Bias in Unsupervised Anomaly Detection in Brain MRI

Unsupervised anomaly detection methods offer a promising and flexible alternative to supervised approaches, holding the potential to revolutionize medical scan analysis and enhance diagnostic performance. In the current landscape, it is commonly assumed that differences between a test case and the training distribution are attributed solely to pathological conditions, implying that any disparity indicates an anomaly. However, the presence of other potential sources of distributional shift, including scanner, age, sex, or race, is frequently overlooked. These shifts can significantly impact the accuracy of the anomaly detection task. Prominent instances of such failures have sparked concerns regarding the bias, credibility, and fairness of anomaly detection. This work presents a novel analysis of biases in unsupervised anomaly detection. By examining potential non-pathological distributional shifts between the training and testing distributions, we shed light on the extent of these biases and their influence on anomaly detection results. Moreover, this study examines the algorithmic limitations that arise due to biases, providing valuable insights into the challenges encountered by anomaly detection algorithms in accurately learning and capturing the entire range of variability present in the normative distribution. Through this analysis, we aim to enhance the understanding of these biases and pave the way for future improvements in the field. Here, we specifically investigate Alzheimer's disease detection from brain MR imaging as a case study, revealing significant biases related to sex, race, and scanner variations that substantially impact the results. These findings align with the broader goal of improving the reliability, fairness, and effectiveness of anomaly detection in medical imaging.

ICoNIK: Generating Respiratory-Resolved Abdominal MR Reconstructions Using Neural Implicit Representations in k-Space

Motion-resolved reconstruction for abdominal magnetic resonance imaging (MRI) remains a challenge due to the trade-off between residual motion blurring caused by discretized motion states and undersampling artefacts. In this work, we propose to generate blurring-free motion-resolved abdominal reconstructions by learning a neural implicit representation directly in k-space (NIK). Using measured sampling points and a data-derived respiratory navigator signal, we train a network to generate continuous signal values. To aid the regularization of sparsely sampled regions, we introduce an additional informed correction layer (ICo), which leverages information from neighboring regions to correct NIK's prediction. Our proposed generative reconstruction methods, NIK and ICoNIK, outperform standard motion-resolved reconstruction techniques and provide a promising solution to address motion artefacts in abdominal MRI.

Attribute Regularized Soft Introspective VAE: Towards Cardiac Attribute Regularization Through MRI Domains

Deep generative models have emerged as influential instruments for data generation and manipulation. Enhancing the controllability of these models by selectively modifying data attributes has been a recent focus. Variational Autoencoders (VAEs) have shown promise in capturing hidden attributes but often produce blurry reconstructions. Controlling these attributes through different imaging domains is difficult in medical imaging. Recently, Soft Introspective VAE leverage the benefits of both VAEs and Generative Adversarial Networks (GANs), which have demonstrated impressive image synthesis capabilities, by incorporating an adversarial loss into VAE training. In this work, we propose the Attributed Soft Introspective VAE (Attri-SIVAE) by incorporating an attribute regularized loss, into the Soft-Intro VAE framework. We evaluate experimentally the proposed method on cardiac MRI data from different domains, such as various scanner vendors and acquisition centers. The proposed method achieves similar performance in terms of reconstruction and regularization compared to the state-of-the-art Attributed regularized VAE but additionally also succeeds in keeping the same regularization level when tested on a different dataset, unlike the compared method.

Mask, Stitch, and Re-Sample: Enhancing Robustness and Generalizability in Anomaly Detection through Automatic Diffusion Models

The introduction of diffusion models in anomaly detection has paved the way for more effective and accurate image reconstruction in pathologies. However, the current limitations in controlling noise granularity hinder diffusion models' ability to generalize across diverse anomaly types and compromise the restoration of healthy tissues. To overcome these challenges, we propose AutoDDPM, a novel approach that enhances the robustness of diffusion models. AutoDDPM utilizes diffusion models to generate initial likelihood maps of potential anomalies and seamlessly integrates them with the original image. Through joint noised distribution re-sampling, AutoDDPM achieves harmonization and in-painting effects. Our study demonstrates the efficacy of AutoDDPM in replacing anomalous regions while preserving healthy tissues, considerably surpassing diffusion models' limitations. It also contributes valuable insights and analysis on the limitations of current diffusion models, promoting robust and interpretable anomaly detection in medical imaging - an essential aspect of building autonomous clinical decision systems with higher interpretability.

Deep Learning for Retrospective Motion Correction in MRI: A Comprehensive Review

Motion represents one of the major challenges in magnetic resonance imaging (MRI). Since the MR signal is acquired in frequency space, any motion of the imaged object leads to complex artefacts in the reconstructed image in addition to other MR imaging artefacts. Deep learning has been frequently proposed for motion correction at several stages of the reconstruction process. The wide range of MR acquisition sequences, anatomies and pathologies of interest, and motion patterns (rigid vs. deformable and random vs. regular) makes a comprehensive solution unlikely. To facilitate the transfer of ideas between different applications, this review provides a detailed overview of proposed methods for learning-based motion correction in MRI together with their common challenges and potentials. This review identifies differences and synergies in underlying data usage, architectures and evaluation strategies. We critically discuss general trends and outline future directions, with the aim to enhance interaction between different application areas and research fields.

Deep Learning-Based Detection of Motion-Affected k-Space Lines for T2*-Weighted MRI

T2*-weighted gradient echo MR imaging is strongly impacted by subject head motion due to motion-related changes in B0 inhomogeneities. Within the oxygenation-sensitive mqBOLD protocol, even mild motion during the acquisition of the T2*-weighted data propagates into errors in derived quantitative parameter maps. In order to correct these images without the need of repeated measurements, we propose to learn a classification of motion-affected k-space lines. To test this, we perform realistic motion simulations including motion-induced field inhomogeneity changes for supervised training. To detect the presence of motion in each phase encoding line, we train a convolutional neural network, leveraging the multi-echo information of the T2*-weighted images. The proposed network accurately detects motion-affected k-space lines for simulated displacements of $\geq$ 0.5mm (accuracy on test set: 92.5%). Finally, we show example reconstructions where we include these classification labels as weights in the data consistency term of an iterative reconstruction procedure, opening up exciting opportunities of k-space line detection in combination with more powerful reconstruction methods.

3D Masked Autoencoders with Application to Anomaly Detection in Non-Contrast Enhanced Breast MRI

Self-supervised models allow (pre-)training on unlabeled data and therefore have the potential to overcome the need for large annotated cohorts. One leading self-supervised model is the masked autoencoder (MAE) which was developed on natural imaging data. The MAE is masking out a high fraction of visual transformer (ViT) input patches, to then recover the uncorrupted images as a pretraining task. In this work, we extend MAE to perform anomaly detection on breast magnetic resonance imaging (MRI). This new model, coined masked autoencoder for medical imaging (MAEMI) is trained on two non-contrast enhanced MRI sequences, aiming at lesion detection without the need for intravenous injection of contrast media and temporal image acquisition. During training, only non-cancerous images are presented to the model, with the purpose of localizing anomalous tumor regions during test time. We use a public dataset for model development. Performance of the architecture is evaluated in reference to subtraction images created from dynamic contrast enhanced (DCE)-MRI.

Fully transformer-based biomarker prediction from colorectal cancer histology: a large-scale multicentric study

Background: Deep learning (DL) can extract predictive and prognostic biomarkers from routine pathology slides in colorectal cancer. For example, a DL test for the diagnosis of microsatellite instability (MSI) in CRC has been approved in 2022. Current approaches rely on convolutional neural networks (CNNs). Transformer networks are outperforming CNNs and are replacing them in many applications, but have not been used for biomarker prediction in cancer at a large scale. In addition, most DL approaches have been trained on small patient cohorts, which limits their clinical utility. Methods: In this study, we developed a new fully transformer-based pipeline for end-to-end biomarker prediction from pathology slides. We combine a pre-trained transformer encoder and a transformer network for patch aggregation, capable of yielding single and multi-target prediction at patient level. We train our pipeline on over 9,000 patients from 10 colorectal cancer cohorts. Results: A fully transformer-based approach massively improves the performance, generalizability, data efficiency, and interpretability as compared with current state-of-the-art algorithms. After training on a large multicenter cohort, we achieve a sensitivity of 0.97 with a negative predictive value of 0.99 for MSI prediction on surgical resection specimens. We demonstrate for the first time that resection specimen-only training reaches clinical-grade performance on endoscopic biopsy tissue, solving a long-standing diagnostic problem. Interpretation: A fully transformer-based end-to-end pipeline trained on thousands of pathology slides yields clinical-grade performance for biomarker prediction on surgical resections and biopsies. Our new methods are freely available under an open source license.

Automated Quality Controlled Analysis of 2D Phase Contrast Cardiovascular Magnetic Resonance Imaging

Flow analysis carried out using phase contrast cardiac magnetic resonance imaging (PC-CMR) enables the quantification of important parameters that are used in the assessment of cardiovascular function. An essential part of this analysis is the identification of the correct CMR views and quality control (QC) to detect artefacts that could affect the flow quantification. We propose a novel deep learning based framework for the fully-automated analysis of flow from full CMR scans that first carries out these view selection and QC steps using two sequential convolutional neural networks, followed by automatic aorta and pulmonary artery segmentation to enable the quantification of key flow parameters. Accuracy values of 0.958 and 0.914 were obtained for view classification and QC, respectively. For segmentation, Dice scores were $>$0.969 and the Bland-Altman plots indicated excellent agreement between manual and automatic peak flow values. In addition, we tested our pipeline on an external validation data set, with results indicating good robustness of the pipeline. This work was carried out using multivendor clinical data consisting of 986 cases, indicating the potential for the use of this pipeline in a clinical setting.

Evaluation of 3D GANs for Lung Tissue Modelling in Pulmonary CT

GANs are able to model accurately the distribution of complex, high-dimensional datasets, e.g. images. This makes high-quality GANs useful for unsupervised anomaly detection in medical imaging. However, differences in training datasets such as output image dimensionality and appearance of semantically meaningful features mean that GAN models from the natural image domain may not work `out-of-the-box' for medical imaging, necessitating re-implementation and re-evaluation. In this work we adapt and evaluate three GAN models to the task of modelling 3D healthy image patches for pulmonary CT. To the best of our knowledge, this is the first time that such an evaluation has been performed. The DCGAN, styleGAN and the bigGAN architectures were investigated due to their ubiquity and high performance in natural image processing. We train different variants of these methods and assess their performance using the FID score. In addition, the quality of the generated images was evaluated by a human observer study, the ability of the networks to model 3D domain-specific features was investigated, and the structure of the GAN latent spaces was analysed. Results show that the 3D styleGAN produces realistic-looking images with meaningful 3D structure, but suffer from mode collapse which must be addressed during training to obtain samples diversity. Conversely, the 3D DCGAN models show a greater capacity for image variability, but at the cost of poor-quality images. The 3D bigGAN models provide an intermediate level of image quality, but most accurately model the distribution of selected semantically meaningful features. The results suggest that future development is required to realise a 3D GAN with sufficient capacity for patch-based lung CT anomaly detection and we offer recommendations for future areas of research, such as experimenting with other architectures and incorporation of position-encoding.