Unsupervised Lesion Detection via Image Restoration with a Normative Prior

Unsupervised lesion detection is a challenging problem that requires accurately estimating normative distributions of healthy anatomy and detecting lesions as outliers without training examples. Recently, this problem has received increased attention from the research community following the advances in unsupervised learning with deep learning. Such advances allow the estimation of high-dimensional distributions, such as normative distributions, with higher accuracy than previous methods.The main approach of the recently proposed methods is to learn a latent-variable model parameterized with networks to approximate the normative distribution using example images showing healthy anatomy, perform prior-projection, i.e. reconstruct the image with lesions using the latent-variable model, and determine lesions based on the differences between the reconstructed and original images. While being promising, the prior-projection step often leads to a large number of false positives. In this work, we approach unsupervised lesion detection as an image restoration problem and propose a probabilistic model that uses a network-based prior as the normative distribution and detect lesions pixel-wise using MAP estimation. The probabilistic model punishes large deviations between restored and original images, reducing false positives in pixel-wise detections. Experiments with gliomas and stroke lesions in brain MRI using publicly available datasets show that the proposed approach outperforms the state-of-the-art unsupervised methods by a substantial margin, +0.13 (AUC), for both glioma and stroke detection. Extensive model analysis confirms the effectiveness of MAP-based image restoration.Comment: Extended version of 'Unsupervised Lesion Detection via Image Restoration with a Normative Prior' (MIDL2019

Unsupervised 3D Brain Anomaly Detection

Anomaly detection (AD) is the identification of data samples that do not fit a learned data distribution. As such, AD systems can help physicians to determine the presence, severity, and extension of a pathology. Deep generative models, such as Generative Adversarial Networks (GANs), can be exploited to capture anatomical variability. Consequently, any outlier (i.e., sample falling outside of the learned distribution) can be detected as an abnormality in an unsupervised fashion. By using this method, we can not only detect expected or known lesions, but we can even unveil previously unrecognized biomarkers. To the best of our knowledge, this study exemplifies the first AD approach that can efficiently handle volumetric data and detect 3D brain anomalies in one single model. Our proposal is a volumetric and high-detail extension of the 2D f-AnoGAN model obtained by combining a state-of-the-art 3D GAN with refinement training steps. In experiments using non-contrast computed tomography images from traumatic brain injury (TBI) patients, the model detects and localizes TBI abnormalities with an area under the ROC curve of ~75%. Moreover, we test the potential of the method for detecting other anomalies such as low quality images, preprocessing inaccuracies, artifacts, and even the presence of post-operative signs (such as a craniectomy or a brain shunt). The method has potential for rapidly labeling abnormalities in massive imaging datasets, as well as identifying new biomarkers.Comment: Accepted at BrainLes Workshop in MICCAI 202

Anomaly detection through latent space restoration using vector-quantized variational autoencoders

We propose an out-of-distribution detection method that combines density and restoration-based approaches using Vector-Quantized Variational Auto-Encoders (VQ-VAEs). The VQ-VAE model learns to encode images in a categorical latent space. The prior distribution of latent codes is then modelled using an Auto-Regressive (AR) model. We found that the prior probability estimated by the AR model can be useful for unsupervised anomaly detection and enables the estimation of both sample and pixel-wise anomaly scores. The sample-wise score is defined as the negative log-likelihood of the latent variables above a threshold selecting highly unlikely codes. Additionally, out-of-distribution images are restored into in-distribution images by replacing unlikely latent codes with samples from the prior model and decoding to pixel space. The average L1 distance between generated restorations and original image is used as pixel-wise anomaly score. We tested our approach on the MOOD challenge datasets, and report higher accuracies compared to a standard reconstruction-based approach with VAEs

Automated triaging of head MRI examinations using convolutional neural networks

The growing demand for head magnetic resonance imaging (MRI) examinations, along with a global shortage of radiologists, has led to an increase in the time taken to report head MRI scans around the world. For many neurological conditions, this delay can result in increased morbidity and mortality. An automated triaging tool could reduce reporting times for abnormal examinations by identifying abnormalities at the time of imaging and prioritizing the reporting of these scans. In this work, we present a convolutional neural network for detecting clinically-relevant abnormalities in $\text{T}_2$-weighted head MRI scans. Using a validated neuroradiology report classifier, we generated a labelled dataset of 43,754 scans from two large UK hospitals for model training, and demonstrate accurate classification (area under the receiver operating curve (AUC) = 0.943) on a test set of 800 scans labelled by a team of neuroradiologists. Importantly, when trained on scans from only a single hospital the model generalized to scans from the other hospital ($\Delta$AUC $\leq$ 0.02). A simulation study demonstrated that our model would reduce the mean reporting time for abnormal examinations from 28 days to 14 days and from 9 days to 5 days at the two hospitals, demonstrating feasibility for use in a clinical triage environment.Comment: Accepted as an oral presentation at Medical Imaging with Deep Learning (MIDL) 202

A large, curated, open-source stroke neuroimaging dataset to improve lesion segmentation algorithms.

Accurate lesion segmentation is critical in stroke rehabilitation research for the quantification of lesion burden and accurate image processing. Current automated lesion segmentation methods for T1-weighted (T1w) MRIs, commonly used in stroke research, lack accuracy and reliability. Manual segmentation remains the gold standard, but it is time-consuming, subjective, and requires neuroanatomical expertise. We previously released an open-source dataset of stroke T1w MRIs and manually-segmented lesion masks (ATLAS v1.2, N = 304) to encourage the development of better algorithms. However, many methods developed with ATLAS v1.2 report low accuracy, are not publicly accessible or are improperly validated, limiting their utility to the field. Here we present ATLAS v2.0 (N = 1271), a larger dataset of T1w MRIs and manually segmented lesion masks that includes training (n = 655), test (hidden masks, n = 300), and generalizability (hidden MRIs and masks, n = 316) datasets. Algorithm development using this larger sample should lead to more robust solutions; the hidden datasets allow for unbiased performance evaluation via segmentation challenges. We anticipate that ATLAS v2.0 will lead to improved algorithms, facilitating large-scale stroke research