Structural connectome quantifies tumour invasion and predicts survival in glioblastoma patients.

Glioblastoma is characterized by diffuse infiltration into the surrounding tissue along white matter tracts. Identifying the invisible tumour invasion beyond focal lesion promises more effective treatment, which remains a significant challenge. It is increasingly accepted that glioblastoma could widely affect brain structure and function, and further lead to reorganization of neural connectivity. Quantifying neural connectivity in glioblastoma may provide a valuable tool for identifying tumour invasion. Here we propose an approach to systematically identify tumour invasion by quantifying the structural connectome in glioblastoma patients. We first recruit two independent prospective glioblastoma cohorts: the discovery cohort with 117 patients and validation cohort with 42 patients. Next, we use diffusion MRI of healthy subjects to construct tractography templates indicating white matter connection pathways between brain regions. Next, we construct fractional anisotropy skeletons from diffusion MRI using an improved voxel projection approach based on the tract-based spatial statistics, where the strengths of white matter connection and brain regions are estimated. To quantify the disrupted connectome, we calculate the deviation of the connectome strengths of patients from that of the age-matched healthy controls. We then categorize the disruption into regional disruptions on the basis of the relative location of connectome to focal lesions. We also characterize the topological properties of the patient connectome based on the graph theory. Finally, we investigate the clinical, cognitive and prognostic significance of connectome metrics using Pearson correlation test, mediation test and survival models. Our results show that the connectome disruptions in glioblastoma patients are widespread in the normal-appearing brain beyond focal lesions, associated with lower preoperative performance (P < 0.001), impaired cognitive function (P < 0.001) and worse survival (overall survival: hazard ratio = 1.46, P = 0.049; progression-free survival: hazard ratio = 1.49, P = 0.019). Additionally, these distant disruptions mediate the effect on topological alterations of the connectome (mediation effect: clustering coefficient -0.017, P < 0.001, characteristic path length 0.17, P = 0.008). Further, the preserved connectome in the normal-appearing brain demonstrates evidence of connectivity reorganization, where the increased neural connectivity is associated with better overall survival (log-rank P = 0.005). In conclusion, our connectome approach could reveal and quantify the glioblastoma invasion distant from the focal lesion and invisible on the conventional MRI. The structural disruptions in the normal-appearing brain were associated with the topological alteration of the brain and could indicate treatment target. Our approach promises to aid more accurate patient stratification and more precise treatment planning.

Calibrating the Dice Loss to Handle Neural Network Overconfidence for Biomedical Image Segmentation.

The Dice similarity coefficient (DSC) is both a widely used metric and loss function for biomedical image segmentation due to its robustness to class imbalance. However, it is well known that the DSC loss is poorly calibrated, resulting in overconfident predictions that cannot be usefully interpreted in biomedical and clinical practice. Performance is often the only metric used to evaluate segmentations produced by deep neural networks, and calibration is often neglected. However, calibration is important for translation into biomedical and clinical practice, providing crucial contextual information to model predictions for interpretation by scientists and clinicians. In this study, we provide a simple yet effective extension of the DSC loss, named the DSC++ loss, that selectively modulates the penalty associated with overconfident, incorrect predictions. As a standalone loss function, the DSC++ loss achieves significantly improved calibration over the conventional DSC loss across six well-validated open-source biomedical imaging datasets, including both 2D binary and 3D multi-class segmentation tasks. Similarly, we observe significantly improved calibration when integrating the DSC++ loss into four DSC-based loss functions. Finally, we use softmax thresholding to illustrate that well calibrated outputs enable tailoring of recall-precision bias, which is an important post-processing technique to adapt the model predictions to suit the biomedical or clinical task. The DSC++ loss overcomes the major limitation of the DSC loss, providing a suitable loss function for training deep learning segmentation models for use in biomedical and clinical practice. Source code is available at https://github.com/mlyg/DicePlusPlus .

Enhancing the spatial resolution of hyperpolarized carbon-13 MRI of human brain metabolism using structure guidance.

PURPOSE: Dynamic nuclear polarization is an emerging imaging method that allows noninvasive investigation of tissue metabolism. However, the relatively low metabolic spatial resolution that can be achieved limits some applications, and improving this resolution could have important implications for the technique. METHODS: We propose to enhance the 3D resolution of carbon-13 magnetic resonance imaging (13 C-MRI) using the structural information provided by hydrogen-1 MRI (1 H-MRI). The proposed approach relies on variational regularization in 3D with a directional total variation regularizer, resulting in a convex optimization problem which is robust with respect to the parameters and can efficiently be solved by many standard optimization algorithms. Validation was carried out using an in silico phantom, an in vitro phantom and in vivo data from four human volunteers. RESULTS: The clinical data used in this study were upsampled by a factor of 4 in-plane and by a factor of 15 out-of-plane, thereby revealing occult information. A key finding is that 3D super-resolution shows superior performance compared to several 2D super-resolution approaches: for example, for the in silico data, the mean-squared-error was reduced by around 40% and for all data produced increased anatomical definition of the metabolic imaging. CONCLUSION: The proposed approach generates images with enhanced anatomical resolution while largely preserving the quantitative measurements of metabolism. Although the work requires clinical validation against tissue measures of metabolism, it offers great potential in the field of 13 C-MRI and could significantly improve image quality in the future.

GraphXCOVID: Explainable deep graph diffusion pseudo-Labelling for identifying COVID-19 on chest X-rays.

Can one learn to diagnose COVID-19 under extreme minimal supervision? Since the outbreak of the novel COVID-19 there has been a rush for developing automatic techniques for expert-level disease identification on Chest X-ray data. In particular, the use of deep supervised learning has become the go-to paradigm. However, the performance of such models is heavily dependent on the availability of a large and representative labelled dataset. The creation of which is a heavily expensive and time consuming task, and especially imposes a great challenge for a novel disease. Semi-supervised learning has shown the ability to match the incredible performance of supervised models whilst requiring a small fraction of the labelled examples. This makes the semi supervised paradigm an attractive option for identifying COVID-19. In this work, we introduce a graph based deep semi-supervised framework for classifying COVID-19 from chest X-rays. Our framework introduces an optimisation model for graph diffusion that reinforces the natural relation among the tiny labelled set and the vast unlabelled data. We then connect the diffusion prediction output as pseudo-labels that are used in an iterative scheme in a deep net. We demonstrate, through our experiments, that our model is able to outperform the current leading supervised model with a tiny fraction of the labelled examples. Finally, we provide attention maps to accommodate the radiologist's mental model, better fitting their perceptual and cognitive abilities. These visualisation aims to assist the radiologist in judging whether the diagnostic is correct or not, and in consequence to accelerate the decision.

Equivariant neural networks for inverse problems.

In recent years the use of convolutional layers to encode an inductive bias (translational equivariance) in neural networks has proven to be a very fruitful idea. The successes of this approach have motivated a line of research into incorporating other symmetries into deep learning methods, in the form of group equivariant convolutional neural networks. Much of this work has been focused on roto-translational symmetry of R d , but other examples are the scaling symmetry of R d and rotational symmetry of the sphere. In this work, we demonstrate that group equivariant convolutional operations can naturally be incorporated into learned reconstruction methods for inverse problems that are motivated by the variational regularisation approach. Indeed, if the regularisation functional is invariant under a group symmetry, the corresponding proximal operator will satisfy an equivariance property with respect to the same group symmetry. As a result of this observation, we design learned iterative methods in which the proximal operators are modelled as group equivariant convolutional neural networks. We use roto-translationally equivariant operations in the proposed methodology and apply it to the problems of low-dose computerised tomography reconstruction and subsampled magnetic resonance imaging reconstruction. The proposed methodology is demonstrated to improve the reconstruction quality of a learned reconstruction method with a little extra computational cost at training time but without any extra cost at test time.

A multi-contrast MRI approach to thalamus segmentation.

Thalamic alterations occur in many neurological disorders including Alzheimer's disease, Parkinson's disease and multiple sclerosis. Routine interventions to improve symptom severity in movement disorders, for example, often consist of surgery or deep brain stimulation to diencephalic nuclei. Therefore, accurate delineation of grey matter thalamic subregions is of the upmost clinical importance. MRI is highly appropriate for structural segmentation as it provides different views of the anatomy from a single scanning session. Though with several contrasts potentially available, it is also of increasing importance to develop new image segmentation techniques that can operate multi-spectrally. We hereby propose a new segmentation method for use with multi-modality data, which we evaluated for automated segmentation of major thalamic subnuclear groups using T1 -weighted, T2* -weighted and quantitative susceptibility mapping (QSM) information. The proposed method consists of four steps: Highly iterative image co-registration, manual segmentation on the average training-data template, supervised learning for pattern recognition, and a final convex optimisation step imposing further spatial constraints to refine the solution. This led to solutions in greater agreement with manual segmentation than the standard Morel atlas based approach. Furthermore, we show that the multi-contrast approach boosts segmentation performances. We then investigated whether prior knowledge using the training-template contours could further improve convex segmentation accuracy and robustness, which led to highly precise multi-contrast segmentations in single subjects. This approach can be extended to most 3D imaging data types and any region of interest discernible in single scans or multi-subject templates.

Variational regularisation for inverse problems with imperfect forward operators and general noise models.

We study variational regularisation methods for inverse problems with imperfect forward operators whose errors can be modelled by order intervals in a partial order of a Banach lattice. We carry out analysis with respect to existence and convex duality for general data fidelity terms and regularisation functionals. Both for a priori and a posteriori parameter choice rules, we obtain convergence rates of the regularised solutions in terms of Bregman distances. Our results apply to fidelity terms such as Wasserstein distances, φ-divergences, norms, as well as sums and infimal convolutions of those.

An anisotropic interaction model for simulating fingerprints.

Evidence suggests that both the interaction of so-called Merkel cells and the epidermal stress distribution play an important role in the formation of fingerprint patterns during pregnancy. To model the formation of fingerprint patterns in a biologically meaningful way these patterns have to become stationary. For the creation of synthetic fingerprints it is also very desirable that rescaling the model parameters leads to rescaled distances between the stationary fingerprint ridges. Based on these observations, as well as the model introduced by Kücken and Champod we propose a new model for the formation of fingerprint patterns during pregnancy. In this anisotropic interaction model the interaction forces not only depend on the distance vector between the cells and the model parameters, but additionally on an underlying tensor field, representing a stress field. This dependence on the tensor field leads to complex, anisotropic patterns. We study the resulting stationary patterns both analytically and numerically. In particular, we show that fingerprint patterns can be modeled as stationary solutions by choosing the underlying tensor field appropriately.

Mathematical imaging methods for mitosis analysis in live-cell phase contrast microscopy.

In this paper we propose a workflow to detect and track mitotic cells in time-lapse microscopy image sequences. In order to avoid the requirement for cell lines expressing fluorescent markers and the associated phototoxicity, phase contrast microscopy is often preferred over fluorescence microscopy in live-cell imaging. However, common specific image characteristics complicate image processing and impede use of standard methods. Nevertheless, automated analysis is desirable due to manual analysis being subjective, biased and extremely time-consuming for large data sets. Here, we present the following workflow based on mathematical imaging methods. In the first step, mitosis detection is performed by means of the circular Hough transform. The obtained circular contour subsequently serves as an initialisation for the tracking algorithm based on variational methods. It is sub-divided into two parts: in order to determine the beginning of the whole mitosis cycle, a backwards tracking procedure is performed. After that, the cell is tracked forwards in time until the end of mitosis. As a result, the average of mitosis duration and ratios of different cell fates (cell death, no division, division into two or more daughter cells) can be measured and statistics on cell morphologies can be obtained. All of the tools are featured in the user-friendly MATLAB®Graphical User Interface MitosisAnalyser.

Can physics-informed neural networks beat the finite element method?

Partial differential equations (PDEs) play a fundamental role in the mathematical modelling of many processes and systems in physical, biological and other sciences. To simulate such processes and systems, the solutions of PDEs often need to be approximated numerically. The finite element method, for instance, is a usual standard methodology to do so. The recent success of deep neural networks at various approximation tasks has motivated their use in the numerical solution of PDEs. These so-called physics-informed neural networks and their variants have shown to be able to successfully approximate a large range of PDEs. So far, physics-informed neural networks and the finite element method have mainly been studied in isolation of each other. In this work, we compare the methodologies in a systematic computational study. Indeed, we employ both methods to numerically solve various linear and nonlinear PDEs: Poisson in 1D, 2D and 3D, Allen-Cahn in 1D, semilinear Schrödinger in 1D and 2D. We then compare computational costs and approximation accuracies. In terms of solution time and accuracy, physics-informed neural networks have not been able to outperform the finite element method in our study. In some experiments, they were faster at evaluating the solved PDE.

Implicit neural representations for unsupervised super-resolution and denoising of 4D flow MRI.

BACKGROUND AND OBJECTIVE: 4D flow magnetic resonance imaging provides time-resolved blood flow velocity measurements, but suffers from limitations in spatio-temporal resolution and noise. In this study, we investigated the use of sinusoidal representation networks (SIRENs) to improve denoising and super-resolution of velocity fields measured by 4D flow MRI in the thoracic aorta. METHODS: Efficient training of SIRENs in 4D was achieved by sampling voxel coordinates and enforcing the no-slip condition at the vessel wall. A set of synthetic measurements were generated from computational fluid dynamics simulations, reproducing different noise levels. The influence of SIREN architecture was systematically investigated, and the performance of our method was compared to existing approaches for 4D flow denoising and super-resolution. RESULTS: Compared to existing techniques, a SIREN with 300 neurons per layer and 20 layers achieved lower errors (up to 50% lower vector normalized root mean square error, 42% lower magnitude normalized root mean square error, and 15% lower direction error) in velocity and wall shear stress fields. Applied to real 4D flow velocity measurements in a patient-specific aortic aneurysm, our method produced denoised and super-resolved velocity fields while maintaining accurate macroscopic flow measurements. CONCLUSIONS: This study demonstrates the feasibility of using SIRENs for complex blood flow velocity representation from clinical 4D flow, with quick execution and straightforward implementation.

Deep learning-based diffusion tensor cardiac magnetic resonance reconstruction: a comparison study.

In vivo cardiac diffusion tensor imaging (cDTI) is a promising Magnetic Resonance Imaging (MRI) technique for evaluating the microstructure of myocardial tissue in living hearts, providing insights into cardiac function and enabling the development of innovative therapeutic strategies. However, the integration of cDTI into routine clinical practice poses challenging due to the technical obstacles involved in the acquisition, such as low signal-to-noise ratio and prolonged scanning times. In this study, we investigated and implemented three different types of deep learning-based MRI reconstruction models for cDTI reconstruction. We evaluated the performance of these models based on the reconstruction quality assessment, the diffusion tensor parameter assessment as well as the computational cost assessment. Our results indicate that the models discussed in this study can be applied for clinical use at an acceleration factor (AF) of × 2 and × 4 , with the D5C5 model showing superior fidelity for reconstruction and the SwinMR model providing higher perceptual scores. There is no statistical difference from the reference for all diffusion tensor parameters at AF × 2 or most DT parameters at AF × 4 , and the quality of most diffusion tensor parameter maps is visually acceptable. SwinMR is recommended as the optimal approach for reconstruction at AF × 2 and AF × 4 . However, we believe that the models discussed in this study are not yet ready for clinical use at a higher AF. At AF × 8 , the performance of all models discussed remains limited, with only half of the diffusion tensor parameters being recovered to a level with no statistical difference from the reference. Some diffusion tensor parameter maps even provide wrong and misleading information.

Extracting chain lines and laid lines from digital images of medieval paper using spectral total variation decomposition.

Medieval paper, a handmade product, is made with a mould which leaves an indelible imprint on the sheet of paper. This imprint includes chain lines, laid lines and watermarks which are often visible on the sheet. Extracting these features allows the identification of the paper stock and gives information about the chronology, localisation and movement of manuscripts and people. Most computational work for feature extraction of paper analysis has so far focused on radiography or transmitted light images. While these imaging methods provide clear visualisation of the features of interest, they are expensive and time consuming in their acquisition and not feasible for smaller institutions. However, reflected light images of medieval paper manuscripts are abundant and possibly cheaper in their acquisition. In this paper, we propose algorithms to detect and extract the laid and chain lines from reflected light images. We tackle the main drawback of reflected light images, that is, the low contrast attenuation of chain and laid lines and intensity jumps due to noise and degradation, by employing the spectral total variation decomposition and develop methods for subsequent chain and laid line extraction. Our results clearly demonstrate the feasibility of using reflected light images in paper analysis. This work enables feature extraction for paper manuscripts that have otherwise not been analysed due to a lack of appropriate images. We also open the door for paper stock identification at scale.

Contrastive Registration for Unsupervised Medical Image Segmentation.

Medical image segmentation is an important task in medical imaging, as it serves as the first step for clinical diagnosis and treatment planning. While major success has been reported using deep learning supervised techniques, they assume a large and well-representative labeled set. This is a strong assumption in the medical domain where annotations are expensive, time-consuming, and inherent to human bias. To address this problem, unsupervised segmentation techniques have been proposed in the literature. Yet, none of the existing unsupervised segmentation techniques reach accuracies that come even near to the state-of-the-art of supervised segmentation methods. In this work, we present a novel optimization model framed in a new convolutional neural network (CNN)-based contrastive registration architecture for unsupervised medical image segmentation called CLMorph. The core idea of our approach is to exploit image-level registration and feature-level contrastive learning, to perform registration-based segmentation. First, we propose an architecture to capture the image-to-image transformation mapping via registration for unsupervised medical image segmentation. Second, we embed a contrastive learning mechanism in the registration architecture to enhance the discriminative capacity of the network at the feature level. We show that our proposed CLMorph technique mitigates the major drawbacks of existing unsupervised techniques. We demonstrate, through numerical and visual experiments, that our technique substantially outperforms the current state-of-the-art unsupervised segmentation methods on two major medical image datasets.

On Krylov methods for large-scale CBCT reconstruction.

Krylov subspace methods are a powerful family of iterative solvers for linear systems of equations, which are commonly used for inverse problems due to their intrinsic regularization properties. Moreover, these methods are naturally suited to solve large-scale problems, as they only require matrix-vector products with the system matrix (and its adjoint) to compute approximate solutions, and they display a very fast convergence. Even if this class of methods has been widely researched and studied in the numerical linear algebra community, its use in applied medical physics and applied engineering is still very limited. e.g. in realistic large-scale computed tomography (CT) problems, and more specifically in cone beam CT (CBCT). This work attempts to breach this gap by providing a general framework for the most relevant Krylov subspace methods applied to 3D CT problems, including the most well-known Krylov solvers for non-square systems (CGLS, LSQR, LSMR), possibly in combination with Tikhonov regularization, and methods that incorporate total variation regularization. This is provided within an open source framework: the tomographic iterative GPU-based reconstruction toolbox, with the idea of promoting accessibility and reproducibility of the results for the algorithms presented. Finally, numerical results in synthetic and real-world 3D CT applications (medical CBCT andµ-CT datasets) are provided to showcase and compare the different Krylov subspace methods presented in the paper, as well as their suitability for different kinds of problems.

Multi-Modal Learning for Predicting the Genotype of Glioma.

The isocitrate dehydrogenase (IDH) gene mutation is an essential biomarker for the diagnosis and prognosis of glioma. It is promising to better predict glioma genotype by integrating focal tumor image and geometric features with brain network features derived from MRI. Convolutional neural networks show reasonable performance in predicting IDH mutation, which, however, cannot learn from non-Euclidean data, e.g., geometric and network data. In this study, we propose a multi-modal learning framework using three separate encoders to extract features of focal tumor image, tumor geometrics and global brain networks. To mitigate the limited availability of diffusion MRI, we develop a self-supervised approach to generate brain networks from anatomical multi-sequence MRI. Moreover, to extract tumor-related features from the brain network, we design a hierarchical attention module for the brain network encoder. Further, we design a bi-level multi-modal contrastive loss to align the multi-modal features and tackle the domain gap at the focal tumor and global brain. Finally, we propose a weighted population graph to integrate the multi-modal features for genotype prediction. Experimental results on the testing set show that the proposed model outperforms the baseline deep learning models. The ablation experiments validate the performance of different components of the framework. The visualized interpretation corresponds to clinical knowledge with further validation. In conclusion, the proposed learning framework provides a novel approach for predicting the genotype of glioma.

Artificial intelligence for early detection of renal cancer in computed tomography: A review.

Renal cancer is responsible for over 100,000 yearly deaths and is principally discovered in computed tomography (CT) scans of the abdomen. CT screening would likely increase the rate of early renal cancer detection, and improve general survival rates, but it is expected to have a prohibitively high financial cost. Given recent advances in artificial intelligence (AI), it may be possible to reduce the cost of CT analysis and enable CT screening by automating the radiological tasks that constitute the early renal cancer detection pipeline. This review seeks to facilitate further interdisciplinary research in early renal cancer detection by summarising our current knowledge across AI, radiology, and oncology and suggesting useful directions for future novel work. Initially, this review discusses existing approaches in automated renal cancer diagnosis, and methods across broader AI research, to summarise the existing state of AI cancer analysis. Then, this review matches these methods to the unique constraints of early renal cancer detection and proposes promising directions for future research that may enable AI-based early renal cancer detection via CT screening. The primary targets of this review are clinicians with an interest in AI and data scientists with an interest in the early detection of cancer.

Common methodological pitfalls in ICI pneumonitis risk prediction studies.

Background: Pneumonitis is one of the most common adverse events induced by the use of immune checkpoint inhibitors (ICI), accounting for a 20% of all ICI-associated deaths. Despite numerous efforts to identify risk factors and develop predictive models, there is no clinically deployed risk prediction model for patient risk stratification or for guiding subsequent monitoring. We believe this is due to systemic suboptimal approaches in study designs and methodologies in the literature. The nature and prevalence of different methodological approaches has not been thoroughly examined in prior systematic reviews. Methods: The PubMed, medRxiv and bioRxiv databases were used to identify studies that aimed at risk factor discovery and/or risk prediction model development for ICI-induced pneumonitis (ICI pneumonitis). Studies were then analysed to identify common methodological pitfalls and their contribution to the risk of bias, assessed using the QUIPS and PROBAST tools. Results: There were 51 manuscripts eligible for the review, with Japan-based studies over-represented, being nearly half (24/51) of all papers considered. Only 2/51 studies had a low risk of bias overall. Common bias-inducing practices included unclear diagnostic method or potential misdiagnosis, lack of multiple testing correction, the use of univariate analysis for selecting features for multivariable analysis, discretization of continuous variables, and inappropriate handling of missing values. Results from the risk model development studies were also likely to have been overoptimistic due to lack of holdout sets. Conclusions: Studies with low risk of bias in their methodology are lacking in the existing literature. High-quality risk factor identification and risk model development studies are urgently required by the community to give the best chance of them progressing into a clinically deployable risk prediction model. Recommendations and alternative approaches for reducing the risk of bias were also discussed to guide future studies.

A pipeline to further enhance quality, integrity and reusability of the NCCID clinical data.

The National COVID-19 Chest Imaging Database (NCCID) is a centralized UK database of thoracic imaging and corresponding clinical data. It is made available by the National Health Service Artificial Intelligence (NHS AI) Lab to support the development of machine learning tools focused on Coronavirus Disease 2019 (COVID-19). A bespoke cleaning pipeline for NCCID, developed by the NHSx, was introduced in 2021. We present an extension to the original cleaning pipeline for the clinical data of the database. It has been adjusted to correct additional systematic inconsistencies in the raw data such as patient sex, oxygen levels and date values. The most important changes will be discussed in this paper, whilst the code and further explanations are made publicly available on GitLab. The suggested cleaning will allow global users to work with more consistent data for the development of machine learning tools without being an expert. In addition, it highlights some of the challenges when working with clinical multi-center data and includes recommendations for similar future initiatives.

Integrating Artificial Intelligence Tools in the Clinical Research Setting: The Ovarian Cancer Use Case.

Artificial intelligence (AI) methods applied to healthcare problems have shown enormous potential to alleviate the burden of health services worldwide and to improve the accuracy and reproducibility of predictions. In particular, developments in computer vision are creating a paradigm shift in the analysis of radiological images, where AI tools are already capable of automatically detecting and precisely delineating tumours. However, such tools are generally developed in technical departments that continue to be siloed from where the real benefit would be achieved with their usage. Significant effort still needs to be made to make these advancements available, first in academic clinical research and ultimately in the clinical setting. In this paper, we demonstrate a prototype pipeline based entirely on open-source software and free of cost to bridge this gap, simplifying the integration of tools and models developed within the AI community into the clinical research setting, ensuring an accessible platform with visualisation applications that allow end-users such as radiologists to view and interact with the outcome of these AI tools.