'Earlier than Early' Detection of Breast Cancer in Israeli BRCA Mutation Carriers Applying AI-Based Analysis to Consecutive MRI Scans.

Female BRCA1/BRCA2 (=BRCA) pathogenic variants (PVs) carriers are at a substantially higher risk for developing breast cancer (BC) compared with the average risk population. Detection of BC at an early stage significantly improves prognosis. To facilitate early BC detection, a surveillance scheme is offered to BRCA PV carriers from age 25-30 years that includes annual MRI based breast imaging. Indeed, adherence to the recommended scheme has been shown to be associated with earlier disease stages at BC diagnosis, more in-situ pathology, smaller tumors, and less axillary involvement. While MRI is the most sensitive modality for BC detection in BRCA PV carriers, there are a significant number of overlooked or misinterpreted radiological lesions (mostly enhancing foci), leading to a delayed BC diagnosis at a more advanced stage. In this study we developed an artificial intelligence (AI)-network, aimed at a more accurate classification of enhancing foci, in MRIs of BRCA PV carriers, thus reducing false-negative interpretations. Retrospectively identified foci in prior MRIs that were either diagnosed as BC or benign/normal in a subsequent MRI were manually segmented and served as input for a convolutional network architecture. The model was successful in classification of 65% of the cancerous foci, most of them triple-negative BC. If validated, applying this scheme routinely may facilitate 'earlier than early' BC diagnosis in BRCA PV carriers.

Classification of contrast-enhanced spectral mammography (CESM) images.

PURPOSE: Contrast-enhanced spectral mammography (CESM) is a recently developed breast imaging technique. CESM relies on dual-energy acquisition following contrast agent injection to improve mammography sensitivity. CESM is comparable to contrast-enhanced MRI in terms of sensitivity, at a fraction of the cost. However, since lesion variability is large, even with the improved visibility provided by CESM, differentiation between benign and malignant enhancement is not accurate and a biopsy is usually performed for final assessment. Breast biopsies can be stressful to the patient and are expensive to healthcare systems. Moreover, as the biopsies results are most of the time benign, a specificity improvement in the radiologist diagnosis is required. This work presents a deep learning-based decision support system, which aims at improving the specificity of breast cancer diagnosis by CESM without affecting sensitivity. METHODS: We compare two analysis approaches, fine-tuning a pretrained network and fully training a convolutional neural network, for classification of CESM breast mass as benign or malignant. Breast Imaging Reporting and Data Systems (BIRADS) is a radiological lexicon, used with breast images, to categorize lesions. We improve each classification network by incorporating BIRADS textual features as an additional input to the network. We evaluate two ways of BIRADS fusion as network input: feature fusion and decision fusion. This leads to multimodal network architectures. At classification, we also exploit information from apparently normal breast tissue in the CESM of the considered patient, leading to a patient-specific classification. RESULTS: We evaluate performance using fivefold cross-validation, on 129 randomly selected breast lesions annotated by an experienced radiologist. Each annotation includes a contour of the mass in the image, biopsy-proven label of benign or malignant lesion and BIRADS descriptors. At 100% sensitivity, specificity of 66% was achieved using a multimodal network, which combines inputs at feature level and patient-specific classification. CONCLUSIONS: The presented multimodal network may significantly reduce benign biopsies, without compromising sensitivity.

The fiber-density-coreset for redundancy reduction in huge fiber-sets.

State of the art Diffusion Weighted Magnetic Resonance Imaging (DW-MRI) protocols of white matter followed by advanced tractography techniques produce impressive reconstructions of White Matter (WM) pathways. These pathways often contain millions of trajectories (fibers). While for several applications the high number of fibers is essential, other applications (visualization, registration, some types of across-subject comparison) can achieve satisfying results using much smaller sets and may be overburdened by the computational load of the large fiber sets. In this paper we propose a novel, highly efficient algorithm for extracting a meaningful subset of fibers, which we term the Fiber-Density-Coreset (FDC). The reduced set is optimized to represent the main structures of the brain. FDC is based on an efficient geometric approximation paradigm named coresets, an optimization scheme showing much success in tasks requiring large computation time and/or memory. FDC was compared to two commonly used methods for selecting a reduced set of fibers: fiber-clustering and downsampling. The reduced sets were evaluated by several methods, including a novel structural comparison to the full sets called 3D indicator structure comparison (3D-ISC). The comparison was applied to High Angular Resolution Diffusion Imaging (HARDI) scans of 15 healthy individuals obtained from the Human Connectome Project. FDC produced the most satisfying subsets, consistently in all 15 subjects. It also displayed low memory usage and significantly lower running time than conventional fiber reduction schemes.

Whole brain fiber-based comparison (FBC)-A tool for diffusion tensor imaging-based cohort studies.

We present a novel method for fiber-based comparison of diffusion tensor imaging (DTI) scans of groups of subjects. The method entails initial preprocessing and fiber reconstruction by tractography of each brain in its native coordinate system. Several diffusion parameters are sampled along each fiber and used in subsequent comparisons. A spatial correspondence between subjects is established based on geometric similarity between fibers in a template set (several choices for template are explored), and fibers in all other subjects. Diffusion parameters between groups are compared statistically for each template fiber. Results are presented at single fiber resolution. As an initial exploratory step in neurological population studies this method points to the locations affected by the pathology of interest, without requiring a hypothesis. It does not make any grouping assumptions on the fibers and no manual intervention is needed. The framework was applied here to 18 healthy subjects and 23 amyotrophic lateral sclerosis (ALS) patients. The results are compatible with previous findings and with the tract based spatial statistics (TBSS) method. Hum Brain Mapp 37:477-490, 2016. © 2015 Wiley Periodicals, Inc.

Automatic classification of cancer cells in multispectral microscopic images of lymph node samples.

Histopathological analysis is crucial for the diagnosis of a large number of cancer types. A lot of progress has been made in the development of molecular based assays, but many of the cases still require the careful analysis of the stained tissue under a bright-field microscope and its analysis. This procedure is costly and time-consuming. We present a novel method for classification of cancer cells in lymph node images. It is based on the measurement of the spectral image of hematoxylin and eosin stained sample under the microscope and the analysis of the acquired data using state of the art machine learning techniques. The method is based on the analysis of the spectral information of the cells as well as their morphological properties. A large number of descriptors is extracted for each cell location, which are used to train a supervised classifier which discriminates between normal and cancer cells. We show that a reliable analysis can be made with detection rate (recall) of 81%-100% for the cancer class.

A supervised framework for the registration and segmentation of white matter fiber tracts.

A supervised framework is presented for the automatic registration and segmentation of white matter (WM) tractographies extracted from brain DT-MRI. The framework relies on the direct registration between the fibers, without requiring any intensity-based registration as preprocessing. An affine transform is recovered together with a set of segmented fibers. A recently introduced probabilistic boosting tree classifier is used in a segmentation refinement step to improve the precision of the target tract segmentation. The proposed method compares favorably with a state-of-the-art intensity-based algorithm for affine registration of DTI tractographies. Segmentation results for 12 major WM tracts are demonstrated. Quantitative results are also provided for the segmentation of a particularly difficult case, the optic radiation tract. An average precision of 80% and recall of 55% were obtained for the optimal configuration of the presented method.