P. Ellen Grant

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.

Benjamin Billot, Neel Dey, Daniel Moyer et al. · mit

Rigid motion tracking is paramount in many medical imaging applications where movements need to be detected, corrected, or accounted for. Modern strategies rely on convolutional neural networks (CNN) and pose this problem as rigid registration. Yet, CNNs do not exploit natural symmetries in this task, as they are equivariant to translations (their outputs shift with their inputs) but not to rotations. Here we propose EquiTrack, the first method that uses recent steerable SE(3)-equivariant CNNs (E-CNN) for motion tracking. While steerable E-CNNs can extract corresponding features across different poses, testing them on noisy medical images reveals that they do not have enough learning capacity to learn noise invariance. Thus, we introduce a hybrid architecture that pairs a denoiser with an E-CNN to decouple the processing of anatomically irrelevant intensity features from the extraction of equivariant spatial features. Rigid transforms are then estimated in closed-form. EquiTrack outperforms state-of-the-art learning and optimisation methods for motion tracking in adult brain MRI and fetal MRI time series. Our code is available at https://github.com/BBillot/EquiTrack.

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.

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 .

Rina Bao, Erfan Darzi, Sheng He et al.

Foundation models refer to artificial intelligence (AI) models that are trained on massive amounts of data and demonstrate broad generalizability across various tasks with high accuracy. These models offer versatile, one-for-many or one-for-all solutions, eliminating the need for developing task-specific AI models. Examples of such foundation models include the Chat Generative Pre-trained Transformer (ChatGPT) and the Segment Anything Model (SAM). These models have been trained on millions to billions of samples and have shown wide-ranging and accurate applications in numerous tasks such as text processing (using ChatGPT) and natural image segmentation (using SAM). In medical image segmentation - finding target regions in medical images - there is a growing need for these one-for-many or one-for-all foundation models. Such models could obviate the need to develop thousands of task-specific AI models, which is currently standard practice in the field. They can also be adapted to tasks with datasets too small for effective training. We discuss two paths to achieve foundation models for medical image segmentation and comment on progress, challenges, and opportunities. One path is to adapt or fine-tune existing models, originally developed for natural images, for use with medical images. The second path entails building models from scratch, exclusively training on medical images.

Molin Zhang, Polina Golland, Patricia Ellen Grant et al.

The quality of fetal MRI is significantly affected by unpredictable and substantial fetal motion, leading to the introduction of artifacts even when fast acquisition sequences are employed. The development of 3D real-time fetal pose estimation approaches on volumetric EPI fetal MRI opens up a promising avenue for fetal motion monitoring and prediction. Challenges arise in fetal pose estimation due to limited number of real scanned fetal MR training images, hindering model generalization when the acquired fetal MRI lacks adequate pose. In this study, we introduce FetalDiffusion, a novel approach utilizing a conditional diffusion model to generate 3D synthetic fetal MRI with controllable pose. Additionally, an auxiliary pose-level loss is adopted to enhance model performance. Our work demonstrates the success of this proposed model by producing high-quality synthetic fetal MRI images with accurate and recognizable fetal poses, comparing favorably with in-vivo real fetal MRI. Furthermore, we show that the integration of synthetic fetal MR images enhances the fetal pose estimation model's performance, particularly when the number of available real scanned data is limited resulting in 15.4% increase in PCK and 50.2% reduced in mean error. All experiments are done on a single 32GB V100 GPU. Our method holds promise for improving real-time tracking models, thereby addressing fetal motion issues more effectively.

Rina Bao, Sheng He, Ellen Grant et al.

Hypoxic-Ischemic Encephalopathy (HIE) affects 1 to 5 out of every 1,000 newborns, with 30% to 50% of cases resulting in adverse neurocognitive outcomes. However, these outcomes can only be reliably assessed as early as age 2. Therefore, early and accurate prediction of HIE-related neurocognitive outcomes using deep learning models is critical for improving clinical decision-making, guiding treatment decisions and assessing novel therapies. However, a major challenge in developing deep learning models for this purpose is the scarcity of large, annotated HIE datasets. We have assembled the first and largest public dataset, however it contains only 156 cases with 2-year neurocognitive outcome labels. In contrast, we have collected 8,859 normal brain black Magnetic Resonance Imagings (MRIs) with 0-97 years of age that are available for brain age estimation using deep learning models. In this paper, we introduce AGE2HIE to transfer knowledge learned by deep learning models from healthy controls brain MRIs to a diseased cohort, from structural to diffusion MRIs, from regression of continuous age estimation to prediction of the binary neurocognitive outcomes, and from lifespan age (0-97 years) to infant (0-2 weeks). Compared to training from scratch, transfer learning from brain age estimation significantly improves not only the prediction accuracy (3% or 2% improvement in same or multi-site), but also the model generalization across different sites (5% improvement in cross-site validation).

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.

Daniel Moyer, Esra Abaci Turk, P Ellen Grant et al.

We demonstrate an object tracking method for 3D images with fixed computational cost and state-of-the-art performance. Previous methods predicted transformation parameters from convolutional layers. We instead propose an architecture that does not include either flattening of convolutional features or fully connected layers, but instead relies on equivariant filters to preserve transformations between inputs and outputs (e.g. rot./trans. of inputs rotate/translate outputs). The transformation is then derived in closed form from the outputs of the filters. This method is useful for applications requiring low latency, such as real-time tracking. We demonstrate our model on synthetically augmented adult brain MRI, as well as fetal brain MRI, which is the intended use-case.

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.

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

The performance and diagnostic utility of magnetic resonance imaging (MRI) in pregnancy is fundamentally constrained by fetal motion. Motion of the fetus, which is unpredictable and rapid on the scale of conventional imaging times, limits the set of viable acquisition techniques to single-shot imaging with severe compromises in signal-to-noise ratio and diagnostic contrast, and frequently results in unacceptable image quality. Surprisingly little is known about the characteristics of fetal motion during MRI and here we propose and demonstrate methods that exploit a growing repository of MRI observations of the gravid abdomen that are acquired at low spatial resolution but relatively high temporal resolution and over long durations (10-30 minutes). We estimate fetal pose per frame in MRI volumes of the pregnant abdomen via deep learning algorithms that detect key fetal landmarks. Evaluation of the proposed method shows that our framework achieves quantitatively an average error of 4.47 mm and 96.4\% accuracy (with error less than 10 mm). Fetal pose estimation in MRI time series yields novel means of quantifying fetal movements in health and disease, and enables the learning of kinematic models that may enhance prospective mitigation of fetal motion artifacts during MRI acquisition.

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.

Ruizhi Liao, Esra Turk, Miaomiao Zhang et al.

We present a robust method to correct for motion and deformations for in-utero volumetric MRI time series. Spatio-temporal analysis of dynamic MRI requires robust alignment across time in the presence of substantial and unpredictable motion. We make a Markov assumption on the nature of deformations to take advantage of the temporal structure 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 demonstrate the utility of the temporal model by showing that its use improves the accuracy of the segmentation propagation through temporal registration. Our results suggest that the proposed model captures accurately the temporal dynamics of deformations in in-utero MRI time series.