P. Ellen Grant

Neel Dey, S. Mazdak Abulnaga, Benjamin Billot et al. · mit

Star-convex shapes arise across bio-microscopy and radiology in the form of nuclei, nodules, metastases, and other units. Existing instance segmentation networks for such structures train on densely labeled instances for each dataset, which requires substantial and often impractical manual annotation effort. Further, significant reengineering or finetuning is needed when presented with new datasets and imaging modalities due to changes in contrast, shape, orientation, resolution, and density. We present AnyStar, a domain-randomized generative model that simulates synthetic training data of blob-like objects with randomized appearance, environments, and imaging physics to train general-purpose star-convex instance segmentation networks. As a result, networks trained using our generative model do not require annotated images from unseen datasets. A single network trained on our synthesized data accurately 3D segments C. elegans and P. dumerilii nuclei in fluorescence microscopy, mouse cortical nuclei in micro-CT, zebrafish brain nuclei in EM, and placental cotyledons in human fetal MRI, all without any retraining, finetuning, transfer learning, or domain adaptation. Code is available at https://github.com/neel-dey/AnyStar.

S. Mazdak Abulnaga, Sean I. Young, Katherine Hobgood et al. · mit

Blood oxygen level dependent (BOLD) MRI with maternal hyperoxia can assess oxygen transport within the placenta and has emerged as a promising tool to study placental function. Measuring signal changes over time requires segmenting the placenta in each volume of the time series. Due to the large number of volumes in the BOLD time series, existing studies rely on registration to map all volumes to a manually segmented template. As the placenta can undergo large deformation due to fetal motion, maternal motion, and contractions, this approach often results in a large number of discarded volumes, where the registration approach fails. In this work, we propose a machine learning model based on a U-Net neural network architecture to automatically segment the placenta in BOLD MRI and apply it to segmenting each volume in a time series. We use a boundary-weighted loss function to accurately capture the placental shape. Our model is trained and tested on a cohort of 91 subjects containing healthy fetuses, fetuses with fetal growth restriction, and mothers with high BMI. We achieve a Dice score of 0.83+/-0.04 when matching with ground truth labels and our model performs reliably in segmenting volumes in both normoxic and hyperoxic points in the BOLD time series. Our code and trained model are available at https://github.com/mabulnaga/automatic-placenta-segmentation.

Zeen Chi, Zhongxiao Cong, Clinton J. Wang et al. · mit

We present a method for fast biomedical image atlas construction using neural fields. Atlases are key to biomedical image analysis tasks, yet conventional and deep network estimation methods remain time-intensive. In this preliminary work, we frame subject-specific atlas building as learning a neural field of deformable spatiotemporal observations. We apply our method to learning subject-specific atlases and motion stabilization of dynamic BOLD MRI time-series of fetuses in utero. Our method yields high-quality atlases of fetal BOLD time-series with $\sim$5-7$\times$ faster convergence compared to existing work. While our method slightly underperforms well-tuned baselines in terms of anatomical overlap, it estimates templates significantly faster, thus enabling rapid processing and stabilization of large databases of 4D dynamic MRI acquisitions. Code is available at https://github.com/Kidrauh/neural-atlasing

Yingcheng Liu, Neerav Karani, Neel Dey et al. · mit

The placenta plays a crucial role in fetal development. Automated 3D placenta segmentation from fetal EPI MRI holds promise for advancing prenatal care. This paper proposes an effective semi-supervised learning method for improving placenta segmentation in fetal EPI MRI time series. We employ consistency regularization loss that promotes consistency under spatial transformation of the same image and temporal consistency across nearby images in a time series. The experimental results show that the method improves the overall segmentation accuracy and provides better performance for outliers and hard samples. The evaluation also indicates that our method improves the temporal coherency of the prediction, which could lead to more accurate computation of temporal placental biomarkers. This work contributes to the study of the placenta and prenatal clinical decision-making. Code is available at https://github.com/firstmover/cr-seg.

Junshen Xu, Daniel Moyer, P. Ellen Grant et al. · mit

Volumetric reconstruction of fetal brains from multiple stacks of MR slices, acquired in the presence of almost unpredictable and often severe subject motion, is a challenging task that is highly sensitive to the initialization of slice-to-volume transformations. We propose a novel slice-to-volume registration method using Transformers trained on synthetically transformed data, which model multiple stacks of MR slices as a sequence. With the attention mechanism, our model automatically detects the relevance between slices and predicts the transformation of one slice using information from other slices. We also estimate the underlying 3D volume to assist slice-to-volume registration and update the volume and transformations alternately to improve accuracy. Results on synthetic data show that our method achieves lower registration error and better reconstruction quality compared with existing state-of-the-art methods. Experiments with real-world MRI data are also performed to demonstrate the ability of the proposed model to improve the quality of 3D reconstruction under severe fetal motion.

Sheng He, Yanfang Feng, P. Ellen Grant et al.

Deep convolutional neural networks (CNNs) have been widely used for medical image segmentation. In most studies, only the output layer is exploited to compute the final segmentation results and the hidden representations of the deep learned features have not been well understood. In this paper, we propose a prototype segmentation (ProtoSeg) method to compute a binary segmentation map based on deep features. We measure the segmentation abilities of the features by computing the Dice between the feature segmentation map and ground-truth, named as the segmentation ability score (SA score for short). The corresponding SA score can quantify the segmentation abilities of deep features in different layers and units to understand the deep neural networks for segmentation. In addition, our method can provide a mean SA score which can give a performance estimation of the output on the test images without ground-truth. Finally, we use the proposed ProtoSeg method to compute the segmentation map directly on input images to further understand the segmentation ability of each input image. Results are presented on segmenting tumors in brain MRI, lesions in skin images, COVID-related abnormality in CT images, prostate segmentation in abdominal MRI, and pancreatic mass segmentation in CT images. Our method can provide new insights for interpreting and explainable AI systems for medical image segmentation. Our code is available on: \url{https://github.com/shengfly/ProtoSeg}.

Ramya Muthukrishnan, Borjan Gagoski, Aryn Lee et al.

We present E(3)-Pose, a novel fast pose estimation method that jointly and explicitly models rotation equivariance and object symmetry. Our work is motivated by the challenging problem of accounting for fetal head motion during a diagnostic MRI scan. We aim to enable automatic adaptive prescription of 2D diagnostic MRI slices with 6-DoF head pose estimation, supported by 3D MRI volumes rapidly acquired before each 2D slice. Existing methods struggle to generalize to clinical volumes, due to pose ambiguities induced by inherent anatomical symmetries, as well as low resolution, noise, and artifacts. In contrast, E(3)-Pose captures anatomical symmetries and rigid pose equivariance by construction, and yields robust estimates of the fetal head pose. Our experiments on publicly available and representative clinical fetal MRI datasets demonstrate the superior robustness and generalization of our method across domains. Crucially, E(3)-Pose achieves state-of-the-art accuracy on clinical MRI volumes, supporting future clinical translation. Our implementation is publicly available at github.com/MedicalVisionGroup/E3-Pose.

Sheng He, Rina Bao, Jingpeng Li et al.

Background: The segment-anything model (SAM), introduced in April 2023, shows promise as a benchmark model and a universal solution to segment various natural images. It comes without previously-required re-training or fine-tuning specific to each new dataset. Purpose: To test SAM's accuracy in various medical image segmentation tasks and investigate potential factors that may affect its accuracy in medical images. Methods: SAM was tested on 12 public medical image segmentation datasets involving 7,451 subjects. The accuracy was measured by the Dice overlap between the algorithm-segmented and ground-truth masks. SAM was compared with five state-of-the-art algorithms specifically designed for medical image segmentation tasks. Associations of SAM's accuracy with six factors were computed, independently and jointly, including segmentation difficulties as measured by segmentation ability score and by Dice overlap in U-Net, image dimension, size of the target region, image modality, and contrast. Results: The Dice overlaps from SAM were significantly lower than the five medical-image-based algorithms in all 12 medical image segmentation datasets, by a margin of 0.1-0.5 and even 0.6-0.7 Dice. SAM-Semantic was significantly associated with medical image segmentation difficulty and the image modality, and SAM-Point and SAM-Box were significantly associated with image segmentation difficulty, image dimension, target region size, and target-vs-background contrast. All these 3 variations of SAM were more accurate in 2D medical images, larger target region sizes, easier cases with a higher Segmentation Ability score and higher U-Net Dice, and higher foreground-background contrast.

Sheng He, Yanfang Feng, P. Ellen Grant et al.

Most deep learning models for temporal regression directly output the estimation based on single input images, ignoring the relationships between different images. In this paper, we propose deep relation learning for regression, aiming to learn different relations between a pair of input images. Four non-linear relations are considered: "cumulative relation", "relative relation", "maximal relation" and "minimal relation". These four relations are learned simultaneously from one deep neural network which has two parts: feature extraction and relation regression. We use an efficient convolutional neural network to extract deep features from the pair of input images and apply a Transformer for relation learning. The proposed method is evaluated on a merged dataset with 6,049 subjects with ages of 0-97 years using 5-fold cross-validation for the task of brain age estimation. The experimental results have shown that the proposed method achieved a mean absolute error (MAE) of 2.38 years, which is lower than the MAEs of 8 other state-of-the-art algorithms with statistical significance (p$<$0.05) in paired T-test (two-side).

Sheng He, Rina Bao, P. Ellen Grant et al.

The combination of the U-Net based deep learning models and Transformer is a new trend for medical image segmentation. U-Net can extract the detailed local semantic and texture information and Transformer can learn the long-rang dependencies among pixels in the input image. However, directly adapting the Transformer for segmentation has ``token-flatten" problem (flattens the local patches into 1D tokens which losses the interaction among pixels within local patches) and ``scale-sensitivity" problem (uses a fixed scale to split the input image into local patches). Compared to directly combining U-Net and Transformer, we propose a new global-local fashion combination of U-Net and Transformer, named U-Netmer, to solve the two problems. The proposed U-Netmer splits an input image into local patches. The global-context information among local patches is learnt by the self-attention mechanism in Transformer and U-Net segments each local patch instead of flattening into tokens to solve the `token-flatten" problem. The U-Netmer can segment the input image with different patch sizes with the identical structure and the same parameter. Thus, the U-Netmer can be trained with different patch sizes to solve the ``scale-sensitivity" problem. We conduct extensive experiments in 7 public datasets on 7 organs (brain, heart, breast, lung, polyp, pancreas and prostate) and 4 imaging modalities (MRI, CT, ultrasound, and endoscopy) to show that the proposed U-Netmer can be generally applied to improve accuracy of medical image segmentation. These experimental results show that U-Netmer provides state-of-the-art performance compared to baselines and other models. In addition, the discrepancy among the outputs of U-Netmer with different scales is linearly correlated to the segmentation accuracy which can be considered as a confidence score to rank test images by difficulty without ground-truth.

Margherita Firenze, Sean I. Young, Clinton J. Wang et al.

Fully convolutional networks have become the backbone of modern medical imaging due to their ability to learn multi-scale representations and perform end-to-end inference. Yet their potential for slice-to-volume reconstruction (SVR), the task of jointly estimating 3D anatomy and slice poses from misaligned 2D acquisitions, remains underexplored. We introduce a fast convolutional framework that fuses multiple orthogonal 2D slice stacks to recover coherent 3D structure and refines slice alignment through lightweight model-based optimization. Applied to fetal brain MRI, our approach reconstructs high-quality 3D volumes in under 10s, with 1s slice registration and accuracy on par with state-of-the-art iterative SVR pipelines, offering more than speedup. The framework uses non-rigid displacement fields to represent transformations, generalizing to other SVR problems like fetal body and placental MRI. Additionally, the fast inference time paves the way for real-time, scanner-side volumetric feedback during MRI acquisition.

Athena Taymourtash, S. Mazdak Abulnaga, Esra Abaci Turk et al.

Establishing dense volumetric correspondences across anatomical shapes is essential for group-level analysis but remains challenging for implicit neural representations. Most existing implicit registration methods rely on supervision near the zero-level set and thus capture only surface correspondences, leaving interior deformations under-constrained. We introduce a volumetrically consistent implicit model that couples reconstruction of signed distance functions (SDFs) with neural diffeomorphic flow to learn a shared canonical template of the placenta. Volumetric regularization, including Jacobian-determinant and biharmonic penalties, suppresses local folding and promotes globally coherent deformations. In the motivating application to placenta MRI, our formulation jointly reconstructs individual placentas, aligns them to a population-derived implicit template, and enables voxel-wise intensity mapping in a unified canonical space. Experiments on in-vivo placenta MRI scans demonstrate improved geometric fidelity and volumetric alignment over surface-based implicit baseline methods, yielding anatomically interpretable and topologically consistent flattening suitable for group analysis.

Yingcheng Liu, Athena Taymourtash, Yang Liu et al.

Automated analysis of articulated bodies is crucial in medical imaging. Existing surface-based models often ignore internal volumetric structures and rely on deformation methods that lack anatomical consistency guarantees. To address this problem, we introduce a differentiable volumetric body model based on the Skinned Multi-Person Linear (SMPL) formulation, driven by a new Kinematic Tree-based Log-Euclidean PolyRigid (KTPolyRigid) transform. KTPolyRigid resolves Lie algebra ambiguities associated with large, non-local articulated motions, and encourages smooth, bijective volumetric mappings. Evaluated on 53 fetal MRI volumes, KTPolyRigid yields deformation fields with significantly fewer folding artifacts. Furthermore, our framework enables robust groupwise image registration and a label-efficient, template-based segmentation of fetal organs. It provides a robust foundation for standardized volumetric analysis of articulated bodies in medical imaging.

S. Mazdak Abulnaga, Neel Dey, Sean I. Young et al. · mit

Blood oxygen level dependent (BOLD) MRI time series with maternal hyperoxia can assess placental oxygenation and function. Measuring precise BOLD changes in the placenta requires accurate temporal placental segmentation and is confounded by fetal and maternal motion, contractions, and hyperoxia-induced intensity changes. Current BOLD placenta segmentation methods warp a manually annotated subject-specific template to the entire time series. However, as the placenta is a thin, elongated, and highly non-rigid organ subject to large deformations and obfuscated edges, existing work cannot accurately segment the placental shape, especially near boundaries. In this work, we propose a machine learning segmentation framework for placental BOLD MRI and apply it to segmenting each volume in a time series. We use a placental-boundary weighted loss formulation and perform a comprehensive evaluation across several popular segmentation objectives. Our model is trained and tested on a cohort of 91 subjects containing healthy fetuses, fetuses with fetal growth restriction, and mothers with high BMI. Biomedically, our model performs reliably in segmenting volumes in both normoxic and hyperoxic points in the BOLD time series. We further find that boundary-weighting increases placental segmentation performance by 8.3% and 6.0% Dice coefficient for the cross-entropy and signed distance transform objectives, respectively. Our code and trained model is available at https://github.com/mabulnaga/automatic-placenta-segmentation.

Benjamin Billot, Ramya Muthukrishnan, Esra Abaci-Turk et al.

Unsupervised registration strategies bypass requirements in ground truth transforms or segmentations by optimising similarity metrics between fixed and moved volumes. Among these methods, a recent subclass of approaches based on unsupervised keypoint detection stand out as very promising for interpretability. Specifically, these methods train a network to predict feature maps for fixed and moving images, from which explainable centres of mass are computed to obtain point clouds, that are then aligned in closed-form. However, the features returned by the network often yield spatially diffuse patterns that are hard to interpret, thus undermining the purpose of keypoint-based registration. Here, we propose a three-fold loss to regularise the spatial distribution of the features. First, we use the KL divergence to model features as point spread functions that we interpret as probabilistic keypoints. Then, we sharpen the spatial distributions of these features to increase the precision of the detected landmarks. Finally, we introduce a new repulsive loss across keypoints to encourage spatial diversity. Overall, our loss considerably improves the interpretability of the features, which now correspond to precise and anatomically meaningful landmarks. We demonstrate our three-fold loss in foetal rigid motion tracking and brain MRI affine registration tasks, where it not only outperforms state-of-the-art unsupervised strategies, but also bridges the gap with state-of-the-art supervised methods. Our code is available at https://github.com/BenBillot/spatial_regularisation.

Sebastian Diaz, Benjamin Billot, Neel Dey et al. · mit

Fetal motion is a critical indicator of neurological development and intrauterine health, yet its quantification remains challenging, particularly at earlier gestational ages (GA). Current methods track fetal motion by predicting the location of annotated landmarks on 3D echo planar imaging (EPI) time-series, primarily in third-trimester fetuses. The predicted landmarks enable simplification of the fetal body for downstream analysis. While these methods perform well within their training age distribution, they consistently fail to generalize to early GAs due to significant anatomical changes in both mother and fetus across gestation, as well as the difficulty of obtaining annotated early GA EPI data. In this work, we develop a cross-population data augmentation framework that enables pose estimation models to robustly generalize to younger GA clinical cohorts using only annotated images from older GA cohorts. Specifically, we introduce a fetal-specific augmentation strategy that simulates the distinct intrauterine environment and fetal positioning of early GAs. Our experiments find that cross-population augmentation yields reduced variability and significant improvements across both older GA and challenging early GA cases. By enabling more reliable pose estimation across gestation, our work potentially facilitates early clinical detection and intervention in challenging 4D fetal imaging settings. Code is available at https://github.com/sebodiaz/cross-population-pose.

Yingcheng Liu, Peiqi Wang, Sebastian Diaz et al.

Analyzing fetal body motion and shape is paramount in prenatal diagnostics and monitoring. Existing methods for fetal MRI analysis mainly rely on anatomical keypoints or volumetric body segmentations. Keypoints simplify body structure to facilitate motion analysis, but may ignore important details of full-body shape. Body segmentations capture complete shape information but complicate temporal analysis due to large non-local fetal movements. To address these limitations, we construct a 3D articulated statistical fetal body model based on the Skinned Multi-Person Linear Model (SMPL). Our algorithm iteratively estimates body pose in the image space and body shape in the canonical pose space. This approach improves robustness to MRI motion artifacts and intensity distortions, and reduces the impact of incomplete surface observations due to challenging fetal poses. We train our model on segmentations and keypoints derived from $19,816$ MRI volumes across $53$ subjects. Our model captures body shape and motion across time series and provides intuitive visualization. Furthermore, it enables automated anthropometric measurements traditionally difficult to obtain from segmentations and keypoints. When tested on unseen fetal body shapes, our method yields a surface alignment error of $3.2$ mm for $3$ mm MRI voxel size. To our knowledge, this represents the first 3D articulated statistical fetal body model, paving the way for enhanced fetal motion and shape analysis in prenatal diagnostics. The code is available at https://github.com/MedicalVisionGroup/fetal-smpl .

S. Mazdak Abulnaga, Esra Abaci Turk, Mikhail Bessmeltsev et al.

We present a volumetric mesh-based algorithm for parameterizing the placenta to a flattened template to enable effective visualization of local anatomy and function. MRI shows potential as a research tool as it provides signals directly related to placental function. However, due to the curved and highly variable in vivo shape of the placenta, interpreting and visualizing these images is difficult. We address interpretation challenges by mapping the placenta so that it resembles the familiar ex vivo shape. We formulate the parameterization as an optimization problem for mapping the placental shape represented by a volumetric mesh to a flattened template. We employ the symmetric Dirichlet energy to control local distortion throughout the volume. Local injectivity in the mapping is enforced by a constrained line search during the gradient descent optimization. We validate our method using a research study of 111 placental shapes extracted from BOLD MRI images. Our mapping achieves sub-voxel accuracy in matching the template while maintaining low distortion throughout the volume. We demonstrate how the resulting flattening of the placenta improves visualization of anatomy and function. Our code is freely available at https://github.com/mabulnaga/placenta-flattening .

Sheng He, P. Ellen Grant, Yangming Ou

Deep learning can provide rapid brain age estimation based on brain magnetic resonance imaging (MRI). However, most studies use one neural network to extract the global information from the whole input image, ignoring the local fine-grained details. In this paper, we propose a global-local transformer, which consists of a global-pathway to extract the global-context information from the whole input image and a local-pathway to extract the local fine-grained details from local patches. The fine-grained information from the local patches are fused with the global-context information by the attention mechanism, inspired by the transformer, to estimate the brain age. We evaluate the proposed method on 8 public datasets with 8,379 healthy brain MRIs with the age range of 0-97 years. 6 datasets are used for cross-validation and 2 datasets are used for evaluating the generality. Comparing with other state-of-the-art methods, the proposed global-local transformer reduces the mean absolute error of the estimated ages to 2.70 years and increases the correlation coefficient of the estimated age and the chronological age to 0.9853. In addition, our proposed method provides regional information of which local patches are most informative for brain age estimation. Our source code is available on: \url{https://github.com/shengfly/global-local-transformer}.

S. Mazdak Abulnaga, Esra Abaci Turk, Mikhail Bessmeltsev et al.

We present a volumetric mesh-based algorithm for flattening the placenta to a canonical template to enable effective visualization of local anatomy and function. Monitoring placental function in vivo promises to support pregnancy assessment and to improve care outcomes. We aim to alleviate visualization and interpretation challenges presented by the shape of the placenta when it is attached to the curved uterine wall. To do so, we flatten the volumetric mesh that captures placental shape to resemble the well-studied ex vivo shape. We formulate our method as a map from the in vivo shape to a flattened template that minimizes the symmetric Dirichlet energy to control distortion throughout the volume. Local injectivity is enforced via constrained line search during gradient descent. We evaluate the proposed method on 28 placenta shapes extracted from MRI images in a clinical study of placental function. We achieve sub-voxel accuracy in mapping the boundary of the placenta to the template while successfully controlling distortion throughout the volume. We illustrate how the resulting mapping of the placenta enhances visualization of placental anatomy and function. Our code is freely available at https://github.com/mabulnaga/placenta-flattening .

Qi Zeng, Weide Liu, Bo Li et al.

This paper presents FeTal-SAM, a novel adaptation of the Segment Anything Model (SAM) tailored for fetal brain MRI segmentation. Traditional deep learning methods often require large annotated datasets for a fixed set of labels, making them inflexible when clinical or research needs change. By integrating atlas-based prompts and foundation-model principles, FeTal-SAM addresses two key limitations in fetal brain MRI segmentation: (1) the need to retrain models for varying label definitions, and (2) the lack of insight into whether segmentations are driven by genuine image contrast or by learned spatial priors. We leverage multi-atlas registration to generate spatially aligned label templates that serve as dense prompts, alongside a bounding-box prompt, for SAM's segmentation decoder. This strategy enables binary segmentation on a per-structure basis, which is subsequently fused to reconstruct the full 3D segmentation volumes. Evaluations on two datasets, the dHCP dataset and an in-house dataset demonstrate FeTal-SAM's robust performance across gestational ages. Notably, it achieves Dice scores comparable to state-of-the-art baselines which were trained for each dataset and label definition for well-contrasted structures like cortical plate and cerebellum, while maintaining the flexibility to segment any user-specified anatomy. Although slightly lower accuracy is observed for subtle, low-contrast structures (e.g., hippocampus, amygdala), our results highlight FeTal-SAM's potential to serve as a general-purpose segmentation model without exhaustive retraining. This method thus constitutes a promising step toward clinically adaptable fetal brain MRI analysis tools.

Neel Dey, Benjamin Billot, Hallee E. Wong et al. · mit

Current volumetric biomedical foundation models struggle to generalize as public 3D datasets are small and do not cover the broad diversity of medical procedures, conditions, anatomical regions, and imaging protocols. We address this by creating a representation learning method that instead anticipates strong domain shifts at training time itself. We first propose a data engine that synthesizes highly variable training samples that would enable generalization to new biomedical contexts. To then train a single 3D network for any voxel-level task, we develop a contrastive learning method that pretrains the network to be stable against nuisance imaging variation simulated by the data engine, a key inductive bias for generalization. This network's features can be used as robust representations of input images for downstream tasks and its weights provide a strong, dataset-agnostic initialization for finetuning on new datasets. As a result, we set new standards across both multimodality registration and few-shot segmentation, a first for any 3D biomedical vision model, all without (pre-)training on any existing dataset of real images.

Sheng He, Rina Bao, P. Ellen Grant et al.

Towards clinical interpretations, this paper presents a new ''output-with-confidence'' segmentation neural network with multiple input images and multiple output segmentation maps and their pairwise relations. A confidence score of the test image without ground-truth can be estimated from the difference among the estimated relation maps. We evaluate the method based on the widely used vanilla U-Net for segmentation and our new model is named Relation U-Net which can output segmentation maps of the input images as well as an estimated confidence score of the test image without ground-truth. Experimental results on four public datasets show that Relation U-Net can not only provide better accuracy than vanilla U-Net but also estimate a confidence score which is linearly correlated to the segmentation accuracy on test images.

Malte Hoffmann, Esra Abaci Turk, Borjan Gagoski et al.

In fetal-brain MRI, head-pose changes between prescription and acquisition present a challenge to obtaining the standard sagittal, coronal and axial views essential to clinical assessment. As motion limits acquisitions to thick slices that preclude retrospective resampling, technologists repeat ~55-second stack-of-slices scans (HASTE) with incrementally reoriented field of view numerous times, deducing the head pose from previous stacks. To address this inefficient workflow, we propose a robust head-pose detection algorithm using full-uterus scout scans (EPI) which take ~5 seconds to acquire. Our ~2-second procedure automatically locates the fetal brain and eyes, which we derive from maximally stable extremal regions (MSERs). The success rate of the method exceeds 94% in the third trimester, outperforming a trained technologist by up to 20%. The pipeline may be used to automatically orient the anatomical sequence, removing the need to estimate the head pose from 2D views and reducing delays during which motion can occur.

Junshen Xu, Esra Abaci Turk, P. Ellen Grant et al.

Fetal motion is unpredictable and rapid on the scale of conventional MR scan times. Therefore, dynamic fetal MRI, which aims at capturing fetal motion and dynamics of fetal function, is limited to fast imaging techniques with compromises in image quality and resolution. Super-resolution for dynamic fetal MRI is still a challenge, especially when multi-oriented stacks of image slices for oversampling are not available and high temporal resolution for recording the dynamics of the fetus or placenta is desired. Further, fetal motion makes it difficult to acquire high-resolution images for supervised learning methods. To address this problem, in this work, we propose STRESS (Spatio-Temporal Resolution Enhancement with Simulated Scans), a self-supervised super-resolution framework for dynamic fetal MRI with interleaved slice acquisitions. Our proposed method simulates an interleaved slice acquisition along the high-resolution axis on the originally acquired data to generate pairs of low- and high-resolution images. Then, it trains a super-resolution network by exploiting both spatial and temporal correlations in the MR time series, which is used to enhance the resolution of the original data. Evaluations on both simulated and in utero data show that our proposed method outperforms other self-supervised super-resolution methods and improves image quality, which is beneficial to other downstream tasks and evaluations.

Molin Zhang, Junshen Xu, Esra Abaci Turk et al.

Fetal MRI is heavily constrained by unpredictable and substantial fetal motion that causes image artifacts and limits the set of viable diagnostic image contrasts. Current mitigation of motion artifacts is predominantly performed by fast, single-shot MRI and retrospective motion correction. Estimation of fetal pose in real time during MRI stands to benefit prospective methods to detect and mitigate fetal motion artifacts where inferred fetal motion is combined with online slice prescription with low-latency decision making. Current developments of deep reinforcement learning (DRL), offer a novel approach for fetal landmarks detection. In this task 15 agents are deployed to detect 15 landmarks simultaneously by DRL. The optimization is challenging, and here we propose an improved DRL that incorporates priors on physical structure of the fetal body. First, we use graph communication layers to improve the communication among agents based on a graph where each node represents a fetal-body landmark. Further, additional reward based on the distance between agents and physical structures such as the fetal limbs is used to fully exploit physical structure. Evaluation of this method on a repository of 3-mm resolution in vivo data demonstrates a mean accuracy of landmark estimation within 10 mm of ground truth as 87.3%, and a mean error of 6.9 mm. The proposed DRL for fetal pose landmark search demonstrates a potential clinical utility for online detection of fetal motion that guides real-time mitigation of motion artifacts as well as health diagnosis during MRI of the pregnant mother.

Junshen Xu, Sayeri Lala, Borjan Gagoski et al.

Fetal brain MRI is useful for diagnosing brain abnormalities but is challenged by fetal motion. The current protocol for T2-weighted fetal brain MRI is not robust to motion so image volumes are degraded by inter- and intra- slice motion artifacts. Besides, manual annotation for fetal MR image quality assessment are usually time-consuming. Therefore, in this work, a semi-supervised deep learning method that detects slices with artifacts during the brain volume scan is proposed. Our method is based on the mean teacher model, where we not only enforce consistency between student and teacher models on the whole image, but also adopt an ROI consistency loss to guide the network to focus on the brain region. The proposed method is evaluated on a fetal brain MR dataset with 11,223 labeled images and more than 200,000 unlabeled images. Results show that compared with supervised learning, the proposed method can improve model accuracy by about 6\% and outperform other state-of-the-art semi-supervised learning methods. The proposed method is also implemented and evaluated on an MR scanner, which demonstrates the feasibility of online image quality assessment and image reacquisition during fetal MR scans.

Sheng He, Randy L. Gollub, Shawn N. Murphy et al.

Brain age prediction based on children's brain MRI is an important biomarker for brain health and brain development analysis. In this paper, we consider the 3D brain MRI volume as a sequence of 2D images and propose a new framework using the recurrent neural network for brain age estimation. The proposed method is named as 2D-ResNet18+Long short-term memory (LSTM), which consists of four parts: 2D ResNet18 for feature extraction on 2D images, a pooling layer for feature reduction over the sequences, an LSTM layer, and a final regression layer. We apply the proposed method on a public multisite NIH-PD dataset and evaluate generalization on a second multisite dataset, which shows that the proposed 2D-ResNet18+LSTM method provides better results than traditional 3D based neural network for brain age estimation.

Amod Jog, P. Ellen Grant, Joseph L. Jacobson et al.

Skullstripping is defined as the task of segmenting brain tissue from a full head magnetic resonance image~(MRI). It is a critical component in neuroimage processing pipelines. Downstream deformable registration and whole brain segmentation performance is highly dependent on accurate skullstripping. Skullstripping is an especially challenging task for infant~(age range 0--18 months) head MRI images due to the significant size and shape variability of the head and the brain in that age range. Infant brain tissue development also changes the $T_1$-weighted image contrast over time, making consistent skullstripping a difficult task. Existing tools for adult brain MRI skullstripping are ill equipped to handle these variations and a specialized infant MRI skullstripping algorithm is necessary. In this paper, we describe a supervised skullstripping algorithm that utilizes three trained fully convolutional neural networks~(CNN), each of which segments 2D $T_1$-weighted slices in axial, coronal, and sagittal views respectively. The three probabilistic segmentations in the three views are linearly fused and thresholded to produce a final brain mask. We compared our method to existing adult and infant skullstripping algorithms and showed significant improvement based on Dice overlap metric~(average Dice of 0.97) with a manually labeled ground truth data set. Label fusion experiments on multiple, unlabeled data sets show that our method is consistent and has fewer failure modes. In addition, our method is computationally very fast with a run time of 30 seconds per image on NVidia P40/P100/Quadro 4000 GPUs.

Ruizhi Liao, Esra A. Turk, Miaomiao Zhang et al.

We present a robust method to correct for motion in volumetric in-utero MRI time series. Time-course analysis for in-utero volumetric MRI time series often suffers from substantial and unpredictable fetal motion. Registration provides voxel correspondences between images and is commonly employed for motion correction. Current registration methods often fail when aligning images that are substantially different from a template (reference image). To achieve accurate and robust alignment, we make a Markov assumption on the nature of motion and take advantage of the temporal smoothness in the image data. Forward message passing in the corresponding hidden Markov model (HMM) yields an estimation algorithm that only has to account for relatively small motion between consecutive frames. We evaluate the utility of the temporal model in the context of in-utero MRI time series alignment by examining the accuracy of propagated segmentation label maps. Our results suggest that the proposed model captures accurately the temporal dynamics of transformations in in-utero MRI time series.