Local Axial Scale-Attention for Universal Lesion Detection.

Universal lesion detection (ULD) in computed tomography (CT) images is an important and challenging prerequisite for computer-aided diagnosis (CAD) to find abnormal tissue, such as tumors of lymph nodes, liver tumors, and lymphadenopathy. The key challenge is that lesions have a tiny size and high similarity with non-lesions, which can easily lead to high false positives. Specifically , non-lesions are nearby normal anatomy that include the bowel, vasculature, and mesentery, which decrease the conspicuity of small lesions since they are often hard to differentiate. In this study, we present a novel scale-attention module that enhances feature discrimination between lesion and non-lesion regions by utilizing the domain knowledge of radiologists to reduce false positives effectively. Inspired by the domain knowledge that radiologists tend to divide each CT image into multiple areas, then detect lesions in these smaller areas separately, a local axial scale-attention (LASA) module is proposed to re-weight each pixel in a feature map by aggregating local features from multiple scales adaptively. In addition, to keep the same weight, a combination of axial pixels in the height- and width-axes is designed, attached with position embedding. The model can be used in CNNs easily and flexibly. We test our method on the DeepLesion dataset. The sensitivities at 0.5, 1, 2, 4, 8, and 16 false positives (FPs) per image and average sensitivity at [0.5, 1, 2, 4] are calculated to evaluate the accuracy. The sensitivities are 78.30%, 84.96%, 89.86%, 93.14%, 95.36%, and 95.54% at 0.5, 1, 2, 4, 8, and 16 FPs per image; the average sensitivity is 86.56%, outperforming the former methods. The proposed method enhances feature discrimination between lesion and non-lesion regions by adding LASA modules. These encouraging results illustrate the potential advantage of exploiting the domain knowledge for lesion detection.