Accurate segmentation of the left atrium (LA) from late gadolinium-enhanced magnetic resonance imaging plays a vital role in visualizing diseased atrial structures, enabling the diagnosis and management of cardiovascular diseases. It is particularly essential for planning treatment with ablation therapy, a key intervention for atrial fibrillation (AF). However, manual segmentation is time-intensive and prone to inter-observer variability, underscoring the need for automated solutions. Class-agnostic foundation models like DINOv2 have demonstrated remarkable feature extraction capabilities in vision tasks. However, their lack of domain specificity and task-specific adaptation can reduce spatial resolution during feature extraction, impacting the capture of fine anatomical detail in medical imaging. To address this limitation, we propose a segmentation framework that integrates DINOv2 as an encoder with a UNet-style decoder, incorporating multi-scale feature fusion and input image integration to enhance segmentation accuracy. The learnable weighting mechanism dynamically prioritizes hierarchical features from different encoder blocks of the foundation model, optimizing feature selection for task relevance. Additionally, the input image is reintroduced during the decoding stage to preserve high-resolution spatial details, addressing limitations of downsampling in the encoder. We validate our approach on the LAScarQS 2022 dataset and demonstrate improved performance with a 92.3% Dice and 84.1% IoU score for giant architecture compared to the nnUNet baseline model. These findings emphasize the efficacy of our approach in advancing the field of automated left atrium segmentation from cardiac MRI.
Semi-supervised medical image segmentation (SSMIS) has been demonstrated the potential to mitigate the issue of limited medical labeled data. However, confirmation and cognitive biases may affect the prevalent teacher-student based SSMIS methods due to erroneous pseudo-labels. To tackle this challenge, we improve the mean teacher approach and propose the Students Discrepancy-Informed Correction Learning (SDCL) framework that includes two students and one non-trainable teacher, which utilizes the segmentation difference between the two students to guide the self-correcting learning. The essence of SDCL is to identify the areas of segmentation discrepancy as the potential bias areas, and then encourage the model to review the correct cognition and rectify their own biases in these areas. To facilitate the bias correction learning with continuous review and rectification, two correction loss functions are employed to minimize the correct segmentation voxel distance and maximize the erroneous segmentation voxel entropy. We conducted experiments on three public medical image datasets: two 3D datasets (CT and MRI) and one 2D dataset (MRI). The results show that our SDCL surpasses the current State-of-the-Art (SOTA) methods by 2.57\%, 3.04\%, and 2.34\% in the Dice score on the Pancreas, LA, and ACDC datasets, respectively. In addition, the accuracy of our method is very close to the fully supervised method on the ACDC dataset, and even exceeds the fully supervised method on the Pancreas and LA dataset. (Code available at \url{https://github.com/pascalcpp/SDCL}).
Background: Deep learning has presented great potential in accurate MR image segmentation when enough labeled data are provided for network optimization. However, manually annotating 3D MR images is tedious and time-consuming, requiring experts with rich domain knowledge and experience. Purpose: To build a deep learning method exploring sparse annotations, namely only a single 2D slice label for each 3D training MR image. Population: 3D MR images of 150 subjects from two publicly available datasets were included. Among them, 50 (1,377 image slices) are for prostate segmentation. The other 100 (8,800 image slices) are for left atrium segmentation. Five-fold cross-validation experiments were carried out utilizing the first dataset. For the second dataset, 80 subjects were used for training and 20 were used for testing. Assessment: A collaborative learning method by integrating the strengths of semi-supervised and self-supervised learning schemes was developed. The method was trained using labeled central slices and unlabeled non-central slices. Segmentation performance on testing set was reported quantitatively and qualitatively. Results: Compared to FS-LCS, MT, UA-MT, DCT-Seg, ICT, and AC-MT, the proposed method achieved a substantial improvement in segmentation accuracy, increasing the mean B-IoU significantly by more than 10.0% for prostate segmentation (proposed method B-IoU: 70.3% vs. ICT B-IoU: 60.3%) and by more than 6.0% for left atrium segmentation (proposed method B-IoU: 66.1% vs. ICT B-IoU: 60.1%).
Semi-supervised learning has greatly advanced medical image segmentation since it effectively alleviates the need of acquiring abundant annotations from experts and utilizes unlabeled data which is much easier to acquire. Among existing perturbed consistency learning methods, mean-teacher model serves as a standard baseline for semi-supervised medical image segmentation. In this paper, we present a simple yet efficient competitive ensembling teacher student framework for semi-supervised for left atrium segmentation from 3D MR images, in which two student models with different task-level disturbances are introduced to learn mutually, while a competitive ensembling strategy is performed to ensemble more reliable information to teacher model. Different from the one-way transfer between teacher and student models, our framework facilitates the collaborative learning procedure of different student models with the guidance of teacher model and motivates different training networks for a competitive learning and ensembling procedure to achieve better performance. We evaluate our proposed method on the public Left Atrium (LA) dataset and it obtains impressive performance gains by exploiting the unlabeled data effectively and outperforms several existing semi-supervised methods.
Consistency regularization and pseudo labeling-based semi-supervised methods perform co-training using the pseudo labels from multi-view inputs. However, such co-training models tend to converge early to a consensus, degenerating to the self-training ones, and produce low-confidence pseudo labels from the perturbed inputs during training. To address these issues, we propose an Uncertainty-guided Collaborative Mean-Teacher (UCMT) for semi-supervised semantic segmentation with the high-confidence pseudo labels. Concretely, UCMT consists of two main components: 1) collaborative mean-teacher (CMT) for encouraging model disagreement and performing co-training between the sub-networks, and 2) uncertainty-guided region mix (UMIX) for manipulating the input images according to the uncertainty maps of CMT and facilitating CMT to produce high-confidence pseudo labels. Combining the strengths of UMIX with CMT, UCMT can retain model disagreement and enhance the quality of pseudo labels for the co-training segmentation. Extensive experiments on four public medical image datasets including 2D and 3D modalities demonstrate the superiority of UCMT over the state-of-the-art. Code is available at: https://github.com/Senyh/UCMT.
Medical image segmentation is a fundamental and critical step in many clinical approaches. Semi-supervised learning has been widely applied to medical image segmentation tasks since it alleviates the heavy burden of acquiring expert-examined annotations and takes the advantage of unlabeled data which is much easier to acquire. Although consistency learning has been proven to be an effective approach by enforcing an invariance of predictions under different distributions, existing approaches cannot make full use of region-level shape constraint and boundary-level distance information from unlabeled data. In this paper, we propose a novel uncertainty-guided mutual consistency learning framework to effectively exploit unlabeled data by integrating intra-task consistency learning from up-to-date predictions for self-ensembling and cross-task consistency learning from task-level regularization to exploit geometric shape information. The framework is guided by the estimated segmentation uncertainty of models to select out relatively certain predictions for consistency learning, so as to effectively exploit more reliable information from unlabeled data. Experiments on two publicly available benchmark datasets showed that: 1) Our proposed method can achieve significant performance improvement by leveraging unlabeled data, with up to 4.13% and 9.82% in Dice coefficient compared to supervised baseline on left atrium segmentation and brain tumor segmentation, respectively. 2) Compared with other semi-supervised segmentation methods, our proposed method achieve better segmentation performance under the same backbone network and task settings on both datasets, demonstrating the effectiveness and robustness of our method and potential transferability for other medical image segmentation tasks.
Semi-supervised learning (SSL) is a promising machine learning paradigm to address the issue of label scarcity in medical imaging. SSL methods were originally developed in image classification. The state-of-the-art SSL methods in image classification utilise consistency regularisation to learn unlabelled predictions which are invariant to input level perturbations. However, image level perturbations violate the cluster assumption in the setting of segmentation. Moreover, existing image level perturbations are hand-crafted which could be sub-optimal. Therefore, it is a not trivial to straightforwardly adapt existing SSL image classification methods in segmentation. In this paper, we propose MisMatch, a semi-supervised segmentation framework based on the consistency between paired predictions which are derived from two differently learnt morphological feature perturbations. MisMatch consists of an encoder and two decoders. One decoder learns positive attention for foreground on unlabelled data thereby generating dilated features of foreground. The other decoder learns negative attention for foreground on the same unlabelled data thereby generating eroded features of foreground. We first develop a 2D U-net based MisMatch framework and perform extensive cross-validation on a CT-based pulmonary vessel segmentation task and show that MisMatch statistically outperforms state-of-the-art semi-supervised methods when only 6.25\% of the total labels are used. In a second experiment, we show that U-net based MisMatch outperforms state-of-the-art methods on an MRI-based brain tumour segmentation task. In a third experiment, we show that a 3D MisMatch outperforms a previous method using input level augmentations, on a left atrium segmentation task. Lastly, we find that the performance improvement of MisMatch over the baseline might originate from its better calibration.
Consistency training has proven to be an advanced semi-supervised framework and achieved promising results in medical image segmentation tasks through enforcing an invariance of the predictions over different views of the inputs. However, with the iterative updating of model parameters, the models would tend to reach a coupled state and eventually lose the ability to exploit unlabeled data. To address the issue, we present a novel semi-supervised segmentation model based on parameter decoupling strategy to encourage consistent predictions from diverse views. Specifically, we first adopt a two-branch network to simultaneously produce predictions for each image. During the training process, we decouple the two prediction branch parameters by quadratic cosine distance to construct different views in latent space. Based on this, the feature extractor is constrained to encourage the consistency of probability maps generated by classifiers under diversified features. In the overall training process, the parameters of feature extractor and classifiers are updated alternately by consistency regularization operation and decoupling operation to gradually improve the generalization performance of the model. Our method has achieved a competitive result over the state-of-the-art semi-supervised methods on the Atrial Segmentation Challenge dataset, demonstrating the effectiveness of our framework. Code is available at https://github.com/BX0903/PDC.
Semi-supervised learning provides great significance in left atrium (LA) segmentation model learning with insufficient labelled data. Generalising semi-supervised learning to cross-domain data is of high importance to further improve model robustness. However, the widely existing distribution difference and sample mismatch between different data domains hinder the generalisation of semi-supervised learning. In this study, we alleviate these problems by proposing an Adaptive Hierarchical Dual Consistency (AHDC) for the semi-supervised LA segmentation on cross-domain data. The AHDC mainly consists of a Bidirectional Adversarial Inference module (BAI) and a Hierarchical Dual Consistency learning module (HDC). The BAI overcomes the difference of distributions and the sample mismatch between two different domains. It mainly learns two mapping networks adversarially to obtain two matched domains through mutual adaptation. The HDC investigates a hierarchical dual learning paradigm for cross-domain semi-supervised segmentation based on the obtained matched domains. It mainly builds two dual-modelling networks for mining the complementary information in both intra-domain and inter-domain. For the intra-domain learning, a consistency constraint is applied to the dual-modelling targets to exploit the complementary modelling information. For the inter-domain learning, a consistency constraint is applied to the LAs modelled by two dual-modelling networks to exploit the complementary knowledge among different data domains. We demonstrated the performance of our proposed AHDC on four 3D late gadolinium enhancement cardiac MR (LGE-CMR) datasets from different centres and a 3D CT dataset. Compared to other state-of-the-art methods, our proposed AHDC achieved higher segmentation accuracy, which indicated its capability in the cross-domain semi-supervised LA segmentation.
Deep learning has achieved promising segmentation performance on 3D left atrium MR images. However, annotations for segmentation tasks are expensive, costly and difficult to obtain. In this paper, we introduce a novel hierarchical consistency regularized mean teacher framework for 3D left atrium segmentation. In each iteration, the student model is optimized by multi-scale deep supervision and hierarchical consistency regularization, concurrently. Extensive experiments have shown that our method achieves competitive performance as compared with full annotation, outperforming other state-of-the-art semi-supervised segmentation methods.
Semi-supervised learning has attracted great attention in the field of machine learning, especially for medical image segmentation tasks, since it alleviates the heavy burden of collecting abundant densely annotated data for training. However, most of existing methods underestimate the importance of challenging regions (e.g. small branches or blurred edges) during training. We believe that these unlabeled regions may contain more crucial information to minimize the uncertainty prediction for the model and should be emphasized in the training process. Therefore, in this paper, we propose a novel Mutual Consistency Network (MC-Net) for semi-supervised left atrium segmentation from 3D MR images. Particularly, our MC-Net consists of one encoder and two slightly different decoders, and the prediction discrepancies of two decoders are transformed as an unsupervised loss by our designed cycled pseudo label scheme to encourage mutual consistency. Such mutual consistency encourages the two decoders to have consistent and low-entropy predictions and enables the model to gradually capture generalized features from these unlabeled challenging regions. We evaluate our MC-Net on the public Left Atrium (LA) database and it obtains impressive performance gains by exploiting the unlabeled data effectively. Our MC-Net outperforms six recent semi-supervised methods for left atrium segmentation, and sets the new state-of-the-art performance on the LA database.
This study proposes a fully automated approach for the left atrial segmentation from routine cine long-axis cardiac magnetic resonance image sequences using deep convolutional neural networks and Bayesian filtering. The proposed approach consists of a classification network that automatically detects the type of long-axis sequence and three different convolutional neural network models followed by unscented Kalman filtering (UKF) that delineates the left atrium. Instead of training and predicting all long-axis sequence types together, the proposed approach first identifies the image sequence type as to 2, 3 and 4 chamber views, and then performs prediction based on neural nets trained for that particular sequence type. The datasets were acquired retrospectively and ground truth manual segmentation was provided by an expert radiologist. In addition to neural net based classification and segmentation, another neural net is trained and utilized to select image sequences for further processing using UKF to impose temporal consistency over cardiac cycle. A cyclic dynamic model with time-varying angular frequency is introduced in UKF to characterize the variations in cardiac motion during image scanning. The proposed approach was trained and evaluated separately with varying amount of training data with images acquired from 20, 40, 60 and 80 patients. Evaluations over 1515 images with equal number of images from each chamber group acquired from an additional 20 patients demonstrated that the proposed model outperformed state-of-the-art and yielded a mean Dice coefficient value of 94.1%, 93.7% and 90.1% for 2, 3 and 4-chamber sequences, respectively, when trained with datasets from 80 patients.
Segmentation of cardiac images, particularly late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) widely used for visualizing diseased cardiac structures, is a crucial first step for clinical diagnosis and treatment. However, direct segmentation of LGE-MRIs is challenging due to its attenuated contrast. Since most clinical studies have relied on manual and labor-intensive approaches, automatic methods are of high interest, particularly optimized machine learning approaches. To address this, we organized the "2018 Left Atrium Segmentation Challenge" using 154 3D LGE-MRIs, currently the world's largest cardiac LGE-MRI dataset, and associated labels of the left atrium segmented by three medical experts, ultimately attracting the participation of 27 international teams. In this paper, extensive analysis of the submitted algorithms using technical and biological metrics was performed by undergoing subgroup analysis and conducting hyper-parameter analysis, offering an overall picture of the major design choices of convolutional neural networks (CNNs) and practical considerations for achieving state-of-the-art left atrium segmentation. Results show the top method achieved a dice score of 93.2% and a mean surface to a surface distance of 0.7 mm, significantly outperforming prior state-of-the-art. Particularly, our analysis demonstrated that double, sequentially used CNNs, in which a first CNN is used for automatic region-of-interest localization and a subsequent CNN is used for refined regional segmentation, achieved far superior results than traditional methods and pipelines containing single CNNs. This large-scale benchmarking study makes a significant step towards much-improved segmentation methods for cardiac LGE-MRIs, and will serve as an important benchmark for evaluating and comparing the future works in the field.
Training deep convolutional neural networks usually requires a large amount of labeled data. However, it is expensive and time-consuming to annotate data for medical image segmentation tasks. In this paper, we present a novel uncertainty-aware semi-supervised framework for left atrium segmentation from 3D MR images. Our framework can effectively leverage the unlabeled data by encouraging consistent predictions of the same input under different perturbations. Concretely, the framework consists of a student model and a teacher model, and the student model learns from the teacher model by minimizing a segmentation loss and a consistency loss with respect to the targets of the teacher model. We design a novel uncertainty-aware scheme to enable the student model to gradually learn from the meaningful and reliable targets by exploiting the uncertainty information. Experiments show that our method achieves high performance gains by incorporating the unlabeled data. Our method outperforms the state-of-the-art semi-supervised methods, demonstrating the potential of our framework for the challenging semi-supervised problems.
Difficult image segmentation problems, for instance left atrium MRI, can be addressed by incorporating shape priors to find solutions that are consistent with known objects. Nonetheless, a single multivariate Gaussian is not an adequate model in cases with significant nonlinear shape variation or where the prior distribution is multimodal. Nonparametric density estimation is more general, but has a ravenous appetite for training samples and poses serious challenges in optimization, especially in high dimensional spaces. Here, we propose a maximum-a-posteriori formulation that relies on a generative image model by incorporating both local intensity and global shape priors. We use deep autoencoders to capture the complex intensity distribution while avoiding the careful selection of hand-crafted features. We formulate the shape prior as a mixture of Gaussians and learn the corresponding parameters in a high-dimensional shape space rather than pre-projecting onto a low-dimensional subspace. In segmentation, we treat the identity of the mixture component as a latent variable and marginalize it within a generalized expectation-maximization framework. We present a conditional maximization-based scheme that alternates between a closed-form solution for component-specific shape parameters that provides a global update-based optimization strategy, and an intensity-based energy minimization that translates the global notion of a nonlinear shape prior into a set of local penalties. We demonstrate our approach on the left atrial segmentation from gadolinium-enhanced MRI, which is useful in quantifying the atrial geometry in patients with atrial fibrillation.
Segmenting left atrium in MR volume holds great potentials in promoting the treatment of atrial fibrillation. However, the varying anatomies, artifacts and low contrasts among tissues hinder the advance of both manual and automated solutions. In this paper, we propose a fully-automated framework to segment left atrium in gadolinium-enhanced MR volumes. The region of left atrium is firstly automatically localized by a detection module. Our framework then originates with a customized 3D deep neural network to fully explore the spatial dependency in the region for segmentation. To alleviate the risk of low training efficiency and potential overfitting, we enhance our deep network with the transfer learning and deep supervision strategy. Main contribution of our network design lies in the composite loss function to combat the boundary ambiguity and hard examples. We firstly adopt the Overlap loss to encourage network reduce the overlap between the foreground and background and thus sharpen the predictions on boundary. We then propose a novel Focal Positive loss to guide the learning of voxel-specific threshold and emphasize the foreground to improve classification sensitivity. Further improvement is obtained with an recursive training scheme. With ablation studies, all the introduced modules prove to be effective. The proposed framework achieves an average Dice of 92.24 in segmenting left atrium with pulmonary veins on 20 testing volumes.
Accurately segmenting left atrium in MR volume can benefit the ablation procedure of atrial fibrillation. Traditional automated solutions often fail in relieving experts from the labor-intensive manual labeling. In this paper, we propose a deep neural network based solution for automated left atrium segmentation in gadolinium-enhanced MR volumes with promising performance. We firstly argue that, for this volumetric segmentation task, networks in 2D fashion can present great superiorities in time efficiency and segmentation accuracy than networks with 3D fashion. Considering the highly varying shape of atrium and the branchy structure of associated pulmonary veins, we propose to adopt a pyramid module to collect semantic cues in feature maps from multiple scales for fine-grained segmentation. Also, to promote our network in classifying the hard examples, we propose an Online Hard Negative Example Mining strategy to identify voxels in slices with low classification certainties and penalize the wrong predictions on them. Finally, we devise a competitive training scheme to further boost the generalization ability of networks. Extensively verified on 20 testing volumes, our proposed framework achieves an average Dice of 92.83% in segmenting the left atria and pulmonary veins.
Segmentation of the left atrium and deriving its size can help to predict and detect various cardiovascular conditions. Automation of this process in 3D Ultrasound image data is desirable, since manual delineations are time-consuming, challenging and observer-dependent. Convolutional neural networks have made improvements in computer vision and in medical image analysis. They have successfully been applied to segmentation tasks and were extended to work on volumetric data. In this paper we introduce a combined deep-learning based approach on volumetric segmentation in Ultrasound acquisitions with incorporation of prior knowledge about left atrial shape and imaging device. The results show, that including a shape prior helps the domain adaptation and the accuracy of segmentation is further increased with adversarial learning.