Sergio Uribe

Pablo Arratia López, Hernán Mella, Sergio Uribe et al.

Heart failure is typically diagnosed with a global function assessment, such as ejection fraction. However, these metrics have low discriminate power, failing to distinguish different types of this disease. Quantifying local deformations in the form of cardiac strain can provide helpful information, but it remains a challenge. In this work, we introduce WarpPINN, a physics-informed neural network to perform image registration to obtain local metrics of the heart deformation. We apply this method to cine magnetic resonance images to estimate the motion during the cardiac cycle. We inform our neural network of near-incompressibility of cardiac tissue by penalizing the jacobian of the deformation field. The loss function has two components: an intensity-based similarity term between the reference and the warped template images, and a regularizer that represents the hyperelastic behavior of the tissue. The architecture of the neural network allows us to easily compute the strain via automatic differentiation to assess cardiac activity. We use Fourier feature mappings to overcome the spectral bias of neural networks, allowing us to capture discontinuities in the strain field. We test our algorithm on a synthetic example and on a cine-MRI benchmark of 15 healthy volunteers. We outperform current methodologies both landmark tracking and strain estimation. We expect that WarpPINN will enable more precise diagnostics of heart failure based on local deformation information. Source code is available at https://github.com/fsahli/WarpPINN.

Jeremias Garay, Jocelyn Dunstan, Sergio Uribe et al.

Physics-informed neural networks (PINNs) have emerged as a powerful tool for solving inverse problems, especially in cases where no complete information about the system is known and scatter measurements are available. This is especially useful in hemodynamics since the boundary information is often difficult to model, and high-quality blood flow measurements are generally hard to obtain. In this work, we use the PINNs methodology for estimating reduced-order model parameters and the full velocity field from scatter 2D noisy measurements in the ascending aorta. The results show stable and accurate parameter estimations when using the method with simulated data, while the velocity reconstruction shows dependence on the measurement quality and the flow pattern complexity. The method allows for solving clinical-relevant inverse problems in hemodynamics and complex coupled physical systems.

Javier Bisbal, Julio Sotelo, Hernán Mella et al.

This work introduces an unsupervised Divergence and Aliasing-Free neural network (DAF-FlowNet) for 4D Flow Magnetic Resonance Imaging (4D Flow MRI) that jointly enhances noisy velocity fields and corrects phase wrapping artifacts. DAF-FlowNet parameterizes velocities as the curl of a vector potential, enforcing mass conservation by construction and avoiding explicit divergence-penalty tuning. A cosine data-consistency loss enables simultaneous denoising and unwrapping from wrapped phase images. On synthetic aortic 4D Flow MRI generated from computational fluid dynamics, DAF-FlowNet achieved lower errors than existing techniques (up to 11% lower velocity normalized root mean square error, 11% lower directional error, and 44% lower divergence relative to the best-performing alternative across noise levels), with robustness to moderate segmentation perturbations. For unwrapping, at peak velocity/velocity-encoding ratios of 1.4 and 2.1, DAF-FlowNet achieved 0.18% and 5.2% residual wrapped voxels, representing reductions of 72% and 18% relative to the best alternative method, respectively. In scenarios with both noise and aliasing, the proposed single-stage formulation outperformed a state-of-the-art sequential pipeline (up to 15% lower velocity normalized root mean square error, 11% lower directional error, and 28% lower divergence). Across 10 hypertrophic cardiomyopathy patient datasets, DAF-FlowNet preserved fine-scale flow features, corrected aliased regions, and improved internal flow consistency, as indicated by reduced inter-plane flow bias in aortic and pulmonary mass-conservation analyses recommended by the 4D Flow MRI consensus guidelines. These results support DAF-FlowNet as a framework that unifies velocity enhancement and phase unwrapping to improve the reliability of cardiovascular 4D Flow MRI.

Javier Bisbal, Patrick Winter, Sebastian Jofre et al.

Accurate anatomical labeling of intracranial arteries is essential for cerebrovascular diagnosis and hemodynamic analysis but remains time-consuming and subject to interoperator variability. We present a deep learning-based framework for automated artery labeling from 3D Time-of-Flight Magnetic Resonance Angiography (3D ToF-MRA) segmentations (n=35), incorporating uncertainty quantification to enhance interpretability and reliability. We evaluated three convolutional neural network architectures: (1) a UNet with residual encoder blocks, reflecting commonly used baselines in vascular labeling; (2) CS-Net, an attention-augmented UNet incorporating channel and spatial attention mechanisms for enhanced curvilinear structure recognition; and (3) nnUNet, a self-configuring framework that automates preprocessing, training, and architectural adaptation based on dataset characteristics. Among these, nnUNet achieved the highest labeling performance (average Dice score: 0.922; average surface distance: 0.387 mm), with improved robustness in anatomically complex vessels. To assess predictive confidence, we implemented test-time augmentation (TTA) and introduced a novel coordinate-guided strategy to reduce interpolation errors during augmented inference. The resulting uncertainty maps reliably indicated regions of anatomical ambiguity, pathological variation, or manual labeling inconsistency. We further validated clinical utility by comparing flow velocities derived from automated and manual labels in co-registered 4D Flow MRI datasets, observing close agreement with no statistically significant differences. Our framework offers a scalable, accurate, and uncertainty-aware solution for automated cerebrovascular labeling, supporting downstream hemodynamic analysis and facilitating clinical integration.

Javier Bisbal, Julio Sotelo, Maria I Valdés et al.

Deep reinforcement learning (DRL) algorithms have shown robust results in plane reformatting tasks. In these methods, an agent sequentially adjusts the position and orientation of an initial plane towards an objective location. This process allows accurate plane reformatting, without the need for detailed landmarks, which makes it suitable for images with limited contrast and resolution, such as 4D flow MRI. However, current DRL methods require the test dataset to be in the same position and orientation as the training dataset. In this paper, we present a novel technique that utilizes a flexible coordinate system based on the current state, enabling navigation in volumes at any position or orientation. We adopted the Asynchronous Advantage Actor Critic (A3C) algorithm for reinforcement learning, outperforming Deep Q Network (DQN). Experimental results in 4D flow MRI demonstrate improved accuracy in plane reformatting angular and distance errors (6.32 +- 4.15 ° and 3.40 +- 2.75 mm), as well as statistically equivalent flow measurements determined by a plane reformatting process done by an expert (p=0.21). The method's flexibility and adaptability make it a promising candidate for other medical imaging applications beyond 4D flow MRI.

Pablo Pino, Denis Parra, Pablo Messina et al.

Several deep learning architectures have been proposed over the last years to deal with the problem of generating a written report given an imaging exam as input. Most works evaluate the generated reports using standard Natural Language Processing (NLP) metrics (e.g. BLEU, ROUGE), reporting significant progress. In this article, we contrast this progress by comparing state of the art (SOTA) models against weak baselines. We show that simple and even naive approaches yield near SOTA performance on most traditional NLP metrics. We conclude that evaluation methods in this task should be further studied towards correctly measuring clinical accuracy, ideally involving physicians to contribute to this end.

Pablo Messina, Pablo Pino, Denis Parra et al.

Every year physicians face an increasing demand of image-based diagnosis from patients, a problem that can be addressed with recent artificial intelligence methods. In this context, we survey works in the area of automatic report generation from medical images, with emphasis on methods using deep neural networks, with respect to: (1) Datasets, (2) Architecture Design, (3) Explainability and (4) Evaluation Metrics. Our survey identifies interesting developments, but also remaining challenges. Among them, the current evaluation of generated reports is especially weak, since it mostly relies on traditional Natural Language Processing (NLP) metrics, which do not accurately capture medical correctness.