis of the results. In brief, there is a cluster of four methods that rank significantly better than the other methods, with one clear winner. The inter-scanner robustness ranking shows that not all methods generalize to unseen scanners. The challenge remains open for future submissions and provides a public platform for method evaluation.