arXiv subjects

Alessandro Cagol

Publications and source records attributed to Alessandro Cagol.

5 recordsLinked to original sources

arXiv2026

Efficient Transformer-Based Localized Patch Sampling for Choroid Plexus Segmentation in Multiple Sclerosis

Background: The lateral ventricle choroid plexus (LVCP) is gaining recognition as a key imaging biomarker for multiple sclerosis (MS) related to physical disability and neuroinflammation. Yet, manual segmentation of the LVCP is highly tedious, restricting its use in broad clinical trials and longitudinal assessments. This research aims to develop a SwinUNETR-driven pipeline that leverages targeted intra- and peri-ventricular small patch sampling to automatically segment the LVCP in MS from both standalone and multi-modal MRI inputs. Methods: We retrospectively assessed 3T MRI scans across three sets of data stemming from two separate MS-dominant cohorts (Dataset 1: n=177; Dataset 2: n=177; expanded test set: n=388). Our method employed a SwinUNETR architecture trained on 32x32x32 voxel patches, benchmarking it against the 3D UXNET model. The primary metric for evaluation was the Dice Similarity Coefficient (DSC), supplemented by computational demand (GFLOPs) and the 95th percentile Hausdorff Distance (HD95). Results: On the extended test set, the SwinUNETR model secured a mean DSC of 0.868 (95% CI: 0.863-0.872) with MPRAGE and FLAIR combined, showing a statistically significant gain over UXNET (DSC: 0.858 [95% CI: 0.853-0.862], p<0.0001). When restricted to standalone FLAIR inputs, the transformer-based approach sustained a high DSC of 0.863, while the spatial localization of UXNET worsened considerably (HD95: 1.86 vs. 3.00 mm). Importantly, the proposed framework lowered computational load by 99% (91.8 vs. 22,080 GFLOPs). By integrating localized patch sampling with a SwinUNETR architecture, this methodology offers an accurate, robust, and statistically superior alternative to current leading models for LVCP segmentation. Its vast reduction in computational cost makes it ideal for widespread implementation in clinical and research environments.

cs.CV↗

arXiv2025

Benchmarking and Explaining Deep Learning Cortical Lesion MRI Segmentation in Multiple Sclerosis

Cortical lesions (CLs) have emerged as valuable biomarkers in multiple sclerosis (MS), offering high diagnostic specificity and prognostic relevance. However, their routine clinical integration remains limited due to subtle magnetic resonance imaging (MRI) appearance, challenges in expert annotation, and a lack of standardized automated methods. We propose a comprehensive multi-centric benchmark of CL detection and segmentation in MRI. A total of 656 MRI scans, including clinical trial and research data from four institutions, were acquired at 3T and 7T using MP2RAGE and MPRAGE sequences with expert-consensus annotations. We rely on the self-configuring nnU-Net framework, designed for medical imaging segmentation, and propose adaptations tailored to the improved CL detection. We evaluated model generalization through out-of-distribution testing, demonstrating strong lesion detection capabilities with an F1-score of 0.64 and 0.5 in and out of the domain, respectively. We also analyze internal model features and model errors for a better understanding of AI decision-making. Our study examines how data variability, lesion ambiguity, and protocol differences impact model performance, offering future recommendations to address these barriers to clinical adoption. To reinforce the reproducibility, the implementation and models will be publicly accessible and ready to use at https://github.com/Medical-Image-Analysis-Laboratory/ and https://doi.org/10.5281/zenodo.15911797.

eess.IV↗

arXiv2025

Explaining Uncertainty in Multiple Sclerosis Cortical Lesion Segmentation Beyond Prediction Errors

Trustworthy artificial intelligence (AI) is essential in healthcare, particularly for high-stakes tasks like medical image segmentation. Explainable AI and uncertainty quantification significantly enhance AI reliability by addressing key attributes such as robustness, usability, and explainability. Despite extensive technical advances in uncertainty quantification for medical imaging, understanding the clinical informativeness and interpretability of uncertainty remains limited. This study presents an interpretability framework for analyzing lesion-scale predictive uncertainty in cortical lesion segmentation in multiple sclerosis using deep ensembles. The analysis shifts the focus from the uncertainty--error relationship towards clinically relevant medical and engineering factors. Our findings reveal that instance-wise uncertainty is strongly related to lesion size, shape, and cortical involvement. Expert rater feedback confirms that similar factors impede annotator confidence. Evaluations conducted on two datasets (206 patients, almost 2000 lesions) under both in-domain and distribution-shift conditions highlight the utility of the framework in different scenarios.

eess.IV↗

arXiv2024

Unveiling Normative Trajectories of Lifespan Brain Maturation Using Quantitative MRI

Background: Brain maturation and aging involve significant microstructural changes, resulting in functional and cognitive alterations. Quantitative MRI (qMRI) can measure this evolution, distinguishing the physiological effects of normal aging from pathological deviations. Methods: We conducted a multicentre study using qMRI metrics (R1, R2*, and Quantitative Susceptibility Mapping) to model age trajectories across brain structures, including tractography-based white matter bundles (TWMB), superficial white matter (SWM), and cortical grey matter (CGM). MRI data from 537 healthy subjects, aged 8 to 79 years, were harmonized using two independent methods. We modeled age trajectories and performed regional analyses to capture maturation patterns and aging effects across the lifespan. Findings: Our findings revealed a distinct brain maturation gradient, with early qMRI peak values in TWMB, followed by SWM, and culminating in CGM regions. This gradient was observed as a posterior-to-anterior maturation pattern in the cortex and an inferior-to-superior maturation pattern in white matter tracts. R1 demonstrated the most robust age trajectories, while R2* and susceptibility exhibited greater variability and different patterns. The normative modeling framework confirmed the reliability of our age-modelled trajectories across datasets. Interpretation: Our study highlights the potential of multiparametric qMRI to capture complex, region-specific brain development patterns, addressing the need for comprehensive, age-spanning studies across multiple brain structures. Various harmonization strategies can merge qMRI cohorts, improving the robustness of qMRI-based age models and facilitating the understanding of normal patterns and disease-associated deviations.

physics.med-ph↗

arXiv2023

Fast refacing of MR images with a generative neural network lowers re-identification risk and preserves volumetric consistency

With the rise of open data, identifiability of individuals based on 3D renderings obtained from routine structural magnetic resonance imaging (MRI) scans of the head has become a growing privacy concern. To protect subject privacy, several algorithms have been developed to de-identify imaging data using blurring, defacing or refacing. Completely removing facial structures provides the best re-identification protection but can significantly impact post-processing steps, like brain morphometry. As an alternative, refacing methods that replace individual facial structures with generic templates have a lower effect on the geometry and intensity distribution of original scans, and are able to provide more consistent post-processing results by the price of higher re-identification risk and computational complexity. In the current study, we propose a novel method for anonymised face generation for defaced 3D T1-weighted scans based on a 3D conditional generative adversarial network. To evaluate the performance of the proposed de-identification tool, a comparative study was conducted between several existing defacing and refacing tools, with two different segmentation algorithms (FAST and Morphobox). The aim was to evaluate (i) impact on brain morphometry reproducibility, (ii) re-identification risk, (iii) balance between (i) and (ii), and (iv) the processing time. The proposed method takes 9 seconds for face generation and is suitable for recovering consistent post-processing results after defacing.

eess.IV↗