  Unsupervised lesion detection is a challenging problem that requires
accurately estimating normative distributions of healthy anatomy and detecting
lesions as outliers without training examples. Recently, this problem has
received increased attention from the research community following the advances
in unsupervised learning with deep learning. Such advances allow the estimation
of high-dimensional distributions, such as normative distributions, with higher
accuracy than previous methods.The main approach of the recently proposed
methods is to learn a latent-variable model parameterized with networks to
approximate the normative distribution using example images showing healthy
anatomy, perform prior-projection, i.e. reconstruct the image with lesions
using the latent-variable model, and determine lesions based on the differences
between the reconstructed and original images. While being promising, the
prior-projection step often leads to a large number of false positives. In this
work, we approach unsupervised lesion detection as an image restoration problem
and propose a probabilistic model that uses a network-based prior as the
normative distribution and detect lesions pixel-wise using MAP estimation. The
probabilistic model punishes large deviations between restored and original
images, reducing false positives in pixel-wise detections. Experiments with
gliomas and stroke lesions in brain MRI using publicly available datasets show
that the proposed approach outperforms the state-of-the-art unsupervised
methods by a substantial margin, +0.13 (AUC), for both glioma and stroke
detection. Extensive model analysis confirms the effectiveness of MAP-based
image restoration.
