Recently, numerous pancreas segmentation methods have achieved promising performance on local single-source datasets. However, these methods don't adequately account for generalizability issues, and hence typically show limited performance and low stability on test data from other sources. Considering the limited availability of distinct data sources, we seek to improve the generalization performance of a pancreas segmentation model trained with a single-source dataset, i.e., the single source generalization task. In particular, we propose a dual self-supervised learning model that incorporates both global and local anatomical contexts. Our model aims to fully exploit the anatomical features of the intra-pancreatic and extra-pancreatic regions, and hence enhance the characterization of the high-uncertainty regions for more robust generalization. Specifically, we first construct a global-feature contrastive self-supervised learning module that is guided by the pancreatic spatial structure. This module obtains complete and consistent pancreatic features through promoting intra-class cohesion, and also extracts more discriminative features for differentiating between pancreatic and non-pancreatic tissues through maximizing inter-class separation. It mitigates the influence of surrounding tissue on the segmentation outcomes in high-uncertainty regions. Subsequently, a local-image restoration self-supervised learning module is introduced to further enhance the characterization of the high uncertainty regions. In this module, informative anatomical contexts are actually learned to recover randomly corrupted appearance patterns in those regions.
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.
Pancreatic cancer, which has a low survival rate, is the most intractable one among all cancers. Most diagnoses of this cancer heavily depend on abdominal computed tomography (CT) scans. Therefore, pancreas segmentation is crucial but challenging. Because of the obscure position of the pancreas, surrounded by other large organs, and its small area, the pancreas has often been impeded and difficult to detect. With these challenges , the segmentation results based on Deep Learning (DL) models still need to be improved. In this research, we propose a novel adaptive TverskyCE loss for DL model training, which combines Tversky loss with cross-entropy loss using learnable weights. Our method enables the model to adjust the loss contribution automatically and find the best objective function during training. All experiments were conducted on the National Institutes of Health (NIH) Pancreas-CT dataset. We evaluated the adaptive TverskyCE loss on the UNet-3D and Dilated UNet-3D, and our method achieved a Dice Similarity Coefficient (DSC) of 85.59%, with peak performance up to 95.24%, and the score of 85.14%. DSC and the score were improved by 9.47% and 8.98% respectively compared with the baseline UNet-3D with Tversky loss for pancreas segmentation. Keywords: Pancreas segmentation, Tversky loss, Cross-entropy loss, UNet-3D, Dilated UNet-3D
An accurate segmentation of the pancreas on CT is crucial to identify pancreatic pathologies and extract imaging-based biomarkers. However, prior research on pancreas segmentation has primarily focused on modifying the segmentation model architecture or utilizing pre- and post-processing techniques. In this article, we investigate the utility of anatomical priors to enhance the segmentation performance of the pancreas. Two 3D full-resolution nnU-Net models were trained, one with 8 refined labels from the public PANORAMA dataset, and another that combined them with labels derived from the public TotalSegmentator (TS) tool. The addition of anatomical priors resulted in a 6\% increase in Dice score ($p < .001$) and a 36.5 mm decrease in Hausdorff distance for pancreas segmentation ($p < .001$). Moreover, the pancreas was always detected when anatomy priors were used, whereas there were 8 instances of failed detections without their use. The use of anatomy priors shows promise for pancreas segmentation and subsequent derivation of imaging biomarkers.
Multiphase CT studies are routinely obtained in clinical practice for diagnosis and management of various diseases, such as cancer. However, the CT studies can be acquired with low radiation doses, different scanners, and are frequently affected by motion and metal artifacts. Prior approaches have targeted the quality improvement of one specific CT phase (e.g., non-contrast CT). In this work, we hypothesized that leveraging multiple CT phases for the quality enhancement of one phase may prove advantageous for downstream tasks, such as segmentation. A 3D progressive fusion and non-local (PFNL) network was developed. It was trained with three degraded (low-quality) phases (non-contrast, arterial, and portal venous) to enhance the quality of the portal venous phase. Then, the effect of scan quality enhancement was evaluated using a proxy task of pancreas segmentation, which is useful for tracking pancreatic cancer. The proposed approach improved the pancreas segmentation by 3% over the corresponding low-quality CT scan. To the best of our knowledge, we are the first to harness multiphase CT for scan quality enhancement and improved pancreas segmentation.
Convolutional neural networks (CNNs) have shown great effectiveness in medical image segmentation. However, they may be limited in modeling large inter-subject variations in organ shapes and sizes and exploiting global long-range contextual information. This is because CNNs typically employ convolutions with fixed-sized local receptive fields and lack the mechanisms to utilize global information. To address these limitations, we developed Dynamic Multi-Resolution Convolution (DMRC) and Dynamic Multi-Scale Convolution (DMSC) modules. Both modules enhance the representation capabilities of single convolutions to capture varying scaled features and global contextual information. This is achieved in the DMRC module by employing a convolutional filter on images with different resolutions and subsequently utilizing dynamic mechanisms to model global inter-dependencies between features. In contrast, the DMSC module extracts features at different scales by employing convolutions with different kernel sizes and utilizing dynamic mechanisms to extract global contextual information. The utilization of convolutions with different kernel sizes in the DMSC module may increase computational complexity. To lessen this burden, we propose to use a lightweight design for convolution layers with a large kernel size. Thus, DMSC and DMRC modules are designed as lightweight drop-in replacements for single convolutions, and they can be easily integrated into general CNN architectures for end-to-end training. The segmentation network was proposed by incorporating our DMSC and DMRC modules into a standard U-Net architecture, termed Dynamic Multi-scale and Multi-resolution Convolution network (DMC-Net). The results demonstrate that our proposed DMSC and DMRC can enhance the representation capabilities of single convolutions and improve segmentation accuracy.
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.
Pancreas segmentation has been traditionally challenging due to its small size in computed tomography abdominal volumes, high variability of shape and positions among patients, and blurred boundaries due to low contrast between the pancreas and surrounding organs. Many deep learning models for pancreas segmentation have been proposed in the past few years. We present a thorough systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The literature search was conducted on PubMed, Web of Science, Scopus, and IEEE Xplore on original studies published in peer-reviewed journals from 2013 to 2023. Overall, 130 studies were retrieved. We initially provided an overview of the technical background of the most common network architectures and publicly available datasets. Then, the analysis of the studies combining visual presentation in tabular form and text description was reported. The tables grouped the studies specifying the application, dataset size, design (model architecture, learning strategy, and loss function), results, and main contributions. We first analyzed the studies focusing on parenchyma segmentation using coarse-to-fine approaches, multi-organ segmentation, semi-supervised learning, and unsupervised learning, followed by those studies on generalization to other datasets and those concerning the design of new loss functions. Then, we analyzed the studies on segmentation of tumors, cysts, and inflammation reporting multi-stage methods, semi-supervised learning, generalization to other datasets, and design of new loss functions. Finally, we provided a critical discussion on the subject based on the published evidence underlining current issues that need to be addressed before clinical translation.
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}.
Accurately segmenting the pancreas remains a huge challenge. Traditional methods encounter difficulties in semantic localization due to the small volume and distorted structure of the pancreas, while deep learning methods encounter challenges in obtaining accurate edges because of low contrast and organ overlapping. To overcome these issues, we propose a multi-cue level set method based on the diffusion probabilistic model, namely Diff-mcs. Our method adopts a coarse-to-fine segmentation strategy. We use the diffusion probabilistic model in the coarse segmentation stage, with the obtained probability distribution serving as both the initial localization and prior cues for the level set method. In the fine segmentation stage, we combine the prior cues with grayscale cues and texture cues to refine the edge by maximizing the difference between probability distributions of the cues inside and outside the level set curve. The method is validated on three public datasets and achieves state-of-the-art performance, which can obtain more accurate segmentation results with lower uncertainty segmentation edges. In addition, we conduct ablation studies and uncertainty analysis to verify that the diffusion probability model provides a more appropriate initialization for the level set method. Furthermore, when combined with multiple cues, the level set method can better obtain edges and improve the overall accuracy. Our code is available at https://github.com/GOUYUEE/Diff-mcs.
Segmenting organs in CT scan images is a necessary process for multiple downstream medical image analysis tasks. Currently, manual CT scan segmentation by radiologists is prevalent, especially for organs like the pancreas, which requires a high level of domain expertise for reliable segmentation due to factors like small organ size, occlusion, and varying shapes. When resorting to automated pancreas segmentation, these factors translate to limited reliable labeled data to train effective segmentation models. Consequently, the performance of contemporary pancreas segmentation models is still not within acceptable ranges. To improve that, we propose M3BUNet, a fusion of MobileNet and U-Net neural networks, equipped with a novel Mean-Max (MM) attention that operates in two stages to gradually segment pancreas CT images from coarse to fine with mask guidance for object detection. This approach empowers the network to surpass segmentation performance achieved by similar network architectures and achieve results that are on par with complex state-of-the-art methods, all while maintaining a low parameter count. Additionally, we introduce external contour segmentation as a preprocessing step for the coarse stage to assist in the segmentation process through image standardization. For the fine segmentation stage, we found that applying a wavelet decomposition filter to create multi-input images enhances pancreas segmentation performance. We extensively evaluate our approach on the widely known NIH pancreas dataset and MSD pancreas dataset. Our approach demonstrates a considerable performance improvement, achieving an average Dice Similarity Coefficient (DSC) value of up to 89.53% and an Intersection Over Union (IOU) score of up to 81.16 for the NIH pancreas dataset, and 88.60% DSC and 79.90% IOU for the MSD Pancreas dataset.
Due to the poor prognosis of Pancreatic cancer, accurate early detection and segmentation are critical for improving treatment outcomes. However, pancreatic segmentation is challenged by blurred boundaries, high shape variability, and class imbalance. To tackle these problems, we propose a multiscale attention network with shape context and prior constraint for robust pancreas segmentation. Specifically, we proposed a Multi-scale Feature Extraction Module (MFE) and a Mixed-scale Attention Integration Module (MAI) to address unclear pancreas boundaries. Furthermore, a Shape Context Memory (SCM) module is introduced to jointly model semantics across scales and pancreatic shape. Active Shape Model (ASM) is further used to model the shape priors. Experiments on NIH and MSD datasets demonstrate the efficacy of our model, which improves the state-of-the-art Dice Score for 1.01% and 1.03% respectively. Our architecture provides robust segmentation performance, against the blurry boundaries, and variations in scale and shape of pancreas.
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.
Pancreatic cancer is one of the deadliest types of cancer, with 25% of the diagnosed patients surviving for only one year and 6% of them for five. Computed tomography (CT) screening trials have played a key role in improving early detection of pancreatic cancer, which has shown significant improvement in patient survival rates. However, advanced analysis of such images often requires manual segmentation of the pancreas, which is a time-consuming task. Moreover, pancreas presents high variability in shape, while occupying only a very small area of the entire abdominal CT scans, which increases the complexity of the problem. The rapid development of deep learning can contribute to offering robust algorithms that provide inexpensive, accurate, and user-independent segmentation results that can guide the domain experts. This dissertation addresses this task by investigating a two-step approach for pancreas segmentation, by assisting the task with a prior rough localization or detection of pancreas. This rough localization of the pancreas is provided by an estimated probability map and the detection task is achieved by using the YOLOv4 deep learning algorithm. The segmentation task is tackled by a modified U-Net model applied on cropped data, as well as by using a morphological active contours algorithm. For comparison, the U-Net model was also applied on the full CT images, which provide a coarse pancreas segmentation to serve as reference. Experimental results of the detection network on the National Institutes of Health (NIH) dataset and the pancreas tumour task dataset within the Medical Segmentation Decathlon show 50.67% mean Average Precision. The best segmentation network achieved good segmentation results on the NIH dataset, reaching 67.67% Dice score.
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.
CT organ segmentation on computed tomography (CT) images becomes a significant brick for modern medical image analysis, supporting clinic workflows in multiple domains. Previous segmentation methods include 2D convolution neural networks (CNN) based approaches, fed by CT image slices that lack the structural knowledge in axial view, and 3D CNN-based methods with the expensive computation cost in multi-organ segmentation applications. This paper introduces an adversarial performance validation network into a 2D-to-3D segmentation framework. The classifier and performance validator competition contribute to accurate segmentation results via back-propagation. The proposed network organically converts the 2D-coarse result to 3D high-quality segmentation masks in a coarse-to-fine manner, allowing joint optimization to improve segmentation accuracy. Besides, the structural information of one specific organ is depicted by a statistics-meaningful prior bounding box, which is transformed into a global feature leveraging the learning process in 3D fine segmentation. The experiments on the NIH pancreas segmentation dataset demonstrate the proposed network achieves state-of-the-art accuracy on small organ segmentation and outperforms the previous best. High accuracy is also reported on multi-organ segmentation in a dataset collected by ourselves.
Federated learning (FL) is a distributed machine learning technique that enables collaborative model training while avoiding explicit data sharing. The inherent privacy-preserving property of FL algorithms makes them especially attractive to the medical field. However, in case of heterogeneous client data distributions, standard FL methods are unstable and require intensive hyperparameter tuning to achieve optimal performance. Conventional hyperparameter optimization algorithms are impractical in real-world FL applications as they involve numerous training trials, which are often not affordable with limited compute budgets. In this work, we propose an efficient reinforcement learning (RL)-based federated hyperparameter optimization algorithm, termed Auto-FedRL, in which an online RL agent can dynamically adjust hyperparameters of each client based on the current training progress. Extensive experiments are conducted to investigate different search strategies and RL agents. The effectiveness of the proposed method is validated on a heterogeneous data split of the CIFAR-10 dataset as well as two real-world medical image segmentation datasets for COVID-19 lesion segmentation in chest CT and pancreas segmentation in abdominal CT.