The accurate assessment of White matter hyperintensities (WMH) burden is of crucial importance for epidemiological studies to determine association between WMHs, cognitive and clinical data. The manual delineation of WMHs is tedious, costly and time consuming. This is further complicated by the fact that other pathological features (i.e. stroke lesions) often also appear as hyperintense. Several automated methods aiming to tackle the challenges of WMH segmentation have been proposed, however cannot differentiate between WMH and strokes. Other methods, capable of distinguishing between different pathologies in brain MRI, are not designed with simultaneous WMH and stroke segmentation in mind. In this work we propose to use a convolutional neural network (CNN) that is able to segment hyperintensities and differentiate between WMHs and stroke lesions. Specifically, we aim to distinguish between WMH pathologies from those caused by stroke lesions due to either cortical, large or small subcortical infarcts. As far as we know, this is the first time such differentiation task has explicitly been proposed. The proposed fully convolutional CNN architecture, is comprised of an analysis path, that gradually learns low and high level features, followed by a synthesis path, that gradually combines and up-samples the low and high level features into a class likelihood semantic segmentation. Quantitatively, the proposed CNN architecture is shown to outperform other well established and state-of-the-art algorithms in terms of overlap with manual expert annotations. Clinically, the extracted WMH volumes were found to correlate better with the Fazekas visual rating score. Additionally, a comparison of the associations found between clinical risk-factors and the WMH volumes generated by the proposed method, were found to be in line with the associations found with the expert-annotated volumes.
In the following we review existing methods and challenges that are related to our work, especially on Multiple sclerosis (MS), WMH and stroke lesion segmentation in MR imaging. Additionally, some more general CNN segmentation approaches that share architectural similarities with the method we propose here are also reviewed in this section. Over the last few years, there has been an increased amount of research going on in these areas @cite_70 @cite_47 @cite_24 @cite_18 . Although some of the methods mentioned here were proposed for segmenting different pathologies rather than the ones we explore in this work, they can in fact be applied to different tasks. As mentioned before, these methods can be broadly classified into , , and , depending on the amount of expertly annotated data available.
@cite_70 @cite_47 @cite_18 @cite_24
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Abstract In this paper, we present a novel automated method for White Matter (WM) lesion segmentation of Multiple Sclerosis (MS) patient images. Our approach is based on a cascade of two 3D patch-wise convolutional neural networks (CNN). The first network is trained to be more sensitive revealing possible candidate lesion voxels while the second network is trained to reduce the number of misclassified voxels coming from the first network. This cascaded CNN architecture tends to learn well from a small ( n ≤ 35 ) set of labeled data of the same MRI contrast, which can be very interesting in practice, given the difficulty to obtain manual label annotations and the large amount of available unlabeled Magnetic Resonance Imaging (MRI) data. We evaluate the accuracy of the proposed method on the public MS lesion segmentation challenge MICCAI2008 dataset, comparing it with respect to other state-of-the-art MS lesion segmentation tools. Furthermore, the proposed method is also evaluated on two private MS clinical datasets, where the performance of our method is also compared with different recent public available state-of-the-art MS lesion segmentation methods. At the time of writing this paper, our method is the best ranked approach on the MICCAI2008 challenge, outperforming the rest of 60 participant methods when using all the available input modalities (T1-w, T2-w and FLAIR), while still in the top-rank (3rd position) when using only T1-w and FLAIR modalities. On clinical MS data, our approach exhibits a significant increase in the accuracy segmenting of WM lesions when compared with the rest of evaluated methods, highly correlating ( r ≥ 0.97 ) also with the expected lesion volume. Abstract Magnetic resonance (MR) imaging is often used to characterize and quantify multiple sclerosis (MS) lesions in the brain and spinal cord. The number and volume of lesions have been used to evaluate MS disease burden, to track the progression of the disease and to evaluate the effect of new pharmaceuticals in clinical trials. Accurate identification of MS lesions in MR images is extremely difficult due to variability in lesion location, size and shape in addition to anatomical variability between subjects. Since manual segmentation requires expert knowledge, is time consuming and is subject to intra- and inter-expert variability, many methods have been proposed to automatically segment lesions. The objective of this study was to carry out a systematic review of the literature to evaluate the state of the art in automated multiple sclerosis lesion segmentation. From 1240 hits found initially with PubMed and Google scholar, our selection criteria identified 80 papers that described an automatic lesion segmentation procedure applied to MS. Only 47 of these included quantitative validation with at least one realistic image. In this paper, we describe the complexity of lesion segmentation, classify the automatic MS lesion segmentation methods found, and review the validation methods applied in each of the papers reviewed. Although many segmentation solutions have been proposed, including some with promising results using MRI data obtained on small groups of patients, no single method is widely employed due to performance issues related to the high variability of MS lesion appearance and differences in image acquisition. The challenge remains to provide segmentation techniques that work in all cases regardless of the type of MS, duration of the disease, or MRI protocol, and this within a comprehensive, standardized validation framework. MS lesion segmentation remains an open problem. A new algorithm is presented for the automatic segmentation of Multiple Sclerosis (MS) lesions in 3D Magnetic Resonance (MR) images. It builds on a discriminative random decision forest framework to provide a voxel-wise probabilistic classification of the volume. The method uses multi-channel MR intensities (T1, T2, and FLAIR), knowledge on tissue classes and long-range spatial context to discriminate lesions from background. A symmetry feature is introduced accounting for the fact that some MS lesions tend to develop in an asymmetric way. Quantitative evaluation of the proposed methods is carried out on publicly available labeled cases from the MICCAI MS Lesion Segmentation Challenge 2008 dataset. When tested on the same data, the presented method compares favorably to all earlier methods. In an a posteriori analysis, we show how selected features during classification can be ranked according to their discriminative power and reveal the most important ones. We propose a novel segmentation approach based on deep 3D convolutional encoder networks with shortcut connections and apply it to the segmentation of multiple sclerosis (MS) lesions in magnetic resonance images. Our model is a neural network that consists of two interconnected pathways, a convolutional pathway, which learns increasingly more abstract and higher-level image features, and a deconvolutional pathway, which predicts the final segmentation at the voxel level. The joint training of the feature extraction and prediction pathways allows for the automatic learning of features at different scales that are optimized for accuracy for any given combination of image types and segmentation task. In addition, shortcut connections between the two pathways allow high- and low-level features to be integrated, which enables the segmentation of lesions across a wide range of sizes. We have evaluated our method on two publicly available data sets (MICCAI 2008 and ISBI 2015 challenges) with the results showing that our method performs comparably to the top-ranked state-of-the-art methods, even when only relatively small data sets are available for training. In addition, we have compared our method with five freely available and widely used MS lesion segmentation methods (EMS, LST-LPA, LST-LGA, Lesion-TOADS, and SLS) on a large data set from an MS clinical trial. The results show that our method consistently outperforms these other methods across a wide range of lesion sizes.