Learning Multiparametric Biomarkers for Assessing MR-Guided Focused Ultrasound Treatments Using Volume-Conserving Registration

Noninvasive MR-guided focused ultrasound (MRgFUS) treatments are promising alternatives to the surgical removal of malignant tumors. A significant challenge is assessing the treated tissue immediately after MRgFUS procedures. Although current clinical assessment uses the immediate nonperfused volume (NPV) biomarker derived from contrast enhanced imaging, the use of contrast agent prevents continuing MRgFUS treatment if margins are not adequate. In addition, the NPV has been shown to provide variable accuracy for the true treatment outcome as evaluated by follow-up biomarkers. This work presents a novel, noncontrast, learned multiparametric MR biomarker that is conducive for intratreatment assessment. MRgFUS ablations were performed in a rabbit VX2 tumor model. Multiparametric MRI was obtained both during and immediately after the MRgFUS ablation, as well as during follow-up imaging. Segmentation of the NPV obtained during follow-up imaging was used to train a neural network on noncontrast multiparametric MR images. The NPV follow-up segmentation was registered to treatment-day images using a novel volume-conserving registration algorithm, allowing a voxel-wise correlation between imaging sessions. Contrasted with state-of-the-art registration algorithms that change the average volume by 16.8%, the presented volume-conserving registration algorithm changes the average volume by only 0.28%. After registration, the learned multiparametric MR biomarker predicted the follow-up NPV with an average DICE coefficient of 0.71, outperforming the DICE coefficient of 0.53 from the current standard of NPV obtained immediately after the ablation treatment. Noncontrast multiparametric MR imaging can provide a more accurate prediction of treated tissue immediately after treatment. Noncontrast assessment of MRgFUS procedures will potentially lead to more efficacious MRgFUS ablation treatments.

Real-Time Patient-Specific Lung Radiotherapy Targeting using Deep Learning

Radiation therapy has presented a need for dynamic tracking of a target tumor volume. Fiducial markers such as implanted gold seeds have been used to gate radiation delivery but the markers are invasive and gating significantly increases treatment time. Pretreatment acquisition of a 4DCT allows for the development of accurate motion estimation for treatment planning. A deep convolutional neural network and subspace motion tracking is used to recover anatomical positions from a single radiograph projection in real-time. We approximate the nonlinear inverse of a diffeomorphic transformation composed with radiographic projection as a deep network that produces subspace coordinates to define the patient-specific deformation of the lungs from a baseline anatomic position. The geometric accuracy of the subspace projections on real patient data is similar to accuracy attained by original image registration between individual respiratory-phase image volumes.