Alistair A. Young

Simon Dahan, Hao Xu, Logan Z. J. Williams et al.

Recent state-of-the-art performances of Vision Transformers (ViT) in computer vision tasks demonstrate that a general-purpose architecture, which implements long-range self-attention, could replace the local feature learning operations of convolutional neural networks. In this paper, we extend ViTs to surfaces by reformulating the task of surface learning as a sequence-to-sequence learning problem, by proposing patching mechanisms for general surface meshes. Sequences of patches are then processed by a transformer encoder and used for classification or regression. We validate our method on a range of different biomedical surface domains and tasks: brain age prediction in the developing Human Connectome Project (dHCP), fluid intelligence prediction in the Human Connectome Project (HCP), and coronary artery calcium score classification using surfaces from the Scottish Computed Tomography of the Heart (SCOT-HEART) dataset, and investigate the impact of pretraining and data augmentation on model performance. Results suggest that Surface Vision Transformers (SiT) demonstrate consistent improvement over geometric deep learning methods for brain age and fluid intelligence prediction and achieve comparable performance on calcium score classification to standard metrics used in clinical practice. Furthermore, analysis of transformer attention maps offers clear and individualised predictions of the features driving each task. Code is available on Github: https://github.com/metrics-lab/surface-vision-transformers

Yiyang Xu, Hao Xu, Matthew Sinclair et al.

Cardiac magnetic resonance (CMR) imaging and computed tomography (CT) are two common non-invasive imaging methods for assessing patients with cardiovascular disease. CMR typically acquires multiple sparse 2D slices, with unavoidable respiratory motion artefacts between slices, whereas CT acquires isotropic dense data but uses ionising radiation. In this study, we explore the combination of Slice Shifting Algorithm (SSA), Spatial Transformer Network (STN), and Label Transformer Network (LTN) to: 1) correct respiratory motion between segmented slices, and 2) transform sparse segmentation data into dense segmentation. All combinations were validated using synthetic motion-corrupted CMR slice segmentation generated from CT in 1699 cases, where the dense CT serves as the ground truth. In 199 testing cases, SSA-LTN achieved the best results for Dice score and Huasdorff distance (94.0% and 4.7 mm respectively, average over 5 labels) but gave topological errors in 8 cases. STN was effective as a plug-in tool for correcting all topological errors with minimal impact on overall performance (93.5% and 5.0 mm respectively). SSA also proves to be a valuable plug-in tool, enhancing performance over both STN-based and LTN-based models. The code for these different combinations is available at https://github.com/XESchong/STACOM2024.

Inês P. Machado, Esther Puyol-Antón, Kerstin Hammernik et al.

Cine cardiac magnetic resonance (CMR) imaging is considered the gold standard for cardiac function evaluation. However, cine CMR acquisition is inherently slow and in recent decades considerable effort has been put into accelerating scan times without compromising image quality or the accuracy of derived results. In this paper, we present a fully-automated, quality-controlled integrated framework for reconstruction, segmentation and downstream analysis of undersampled cine CMR data. The framework enables active acquisition of radial k-space data, in which acquisition can be stopped as soon as acquired data are sufficient to produce high quality reconstructions and segmentations. This results in reduced scan times and automated analysis, enabling robust and accurate estimation of functional biomarkers. To demonstrate the feasibility of the proposed approach, we perform realistic simulations of radial k-space acquisitions on a dataset of subjects from the UK Biobank and present results on in-vivo cine CMR k-space data collected from healthy subjects. The results demonstrate that our method can produce quality-controlled images in a mean scan time reduced from 12 to 4 seconds per slice, and that image quality is sufficient to allow clinically relevant parameters to be automatically estimated to within 5% mean absolute difference.

Leon Ericsson, Adam Hjalmarsson, Muhammad Usman Akbar et al.

4D Flow Magnetic Resonance Imaging (4D Flow MRI) is a non-invasive measurement technique capable of quantifying blood flow across the cardiovascular system. While practical use is limited by spatial resolution and image noise, incorporation of trained super-resolution (SR) networks has potential to enhance image quality post-scan. However, these efforts have predominantly been restricted to narrowly defined cardiovascular domains, with limited exploration of how SR performance extends across the cardiovascular system; a task aggravated by contrasting hemodynamic conditions apparent across the cardiovasculature. The aim of our study was to explore the generalizability of SR 4D Flow MRI using a combination of heterogeneous training sets and dedicated ensemble learning. With synthetic training data generated across three disparate domains (cardiac, aortic, cerebrovascular), varying convolutional base and ensemble learners were evaluated as a function of domain and architecture, quantifying performance on both in-silico and acquired in-vivo data from the same three domains. Results show that both bagging and stacking ensembling enhance SR performance across domains, accurately predicting high-resolution velocities from low-resolution input data in-silico. Likewise, optimized networks successfully recover native resolution velocities from downsampled in-vivo data, as well as show qualitative potential in generating denoised SR-images from clinical level input data. In conclusion, our work presents a viable approach for generalized SR 4D Flow MRI, with ensemble learning extending utility across various clinical areas of interest.

Marica Muffoletto, Uxio Hermida, Charlène Mauger et al.

Accurate reconstruction of cardiac anatomy from sparse clinical images remains a major challenge in patient-specific modeling. While neural implicit functions have previously been applied to this task, their application to mapping anatomical consistency across subjects has been limited. In this work, we introduce Neural Implicit Heart Coordinates (NIHCs), a standardized implicit coordinate system, based on universal ventricular coordinates, that provides a common anatomical reference frame for the human heart. Our method predicts NIHCs directly from a limited number of 2D segmentations (sparse acquisition) and subsequently decodes them into dense 3D segmentations and high-resolution meshes at arbitrary output resolution. Trained on a large dataset of 5,000 cardiac meshes, the model achieves high reconstruction accuracy on clinical contours, with mean Euclidean surface errors of 2.51$\pm$0.33 mm in a diseased cohort (n=4549) and 2.3$\pm$0.36 mm in a healthy cohort (n=5576). The NIHC representation enables anatomically coherent reconstruction even under severe slice sparsity and segmentation noise, faithfully recovering complex structures such as the valve planes. Compared with traditional pipelines, inference time is reduced from over 60 s to 5-15 s. These results demonstrate that NIHCs constitute a robust and efficient anatomical representation for patient-specific 3D cardiac reconstruction from minimal input data.

Devran Ugurlu, Shuang Qian, Elliot Fairweather et al.

A cardiac digital twin is a virtual replica of a patient's heart for screening, diagnosis, prognosis, risk assessment, and treatment planning of cardiovascular diseases. This requires an anatomically accurate patient-specific 3D structural representation of the heart, suitable for electro-mechanical simulations or study of disease mechanisms. However, generation of cardiac digital twins at scale is demanding and there are no public repositories of models across demographic groups. We describe an automatic open-source pipeline for creating patient-specific left and right ventricular meshes from cardiovascular magnetic resonance images, its application to a large cohort of ~55000 participants from UK Biobank, and the construction of the most comprehensive cohort of adult heart models to date, comprising 1423 representative meshes across sex (male, female), body mass index (range: 16 - 42 kg/m$^2$) and age (range: 49 - 80 years). Our code is available at https://github.com/cdttk/biv-volumetric-meshing/tree/plos2025 , and pre-trained networks, representative volumetric meshes with fibers and UVCs will be made available soon.

Xabier Morales, Ayah Elsayed, Debbie Zhao et al.

The left atrium (LA) plays a pivotal role in modulating left ventricular filling, but our comprehension of its hemodynamics is significantly limited by the constraints of conventional ultrasound analysis. 4D flow magnetic resonance imaging (4D Flow MRI) holds promise for enhancing our understanding of atrial hemodynamics. However, the low velocities within the LA and the limited spatial resolution of 4D Flow MRI make analyzing this chamber challenging. Furthermore, the absence of dedicated computational frameworks, combined with diverse acquisition protocols and vendors, complicates gathering large cohorts for studying the prognostic value of hemodynamic parameters provided by 4D Flow MRI. In this study, we introduce the first open-source computational framework tailored for the analysis of 4D Flow MRI in the LA, enabling comprehensive qualitative and quantitative analysis of advanced hemodynamic parameters. Our framework proves robust to data from different centers of varying quality, producing high-accuracy automated segmentations (Dice $>$ 0.9 and Hausdorff 95 $<$ 3 mm), even with limited training data. Additionally, we conducted the first comprehensive assessment of energy, vorticity, and pressure parameters in the LA across a spectrum of disorders to investigate their potential as prognostic biomarkers.

Oliver Welin Odeback, Arivazhagan Geetha Balasubramanian, Jonas Schollenberger et al.

4D Flow Magnetic Resonance Imaging (4D Flow MRI) enables non-invasive quantification of blood flow and hemodynamic parameters. However, its clinical application is limited by low spatial resolution and noise, particularly affecting near-wall velocity measurements. Machine learning-based super-resolution has shown promise in addressing these limitations, but challenges remain, not least in recovering near-wall velocities. Generative adversarial networks (GANs) offer a compelling solution, having demonstrated strong capabilities in restoring sharp boundaries in non-medical super-resolution tasks. Yet, their application in 4D Flow MRI remains unexplored, with implementation challenged by known issues such as training instability and non-convergence. In this study, we investigate GAN-based super-resolution in 4D Flow MRI. Training and validation were conducted using patient-specific cerebrovascular in-silico models, converted into synthetic images via an MR-true reconstruction pipeline. A dedicated GAN architecture was implemented and evaluated across three adversarial loss functions: Vanilla, Relativistic, and Wasserstein. Our results demonstrate that the proposed GAN improved near-wall velocity recovery compared to a non-adversarial reference (vNRMSE: 6.9% vs. 9.6%); however, that implementation specifics are critical for stable network training. While Vanilla and Relativistic GANs proved unstable compared to generator-only training (vNRMSE: 8.1% and 7.8% vs. 7.2%), a Wasserstein GAN demonstrated optimal stability and incremental improvement (vNRMSE: 6.9% vs. 7.2%). The Wasserstein GAN further outperformed the generator-only baseline at low SNR (vNRMSE: 8.7% vs. 10.7%). These findings highlight the potential of GAN-based super-resolution in enhancing 4D Flow MRI, particularly in challenging cerebrovascular regions, while emphasizing the need for careful selection of adversarial strategies.

Yilin Lyu, Fan Yang, Xiaoyue Liu et al.

Accurate representation of myocardial infarct geometry is crucial for patient-specific cardiac modeling in MI patients. While Late gadolinium enhancement (LGE) MRI is the clinical gold standard for infarct detection, it requires contrast agents, introducing side effects and patient discomfort. Moreover, infarct reconstruction from LGE often relies on sparsely sampled 2D slices, limiting spatial resolution and accuracy. In this work, we propose a novel framework for automatically reconstructing high-fidelity 3D myocardial infarct geometry from 2D clinically standard cine MRI, eliminating the need for contrast agents. Specifically, we first reconstruct the 4D biventricular mesh from multi-view cine MRIs via an automatic deep shape fitting model, biv-me. Then, we design a infarction reconstruction model, CMotion2Infarct-Net, to explicitly utilize the motion patterns within this dynamic geometry to localize infarct regions. Evaluated on 205 cine MRI scans from 126 MI patients, our method shows reasonable agreement with manual delineation. This study demonstrates the feasibility of contrast-free, cardiac motion-driven 3D infarct reconstruction, paving the way for efficient digital twin of MI.

Pia Callmer, Mia Bonini, Edward Ferdian et al.

4D Flow Magnetic Resonance Imaging (4D Flow MRI) is a non-invasive technique for volumetric, time-resolved blood flow quantification. However, apparent trade-offs between acquisition time, image noise, and resolution limit clinical applicability. In particular, in regions of highly transient flow, coarse temporal resolution can hinder accurate capture of physiologically relevant flow variations. To overcome these issues, post-processing techniques using deep learning have shown promising results to enhance resolution post-scan using so-called super-resolution networks. However, while super-resolution has been focusing on spatial upsampling, temporal super-resolution remains largely unexplored. The aim of this study was therefore to implement and evaluate a residual network for temporal super-resolution 4D Flow MRI. To achieve this, an existing spatial network (4DFlowNet) was re-designed for temporal upsampling, adapting input dimensions, and optimizing internal layer structures. Training and testing were performed using synthetic 4D Flow MRI data originating from patient-specific in-silico models, as well as using in-vivo datasets. Overall, excellent performance was achieved with input velocities effectively denoised and temporally upsampled, with a mean absolute error (MAE) of 1.0 cm/s in an unseen in-silico setting, outperforming deterministic alternatives (linear interpolation MAE = 2.3 cm/s, sinc interpolation MAE = 2.6 cm/s). Further, the network synthesized high-resolution temporal information from unseen low-resolution in-vivo data, with strong correlation observed at peak flow frames. As such, our results highlight the potential of utilizing data-driven neural networks for temporal super-resolution 4D Flow MRI, enabling high-frame-rate flow quantification without extending acquisition times beyond clinically acceptable limits.

Yu Deng, Yiyang Xu, Linglong Qian et al.

Cardiac Magnetic Resonance (CMR) imaging is widely used for heart modelling and digital twin computational analysis due to its ability to visualize soft tissues and capture dynamic functions. However, the anisotropic nature of CMR images, characterized by large inter-slice distances and misalignments from cardiac motion, poses significant challenges to accurate model reconstruction. These limitations result in data loss and measurement inaccuracies, hindering the capture of detailed anatomical structures. This study introduces MorphiNet, a novel network that enhances heart model reconstruction by leveraging high-resolution Computer Tomography (CT) images, unpaired with CMR images, to learn heart anatomy. MorphiNet encodes anatomical structures as gradient fields, transforming template meshes into patient-specific geometries. A multi-layer graph subdivision network refines these geometries while maintaining dense point correspondence. The proposed method achieves high anatomy fidelity, demonstrating approximately 40% higher Dice scores, half the Hausdorff distance, and around 3 mm average surface error compared to state-of-the-art methods. MorphiNet delivers superior results with greater inference efficiency. This approach represents a significant advancement in addressing the challenges of CMR-based heart model reconstruction, potentially improving digital twin computational analyses of cardiac structure and functions.

Avan Suinesiaputra, Charlene A Mauger, Bharath Ambale-Venkatesh et al.

The shape and motion of the heart provide essential clues to understanding the mechanisms of cardiovascular disease. With the advent of large-scale cardiac imaging data, statistical atlases become a powerful tool to provide automated and precise quantification of the status of patient-specific heart geometry with respect to reference populations. The Multi-Ethnic Study of Atherosclerosis (MESA), begun in 2000, was the first large cohort study to incorporate cardiovascular MRI in over 5000 participants, and there is now a wealth of follow-up data over 20 years. Building a machine learning based automated analysis is necessary to extract the additional imaging information necessary for expanding original manual analyses. However, machine learning tools trained on MRI datasets with different pulse sequences fail on such legacy datasets. Here, we describe an automated atlas construction pipeline using deep learning methods applied to the legacy cardiac MRI data in MESA. For detection of anatomical cardiac landmark points, a modified VGGNet convolutional neural network architecture was used in conjunction with a transfer learning sequence between two-chamber, four-chamber, and short-axis MRI views. A U-Net architecture was used for detection of the endocardial and epicardial boundaries in short axis images. Both network architectures resulted in good segmentation and landmark detection accuracies compared with inter-observer variations. Statistical relationships with common risk factors were similar between atlases derived from automated vs manual annotations. The automated atlas can be employed in future studies to examine the relationships between cardiac morphology and future events.

Devran Ugurlu, Esther Puyol-Anton, Bram Ruijsink et al.

Domain shift refers to the difference in the data distribution of two datasets, normally between the training set and the test set for machine learning algorithms. Domain shift is a serious problem for generalization of machine learning models and it is well-established that a domain shift between the training and test sets may cause a drastic drop in the model's performance. In medical imaging, there can be many sources of domain shift such as different scanners or scan protocols, different pathologies in the patient population, anatomical differences in the patient population (e.g. men vs women) etc. Therefore, in order to train models that have good generalization performance, it is important to be aware of the domain shift problem, its potential causes and to devise ways to address it. In this paper, we study the effect of domain shift on left and right ventricle blood pool segmentation in short axis cardiac MR images. Our dataset contains short axis images from 4 different MR scanners and 3 different pathology groups. The training is performed with nnUNet. The results show that scanner differences cause a greater drop in performance compared to changing the pathology group, and that the impact of domain shift is greater on right ventricle segmentation compared to left ventricle segmentation. Increasing the number of training subjects increased cross-scanner performance more than in-scanner performance at small training set sizes, but this difference in improvement decreased with larger training set sizes. Training models using data from multiple scanners improved cross-domain performance.

Ruth P Lim, Stefan Kachel, Adriana DM Villa et al.

Objectives: To develop an image-based automatic deep learning method to classify cardiac MR images by sequence type and imaging plane for improved clinical post-processing efficiency. Methods: Multi-vendor cardiac MRI studies were retrospectively collected from 4 centres and 3 vendors. A two-head convolutional neural network ('CardiSort') was trained to classify 35 sequences by imaging sequence (n=17) and plane (n=10). Single vendor training (SVT) on single centre images (n=234 patients) and multi-vendor training (MVT) with multicentre images (n = 479 patients, 3 centres) was performed. Model accuracy was compared to manual ground truth labels by an expert radiologist on a hold-out test set for both SVT and MVT. External validation of MVT (MVTexternal) was performed on data from 3 previously unseen magnet systems from 2 vendors (n=80 patients). Results: High sequence and plane accuracies were observed for SVT (85.2% and 93.2% respectively), and MVT (96.5% and 98.1% respectively) on the hold-out test set. MVTexternal yielded sequence accuracy of 92.7% and plane accuracy of 93.0%. There was high accuracy for common sequences and conventional cardiac planes. Poor accuracy was observed for underrepresented classes and sequences where there was greater variability in acquisition parameters across centres, such as perfusion imaging. Conclusions: A deep learning network was developed on multivendor data to classify MRI studies into component sequences and planes, with external validation. With refinement, it has potential to improve workflow by enabling automated sequence selection, an important first step in completely automated post-processing pipelines.

Ines Machado, Esther Puyol-Anton, Kerstin Hammernik et al.

Cine cardiac MRI is routinely acquired for the assessment of cardiac health, but the imaging process is slow and typically requires several breath-holds to acquire sufficient k-space profiles to ensure good image quality. Several undersampling-based reconstruction techniques have been proposed during the last decades to speed up cine cardiac MRI acquisition. However, the undersampling factor is commonly fixed to conservative values before acquisition to ensure diagnostic image quality, potentially leading to unnecessarily long scan times. In this paper, we propose an end-to-end quality-aware cine short-axis cardiac MRI framework that combines image acquisition and reconstruction with downstream tasks such as segmentation, volume curve analysis and estimation of cardiac functional parameters. The goal is to reduce scan time by acquiring only a fraction of k-space data to enable the reconstruction of images that can pass quality control checks and produce reliable estimates of cardiac functional parameters. The framework consists of a deep learning model for the reconstruction of 2D+t cardiac cine MRI images from undersampled data, an image quality-control step to detect good quality reconstructions, followed by a deep learning model for bi-ventricular segmentation, a quality-control step to detect good quality segmentations and automated calculation of cardiac functional parameters. To demonstrate the feasibility of the proposed approach, we perform simulations using a cohort of selected participants from the UK Biobank (n=270), 200 healthy subjects and 70 patients with cardiomyopathies. Our results show that we can produce quality-controlled images in a scan time reduced from 12 to 4 seconds per slice, enabling reliable estimates of cardiac functional parameters such as ejection fraction within 5% mean absolute error.

Edward Ferdian, Avan Suinesiaputra, David Dubowitz et al.

4D-flow magnetic resonance imaging (MRI) is an emerging imaging technique where spatiotemporal 3D blood velocity can be captured with full volumetric coverage in a single non-invasive examination. This enables qualitative and quantitative analysis of hemodynamic flow parameters of the heart and great vessels. An increase in the image resolution would provide more accuracy and allow better assessment of the blood flow, especially for patients with abnormal flows. However, this must be balanced with increasing imaging time. The recent success of deep learning in generating super resolution images shows promise for implementation in medical images. We utilized computational fluid dynamics simulations to generate fluid flow simulations and represent them as synthetic 4D flow MRI data. We built our training dataset to mimic actual 4D flow MRI data with its corresponding noise distribution. Our novel 4DFlowNet network was trained on this synthetic 4D flow data and was capable in producing noise-free super resolution 4D flow phase images with upsample factor of 2. We also tested the 4DFlowNet in actual 4D flow MR images of a phantom and normal volunteer data, and demonstrated comparable results with the actual flow rate measurements giving an absolute relative error of 0.6 to 5.8% and 1.1 to 3.8% in the phantom data and normal volunteer data, respectively.