Automated Prediction of Breast Cancer Response to Neoadjuvant Chemotherapy from DWI Data

Effective surgical planning for breast cancer hinges on accurately predicting pathological complete response (pCR) to neoadjuvant chemotherapy (NAC). Diffusion-weighted MRI (DWI) and machine learning offer a non-invasive approach for early pCR assessment. However, most machine-learning models require manual tumor segmentation, a cumbersome and error-prone task. We propose a deep learning model employing "Size-Adaptive Lesion Weighting" for automatic DWI tumor segmentation to enhance pCR prediction accuracy. Despite histopathological changes during NAC complicating DWI image segmentation, our model demonstrates robust performance. Utilizing the BMMR2 challenge dataset, it matches human experts in pCR prediction pre-NAC with an area under the curve (AUC) of 0.76 vs. 0.796, and surpasses standard automated methods mid-NAC, with an AUC of 0.729 vs. 0.654 and 0.576. Our approach represents a significant advancement in automating breast cancer treatment planning, enabling more reliable pCR predictions without manual segmentation.

NPB-REC: A Non-parametric Bayesian Deep-learning Approach for Undersampled MRI Reconstruction with Uncertainty Estimation

The ability to reconstruct high-quality images from undersampled MRI data is vital in improving MRI temporal resolution and reducing acquisition times. Deep learning methods have been proposed for this task, but the lack of verified methods to quantify the uncertainty in the reconstructed images hampered clinical applicability. We introduce "NPB-REC", a non-parametric fully Bayesian framework, for MRI reconstruction from undersampled data with uncertainty estimation. We use Stochastic Gradient Langevin Dynamics during training to characterize the posterior distribution of the network parameters. This enables us to both improve the quality of the reconstructed images and quantify the uncertainty in the reconstructed images. We demonstrate the efficacy of our approach on a multi-coil MRI dataset from the fastMRI challenge and compare it to the baseline End-to-End Variational Network (E2E-VarNet). Our approach outperforms the baseline in terms of reconstruction accuracy by means of PSNR and SSIM ($34.55$, $0.908$ vs. $33.08$, $0.897$, $p<0.01$, acceleration rate $R=8$) and provides uncertainty measures that correlate better with the reconstruction error (Pearson correlation, $R=0.94$ vs. $R=0.91$). Additionally, our approach exhibits better generalization capabilities against anatomical distribution shifts (PSNR and SSIM of $32.38$, $0.849$ vs. $31.63$, $0.836$, $p<0.01$, training on brain data, inference on knee data, acceleration rate $R=8$). NPB-REC has the potential to facilitate the safe utilization of deep learning-based methods for MRI reconstruction from undersampled data. Code and trained models are available at \url{https://github.com/samahkh/NPB-REC}.

A self-attention model for robust rigid slice-to-volume registration of functional MRI

Functional Magnetic Resonance Imaging (fMRI) is vital in neuroscience, enabling investigations into brain disorders, treatment monitoring, and brain function mapping. However, head motion during fMRI scans, occurring between shots of slice acquisition, can result in distortion, biased analyses, and increased costs due to the need for scan repetitions. Therefore, retrospective slice-level motion correction through slice-to-volume registration (SVR) is crucial. Previous studies have utilized deep learning (DL) based models to address the SVR task; however, they overlooked the uncertainty stemming from the input stack of slices and did not assign weighting or scoring to each slice. In this work, we introduce an end-to-end SVR model for aligning 2D fMRI slices with a 3D reference volume, incorporating a self-attention mechanism to enhance robustness against input data variations and uncertainties. It utilizes independent slice and volume encoders and a self-attention module to assign pixel-wise scores for each slice. We conducted evaluation experiments on 200 images involving synthetic rigid motion generated from 27 subjects belonging to the test set, from the publicly available Healthy Brain Network (HBN) dataset. Our experimental results demonstrate that our model achieves competitive performance in terms of alignment accuracy compared to state-of-the-art deep learning-based methods (Euclidean distance of $0.93$ [mm] vs. $1.86$ [mm]). Furthermore, our approach exhibits significantly faster registration speed compared to conventional iterative methods ($0.096$ sec. vs. $1.17$ sec.). Our end-to-end SVR model facilitates real-time head motion tracking during fMRI acquisition, ensuring reliability and robustness against uncertainties in inputs. source code, which includes the training and evaluations, will be available soon.

CIMIL-CRC: a clinically-informed multiple instance learning framework for patient-level colorectal cancer molecular subtypes classification from H\&E stained images

Treatment approaches for colorectal cancer (CRC) are highly dependent on the molecular subtype, as immunotherapy has shown efficacy in cases with microsatellite instability (MSI) but is ineffective for the microsatellite stable (MSS) subtype. There is promising potential in utilizing deep neural networks (DNNs) to automate the differentiation of CRC subtypes by analyzing Hematoxylin and Eosin (H\&E) stained whole-slide images (WSIs). Due to the extensive size of WSIs, Multiple Instance Learning (MIL) techniques are typically explored. However, existing MIL methods focus on identifying the most representative image patches for classification, which may result in the loss of critical information. Additionally, these methods often overlook clinically relevant information, like the tendency for MSI class tumors to predominantly occur on the proximal (right side) colon. We introduce `CIMIL-CRC', a DNN framework that: 1) solves the MSI/MSS MIL problem by efficiently combining a pre-trained feature extraction model with principal component analysis (PCA) to aggregate information from all patches, and 2) integrates clinical priors, particularly the tumor location within the colon, into the model to enhance patient-level classification accuracy. We assessed our CIMIL-CRC method using the average area under the curve (AUC) from a 5-fold cross-validation experimental setup for model development on the TCGA-CRC-DX cohort, contrasting it with a baseline patch-level classification, MIL-only approach, and Clinically-informed patch-level classification approach. Our CIMIL-CRC outperformed all methods (AUROC: $0.92\pm0.002$ (95\% CI 0.91-0.92), vs. $0.79\pm0.02$ (95\% CI 0.76-0.82), $0.86\pm0.01$ (95\% CI 0.85-0.88), and $0.87\pm0.01$ (95\% CI 0.86-0.88), respectively). The improvement was statistically significant.

IVIM-Morph: Motion-compensated quantitative Intra-voxel Incoherent Motion (IVIM) analysis for functional fetal lung maturity assessment from diffusion-weighted MRI data

Quantitative analysis of pseudo-diffusion in diffusion-weighted magnetic resonance imaging (DWI) data shows potential for assessing fetal lung maturation and generating valuable imaging biomarkers. Yet, the clinical utility of DWI data is hindered by unavoidable fetal motion during acquisition. We present IVIM-morph, a self-supervised deep neural network model for motion-corrected quantitative analysis of DWI data using the Intra-voxel Incoherent Motion (IVIM) model. IVIM-morph combines two sub-networks, a registration sub-network, and an IVIM model fitting sub-network, enabling simultaneous estimation of IVIM model parameters and motion. To promote physically plausible image registration, we introduce a biophysically informed loss function that effectively balances registration and model-fitting quality. We validated the efficacy of IVIM-morph by establishing a correlation between the predicted IVIM model parameters of the lung and gestational age (GA) using fetal DWI data of 39 subjects. IVIM-morph exhibited a notably improved correlation with gestational age (GA) when performing in-vivo quantitative analysis of fetal lung DWI data during the canalicular phase. IVIM-morph shows potential in developing valuable biomarkers for non-invasive assessment of fetal lung maturity with DWI data. Moreover, its adaptability opens the door to potential applications in other clinical contexts where motion compensation is essential for quantitative DWI analysis. The IVIM-morph code is readily available at: https://github.com/TechnionComputationalMRILab/qDWI-Morph.

LUNet: Deep Learning for the Segmentation of Arterioles and Venules in High Resolution Fundus Images

The retina is the only part of the human body in which blood vessels can be accessed non-invasively using imaging techniques such as digital fundus images (DFI). The spatial distribution of the retinal microvasculature may change with cardiovascular diseases and thus the eyes may be regarded as a window to our hearts. Computerized segmentation of the retinal arterioles and venules (A/V) is essential for automated microvasculature analysis. Using active learning, we created a new DFI dataset containing 240 crowd-sourced manual A/V segmentations performed by fifteen medical students and reviewed by an ophthalmologist, and developed LUNet, a novel deep learning architecture for high resolution A/V segmentation. LUNet architecture includes a double dilated convolutional block that aims to enhance the receptive field of the model and reduce its parameter count. Furthermore, LUNet has a long tail that operates at high resolution to refine the segmentation. The custom loss function emphasizes the continuity of the blood vessels. LUNet is shown to significantly outperform two state-of-the-art segmentation algorithms on the local test set as well as on four external test sets simulating distribution shifts across ethnicity, comorbidities, and annotators. We make the newly created dataset open access (upon publication).

PCMC-T1: Free-breathing myocardial T1 mapping with Physically-Constrained Motion Correction

T1 mapping is a quantitative magnetic resonance imaging (qMRI) technique that has emerged as a valuable tool in the diagnosis of diffuse myocardial diseases. However, prevailing approaches have relied heavily on breath-hold sequences to eliminate respiratory motion artifacts. This limitation hinders accessibility and effectiveness for patients who cannot tolerate breath-holding. Image registration can be used to enable free-breathing T1 mapping. Yet, inherent intensity differences between the different time points make the registration task challenging. We introduce PCMC-T1, a physically-constrained deep-learning model for motion correction in free-breathing T1 mapping. We incorporate the signal decay model into the network architecture to encourage physically-plausible deformations along the longitudinal relaxation axis. We compared PCMC-T1 to baseline deep-learning-based image registration approaches using a 5-fold experimental setup on a publicly available dataset of 210 patients. PCMC-T1 demonstrated superior model fitting quality (R2: 0.955) and achieved the highest clinical impact (clinical score: 3.93) compared to baseline methods (0.941, 0.946 and 3.34, 3.62 respectively). Anatomical alignment results were comparable (Dice score: 0.9835 vs. 0.984, 0.988). Our code and trained models are available at https://github.com/eyalhana/PCMC-T1.

Biologically-primed deep neural network improves colorectal Cancer Molecular subtypes prediction from H&E stained images

Colorectal cancer (CRC) molecular subtypes play a crucial role in determining treatment options. Immunotherapy is effective for the microsatellite instability (MSI) subtype of CRC, but not for the microsatellite stability (MSS) subtype. Recently, convolutional neural networks (CNNs) have been proposed for automated determination of CRC subtypes from H\&E stained histopathological images. However, previous CNN architectures only consider binary outcomes of MSI or MSS, and do not account for additional biological cues that may affect the histopathological imaging phenotype. In this study, we propose a biologically-primed CNN (BP-CNN) architecture for CRC subtype classification from H\&E stained images. Our BP-CNN accounts for additional biological cues by casting the binary classification outcome into a biologically-informed multi-class outcome. We evaluated the BP-CNN approach using a 5-fold cross-validation experimental setup for model development on the TCGA-CRC-DX cohort, comparing it to a baseline binary classification CNN. Our BP-CNN achieved superior performance when using either single-nucleotide-polymorphism (SNP) molecular features (AUC: 0.824$\pm$0.02 vs. 0.761$\pm$0.04, paired t-test, p$<$0.05) or CpG-Island methylation phenotype (CIMP) molecular features (AUC: 0.834$\pm$0.01 vs. 0.787$\pm$0.03, paired t-test, p$<$0.05). A combination of CIMP and SNP models further improved classification accuracy (AUC: 0.847$\pm$0.01 vs. 0.787$\pm$0.03, paired t-test, p$=$0.01). Our BP-CNN approach has the potential to provide insight into the biological cues that influence cancer histopathological imaging phenotypes and to improve the accuracy of deep-learning-based methods for determining cancer subtypes from histopathological imaging data.

P2T2: a Physically-primed deep-neural-network approach for robust $T_{2}$ distribution estimation from quantitative $T_{2}$-weighted MRI

Estimation of the T2 distribution from multi-echo T2-Weighted MRI (T2W) data can provide insight into the microscopic content of tissue using macroscopic imaging. This information can be used as a biomarker for several pathologies, such as tumor characterization, osteoarthritis, and neurodegenerative diseases. Recently, deep neural network (DNN) based methods were proposed for T2 distribution estimation from MRI data. However, these methods are highly sensitive to distribution shifts such as variations in the echo-times (TE) used during acquisition. Therefore, DNN-based methods cannot be utilized in large-scale multi-institutional trials with heterogeneous acquisition protocols. We present P2T2, a new physically-primed DNN approach for T2 distribution estimation that is robust to different acquisition parameters while maintaining state-of-the-art estimation accuracy. Our P2T2 model encodes the forward model of the signal decay by taking as input the TE acquisition array, in addition to the MRI signal, and provides an estimate of the corresponding T2 distribution as its output. Our P2T2 model has improved the robustness against distribution shifts in the acquisition process by more than 50% compared to the previously proposed DNN model. When tested without any distribution shifts, our model achieved about the same accuracy. Finally, when applied to real human MRI data, our P2T2 model produced the most detailed Myelin-Water fraction maps compared to both the MIML model and classical approaches. Our proposed physically-primed approach improved the generalization capacity of DNN models for T2 distribution estimation and their robustness against distribution shifts compared to previous approaches without compromising the accuracy.

Patient-level Microsatellite Stability Assessment from Whole Slide Images By Combining Momentum Contrast Learning and Group Patch Embeddings

Assessing microsatellite stability status of a patient's colorectal cancer is crucial in personalizing treatment regime. Recently, convolutional-neural-networks (CNN) combined with transfer-learning approaches were proposed to circumvent traditional laboratory testing for determining microsatellite status from hematoxylin and eosin stained biopsy whole slide images (WSI). However, the high resolution of WSI practically prevent direct classification of the entire WSI. Current approaches bypass the WSI high resolution by first classifying small patches extracted from the WSI, and then aggregating patch-level classification logits to deduce the patient-level status. Such approaches limit the capacity to capture important information which resides at the high resolution WSI data. We introduce an effective approach to leverage WSI high resolution information by momentum contrastive learning of patch embeddings along with training a patient-level classifier on groups of those embeddings. Our approach achieves up to 7.4\% better accuracy compared to the straightforward patch-level classification and patient level aggregation approach with a higher stability (AUC, $0.91 \pm 0.01$ vs. $0.85 \pm 0.04$, p-value$<0.01$). Our code can be found at https://github.com/TechnionComputationalMRILab/colorectal_cancer_ai.