arXiv subjects

Ivana Išgum

Publications and source records attributed to Ivana Išgum.

At least 37 records · Page 2Linked to original sources

arXiv2021

AI for Calcium Scoring

Calcium scoring, a process in which arterial calcifications are detected and quantified in CT, is valuable in estimating the risk of cardiovascular disease events. Especially when used to quantify the extent of calcification in the coronary arteries, it is a strong and independent predictor of coronary heart disease events. Advances in artificial intelligence (AI)-based image analysis have produced a multitude of automatic calcium scoring methods. While most early methods closely follow standard calcium scoring accepted in clinic, recent approaches extend this procedure to enable faster or more reproducible calcium scoring. This chapter provides an introduction to AI for calcium scoring, and an overview of the developed methods and their applications. We conclude with a discussion on AI methods in calcium scoring and propose potential directions for future research.

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arXiv2020

Automatic segmentation with detection of local segmentation failures in cardiac MRI

Segmentation of cardiac anatomical structures in cardiac magnetic resonance images (CMRI) is a prerequisite for automatic diagnosis and prognosis of cardiovascular diseases. To increase robustness and performance of segmentation methods this study combines automatic segmentation and assessment of segmentation uncertainty in CMRI to detect image regions containing local segmentation failures. Three state-of-the-art convolutional neural networks (CNN) were trained to automatically segment cardiac anatomical structures and obtain two measures of predictive uncertainty: entropy and a measure derived by MC-dropout. Thereafter, using the uncertainties another CNN was trained to detect local segmentation failures that potentially need correction by an expert. Finally, manual correction of the detected regions was simulated. Using publicly available CMR scans from the MICCAI 2017 ACDC challenge, the impact of CNN architecture and loss function for segmentation, and the uncertainty measure was investigated. Performance was evaluated using the Dice coefficient and 3D Hausdorff distance between manual and automatic segmentation. The experiments reveal that combining automatic segmentation with simulated manual correction of detected segmentation failures leads to statistically significant performance increase.

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arXiv2020

Unsupervised Super-Resolution: Creating High-Resolution Medical Images from Low-Resolution Anisotropic Examples

Although high resolution isotropic 3D medical images are desired in clinical practice, their acquisition is not always feasible. Instead, lower resolution images are upsampled to higher resolution using conventional interpolation methods. Sophisticated learning-based super-resolution approaches are frequently unavailable in clinical setting, because such methods require training with high-resolution isotropic examples. To address this issue, we propose a learning-based super-resolution approach that can be trained using solely anisotropic images, i.e. without high-resolution ground truth data. The method exploits the latent space, generated by autoencoders trained on anisotropic images, to increase spatial resolution in low-resolution images. The method was trained and evaluated using 100 publicly available cardiac cine MR scans from the Automated Cardiac Diagnosis Challenge (ACDC). The quantitative results show that the proposed method performs better than conventional interpolation methods. Furthermore, the qualitative results indicate that especially finer cardiac structures are synthesized with high quality. The method has the potential to be applied to other anatomies and modalities and can be easily applied to any 3D anisotropic medical image dataset.

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arXiv2020

Deep Group-wise Variational Diffeomorphic Image Registration

Deep neural networks are increasingly used for pair-wise image registration. We propose to extend current learning-based image registration to allow simultaneous registration of multiple images. To achieve this, we build upon the pair-wise variational and diffeomorphic VoxelMorph approach and present a general mathematical framework that enables both registration of multiple images to their geodesic average and registration in which any of the available images can be used as a fixed image. In addition, we provide a likelihood based on normalized mutual information, a well-known image similarity metric in registration, between multiple images, and a prior that allows for explicit control over the viscous fluid energy to effectively regularize deformations. We trained and evaluated our approach using intra-patient registration of breast MRI and Thoracic 4DCT exams acquired over multiple time points. Comparison with Elastix and VoxelMorph demonstrates competitive quantitative performance of the proposed method in terms of image similarity and reference landmark distances at significantly faster registration.

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arXiv2020

Deep Learning from Dual-Energy Information for Whole-Heart Segmentation in Dual-Energy and Single-Energy Non-Contrast-Enhanced Cardiac CT

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.

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arXiv2020

Deep Learning-Based Regression and Classification for Automatic Landmark Localization in Medical Images

In this study, we propose a fast and accurate method to automatically localize anatomical landmarks in medical images. We employ a global-to-local localization approach using fully convolutional neural networks (FCNNs). First, a global FCNN localizes multiple landmarks through the analysis of image patches, performing regression and classification simultaneously. In regression, displacement vectors pointing from the center of image patches towards landmark locations are determined. In classification, presence of landmarks of interest in the patch is established. Global landmark locations are obtained by averaging the predicted displacement vectors, where the contribution of each displacement vector is weighted by the posterior classification probability of the patch that it is pointing from. Subsequently, for each landmark localized with global localization, local analysis is performed. Specialized FCNNs refine the global landmark locations by analyzing local sub-images in a similar manner, i.e. by performing regression and classification simultaneously and combining the results. Evaluation was performed through localization of 8 anatomical landmarks in CCTA scans, 2 landmarks in olfactory MR scans, and 19 landmarks in cephalometric X-rays. We demonstrate that the method performs similarly to a second observer and is able to localize landmarks in a diverse set of medical images, differing in image modality, image dimensionality, and anatomical coverage.

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arXiv2019

Exploiting Clinically Available Delineations for CNN-based Segmentation in Radiotherapy Treatment Planning

Convolutional neural networks (CNNs) have been widely and successfully used for medical image segmentation. However, CNNs are typically considered to require large numbers of dedicated expert-segmented training volumes, which may be limiting in practice. This work investigates whether clinically obtained segmentations which are readily available in picture archiving and communication systems (PACS) could provide a possible source of data to train a CNN for segmentation of organs-at-risk (OARs) in radiotherapy treatment planning. In such data, delineations of structures deemed irrelevant to the target clinical use may be lacking. To overcome this issue, we use multi-label instead of multi-class segmentation. We empirically assess how many clinical delineations would be sufficient to train a CNN for the segmentation of OARs and find that increasing the training set size beyond a limited number of images leads to sharply diminishing returns. Moreover, we find that by using multi-label segmentation, missing structures in the reference standard do not have a negative effect on overall segmentation accuracy. These results indicate that segmentations obtained in a clinical workflow can be used to train an accurate OAR segmentation model.

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arXiv2019

Automatic Online Quality Control of Synthetic CTs

Accurate MR-to-CT synthesis is a requirement for MR-only workflows in radiotherapy (RT) treatment planning. In recent years, deep learning-based approaches have shown impressive results in this field. However, to prevent downstream errors in RT treatment planning, it is important that deep learning models are only applied to data for which they are trained and that generated synthetic CT (sCT) images do not contain severe errors. For this, a mechanism for online quality control should be in place. In this work, we use an ensemble of sCT generators and assess their disagreement as a measure of uncertainty of the results. We show that this uncertainty measure can be used for two kinds of online quality control. First, to detect input images that are outside the expected distribution of MR images. Second, to identify sCT images that were generated from suitable MR images but potentially contain errors. Such automatic online quality control for sCT generation is likely to become an integral part of MR-only RT workflows.

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arXiv2019

Deep learning analysis of coronary arteries in cardiac CT angiography for detection of patients requiring invasive coronary angiography

In patients with obstructive coronary artery disease, the functional significance of a coronary artery stenosis needs to be determined to guide treatment. This is typically established through fractional flow reserve (FFR) measurement, performed during invasive coronary angiography (ICA). We present a method for automatic and non-invasive detection of patients requiring ICA, employing deep unsupervised analysis of complete coronary arteries in cardiac CT angiography (CCTA) images. We retrospectively collected CCTA scans of 187 patients, 137 of them underwent invasive FFR measurement in 192 different coronary arteries. These FFR measurements served as a reference standard for the functional significance of the coronary stenosis. The centerlines of the coronary arteries were extracted and used to reconstruct straightened multi-planar reformatted (MPR) volumes. To automatically identify arteries with functionally significant stenosis that require ICA, each MPR volume was encoded into a fixed number of encodings using two disjoint 3D and 1D convolutional autoencoders performing spatial and sequential encodings, respectively. Thereafter, these encodings were employed to classify arteries using a support vector machine classifier. The detection of coronary arteries requiring invasive evaluation, evaluated using repeated cross-validation experiments, resulted in an area under the receiver operating characteristic curve of $0.81 \pm 0.02$ on the artery-level, and $0.87 \pm 0.02$ on the patient-level. The results demonstrate the feasibility of automatic non-invasive detection of patients that require ICA and possibly subsequent coronary artery intervention. This could potentially reduce the number of patients that unnecessarily undergo ICA.

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arXiv2019

Combined analysis of coronary arteries and the left ventricular myocardium in cardiac CT angiography for detection of patients with functionally significant stenosis

Treatment of patients with obstructive coronary artery disease is guided by the functional significance of a coronary artery stenosis. Fractional flow reserve (FFR), measured during invasive coronary angiography (ICA), is considered the gold standard to define the functional significance of a coronary stenosis. Here, we present a method for non-invasive detection of patients with functionally significant coronary artery stenosis, combining analysis of the coronary artery tree and the left ventricular (LV) myocardium in cardiac CT angiography (CCTA) images. We retrospectively collected CCTA scans of 126 patients who underwent invasive FFR measurements, to determine the functional significance of coronary stenoses. We combine our previous works for the analysis of the complete coronary artery tree and the LV myocardium: Coronary arteries are encoded by two disjoint convolutional autoencoders (CAEs) and the LV myocardium is characterized by a convolutional neural network (CNN) and a CAE. Thereafter, using the extracted encodings of all coronary arteries and the LV myocardium, patients are classified according to the presence of functionally significant stenosis, as defined by the invasively measured FFR. To handle the varying number of coronary arteries in a patient, the classification is formulated as a multiple instance learning problem and is performed using an attention-based neural network. Cross-validation experiments resulted in an average area under the receiver operating characteristic curve of $0.74 \pm 0.01$, and showed that the proposed combined analysis outperformed the analysis of the coronary arteries or the LV myocardium only. The results demonstrate the feasibility of combining the analyses of the complete coronary artery tree and the LV myocardium in CCTA images for the detection of patients with functionally significant stenosis in coronary arteries.

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arXiv2019

CNN-Based Segmentation of the Cardiac Chambers and Great Vessels in Non-Contrast-Enhanced Cardiac CT

Quantification of cardiac structures in non-contrast CT (NCCT) could improve cardiovascular risk stratification. However, setting a manual reference to train a fully convolutional network (FCN) for automatic segmentation of NCCT images is hardly feasible, and an FCN trained on coronary CT angiography (CCTA) images would not generalize to NCCT. Therefore, we propose to train an FCN with virtual non-contrast (VNC) images from a dual-layer detector CT scanner and a reference standard obtained on perfectly aligned CCTA images.

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arXiv2019

Graph Convolutional Networks for Coronary Artery Segmentation in Cardiac CT Angiography

Detection of coronary artery stenosis in coronary CT angiography (CCTA) requires highly personalized surface meshes enclosing the coronary lumen. In this work, we propose to use graph convolutional networks (GCNs) to predict the spatial location of vertices in a tubular surface mesh that segments the coronary artery lumen. Predictions for individual vertex locations are based on local image features as well as on features of neighboring vertices in the mesh graph. The method was trained and evaluated using the publicly available Coronary Artery Stenoses Detection and Quantification Evaluation Framework. Surface meshes enclosing the full coronary artery tree were automatically extracted. A quantitative evaluation on 78 coronary artery segments showed that these meshes corresponded closely to reference annotations, with a Dice similarity coefficient of 0.75/0.73, a mean surface distance of 0.25/0.28 mm, and a Hausdorff distance of 1.53/1.86 mm in healthy/diseased vessel segments. The results showed that inclusion of mesh information in a GCN improves segmentation overlap and accuracy over a baseline model without interaction on the mesh. The results indicate that GCNs allow efficient extraction of coronary artery surface meshes and that the use of GCNs leads to regular and more accurate meshes.

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arXiv2019

Vertebra partitioning with thin-plate spline surfaces steered by a convolutional neural network

Thin-plate splines can be used for interpolation of image values, but can also be used to represent a smooth surface, such as the boundary between two structures. We present a method for partitioning vertebra segmentation masks into two substructures, the vertebral body and the posterior elements, using a convolutional neural network that predicts the boundary between the two structures. This boundary is modeled as a thin-plate spline surface defined by a set of control points predicted by the network. The neural network is trained using the reconstruction error of a convolutional autoencoder to enable the use of unpaired data.

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arXiv2019

Adversarial optimization for joint registration and segmentation in prostate CT radiotherapy

Joint image registration and segmentation has long been an active area of research in medical imaging. Here, we reformulate this problem in a deep learning setting using adversarial learning. We consider the case in which fixed and moving images as well as their segmentations are available for training, while segmentations are not available during testing; a common scenario in radiotherapy. The proposed framework consists of a 3D end-to-end generator network that estimates the deformation vector field (DVF) between fixed and moving images in an unsupervised fashion and applies this DVF to the moving image and its segmentation. A discriminator network is trained to evaluate how well the moving image and segmentation align with the fixed image and segmentation. The proposed network was trained and evaluated on follow-up prostate CT scans for image-guided radiotherapy, where the planning CT contours are propagated to the daily CT images using the estimated DVF. A quantitative comparison with conventional registration using \texttt{elastix} showed that the proposed method improved performance and substantially reduced computation time, thus enabling real-time contour propagation necessary for online-adaptive radiotherapy.

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arXiv2019

Iterative fully convolutional neural networks for automatic vertebra segmentation and identification

Precise segmentation and anatomical identification of the vertebrae provides the basis for automatic analysis of the spine, such as detection of vertebral compression fractures or other abnormalities. Most dedicated spine CT and MR scans as well as scans of the chest, abdomen or neck cover only part of the spine. Segmentation and identification should therefore not rely on the visibility of certain vertebrae or a certain number of vertebrae. We propose an iterative instance segmentation approach that uses a fully convolutional neural network to segment and label vertebrae one after the other, independently of the number of visible vertebrae. This instance-by-instance segmentation is enabled by combining the network with a memory component that retains information about already segmented vertebrae. The network iteratively analyzes image patches, using information from both image and memory to search for the next vertebra. To efficiently traverse the image, we include the prior knowledge that the vertebrae are always located next to each other, which is used to follow the vertebral column. This method was evaluated with five diverse datasets, including multiple modalities (CT and MR), various fields of view and coverages of different sections of the spine, and a particularly challenging set of low-dose chest CT scans. The proposed iterative segmentation method compares favorably with state-of-the-art methods and is fast, flexible and generalizable.

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arXiv2019

Improving Myocardium Segmentation in Cardiac CT Angiography using Spectral Information

Accurate segmentation of the left ventricle myocardium in cardiac CT angiography (CCTA) is essential for e.g. the assessment of myocardial perfusion. Automatic deep learning methods for segmentation in CCTA might suffer from differences in contrast-agent attenuation between training and test data due to non-standardized contrast administration protocols and varying cardiac output. We propose augmentation of the training data with virtual mono-energetic reconstructions from a spectral CT scanner which show different attenuation levels of the contrast agent. We compare this to an augmentation by linear scaling of all intensity values, and combine both types of augmentation. We train a 3D fully convolutional network (FCN) with 10 conventional CCTA images and corresponding virtual mono-energetic reconstructions acquired on a spectral CT scanner, and evaluate on 40 CCTA scans acquired on a conventional CT scanner. We show that training with data augmentation using virtual mono-energetic images improves upon training with only conventional images (Dice similarity coefficient (DSC) 0.895 $\pm$ 0.039 vs. 0.846 $\pm$ 0.125). In comparison, training with data augmentation using linear scaling improves the DSC to 0.890 $\pm$ 0.039. Moreover, combining the results of both augmentation methods leads to a DSC of 0.901 $\pm$ 0.036, showing that both augmentations lead to different local improvements of the segmentations. Our results indicate that virtual mono-energetic images improve the generalization of an FCN used for myocardium segmentation in CCTA images.

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arXiv2019

Towards increased trustworthiness of deep learning segmentation methods on cardiac MRI

Current state-of-the-art deep learning segmentation methods have not yet made a broad entrance into the clinical setting in spite of high demand for such automatic methods. One important reason is the lack of reliability caused by models that fail unnoticed and often locally produce anatomically implausible results that medical experts would not make. This paper presents an automatic image segmentation method based on (Bayesian) dilated convolutional networks (DCNN) that generate segmentation masks and spatial uncertainty maps for the input image at hand. The method was trained and evaluated using segmentation of the left ventricle (LV) cavity, right ventricle (RV) endocardium and myocardium (Myo) at end-diastole (ED) and end-systole (ES) in 100 cardiac 2D MR scans from the MICCAI 2017 Challenge (ACDC). Combining segmentations and uncertainty maps and employing a human-in-the-loop setting, we provide evidence that image areas indicated as highly uncertain regarding the obtained segmentation almost entirely cover regions of incorrect segmentations. The fused information can be harnessed to increase segmentation performance. Our results reveal that we can obtain valuable spatial uncertainty maps with low computational effort using DCNNs.

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arXiv2018

Generative adversarial networks and adversarial methods in biomedical image analysis

Generative adversarial networks (GANs) and other adversarial methods are based on a game-theoretical perspective on joint optimization of two neural networks as players in a game. Adversarial techniques have been extensively used to synthesize and analyze biomedical images. We provide an introduction to GANs and adversarial methods, with an overview of biomedical image analysis tasks that have benefited from such methods. We conclude with a discussion of strengths and limitations of adversarial methods in biomedical image analysis, and propose potential future research directions.

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