Whole-heart segmentation from CT and MRI scans is crucial for cardiovascular disease analysis, yet existing methods struggle with modality-specific biases and the need for extensive labeled datasets. To address these challenges, we propose a foundation model for whole-heart segmentation using a self-supervised learning (SSL) framework based on a student-teacher architecture. Our model is pretrained on a large, unlabeled dataset of CT and MRI scans, leveraging the xLSTM backbone to capture long-range spatial dependencies and complex anatomical structures in 3D medical images. By incorporating multi-modal pretraining, our approach ensures strong generalization across both CT and MRI modalities, mitigating modality-specific variations and improving segmentation accuracy in diverse clinical settings. The use of large-scale unlabeled data significantly reduces the dependency on manual annotations, enabling robust performance even with limited labeled data. We further introduce an xLSTM-UNet-based architecture for downstream whole-heart segmentation tasks, demonstrating its effectiveness on few-label CT and MRI datasets. Our results validate the robustness and adaptability of the proposed model, highlighting its potential for advancing automated whole-heart segmentation in medical imaging.
The proposed system consists of a two-stage cascade. The first stage performs a rough heartbeat detection while the second stage refines the previous one, improving the temporal localization and also classifying the heartbeats into types S1 and S2. The first contribution is a novel approach that combines the dissimilarity matrix with the frame-level spectral divergence to locate heartbeats using the repetitiveness shown by the heart sounds and the temporal relationships between the intervals defined by the events S1/S2 and non-S1/S2 (systole and diastole). The second contribution is a verification-correction-classification process based on a sliding window that allows the preservation of the temporal structure of the cardiac cycle in order to be applied in the heart sound classification. The proposed method has been assessed using the open access databases PASCAL, CirCor DigiScope Phonocardiogram and an additional sound mixing procedure considering both Additive White Gaussian Noise (AWGN) and different kinds of clinical ambient noises from a commercial database. The proposed method provides the best detection/classification performance in realistic scenarios where the presence of cardiac anomalies as well as different types of clinical environmental noises are active in the PCG signal. Of note, the promising modelling of the temporal structures of the heart provided by the dissimilarity matrix together with the frame-level spectral divergence, as well as the removal of a significant number of spurious heart events and recovery of missing heart events, both corrected by the proposed verification-correction-classification algorithm, suggest that our proposal is a successful tool to be applied in heart segmentation.
Whole heart segmentation (WHS) supports cardiovascular disease (CVD) diagnosis, disease monitoring, treatment planning, and prognosis. Deep learning has become the most widely used method for WHS applications in recent years. However, segmentation of whole-heart structures faces numerous challenges including heart shape variability during the cardiac cycle, clinical artifacts like motion and poor contrast-to-noise ratio, domain shifts in multi-center data, and the distinct modalities of CT and MRI. To address these limitations and improve segmentation quality, this paper introduces a new topology-preserving module that is integrated into deep neural networks. The implementation achieves anatomically plausible segmentation by using learned topology-preserving fields, which are based entirely on 3D convolution and are therefore very effective for 3D voxel data. We incorporate natural constraints between structures into the end-to-end training and enrich the feature representation of the neural network. The effectiveness of the proposed method is validated on an open-source medical heart dataset, specifically using the WHS++ data. The results demonstrate that the architecture performs exceptionally well, achieving a Dice coefficient of 0.939 during testing. This indicates full topology preservation for individual structures and significantly outperforms other baselines in preserving the overall scene topology.
This study provides a comparative analysis of deep learning models including UNet, Res-UNet, Attention Res-UNet, and nnUNet, and evaluates their performance in brain tumour, polyp, and multi-class heart segmentation tasks. The analysis focuses on precision, accuracy, recall, Dice Similarity Coefficient (DSC), and Intersection over Union (IoU) to assess their clinical applicability. In brain tumour segmentation, Res-UNet and nnUNet significantly outperformed UNet, with Res-UNet leading in DSC and IoU scores, indicating superior accuracy in tumour delineation. Meanwhile, nnUNet excelled in recall and accuracy, which are crucial for reliable tumour detection in clinical diagnosis and planning. In polyp detection, nnUNet was the most effective, achieving the highest metrics across all categories and proving itself as a reliable diagnostic tool in endoscopy. In the complex task of heart segmentation, Res-UNet and Attention Res-UNet were outstanding in delineating the left ventricle, with Res-UNet also leading in right ventricle segmentation. nnUNet was unmatched in myocardium segmentation, achieving top scores in precision, recall, DSC, and IoU. The conclusion notes that although Res-UNet occasionally outperforms nnUNet in specific metrics, the differences are quite small. Moreover, nnUNet consistently shows superior overall performance across the experiments. Particularly noted for its high recall and accuracy, which are crucial in clinical settings to minimize misdiagnosis and ensure timely treatment, nnUNet's robust performance in crucial metrics across all tested categories establishes it as the most effective model for these varied and complex segmentation tasks.
Automated segmentation of Cardiac Magnetic Resonance (CMR) plays a pivotal role in efficiently assessing cardiac function, offering rapid clinical evaluations that benefit both healthcare practitioners and patients. While recent research has primarily focused on delineating structures in the short-axis orientation, less attention has been given to long-axis representations, mainly due to the complex nature of structures in this orientation. Performing pixel-wise segmentation of the left ventricular (LV) myocardium and the four cardiac chambers in 2-D steady-state free precession (SSFP) cine sequences is a crucial preprocessing stage for various analyses. However, the challenge lies in the significant variability in contrast, appearance, orientation, and positioning of the heart across different patients, clinical views, scanners, and imaging protocols. Consequently, achieving fully automatic semantic segmentation in this context is notoriously challenging. In recent years, several deep learning models have been proposed to accurately quantify and diagnose cardiac pathologies. These automated tools heavily rely on the accurate segmentation of cardiac structures in magnetic resonance images (MRI). Hence, there is a need for new methods to handle such structures' geometrical and textural complexities. We proposed 2D and 3D two-stage self-supervised deep learning segmentation hybrid transformer and CNN-based architectures for 4CH whole heart segmentation. Accurate segmentation of the ventricles and atria in 4CH views is crucial for analyzing heart health and reconstructing four-chamber meshes, which are essential for estimating various parameters to assess overall heart condition. Our proposed method outperformed state-of-the-art techniques, demonstrating superior performance in this domain.
The use of multimodal data in assisted diagnosis and segmentation has emerged as a prominent area of interest in current research. However, one of the primary challenges is how to effectively fuse multimodal features. Most of the current approaches focus on the integration of multimodal features while ignoring the correlation and consistency between different modal features, leading to the inclusion of potentially irrelevant information. To address this issue, we introduce an innovative Multimodal Information Cross Transformer (MicFormer), which employs a dual-stream architecture to simultaneously extract features from each modality. Leveraging the Cross Transformer, it queries features from one modality and retrieves corresponding responses from another, facilitating effective communication between bimodal features. Additionally, we incorporate a deformable Transformer architecture to expand the search space. We conducted experiments on the MM-WHS dataset, and in the CT-MRI multimodal image segmentation task, we successfully improved the whole-heart segmentation DICE score to 85.57 and MIoU to 75.51. Compared to other multimodal segmentation techniques, our method outperforms by margins of 2.83 and 4.23, respectively. This demonstrates the efficacy of MicFormer in integrating relevant information between different modalities in multimodal tasks. These findings hold significant implications for multimodal image tasks, and we believe that MicFormer possesses extensive potential for broader applications across various domains. Access to our method is available at https://github.com/fxxJuses/MICFormer
Adapting a medical image segmentation model to a new domain is important for improving its cross-domain transferability, and due to the expensive annotation process, Unsupervised Domain Adaptation (UDA) is appealing where only unlabeled images are needed for the adaptation. Existing UDA methods are mainly based on image or feature alignment with adversarial training for regularization, and they are limited by insufficient supervision in the target domain. In this paper, we propose an enhanced Filtered Pseudo Label (FPL+)-based UDA method for 3D medical image segmentation. It first uses cross-domain data augmentation to translate labeled images in the source domain to a dual-domain training set consisting of a pseudo source-domain set and a pseudo target-domain set. To leverage the dual-domain augmented images to train a pseudo label generator, domain-specific batch normalization layers are used to deal with the domain shift while learning the domain-invariant structure features, generating high-quality pseudo labels for target-domain images. We then combine labeled source-domain images and target-domain images with pseudo labels to train a final segmentor, where image-level weighting based on uncertainty estimation and pixel-level weighting based on dual-domain consensus are proposed to mitigate the adverse effect of noisy pseudo labels. Experiments on three public multi-modal datasets for Vestibular Schwannoma, brain tumor and whole heart segmentation show that our method surpassed ten state-of-the-art UDA methods, and it even achieved better results than fully supervised learning in the target domain in some cases.
This paper investigates the combination of intensity-based distance maps with boundary loss for point-supervised semantic segmentation. By design the boundary loss imposes a stronger penalty on the false positives the farther away from the object they occur. Hence it is intuitively inappropriate for weak supervision, where the ground truth label may be much smaller than the actual object and a certain amount of false positives (w.r.t. the weak ground truth) is actually desirable. Using intensity-aware distances instead may alleviate this drawback, allowing for a certain amount of false positives without a significant increase to the training loss. The motivation for applying the boundary loss directly under weak supervision lies in its great success for fully supervised segmentation tasks, but also in not requiring extra priors or outside information that is usually required -- in some form -- with existing weakly supervised methods in the literature. This formulation also remains potentially more attractive than existing CRF-based regularizers, due to its simplicity and computational efficiency. We perform experiments on two multi-class datasets; ACDC (heart segmentation) and POEM (whole-body abdominal organ segmentation). Preliminary results are encouraging and show that this supervision strategy has great potential. On ACDC it outperforms the CRF-loss based approach, and on POEM data it performs on par with it. The code for all our experiments is openly available.
When it comes to clinical images, automatic segmentation has a wide variety of applications and a considerable diversity of input domains, such as different types of Magnetic Resonance Images (MRIs) and Computerized Tomography (CT) scans. This heterogeneity is a challenge for cross-modality algorithms that should equally perform independently of the input image type fed to them. Often, segmentation models are trained using a single modality, preventing generalization to other types of input data without resorting to transfer learning techniques. Furthermore, the multi-modal or cross-modality architectures proposed in the literature frequently require registered images, which are not easy to collect in clinical environments, or need additional processing steps, such as synthetic image generation. In this work, we propose a simple framework to achieve fair image segmentation of multiple modalities using a single conditional model that adapts its normalization layers based on the input type, trained with non-registered interleaved mixed data. We show that our framework outperforms other cross-modality segmentation methods, when applied to the same 3D UNet baseline model, on the Multi-Modality Whole Heart Segmentation Challenge. Furthermore, we define the Conditional Vision Transformer (C-ViT) encoder, based on the proposed cross-modality framework, and we show that it brings significant improvements to the resulting segmentation, up to 6.87\% of Dice accuracy, with respect to its baseline reference. The code to reproduce our experiments and the trained model weights are available at https://github.com/matteo-bastico/MI-Seg.
Automatic segmentation of medical images is crucial in modern clinical workflows. The Segment Anything Model (SAM) has emerged as a versatile tool for image segmentation without specific domain training, but it requires human prompts and may have limitations in specific domains. Traditional models like nnUNet perform automatic segmentation during inference and are effective in specific domains but need extensive domain-specific training. To combine the strengths of foundational and domain-specific models, we propose nnSAM, integrating SAM's robust feature extraction with nnUNet's automatic configuration to enhance segmentation accuracy on small datasets. Our nnSAM model optimizes two main approaches: leveraging SAM's feature extraction and nnUNet's domain-specific adaptation, and incorporating a boundary shape supervision loss function based on level set functions and curvature calculations to learn anatomical shape priors from limited data. We evaluated nnSAM on four segmentation tasks: brain white matter, liver, lung, and heart segmentation. Our method outperformed others, achieving the highest DICE score of 82.77% and the lowest ASD of 1.14 mm in brain white matter segmentation with 20 training samples, compared to nnUNet's DICE score of 79.25% and ASD of 1.36 mm. A sample size study highlighted nnSAM's advantage with fewer training samples. Our results demonstrate significant improvements in segmentation performance with nnSAM, showcasing its potential for small-sample learning in medical image segmentation.
Recent trends in self-supervised representation learning have focused on removing inductive biases from training pipelines. However, inductive biases can be useful in settings when limited data are available or provide additional insight into the underlying data distribution. We present spatial prior attention (SPAN), a framework that takes advantage of consistent spatial and semantic structure in unlabeled image datasets to guide Vision Transformer attention. SPAN operates by regularizing attention masks from separate transformer heads to follow various priors over semantic regions. These priors can be derived from data statistics or a single labeled sample provided by a domain expert. We study SPAN through several detailed real-world scenarios, including medical image analysis and visual quality assurance. We find that the resulting attention masks are more interpretable than those derived from domain-agnostic pretraining. SPAN produces a 58.7 mAP improvement for lung and heart segmentation. We also find that our method yields a 2.2 mAUC improvement compared to domain-agnostic pretraining when transferring the pretrained model to a downstream chest disease classification task. Lastly, we show that SPAN pretraining leads to higher downstream classification performance in low-data regimes compared to domain-agnostic pretraining.
Obtaining precise whole-heart segmentation from computed tomography (CT) or other imaging techniques is prerequisite to clinically analyze the cardiac status, which plays an important role in the treatment of cardiovascular diseases. However, the whole-heart segmentation is still a challenging task due to the characteristic of medical images, such as far more background voxels than foreground voxels and the indistinct boundaries of adjacent tissues. In this paper, we first present a new deeply supervised 3D UNET which applies multi-depth fusion to the original network for a better extract context information. Then, we apply focal loss to the field of image segmentation and expand its application to multi-category tasks. Finally, the focal loss is incorporated into the Dice loss function (which can be used to solve category imbalance problem) to form a new loss function, which we call hybrid loss. We evaluate our new pipeline on the MICCAI 2017 whole-heart CT dataset, and it obtains a Dice score of 90.73%, which is better than most of the state-of-the-art methods.
Unsupervised domain adaptation is useful in medical image segmentation. Particularly, when ground truths of the target images are not available, domain adaptation can train a target-specific model by utilizing the existing labeled images from other modalities. Most of the reported works mapped images of both the source and target domains into a common latent feature space, and then reduced their discrepancy either implicitly with adversarial training or explicitly by directly minimizing a discrepancy metric. In this work, we propose a new framework, where the latent features of both domains are driven towards a common and parameterized variational form, whose conditional distribution given the image is Gaussian. This is achieved by two networks based on variational auto-encoders (VAEs) and a regularization for this variational approximation. Both of the VAEs, each for one domain, contain a segmentation module, where the source segmentation is trained in a supervised manner, while the target one is trained unsupervisedly. We validated the proposed domain adaptation method using two cardiac segmentation tasks, i.e., the cross-modality (CT and MR) whole heart segmentation and the cross-sequence cardiac MR segmentation. Results show that the proposed method achieved better accuracies compared to two state-of-the-art approaches and demonstrated good potential for cardiac segmentation. Furthermore, the proposed explicit regularization was shown to be effective and efficient in narrowing down the distribution gap between domains, which is useful for unsupervised domain adaptation. Our code and data has been released via https://zmiclab.github.io/projects.html.
This paper addresses the domain shift problem for segmentation. As a solution, we propose OLVA, a novel and lightweight unsupervised domain adaptation method based on a Variational Auto-Encoder (VAE) and Optimal Transport (OT) theory. Thanks to the VAE, our model learns a shared cross-domain latent space that follows a normal distribution, which reduces the domain shift. To guarantee valid segmentations, our shared latent space is designed to model the shape rather than the intensity variations. We further rely on an OT loss to match and align the remaining discrepancy between the two domains in the latent space. We demonstrate OLVA's effectiveness for the segmentation of multiple cardiac structures on the public Multi-Modality Whole Heart Segmentation (MM-WHS) dataset, where the source domain consists of annotated 3D MR images and the unlabelled target domain of 3D CTs. Our results show remarkable improvements with an additional margin of 12.5\% dice score over concurrent generative training approaches.
Cardiac segmentation of atriums, ventricles, and myocardium in computed tomography (CT) images is an important first-line task for presymptomatic cardiovascular disease diagnosis. In several recent studies, deep learning models have shown significant breakthroughs in medical image segmentation tasks. Unlike other organs such as the lungs and liver, the cardiac organ consists of multiple substructures, i.e., ventricles, atriums, aortas, arteries, veins, and myocardium. These cardiac substructures are proximate to each other and have indiscernible boundaries (i.e., homogeneous intensity values), making it difficult for the segmentation network focus on the boundaries between the substructures. In this paper, to improve the segmentation accuracy between proximate organs, we introduce a novel model to exploit shape and boundary-aware features. We primarily propose a shape-aware attention module, that exploits distance regression, which can guide the model to focus on the edges between substructures so that it can outperform the conventional contour-based attention method. In the experiments, we used the Multi-Modality Whole Heart Segmentation dataset that has 20 CT cardiac images for training and validation, and 40 CT cardiac images for testing. The experimental results show that the proposed network produces more accurate results than state-of-the-art networks by improving the Dice similarity coefficient score by 4.97%. Our proposed shape-aware contour attention mechanism demonstrates that distance transformation and boundary features improve the actual attention map to strengthen the responses in the boundary area. Moreover, our proposed method significantly reduces the false-positive responses of the final output, resulting in accurate segmentation.
Deep learning methods have reached state-of-the-art performance in cardiac image segmentation. Currently, the main bottleneck towards their effective translation into clinics requires assuring continuous high model performance and segmentation results. In this work, we present a novel learning framework to monitor the performance of heart segmentation models in the absence of ground truth. Formulated as an anomaly detection problem, the monitoring framework allows deriving surrogate quality measures for a segmentation and allows flagging suspicious results. We propose two different types of quality measures, a global score and a pixel-wise map. We demonstrate their use by reproducing the final rankings of a cardiac segmentation challenge in the absence of ground truth. Results show that our framework is accurate, fast, and scalable, confirming it is a viable option for quality control monitoring in clinical practice and large population studies.
Chest radiography is the most common radiographic examination performed in daily clinical practice for the detection of various heart and lung abnormalities. The large amount of data to be read and reported, with more than 100 studies per day for a single radiologist, poses a challenge in consistently maintaining high interpretation accuracy. The introduction of large-scale public datasets has led to a series of novel systems for automated abnormality classification. However, the labels of these datasets were obtained using natural language processed medical reports, yielding a large degree of label noise that can impact the performance. In this study, we propose novel training strategies that handle label noise from such suboptimal data. Prior label probabilities were measured on a subset of training data re-read by 4 board-certified radiologists and were used during training to increase the robustness of the training model to the label noise. Furthermore, we exploit the high comorbidity of abnormalities observed in chest radiography and incorporate this information to further reduce the impact of label noise. Additionally, anatomical knowledge is incorporated by training the system to predict lung and heart segmentation, as well as spatial knowledge labels. To deal with multiple datasets and images derived from various scanners that apply different post-processing techniques, we introduce a novel image normalization strategy. Experiments were performed on an extensive collection of 297,541 chest radiographs from 86,876 patients, leading to a state-of-the-art performance level for 17 abnormalities from 2 datasets. With an average AUC score of 0.880 across all abnormalities, our proposed training strategies can be used to significantly improve performance scores.
Accurate and robust whole heart substructure segmentation is crucial in developing clinical applications, such as computer-aided diagnosis and computer-aided surgery. However, segmentation of different heart substructures is challenging because of inadequate edge or boundary information, the complexity of the background and texture, and the diversity in different substructures' sizes and shapes. This article proposes a framework for multi-class whole heart segmentation employing non-rigid registration-based probabilistic atlas incorporating the Bayesian framework. We also propose a non-rigid registration pipeline utilizing a multi-resolution strategy for obtaining the highest attainable mutual information between the moving and fixed images. We further incorporate non-rigid registration into the expectation-maximization algorithm and implement different deep convolutional neural network-based encoder-decoder networks for ablation studies. All the extensive experiments are conducted utilizing the publicly available dataset for the whole heart segmentation containing 20 MRI and 20 CT cardiac images. The proposed approach exhibits an encouraging achievement, yielding a mean volume overlapping error of 14.5 % for CT scans exceeding the state-of-the-art results by a margin of 1.3 % in terms of the same metric. As the proposed approach provides better-results to delineate the different substructures of the heart, it can be a medical diagnostic aiding tool for helping experts with quicker and more accurate results.
As the COVID-19 pandemic aggravated the excessive workload of doctors globally, the demand for computer aided methods in medical imaging analysis increased even further. Such tools can result in more robust diagnostic pipelines which are less prone to human errors. In our paper, we present a deep neural network to which we refer to as Attention BCDU-Net, and apply it to the task of lung and heart segmentation from chest X-ray (CXR) images, a basic but ardous step in the diagnostic pipeline, for instance for the detection of cardiomegaly. We show that the fine-tuned model exceeds previous state-of-the-art results, reaching $98.1\pm 0.1\%$ Dice score and $95.2\pm 0.1\%$ IoU score on the dataset of Japanese Society of Radiological Technology (JSRT). Besides that, we demonstrate the relative simplicity of the task by attaining surprisingly strong results with training sets of size 10 and 20: in terms of Dice score, $97.0\pm 0.8\%$ and $97.3\pm 0.5$, respectively, while in terms of IoU score, $92.2\pm 1.2\%$ and $93.3\pm 0.4\%$, respectively. To achieve these scores, we capitalize on the mixup augmentation technique, which yields a remarkable gain above $4\%$ IoU score in the size 10 setup.
Deep learning-based whole-heart segmentation in coronary CT angiography (CCTA) allows the extraction of quantitative imaging measures for cardiovascular risk prediction. Automatic extraction of these measures in patients undergoing only non-contrast-enhanced CT (NCCT) scanning would be valuable. In this work, we leverage information provided by a dual-layer detector CT scanner to obtain a reference standard in virtual non-contrast (VNC) CT images mimicking NCCT images, and train a 3D convolutional neural network (CNN) for the segmentation of VNC as well as NCCT images. Contrast-enhanced acquisitions on a dual-layer detector CT scanner were reconstructed into a CCTA and a perfectly aligned VNC image. In each CCTA image, manual reference segmentations of the left ventricular (LV) myocardium, LV cavity, right ventricle, left atrium, right atrium, ascending aorta, and pulmonary artery trunk were obtained and propagated to the corresponding VNC image. These VNC images and reference segmentations were used to train 3D CNNs for automatic segmentation in either VNC images or NCCT images. Automatic segmentations in VNC images showed good agreement with reference segmentations, with an average Dice similarity coefficient of 0.897 \pm 0.034 and an average symmetric surface distance of 1.42 \pm 0.45 mm. Volume differences [95% confidence interval] between automatic NCCT and reference CCTA segmentations were -19 [-67; 30] mL for LV myocardium, -25 [-78; 29] mL for LV cavity, -29 [-73; 14] mL for right ventricle, -20 [-62; 21] mL for left atrium, and -19 [-73; 34] mL for right atrium, respectively. In 214 (74%) NCCT images from an independent multi-vendor multi-center set, two observers agreed that the automatic segmentation was mostly accurate or better. This method might enable quantification of additional cardiac measures from NCCT images for improved cardiovascular risk prediction.