Putting the Segment Anything Model to the Test with 3D Knee MRI -- A Comparison with State-of-the-Art Performance

Menisci are cartilaginous tissue found within the knee that contribute to joint lubrication and weight dispersal. Damage to menisci can lead to onset and progression of knee osteoarthritis (OA), a condition that is a leading cause of disability, and for which there are few effective therapies. Accurate automated segmentation of menisci would allow for earlier detection and treatment of meniscal abnormalities, as well as shedding more light on the role the menisci play in OA pathogenesis. Focus in this area has mainly used variants of convolutional networks, but there has been no attempt to utilise recent large vision transformer segmentation models. The Segment Anything Model (SAM) is a so-called foundation segmentation model, which has been found useful across a range of different tasks due to the large volume of data used for training the model. In this study, SAM was adapted to perform fully-automated segmentation of menisci from 3D knee magnetic resonance images. A 3D U-Net was also trained as a baseline. It was found that, when fine-tuning only the decoder, SAM was unable to compete with 3D U-Net, achieving a Dice score of $0.81\pm0.03$, compared to $0.87\pm0.03$, on a held-out test set. When fine-tuning SAM end-to-end, a Dice score of $0.87\pm0.03$ was achieved. The performance of both the end-to-end trained SAM configuration and the 3D U-Net were comparable to the winning Dice score ($0.88\pm0.03$) in the IWOAI Knee MRI Segmentation Challenge 2019. Performance in terms of the Hausdorff Distance showed that both configurations of SAM were inferior to 3D U-Net in matching the meniscus morphology. Results demonstrated that, despite its generalisability, SAM was unable to outperform a basic 3D U-Net in meniscus segmentation, and may not be suitable for similar 3D medical image segmentation tasks also involving fine anatomical structures with low contrast and poorly-defined boundaries.

Integrating Deep Learning with Fundus and Optical Coherence Tomography for Cardiovascular Disease Prediction

Early identification of patients at risk of cardiovascular diseases (CVD) is crucial for effective preventive care, reducing healthcare burden, and improving patients' quality of life. This study demonstrates the potential of retinal optical coherence tomography (OCT) imaging combined with fundus photographs for identifying future adverse cardiac events. We used data from 977 patients who experienced CVD within a 5-year interval post-image acquisition, alongside 1,877 control participants without CVD, totaling 2,854 subjects. We propose a novel binary classification network based on a Multi-channel Variational Autoencoder (MCVAE), which learns a latent embedding of patients' fundus and OCT images to classify individuals into two groups: those likely to develop CVD in the future and those who are not. Our model, trained on both imaging modalities, achieved promising results (AUROC 0.78 +/- 0.02, accuracy 0.68 +/- 0.002, precision 0.74 +/- 0.02, sensitivity 0.73 +/- 0.02, and specificity 0.68 +/- 0.01), demonstrating its efficacy in identifying patients at risk of future CVD events based on their retinal images. This study highlights the potential of retinal OCT imaging and fundus photographs as cost-effective, non-invasive alternatives for predicting cardiovascular disease risk. The widespread availability of these imaging techniques in optometry practices and hospitals further enhances their potential for large-scale CVD risk screening. Our findings contribute to the development of standardized, accessible methods for early CVD risk identification, potentially improving preventive care strategies and patient outcomes.

Multi-Resolution Histopathology Patch Graphs for Ovarian Cancer Subtyping

Computer vision models are increasingly capable of classifying ovarian epithelial cancer subtypes, but they differ from pathologists by processing small tissue patches at a single resolution. Multi-resolution graph models leverage the spatial relationships of patches at multiple magnifications, learning the context for each patch. In this study, we conduct the most thorough validation of a graph model for ovarian cancer subtyping to date. Seven models were tuned and trained using five-fold cross-validation on a set of 1864 whole slide images (WSIs) from 434 patients treated at Leeds Teaching Hospitals NHS Trust. The cross-validation models were ensembled and evaluated using a balanced hold-out test set of 100 WSIs from 30 patients, and an external validation set of 80 WSIs from 80 patients in the Transcanadian Study. The best-performing model, a graph model using 10x+20x magnification data, gave balanced accuracies of 73%, 88%, and 99% in cross-validation, hold-out testing, and external validation, respectively. However, this only exceeded the performance of attention-based multiple instance learning in external validation, with a 93% balanced accuracy. Graph models benefitted greatly from using the UNI foundation model rather than an ImageNet-pretrained ResNet50 for feature extraction, with this having a much greater effect on performance than changing the subsequent classification approach. The accuracy of the combined foundation model and multi-resolution graph network offers a step towards the clinical applicability of these models, with a new highest-reported performance for this task, though further validations are still required to ensure the robustness and usability of the models.

Histopathology Foundation Models Enable Accurate Ovarian Cancer Subtype Classification

Large pretrained transformers are increasingly being developed as generalised foundation models which can underpin powerful task-specific artificial intelligence models. Histopathology foundation models show promise across many tasks, but analyses have been limited by arbitrary hyperparameters that were not tuned to the specific task/dataset. We report the most rigorous single-task validation conducted to date of a histopathology foundation model, and the first performed in ovarian cancer subtyping. Attention-based multiple instance learning classifiers were compared using vision transformer and ResNet features generated through varied preprocessing and pretraining procedures. The training set consisted of 1864 whole slide images from 434 ovarian carcinoma cases at Leeds Hospitals. Five-class classification performance was evaluated through five-fold cross-validation, and these cross-validation models were ensembled for evaluation on a hold-out test set and an external set from the Transcanadian study. Reporting followed the TRIPOD+AI checklist. The vision transformer-based histopathology foundation model, UNI, performed best in every evaluation, with five-class balanced accuracies of 88% and 93% in hold-out internal and external testing, compared to the best ResNet model scores of 68% and 81%, respectively. Normalisations and augmentations aided the generalisability of ResNet-based models, but these still did not match the performance of UNI, which gave the best external performance in any ovarian cancer subtyping study to date. Histopathology foundation models offer a clear benefit to subtyping, improving classification performance to a degree where clinical utility is tangible, albeit with an increased computational burden. Such models could provide a second opinion in challenging cases and may improve the accuracy, objectivity, and efficiency of pathological diagnoses overall.

GS-EMA: Integrating Gradient Surgery Exponential Moving Average with Boundary-Aware Contrastive Learning for Enhanced Domain Generalization in Aneurysm Segmentation

The automated segmentation of cerebral aneurysms is pivotal for accurate diagnosis and treatment planning. Confronted with significant domain shifts and class imbalance in 3D Rotational Angiography (3DRA) data from various medical institutions, the task becomes challenging. These shifts include differences in image appearance, intensity distribution, resolution, and aneurysm size, all of which complicate the segmentation process. To tackle these issues, we propose a novel domain generalization strategy that employs gradient surgery exponential moving average (GS-EMA) optimization technique coupled with boundary-aware contrastive learning (BACL). Our approach is distinct in its ability to adapt to new, unseen domains by learning domain-invariant features, thereby improving the robustness and accuracy of aneurysm segmentation across diverse clinical datasets. The results demonstrate that our proposed approach can extract more domain-invariant features, minimizing over-segmentation and capturing more complete aneurysm structures.

Unsupervised Domain Adaptation for Brain Vessel Segmentation through Transwarp Contrastive Learning

Unsupervised domain adaptation (UDA) aims to align the labelled source distribution with the unlabelled target distribution to obtain domain-invariant predictive models. Since cross-modality medical data exhibit significant intra and inter-domain shifts and most are unlabelled, UDA is more important while challenging in medical image analysis. This paper proposes a simple yet potent contrastive learning framework for UDA to narrow the inter-domain gap between labelled source and unlabelled target distribution. Our method is validated on cerebral vessel datasets. Experimental results show that our approach can learn latent features from labelled 3DRA modality data and improve vessel segmentation performance in unlabelled MRA modality data.

Segmenting Cardiac Muscle Z-disks with Deep Neural Networks

Z-disks are complex structures that delineate repeating sarcomeres in striated muscle. They play significant roles in cardiomyocytes such as providing mechanical stability for the contracting sarcomere, cell signalling and autophagy. Changes in Z-disk architecture have been associated with impaired cardiac function. Hence, there is a strong need to create tools to segment Z-disks from microscopy images, that overcome traditional limitations such as variability in image brightness and staining technique. In this study, we apply deep learning based segmentation models to extract Z-disks in images of striated muscle tissue. We leverage a novel Airyscan confocal dataset, which comprises high resolution images of Z-disks of healthy heart tissue, stained with Affimers for specific Z-disk proteins. We employed an interactive labelling tool, Ilastik to obtain ground truth segmentation masks and use the resulting data set to train and evaluate the performance of several state-of-the-art segmentation networks. On the test set, UNet++ achieves best segmentation performance for Z-disks in cardiomyocytes, with an average Dice score of 0.91 and outperforms other established segmentation methods including UNet, FPN, DeepLabv3+ and pix2pix. However, pix2pix demonstrates improved generalisation, when tested on an additional dataset of cardiomyocytes with a titin mutation. This is the first study to demonstrate that automated machine learning-based segmentation approaches may be used effectively to segment Z-disks in confocal microscopy images. Automated segmentation approaches and predicted segmentation masks could be used to derive morphological features of Z-disks (e.g. width and orientation), and subsequently, to quantify disease-related changes to cardiac microstructure.

Reducing Histopathology Slide Magnification Improves the Accuracy and Speed of Ovarian Cancer Subtyping

Artificial intelligence has found increasing use for ovarian cancer morphological subtyping from histopathology slides, but the optimal magnification for computational interpretation is unclear. Higher magnifications offer abundant cytological information, whereas lower magnifications give a broader histoarchitectural overview. Using attention-based multiple instance learning, we performed the most extensive analysis of ovarian cancer tissue magnifications to date, with data at six magnifications subjected to the same preprocessing, hyperparameter tuning, cross-validation and hold-out testing procedures. The lowest magnifications (1.25x and 2.5x) performed best in cross-validation, and intermediate magnifications (5x and 10x) performed best in hold-out testing (62% and 61% accuracy, respectively). Lower magnification models were also significantly faster, with the 5x model taking 5% as long to train and 31% as long to evaluate slides compared to 40x. This indicates that the standard usage of high magnifications for computational ovarian cancer subtyping may be unnecessary, with lower magnifications giving faster, more accurate alternatives.

Multi-view Hybrid Graph Convolutional Network for Volume-to-mesh Reconstruction in Cardiovascular MRI

Cardiovascular magnetic resonance imaging is emerging as a crucial tool to examine cardiac morphology and function. Essential to this endeavour are anatomical 3D surface and volumetric meshes derived from CMR images, which facilitate computational anatomy studies, biomarker discovery, and in-silico simulations. However, conventional surface mesh generation methods, such as active shape models and multi-atlas segmentation, are highly time-consuming and require complex processing pipelines to generate simulation-ready 3D meshes. In response, we introduce HybridVNet, a novel architecture for direct image-to-mesh extraction seamlessly integrating standard convolutional neural networks with graph convolutions, which we prove can efficiently handle surface and volumetric meshes by encoding them as graph structures. To further enhance accuracy, we propose a multiview HybridVNet architecture which processes both long axis and short axis CMR, showing that it can increase the performance of cardiac MR mesh generation. Our model combines traditional convolutional networks with variational graph generative models, deep supervision and mesh-specific regularisation. Experiments on a comprehensive dataset from the UK Biobank confirm the potential of HybridVNet to significantly advance cardiac imaging and computational cardiology by efficiently generating high-fidelity and simulation ready meshes from CMR images.

Radiology Report Generation Using Transformers Conditioned with Non-imaging Data

Medical image interpretation is central to most clinical applications such as disease diagnosis, treatment planning, and prognostication. In clinical practice, radiologists examine medical images and manually compile their findings into reports, which can be a time-consuming process. Automated approaches to radiology report generation, therefore, can reduce radiologist workload and improve efficiency in the clinical pathway. While recent deep-learning approaches for automated report generation from medical images have seen some success, most studies have relied on image-derived features alone, ignoring non-imaging patient data. Although a few studies have included the word-level contexts along with the image, the use of patient demographics is still unexplored. This paper proposes a novel multi-modal transformer network that integrates chest x-ray (CXR) images and associated patient demographic information, to synthesise patient-specific radiology reports. The proposed network uses a convolutional neural network to extract visual features from CXRs and a transformer-based encoder-decoder network that combines the visual features with semantic text embeddings of patient demographic information, to synthesise full-text radiology reports. Data from two public databases were used to train and evaluate the proposed approach. CXRs and reports were extracted from the MIMIC-CXR database and combined with corresponding patients' data MIMIC-IV. Based on the evaluation metrics used including patient demographic information was found to improve the quality of reports generated using the proposed approach, relative to a baseline network trained using CXRs alone. The proposed approach shows potential for enhancing radiology report generation by leveraging rich patient metadata and combining semantic text embeddings derived thereof, with medical image-derived visual features.