SAC-Net: Learning with weak and noisy labels in histopathology image segmentation

Deep convolutional neural networks have been highly effective in segmentation tasks. However, segmentation becomes more difficult when training images include many complex instances to segment, such as the task of nuclei segmentation in histopathology images. Weakly supervised learning can reduce the need for large-scale, high-quality ground truth annotations by involving non-expert annotators or algorithms to generate supervision information for segmentation. However, there is still a significant performance gap between weakly supervised learning and fully supervised learning approaches. In this work, we propose a weakly-supervised nuclei segmentation method in a two-stage training manner that only requires annotation of the nuclear centroids. First, we generate boundary and superpixel-based masks as pseudo ground truth labels to train our SAC-Net, which is a segmentation network enhanced by a constraint network and an attention network to effectively address the problems caused by noisy labels. Then, we refine the pseudo labels at the pixel level based on Confident Learning to train the network again. Our method shows highly competitive performance of cell nuclei segmentation in histopathology images on three public datasets. Code will be available at: https://github.com/RuoyuGuo/MaskGA_Net.     

Dense regression activation maps for lesion segmentation in CT scans of COVID-19 patients

Automatic lesion segmentation on thoracic CT enables rapid quantitative analysis of lung involvement in COVID-19 infections. However, obtaining a large amount of voxel-level annotations for training segmentation networks is prohibitively expensive. Therefore, we propose a weakly-supervised segmentation method based on dense regression activation maps (dRAMs). Most weakly-supervised segmentation approaches exploit class activation maps (CAMs) to localize objects. However, because CAMs were trained for classification, they do not align precisely with the object segmentations. Instead, we produce high-resolution activation maps using dense features from a segmentation network that was trained to estimate a per-lobe lesion percentage. In this way, the network can exploit knowledge regarding the required lesion volume. In addition, we propose an attention neural network module to refine dRAMs, optimized together with the main regression task. We evaluated our algorithm on 90 subjects. Results show our method achieved 70.2% Dice coefficient, substantially outperforming the CAM-based baseline at 48.6%. We published our source code at https://github.com/DIAGNijmegen/bodyct-dram.     

Weakly supervised segmentation on neural compressed histopathology with self-equivariant regularization

In digital pathology, segmentation is a fundamental task for the diagnosis and treatment of diseases. Existing fully supervised methods often require accurate pixel-level annotations that are both time-consuming and laborious to generate. Typical approaches first pre-process histology images into patches to meet memory constraints and later perform stitching for segmentation; at times leading to lower performance given the lack of global context. Since image level labels are cheaper to acquire, weakly supervised learning is a more practical alternative for training segmentation algorithms. In this work, we present a weakly supervised framework for histopathology segmentation using only image-level labels by refining class activation maps (CAM) with self-supervision. First, we compress gigapixel histology images with an unsupervised contrastive learning technique to retain high-level spatial context. Second, a network is trained on the compressed images to jointly predict image-labels and refine the initial CAMs via self-supervised losses. In particular, we achieve refinement via a pixel correlation module (PCM) that leverages self-attention between the initial CAM and the input to encourage fine-grained activations. Also, we introduce a feature masking technique that performs spatial dropout on the compressed input to suppress low confidence predictions. To effectively train our model, we propose a loss function that includes a classification objective with image-labels, self-supervised regularization and entropy minimization between the CAM predictions. Experimental results on two curated datasets show that our approach is comparable to fully-supervised methods and can outperform existing state-of-the-art patch-based methods. https://github.com/PhilipChicco/wsshisto     

Benchmarking weakly-supervised deep learning pipelines for whole slide classification in computational pathology

Artificial intelligence (AI) can extract visual information from histopathological slides and yield biological insight and clinical biomarkers. Whole slide images are cut into thousands of tiles and classification problems are often weakly-supervised: the ground truth is only known for the slide, not for every single tile. In classical weakly-supervised analysis pipelines, all tiles inherit the slide label while in multiple-instance learning (MIL), only bags of tiles inherit the label. However, it is still unclear how these widely used but markedly different approaches perform relative to each other.We implemented and systematically compared six methods in six clinically relevant end-to-end prediction tasks using data from N=2980 patients for training with rigorous external validation. We tested three classical weakly-supervised approaches with convolutional neural networks and vision transformers (ViT) and three MIL-based approaches with and without an additional attention module. Our results empirically demonstrate that histological tumor subtyping of renal cell carcinoma is an easy task in which all approaches achieve an area under the receiver operating curve (AUROC) of above 0.9. In contrast, we report significant performance differences for clinically relevant tasks of mutation prediction in colorectal, gastric, and bladder cancer. In these mutation prediction tasks, classical weakly-supervised workflows outperformed MIL-based weakly-supervised methods for mutation prediction, which is surprising given their simplicity. This shows that new end-to-end image analysis pipelines in computational pathology should be compared to classical weakly-supervised methods. Also, these findings motivate the development of new methods which combine the elegant assumptions of MIL with the empirically observed higher performance of classical weakly-supervised approaches. We make all source codes publicly available at https://github.com/KatherLab/HIA, allowing easy application of all methods to any similar task.     

Transformer-based unsupervised contrastive learning for histopathological image classification

A large-scale and well-annotated dataset is a key factor for the success of deep learning in medical image analysis. However, assembling such large annotations is very challenging, especially for histopathological images with unique characteristics (e.g., gigapixel image size, multiple cancer types, and wide staining variations). To alleviate this issue, self-supervised learning (SSL) could be a promising solution that relies only on unlabeled data to generate informative representations and generalizes well to various downstream tasks even with limited annotations. In this work, we propose a novel SSL strategy called semantically-relevant contrastive learning (SRCL), which compares relevance between instances to mine more positive pairs. Compared to the two views from an instance in traditional contrastive learning, our SRCL aligns multiple positive instances with similar visual concepts, which increases the diversity of positives and then results in more informative representations. We employ a hybrid model (CTransPath) as the backbone, which is designed by integrating a convolutional neural network (CNN) and a multi-scale Swin Transformer architecture. The CTransPath is pretrained on massively unlabeled histopathological images that could serve as a collaborative local–global feature extractor to learn universal feature representations more suitable for tasks in the histopathology image domain. The effectiveness of our SRCL-pretrained CTransPath is investigated on five types of downstream tasks (patch retrieval, patch classification, weakly-supervised whole-slide image classification, mitosis detection, and colorectal adenocarcinoma gland segmentation), covering nine public datasets. The results show that our SRCL-based visual representations not only achieve state-of-the-art performance in each dataset, but are also more robust and transferable than other SSL methods and ImageNet pretraining (both supervised and self-supervised methods). Our code and pretrained model are available at https://github.com/Xiyue-Wang/TransPath.     

Multi-layer pseudo-supervision for histopathology tissue semantic segmentation using patch-level classification labels

Tissue-level semantic segmentation is a vital step in computational pathology. Fully-supervised models have already achieved outstanding performance with dense pixel-level annotations. However, drawing such labels on the giga-pixel whole slide images is extremely expensive and time-consuming. In this paper, we use only patch-level classification labels to achieve tissue semantic segmentation on histopathology images, finally reducing the annotation efforts. We propose a two-step model including a classification and a segmentation phases. In the classification phase, we propose a CAM-based model to generate pseudo masks by patch-level labels. In the segmentation phase, we achieve tissue semantic segmentation by our propose Multi-Layer Pseudo-Supervision. Several technical novelties have been proposed to reduce the information gap between pixel-level and patch-level annotations. As a part of this paper, we introduce a new weakly-supervised semantic segmentation (WSSS) dataset for lung adenocarcinoma (LUAD-HistoSeg). We conduct several experiments to evaluate our proposed model on two datasets. Our proposed model outperforms five state-of-the-art WSSS approaches. Note that we can achieve comparable quantitative and qualitative results with the fully-supervised model, with only around a 2% gap for MIoU and FwIoU. By comparing with manual labeling on a randomly sampled 100 patches dataset, patch-level labeling can greatly reduce the annotation time from hours to minutes. The source code and the released datasets are available at: https://github.com/ChuHan89/WSSS-Tissue.     

Meta multi-task nuclei segmentation with fewer training samples

Cells/nuclei deliver massive information of microenvironment. An automatic nuclei segmentation approach can reduce pathologists’ workload and allow precise of the microenvironment for biological and clinical researches. Existing deep learning models have achieved outstanding performance under the supervision of a large amount of labeled data. However, when data from the unseen domain comes, we still have to prepare a certain degree of manual annotations for training for each domain. Unfortunately, obtaining histopathological annotations is extremely difficult. It is high expertise-dependent and time-consuming. In this paper, we attempt to build a generalized nuclei segmentation model with less data dependency and more generalizability. To this end, we propose a meta multi-task learning (Meta-MTL) model for nuclei segmentation which requires fewer training samples. A model-agnostic meta-learning is applied as the outer optimization algorithm for the segmentation model. We introduce a contour-aware multi-task learning model as the inner model. A feature fusion and interaction block (FFIB) is proposed to allow feature communication across both tasks. Extensive experiments prove that our proposed Meta-MTL model can improve the model generalization and obtain a comparable performance with state-of-the-art models with fewer training samples. Our model can also perform fast adaptation on the unseen domain with only a few manual annotations. Code is available at https://github.com/ChuHan89/Meta-MTL4NucleiSegmentation     

Segmentation with mixed supervision: Confidence maximization helps knowledge distillation

Despite achieving promising results in a breadth of medical image segmentation tasks, deep neural networks (DNNs) require large training datasets with pixel-wise annotations. Obtaining these curated datasets is a cumbersome process which limits the applicability of DNNs in scenarios where annotated images are scarce. Mixed supervision is an appealing alternative for mitigating this obstacle. In this setting, only a small fraction of the data contains complete pixel-wise annotations and other images have a weaker form of supervision, e.g., only a handful of pixels are labeled. In this work, we propose a dual-branch architecture, where the upper branch (teacher) receives strong annotations, while the bottom one (student) is driven by limited supervision and guided by the upper branch. Combined with a standard cross-entropy loss over the labeled pixels, our novel formulation integrates two important terms: (i) a Shannon entropy loss defined over the less-supervised images, which encourages confident student predictions in the bottom branch; and (ii) a Kullback–Leibler (KL) divergence term, which transfers the knowledge (i.e., predictions) of the strongly supervised branch to the less-supervised branch and guides the entropy (student-confidence) term to avoid trivial solutions. We show that the synergy between the entropy and KL divergence yields substantial improvements in performance. We also discuss an interesting link between Shannon-entropy minimization and standard pseudo-mask generation, and argue that the former should be preferred over the latter for leveraging information from unlabeled pixels. We evaluate the effectiveness of the proposed formulation through a series of quantitative and qualitative experiments using two publicly available datasets. Results demonstrate that our method significantly outperforms other strategies for semantic segmentation within a mixed-supervision framework, as well as recent semi-supervised approaches. Moreover, in line with recent observations in classification, we show that the branch trained with reduced supervision and guided by the top branch largely outperforms the latter. Our code is publicly available: https://github.com/by-liu/ConfKD.     

Ms RED: A novel multi-scale residual encoding and decoding network for skin lesion segmentation

Computer-Aided Diagnosis (CAD) for dermatological diseases offers one of the most notable showcases where deep learning technologies display their impressive performance in acquiring and surpassing human experts. In such the CAD process, a critical step is concerned with segmenting skin lesions from dermoscopic images. Despite remarkable successes attained by recent deep learning efforts, much improvement is still anticipated to tackle challenging cases, e.g., segmenting lesions that are irregularly shaped, bearing low contrast, or possessing blurry boundaries. To address such inadequacies, this study proposes a novel Multi-scale Residual Encoding and Decoding network (Ms RED) for skin lesion segmentation, which is able to accurately and reliably segment a variety of lesions with efficiency. Specifically, a multi-scale residual encoding fusion module (MsR-EFM) is employed in an encoder, and a multi-scale residual decoding fusion module (MsR-DFM) is applied in a decoder to fuse multi-scale features adaptively. In addition, to enhance the representation learning capability of the newly proposed pipeline, we propose a novel multi-resolution, multi-channel feature fusion module (M²F²), which replaces conventional convolutional layers in encoder and decoder networks. Furthermore, we introduce a novel pooling module (Soft-pool) to medical image segmentation for the first time, retaining more helpful information when down-sampling and getting better segmentation performance. To validate the effectiveness and advantages of the proposed network, we compare it with several state-of-the-art methods on ISIC 2016, 2017, 2018, and PH². Experimental results consistently demonstrate that the proposed Ms RED attains significantly superior segmentation performance across five popularly used evaluation criteria. Last but not least, the new model utilizes much fewer model parameters than its peer approaches, leading to a greatly reduced number of labeled samples required for model training, which in turn produces a substantially faster converging training process than its peers. The source code is available at https://github.com/duweidai/Ms-RED.     

Mutual consistency learning for semi-supervised medical image segmentation

In this paper, we propose a novel mutual consistency network (MC-Net+) to effectively exploit the unlabeled data for semi-supervised medical image segmentation. The MC-Net+ model is motivated by the observation that deep models trained with limited annotations are prone to output highly uncertain and easily mis-classified predictions in the ambiguous regions (e.g., adhesive edges or thin branches) for medical image segmentation. Leveraging these challenging samples can make the semi-supervised segmentation model training more effective. Therefore, our proposed MC-Net+ model consists of two new designs. First, the model contains one shared encoder and multiple slightly different decoders (i.e., using different up-sampling strategies). The statistical discrepancy of multiple decoders’ outputs is computed to denote the model’s uncertainty, which indicates the unlabeled hard regions. Second, we apply a novel mutual consistency constraint between one decoder’s probability output and other decoders’ soft pseudo labels. In this way, we minimize the discrepancy of multiple outputs (i.e., the model uncertainty) during training and force the model to generate invariant results in such challenging regions, aiming at regularizing the model training. We compared the segmentation results of our MC-Net+ model with five state-of-the-art semi-supervised approaches on three public medical datasets. Extension experiments with two standard semi-supervised settings demonstrate the superior performance of our model over other methods, which sets a new state of the art for semi-supervised medical image segmentation. Our code is released publicly at https://github.com/ycwu1997/MC-Net.     

AWSnet: An auto-weighted supervision attention network for myocardial scar and edema segmentation in multi-sequence cardiac magnetic resonance images

Multi-sequence cardiac magnetic resonance (CMR) provides essential pathology information (scar and edema) to diagnose myocardial infarction. However, automatic pathology segmentation can be challenging due to the difficulty of effectively exploring the underlying information from the multi-sequence CMR data. This paper aims to tackle the scar and edema segmentation from multi-sequence CMR with a novel auto-weighted supervision framework, where the interactions among different supervised layers are explored under a task-specific objective using reinforcement learning. Furthermore, we design a coarse-to-fine framework to boost the small myocardial pathology region segmentation with shape prior knowledge. The coarse segmentation model identifies the left ventricle myocardial structure as a shape prior, while the fine segmentation model integrates a pixel-wise attention strategy with an auto-weighted supervision model to learn and extract salient pathological structures from the multi-sequence CMR data. Extensive experimental results on a publicly available dataset from Myocardial pathology segmentation combining multi-sequence CMR (MyoPS 2020) demonstrate our method can achieve promising performance compared with other state-of-the-art methods. Our method is promising in advancing the myocardial pathology assessment on multi-sequence CMR data. To motivate the community, we have made our code publicly available via https://github.com/soleilssss/AWSnet/tree/master.     

Federated learning for computational pathology on gigapixel whole slide images

Deep Learning-based computational pathology algorithms have demonstrated profound ability to excel in a wide array of tasks that range from characterization of well known morphological phenotypes to predicting non human-identifiable features from histology such as molecular alterations. However, the development of robust, adaptable and accurate deep learning-based models often rely on the collection and time-costly curation large high-quality annotated training data that should ideally come from diverse sources and patient populations to cater for the heterogeneity that exists in such datasets. Multi-centric and collaborative integration of medical data across multiple institutions can naturally help overcome this challenge and boost the model performance but is limited by privacy concerns among other difficulties that may arise in the complex data sharing process as models scale towards using hundreds of thousands of gigapixel whole slide images. In this paper, we introduce privacy-preserving federated learning for gigapixel whole slide images in computational pathology using weakly-supervised attention multiple instance learning and differential privacy. We evaluated our approach on two different diagnostic problems using thousands of histology whole slide images with only slide-level labels. Additionally, we present a weakly-supervised learning framework for survival prediction and patient stratification from whole slide images and demonstrate its effectiveness in a federated setting. Our results show that using federated learning, we can effectively develop accurate weakly-supervised deep learning models from distributed data silos without direct data sharing and its associated complexities, while also preserving differential privacy using randomized noise generation. We also make available an easy-to-use federated learning for computational pathology software package: http://github.com/mahmoodlab/HistoFL.     

A generalizable and robust deep learning algorithm for mitosis detection in multicenter breast histopathological images

Mitosis counting of biopsies is an important biomarker for breast cancer patients, which supports disease prognostication and treatment planning. Developing a robust mitotic cell detection model is highly challenging due to its complex growth pattern and high similarities with non-mitotic cells. Most mitosis detection algorithms have poor generalizability across image domains and lack reproducibility and validation in multicenter settings. To overcome these issues, we propose a generalizable and robust mitosis detection algorithm (called FMDet), which is independently tested on multicenter breast histopathological images. To capture more refined morphological features of cells, we convert the object detection task as a semantic segmentation problem. The pixel-level annotations for mitotic nuclei are obtained by taking the intersection of the masks generated from a well-trained nuclear segmentation model and the bounding boxes provided by the MIDOG 2021 challenge. In our segmentation framework, a robust feature extractor is developed to capture the appearance variations of mitotic cells, which is constructed by integrating a channel-wise multi-scale attention mechanism into a fully convolutional network structure. Benefiting from the fact that the changes in the low-level spectrum do not affect the high-level semantic perception, we employ a Fourier-based data augmentation method to reduce domain discrepancies by exchanging the low-frequency spectrum between two domains. Our FMDet algorithm has been tested in the MIDOG 2021 challenge and ranked first place. Further, our algorithm is also externally validated on four independent datasets for mitosis detection, which exhibits state-of-the-art performance in comparison with previously published results. These results demonstrate that our algorithm has the potential to be deployed as an assistant decision support tool in clinical practice. Our code has been released at https://github.com/Xiyue-Wang/1st-in-MICCAI-MIDOG-2021-challenge.     

FAT-Net: Feature adaptive transformers for automated skin lesion segmentation

Skin lesion segmentation from dermoscopic image is essential for improving the quantitative analysis of melanoma. However, it is still a challenging task due to the large scale variations and irregular shapes of the skin lesions. In addition, the blurred lesion boundaries between the skin lesions and the surrounding tissues may also increase the probability of incorrect segmentation. Due to the inherent limitations of traditional convolutional neural networks (CNNs) in capturing global context information, traditional CNN-based methods usually cannot achieve a satisfactory segmentation performance. In this paper, we propose a novel feature adaptive transformer network based on the classical encoder-decoder architecture, named FAT-Net, which integrates an extra transformer branch to effectively capture long-range dependencies and global context information. Furthermore, we also employ a memory-efficient decoder and a feature adaptation module to enhance the feature fusion between the adjacent-level features by activating the effective channels and restraining the irrelevant background noise. We have performed extensive experiments to verify the effectiveness of our proposed method on four public skin lesion segmentation datasets, including the ISIC 2016, ISIC 2017, ISIC 2018, and PH2 datasets. Ablation studies demonstrate the effectiveness of our feature adaptive transformers and memory-efficient strategies. Comparisons with state-of-the-art methods also verify the superiority of our proposed FAT-Net in terms of both accuracy and inference speed. The code is available at https://github.com/SZUcsh/FAT-Net.     

Unsupervised domain selective graph convolutional network for preoperative prediction of lymph node metastasis in gastric cancer

Preoperative prediction of lymph node (LN) metastasis based on computed tomography (CT) scans is an important task in gastric cancer, but few machine learning-based techniques have been proposed. While multi-center datasets increase sample size and representation ability, they suffer from inter-center heterogeneity. To tackle the above issue, we propose a novel multi-source domain adaptation framework for this diagnosis task, which not only considers domain-invariant and domain-specific features, but also achieves the imbalanced knowledge transfer and class-aware feature alignment across domains. First, we develop a 3D improved feature pyramidal network (i.e., 3D IFPN) to extract common multi-level features from the high-resolution 3D CT images, where a feature dynamic transfer (FDT) module can promote the network's ability to recognize the small target (i.e., LN). Then, we design an unsupervised domain selective graph convolutional network (i.e., UDS-GCN), which mainly includes three types of components: domain-specific feature extractor, domain selector and class-aware GCN classifier. Specifically, multiple domain-specific feature extractors are employed for learning domain-specific features from the common multi-level features generated by the 3D IFPN. A domain selector via the optimal transport (OT) theory is designed for controlling the amount of knowledge transferred from source domains to the target domain. A class-aware GCN classifier is developed to explicitly enhance/weaken the intra-class/inter-class similarity of all sample pairs across domains. To optimize UDS-GCN, the domain selector and the class-aware GCN classifier provide reliable target pseudo-labels to each other in the iterative process by collaborative learning. The extensive experiments are conducted on an in-house CT image dataset collected from four medical centers to demonstrate the efficacy of our proposed method. Experimental results verify that the proposed method boosts LN metastasis diagnosis performance and outperforms state-of-the-art methods. Our code is publically available at https://github.com/infinite-tao/LN_MSDA.     

A novel multi-attention,multi-scale 3D deep network for coronary artery segmentation

Automatic segmentation of coronary arteries provides vital assistance to enable accurate and efficient diagnosis and evaluation of coronary artery disease (CAD). However, the task of coronary artery segmentation (CAS) remains highly challenging due to the large-scale variations exhibited by coronary arteries, their complicated anatomical structures and morphologies, as well as the low contrast between vessels and their background. To comprehensively tackle these challenges, we propose a novel multi-attention, multi-scale 3D deep network for CAS, which we call CAS-Net. Specifically, we first propose an attention-guided feature fusion (AGFF) module to efficiently fuse adjacent hierarchical features in the encoding and decoding stages to capture more effectively latent semantic information. Then, we propose a scale-aware feature enhancement (SAFE) module, aiming to dynamically adjust the receptive fields to extract more expressive features effectively, thereby enhancing the feature representation capability of the network. Furthermore, we employ the multi-scale feature aggregation (MSFA) module to learn a more distinctive semantic representation for refining the vessel maps. In addition, considering that the limited training data annotated with a quality golden standard are also a significant factor restricting the development of CAS, we construct a new dataset containing 119 cases consisting of coronary computed tomographic angiography (CCTA) volumes and annotated coronary arteries. Extensive experiments on our self-collected dataset and three publicly available datasets demonstrate that the proposed method has good segmentation performance and generalization ability, outperforming multiple state-of-the-art algorithms on various metrics. Compared with U-Net3D, the proposed method significantly improves the Dice similarity coefficient (DSC) by at least 4% on each dataset, due to the synergistic effect among the three core modules, AGFF, SAFE, and MSFA. Our implementation is released at https://github.com/Cassie-CV/CAS-Net.     

Volumetric memory network for interactive medical image segmentation

Despite recent progress of automatic medical image segmentation techniques, fully automatic results usually fail to meet clinically acceptable accuracy, thus typically require further refinement. To this end, we propose a novel Volumetric Memory Network, dubbed as VMN, to enable segmentation of 3D medical images in an interactive manner. Provided by user hints on an arbitrary slice, a 2D interaction network is firstly employed to produce an initial 2D segmentation for the chosen slice. Then, the VMN propagates the initial segmentation mask bidirectionally to all slices of the entire volume. Subsequent refinement based on additional user guidance on other slices can be incorporated in the same manner. To facilitate smooth human-in-the-loop segmentation, a quality assessment module is introduced to suggest the next slice for interaction based on the segmentation quality of each slice produced in the previous round. Our VMN demonstrates two distinctive features: First, the memory-augmented network design offers our model the ability to quickly encode past segmentation information, which will be retrieved later for the segmentation of other slices; Second, the quality assessment module enables the model to directly estimate the quality of each segmentation prediction, which allows for an active learning paradigm where users preferentially label the lowest-quality slice for multi-round refinement. The proposed network leads to a robust interactive segmentation engine, which can generalize well to various types of user annotations (e.g., scribble, bounding box, extreme clicking). Extensive experiments have been conducted on three public medical image segmentation datasets (i.e., MSD, KiTS₁₉, CVC-ClinicDB), and the results clearly confirm the superiority of our approach in comparison with state-of-the-art segmentation models. The code is made publicly available at https://github.com/0liliulei/Mem3D.     

Embracing imperfect datasets: A review of deep learning solutions for medical image segmentation

The medical imaging literature has witnessed remarkable progress in high-performing segmentation models based on convolutional neural networks. Despite the new performance highs, the recent advanced segmentation models still require large, representative, and high quality annotated datasets. However, rarely do we have a perfect training dataset, particularly in the field of medical imaging, where data and annotations are both expensive to acquire. Recently, a large body of research has studied the problem of medical image segmentation with imperfect datasets, tackling two major dataset limitations: scarce annotations where only limited annotated data is available for training, and weak annotations where the training data has only sparse annotations, noisy annotations, or image-level annotations. In this article, we provide a detailed review of the solutions above, summarizing both the technical novelties and empirical results. We further compare the benefits and requirements of the surveyed methodologies and provide our recommended solutions. We hope this survey article increases the community awareness of the techniques that are available to handle imperfect medical image segmentation datasets.     

Learning what and where to segment: A new perspective on medical image few-shot segmentation

Traditional medical image segmentation methods based on deep learning require experts to provide extensive manual delineations for model training. Few-shot learning aims to reduce the dependence on the scale of training data but usually shows poor generalizability to the new target. The trained model tends to favor the training classes rather than being absolutely class-agnostic. In this work, we propose a novel two-branch segmentation network based on unique medical prior knowledge to alleviate the above problem. Specifically, we explicitly introduce a spatial branch to provide the spatial information of the target. In addition, we build a segmentation branch based on the classical encoder–decoder structure in supervised learning and integrate prototype similarity and spatial information as prior knowledge. To achieve effective information integration, we propose an attention-based fusion module (AF) that enables the content interaction of decoder features and prior knowledge. Experiments on an echocardiography dataset and an abdominal MRI dataset show that the proposed model achieves substantial improvements over state-of-the-art methods. Moreover, some results are comparable to those of the fully supervised model. The source code is available at github.com/warmestwind/RAPNet.