Sylvain Bouix

Basar Demir, Lin Tian, Thomas Hastings Greer et al. · harvard

Modern medical image registration approaches predict deformations using deep networks. These approaches achieve state-of-the-art (SOTA) registration accuracy and are generally fast. However, deep learning (DL) approaches are, in contrast to conventional non-deep-learning-based approaches, anatomy-specific. Recently, a universal deep registration approach, uniGradICON, has been proposed. However, uniGradICON focuses on monomodal image registration. In this work, we therefore develop multiGradICON as a first step towards universal *multimodal* medical image registration. Specifically, we show that 1) we can train a DL registration model that is suitable for monomodal *and* multimodal registration; 2) loss function randomization can increase multimodal registration accuracy; and 3) training a model with multimodal data helps multimodal generalization. Our code and the multiGradICON model are available at https://github.com/uncbiag/uniGradICON.

Lin Tian, Hastings Greer, François-Xavier Vialard et al. · harvard

We present an approach to learning regular spatial transformations between image pairs in the context of medical image registration. Contrary to optimization-based registration techniques and many modern learning-based methods, we do not directly penalize transformation irregularities but instead promote transformation regularity via an inverse consistency penalty. We use a neural network to predict a map between a source and a target image as well as the map when swapping the source and target images. Different from existing approaches, we compose these two resulting maps and regularize deviations of the $\bf{Jacobian}$ of this composition from the identity matrix. This regularizer -- $\texttt{GradICON}$ -- results in much better convergence when training registration models compared to promoting inverse consistency of the composition of maps directly while retaining the desirable implicit regularization effects of the latter. We achieve state-of-the-art registration performance on a variety of real-world medical image datasets using a single set of hyperparameters and a single non-dataset-specific training protocol.

Hastings Greer, Lin Tian, Francois-Xavier Vialard et al. · harvard

Inverse consistency is a desirable property for image registration. We propose a simple technique to make a neural registration network inverse consistent by construction, as a consequence of its structure, as long as it parameterizes its output transform by a Lie group. We extend this technique to multi-step neural registration by composing many such networks in a way that preserves inverse consistency. This multi-step approach also allows for inverse-consistent coarse to fine registration. We evaluate our technique on synthetic 2-D data and four 3-D medical image registration tasks and obtain excellent registration accuracy while assuring inverse consistency.

Lin Tian, Hastings Greer, Roland Kwitt et al. · harvard

Conventional medical image registration approaches directly optimize over the parameters of a transformation model. These approaches have been highly successful and are used generically for registrations of different anatomical regions. Recent deep registration networks are incredibly fast and accurate but are only trained for specific tasks. Hence, they are no longer generic registration approaches. We therefore propose uniGradICON, a first step toward a foundation model for registration providing 1) great performance \emph{across} multiple datasets which is not feasible for current learning-based registration methods, 2) zero-shot capabilities for new registration tasks suitable for different acquisitions, anatomical regions, and modalities compared to the training dataset, and 3) a strong initialization for finetuning on out-of-distribution registration tasks. UniGradICON unifies the speed and accuracy benefits of learning-based registration algorithms with the generic applicability of conventional non-deep-learning approaches. We extensively trained and evaluated uniGradICON on twelve different public datasets. Our code and the uniGradICON model are available at https://github.com/uncbiag/uniGradICON.

Ahmed Rekik, R. Jarrett Rushmore, Sylvain Bouix et al.

Precise segmentation of brain structures in magnetic resonance imaging (MRI) is essential for reliable neuroimaging analysis, yet voxel-wise deep models often yield anatomically inconsistent results that diverge from expert-defined boundaries. In this research, we propose a landmark-guided 3D brain segmentation approach that explicitly mimics the manual segmentation protocol of the Harvard--Oxford Atlas. A Global-to-Local network automatically detects 16 landmarks representing key subcortical reference points. Then, a semantic segmentation model produces a coarse segmentation of 12 anatomical labels, each grouping multiple subcortical regions. Finally, a landmark-driven post-processing step separates these 12 labels into 26 distinct structures by enforcing local anatomical constraints. Experimental results demonstrate consistent improvements in boundary accuracy. Overall, integrating learned landmarks aligns segmentations more closely with manual protocols.

Ghazal Danaee, Mélanie Gaillochet, Christian Desrosiers et al.

Active learning (AL) has emerged as a crucial strategy for reducing the prohibitive costs associated with medical image segmentation. However, standard uncertainty-based AL methods typically focus on maximizing performance metrics, ignoring performance disparities or fairness across groups with sensitive attributes. While fair active learning has been explored in classification tasks, its intersection with medical image segmentation remains unaddressed. In this work, we introduced a fairness-aware active learning framework with a Weighted Entropy selection strategy that modulates uncertainty based on current group-specific performance estimates on the labeled set. To decouple true epistemic uncertainty from anatomical volume variances, we further utilized a masked, scaled entropy restricted to the region of interest. The framework was evaluated on synthetic T1-weighted brain MRIs with controlled left caudate bias in both strong and weak bias settings. A 3D U-Net was trained to segment the left caudate under several AL strategies, starting from both demographically balanced and strongly imbalanced initial labeled sets. Experiments demonstrated that our method markedly reduces performance disparities between groups compared to random sampling and standard uncertainty sampling. By prioritizing poorly segmented subgroups during the AL cycles, our method consistently achieved the highest equity-scaled performance and reduced the disparity metric by 75% (strong bias) and 86% (weak bias) relative to standard entropy at the final budget. Overall, this work is among the first studies on fair AL for medical image segmentation, offering an efficient strategy to train more equitable models in resource-constrained environments.

Charles Bricout, Kang Ik K. Cho, Michael Harms et al.

MRI quality control (QC) is challenging due to unbalanced and limited datasets, as well as subjective scoring, which hinder the development of reliable automated QC systems. To address these issues, we introduce an approach that pretrains a model on synthetically generated motion artifacts before applying transfer learning for QC classification. This method not only improves the accuracy in identifying poor-quality scans but also reduces training time and resource requirements compared to training from scratch. By leveraging synthetic data, we provide a more robust and resource-efficient solution for QC automation in MRI, paving the way for broader adoption in diverse research settings.

Ghazal Danaee, Marc Niethammer, Jarrett Rushmore et al.

Deep-learning-based segmentation algorithms have substantially advanced the field of medical image analysis, particularly in structural delineations in MRIs. However, an important consideration is the intrinsic bias in the data. Concerns about unfairness, such as performance disparities based on sensitive attributes like race and sex, are increasingly urgent. In this work, we evaluate the results of three different segmentation models (UNesT, nnU-Net, and CoTr) and a traditional atlas-based method (ANTs), applied to segment the left and right nucleus accumbens (NAc) in MRI images. We utilize a dataset including four demographic subgroups: black female, black male, white female, and white male. We employ manually labeled gold-standard segmentations to train and test segmentation models. This study consists of two parts: the first assesses the segmentation performance of models, while the second measures the volumes they produce to evaluate the effects of race, sex, and their interaction. Fairness is quantitatively measured using a metric designed to quantify fairness in segmentation performance. Additionally, linear mixed models analyze the impact of demographic variables on segmentation accuracy and derived volumes. Training on the same race as the test subjects leads to significantly better segmentation accuracy for some models. ANTs and UNesT show notable improvements in segmentation accuracy when trained and tested on race-matched data, unlike nnU-Net, which demonstrates robust performance independent of demographic matching. Finally, we examine sex and race effects on the volume of the NAc using segmentations from the manual rater and from our biased models. Results reveal that the sex effects observed with manual segmentation can also be observed with biased models, whereas the race effects disappear in all but one model.

Sedigheh Dargahi, Sylvain Bouix, Christian Desrosiers

Diffusion MRI (dMRI) is a valuable tool to map brain microstructure and connectivity by analyzing water molecule diffusion in tissue. However, acquiring dMRI data requires to capture multiple 3D brain volumes in a short time, often leading to trade-offs in image quality. One challenging artifact is susceptibility-induced distortion, which introduces significant geometric and intensity deformations. Traditional correction methods, such as topup, rely on having access to blip-up and blip-down image pairs, limiting their applicability to retrospective data acquired with a single phase encoding direction. In this work, we propose a deep learning-based approach to correct susceptibility distortions using only a single acquisition (either blip-up or blip-down), eliminating the need for paired acquisitions. Experimental results show that our method achieves performance comparable to topup, demonstrating its potential as an efficient and practical alternative for susceptibility distortion correction in dMRI.

Kaveh Moradkhani, R Jarrett Rushmore, Sylvain Bouix

Accurate cortical surface reconstruction from magnetic resonance imaging (MRI) data is crucial for reliable neuroanatomical analyses. Current methods have to contend with complex cortical geometries, strict topological requirements, and often produce surfaces with overlaps, self-intersections, and topological defects. To overcome these shortcomings, we introduce SimCortex, a deep learning framework that simultaneously reconstructs all brain surfaces (left/right white-matter and pial) from T1-weighted(T1w) MRI volumes while preserving topological properties. Our method first segments the T1w image into a nine-class tissue label map. From these segmentations, we generate subject-specific, collision-free initial surface meshes. These surfaces serve as precise initializations for subsequent multiscale diffeomorphic deformations. Employing stationary velocity fields (SVFs) integrated via scaling-and-squaring, our approach ensures smooth, topology-preserving transformations with significantly reduced surface collisions and self-intersections. Evaluations on standard datasets demonstrate that SimCortex dramatically reduces surface overlaps and self-intersections, surpassing current methods while maintaining state-of-the-art geometric accuracy.

Charles Bricout, Samira Ebrahimi Kahou, Sylvain Bouix

Motion-related artifacts are inevitable in Magnetic Resonance Imaging (MRI) and can bias automated neuroanatomical metrics such as cortical thickness. These biases can interfere with statistical analysis which is a major concern as motion has been shown to be more prominent in certain populations such as children or individuals with ADHD. Manual review cannot objectively quantify motion in anatomical scans, and existing quantitative automated approaches often require specialized hardware or custom acquisition protocols. Here, we train a 3D convolutional neural network to estimate a summary motion metric in retrospective routine research scans by leveraging a large training dataset of synthetically motion-corrupted volumes. We validate our method with one held-out site from our training cohort and with 14 fully independent datasets, including one with manual ratings, achieving a representative $R^2 = 0.65$ versus manual labels and significant thickness-motion correlations in 12/15 datasets. Furthermore, our predicted motion correlates with subject age in line with prior studies. Our approach generalizes across scanner brands and protocols, enabling objective, scalable motion assessment in structural MRI studies without prospective motion correction. By providing reliable motion estimates, our method offers researchers a tool to assess and account for potential biases in cortical thickness analyses.