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1. Siamese neural networks for continuous disease severity evaluation and change detection in medical imaging

   https://doi.org/10.1038/s41746-020-0255-1  

   Li, Matthew D. ; Chang, Ken ; Bearce, Ben ; Chang, Connie Y. ; Huang, Ambrose J. ; Campbell, J. Peter ; Brown, James M. ; Singh, Praveer ; Hoebel, Katharina V. ; Erdoğmuş, Deniz ; et al ( March 2020 , npj Digital Medicine)

   Using medical images to evaluate disease severity and change over time is a routine and important task in clinical decision making. Grading systems are often used, but are unreliable as domain experts disagree on disease severity category thresholds. These discrete categories also do not reflect the underlying continuous spectrum of disease severity. To address these issues, we developed a convolutional Siamese neural network approach to evaluate disease severity at single time points and change between longitudinal patient visits on a continuous spectrum. We demonstrate this in two medical imaging domains: retinopathy of prematurity (ROP) in retinal photographs and osteoarthritis in knee radiographs. Our patient cohorts consist of 4861 images from 870 patients in the Imaging and Informatics in Retinopathy of Prematurity (i-ROP) cohort study and 10,012 images from 3021 patients in the Multicenter Osteoarthritis Study (MOST), both of which feature longitudinal imaging data. Multiple expert clinician raters ranked 100 retinal images and 100 knee radiographs from excluded test sets for severity of ROP and osteoarthritis, respectively. The Siamese neural network output for each image in comparison to a pool of normal reference images correlates with disease severity rank (ρ = 0.87 for ROP andρ = 0.89 for osteoarthritis), both within and between themore »clinical grading categories. Thus, this output can represent the continuous spectrum of disease severity at any single time point. The difference in these outputs can be used to show change over time. Alternatively, paired images from the same patient at two time points can be directly compared using the Siamese neural network, resulting in an additional continuous measure of change between images. Importantly, our approach does not require manual localization of the pathology of interest and requires only a binary label for training (same versus different). The location of disease and site of change detected by the algorithm can be visualized using an occlusion sensitivity map-based approach. For a longitudinal binary change detection task, our Siamese neural networks achieve test set receiving operator characteristic area under the curves (AUCs) of up to 0.90 in evaluating ROP or knee osteoarthritis change, depending on the change detection strategy. The overall performance on this binary task is similar compared to a conventional convolutional deep-neural network trained for multi-class classification. Our results demonstrate that convolutional Siamese neural networks can be a powerful tool for evaluating the continuous spectrum of disease severity and change in medical imaging.

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2. Multi-Series CT Image Super-Resolution by using Transfer Generative Adversarial Network

   Xiao, Yao ; Arreola, Manuel M. ; Barreto, Izabella ; Bolch, Wesley E. ; Fox, W. Christopher ; Peters, Keith ; Rajderkar, Dhanashree A. ; Rees, John H. ; Fang, Ruogu ( June 2020 , Society for Imaging Informatics in Medicine (SIIM) Annual Meeting)

   Introduction Multi-series CT (MSCT) scans, including non-contrast CT (NCCT), CT Perfusion (CTP), and CT Angiography (CTA), are widely used in acute stroke imaging. While each scan has its advantage in disease diagnosis, the varying image resolution of different series hinders the ability of the radiologist to discern subtle suspicious findings. Besides, higher image quality requires high radiation doses, leading to increases in health risks such as cataract formation and cancer induction. Thus, it is highly crucial to develop an approach to improve MSCT resolution and to lower radiation exposure. Hypothesis MSCT imaging of the same patient is highly correlated in structural features, the transferring and integration of the shared and complementary information from different series are beneficial for achieving high image quality. Methods We propose TL-GAN, a learning-based method by using Transfer Learning (TL) and Generative Adversarial Network (GAN) to reconstruct high-quality diagnostic images. Our TL-GAN method is evaluated on 4,382 images collected from nine patients’ MSCT scans, including 415 NCCT slices, 3,696 CTP slices, and 271 CTA slices. We randomly split the nine patients into a training set (4 patients), a validation set (2 patients), and a testing set (3 patients). In preprocessing, we remove the background and skullmore »and visualize in brain window. The low-resolution images (1/4 of the original spatial size) are simulated by bicubic down-sampling. For training without TL, we train different series individually, and for with TL, we follow the scanning sequence (NCCT, CTP, and CTA) by finetuning. Results The performance of TL-GAN is evaluated by the peak-signal-to-noise ratio (PSNR) and structural similarity (SSIM) index on 184 NCCT, 882 CTP, and 107 CTA test images. Figure 1 provides both visual (a-c) and quantity (d-f) comparisons. Through TL-GAN, there is a significant improvement with TL than without TL (training from scratch) for NCCT, CTP, and CTA images, respectively. These significances of performance improvement are evaluated by one-tailed paired t-tests (p < 0.05). We enlarge the regions of interest for detail visual comparisons. Further, we evaluate the CTP performance by calculating the perfusion maps, including cerebral blood flow (CBF) and cerebral blood volume (CBV). The visual comparison of the perfusion maps in Figure 2 demonstrate that TL-GAN is beneficial for achieving high diagnostic image quality, which are comparable to the ground truth images for both CBF and CBV maps. Conclusion Utilizing TL-GAN can effectively improve the image resolution for MSCT, provides radiologists more image details for suspicious findings, which is a practical solution for MSCT image quality enhancement.« less
3. BNU-Net: A Novel Deep Learning Approach for LV MRI Analysis in Short-Axis MRI

   https://doi.org/10.1109/BIBE.2019.00137  

   Chu, Wenhui ; Molina, Giovanni ; Navkar, Nikhil V. ; Eick, Christoph F. ; Becker, Aaron T. ; Tsiamyrtzis, Panagiotis ; Tsekos, Nikolaos V. ( October 2019 , 2019 IEEE 19th International Conference on Bioinformatics and Bioengineering (BIBE))

   This work presents a novel deep learning architecture called BNU-Net for the purpose of cardiac segmentation based on short-axis MRI images. Its name is derived from the Batch Normalized (BN) U-Net architecture for medical image segmentation. New generations of deep neural networks (NN) are called convolutional NN (CNN). CNNs like U-Net have been widely used for image classification tasks. CNNs are supervised training models which are trained to learn hierarchies of features automatically and robustly perform classification. Our architecture consists of an encoding path for feature extraction and a decoding path that enables precise localization. We compare this approach with a parallel approach named U-Net. Both BNU-Net and U-Net are cardiac segmentation approaches: while BNU-Net employs batch normalization to the results of each convolutional layer and applies an exponential linear unit (ELU) approach that operates as activation function, U-Net does not apply batch normalization and is based on Rectified Linear Units (ReLU). The presented work (i) facilitates various image preprocessing techniques, which includes affine transformations and elastic deformations, and (ii) segments the preprocessed images using the new deep learning architecture. We evaluate our approach on a dataset containing 805 MRI images from 45 patients. The experimental results reveal that ourmore »approach accomplishes comparable or better performance than other state-of-the-art approaches in terms of the Dice coefficient and the average perpendicular distance.« less
4. BNU- Net: a Novel Deep Learning Approach for LV MRI Analysis in Short-Axis MRI

   Chu, Wenhui ; Molina, Giovanni ; Navkar, Nikhil ; Eick, Christoph ; Becker, Aaron ; Tsekos, Nikolaos ( October 2019 , IEEE International Conference on Bioinformatics and Bioengineering (BIBE))

   This work presents a novel deep learning architecture called BNU-Net for the purpose of cardiac segmentation based on short-axis MRI images. Its name is derived from the Batch Normalized (BN) U-Net architecture for medical image segmentation. New generations of deep neural networks (NN) are called convolutional NN (CNN). CNNs like U-Net have been widely used for image classification tasks. CNNs are supervised training models which are trained to learn hierarchies of features automatically and robustly perform classification. Our architecture consists of an encoding path for feature extraction and a decoding path that enables precise localization. We compare this approach with a parallel approach named U-Net. Both BNU-Net and U-Net are cardiac segmentation approaches: while BNU-Net employs batch normalization to the results of each convolutional layer and applies an exponential linear unit (ELU) approach that operates as activation function, U-Net does not apply batch normalization and is based on Rectified Linear Units (ReLU). The presented work (i) facilitates various image preprocessing techniques, which includes affine transformations and elastic deformations, and (ii) segments the preprocessed images using the new deep learning architecture. We evaluate our approach on a dataset containing 805 MRI images from 45 patients. The experimental results reveal that ourmore »approach accomplishes comparable or better performance than other state-of-the-art approaches in terms of the Dice coefficient and the average perpendicular distance. Index Terms—Magnetic Resonance Imaging; Batch Normalization; Exponential Linear Units« less
5. Knee Osteoarthritis Classification Using 3D CNN and MRI

   https://doi.org/10.3390/app11115196  

   Guida, Carmine ; Zhang, Ming ; Shan, Juan ( June 2021 , Applied Sciences)

   null (Ed.)

   Osteoarthritis (OA) is the most common form of arthritis and can often occur in the knee. While convolutional neural networks (CNNs) have been widely used to study medical images, the application of a 3-dimensional (3D) CNN in knee OA diagnosis is limited. This study utilizes a 3D CNN model to analyze sequences of knee magnetic resonance (MR) images to perform knee OA classification. An advantage of using 3D CNNs is the ability to analyze the whole sequence of 3D MR images as a single unit as opposed to a traditional 2D CNN, which examines one image at a time. Therefore, 3D features could be extracted from adjacent slices, which may not be detectable from a single 2D image. The input data for each knee were a sequence of double-echo steady-state (DESS) MR images, and each knee was labeled by the Kellgren and Lawrence (KL) grade of severity at levels 0–4. In addition to the 5-category KL grade classification, we further examined a 2-category classification that distinguishes non-OA (KL ≤ 1) from OA (KL ≥ 2) knees. Clinically, diagnosing a patient with knee OA is the ultimate goal of assigning a KL grade. On a dataset with 1100 knees, the 3Dmore »CNN model that classifies knees with and without OA achieved an accuracy of 86.5% on the validation set and 83.0% on the testing set. We further conducted a comparative study between MRI and X-ray. Compared with a CNN model using X-ray images trained from the same group of patients, the proposed 3D model with MR images achieved higher accuracy in both the 5-category classification (54.0% vs. 50.0%) and the 2-category classification (83.0% vs. 77.0%). The result indicates that MRI, with the application of a 3D CNN model, has greater potential to improve diagnosis accuracy for knee OA clinically than the currently used X-ray methods.« less