Vision Transformer-based Multimodal Feature Fusion Network for Lymphoma Segmentation on PET/CT Images

Background: Diffuse large B-cell lymphoma (DLBCL) segmentation is a challenge in medical image analysis. Traditional segmentation methods for lymphoma struggle with the complex patterns and the presence of DLBCL lesions. Objective: We aim to develop an accurate method for lymphoma segmentation with 18F-Fluorodeoxyglucose positron emission tomography (PET) and computed tomography (CT) images. Methods: Our lymphoma segmentation approach combines a vision transformer with dual encoders, adeptly fusing PET and CT data via multimodal cross-attention fusion (MMCAF) module. In this study, PET and CT data from 165 DLBCL patients were analyzed. A 5-fold cross-validation was employed to evaluate the performance and generalization ability of our method. Ground truths were annotated by experienced nuclear medicine experts. We calculated the total metabolic tumor volume (TMTV) and performed a statistical analysis on our results. Results: The proposed method exhibited accurate performance in DLBCL lesion segmentation, achieving a Dice similarity coefficient of 0.9173$\pm$0.0071, a Hausdorff distance of 2.71$\pm$0.25mm, a sensitivity of 0.9462$\pm$0.0223, and a specificity of 0.9986$\pm$0.0008. Additionally, a Pearson correlation coefficient of 0.9030$\pm$0.0179 and an R-square of 0.8586$\pm$0.0173 were observed in TMTV when measured on manual annotation compared to our segmentation results. Conclusion: This study highlights the advantages of MMCAF and vision transformer for lymphoma segmentation using PET and CT, offering great promise for computer-aided lymphoma diagnosis and treatment.

A Robust Deep Learning Method with Uncertainty Estimation for the Pathological Classification of Renal Cell Carcinoma based on CT Images

Objectives To develop and validate a deep learning-based diagnostic model incorporating uncertainty estimation so as to facilitate radiologists in the preoperative differentiation of the pathological subtypes of renal cell carcinoma (RCC) based on CT images. Methods Data from 668 consecutive patients, pathologically proven RCC, were retrospectively collected from Center 1. By using five-fold cross-validation, a deep learning model incorporating uncertainty estimation was developed to classify RCC subtypes into clear cell RCC (ccRCC), papillary RCC (pRCC), and chromophobe RCC (chRCC). An external validation set of 78 patients from Center 2 further evaluated the model's performance. Results In the five-fold cross-validation, the model's area under the receiver operating characteristic curve (AUC) for the classification of ccRCC, pRCC, and chRCC was 0.868 (95% CI: 0.826-0.923), 0.846 (95% CI: 0.812-0.886), and 0.839 (95% CI: 0.802-0.88), respectively. In the external validation set, the AUCs were 0.856 (95% CI: 0.838-0.882), 0.787 (95% CI: 0.757-0.818), and 0.793 (95% CI: 0.758-0.831) for ccRCC, pRCC, and chRCC, respectively. Conclusions The developed deep learning model demonstrated robust performance in predicting the pathological subtypes of RCC, while the incorporated uncertainty emphasized the importance of understanding model confidence, which is crucial for assisting clinical decision-making for patients with renal tumors. Clinical relevance statement Our deep learning approach, integrated with uncertainty estimation, offers clinicians a dual advantage: accurate RCC subtype predictions complemented by diagnostic confidence references, promoting informed decision-making for patients with RCC.

MLA-BIN: Model-level Attention and Batch-instance Style Normalization for Domain Generalization of Federated Learning on Medical Image Segmentation

The privacy protection mechanism of federated learning (FL) offers an effective solution for cross-center medical collaboration and data sharing. In multi-site medical image segmentation, each medical site serves as a client of FL, and its data naturally forms a domain. FL supplies the possibility to improve the performance of seen domains model. However, there is a problem of domain generalization (DG) in the actual de-ployment, that is, the performance of the model trained by FL in unseen domains will decrease. Hence, MLA-BIN is proposed to solve the DG of FL in this study. Specifically, the model-level attention module (MLA) and batch-instance style normalization (BIN) block were designed. The MLA represents the unseen domain as a linear combination of seen domain models. The atten-tion mechanism is introduced for the weighting coefficient to obtain the optimal coefficient ac-cording to the similarity of inter-domain data features. MLA enables the global model to gen-eralize to unseen domain. In the BIN block, batch normalization (BN) and instance normalization (IN) are combined to perform the shallow layers of the segmentation network for style normali-zation, solving the influence of inter-domain image style differences on DG. The extensive experimental results of two medical image seg-mentation tasks demonstrate that the proposed MLA-BIN outperforms state-of-the-art methods.

A new method incorporating deep learning with shape priors for left ventricular segmentation in myocardial perfusion SPECT images

Background: The assessment of left ventricular (LV) function by myocardial perfusion SPECT (MPS) relies on accurate myocardial segmentation. The purpose of this paper is to develop and validate a new method incorporating deep learning with shape priors to accurately extract the LV myocardium for automatic measurement of LV functional parameters. Methods: A segmentation architecture that integrates a three-dimensional (3D) V-Net with a shape deformation module was developed. Using the shape priors generated by a dynamic programming (DP) algorithm, the model output was then constrained and guided during the model training for quick convergence and improved performance. A stratified 5-fold cross-validation was used to train and validate our models. Results: Results of our proposed method agree well with those from the ground truth. Our proposed model achieved a Dice similarity coefficient (DSC) of 0.9573(0.0244), 0.9821(0.0137), and 0.9903(0.0041), a Hausdorff distances (HD) of 6.7529(2.7334) mm, 7.2507(3.1952) mm, and 7.6121(3.0134) mm in extracting the endocardium, myocardium, and epicardium, respectively. Conclusion: Our proposed method achieved a high accuracy in extracting LV myocardial contours and assessing LV function.