Publications by Kevin Marchesini

Cone-beam computed tomography (CBCT) is widely used for dento-maxillofacial diagnostics and treatment planning, and comprehensive multi-structure segmentation remains time-consuming, limiting large-scale, reproducible research. In this article, we present ToothFairy2, a MICCAI 2024 challenge on multi-structure segmentation in maxillofacial CBCT. The accompanying dataset comprises 530 CBCT volumes (480 public training, 50 hidden test) with expert 3D annotations of 42 classes, including maxilla, mandible, crowns, bridges, implants, inferior alveolar canals, maxillary sinuses, pharynx, and teeth using the International Tooth Numbering System (FDI). 26 international teams participated in ToothFairy2, and their methods were run and evaluated for voxel-wise multi-class segmentation using a standardized protocol. This report extends the evaluation of teeth to also investigate the current capabilities of tooth detection and FDI numbering. Furthermore, ranking stability was analyzed to assess the robustness of the final challenge outcome. Overall, challenge participants achieved consistently high performance for large, high-contrast structures such as jawbones, pharynx, and most teeth, while maxillary sinuses, dental restorations, and fine structures remain challenging due to class imbalance and metal artifacts. Analysis of tooth-related metrics further revealed that assigning correct FDI numbers was more challenging than delineating individual teeth. By releasing CBCT data, 3D annotations, baseline models, and evaluation code, ToothFairy2 establishes a long-term benchmark to drive the development of automated methods for robust, clinically meaningful multi-structure segmentation in maxillofacial CBCT.

CNNs and Transformer-based architectures are recently dominating the field of 3D medical segmentation. While CNNs face limitations in the local receptive field, Transformers require significant memory and data, making them less suitable for analyzing large 3D medical volumes. Consequently, fully convolutional network models like U-Net are still leading the 3D segmentation scenario. Although efforts have been made to reduce the Transformers computational complexity, such optimized models still struggle with content-based reasoning. This paper examines Mamba, a Recurrent Neural Network (RNN) based on State Space Models (SSMs), which achieves linear complexity and has outperformed Transformers in long-sequence tasks. Specifically, we assess Mamba’s performance in 3D medical segmentation using three widely recognized and commonly employed datasets and propose architectural enhancements to improve its segmentation effectiveness by mitigating the primary shortcomings of existing Mamba-based solutions.

Testicular ultrasound imaging is vital for assessing male infertility, with testicular inhomogeneity serving as a key biomarker. However, subjective interpretation and the scarcity of publicly available datasets pose challenges to automated classification. In this study, we explore supervised and unsupervised pretraining strategies using a ResNet-based architecture, supplemented by diffusion-based generative models to synthesize realistic ultrasound images. Our results demonstrate that pretraining significantly enhances classification performance compared to training from scratch, and synthetic data can effectively substitute real images in the pretraining process, alleviating data-sharing constraints. These methods offer promising advancements toward robust, clinically valuable automated analysis of male infertility. The source code is publicly available at https://github.com/AImageLab-zip/TesticulUS/.

Brain tumor segmentation is a crucial task in medical imaging that involves the integrated modeling of four distinct imaging modalities to identify tumor regions accurately. Unfortunately, in real-life scenarios, the full availability of such four modalities is often violated due to scanning cost, time, and patient condition. Consequently, several deep learning models have been developed to address the challenge of brain tumor segmentation under conditions of missing imaging modalities. However, the majority of these models have been evaluated using the 2018 version of the BraTS dataset, which comprises only $285$ volumes. In this study, we reproduce and extensively analyze the most relevant models using BraTS2023, which includes 1,250 volumes, thereby providing a more comprehensive and reliable comparison of their performance. Furthermore, we propose and evaluate the adoption of Mamba as an alternative fusion mechanism for brain tumor segmentation in the presence of missing modalities. Experimental results demonstrate that transformer-based architectures achieve leading performance on BraTS2023, outperforming purely convolutional models that were instead superior in BraTS2018. Meanwhile, the proposed Mamba-based architecture exhibits promising performance in comparison to state-of-the-art models, competing and even outperforming transformers. The source code of the proposed approach is publicly released alongside the benchmark developed for the evaluation: https://github.com/AImageLab-zip/IM-Fuse.

Convolutional Neural Networks (CNNs) have been broadly employed in dermoscopic image analysis, mainly due to the large amount of data gathered by the International Skin Imaging Collaboration (ISIC). But where do neural networks look? Several authors have claimed that the ISIC dataset is affected by strong biases, i.e. spurious correlations between samples that machine learning models unfairly exploit while discarding the useful patterns they are expected to learn. These strong claims have been supported by showing that deep learning models maintain excellent performance even when "no information about the lesion remains" in the debased input images. With this paper, we explore the interpretability of CNNs in dermoscopic image analysis by analyzing which characteristics are considered by autonomous classification algorithms. Starting from a standard setting, experiments presented in this paper gradually conceal well-known crucial dermoscopic features and thoroughly investigate how CNNs performance subsequently evolves. Experimental results carried out on two well-known CNNs, EfficientNet-B3, and ResNet-152, demonstrate that neural networks autonomously learn to extract features that are notoriously important for melanoma detection. Even when some of such features are removed, the others are still enough to achieve satisfactory classification performance. Obtained results demonstrate that literature claims on biases are not supported by carried-out experiments. Finally, to demonstrate the generalization capabilities of state-of-the-art CNN models for skin lesion classification, a large private dataset has been employed as an additional test set.

The synthesis of missing MRI modalities has emerged as a critical solution to address incomplete multi-parametric imaging in brain tumor diagnosis and treatment planning. While recent advances in generative models, especially GANs and diffusion-based approaches, have demonstrated promising results in cross-modality MRI generation, challenges remain in preserving anatomical fidelity and minimizing synthesis artifacts. In this work, we build upon the Hybrid Fusion GAN (\hfgan) framework, introducing several enhancements aimed at improving synthesis quality and generalization across tumor types. Specifically, we incorporate z-score normalization, optimize network components for faster and more stable training, and extend the pipeline to support multi-view generation across various brain tumor categories, including gliomas, metastases, and meningiomas. Our approach focuses on refining 2D slice-based generation to ensure intra-slice coherence and reduce intensity inconsistencies, ultimately supporting more accurate and robust tumor segmentation in scenarios with missing imaging modalities. Our source code is available at https://github.com/AImageLab-zip/BraSyn25.

Cone-beam computed tomography (CBCT) is a standard imaging modality in orofacial and dental practices, providing essential 3D volumetric imaging of anatomical structures, including jawbones, teeth, sinuses, and neurovascular canals. Accurately segmenting these structures is fundamental to numerous clinical applications, such as surgical planning and implant placement. However, manual segmentation of CBCT scans is time-intensive and requires expert input, creating a demand for automated solutions through deep learning. Effective development of such algorithms relies on access to large, well-annotated datasets, yet current datasets are often privately stored or limited in scope and considered structures, especially concerning 3D annotations. This paper proposes ToothFairy2, a comprehensive, publicly accessible CBCT dataset with voxel-level 3D annotations of 42 distinct classes corresponding to maxillofacial structures. We validate the dataset by benchmarking state-of-the-art neural network models, including convolutional, transformer-based, and hybrid Mamba-based architectures, to evaluate segmentation performance across complex anatomical regions. Our work also explores adaptations to the nnU-Net framework to optimize multi-class segmentation for maxillofacial anatomy. The proposed dataset provides a fundamental resource for advancing maxillofacial segmentation and supports future research in automated 3D image analysis in digital dentistry.

In recent years, several algorithms have been developed for the segmentation of the Inferior Alveolar Canal (IAC) in Cone-Beam Computed Tomography (CBCT) scans. However, the availability of public datasets in this domain is limited, resulting in a lack of comparative evaluation studies on a common benchmark. To address this scientific gap and encourage deep learning research in the field, the ToothFairy challenge was organized within the MICCAI 2023 conference. In this context, a public dataset was released to also serve as a benchmark for future research. The dataset comprises 443 CBCT scans, with voxel-level annotations of the IAC available for 153 of them, making it the largest publicly available dataset of its kind. The participants of the challenge were tasked with developing an algorithm to accurately identify the IAC using the 2D and 3D-annotated scans. This paper presents the details of the challenge and the contributions made by the most promising methods proposed by the participants. It represents the first comprehensive comparative evaluation of IAC segmentation methods on a common benchmark dataset, providing insights into the current state-of-the-art algorithms and outlining future research directions. Furthermore, to ensure reproducibility and promote future developments, an open-source repository that collects the implementations of the best submissions was released.

Recently, the field of 3D medical segmentation has been dominated by deep learning models employing Convolutional Neural Networks (CNNs) and Transformer-based architectures, each with its distinctive strengths and limitations. CNNs are constrained by a local receptive field, whereas Transformer are hindered by their substantial memory requirements as well as their data hunger, making them not ideal for processing 3D medical volumes at a fine-grained level. For these reasons, fully convolutional neural networks, as nnU-Net, still dominate the scene when segmenting medical structures in large 3D medical volumes. Despite numerous advancements toward developing transformer variants with subquadratic time and memory complexity, these models still fall short in content-based reasoning. A recent breakthrough is Mamba, a Recurrent Neural Network (RNN) based on State Space Models (SSMs), outperforming Transformers in many long-context tasks (million-length sequences) on famous natural language processing and genomic benchmarks while keeping a linear complexity. In this paper, we evaluate the effectiveness of Mamba-based architectures in comparison to state-of-the-art convolutional and Transformer-based models for 3D medical image segmentation across three well-established datasets: Synapse Abdomen, MSD BrainTumor, and ACDC. Additionally, we address the primary limitations of existing Mamba-based architectures by proposing alternative architectural designs, hence improving segmentation performances. The source code is publicly available to ensure reproducibility and facilitate further research: https://github.com/LucaLumetti/TamingMambas.