Research Group Martin Menten

Topological correctness, i.e., the preservation of structural integrity and specific characteristics of shape, is a fundamental requirement for medical imaging tasks, such as neuron or vessel segmentation. Despite the recent surge in topology-aware methods addressing this challenge, their real-world applicability is hindered by flawed benchmarking practices. In this paper, we identify critical pitfalls in model evaluation that include inadequate connectivity choices, overlooked topological artifacts in ground truth annotations, and inappropriate use of evaluation metrics. Through detailed empirical analysis, we uncover these issues’ profound impact on the evaluation and ranking of segmentation methods. Drawing from our findings, we propose a set of actionable recommendations to establish fair and robust evaluation standards for topology-aware medical image segmentation methods.

Skeletonization extracts thin representations from images that compactly encode their geometry and topology. These representations have become an important topological prior for preserving connectivity in curvilinear structures, aiding medical tasks like vessel segmentation. Existing compatible skeletonization algorithms face significant trade-offs: morphology-based approaches are computationally efficient but prone to frequent breakages, while topology-preserving methods require substantial computational resources.
We propose a novel framework for training iterative skeletonization algorithms with a learnable component. The framework leverages synthetic data, task-specific augmentation, and a model distillation strategy to learn compact neural networks that produce thin, connected skeletons with a fully differentiable iterative algorithm.
Our method demonstrates a 100 times speedup over topology-constrained algorithms while maintaining high accuracy and generalizing effectively to new domains without fine-tuning. Benchmarking and downstream validation in 2D and 3D tasks demonstrate its computational efficiency and real-world applicability.

Cardiovascular diseases (CVD) can be diagnosed using various diagnostic modalities. The electrocardiogram (ECG) is a cost-effective and widely available diagnostic aid that provides functional information of the heart. However, its ability to classify and spatially localise CVD is limited. In contrast, cardiac magnetic resonance (CMR) imaging provides detailed structural information of the heart and thus enables evidence-based diagnosis of CVD, but long scan times and high costs limit its use in clinical routine. In this work, we present a deep learning strategy for cost-effective and comprehensive cardiac screening solely from ECG. Our approach combines multimodal contrastive learning with masked data modelling to transfer domain-specific information from CMR imaging to ECG representations. In extensive experiments using data from 40,044 UK Biobank subjects, we demonstrate the utility and generalisability of our method for subject-specific risk prediction of CVD and the prediction of cardiac phenotypes using only ECG data. Specifically, our novel multimodal pre-training paradigm improves performance by up to 12.19% for risk prediction and 27.59% for phenotype prediction. In a qualitative analysis, we demonstrate that our learned ECG representations incorporate information from CMR image regions of interest.

In this paper, we propose a methodology for extracting molecular tumor biomarkers from hyperspectral imaging (HSI), an emerging technology for intraoperative tissue assessment. To achieve this, we employ spectral unmixing, allowing to decompose the spectral signals recorded by the HSI camera into their constituent molecular components. Traditional unmixing approaches are based on physical models that establish a relationship between tissue molecules and the recorded spectra. However, these methods commonly assume a linear relationship between the spectra and molecular content, which does not capture the whole complexity of light-matter interaction. To address this limitation, we introduce a novel unmixing procedure that allows to take into account non-linear optical effects while preserving the computational benefits of linear spectral unmixing. We validate our methodology on an in-vivo brain tissue HSI dataset and demonstrate that the extracted molecular information leads to superior classification performance.

Supervised contrastive learning (SupCon) has proven to be a powerful alternative to the standard cross-entropy loss for classification of multi-class balanced datasets. However, it struggles to learn well-conditioned representations of datasets with long-tailed class distributions. This problem is potentially exacerbated for binary imbalanced distributions, which are commonly encountered during many real-world problems such as medical diagnosis. In experiments on seven binary datasets of natural and medical images, we show that the performance of SupCon decreases with increasing class imbalance. To substantiate these findings, we introduce two novel metrics that evaluate the quality of the learned representation space. By measuring the class distribution in local neighborhoods, we are able to uncover structural deficiencies of the representation space that classical metrics cannot detect. Informed by these insights, we propose two new supervised contrastive learning strategies tailored to binary imbalanced datasets that improve the structure of the representation space and increase downstream classification accuracy over standard SupCon by up to 35%. We make our code available.

Direct image-to-graph transformation is a challenging task that involves solving object detection and relationship prediction in a single model. Due to this task’s complexity, large training datasets are rare in many domains, making the training of deep-learning methods challenging. This data sparsity necessitates transfer learning strategies akin to the state-of-the-art in general computer vision. In this work, we introduce a set of methods enabling cross-domain and cross-dimension learning for image-to-graph transformers. We propose (1) a regularized edge sampling loss to effectively learn object relations in multiple domains with different numbers of edges, (2) a domain adaptation framework for image-to-graph transformers aligning image- and graph-level features from different domains, and (3) a projection function that allows using 2D data for training 3D transformers. We demonstrate our method’s utility in cross-domain and cross-dimension experiments, where we utilize labeled data from 2D road networks for simultaneous learning in vastly different target domains. Our method consistently outperforms standard transfer learning and self-supervised pretraining on challenging benchmarks, such as retinal or whole-brain vessel graph extraction.

Interpretability, particularly in terms of human understandable concepts, is essential for building trust in machine learning models for disease classification. However, state-of-the-art image classifiers exhibit limited interpretability, posing a significant barrier to their acceptance in clinical practice. To address this, our work introduces two graph representations of the retinal vasculature, aiming to bridge the gap between high-performance classifiers and human-understandable interpretability concepts in ophthalmology. We use these graphs with the aim of training graph neural networks (GNNs) for disease staging. First, we formally and experimentally show that GNNs can learn known clinical biomarkers. In that, we show that GNNs can learn human interpretable concepts. Next, we train GNNs for disease staging and study how different aggregation strategies lead the GNN to learn more and less human interpretable features. Finally, we propose a visualization for integrated gradients on graphs, which allows us to identify if GNN models have learned human-understandable representations of the data.

Background: Alterations of the superficial retinal vasculature are commonly observed in multiple sclerosis (MS) and can be visualized through optical coherence tomography angiography (OCTA).
Objectives: This study aimed to examine changes in the retinal vasculature during MS and to integrate findings into current concepts of the underlying pathology.
Methods: In this cross-sectional study, including 259 relapsing–remitting MS patients and 78 healthy controls, we analyzed OCTAs using deep-learning-based segmentation algorithm tools.
Results: We identified a loss of small-sized vessels (diameter < 10 µm) in the superficial vascular complex in all MS eyes, irrespective of their optic neuritis (ON) history. This alteration was associated with MS disease burden and appears independent of retinal ganglion cell loss. In contrast, an observed reduction of medium-sized vessels (diameter 10–20 µm) was specific to eyes with a history of ON and was closely linked to ganglion cell atrophy.
Conclusion: These findings suggest distinct atrophy patterns in retinal vessels in patients with MS. Further studies are necessary to investigate retinal vessel alterations and their underlying pathology in MS.

Optical coherence tomography angiography (OCTA) is a non-invasive imaging modality that can acquire high-resolution volumes of the retinal vasculature and aid the diagnosis of ocular, neurological and cardiac diseases. Segmenting the visible blood vessels is a common first step when extracting quantitative biomarkers from these images. Classical segmentation algorithms based on thresholding are strongly affected by image artifacts and limited signal-to-noise ratio. The use of modern, deep learning-based segmentation methods has been inhibited by a lack of large datasets with detailed annotations of the blood vessels. To address this issue, recent work has employed transfer learning, where a segmentation network is trained on synthetic OCTA images and is then applied to real data. However, the previously proposed simulations fail to faithfully model the retinal vasculature and do not provide effective domain adaptation. Because of this, current methods are unable to fully segment the retinal vasculature, in particular the smallest capillaries. In this work, we present a lightweight simulation of the retinal vascular network based on space colonization for faster and more realistic OCTA synthesis. We then introduce three contrast adaptation pipelines to decrease the domain gap between real and artificial images. We demonstrate the superior segmentation performance of our approach in extensive quantitative and qualitative experiments on three public datasets that compare our method to traditional computer vision algorithms and supervised training using human annotations. Finally, we make our entire pipeline publicly available, including the source code, pretrained models, and a large dataset of synthetic OCTA images.

Image synthesis is increasingly being adopted in medical image processing, for example for data augmentation or inter-modality image translation. In these critical applications, the generated images must fulfill a high standard of biological correctness. A particular requirement for these images is global consistency, i.e an image being overall coherent and structured so that all parts of the image fit together in a realistic and meaningful way. Yet, established image quality metrics do not explicitly quantify this property of synthetic images. In this work, we introduce two metrics that can measure the global consistency of synthetic images on a per-image basis. To measure the global consistency, we presume that a realistic image exhibits consistent properties, e.g., a person’s body fat in a whole-body MRI, throughout the depicted object or scene. Hence, we quantify global consistency by predicting and comparing explicit attributes of images on patches using supervised trained neural networks. Next, we adapt this strategy to an unlabeled setting by measuring the similarity of implicit image features predicted by a self-supervised trained network. Our results demonstrate that predicting explicit attributes of synthetic images on patches can distinguish globally consistent from inconsistent images. Implicit representations of images are less sensitive to assess global consistency but are still serviceable when labeled data is unavailable. Compared to established metrics, such as the FID, our method can explicitly measure global consistency on a per-image basis, enabling a dedicated analysis of the biological plausibility of single synthetic images.

Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly. Current grading systems based on imaging biomarkers only coarsely group disease stages into broad categories that lack prognostic value for future disease progression. It is widely believed that this is due to their focus on a single point in time, disregarding the dynamic nature of the disease. In this work, we present the first method to automatically propose biomarkers that capture temporal dynamics of disease progression. Our method represents patient time series as trajectories in a latent feature space built with contrastive learning. Then, individual trajectories are partitioned into atomic sub-sequences that encode transitions between disease states. These are clustered using a newly introduced distance metric. In quantitative experiments we found our method yields temporal biomarkers that are predictive of conversion to late AMD. Furthermore, these clusters were highly interpretable to ophthalmologists who confirmed that many of the clusters represent dynamics that have previously been linked to the progression of AMD, even though they are currently not included in any clinical grading system.

The skeleton of a digital image is a compact representation of its topology, geometry, and scale. It has utility in many computer vision applications, such as image description, segmentation, and registration. However, skeletonization has only seen limited use in contemporary deep learning solutions. Most existing skeletonization algorithms are not differentiable, making it impossible to integrate them with gradient-based optimization. Compatible algorithms based on morphological operations and neural networks have been proposed, but their results often deviate from the geometry and topology of the true medial axis. This work introduces the first three-dimensional skeletonization algorithm that is both compatible with gradient-based optimization and preserves an object’s topology. Our method is exclusively based on matrix additions and multiplications, convolutional operations, basic non-linear functions, and sampling from a uniform probability distribution, allowing it to be easily implemented in any major deep learning library. In benchmarking experiments, we prove the advantages of our skeletonization algorithm compared to non-differentiable, morphological, and neural-network-based baselines. Finally, we demonstrate the utility of our algorithm by integrating it with two medical image processing applications that use gradient-based optimization: deep-learning-based blood vessel segmentation, and multimodal registration of the mandible in computed tomography and magnetic resonance images.