By focusing on metabolic and morphological tissue properties respectively, FluoroDeoxyGlucose (FDG)-Positron Emission Tomography (PET) and Computed Tomography (CT) modalities include complementary and synergistic information for cancerous lesion delineation and characterization (e.g. for outcome prediction), in addition to usual clinical variables. This is especially true in Head and Neck Cancer (HNC). The goal of the HEad and neCK TumOR segmentation and outcome prediction (HECKTOR) challenge was to develop and compare modern image analysis methods to best extract and leverage this information automatically. We present here the post-analysis of HECKTOR 2nd edition, at the 24th International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI) 2021. The scope of the challenge was substantially expanded compared to the first edition, by providing a larger population (adding patients from a new clinical center) and proposing an additional task to the challengers, namely the prediction of Progression-Free Survival (PFS). To this end, the participants were given access to a training set of 224 cases from 5 different centers, each with a pre-treatment FDG-PET/CT scan and clinical variables. Their methods were subsequently evaluated on a held-out test set of 101 cases from two centers. For the segmentation task (Task 1), the ranking was based on a Borda counting of their ranks according to two metrics: mean Dice Similarity Coefficient (DSC) and median Hausdorff Distance at 95th percentile (HD95). For the PFS prediction task, challengers could use the tumor contours provided by experts (Task 3) or rely on their own (Task 2). The ranking was obtained according to the Concordance index (C-index) calculated on the predicted risk scores. A total of 103 teams registered for the challenge, for a total of 448 submissions and 29 papers. The best method in the segmentation task obtained an average DSC of 0.759, and the best predictions of PFS obtained a C-index of 0.717 (without relying on the provided contours) and 0.698 (using the expert contours). An interesting finding was that best PFS predictions were reached by relying on DL approaches (with or without explicit tumor segmentation, 4 out of the 5 best ranked) compared to standard radiomics methods using handcrafted features extracted from delineated tumors, and by exploiting alternative tumor contours (automated and/or larger volumes encompassing surrounding tissues) rather than relying on the expert contours. This second edition of the challenge confirmed the promising performance of fully automated primary tumor delineation in PET/CT images of HNC patients, although there is still a margin for improvement in some difficult cases. For the first time, the prediction of outcome was also addressed and the best methods reached relatively good performance (C-index above 0.7). Both results constitute another step forward toward large-scale outcome prediction studies in HNC.

Connected operators provide well-established solutions for digital image processing, typically in conjunction with hierarchical schemes. In graph-based frameworks, such operators basically rely on symmetric adjacency relations between pixels. In this article, we introduce a notion of directed connected operators for hierarchical image processing, by also considering non-symmetric adjacency relations. The induced image representation models are no longer partition hierarchies (i.e., trees), but directed acyclic graphs that generalize standard morphological tree structures such as component trees, binary partition trees or hierarchical watersheds. We describe how to efficiently build and handle these richer data structures, and we illustrate the versatility of the proposed framework in image filtering and image segmentation.

The ultrasound imaging is a coherent imaging technique, the resulting images are characterized by a grainy appearance called speckle. In that case the ultrasound images are difficult to use automatically in clinical use, then treatments are required for this type of images. In fact, a pre-treatment phase is essential to filter the speckle and to improve the quality of ultrasound images which will then be segmented to extract the necessary forms that exist. This paper represents the importance of the pre-treatment for segmentation applied to cardiac echographic images. Speckle filtering is realized by means of the wavelet transform algorithm, and then we use Snakes algorithm to locate and extract cardiac structures.

Thin structure filtering is an important preprocessing task for the analysis of 2D and 3D bio-medical images in various contexts. We propose a filtering framework that relies on three approaches that are distinct and infrequently used together: linear, non-linear and non-local. This strategy, based on recent progress both in algorithmic/computational and methodological points of view, provides results that benefit from the advantages of each approach, while reducing their respective weaknesses. Its relevance is demonstrated by validations on 2D and 3D images.

Segmentation and analysis of blood vessels is an important issue in medical imaging. In 3D cerebral angiographic data, the vascular signal is however hard to accurately detect and can, in particular, be disconnected. In this article, we present a procedure utilising both linear, Hessian-based and morphological methods for blood vessel edge enhancement and reconnection. More specifically, multi-scale second-order derivative analysis is performed to detect candidate vessels as well as their orientation. This information is then fed to a spatially-variant morphological filter for reconnection and reconstruction. The result is a fast and effective vessel-reconnecting method.