Can Diffusion Models Bridge the Domain Gap in Cardiac MR Imaging?

Magnetic resonance (MR) imaging, including cardiac MR, is prone to domain shift due to variations in imaging devices and acquisition protocols. This challenge limits the deployment of trained AI models in real-world scenarios, where performance degrades on unseen domains. Traditional solutions involve increasing the size of the dataset through ad-hoc image augmentation or additional online training/transfer learning, which have several limitations. Synthetic data offers a promising alternative, but anatomical/structural consistency constraints limit the effectiveness of generative models in creating image-label pairs. To address this, we propose a diffusion model (DM) trained on a source domain that generates synthetic cardiac MR images that resemble a given reference. The synthetic data maintains spatial and structural fidelity, ensuring similarity to the source domain and compatibility with the segmentation mask. We assess the utility of our generative approach in multi-centre cardiac MR segmentation, using the 2D nnU-Net, 3D nnU-Net and vanilla U-Net segmentation networks. We explore domain generalisation, where, domain-invariant segmentation models are trained on synthetic source domain data, and domain adaptation, where, we shift target domain data towards the source domain using the DM. Both strategies significantly improved segmentation performance on data from an unseen target domain, in terms of surface-based metrics (Welch's t-test, p < 0.01), compared to training segmentation models on real data alone. The proposed method ameliorates the need for transfer learning or online training to address domain shift challenges in cardiac MR image analysis, especially useful in data-scarce settings.

At-Admission Prediction of Mortality and Pulmonary Embolism in COVID-19 Patients Using Statistical and Machine Learning Methods: An International Cohort Study

By September, 2022, more than 600 million cases of SARS-CoV-2 infection have been reported globally, resulting in over 6.5 million deaths. COVID-19 mortality risk estimators are often, however, developed with small unrepresentative samples and with methodological limitations. It is highly important to develop predictive tools for pulmonary embolism (PE) in COVID-19 patients as one of the most severe preventable complications of COVID-19. Using a dataset of more than 800,000 COVID-19 patients from an international cohort, we propose a cost-sensitive gradient-boosted machine learning model that predicts occurrence of PE and death at admission. Logistic regression, Cox proportional hazards models, and Shapley values were used to identify key predictors for PE and death. Our prediction model had a test AUROC of 75.9% and 74.2%, and sensitivities of 67.5% and 72.7% for PE and all-cause mortality respectively on a highly diverse and held-out test set. The PE prediction model was also evaluated on patients in UK and Spain separately with test results of 74.5% AUROC, 63.5% sensitivity and 78.9% AUROC, 95.7% sensitivity. Age, sex, region of admission, comorbidities (chronic cardiac and pulmonary disease, dementia, diabetes, hypertension, cancer, obesity, smoking), and symptoms (any, confusion, chest pain, fatigue, headache, fever, muscle or joint pain, shortness of breath) were the most important clinical predictors at admission. Our machine learning model developed from an international cohort can serve to better regulate hospital risk prioritisation of at-risk patients.