Spatiotemporal Disentanglement of Arteriovenous Malformations in Digital Subtraction Angiography

Although Digital Subtraction Angiography (DSA) is the most important imaging for visualizing cerebrovascular anatomy, its interpretation by clinicians remains difficult. This is particularly true when treating arteriovenous malformations (AVMs), where entangled vasculature connecting arteries and veins needs to be carefully identified.The presented method aims to enhance DSA image series by highlighting critical information via automatic classification of vessels using a combination of two learning models: An unsupervised machine learning method based on Independent Component Analysis that decomposes the phases of flow and a convolutional neural network that automatically delineates the vessels in image space. The proposed method was tested on clinical DSA images series and demonstrated efficient differentiation between arteries and veins that provides a viable solution to enhance visualizations for clinical use.

Learning Expected Appearances for Intraoperative Registration during Neurosurgery

We present a novel method for intraoperative patient-to-image registration by learning Expected Appearances. Our method uses preoperative imaging to synthesize patient-specific expected views through a surgical microscope for a predicted range of transformations. Our method estimates the camera pose by minimizing the dissimilarity between the intraoperative 2D view through the optical microscope and the synthesized expected texture. In contrast to conventional methods, our approach transfers the processing tasks to the preoperative stage, reducing thereby the impact of low-resolution, distorted, and noisy intraoperative images, that often degrade the registration accuracy. We applied our method in the context of neuronavigation during brain surgery. We evaluated our approach on synthetic data and on retrospective data from 6 clinical cases. Our method outperformed state-of-the-art methods and achieved accuracies that met current clinical standards.

Unified Brain MR-Ultrasound Synthesis using Multi-Modal Hierarchical Representations

We introduce MHVAE, a deep hierarchical variational auto-encoder (VAE) that synthesizes missing images from various modalities. Extending multi-modal VAEs with a hierarchical latent structure, we introduce a probabilistic formulation for fusing multi-modal images in a common latent representation while having the flexibility to handle incomplete image sets as input. Moreover, adversarial learning is employed to generate sharper images. Extensive experiments are performed on the challenging problem of joint intra-operative ultrasound (iUS) and Magnetic Resonance (MR) synthesis. Our model outperformed multi-modal VAEs, conditional GANs, and the current state-of-the-art unified method (ResViT) for synthesizing missing images, demonstrating the advantage of using a hierarchical latent representation and a principled probabilistic fusion operation. Our code is publicly available \url{https://github.com/ReubenDo/MHVAE}.

Deep Learning for Detection and Localization of B-Lines in Lung Ultrasound

Lung ultrasound (LUS) is an important imaging modality used by emergency physicians to assess pulmonary congestion at the patient bedside. B-line artifacts in LUS videos are key findings associated with pulmonary congestion. Not only can the interpretation of LUS be challenging for novice operators, but visual quantification of B-lines remains subject to observer variability. In this work, we investigate the strengths and weaknesses of multiple deep learning approaches for automated B-line detection and localization in LUS videos. We curate and publish, BEDLUS, a new ultrasound dataset comprising 1,419 videos from 113 patients with a total of 15,755 expert-annotated B-lines. Based on this dataset, we present a benchmark of established deep learning methods applied to the task of B-line detection. To pave the way for interpretable quantification of B-lines, we propose a novel "single-point" approach to B-line localization using only the point of origin. Our results show that (a) the area under the receiver operating characteristic curve ranges from 0.864 to 0.955 for the benchmarked detection methods, (b) within this range, the best performance is achieved by models that leverage multiple successive frames as input, and (c) the proposed single-point approach for B-line localization reaches an F1-score of 0.65, performing on par with the inter-observer agreement. The dataset and developed methods can facilitate further biomedical research on automated interpretation of lung ultrasound with the potential to expand the clinical utility.

Double-Uncertainty Assisted Spatial and Temporal Regularization Weighting for Learning-based Registration

In order to tackle the difficulty associated with the ill-posed nature of the image registration problem, researchers use regularization to constrain the solution space. For most learning-based registration approaches, the regularization usually has a fixed weight and only constrains the spatial transformation. Such convention has two limitations: (1) The regularization strength of a specific image pair should be associated with the content of the images, thus the ``one value fits all'' scheme is not ideal; (2) Only spatially regularizing the transformation (but overlooking the temporal consistency of different estimations) may not be the best strategy to cope with the ill-posedness. In this study, we propose a mean-teacher based registration framework. This framework incorporates an additional \textit{temporal regularization} term by encouraging the teacher model's temporal ensemble prediction to be consistent with that of the student model. At each training step, it also automatically adjusts the weights of the \textit{spatial regularization} and the \textit{temporal regularization} by taking account of the transformation uncertainty and appearance uncertainty derived from the perturbed teacher model. We perform experiments on multi- and uni-modal registration tasks, and the results show that our strategy outperforms the traditional and learning-based benchmark methods.

Do Public Datasets Assure Unbiased Comparisons for Registration Evaluation?

With the increasing availability of new image registration approaches, an unbiased evaluation is becoming more needed so that clinicians can choose the most suitable approaches for their applications. Current evaluations typically use landmarks in manually annotated datasets. As a result, the quality of annotations is crucial for unbiased comparisons. Even though most data providers claim to have quality control over their datasets, an objective third-party screening can be reassuring for intended users. In this study, we use the variogram to screen the manually annotated landmarks in two datasets used to benchmark registration in image-guided neurosurgeries. The variogram provides an intuitive 2D representation of the spatial characteristics of annotated landmarks. Using variograms, we identified potentially problematic cases and had them examined by experienced radiologists. We found that (1) a small number of annotations may have fiducial localization errors; (2) the landmark distribution for some cases is not ideal to offer fair comparisons. If unresolved, both findings could incur bias in registration evaluation.

Pilot Study on Verifying the Monotonic Relationship between Error and Uncertainty in Deformable Registration for Neurosurgery

In image-guided neurosurgery, deformable registration currently is not a clinical routine. Although using it in practice is a goal for image-guided therapy, this goal is hampered because surgeons are wary of the less predictable deformable registration error. In the preoperative- to-intraoperative registration, when surgeons notice a misaligned image pattern, they want to know whether it is a registration error or an actual deformation caused by tumor resection or retraction. Here, surgeons need a spatial distribution of error to help them make a better-informed decision, i.e., ignore locations with high error. However, such an error estimate is difficult to acquire. Alternatively, probabilistic image registration (PIR) methods give measures of registration uncertainty, which is a potential surrogate for assessing the quality of registration results. It is intuitive and believed by a lot of people that high uncertainty indicates a large error. Yet to the best of our knowledge, no such conclusion has been reported in the PIR literature. In this study, we look at one PIR method and give preliminary results showing that point-wise registration error and uncertainty are monotonically correlated.

On the Ambiguity of Registration Uncertainty

Estimating the uncertainty in image registration is an area of current research that is aimed at providing information that will enable surgeons to assess the operative risk based on registered image data and the estimated registration uncertainty. If they receive inaccurately calculated registration uncertainty and misplace confidence in the alignment solutions, severe consequences may result. For probabilistic image registration (PIR), most research quantifies the registration uncertainty using summary statistics of the transformation distributions. In this paper, we study a rarely examined topic: whether those summary statistics of the transformation distribution truly represent the registration uncertainty. Using concrete examples, we show that there are two types of uncertainties: the transformation uncertainty, Ut, and label uncertainty Ul. Ut indicates the doubt concerning transformation parameters and can be estimated by conventional uncertainty measures, while Ul is strongly linked to the goal of registration. Further, we show that using Ut to quantify Ul is inappropriate and can be misleading. In addition, we present some potentially critical findings regarding PIR.

A Feature-Driven Active Framework for Ultrasound-Based Brain Shift Compensation

A reliable Ultrasound (US)-to-US registration method to compensate for brain shift would substantially improve Image-Guided Neurological Surgery. Developing such a registration method is very challenging, due to factors such as missing correspondence in images, the complexity of brain pathology and the demand for fast computation. We propose a novel feature-driven active framework. Here, landmarks and their displacement are first estimated from a pair of US images using corresponding local image features. Subsequently, a Gaussian Process (GP) model is used to interpolate a dense deformation field from the sparse landmarks. Kernels of the GP are estimated by using variograms and a discrete grid search method. If necessary, the user can actively add new landmarks based on the image context and visualization of the uncertainty measure provided by the GP to further improve the result. We retrospectively demonstrate our registration framework as a robust and accurate brain shift compensation solution on clinical data acquired during neurosurgery.