David Lloyd

Denis Prokopenko, Kerstin Hammernik, Thomas Roberts et al.

Dynamic free-breathing fetal cardiac MRI is one of the most challenging modalities, which requires high temporal and spatial resolution to depict rapid changes in a small fetal heart. The ability of deep learning methods to recover undersampled data could help to optimise the kt-SENSE acquisition strategy and improve non-gated kt-SENSE reconstruction quality. In this work, we explore supervised deep learning networks for reconstruction of kt-SENSE style acquired data using an extensive in vivo dataset. Having access to fully-sampled low-resolution multi-coil fetal cardiac MRI, we study the performance of the networks to recover fully-sampled data from undersampled data. We consider model architectures together with training strategies taking into account their application in the real clinical setup used to collect the dataset to enable networks to recover prospectively undersampled data. We explore a set of modifications to form a baseline performance evaluation for dynamic fetal cardiac MRI on real data. We systematically evaluate the models on coil-combined data to reveal the effect of the suggested changes to the architecture in the context of fetal heart properties. We show that the best-performers recover a detailed depiction of the maternal anatomy on a large scale, but the dynamic properties of the fetal heart are under-represented. Training directly on multi-coil data improves the performance of the models, allows their prospective application to undersampled data and makes them outperform CTFNet introduced for adult cardiac cine MRI. However, these models deliver similar qualitative performances recovering the maternal body very well but underestimating the dynamic properties of fetal heart. This dynamic feature of fast change of fetal heart that is highly localised suggests both more targeted training and evaluation methods might be needed for fetal heart application.

Paula Ramirez, Alena Uus, Milou P. M. van Poppel et al.

Congenital Heart Disease (CHD) is a group of cardiac malformations present already during fetal life, representing the prevailing category of birth defects globally. Our aim in this study is to aid 3D fetal vessel topology visualisation in aortic arch anomalies, a group which encompasses a range of conditions with significant anatomical heterogeneity. We present a multi-task framework for automated multi-class fetal vessel segmentation from 3D black blood T2w MRI and anomaly classification. Our training data consists of binary manual segmentation masks of the cardiac vessels' region in individual subjects and fully-labelled anomaly-specific population atlases. Our framework combines deep learning label propagation using VoxelMorph with 3D Attention U-Net segmentation and DenseNet121 anomaly classification. We target 11 cardiac vessels and three distinct aortic arch anomalies, including double aortic arch, right aortic arch, and suspected coarctation of the aorta. We incorporate an anomaly classifier into our segmentation pipeline, delivering a multi-task framework with the primary motivation of correcting topological inaccuracies of the segmentation. The hypothesis is that the multi-task approach will encourage the segmenter network to learn anomaly-specific features. As a secondary motivation, an automated diagnosis tool may have the potential to enhance diagnostic confidence in a decision support setting. Our results showcase that our proposed training strategy significantly outperforms label propagation and a network trained exclusively on propagated labels. Our classifier outperforms a classifier trained exclusively on T2w volume images, with an average balanced accuracy of 0.99 (0.01) after joint training. Adding a classifier improves the anatomical and topological accuracy of all correctly classified double aortic arch subjects.

Denis Prokopenko, David F. A. Lloyd, Amedeo Chiribiri et al.

Dynamic fetal heart magnetic resonance imaging (MRI) presents unique challenges due to the fast heart rate of the fetus compared to adult subjects and uncontrolled fetal motion. This requires high temporal and spatial resolutions over a large field of view, in order to encompass surrounding maternal anatomy. In this work, we introduce Dynamic Cardiac Reconstruction Attention Network (DCRA-Net) - a novel deep learning model that employs attention mechanisms in spatial and temporal domains and temporal frequency representation of data to reconstruct the dynamics of the fetal heart from highly accelerated free-running (non-gated) MRI acquisitions. DCRA-Net was trained on retrospectively undersampled complex-valued cardiac MRIs from 42 fetal subjects and separately from 153 adult subjects, and evaluated on data from 14 fetal and 39 adult subjects respectively. Its performance was compared to L+S and k-GIN methods in both fetal and adult cases for an undersampling factor of 8x. The proposed network performed better than the comparators for both fetal and adult data, for both regular lattice and centrally weighted random undersampling. Aliased signals due to the undersampling were comprehensively resolved, and both the spatial details of the heart and its temporal dynamics were recovered with high fidelity. The highest performance was achieved when using lattice undersampling, data consistency and temporal frequency representation, yielding PSNR of 38 for fetal and 35 for adult cases. Our method is publicly available at https://github.com/denproc/DCRA-Net.

Elisa Chotzoglou, Thomas Day, Jeremy Tan et al.

Congenital heart disease is considered as one the most common groups of congenital malformations which affects $6-11$ per $1000$ newborns. In this work, an automated framework for detection of cardiac anomalies during ultrasound screening is proposed and evaluated on the example of Hypoplastic Left Heart Syndrome (HLHS), a sub-category of congenital heart disease. We propose an unsupervised approach that learns healthy anatomy exclusively from clinically confirmed normal control patients. We evaluate a number of known anomaly detection frameworks together with a model architecture based on the $α$-GAN network and find evidence that the proposed model performs significantly better than the state-of-the-art in image-based anomaly detection, yielding average $0.81$ AUC \emph{and} a better robustness towards initialisation compared to previous works.

Qingjie Meng, Jacqueline Matthew, Veronika A. Zimmer et al.

Deep neural networks exhibit limited generalizability across images with different entangled domain features and categorical features. Learning generalizable features that can form universal categorical decision boundaries across domains is an interesting and difficult challenge. This problem occurs frequently in medical imaging applications when attempts are made to deploy and improve deep learning models across different image acquisition devices, across acquisition parameters or if some classes are unavailable in new training databases. To address this problem, we propose Mutual Information-based Disentangled Neural Networks (MIDNet), which extract generalizable categorical features to transfer knowledge to unseen categories in a target domain. The proposed MIDNet adopts a semi-supervised learning paradigm to alleviate the dependency on labeled data. This is important for real-world applications where data annotation is time-consuming, costly and requires training and expertise. We extensively evaluate the proposed method on fetal ultrasound datasets for two different image classification tasks where domain features are respectively defined by shadow artifacts and image acquisition devices. Experimental results show that the proposed method outperforms the state-of-the-art on the classification of unseen categories in a target domain with sparsely labeled training data.

Jeremy Tan, Anselm Au, Qingjie Meng et al.

Prenatal screening with ultrasound can lower neonatal mortality significantly for selected cardiac abnormalities. However, the need for human expertise, coupled with the high volume of screening cases, limits the practically achievable detection rates. In this paper we discuss the potential for deep learning techniques to aid in the detection of congenital heart disease (CHD) in fetal ultrasound. We propose a pipeline for automated data curation and classification. During both training and inference, we exploit an auxiliary view classification task to bias features toward relevant cardiac structures. This bias helps to improve in F1-scores from 0.72 and 0.77 to 0.87 and 0.85 for healthy and CHD classes respectively.

Shuangyi Wang, James Housden, Yohan Noh et al.

The development of robotic-assisted extracorporeal ultrasound systems has a long history and a number of projects have been proposed since the 1990s focusing on different technical aspects. These aim to resolve the deficiencies of on-site manual manipulation of hand-held ultrasound probes. This paper presents the recent ongoing developments of a series of bespoke robotic systems, including both single-arm and dual-arm versions, for a project known as intelligent Fetal Imaging and Diagnosis (iFIND). After a brief review of the development history of the extracorporeal ultrasound robotic system used for fetal and abdominal examinations, the specific aim of the iFIND robots, the design evolution, the implementation details of each version, and the initial clinical feedback of the iFIND robot series are presented. Based on the preliminary testing of these newly-proposed robots on 42 volunteers, the successful and re-liable working of the mechatronic systems were validated. Analysis of a participant questionnaire indicates a comfortable scanning experience for the volunteers and a good acceptance rate to being scanned by the robots.

Amir Alansary, Bernhard Kainz, Martin Rajchl et al.

In this paper we present a novel method for the correction of motion artifacts that are present in fetal Magnetic Resonance Imaging (MRI) scans of the whole uterus. Contrary to current slice-to-volume registration (SVR) methods, requiring an inflexible anatomical enclosure of a single investigated organ, the proposed patch-to-volume reconstruction (PVR) approach is able to reconstruct a large field of view of non-rigidly deforming structures. It relaxes rigid motion assumptions by introducing a specific amount of redundant information that is exploited with parallelized patch-wise optimization, super-resolution, and automatic outlier rejection. We further describe and provide an efficient parallel implementation of PVR allowing its execution within reasonable time on commercially available graphics processing units (GPU), enabling its use in the clinical practice. We evaluate PVR's computational overhead compared to standard methods and observe improved reconstruction accuracy in presence of affine motion artifacts of approximately 30% compared to conventional SVR in synthetic experiments. Furthermore, we have evaluated our method qualitatively and quantitatively on real fetal MRI data subject to maternal breathing and sudden fetal movements. We evaluate peak-signal-to-noise ratio (PSNR), structural similarity index (SSIM), and cross correlation (CC) with respect to the originally acquired data and provide a method for visual inspection of reconstruction uncertainty. With these experiments we demonstrate successful application of PVR motion compensation to the whole uterus, the human fetus, and the human placenta.