Federated learning(FL) is used for distributed scenarios to train artificial intelligence(AI) models while ensuring users' privacy. In federated learning scenario, the server generally never knows about users' data. This type of concept makes the AI training process efficient in terms of data privacy. However, regarding model performance, federated AI models may not sufficiently satisfy AI users' expectations. Furthermore, AI users have a wide range of different needs. It is not easy to satisfy the whole users needs. These types of issues can be addressed through AI model optimization, fine-tuning, or personalization to achieve optimal model performance. To address model optimization challenges, we propose reference model-based federated learning for optimal fine-tuning, which overcomes catastrophic forgetting in each round. This method is derived from Bayesian parameter-efficient transfer learning, which includes an optimal proximal term and enables overcoming the catastrophic forgetting issue in each round by utilizing a reference model that incorporates previous model parameters. As a result, this method achieves both high model performance and low computing cost.
Deep learning has demonstrated remarkable success in medical image segmentation and computer-aided diagnosis. In particular, numerous advanced methods have achieved state-of-the-art performance in brain tumor segmentation from MRI scans. While recent studies in other medical imaging domains have revealed that integrating textual reports with visual data can enhance segmentation accuracy, the field of brain tumor analysis lacks a comprehensive dataset that combines radiological images with corresponding textual annotations. This limitation has hindered the exploration of multimodal approaches that leverage both imaging and textual data. To bridge this critical gap, we introduce the TextBraTS dataset, the first publicly available volume-level multimodal dataset that contains paired MRI volumes and rich textual annotations, derived from the widely adopted BraTS2020 benchmark. Building upon this novel dataset, we propose a novel baseline framework and sequential cross-attention method for text-guided volumetric medical image segmentation. Through extensive experiments with various text-image fusion strategies and templated text formulations, our approach demonstrates significant improvements in brain tumor segmentation accuracy, offering valuable insights into effective multimodal integration techniques. Our dataset, implementation code, and pre-trained models are publicly available at https://github.com/Jupitern52/TextBraTS.
The Brain Tumor Segmentation (BraTS) cluster of challenges has significantly advanced brain tumor image analysis by providing large, curated datasets and addressing clinically relevant tasks. However, despite its success and popularity, algorithms and models developed through BraTS have seen limited adoption in both scientific and clinical communities. To accelerate their dissemination, we introduce BraTS orchestrator, an open-source Python package that provides seamless access to state-of-the-art segmentation and synthesis algorithms for diverse brain tumors from the BraTS challenge ecosystem. Available on GitHub (https://github.com/BrainLesion/BraTS), the package features intuitive tutorials designed for users with minimal programming experience, enabling both researchers and clinicians to easily deploy winning BraTS algorithms for inference. By abstracting the complexities of modern deep learning, BraTS orchestrator democratizes access to the specialized knowledge developed within the BraTS community, making these advances readily available to broader neuro-radiology and neuro-oncology audiences.
In this paper, we address the crucial task of brain tumor segmentation in medical imaging and propose innovative approaches to enhance its performance. The current state-of-the-art nnU-Net has shown promising results but suffers from extensive training requirements and underutilization of pre-trained weights. To overcome these limitations, we integrate Axial-Coronal-Sagittal convolutions and pre-trained weights from ImageNet into the nnU-Net framework, resulting in reduced training epochs, reduced trainable parameters, and improved efficiency. Two strategies for transferring 2D pre-trained weights to the 3D domain are presented, ensuring the preservation of learned relationships and feature representations critical for effective information propagation. Furthermore, we explore a joint classification and segmentation model that leverages pre-trained encoders from a brain glioma grade classification proxy task, leading to enhanced segmentation performance, especially for challenging tumor labels. Experimental results demonstrate that our proposed methods in the fast training settings achieve comparable or even outperform the ensemble of cross-validation models, a common practice in the brain tumor segmentation literature.
Precise segmentation of brain tumors, particularly contrast-enhancing regions visible in post-contrast MRI (areas highlighted by contrast agent injection), is crucial for accurate clinical diagnosis and treatment planning but remains challenging. However, current methods exhibit notable performance degradation in segmenting these enhancing brain tumor areas, largely due to insufficient consideration of MRI-specific tumor features such as complex textures and directional variations. To address this, we propose the Harmonized Frequency Fusion Network (HFF-Net), which rethinks brain tumor segmentation from a frequency-domain perspective. To comprehensively characterize tumor regions, we develop a Frequency Domain Decomposition (FDD) module that separates MRI images into low-frequency components, capturing smooth tumor contours and high-frequency components, highlighting detailed textures and directional edges. To further enhance sensitivity to tumor boundaries, we introduce an Adaptive Laplacian Convolution (ALC) module that adaptively emphasizes critical high-frequency details using dynamically updated convolution kernels. To effectively fuse tumor features across multiple scales, we design a Frequency Domain Cross-Attention (FDCA) integrating semantic, positional, and slice-specific information. We further validate and interpret frequency-domain improvements through visualization, theoretical reasoning, and experimental analyses. Extensive experiments on four public datasets demonstrate that HFF-Net achieves an average relative improvement of 4.48\% (ranging from 2.39\% to 7.72\%) in the mean Dice scores across the three major subregions, and an average relative improvement of 7.33% (ranging from 5.96% to 8.64%) in the segmentation of contrast-enhancing tumor regions, while maintaining favorable computational efficiency and clinical applicability. Code: https://github.com/VinyehShaw/HFF.
Existing methods for multimodal MRI segmentation with missing modalities typically assume that all MRI modalities are available during training. However, in clinical practice, some modalities may be missing due to the sequential nature of MRI acquisition, leading to performance degradation. Furthermore, retraining models to accommodate newly available modalities can be inefficient and may cause overfitting, potentially compromising previously learned knowledge. To address these challenges, we propose Replay-based Hypergraph Domain Incremental Learning (ReHyDIL) for brain tumor segmentation with missing modalities. ReHyDIL leverages Domain Incremental Learning (DIL) to enable the segmentation model to learn from newly acquired MRI modalities without forgetting previously learned information. To enhance segmentation performance across diverse patient scenarios, we introduce the Cross-Patient Hypergraph Segmentation Network (CHSNet), which utilizes hypergraphs to capture high-order associations between patients. Additionally, we incorporate Tversky-Aware Contrastive (TAC) loss to effectively mitigate information imbalance both across and within different modalities. Extensive experiments on the BraTS2019 dataset demonstrate that ReHyDIL outperforms state-of-the-art methods, achieving an improvement of over 2% in the Dice Similarity Coefficient across various tumor regions. Our code is available at https://github.com/reeive/ReHyDIL.
Accurate segmentation of brain images typically requires the integration of complementary information from multiple image modalities. However, clinical data for all modalities may not be available for every patient, creating a significant challenge. To address this, previous studies encode multiple modalities into a shared latent space. While somewhat effective, it remains suboptimal, as each modality contains distinct and valuable information. In this study, we propose DC-Seg (Disentangled Contrastive Learning for Segmentation), a new method that explicitly disentangles images into modality-invariant anatomical representation and modality-specific representation, by using anatomical contrastive learning and modality contrastive learning respectively. This solution improves the separation of anatomical and modality-specific features by considering the modality gaps, leading to more robust representations. Furthermore, we introduce a segmentation-based regularizer that enhances the model's robustness to missing modalities. Extensive experiments on the BraTS 2020 and a private white matter hyperintensity(WMH) segmentation dataset demonstrate that DC-Seg outperforms state-of-the-art methods in handling incomplete multimodal brain tumor segmentation tasks with varying missing modalities, while also demonstrate strong generalizability in WMH segmentation. The code is available at https://github.com/CuCl-2/DC-Seg.
Background: Brain tumor segmentation has a significant impact on the diagnosis and treatment of brain tumors. Accurate brain tumor segmentation remains challenging due to their irregular shapes, vague boundaries, and high variability. Objective: We propose a brain tumor segmentation method that combines deep learning with prior knowledge derived from a region-growing algorithm. Methods: The proposed method utilizes a multi-scale feature fusion (MSFF) module and adaptive attention mechanisms (AAM) to extract multi-scale features and capture global contextual information. To enhance the model's robustness in low-confidence regions, the Monte Carlo Dropout (MC Dropout) strategy is employed for uncertainty estimation. Results: Extensive experiments demonstrate that the proposed method achieves superior performance on Brain Tumor Segmentation (BraTS) datasets, significantly outperforming various state-of-the-art methods. On the BraTS2021 dataset, the test Dice scores are 89.18% for Enhancing Tumor (ET) segmentation, 93.67% for Whole Tumor (WT) segmentation, and 91.23% for Tumor Core (TC) segmentation. On the BraTS2019 validation set, the validation Dice scores are 87.43%, 90.92%, and 90.40% for ET, WT, and TC segmentation, respectively. Ablation studies further confirmed the contribution of each module to segmentation accuracy, indicating that each component played a vital role in overall performance improvement. Conclusion: This study proposed a novel 3D brain tumor segmentation network based on the U-Net architecture. By incorporating the prior knowledge and employing the uncertainty estimation method, the robustness and performance were improved. The code for the proposed method is available at https://github.com/chenzhao2023/UPMAD_Net_BrainSeg.
Multi-contrast magnetic resonance imaging (MRI) plays a vital role in brain tumor segmentation and diagnosis by leveraging complementary information from different contrasts. Each contrast highlights specific tumor characteristics, enabling a comprehensive understanding of tumor morphology, edema, and pathological heterogeneity. However, existing methods still face the challenges of multi-level specificity perception across different contrasts, especially with limited annotations. These challenges include data heterogeneity, granularity differences, and interference from redundant information. To address these limitations, we propose a Task-oriented Uncertainty Collaborative Learning (TUCL) framework for multi-contrast MRI segmentation. TUCL introduces a task-oriented prompt attention (TPA) module with intra-prompt and cross-prompt attention mechanisms to dynamically model feature interactions across contrasts and tasks. Additionally, a cyclic process is designed to map the predictions back to the prompt to ensure that the prompts are effectively utilized. In the decoding stage, the TUCL framework proposes a dual-path uncertainty refinement (DUR) strategy which ensures robust segmentation by refining predictions iteratively. Extensive experimental results on limited labeled data demonstrate that TUCL significantly improves segmentation accuracy (88.2\% in Dice and 10.853 mm in HD95). It shows that TUCL has the potential to extract multi-contrast information and reduce the reliance on extensive annotations. The code is available at: https://github.com/Zhenxuan-Zhang/TUCL_BrainSeg.
Gliomas are aggressive brain tumors that require accurate imaging-based diagnosis, with segmentation playing a critical role in evaluating morphology and treatment decisions. Manual delineation of gliomas is time-consuming and prone to variability, motivating the use of deep learning to improve consistency and alleviate clinical workload. However, existing methods often fail to fully exploit the information available in multi-parametric MRI (mp-MRI), particularly inter-slice contextual features, and typically require considerable computational resources while lacking robustness across tumor type variations. We present GBT-SAM, a parameter-efficient deep learning framework that adapts the Segment Anything Model (SAM), a large-scale vision model, to volumetric mp-MRI data. GBT-SAM reduces input complexity by selecting fewer than 2.6\% of slices per scan while incorporating all four MRI modalities, preserving essential tumor-related information with minimal cost. Furthermore, our model is trained by a two-step fine-tuning strategy that incorporates a depth-aware module to capture inter-slice correlations and lightweight adaptation layers, resulting in just 6.5M trainable parameters, which is the lowest among SAM-based approaches. GBT-SAM achieves a Dice Score of 93.54 on the BraTS Adult Glioma dataset and demonstrates robust performance on Meningioma, Pediatric Glioma, and Sub-Saharan Glioma datasets. These results highlight GBT-SAM's potential as a computationally efficient and domain-robust framework for brain tumor segmentation using mp-MRI. Our code and models are available at https://github.com/vpulab/med-sam-brain .
Accurate and efficient segmentation of brain tumors is critical for diagnosis, treatment planning, and monitoring in clinical practice. In this study, we present an enhanced ResUNet architecture for automatic brain tumor segmentation, integrating an EfficientNetB0 encoder, a channel attention mechanism, and an Atrous Spatial Pyramid Pooling (ASPP) module. The EfficientNetB0 encoder leverages pre-trained features to improve feature extraction efficiency, while the channel attention mechanism enhances the model's focus on tumor-relevant features. ASPP enables multiscale contextual learning, crucial for handling tumors of varying sizes and shapes. The proposed model was evaluated on two benchmark datasets: TCGA LGG and BraTS 2020. Experimental results demonstrate that our method consistently outperforms the baseline ResUNet and its EfficientNet variant, achieving Dice coefficients of 0.903 and 0.851 and HD95 scores of 9.43 and 3.54 for whole tumor and tumor core regions on the BraTS 2020 dataset, respectively. compared with state-of-the-art methods, our approach shows competitive performance, particularly in whole tumor and tumor core segmentation. These results indicate that combining a powerful encoder with attention mechanisms and ASPP can significantly enhance brain tumor segmentation performance. The proposed approach holds promise for further optimization and application in other medical image segmentation tasks.
In Sub-Saharan Africa (SSA), the utilization of lower-quality Magnetic Resonance Imaging (MRI) technology raises questions about the applicability of machine learning methods for clinical tasks. This study aims to provide a robust deep learning-based brain tumor segmentation (BraTS) method tailored for the SSA population using a threefold approach. Firstly, the impact of domain shift from the SSA training data on model efficacy was examined, revealing no significant effect. Secondly, a comparative analysis of 3D and 2D full-resolution models using the nnU-Net framework indicates similar performance of both the models trained for 300 epochs achieving a five-fold cross-validation score of 0.93. Lastly, addressing the performance gap observed in SSA validation as opposed to the relatively larger BraTS glioma (GLI) validation set, two strategies are proposed: fine-tuning SSA cases using the GLI+SSA best-pretrained 2D fullres model at 300 epochs, and introducing a novel neural style transfer-based data augmentation technique for the SSA cases. This investigation underscores the potential of enhancing brain tumor prediction within SSA's unique healthcare landscape.
Automating brain tumor segmentation using deep learning methods is an ongoing challenge in medical imaging. Multiple lingering issues exist including domain-shift and applications in low-resource settings which brings a unique set of challenges including scarcity of data. As a step towards solving these specific problems, we propose Convolutional adapter-inspired Parameter-efficient Fine-tuning (PEFT) of MedNeXt architecture. To validate our idea, we show our method performs comparable to full fine-tuning with the added benefit of reduced training compute using BraTS-2021 as pre-training dataset and BraTS-Africa as the fine-tuning dataset. BraTS-Africa consists of a small dataset (60 train / 35 validation) from the Sub-Saharan African population with marked shift in the MRI quality compared to BraTS-2021 (1251 train samples). We first show that models trained on BraTS-2021 dataset do not generalize well to BraTS-Africa as shown by 20% reduction in mean dice on BraTS-Africa validation samples. Then, we show that PEFT can leverage both the BraTS-2021 and BraTS-Africa dataset to obtain mean dice of 0.8 compared to 0.72 when trained only on BraTS-Africa. Finally, We show that PEFT (0.80 mean dice) results in comparable performance to full fine-tuning (0.77 mean dice) which may show PEFT to be better on average but the boxplots show that full finetuning results is much lesser variance in performance. Nevertheless, on disaggregation of the dice metrics, we find that the model has tendency to oversegment as shown by high specificity (0.99) compared to relatively low sensitivity(0.75). The source code is available at https://github.com/CAMERA-MRI/SPARK2024/tree/main/PEFT_MedNeXt
Neurogliomas are among the most aggressive forms of cancer, presenting considerable challenges in both treatment and monitoring due to their unpredictable biological behavior. Magnetic resonance imaging (MRI) is currently the preferred method for diagnosing and monitoring gliomas. However, the lack of specific imaging techniques often compromises the accuracy of tumor segmentation during the imaging process. To address this issue, we introduce the XLSTM-HVED model. This model integrates a hetero-modal encoder-decoder framework with the Vision XLSTM module to reconstruct missing MRI modalities. By deeply fusing spatial and temporal features, it enhances tumor segmentation performance. The key innovation of our approach is the Self-Attention Variational Encoder (SAVE) module, which improves the integration of modal features. Additionally, it optimizes the interaction of features between segmentation and reconstruction tasks through the Squeeze-Fusion-Excitation Cross Awareness (SFECA) module. Our experiments using the BraTS 2024 dataset demonstrate that our model significantly outperforms existing advanced methods in handling cases where modalities are missing. Our source code is available at https://github.com/Quanato607/XLSTM-HVED.
Deep learning has made significant strides in automated brain tumor segmentation from magnetic resonance imaging (MRI) scans in recent years. However, the reliability of these tools is hampered by the presence of poor-quality segmentation outliers, particularly in out-of-distribution samples, making their implementation in clinical practice difficult. Therefore, there is a need for quality control (QC) to screen the quality of the segmentation results. Although numerous automatic QC methods have been developed for segmentation quality screening, most were designed for cardiac MRI segmentation, which involves a single modality and a single tissue type. Furthermore, most prior works only provided subject-level predictions of segmentation quality and did not identify erroneous parts segmentation that may require refinement. To address these limitations, we proposed a novel multi-task deep learning architecture, termed QCResUNet, which produces subject-level segmentation-quality measures as well as voxel-level segmentation error maps for each available tissue class. To validate the effectiveness of the proposed method, we conducted experiments on assessing its performance on evaluating the quality of two distinct segmentation tasks. First, we aimed to assess the quality of brain tumor segmentation results. For this task, we performed experiments on one internal and two external datasets. Second, we aimed to evaluate the segmentation quality of cardiac Magnetic Resonance Imaging (MRI) data from the Automated Cardiac Diagnosis Challenge. The proposed method achieved high performance in predicting subject-level segmentation-quality metrics and accurately identifying segmentation errors on a voxel basis. This has the potential to be used to guide human-in-the-loop feedback to improve segmentations in clinical settings.
Brain tumor segmentation models have aided diagnosis in recent years. However, they face MRI complexity and variability challenges, including irregular shapes and unclear boundaries, leading to noise, misclassification, and incomplete segmentation, thereby limiting accuracy. To address these issues, we adhere to an outstanding Convolutional Neural Networks (CNNs) design paradigm and propose a novel network named A4-Unet. In A4-Unet, Deformable Large Kernel Attention (DLKA) is incorporated in the encoder, allowing for improved capture of multi-scale tumors. Swin Spatial Pyramid Pooling (SSPP) with cross-channel attention is employed in a bottleneck further to study long-distance dependencies within images and channel relationships. To enhance accuracy, a Combined Attention Module (CAM) with Discrete Cosine Transform (DCT) orthogonality for channel weighting and convolutional element-wise multiplication is introduced for spatial weighting in the decoder. Attention gates (AG) are added in the skip connection to highlight the foreground while suppressing irrelevant background information. The proposed network is evaluated on three authoritative MRI brain tumor benchmarks and a proprietary dataset, and it achieves a 94.4% Dice score on the BraTS 2020 dataset, thereby establishing multiple new state-of-the-art benchmarks. The code is available here: https://github.com/WendyWAAAAANG/A4-Unet.
Accurate and automatic segmentation of brain tumors in multi-parametric magnetic resonance imaging (mpMRI) is essential for quantitative measurements, which play an increasingly important role in clinical diagnosis and prognosis. The International Brain Tumor Segmentation (BraTS) Challenge 2024 offers a unique benchmarking opportunity, including various types of brain tumors in both adult and pediatric populations, such as pediatric brain tumors (PED), meningiomas (MEN-RT) and brain metastases (MET), among others. Compared to previous editions, BraTS 2024 has implemented changes to substantially increase clinical relevance, such as refined tumor regions for evaluation. We propose a deep learning-based ensemble approach that integrates state-of-the-art segmentation models. Additionally, we introduce innovative, adaptive pre- and post-processing techniques that employ MRI-based radiomic analyses to differentiate tumor subtypes. Given the heterogeneous nature of the tumors present in the BraTS datasets, this approach enhances the precision and generalizability of segmentation models. On the final testing sets, our method achieved mean lesion-wise Dice similarity coefficients of 0.926, 0.801, and 0.688 for the whole tumor in PED, MEN-RT, and MET, respectively. These results demonstrate the effectiveness of our approach in improving segmentation performance and generalizability for various brain tumor types. The source code of our implementation is available at https://github.com/Precision-Medical-Imaging-Group/HOPE-Segmenter-Kids. Additionally, an open-source web-application is accessible at https://segmenter.hope4kids.io/ which uses the docker container aparida12/brats-peds-2024:v20240913 .
This paper contributes to the "BraTS 2024 Brain MR Image Synthesis Challenge" and presents a conditional Wavelet Diffusion Model (cWDM) for directly solving a paired image-to-image translation task on high-resolution volumes. While deep learning-based brain tumor segmentation models have demonstrated clear clinical utility, they typically require MR scans from various modalities (T1, T1ce, T2, FLAIR) as input. However, due to time constraints or imaging artifacts, some of these modalities may be missing, hindering the application of well-performing segmentation algorithms in clinical routine. To address this issue, we propose a method that synthesizes one missing modality image conditioned on three available images, enabling the application of downstream segmentation models. We treat this paired image-to-image translation task as a conditional generation problem and solve it by combining a Wavelet Diffusion Model for high-resolution 3D image synthesis with a simple conditioning strategy. This approach allows us to directly apply our model to full-resolution volumes, avoiding artifacts caused by slice- or patch-wise data processing. While this work focuses on a specific application, the presented method can be applied to all kinds of paired image-to-image translation problems, such as CT $\leftrightarrow$ MR and MR $\leftrightarrow$ PET translation, or mask-conditioned anatomically guided image generation.
Identifying key pathological features in brain MRIs is crucial for the long-term survival of glioma patients. However, manual segmentation is time-consuming, requiring expert intervention and is susceptible to human error. Therefore, significant research has been devoted to developing machine learning methods that can accurately segment tumors in 3D multimodal brain MRI scans. Despite their progress, state-of-the-art models are often limited by the data they are trained on, raising concerns about their reliability when applied to diverse populations that may introduce distribution shifts. Such shifts can stem from lower quality MRI technology (e.g., in sub-Saharan Africa) or variations in patient demographics (e.g., children). The BraTS-2024 challenge provides a platform to address these issues. This study presents our methodology for segmenting tumors in the BraTS-2024 SSA and Pediatric Tumors tasks using MedNeXt, comprehensive model ensembling, and thorough postprocessing. Our approach demonstrated strong performance on the unseen validation set, achieving an average Dice Similarity Coefficient (DSC) of 0.896 on the BraTS-2024 SSA dataset and an average DSC of 0.830 on the BraTS Pediatric Tumor dataset. Additionally, our method achieved an average Hausdorff Distance (HD95) of 14.682 on the BraTS-2024 SSA dataset and an average HD95 of 37.508 on the BraTS Pediatric dataset. Our GitHub repository can be accessed here: Project Repository : https://github.com/python-arch/BioMbz-Optimizing-Brain-Tumor-Segmentation-with-MedNeXt-BraTS-2024-SSA-and-Pediatrics
Automatic segmentation of brain tumors in intra-operative ultrasound (iUS) images could facilitate localization of tumor tissue during resection surgery. The lack of large annotated datasets limits the current models performances. In this paper, we investigate the use of tumor annotations in pre-operative MRI images, which are more easily accessible than annotations in iUS images, for training of deep learning models for iUS brain tumor segmentation. We used 180 annotated pre-operative MRI images with corresponding unannotated iUS images, and 29 annotated iUS images. Image registration was performed to transfer the MRI annotations to the corresponding iUS images before training models with the nnU-Net framework. To validate the use of MRI labels, the models were compared to a model trained with only US annotated tumors, and a model with both US and MRI annotated tumors. In addition, the results were compared to annotations validated by an expert neurosurgeon on the same test set to measure inter-observer variability. The results showed similar performance for a model trained with only MRI annotated tumors, compared to a model trained with only US annotated tumors. The model trained using both modalities obtained slightly better results with an average Dice score of 0.62, where external expert annotations achieved a score of 0.67. The results also showed that the deep learning models were comparable to expert annotation for larger tumors (> 200 mm2), but perform clearly worse for smaller tumors (< 200 mm2). This shows that MRI tumor annotations can be used as a substitute for US tumor annotations to train a deep learning model for automatic brain tumor segmentation in intra-operative ultrasound images. Small tumors is a limitation for the current models and will be the focus of future work. The main models are available here: https://github.com/mathildefaanes/us_brain_tumor_segmentation.