Pancreatic cancer, characterized by its notable prevalence and mortality rates, demands accurate lesion delineation for effective diagnosis and therapeutic interventions. The generalizability of extant methods is frequently compromised due to the pronounced variability in imaging and the heterogeneous characteristics of pancreatic lesions, which may mimic normal tissues and exhibit significant inter-patient variability. Thus, we propose a generalization framework that synergizes pixel-level classification and regression tasks, to accurately delineate lesions and improve model stability. This framework not only seeks to align segmentation contours with actual lesions but also uses regression to elucidate spatial relationships between diseased and normal tissues, thereby improving tumor localization and morphological characterization. Enhanced by the reciprocal transformation of task outputs, our approach integrates additional regression supervision within the segmentation context, bolstering the model's generalization ability from a dual-task perspective. Besides, dual self-supervised learning in feature spaces and output spaces augments the model's representational capability and stability across different imaging views. Experiments on 594 samples composed of three datasets with significant imaging differences demonstrate that our generalized pancreas segmentation results comparable to mainstream in-domain validation performance (Dice: 84.07%). More importantly, it successfully improves the results of the highly challenging cross-lesion generalized pancreatic cancer segmentation task by 9.51%. Thus, our model constitutes a resilient and efficient foundational technological support for pancreatic disease management and wider medical applications. The codes will be released at https://github.com/SJTUBME-QianLab/Dual-Task-Seg.
Multimodal fusion promises better pancreas segmentation. However, where to perform fusion in models is still an open question. It is unclear if there is a best location to fuse information when analyzing pairs of imperfectly aligned images. Two main alignment challenges in this pancreas segmentation study are 1) the pancreas is deformable and 2) breathing deforms the abdomen. Even after image registration, relevant deformations are often not corrected. We examine how early through late fusion impacts pancreas segmentation. We used 353 pairs of T2-weighted (T2w) and T1-weighted (T1w) abdominal MR images from 163 subjects with accompanying pancreas labels. We used image registration (deeds) to align the image pairs. We trained a collection of basic UNets with different fusion points, spanning from early to late, to assess how early through late fusion influenced segmentation performance on imperfectly aligned images. We assessed generalization of fusion points on nnUNet. The single-modality T2w baseline using a basic UNet model had a Dice score of 0.73, while the same baseline on the nnUNet model achieved 0.80. For the basic UNet, the best fusion approach occurred in the middle of the encoder (early/mid fusion), which led to a statistically significant improvement of 0.0125 on Dice score compared to the baseline. For the nnUNet, the best fusion approach was na\"ive image concatenation before the model (early fusion), which resulted in a statistically significant Dice score increase of 0.0021 compared to baseline. Fusion in specific blocks can improve performance, but the best blocks for fusion are model specific, and the gains are small. In imperfectly registered datasets, fusion is a nuanced problem, with the art of design remaining vital for uncovering potential insights. Future innovation is needed to better address fusion in cases of imperfect alignment of abdominal image pairs.
Automated volumetric segmentation of the pancreas on cross-sectional imaging is needed for diagnosis and follow-up of pancreatic diseases. While CT-based pancreatic segmentation is more established, MRI-based segmentation methods are understudied, largely due to a lack of publicly available datasets, benchmarking research efforts, and domain-specific deep learning methods. In this retrospective study, we collected a large dataset (767 scans from 499 participants) of T1-weighted (T1W) and T2-weighted (T2W) abdominal MRI series from five centers between March 2004 and November 2022. We also collected CT scans of 1,350 patients from publicly available sources for benchmarking purposes. We developed a new pancreas segmentation method, called PanSegNet, combining the strengths of nnUNet and a Transformer network with a new linear attention module enabling volumetric computation. We tested PanSegNet's accuracy in cross-modality (a total of 2,117 scans) and cross-center settings with Dice and Hausdorff distance (HD95) evaluation metrics. We used Cohen's kappa statistics for intra and inter-rater agreement evaluation and paired t-tests for volume and Dice comparisons, respectively. For segmentation accuracy, we achieved Dice coefficients of 88.3% (std: 7.2%, at case level) with CT, 85.0% (std: 7.9%) with T1W MRI, and 86.3% (std: 6.4%) with T2W MRI. There was a high correlation for pancreas volume prediction with R^2 of 0.91, 0.84, and 0.85 for CT, T1W, and T2W, respectively. We found moderate inter-observer (0.624 and 0.638 for T1W and T2W MRI, respectively) and high intra-observer agreement scores. All MRI data is made available at https://osf.io/kysnj/. Our source code is available at https://github.com/NUBagciLab/PaNSegNet.
Identifying peri-pancreatic edema is a pivotal indicator for identifying disease progression and prognosis, emphasizing the critical need for accurate detection and assessment in pancreatitis diagnosis and management. This study \textit{introduces a novel CT dataset sourced from 255 patients with pancreatic diseases, featuring annotated pancreas segmentation masks and corresponding diagnostic labels for peri-pancreatic edema condition}. With the novel dataset, we first evaluate the efficacy of the \textit{LinTransUNet} model, a linear Transformer based segmentation algorithm, to segment the pancreas accurately from CT imaging data. Then, we use segmented pancreas regions with two distinctive machine learning classifiers to identify existence of peri-pancreatic edema: deep learning-based models and a radiomics-based eXtreme Gradient Boosting (XGBoost). The LinTransUNet achieved promising results, with a dice coefficient of 80.85\%, and mIoU of 68.73\%. Among the nine benchmarked classification models for peri-pancreatic edema detection, \textit{Swin-Tiny} transformer model demonstrated the highest recall of $98.85 \pm 0.42$ and precision of $98.38\pm 0.17$. Comparatively, the radiomics-based XGBoost model achieved an accuracy of $79.61\pm4.04$ and recall of $91.05\pm3.28$, showcasing its potential as a supplementary diagnostic tool given its rapid processing speed and reduced training time. Our code is available \url{https://github.com/NUBagciLab/Peri-Pancreatic-Edema-Detection}.
Pancreas segmentation is challenging due to the small proportion and highly changeable anatomical structure. It motivates us to propose a novel segmentation framework, namely Curriculum Knowledge Switching (CKS) framework, which decomposes detecting pancreas into three phases with different difficulty extent: straightforward, difficult, and challenging. The framework switches from straightforward to challenging phases and thereby gradually learns to detect pancreas. In addition, we adopt the momentum update parameter updating mechanism during switching, ensuring the loss converges gradually when the input dataset changes. Experimental results show that different neural network backbones with the CKS framework achieved state-of-the-art performance on the NIH dataset as measured by the DSC metric.
This study investigates barely-supervised medical image segmentation where only few labeled data, i.e., single-digit cases are available. We observe the key limitation of the existing state-of-the-art semi-supervised solution cross pseudo supervision is the unsatisfactory precision of foreground classes, leading to a degenerated result under barely-supervised learning. In this paper, we propose a novel Compete-to-Win method (ComWin) to enhance the pseudo label quality. In contrast to directly using one model's predictions as pseudo labels, our key idea is that high-quality pseudo labels should be generated by comparing multiple confidence maps produced by different networks to select the most confident one (a compete-to-win strategy). To further refine pseudo labels at near-boundary areas, an enhanced version of ComWin, namely, ComWin+, is proposed by integrating a boundary-aware enhancement module. Experiments show that our method can achieve the best performance on three public medical image datasets for cardiac structure segmentation, pancreas segmentation and colon tumor segmentation, respectively. The source code is now available at https://github.com/Huiimin5/comwin.
Shape information is a strong and valuable prior in segmenting organs in medical images. However, most current deep learning based segmentation algorithms have not taken shape information into consideration, which can lead to bias towards texture. We aim at modeling shape explicitly and using it to help medical image segmentation. Previous methods proposed Variational Autoencoder (VAE) based models to learn the distribution of shape for a particular organ and used it to automatically evaluate the quality of a segmentation prediction by fitting it into the learned shape distribution. Based on which we aim at incorporating VAE into current segmentation pipelines. Specifically, we propose a new unsupervised domain adaptation pipeline based on a pseudo loss and a VAE reconstruction loss under a teacher-student learning paradigm. Both losses are optimized simultaneously and, in return, boost the segmentation task performance. Extensive experiments on three public Pancreas segmentation datasets as well as two in-house Pancreas segmentation datasets show consistent improvements with at least 2.8 points gain in the Dice score, demonstrating the effectiveness of our method in challenging unsupervised domain adaptation scenarios for medical image segmentation. We hope this work will advance shape analysis and geometric learning in medical imaging.
Transformer-based neural networks have surpassed promising performance on many biomedical image segmentation tasks due to a better global information modeling from the self-attention mechanism. However, most methods are still designed for 2D medical images while ignoring the essential 3D volume information. The main challenge for 3D transformer-based segmentation methods is the quadratic complexity introduced by the self-attention mechanism \cite{vaswani2017attention}. In this paper, we propose a novel transformer architecture for 3D medical image segmentation using an encoder-decoder style architecture with linear complexity. Furthermore, we newly introduce a dynamic token concept to further reduce the token numbers for self-attention calculation. Taking advantage of the global information modeling, we provide uncertainty maps from different hierarchy stages. We evaluate this method on multiple challenging CT pancreas segmentation datasets. Our promising results show that our novel 3D Transformer-based segmentor could provide promising highly feasible segmentation performance and accurate uncertainty quantification using single annotation. Code is available https://github.com/freshman97/LinTransUNet.
We propose a novel 3D fully convolutional deep network for automated pancreas segmentation from both MRI and CT scans. More specifically, the proposed model consists of a 3D encoder that learns to extract volume features at different scales; features taken at different points of the encoder hierarchy are then sent to multiple 3D decoders that individually predict intermediate segmentation maps. Finally, all segmentation maps are combined to obtain a unique detailed segmentation mask. We test our model on both CT and MRI imaging data: the publicly available NIH Pancreas-CT dataset (consisting of 82 contrast-enhanced CTs) and a private MRI dataset (consisting of 40 MRI scans). Experimental results show that our model outperforms existing methods on CT pancreas segmentation, obtaining an average Dice score of about 88%, and yields promising segmentation performance on a very challenging MRI data set (average Dice score is about 77%). Additional control experiments demonstrate that the achieved performance is due to the combination of our 3D fully-convolutional deep network and the hierarchical representation decoding, thus substantiating our architectural design.
In recent years, deep learning based methods have shown success in essential medical image analysis tasks such as segmentation. Post-processing and refining the results of segmentation is a common practice to decrease the misclassifications originating from the segmentation network. In addition to widely used methods like Conditional Random Fields (CRFs) which focus on the structure of the segmented volume/area, a graph-based recent approach makes use of certain and uncertain points in a graph and refines the segmentation according to a small graph convolutional network (GCN). However, there are two drawbacks of the approach: most of the edges in the graph are assigned randomly and the GCN is trained independently from the segmentation network. To address these issues, we define a new neighbor-selection mechanism according to feature distances and combine the two networks in the training procedure. According to the experimental results on pancreas segmentation from Computed Tomography (CT) images, we demonstrate improvement in the quantitative measures. Also, examining the dynamic neighbors created by our method, edges between semantically similar image parts are observed. The proposed method also shows qualitative enhancements in the segmentation maps, as demonstrated in the visual results.
With the unprecedented developments in deep learning, automatic segmentation of main abdominal organs seems to be a solved problem as state-of-the-art (SOTA) methods have achieved comparable results with inter-rater variability on many benchmark datasets. However, most of the existing abdominal datasets only contain single-center, single-phase, single-vendor, or single-disease cases, and it is unclear whether the excellent performance can generalize on diverse datasets. This paper presents a large and diverse abdominal CT organ segmentation dataset, termed AbdomenCT-1K, with more than 1000 (1K) CT scans from 12 medical centers, including multi-phase, multi-vendor, and multi-disease cases. Furthermore, we conduct a large-scale study for liver, kidney, spleen, and pancreas segmentation and reveal the unsolved segmentation problems of the SOTA methods, such as the limited generalization ability on distinct medical centers, phases, and unseen diseases. To advance the unsolved problems, we further build four organ segmentation benchmarks for fully supervised, semi-supervised, weakly supervised, and continual learning, which are currently challenging and active research topics. Accordingly, we develop a simple and effective method for each benchmark, which can be used as out-of-the-box methods and strong baselines. We believe the AbdomenCT-1K dataset will promote future in-depth research towards clinical applicable abdominal organ segmentation methods. The datasets, codes, and trained models are publicly available at https://github.com/JunMa11/AbdomenCT-1K.
Model quantization is leveraged to reduce the memory consumption and the computation time of deep neural networks. This is achieved by representing weights and activations with a lower bit resolution when compared to their high precision floating point counterparts. The suitable level of quantization is directly related to the model performance. Lowering the quantization precision (e.g. 2 bits), reduces the amount of memory required to store model parameters and the amount of logic required to implement computational blocks, which contributes to reducing the power consumption of the entire system. These benefits typically come at the cost of reduced accuracy. The main challenge is to quantize a network as much as possible, while maintaining the performance accuracy. In this work, we present a quantization method for the U-Net architecture, a popular model in medical image segmentation. We then apply our quantization algorithm to three datasets: (1) the Spinal Cord Gray Matter Segmentation (GM), (2) the ISBI challenge for segmentation of neuronal structures in Electron Microscopic (EM), and (3) the public National Institute of Health (NIH) dataset for pancreas segmentation in abdominal CT scans. The reported results demonstrate that with only 4 bits for weights and 6 bits for activations, we obtain 8 fold reduction in memory requirements while loosing only 2.21%, 0.57% and 2.09% dice overlap score for EM, GM and NIH datasets respectively. Our fixed point quantization provides a flexible trade off between accuracy and memory requirement which is not provided by previous quantization methods for U-Net such as TernaryNet.
Deep convolutional neural networks (DCNN) are currently ubiquitous in medical imaging. While their versatility and high quality results for common image analysis tasks including segmentation, localisation and prediction is astonishing, the large representational power comes at the cost of highly demanding computational effort. This limits their practical applications for image guided interventions and diagnostic (point-of-care) support using mobile devices without graphics processing units (GPU). We propose a new scheme that approximates both trainable weights and neural activations in deep networks by ternary values and tackles the open question of backpropagation when dealing with non-differentiable functions. Our solution enables the removal of the expensive floating-point matrix multiplications throughout any convolutional neural network and replaces them by energy and time preserving binary operators and population counts. Our approach, which is demonstrated using a fully-convolutional network (FCN) for CT pancreas segmentation leads to more than 10-fold reduced memory requirements and we provide a concept for sub-second inference without GPUs. Our ternary approximation obtains high accuracies (without any post-processing) with a Dice overlap of 71.0% that are statistically equivalent to using networks with high-precision weights and activations. We further demonstrate the significant improvements reached in comparison to binary quantisation and without our proposed ternary hyperbolic tangent continuation. We present a key enabling technique for highly efficient DCNN inference without GPUs that will help to bring the advances of deep learning to practical clinical applications. It has also great promise for improving accuracies in large-scale medical data retrieval.
We propose a novel attention gate (AG) model for medical imaging that automatically learns to focus on target structures of varying shapes and sizes. Models trained with AGs implicitly learn to suppress irrelevant regions in an input image while highlighting salient features useful for a specific task. This enables us to eliminate the necessity of using explicit external tissue/organ localisation modules of cascaded convolutional neural networks (CNNs). AGs can be easily integrated into standard CNN architectures such as the U-Net model with minimal computational overhead while increasing the model sensitivity and prediction accuracy. The proposed Attention U-Net architecture is evaluated on two large CT abdominal datasets for multi-class image segmentation. Experimental results show that AGs consistently improve the prediction performance of U-Net across different datasets and training sizes while preserving computational efficiency. The code for the proposed architecture is publicly available.