Peter Kellman

Arda Atalik, Hui Xue, Rhodri H. Davies et al.

Purpose: To develop and evaluate a deep learning (DL) method for free-breathing phase-sensitive inversion recovery (PSIR) late gadolinium enhancement (LGE) cardiac MRI that produces diagnostic-quality images from a single acquisition over two heartbeats, eliminating the need for 8 to 24 motion-corrected (MOCO) signal averages. Materials and Methods: Raw data comprising 800,653 slices from 55,917 patients, acquired on 1.5T and 3T scanners across multiple sites from 2016 to 2024, were used in this retrospective study. Data were split by patient: 640,000 slices (42,822 patients) for training and the remainder for validation and testing, without overlap. The training and testing data were from different institutions. PSIRNet, a physics-guided DL network with 845 million parameters, was trained end-to-end to reconstruct PSIR images with surface coil correction from a single interleaved IR/PD acquisition over two heartbeats. Reconstruction quality was evaluated using SSIM, PSNR, and NRMSE against MOCO PSIR references. Two expert cardiologists performed an independent qualitative assessment, scoring image quality on a 5-point Likert scale across bright blood, dark blood, and wideband LGE variants. Paired superiority and equivalence (margin = 0.25 Likert points) were tested using exact Wilcoxon signed-rank tests at a significance level of 0.05 using R version 4.5.2. Results: Both readers rated single-average PSIRNet reconstructions superior to MOCO PSIR for dark blood LGE (conservative P = .002); for bright blood and wideband, one reader rated it superior and the other confirmed equivalence (all P < .001). Inference required approximately 100 msec per slice versus more than 5 sec for MOCO PSIR. Conclusion: PSIRNet produces diagnostic-quality free-breathing PSIR LGE images from a single acquisition, enabling 8- to 24-fold reduction in acquisition time.

Yidong Zhao, Peter Kellman, Hui Xue et al.

Pretrained segmentation models for cardiac magnetic resonance imaging (MRI) struggle to generalize across different imaging sequences due to significant variations in image contrast. These variations arise from changes in imaging protocols, yet the same fundamental spin properties, including proton density, T1, and T2 values, govern all acquired images. With this core principle, we introduce Reverse Imaging, a novel physics-driven method for cardiac MRI data augmentation and domain adaptation to fundamentally solve the generalization problem. Our method reversely infers the underlying spin properties from observed cardiac MRI images, by solving ill-posed nonlinear inverse problems regularized by the prior distribution of spin properties. We acquire this "spin prior" by learning a generative diffusion model from the multiparametric SAturation-recovery single-SHot acquisition sequence (mSASHA) dataset, which offers joint cardiac T1 and T2 maps. Our method enables approximate but meaningful spin-property estimates from MR images, which provide an interpretable "latent variable" that lead to highly flexible image synthesis of arbitrary novel sequences. We show that Reverse Imaging enables highly accurate segmentation across vastly different image contrasts and imaging protocols, realizing wide-spectrum generalization of cardiac MRI segmentation.

Hui Xue, Sarah M. Hooper, Iain Pierce et al.

To develop and evaluate a new deep learning MR denoising method that leverages quantitative noise distribution information from the reconstruction process to improve denoising performance and generalization. This retrospective study trained 14 different transformer and convolutional models with two backbone architectures on a large dataset of 2,885,236 images from 96,605 cardiac retro-gated cine complex series acquired at 3T. The proposed training scheme, termed SNRAware, leverages knowledge of the MRI reconstruction process to improve denoising performance by simulating large, high quality, and diverse synthetic datasets, and providing quantitative information about the noise distribution to the model. In-distribution testing was performed on a hold-out dataset of 3000 samples with performance measured using PSNR and SSIM, with ablation comparison without the noise augmentation. Out-of-distribution tests were conducted on cardiac real-time cine, first-pass cardiac perfusion, and neuro and spine MRI, all acquired at 1.5T, to test model generalization across imaging sequences, dynamically changing contrast, different anatomies, and field strengths. The best model found in the in-distribution test generalized well to out-of-distribution samples, delivering 6.5x and 2.9x CNR improvement for real-time cine and perfusion imaging, respectively. Further, a model trained with 100% cardiac cine data generalized well to a T1 MPRAGE neuro 3D scan and T2 TSE spine MRI.

Yi Zhang, Yidong Zhao, Hui Xue et al.

Image registration is essential for medical image applications where alignment of voxels across multiple images is needed for qualitative or quantitative analysis. With recent advancements in deep neural networks and parallel computing, deep learning-based medical image registration methods become competitive with their flexible modelling and fast inference capabilities. However, compared to traditional optimization-based registration methods, the speed advantage may come at the cost of registration performance at inference time. Besides, deep neural networks ideally demand large training datasets while optimization-based methods are training-free. To improve registration accuracy and data efficiency, we propose a novel image registration method, termed Recurrent Inference Image Registration (RIIR) network. RIIR is formulated as a meta-learning solver to the registration problem in an iterative manner. RIIR addresses the accuracy and data efficiency issues, by learning the update rule of optimization, with implicit regularization combined with explicit gradient input. We evaluated RIIR extensively on brain MRI and quantitative cardiac MRI datasets, in terms of both registration accuracy and training data efficiency. Our experiments showed that RIIR outperformed a range of deep learning-based methods, even with only $5\%$ of the training data, demonstrating high data efficiency. Key findings from our ablation studies highlighted the important added value of the hidden states introduced in the recurrent inference framework for meta-learning. Our proposed RIIR offers a highly data-efficient framework for deep learning-based medical image registration.

Hui Xue, Jessica Artico, Marianna Fontana et al.

Purpose: To develop a convolutional neural network (CNN) solution for robust landmark detection in cardiac MR images. Methods: This retrospective study included cine, LGE and T1 mapping scans from two hospitals. The training set included 2,329 patients and 34,019 images. A hold-out test set included 531 patients and 7,723 images. CNN models were developed to detect two mitral valve plane and apical points on long-axis (LAX) images. On short-axis (SAX) images, anterior and posterior RV insertion points and LV center were detected. Model outputs were compared to manual labels by two operators for accuracy with a t-test for statistical significance. The trained model was deployed to MR scanners. Results: For the LAX images, success detection was 99.8% for cine, 99.4% for LGE. For the SAX, success rate was 96.6%, 97.6% and 98.9% for cine, LGE and T1-mapping. The L2 distances between model and manual labels were 2 to 3.5 mm, indicating close agreement between model landmarks to manual labels. No significant differences were found for the anterior RV insertion angle and LV length by the models and operators for all views and imaging sequences. Model inference on MR scanner took 610ms/5.6s on GPU/CPU, respectively, for a typical cardiac cine series. Conclusions: This study developed, validated and deployed a CNN solution for robust landmark detection in both long and short-axis CMR images for cine, LGE and T1 mapping sequences, with the accuracy comparable to the inter-operator variation.

Hui Xue, Rhodri Davies, Louis AE Brown et al.

Recent development of quantitative myocardial blood flow (MBF) mapping allows direct evaluation of absolute myocardial perfusion, by computing pixel-wise flow maps. Clinical studies suggest quantitative evaluation would be more desirable for objectivity and efficiency. Objective assessment can be further facilitated by segmenting the myocardium and automatically generating reports following the AHA model. This will free user interaction for analysis and lead to a 'one-click' solution to improve workflow. This paper proposes a deep neural network based computational workflow for inline myocardial perfusion analysis. Adenosine stress and rest perfusion scans were acquired from three hospitals. Training set included N=1,825 perfusion series from 1,034 patients. Independent test set included 200 scans from 105 patients. Data were consecutively acquired at each site. A convolution neural net (CNN) model was trained to provide segmentation for LV cavity, myocardium and right ventricular by processing incoming 2D+T perfusion Gd series. Model outputs were compared to manual ground-truth for accuracy of segmentation and flow measures derived on global and per-sector basis. The trained models were integrated onto MR scanners for effective inference. Segmentation accuracy and myocardial flow measures were compared between CNN models and manual ground-truth. The mean Dice ratio of CNN derived myocardium was 0.93 +/- 0.04. Both global flow and per-sector values showed no significant difference, compared to manual results. The AHA 16 segment model was automatically generated and reported on the MR scanner. As a result, the fully automated analysis of perfusion flow mapping was achieved. This solution was integrated on the MR scanner, enabling 'one-click' analysis and reporting of myocardial blood flow.

Hui Xue, Ethan Tseng, Kristopher D Knott et al.

Quantification of myocardial perfusion has the potential to improve detection of regional and global flow reduction. Significant effort has been made to automate the workflow, where one essential step is the arterial input function (AIF) extraction. Since failure here invalidates quantification, high accuracy is required. For this purpose, this study presents a robust AIF detection method using the convolutional neural net (CNN) model. CNN models were trained by assembling 25,027 scans (N=12,984 patients) from three hospitals, seven scanners. A test set of 5,721 scans (N=2,805 patients) evaluated model performance. The 2D+T AIF time series was inputted into CNN. Two variations were investigated: a) Two Classes (2CS) for background and foreground (LV mask); b) Three Classes (3CS) for background, foreground LV and RV. Final model was deployed on MR scanners via the Gadgetron InlineAI. Model loading time on MR scanner was ~340ms and applying it took ~180ms. The 3CS model successfully detect LV for 99.98% of all test cases (1 failed out of 5,721 cases). The mean Dice ratio for 3CS was 0.87+/-0.08 with 92.0% of all test cases having Dice ratio >0.75, while the 2CS model gave lower Dice of 0.82+/-0.22 (P<1e-5). Extracted AIF signals using CNN were further compared to manual ground-truth for foot-time, peak-time, first-pass duration, peak value and area-under-curve. No significant differences were found for all features (P>0.2). This study proposed, validated, and deployed a robust CNN solution to detect the LV for the extraction of the AIF signal used in fully automated perfusion flow mapping. A very large data cohort was assembled and resulting models were deployed to MR scanners for fully inline AI in clinical hospitals.