Thyroid ultrasound diagnosis improvement via multi-view self-supervised learning and two-stage pre-training

Thyroid nodule classification and segmentation in ultrasound images are crucial for computer-aided diagnosis; however, they face limitations owing to insufficient labeled data. In this study, we proposed a multi-view contrastive self-supervised method to improve thyroid nodule classification and segmentation performance with limited manual labels. Our method aligns the transverse and longitudinal views of the same nodule, thereby enabling the model to focus more on the nodule area. We designed an adaptive loss function that eliminates the limitations of the paired data. Additionally, we adopted a two-stage pre-training to exploit the pre-training on ImageNet and thyroid ultrasound images. Extensive experiments were conducted on a large-scale dataset collected from multiple centers. The results showed that the proposed method significantly improves nodule classification and segmentation performance with limited manual labels and outperforms state-of-the-art self-supervised methods. The two-stage pre-training also significantly exceeded ImageNet pre-training.

MUVF-YOLOX: A Multi-modal Ultrasound Video Fusion Network for Renal Tumor Diagnosis

Early diagnosis of renal cancer can greatly improve the survival rate of patients. Contrast-enhanced ultrasound (CEUS) is a cost-effective and non-invasive imaging technique and has become more and more frequently used for renal tumor diagnosis. However, the classification of benign and malignant renal tumors can still be very challenging due to the highly heterogeneous appearance of cancer and imaging artifacts. Our aim is to detect and classify renal tumors by integrating B-mode and CEUS-mode ultrasound videos. To this end, we propose a novel multi-modal ultrasound video fusion network that can effectively perform multi-modal feature fusion and video classification for renal tumor diagnosis. The attention-based multi-modal fusion module uses cross-attention and self-attention to extract modality-invariant features and modality-specific features in parallel. In addition, we design an object-level temporal aggregation (OTA) module that can automatically filter low-quality features and efficiently integrate temporal information from multiple frames to improve the accuracy of tumor diagnosis. Experimental results on a multicenter dataset show that the proposed framework outperforms the single-modal models and the competing methods. Furthermore, our OTA module achieves higher classification accuracy than the frame-level predictions. Our code is available at \url{https://github.com/JeunyuLi/MUAF}.

Inflated 3D Convolution-Transformer for Weakly-supervised Carotid Stenosis Grading with Ultrasound Videos

Localization of the narrowest position of the vessel and corresponding vessel and remnant vessel delineation in carotid ultrasound (US) are essential for carotid stenosis grading (CSG) in clinical practice. However, the pipeline is time-consuming and tough due to the ambiguous boundaries of plaque and temporal variation. To automatize this procedure, a large number of manual delineations are usually required, which is not only laborious but also not reliable given the annotation difficulty. In this study, we present the first video classification framework for automatic CSG. Our contribution is three-fold. First, to avoid the requirement of laborious and unreliable annotation, we propose a novel and effective video classification network for weakly-supervised CSG. Second, to ease the model training, we adopt an inflation strategy for the network, where pre-trained 2D convolution weights can be adapted into the 3D counterpart in our network for an effective warm start. Third, to enhance the feature discrimination of the video, we propose a novel attention-guided multi-dimension fusion (AMDF) transformer encoder to model and integrate global dependencies within and across spatial and temporal dimensions, where two lightweight cross-dimensional attention mechanisms are designed. Our approach is extensively validated on a large clinically collected carotid US video dataset, demonstrating state-of-the-art performance compared with strong competitors.

Sketch guided and progressive growing GAN for realistic and editable ultrasound image synthesis

Ultrasound (US) imaging is widely used for anatomical structure inspection in clinical diagnosis. The training of new sonographers and deep learning based algorithms for US image analysis usually requires a large amount of data. However, obtaining and labeling large-scale US imaging data are not easy tasks, especially for diseases with low incidence. Realistic US image synthesis can alleviate this problem to a great extent. In this paper, we propose a generative adversarial network (GAN) based image synthesis framework. Our main contributions include: 1) we present the first work that can synthesize realistic B-mode US images with high-resolution and customized texture editing features; 2) to enhance structural details of generated images, we propose to introduce auxiliary sketch guidance into a conditional GAN. We superpose the edge sketch onto the object mask and use the composite mask as the network input; 3) to generate high-resolution US images, we adopt a progressive training strategy to gradually generate high-resolution images from low-resolution images. In addition, a feature loss is proposed to minimize the difference of high-level features between the generated and real images, which further improves the quality of generated images; 4) the proposed US image synthesis method is quite universal and can also be generalized to the US images of other anatomical structures besides the three ones tested in our study (lung, hip joint, and ovary); 5) extensive experiments on three large US image datasets are conducted to validate our method. Ablation studies, customized texture editing, user studies, and segmentation tests demonstrate promising results of our method in synthesizing realistic US images.

Steerable Pyramid Transform Enables Robust Left Ventricle Quantification

Although multifarious variants of convolutional neural networks (CNNs) have proved successful in cardiac index quantification, they seem vulnerable to mild input perturbations, e.g., spatial transformations, image distortions, and adversarial attacks. Such brittleness erodes our trust in CNN-based automated diagnosis of various cardiovascular diseases. In this work, we describe a simple and effective method to learn robust CNNs for left ventricle (LV) quantification, including cavity and myocardium areas, directional dimensions, and regional wall thicknesses. The key to the success of our approach is the use of the biologically-inspired steerable pyramid transform (SPT) as fixed front-end processing, which brings three computational advantages to LV quantification. First, the basis functions of SPT match the anatomical structure of the LV as well as the geometric characteristics of the estimated indices. Second, SPT enables sharing a CNN across different orientations as a form of parameter regularization, and explicitly captures the scale variations of the LV in a natural way. Third, the residual highpass subband can be conveniently discarded to further encourage robust feature learning. A concise and effective metric, named Robustness Ratio, is proposed to evaluate the robustness under various input perturbations. Extensive experiments on 145 cardiac sequences show that our SPT-augmented method performs favorably against state-of-the-art algorithms in terms of prediction accuracy, but is significantly more robust under input perturbations.

AWSnet: An Auto-weighted Supervision Attention Network for Myocardial Scar and Edema Segmentation in Multi-sequence Cardiac Magnetic Resonance Images

Multi-sequence cardiac magnetic resonance (CMR) provides essential pathology information (scar and edema) to diagnose myocardial infarction. However, automatic pathology segmentation can be challenging due to the difficulty of effectively exploring the underlying information from the multi-sequence CMR data. This paper aims to tackle the scar and edema segmentation from multi-sequence CMR with a novel auto-weighted supervision framework, where the interactions among different supervised layers are explored under a task-specific objective using reinforcement learning. Furthermore, we design a coarse-to-fine framework to boost the small myocardial pathology region segmentation with shape prior knowledge. The coarse segmentation model identifies the left ventricle myocardial structure as a shape prior, while the fine segmentation model integrates a pixel-wise attention strategy with an auto-weighted supervision model to learn and extract salient pathological structures from the multi-sequence CMR data. Extensive experimental results on a publicly available dataset from Myocardial pathology segmentation combining multi-sequence CMR (MyoPS 2020) demonstrate our method can achieve promising performance compared with other state-of-the-art methods. Our method is promising in advancing the myocardial pathology assessment on multi-sequence CMR data. To motivate the community, we have made our code publicly available via https://github.com/soleilssss/AWSnet/tree/master.

Bootstrap Representation Learning for Segmentation on Medical Volumes and Sequences

In this work, we propose a novel straightforward method for medical volume and sequence segmentation with limited annotations. To avert laborious annotating, the recent success of self-supervised learning(SSL) motivates the pre-training on unlabeled data. Despite its success, it is still challenging to adapt typical SSL methods to volume/sequence segmentation, due to their lack of mining on local semantic discrimination and rare exploitation on volume and sequence structures. Based on the continuity between slices/frames and the common spatial layout of organs across volumes/sequences, we introduced a novel bootstrap self-supervised representation learning method by leveraging the predictable possibility of neighboring slices. At the core of our method is a simple and straightforward dense self-supervision on the predictions of local representations and a strategy of predicting locals based on global context, which enables stable and reliable supervision for both global and local representation mining among volumes. Specifically, we first proposed an asymmetric network with an attention-guided predictor to enforce distance-specific prediction and supervision on slices within and across volumes/sequences. Secondly, we introduced a novel prototype-based foreground-background calibration module to enhance representation consistency. The two parts are trained jointly on labeled and unlabeled data. When evaluated on three benchmark datasets of medical volumes and sequences, our model outperforms existing methods with a large margin of 4.5\% DSC on ACDC, 1.7\% on Prostate, and 2.3\% on CAMUS. Intensive evaluations reveals the effectiveness and superiority of our method.

Joint Landmark and Structure Learning for Automatic Evaluation of Developmental Dysplasia of the Hip

The ultrasound (US) screening of the infant hip is vital for the early diagnosis of developmental dysplasia of the hip (DDH). The US diagnosis of DDH refers to measuring alpha and beta angles that quantify hip joint development. These two angles are calculated from key anatomical landmarks and structures of the hip. However, this measurement process is not trivial for sonographers and usually requires a thorough understanding of complex anatomical structures. In this study, we propose a multi-task framework to learn the relationships among landmarks and structures jointly and automatically evaluate DDH. Our multi-task networks are equipped with three novel modules. Firstly, we adopt Mask R-CNN as the basic framework to detect and segment key anatomical structures and add one landmark detection branch to form a new multi-task framework. Secondly, we propose a novel shape similarity loss to refine the incomplete anatomical structure prediction robustly and accurately. Thirdly, we further incorporate the landmark-structure consistent prior to ensure the consistency of the bony rim estimated from the segmented structure and the detected landmark. In our experiments, 1,231 US images of the infant hip from 632 patients are collected, of which 247 images from 126 patients are tested. The average errors in alpha and beta angles are 2.221 degrees and 2.899 degrees. About 93% and 85% estimates of alpha and beta angles have errors less than 5 degrees, respectively. Experimental results demonstrate that the proposed method can accurately and robustly realize the automatic evaluation of DDH, showing great potential for clinical application.

Agent with Warm Start and Adaptive Dynamic Termination for Plane Localization in 3D Ultrasound

Accurate standard plane (SP) localization is the fundamental step for prenatal ultrasound (US) diagnosis. Typically, dozens of US SPs are collected to determine the clinical diagnosis. 2D US has to perform scanning for each SP, which is time-consuming and operator-dependent. While 3D US containing multiple SPs in one shot has the inherent advantages of less user-dependency and more efficiency. Automatically locating SP in 3D US is very challenging due to the huge search space and large fetal posture variations. Our previous study proposed a deep reinforcement learning (RL) framework with an alignment module and active termination to localize SPs in 3D US automatically. However, termination of agent search in RL is important and affects the practical deployment. In this study, we enhance our previous RL framework with a newly designed adaptive dynamic termination to enable an early stop for the agent searching, saving at most 67% inference time, thus boosting the accuracy and efficiency of the RL framework at the same time. Besides, we validate the effectiveness and generalizability of our algorithm extensively on our in-house multi-organ datasets containing 433 fetal brain volumes, 519 fetal abdomen volumes, and 683 uterus volumes. Our approach achieves localization error of 2.52mm/10.26 degrees, 2.48mm/10.39 degrees, 2.02mm/10.48 degrees, 2.00mm/14.57 degrees, 2.61mm/9.71 degrees, 3.09mm/9.58 degrees, 1.49mm/7.54 degrees for the transcerebellar, transventricular, transthalamic planes in fetal brain, abdominal plane in fetal abdomen, and mid-sagittal, transverse and coronal planes in uterus, respectively. Experimental results show that our method is general and has the potential to improve the efficiency and standardization of US scanning.