Spatially-Constrained Fisher Representation for Brain Disease Identification With Incomplete Multi-Modal Neuroimages

A review of deep learning-based information fusion techniques for multimodal medical image classification

Multimodal medical imaging plays a pivotal role in clinical diagnosis and research, as it combines information from various imaging modalities to provide a more comprehensive understanding of the underlying pathology. Recently, deep learning-based multimodal fusion techniques have emerged as powerful tools for improving medical image classification. This review offers a thorough analysis of the developments in deep learning-based multimodal fusion for medical classification tasks. We explore the complementary relationships among prevalent clinical modalities and outline three main fusion schemes for multimodal classification networks: input fusion, intermediate fusion (encompassing single-level fusion, hierarchical fusion, and attention-based fusion), and output fusion. By evaluating the performance of these fusion techniques, we provide insight into the suitability of different network architectures for various multimodal fusion scenarios and application domains. Furthermore, we delve into challenges related to network architecture selection, handling incomplete multimodal data management, and the potential limitations of multimodal fusion. Finally, we spotlight the promising future of Transformer-based multimodal fusion techniques and give recommendations for future research in this rapidly evolving field.

Which neuroimaging and fluid biomarkers method is better in theranostic of Alzheimer's disease? An umbrella review

Biomarkers are measured to evaluate physiological and pathological processes as well as responses to a therapeutic intervention. Biomarkers can be classified as diagnostic, prognostic, predictor, clinical, and therapeutic. In Alzheimer's disease (AD), multiple biomarkers have been reported so far. Nevertheless, finding a specific biomarker in AD remains a major challenge. Three databases, including PubMed, Web of Science, and Scopus were selected with the keywords of Alzheimer's disease, neuroimaging, biomarker, and blood. The results were finalized with 49 potential CSF/blood and 35 neuroimaging biomarkers. To distinguish normal from AD patients, amyloid-beta42 (Aβ42), plasma glial fibrillary acidic protein (GFAP), and neurofilament light (NFL) as potential biomarkers in cerebrospinal fluid (CSF) as well as the serum could be detected. Nevertheless, most of the biomarkers fairly change in the CSF during AD, listed as kallikrein 6, virus-like particles (VLP-1), galectin-3 (Gal-3), and synaptotagmin-1 (Syt-1). From the neuroimaging aspect, atrophy is an accepted biomarker for the neuropathologic progression of AD. In addition, Magnetic resonance spectroscopy (MRS), diffusion weighted imaging (DWI), diffusion tensor imaging (DTI), tractography (DTT), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI), can be used to detect AD. Using neuroimaging and CSF/blood biomarkers, in combination with artificial intelligence, it is possible to obtain information on prognosis and follow-up on the different stages of AD. Hence physicians could select the suitable therapy to attenuate disease symptoms and follow up on the efficiency of the prescribed drug.

Multi-Template Meta-Information Regularized Network for Alzheimer's Disease Diagnosis Using Structural MRI

Structural magnetic resonance imaging (sMRI) has been widely applied in computer-aided Alzheimer's disease (AD) diagnosis, owing to its capabilities in providing detailed brain morphometric patterns and anatomical features in vivo. Although previous works have validated the effectiveness of incorporating metadata (e.g., age, gender, and educational years) for sMRI-based AD diagnosis, existing methods solely paid attention to metadata-associated correlation to AD (e.g., gender bias in AD prevalence) or confounding effects (e.g., the issue of normal aging and metadata-related heterogeneity). Hence, it is difficult to fully excavate the influence of metadata on AD diagnosis. To address these issues, we constructed a novel Multi-template Meta-information Regularized Network (MMRN) for AD diagnosis. Specifically, considering diagnostic variation resulting from different spatial transformations onto different brain templates, we first regarded different transformations as data augmentation for self-supervised learning after template selection. Since the confounding effects may arise from excessive attention to meta-information owing to its correlation with AD, we then designed the modules of weakly supervised meta-information learning and mutual information minimization to learn and disentangle meta-information from learned class-related representations, which accounts for meta-information regularization for disease diagnosis. We have evaluated our proposed MMRN on two public multi-center cohorts, including the Alzheimer's Disease Neuroimaging Initiative (ADNI) with 1,950 subjects and the National Alzheimer's Coordinating Center (NACC) with 1,163 subjects. The experimental results have shown that our proposed method outperformed the state-of-the-art approaches in both tasks of AD diagnosis, mild cognitive impairment (MCI) conversion prediction, and normal control (NC) vs. MCI vs. AD classification.

Cross-site prognosis prediction for nasopharyngeal carcinoma from incomplete multi-modal data

Accurate prognosis prediction for nasopharyngeal carcinoma based on magnetic resonance (MR) images assists in the guidance of treatment intensity, thus reducing the risk of recurrence and death. To reduce repeated labor and sufficiently explore domain knowledge, aggregating labeled/annotated data from external sites enables us to train an intelligent model for a clinical site with unlabeled data. However, this task suffers from the challenges of incomplete multi-modal examination data fusion and image data heterogeneity among sites. This paper proposes a cross-site survival analysis method for prognosis prediction of nasopharyngeal carcinoma from domain adaptation viewpoint. Utilizing a Cox model as the basic framework, our method equips it with a cross-attention based multi-modal fusion regularization. This regularization model effectively fuses the multi-modal information from multi-parametric MR images and clinical features onto a domain-adaptive space, despite the absence of some modalities. To enhance the feature discrimination, we also extend the contrastive learning technique to censored data cases. Compared with the conventional approaches which directly deploy a trained survival model in a new site, our method achieves superior prognosis prediction performance in cross-site validation experiments. These results highlight the key role of cross-site adaptability of our method and support its value in clinical practice.

Parkinson's severity diagnosis explainable model based on 3D multi-head attention residual network

The severity evaluation of Parkinson's disease (PD) is of great significance for the treatment of PD. However, existing methods either have limitations based on prior knowledge or are invasive methods. To propose a more generalized severity evaluation model, this paper proposes an explainable 3D multi-head attention residual convolution network. First, we introduce the 3D attention-based convolution layer to extract video features. Second, features will be fed into LSTM and residual backbone networks, which can be used to capture the contextual information of the video. Finally, we design a feature compression module to condense the learned contextual features. We develop some interpretable experiments to better explain this black-box model so that it can be better generalized. Experiments show that our model can achieve state-of-the-art diagnosis performance. The proposed lightweight but effective model is expected to serve as a suitable end-to-end deep learning baseline in future research on PD video-based severity evaluation and has the potential for large-scale application in PD telemedicine. The source code is available at https://github.com/JackAILab/MARNet.

Joint learning framework of cross-modal synthesis and diagnosis for Alzheimer's disease by mining underlying shared modality information

Alzheimer's disease (AD) is one of the most common neurodegenerative disorders presenting irreversible progression of cognitive impairment. How to identify AD as early as possible is critical for intervention with potential preventive measures. Among various neuroimaging modalities used to diagnose AD, functional positron emission tomography (PET) has higher sensitivity than structural magnetic resonance imaging (MRI), but it is also costlier and often not available in many hospitals. How to leverage massive unpaired unlabeled PET to improve the diagnosis performance of AD from MRI becomes rather important. To address this challenge, this paper proposes a novel joint learning framework of unsupervised cross-modal synthesis and AD diagnosis by mining underlying shared modality information, improving the AD diagnosis from MRI while synthesizing more discriminative PET images. We mine underlying shared modality information in two aspects: diversifying modality information through the cross-modal synthesis network and locating critical diagnosis-related patterns through the AD diagnosis network. First, to diversify the modality information, we propose a novel unsupervised cross-modal synthesis network, which implements the inter-conversion between 3D PET and MRI in a single model modulated by the AdaIN module. Second, to locate shared critical diagnosis-related patterns, we propose an interpretable diagnosis network based on fully 2D convolutions, which takes either 3D synthesized PET or original MRI as input. Extensive experimental results on the ADNI dataset show that our framework can synthesize more realistic images, outperform the state-of-the-art AD diagnosis methods, and have better generalization on external AIBL and NACC datasets.

Disentangle First, Then Distill: A Unified Framework for Missing Modality Imputation and Alzheimer's Disease Diagnosis

Multi-modality medical data provide complementary information, and hence have been widely explored for computer-aided AD diagnosis. However, the research is hindered by the unavoidable missing-data problem, i.e., one data modality was not acquired on some subjects due to various reasons. Although the missing data can be imputed using generative models, the imputation process may introduce unrealistic information to the classification process, leading to poor performance. In this paper, we propose the Disentangle First, Then Distill (DFTD) framework for AD diagnosis using incomplete multi-modality medical images. First, we design a region-aware disentanglement module to disentangle each image into inter-modality relevant representation and intra-modality specific representation with emphasis on disease-related regions. To progressively integrate multi-modality knowledge, we then construct an imputation-induced distillation module, in which a lateral inter-modality transition unit is created to impute representation of the missing modality. The proposed DFTD framework has been evaluated against six existing methods on an ADNI dataset with 1248 subjects. The results show that our method has superior performance in both AD-CN classification and MCI-to-AD prediction tasks, substantially over-performing all competing methods.

Multimodal transformer network for incomplete image generation and diagnosis of Alzheimer's disease

Multimodal images such as magnetic resonance imaging (MRI) and positron emission tomography (PET) could provide complementary information about the brain and have been widely investigated for the diagnosis of neurodegenerative disorders such as Alzheimer's disease (AD). However, multimodal brain images are often incomplete in clinical practice. It is still challenging to make use of multimodality for disease diagnosis with missing data. In this paper, we propose a deep learning framework with the multi-level guided generative adversarial network (MLG-GAN) and multimodal transformer (Mul-T) for incomplete image generation and disease classification, respectively. First, MLG-GAN is proposed to generate the missing data, guided by multi-level information from voxels, features, and tasks. In addition to voxel-level supervision and task-level constraint, a feature-level auto-regression branch is proposed to embed the features of target images for an accurate generation. With the complete multimodal images, we propose a Mul-T network for disease diagnosis, which can not only combine the global and local features but also model the latent interactions and correlations from one modality to another with the cross-modal attention mechanism. Comprehensive experiments on three independent datasets (i.e., ADNI-1, ADNI-2, and OASIS-3) show that the proposed method achieves superior performance in the tasks of image generation and disease diagnosis compared to state-of-the-art methods.

Brain cancer classification based on multistage ensemble generative adversarial network and convolutional neural network

An advanced approach that capitalizes on the synergies between multimodal feature fusion and the dual-path network is presented in this manuscript. Our proposed methodology harnesses a combination of potent techniques, merging the benefits of nonlinear mapping and expansive perception. The foundation of our methodology lies in leveraging well-established pretrained models, namely EfficientNet-B7, ResNet-152, and a meticulously crafted custom convolutional neural network (CNN), to effectively extract salient features from the data. These models are combined in a two-stage ensemble approach. We employ maximum variance unfolding (MVU) to select the most relevant attributes from the extracted features. In this study, we propose a hybrid approach that integrates a generative adversarial network and Neural Autoregressive Distribution Estimation (NADE-K) with a CNN. The resulting two-stage ensemble hybrid CNN model achieves an accuracy of 99.63%. The implementation of the two-stage ensemble hybrid CNN with MVU demonstrates significant improvements in brain tumor classification.

GMRLNet: A Graph-Based Manifold Regularization Learning Framework for Placental Insufficiency Diagnosis on Incomplete Multimodal Ultrasound Data

Multimodal analysis of placental ultrasound (US) and microflow imaging (MFI) could greatly aid in the early diagnosis and interventional treatment of placental insufficiency (PI), ensuring a normal pregnancy. Existing multimodal analysis methods have weaknesses in multimodal feature representation and modal knowledge definitions and fail on incomplete datasets with unpaired multimodal samples. To address these challenges and efficiently leverage the incomplete multimodal dataset for accurate PI diagnosis, we propose a novel graph-based manifold regularization learning (MRL) framework named GMRLNet. It takes US and MFI images as input and exploits their modality-shared and modality-specific information for optimal multimodal feature representation. Specifically, a graph convolutional-based shared and specific transfer network (GSSTN) is designed to explore intra-modal feature associations, thus decoupling each modal input into interpretable shared and specific spaces. For unimodal knowledge definitions, graph-based manifold knowledge is introduced to describe the sample-level feature representation, local inter-sample relations, and global data distribution of each modality. Then, an MRL paradigm is designed for inter-modal manifold knowledge transfer to obtain effective cross-modal feature representations. Furthermore, MRL transfers the knowledge between both paired and unpaired data for robust learning on incomplete datasets. Experiments were conducted on two clinical datasets to validate the PI classification performance and generalization of GMRLNet. State-of-the-art comparisons show the higher accuracy of GMRLNet on incomplete datasets. Our method achieves 0.913 AUC and 0.904 balanced accuracy (bACC) for paired US and MFI images, as well as 0.906 AUC and 0.888 bACC for unimodal US images, illustrating its application potential in PI CAD systems.

MRAβ: A multimodal MRI-derived amyloid-β biomarker for Alzheimer's disease

Florbetapir 18 F (AV45), a highly sensitive and specific positron emission tomographic (PET) molecular biomarker binding to the amyloid-β of Alzheimer's disease (AD), is constrained by radiation and cost. We sought to combat it by combining multimodal magnetic resonance imaging (MRI) images and a collaborative generative adversarial networks model (CollaGAN) to develop a multimodal MRI-derived Amyloid-β (MRAβ) biomarker. We collected multimodal MRI and PET AV45 data of 380 qualified participants from the ADNI dataset and 64 subjects from OASIS3 dataset. A five-fold cross-validation CollaGAN were applied to generate MRAβ. In the ADNI dataset, we found MRAβ could characterize the subject-level AV45 spatial variations in both AD and mild cognitive impairment (MCI). Voxel-wise two-sample t-tests demonstrated amyloid-β depositions identified by MRAβ in AD and MCI were significantly higher than healthy controls (HCs) in widespread cortices (p < .05, corrected) and were much similar to those by AV45 (r > .92, p < .001). Moreover, a 3D ResNet classifier demonstrated that MRAβ was comparable to AV45 in discriminating AD from HC in both the ADNI and OASIS3 datasets, and in discriminate MCI from HC in ADNI. Finally, we found MRAβ could mimic cortical hyper-AV45 in HCs who later converted to MCI (r = .79, p < .001) and was comparable to AV45 in discriminating them from stable HC (p > .05). In summary, our work illustrates that MRAβ synthesized by multimodal MRI could mimic the cerebral amyloid-β depositions like AV45 and lends credence to the feasibility of advancing MRI toward molecular-explainable biomarkers.

Hybrid Multimodality Fusion with Cross-Domain Knowledge Transfer to Forecast Progression Trajectories in Cognitive Decline

Magnetic resonance imaging (MRI) and positron emission tomography (PET) are increasingly used to forecast progression trajectories of cognitive decline caused by preclinical and prodromal Alzheimer's disease (AD). Many existing studies have explored the potential of these two distinct modalities with diverse machine and deep learning approaches. But successfully fusing MRI and PET can be complex due to their unique characteristics and missing modalities. To this end, we develop a hybrid multimodality fusion (HMF) framework with cross-domain knowledge transfer for joint MRI and PET representation learning, feature fusion, and cognitive decline progression forecasting. Our HMF consists of three modules: 1) a module to impute missing PET images, 2) a module to extract multimodality features from MRI and PET images, and 3) a module to fuse the extracted multimodality features. To address the issue of small sample sizes, we employ a cross-domain knowledge transfer strategy from the ADNI dataset, which includes 795 subjects, to independent small-scale AD-related cohorts, in order to leverage the rich knowledge present within the ADNI. The proposed HMF is extensively evaluated in three AD-related studies with 272 subjects across multiple disease stages, such as subjective cognitive decline and mild cognitive impairment. Experimental results demonstrate the superiority of our method over several state-of-the-art approaches in forecasting progression trajectories of AD-related cognitive decline.

Multi-modal graph neural network for early diagnosis of Alzheimer's disease from sMRI and PET scans

In recent years, deep learning models have been applied to neuroimaging data for early diagnosis of Alzheimer's disease (AD). Structural magnetic resonance imaging (sMRI) and positron emission tomography (PET) images provide structural and functional information about the brain, respectively. Combining these features leads to improved performance than using a single modality alone in building predictive models for AD diagnosis. However, current multi-modal approaches in deep learning, based on sMRI and PET, are mostly limited to convolutional neural networks, which do not facilitate integration of both image and phenotypic information of subjects. We propose to use graph neural networks (GNN) that are designed to deal with problems in non-Euclidean domains. In this study, we demonstrate how brain networks are created from sMRI or PET images and can be used in a population graph framework that combines phenotypic information with imaging features of the brain networks. Then, we present a multi-modal GNN framework where each modality has its own branch of GNN and a technique that combines the multi-modal data at both the level of node vectors and adjacency matrices. Finally, we perform late fusion to combine the preliminary decisions made in each branch and produce a final prediction. As multi-modality data becomes available, multi-source and multi-modal is the trend of AD diagnosis. We conducted explorative experiments based on multi-modal imaging data combined with non-imaging phenotypic information for AD diagnosis and analyzed the impact of phenotypic information on diagnostic performance. Results from experiments demonstrated that our proposed multi-modal approach improves performance for AD diagnosis. Our study also provides technical reference and support the need for multivariate multi-modal diagnosis methods.

Brain Network Classification for Accurate Detection of Alzheimer's Disease via Manifold Harmonic Discriminant Analysis

Mounting evidence shows that Alzheimer's disease (AD) manifests the dysfunction of the brain network much earlier before the onset of clinical symptoms, making its early diagnosis possible. Current brain network analyses treat high-dimensional network data as a regular matrix or vector, which destroys the essential network topology, thereby seriously affecting diagnosis accuracy. In this context, harmonic waves provide a solid theoretical background for exploring brain network topology. However, the harmonic waves are originally intended to discover neurological disease propagation patterns in the brain, which makes it difficult to accommodate brain disease diagnosis with high heterogeneity. To address this challenge, this article proposes a network manifold harmonic discriminant analysis (MHDA) method for accurately detecting AD. Each brain network is regarded as an instance drawn on a Stiefel manifold. Every instance is represented by a set of orthonormal eigenvectors (i.e., harmonic waves) derived from its Laplacian matrix, which fully respects the topological structure of the brain network. An MHDA method within the Stiefel space is proposed to identify the group-dependent common harmonic waves, which can be used as group-specific references for downstream analyses. Extensive experiments are conducted to demonstrate the effectiveness of the proposed method in stratifying cognitively normal (CN) controls, mild cognitive impairment (MCI), and AD.

Improving Alzheimer's Disease Diagnosis With Multi-Modal PET Embedding Features by a 3D Multi-Task MLP-Mixer Neural Network

Positron emission tomography (PET) with fluorodeoxyglucose (FDG) or florbetapir (AV45) has been proved effective in the diagnosis of Alzheimer's disease. However, the expensive and radioactive nature of PET has limited its application. Here, employing multi-layer perceptron mixer architecture, we present a deep learning model, namely 3-dimensional multi-task multi-layer perceptron mixer, for simultaneously predicting the standardized uptake value ratios (SUVRs) for FDG-PET and AV45-PET from the cheap and widely used structural magnetic resonance imaging data, and the model can be further used for Alzheimer's disease diagnosis based on embedding features derived from SUVR prediction. Experiment results demonstrate the high prediction accuracy of the proposed method for FDG/AV45-PET SUVRs, where we achieved Pearson's correlation coefficients of 0.66 and 0.61 respectively between the estimated and actual SUVR and the estimated SUVRs also show high sensitivity and distinct longitudinal patterns for different disease status. By taking into account PET embedding features, the proposed method outperforms other competing methods on five independent datasets in the diagnosis of Alzheimer's disease and discriminating between stable and progressive mild cognitive impairments, achieving the area under receiver operating characteristic curves of 0.968 and 0.776 respectively on ADNI dataset, and generalizes better to other external datasets. Moreover, the top-weighted patches extracted from the trained model involve important brain regions related to Alzheimer's disease, suggesting good biological interpretability of our proposed method."

Handling missing values in healthcare data: A systematic review of deep learning-based imputation techniques

OBJECTIVE

The proper handling of missing values is critical to delivering reliable estimates and decisions, especially in high-stakes fields such as clinical research. In response to the increasing diversity and complexity of data, many researchers have developed deep learning (DL)-based imputation techniques. We conducted a systematic review to evaluate the use of these techniques, with a particular focus on the types of data, intending to assist healthcare researchers from various disciplines in dealing with missing data.

MATERIALS AND METHODS

We searched five databases (MEDLINE, Web of Science, Embase, CINAHL, and Scopus) for articles published prior to February 8, 2023 that described the use of DL-based models for imputation. We examined selected articles from four perspectives: data types, model backbones (i.e., main architectures), imputation strategies, and comparisons with non-DL-based methods. Based on data types, we created an evidence map to illustrate the adoption of DL models.

RESULTS

Out of 1822 articles, a total of 111 were included, of which tabular static data (29%, 32/111) and temporal data (40%, 44/111) were the most frequently investigated. Our findings revealed a discernible pattern in the choice of model backbones and data types, for example, the dominance of autoencoder and recurrent neural networks for tabular temporal data. The discrepancy in imputation strategy usage among data types was also observed. The "integrated" imputation strategy, which solves the imputation task simultaneously with downstream tasks, was most popular for tabular temporal data (52%, 23/44) and multi-modal data (56%, 5/9). Moreover, DL-based imputation methods yielded a higher level of imputation accuracy than non-DL methods in most studies.

CONCLUSION

The DL-based imputation models are a family of techniques, with diverse network structures. Their designation in healthcare is usually tailored to data types with different characteristics. Although DL-based imputation models may not be superior to conventional approaches across all datasets, it is highly possible for them to achieve satisfactory results for a particular data type or dataset. There are, however, still issues with regard to portability, interpretability, and fairness associated with current DL-based imputation models.

Cascaded Multi-Modal Mixing Transformers for Alzheimer's Disease Classification with Incomplete Data

Accurate medical classification requires a large number of multi-modal data, and in many cases, different feature types. Previous studies have shown promising results when using multi-modal data, outperforming single-modality models when classifying diseases such as Alzheimer's Disease (AD). However, those models are usually not flexible enough to handle missing modalities. Currently, the most common workaround is discarding samples with missing modalities which leads to considerable data under-utilisation. Adding to the fact that labelled medical images are already scarce, the performance of data-driven methods like deep learning can be severely hampered. Therefore, a multi-modal method that can handle missing data in various clinical settings is highly desirable. In this paper, we present Multi-Modal Mixing Transformer (3MT), a disease classification transformer that not only leverages multi-modal data but also handles missing data scenarios. In this work, we test 3MT for AD and Cognitively normal (CN) classification and mild cognitive impairment (MCI) conversion prediction to progressive MCI (pMCI) or stable MCI (sMCI) using clinical and neuroimaging data. The model uses a novel Cascaded Modality Transformers architecture with cross-attention to incorporate multi-modal information for more informed predictions. We propose a novel modality dropout mechanism to ensure an unprecedented level of modality independence and robustness to handle missing data scenarios. The result is a versatile network that enables the mixing of arbitrary numbers of modalities with different feature types and also ensures full data utilization in missing data scenarios. The model is trained and evaluated on the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset with the state-of-the-art performance and further evaluated with The Australian Imaging Biomarker & Lifestyle Flagship Study of Ageing (AIBL) dataset with missing data.

Applications of generative adversarial networks in neuroimaging and clinical neuroscience

Generative adversarial networks (GANs) are one powerful type of deep learning models that have been successfully utilized in numerous fields. They belong to the broader family of generative methods, which learn to generate realistic data with a probabilistic model by learning distributions from real samples. In the clinical context, GANs have shown enhanced capabilities in capturing spatially complex, nonlinear, and potentially subtle disease effects compared to traditional generative methods. This review critically appraises the existing literature on the applications of GANs in imaging studies of various neurological conditions, including Alzheimer's disease, brain tumors, brain aging, and multiple sclerosis. We provide an intuitive explanation of various GAN methods for each application and further discuss the main challenges, open questions, and promising future directions of leveraging GANs in neuroimaging. We aim to bridge the gap between advanced deep learning methods and neurology research by highlighting how GANs can be leveraged to support clinical decision making and contribute to a better understanding of the structural and functional patterns of brain diseases.

Diagnostic performance of magnetic resonance imaging-based machine learning in Alzheimer's disease detection: a meta-analysis

PURPOSE

Advanced machine learning (ML) algorithms can assist rapid medical image recognition and realize automatic, efficient, noninvasive, and convenient diagnosis. We aim to further evaluate the diagnostic performance of ML to distinguish patients with probable Alzheimer's disease (AD) from normal older adults based on structural magnetic resonance imaging (MRI).

METHODS

The Medline, Embase, and Cochrane Library databases were searched for relevant literature published up until July 2021. We used the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool and Checklist for Artificial Intelligence in Medical Imaging (CLAIM) to evaluate all included studies' quality and potential bias. Random-effects models were used to calculate pooled sensitivity and specificity, and the Deeks' test was used to assess publication bias.

RESULTS

We included 24 models based on different brain features extracted by ML algorithms in 19 papers. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver operating characteristic curve for ML in detecting AD were 0.85 (95%CI 0.81-0.89), 0.88 (95%CI 0.84-0.91), 7.15 (95%CI 5.40-9.47), 0.17 (95%CI 0.12-0.22), 43.34 (95%CI 26.89-69.84), and 0.93 (95%CI 0.91-0.95).

CONCLUSION

ML using structural MRI data performed well in diagnosing probable AD patients and normal elderly. However, more high-quality, large-scale prospective studies are needed to further enhance the reliability and generalizability of ML for clinical applications before it can be introduced into clinical practice.

A Systematic Literature Review on Applications of GAN-Synthesized Images for Brain MRI

With the advances in brain imaging, magnetic resonance imaging (MRI) is evolving as a popular radiological tool in clinical diagnosis. Deep learning (DL) methods can detect abnormalities in brain images without an extensive manual feature extraction process. Generative adversarial network (GAN)-synthesized images have many applications in this field besides augmentation, such as image translation, registration, super-resolution, denoising, motion correction, segmentation, reconstruction, and contrast enhancement. The existing literature was reviewed systematically to understand the role of GAN-synthesized dummy images in brain disease diagnosis. Web of Science and Scopus databases were extensively searched to find relevant studies from the last 6 years to write this systematic literature review (SLR). Predefined inclusion and exclusion criteria helped in filtering the search results. Data extraction is based on related research questions (RQ). This SLR identifies various loss functions used in the above applications and software to process brain MRIs. A comparative study of existing evaluation metrics for GAN-synthesized images helps choose the proper metric for an application. GAN-synthesized images will have a crucial role in the clinical sector in the coming years, and this paper gives a baseline for other researchers in the field.

The role of generative adversarial networks in brain MRI: a scoping review

The performance of artificial intelligence (AI) for brain MRI can improve if enough data are made available. Generative adversarial networks (GANs) showed a lot of potential to generate synthetic MRI data that can capture the distribution of real MRI. Besides, GANs are also popular for segmentation, noise removal, and super-resolution of brain MRI images. This scoping review aims to explore how GANs methods are being used on brain MRI data, as reported in the literature. The review describes the different applications of GANs for brain MRI, presents the most commonly used GANs architectures, and summarizes the publicly available brain MRI datasets for advancing the research and development of GANs-based approaches. This review followed the guidelines of PRISMA-ScR to perform the study search and selection. The search was conducted on five popular scientific databases. The screening and selection of studies were performed by two independent reviewers, followed by validation by a third reviewer. Finally, the data were synthesized using a narrative approach. This review included 139 studies out of 789 search results. The most common use case of GANs was the synthesis of brain MRI images for data augmentation. GANs were also used to segment brain tumors and translate healthy images to diseased images or CT to MRI and vice versa. The included studies showed that GANs could enhance the performance of AI methods used on brain MRI imaging data. However, more efforts are needed to transform the GANs-based methods in clinical applications.

Applications of Generative Adversarial Networks (GANs) in Positron Emission Tomography (PET) imaging: A review

PURPOSE

This paper reviews recent applications of Generative Adversarial Networks (GANs) in Positron Emission Tomography (PET) imaging. Recent advances in Deep Learning (DL) and GANs catalysed the research of their applications in medical imaging modalities. As a result, several unique GAN topologies have emerged and been assessed in an experimental environment over the last two years.

METHODS

The present work extensively describes GAN architectures and their applications in PET imaging. The identification of relevant publications was performed via approved publication indexing websites and repositories. Web of Science, Scopus, and Google Scholar were the major sources of information.

RESULTS

The research identified a hundred articles that address PET imaging applications such as attenuation correction, de-noising, scatter correction, removal of artefacts, image fusion, high-dose image estimation, super-resolution, segmentation, and cross-modality synthesis. These applications are presented and accompanied by the corresponding research works.

CONCLUSION

GANs are rapidly employed in PET imaging tasks. However, specific limitations must be eliminated to reach their full potential and gain the medical community's trust in everyday clinical practice.

BPGAN: Brain PET synthesis from MRI using generative adversarial network for multi-modal Alzheimer's disease diagnosis

BACKGROUND AND OBJECTIVE

Multi-modal medical images, such as magnetic resonance imaging (MRI) and positron emission tomography (PET), have been widely used for the diagnosis of brain disorder diseases like Alzheimer's disease (AD) since they can provide various information. PET scans can detect cellular changes in organs and tissues earlier than MRI. Unlike MRI, PET data is difficult to acquire due to cost, radiation, or other limitations. Moreover, PET data is missing for many subjects in the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset. To solve this problem, a 3D end-to-end generative adversarial network (named BPGAN) is proposed to synthesize brain PET from MRI scans, which can be used as a potential data completion scheme for multi-modal medical image research.

METHODS

We propose BPGAN, which learns an end-to-end mapping function to transform the input MRI scans to their underlying PET scans. First, we design a 3D multiple convolution U-Net (MCU) generator architecture to improve the visual quality of synthetic results while preserving the diverse brain structures of different subjects. By further employing a 3D gradient profile (GP) loss and structural similarity index measure (SSIM) loss, the synthetic PET scans have higher-similarity to the ground truth. In this study, we explore alternative data partitioning ways to study their impact on the performance of the proposed method in different medical scenarios.

RESULTS

We conduct experiments on a publicly available ADNI database. The proposed BPGAN is evaluated by mean absolute error (MAE), peak-signal-to-noise-ratio (PSNR) and SSIM, superior to other compared models in these quantitative evaluation metrics. Qualitative evaluations also validate the effectiveness of our approach. Additionally, combined with MRI and our synthetic PET scans, the accuracies of multi-class AD diagnosis on dataset-A and dataset-B are 85.00% and 56.47%, which have been improved by about 1% and 1%, respectively, compared to the stand-alone MRI.

CONCLUSIONS

The experimental results of quantitative measures, qualitative displays, and classification evaluation demonstrate that the synthetic PET images by BPGAN are reasonable and high-quality, which provide complementary information to improve the performance of AD diagnosis. This work provides a valuable reference for multi-modal medical image analysis.

Assessing clinical progression from subjective cognitive decline to mild cognitive impairment with incomplete multi-modal neuroimages

Accurately assessing clinical progression from subjective cognitive decline (SCD) to mild cognitive impairment (MCI) is crucial for early intervention of pathological cognitive decline. Multi-modal neuroimaging data such as T1-weighted magnetic resonance imaging (MRI) and positron emission tomography (PET), help provide objective and supplementary disease biomarkers for computer-aided diagnosis of MCI. However, there are few studies dedicated to SCD progression prediction since subjects usually lack one or more imaging modalities. Besides, one usually has a limited number (e.g., tens) of SCD subjects, negatively affecting model robustness. To this end, we propose a Joint neuroimage Synthesis and Representation Learning (JSRL) framework for SCD conversion prediction using incomplete multi-modal neuroimages. The JSRL contains two components: 1) a generative adversarial network to synthesize missing images and generate multi-modal features, and 2) a classification network to fuse multi-modal features for SCD conversion prediction. The two components are incorporated into a joint learning framework by sharing the same features, encouraging effective fusion of multi-modal features for accurate prediction. A transfer learning strategy is employed in the proposed framework by leveraging model trained on the Alzheimer's Disease Neuroimaging Initiative (ADNI) with MRI and fluorodeoxyglucose PET from 863 subjects to both the Chinese Longitudinal Aging Study (CLAS) with only MRI from 76 SCD subjects and the Australian Imaging, Biomarkers and Lifestyle (AIBL) with MRI from 235 subjects. Experimental results suggest that the proposed JSRL yields superior performance in SCD and MCI conversion prediction and cross-database neuroimage synthesis, compared with several state-of-the-art methods.

MRI-based Alzheimer's disease prediction via distilling the knowledge in multi-modal data

Mild cognitive impairment (MCI) conversion prediction, i.e., identifying MCI patients of high risks converting to Alzheimer's disease (AD), is essential for preventing or slowing the progression of AD. Although previous studies have shown that the fusion of multi-modal data can effectively improve the prediction accuracy, their applications are largely restricted by the limited availability or high cost of multi-modal data. Building an effective prediction model using only magnetic resonance imaging (MRI) remains a challenging research topic. In this work, we propose a multi-modal multi-instance distillation scheme, which aims to distill the knowledge learned from multi-modal data to an MRI-based network for MCI conversion prediction. In contrast to existing distillation algorithms, the proposed multi-instance probabilities demonstrate a superior capability of representing the complicated atrophy distributions, and can guide the MRI-based network to better explore the input MRI. To our best knowledge, this is the first study that attempts to improve an MRI-based prediction model by leveraging extra supervision distilled from multi-modal information. Experiments demonstrate the advantage of our framework, suggesting its potentials in the data-limited clinical settings.

Task-induced Pyramid and Attention GAN for Multimodal Brain Image Imputation and Classification in Alzheimers disease

With the advance of medical imaging technologies, multimodal images such as magnetic resonance images (MRI) and positron emission tomography (PET) can capture subtle structural and functional changes of brain, facilating the diagnosis of brain diseases such as Alzheimers disease (AD). In practice, multimodal images may be incomplete since PET is often missing due to high financial cost or availability. Most of existing methods simply excluded subjects with missing data, which unfortunately reduced sample size. In addition, how to extract and combine multimodal features is still challenging. To address these problems, we propose a deep learning framework to integrate a task-induced pyramid and attention generative adversarial network (TPA-GAN) with a pathwise transfer dense convolution network (PT-DCN) for imputation and also classification of multimodal brain images. First, we propose a TPA-GAN to integrate pyramid convolution and attention module as well as disease classification task into GAN for generating the missing PET data with their MRI. Then, with the imputed multimodal brain images, we build a dense convolution network with pathwise transfer blocks to gradually learn and combine multimodal features for final disease classification. Experiments are performed on ADNI-1 and ADNI-2 datasets to evaluate our proposed method, achiving superior performance in image imputation and brain disease diagnosis compared to state-of-the-art methods.

Bidirectional Mapping of Brain MRI and PET With 3D Reversible GAN for the Diagnosis of Alzheimer's Disease

Combining multi-modality data for brain disease diagnosis such as Alzheimer's disease (AD) commonly leads to improved performance than those using a single modality. However, it is still challenging to train a multi-modality model since it is difficult in clinical practice to obtain complete data that includes all modality data. Generally speaking, it is difficult to obtain both magnetic resonance images (MRI) and positron emission tomography (PET) images of a single patient. PET is expensive and requires the injection of radioactive substances into the patient's body, while MR images are cheaper, safer, and more widely used in practice. Discarding samples without PET data is a common method in previous studies, but the reduction in the number of samples will result in a decrease in model performance. To take advantage of multi-modal complementary information, we first adopt the Reversible Generative Adversarial Network (RevGAN) model to reconstruct the missing data. After that, a 3D convolutional neural network (CNN) classification model with multi-modality input was proposed to perform AD diagnosis. We have evaluated our method on the Alzheimer's Disease Neuroimaging Initiative (ADNI) database, and compared the performance of the proposed method with those using state-of-the-art methods. The experimental results show that the structural and functional information of brain tissue can be mapped well and that the image synthesized by our method is close to the real image. In addition, the use of synthetic data is beneficial for the diagnosis and prediction of Alzheimer's disease, demonstrating the effectiveness of the proposed framework.

A survey on active learning and human-in-the-loop deep learning for medical image analysis

Fully automatic deep learning has become the state-of-the-art technique for many tasks including image acquisition, analysis and interpretation, and for the extraction of clinically useful information for computer-aided detection, diagnosis, treatment planning, intervention and therapy. However, the unique challenges posed by medical image analysis suggest that retaining a human end-user in any deep learning enabled system will be beneficial. In this review we investigate the role that humans might play in the development and deployment of deep learning enabled diagnostic applications and focus on techniques that will retain a significant input from a human end user. Human-in-the-Loop computing is an area that we see as increasingly important in future research due to the safety-critical nature of working in the medical domain. We evaluate four key areas that we consider vital for deep learning in the clinical practice: (1) Active Learning to choose the best data to annotate for optimal model performance; (2) Interaction with model outputs - using iterative feedback to steer models to optima for a given prediction and offering meaningful ways to interpret and respond to predictions; (3) Practical considerations - developing full scale applications and the key considerations that need to be made before deployment; (4) Future Prospective and Unanswered Questions - knowledge gaps and related research fields that will benefit human-in-the-loop computing as they evolve. We offer our opinions on the most promising directions of research and how various aspects of each area might be unified towards common goals.

Using super-resolution generative adversarial network models and transfer learning to obtain high resolution digital periapical radiographs

Periapical Radiographs are commonly used to detect several anomalies, like caries, periodontal, and periapical diseases. Even considering that digital imaging systems used nowadays tend to provide high-quality images, external factors, or even system limitations can result in a vast amount of radiographic images with low quality and resolution. Commercial solutions offer tools based on interpolation methods to increase image resolution. However, previous literature shows that these methods may create undesirable effects in the images affecting the diagnosis accuracy. One alternative is using deep learning-based super-resolution methods to achieve better high-resolution images. Nevertheless, the amount of data for training such models is limited, demanding transfer learning approaches. In this work, we propose the use of super-resolution generative adversarial network (SRGAN) models and transfer learning to achieve periapical images with higher quality and resolution. Moreover, we evaluate the influence of using the transfer learning approach and the datasets selected for it in the final generated images. For that, we performed an experiment comparing the performance of the SRGAN models (with and without transfer learning) with other super-resolution methods. Considering Mean Square Error (MSE), Peak Signal to Noise Ratio (PSNR), Structural Similarity Index (SSIM), and Mean Opinion Score (MOS), the results of SRGAN models using transfer learning were better on average. This superiority was also verified statistically using the Wilcoxon paired test. In the visual analysis, the high quality achieved by the SRGAN models, in general, is visible, resulting in more defined edges details and fewer blur effects.