A Survey on Deep Learning in Medical Image Analysis <s> Cardiac <s> Abstract The amount of coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular events. CAC is clinically quantified in cardiac calcium scoring CT (CSCT), but it has been shown that cardiac CT angiography (CCTA) may also be used for this purpose. We present a method for automatic CAC quantification in CCTA. This method uses supervised learning to directly identify and quantify CAC without a need for coronary artery extraction commonly used in existing methods. The study included cardiac CT exams of 250 patients for whom both a CCTA and a CSCT scan were available. To restrict the volume-of-interest for analysis, a bounding box around the heart is automatically determined. The bounding box detection algorithm employs a combination of three ConvNets, where each detects the heart in a different orthogonal plane (axial, sagittal, coronal). These ConvNets were trained using 50 cardiac CT exams. In the remaining 200 exams, a reference standard for CAC was defined in CSCT and CCTA. Out of these, 100 CCTA scans were used for training, and the remaining 100 for evaluation of a voxel classification method for CAC identification. The method uses ConvPairs, pairs of convolutional neural networks (ConvNets). The first ConvNet in a pair identifies voxels likely to be CAC, thereby discarding the majority of non-CAC-like voxels such as lung and fatty tissue. The identified CAC-like voxels are further classified by the second ConvNet in the pair, which distinguishes between CAC and CAC-like negatives. Given the different task of each ConvNet, they share their architecture, but not their weights. Input patches are either 2.5D or 3D. The ConvNets are purely convolutional, i.e. no pooling layers are present and fully connected layers are implemented as convolutions, thereby allowing efficient voxel classification. The performance of individual 2.5D and 3D ConvPairs with input sizes of 15 and 25 voxels, as well as the performance of ensembles of these ConvPairs, were evaluated by a comparison with reference annotations in CCTA and CSCT. In all cases, ensembles of ConvPairs outperformed their individual members. The best performing individual ConvPair detected 72% of lesions in the test set, with on average 0.85 false positive (FP) errors per scan. The best performing ensemble combined all ConvPairs and obtained a sensitivity of 71% at 0.48 FP errors per scan. For this ensemble, agreement with the reference mass score in CSCT was excellent (ICC 0.944 [0.918–0.962]). Aditionally, based on the Agatston score in CCTA, this ensemble assigned 83% of patients to the same cardiovascular risk category as reference CSCT. In conclusion, CAC can be accurately automatically identified and quantified in CCTA using the proposed pattern recognition method. This might obviate the need to acquire a dedicated CSCT scan for CAC scoring, which is regularly acquired prior to a CCTA, and thus reduce the CT radiation dose received by patients. <s> BIB001 </s> A Survey on Deep Learning in Medical Image Analysis <s> Cardiac <s> In cardiac magnetic resonance imaging, fully-automatic segmentation of the heart enables precise structural and functional measurements to be taken, e.g. from short-axis MR images of the left-ventricle. In this work we propose a recurrent fully-convolutional network (RFCN) that learns image representations from the full stack of 2D slices and has the ability to leverage inter-slice spatial dependences through internal memory units. RFCN combines anatomical detection and segmentation into a single architecture that is trained end-to-end thus significantly reducing computational time, simplifying the segmentation pipeline, and potentially enabling real-time applications. We report on an investigation of RFCN using two datasets, including the publicly available MICCAI 2009 Challenge dataset. Comparisons have been carried out between fully convolutional networks and deep restricted Boltzmann machines, including a recurrent version that leverages inter-slice spatial correlation. Our studies suggest that RFCN produces state-of-the-art results and can substantially improve the delineation of contours near the apex of the heart. <s> BIB002 </s> A Survey on Deep Learning in Medical Image Analysis <s> Cardiac <s> Accurate measurement of left ventricular volumes and Ejection Fraction from cine MRI is of paramount importance to the evaluation of cardiovascular functions, yet it usually requires laborious and tedious work of trained experts to interpret them. To facilitate this procedure, numerous computer aided diagnosis (CAD) methods and tools have been proposed, most of which focus on the left or right ventricle segmentation. However, the identification of ES and ED frames from cardiac sequences is largely ignored, which is a key procedure in the automated workflow. This seemingly easy task is quite challenging, due to the requirement of high accuracy (i.e., precisely identifying specific frames from a sequence) and subtle differences among consecutive frames. Recently, with the rapid growth of annotated data and the increasing computational power, deep learning methods have been widely exploited in medical image analysis. In this paper, we propose a novel deep learning architecture, named as temporal regression network (TempReg-Net), to accurately identify specific frames from MRI sequences, by integrating the Convolutional Neural Network (CNN) with the Recurrent Neural Network (RNN). Specifically, a CNN encodes the spatial information of a cardiac sequence, and a RNN decodes the temporal information. In addition, we design a new loss function in our network to constrain the structure of predicted labels, which further improves the performance. Our approach is extensively validated on thousands of cardiac sequences and the average difference is merely 0.4 frames, comparing favorably with previous systems. <s> BIB003
Deep learning has been applied to many aspects of cardiac image analysis; the literature is summarized in Table 7 . MRI is the most researched modality and left ventricle segmentation the most common task, but the number of applications is highly diverse: segmentation, tracking, slice classification, image quality assessment, automated calcium scoring and coronary centerline tracking, and super-resolution. Most papers used simple 2D CNNs and analyzed the 3D and often 4D data slice by slice; the exception is BIB001 where 3D CNNs were used. DBNs are used in four papers, but these all originated from the same author group. The DBNs are only used for feature extraction and are integrated in compound segmentation frameworks. Two papers are exceptional because they combined CNNs with RNNs: BIB002 introduced a recurrent connection within the Unet architecture to segment the left ventricle slice by slice and learn what information to remember from the previous slices when segmenting the next one. BIB003 used an architecture with a standard 2D CNN and an LSTM to perform temporal regression to identify specific frames and a cardiac sequence. Many papers use publicly available data. The largest challenge in this field was the 2015 Kaggle Data Science Bowl where the goal was to automatically measure endsystolic and end-diastolic volumes in cardiac MRI. 192 teams competed for $200,000 in prize money and the top ranking teams all used deep learning, in particular fCNN or U-net segmentation schemes.