The state-of-the-art in Cardiac MRI Reconstruction: Results of the CMRxRecon Challenge in MICCAI 2023

Cardiac MRI, crucial for evaluating heart structure and function, faces limitations like slow imaging and motion artifacts. Undersampling reconstruction, especially data-driven algorithms, has emerged as a promising solution to accelerate scans and enhance imaging performance using highly under-sampled data. Nevertheless, the scarcity of publicly available cardiac k-space datasets and evaluation platform hinder the development of data-driven reconstruction algorithms. To address this issue, we organized the Cardiac MRI Reconstruction Challenge (CMRxRecon) in 2023, in collaboration with the 26th International Conference on MICCAI. CMRxRecon presented an extensive k-space dataset comprising cine and mapping raw data, accompanied by detailed annotations of cardiac anatomical structures. With overwhelming participation, the challenge attracted more than 285 teams and over 600 participants. Among them, 22 teams successfully submitted Docker containers for the testing phase, with 7 teams submitted for both cine and mapping tasks. All teams use deep learning based approaches, indicating that deep learning has predominately become a promising solution for the problem. The first-place winner of both tasks utilizes the E2E-VarNet architecture as backbones. In contrast, U-Net is still the most popular backbone for both multi-coil and single-coil reconstructions. This paper provides a comprehensive overview of the challenge design, presents a summary of the submitted results, reviews the employed methods, and offers an in-depth discussion that aims to inspire future advancements in cardiac MRI reconstruction models. The summary emphasizes the effective strategies observed in Cardiac MRI reconstruction, including backbone architecture, loss function, pre-processing techniques, physical modeling, and model complexity, thereby providing valuable insights for further developments in this field.

Deep Separable Spatiotemporal Learning for Fast Dynamic Cardiac MRI

Dynamic magnetic resonance imaging (MRI) plays an indispensable role in cardiac diagnosis. To enable fast imaging, the k-space data can be undersampled but the image reconstruction poses a great challenge of high-dimensional processing. This challenge leads to necessitate extensive training data in many deep learning reconstruction methods. This work proposes a novel and efficient approach, leveraging a dimension-reduced separable learning scheme that excels even with highly limited training data. We further integrate it with spatiotemporal priors to develop a Deep Separable Spatiotemporal Learning network (DeepSSL), which unrolls an iteration process of a reconstruction model with both temporal low-rankness and spatial sparsity. Intermediate outputs are visualized to provide insights into the network's behavior and enhance its interpretability. Extensive results on cardiac cine datasets show that the proposed DeepSSL is superior to the state-of-the-art methods visually and quantitatively, while reducing the demand for training cases by up to 75%. And its preliminary adaptability to cardiac patients has been verified through experienced radiologists' and cardiologists' blind reader study. Additionally, DeepSSL also benefits for achieving the downstream task of cardiac segmentation with higher accuracy and shows robustness in prospective real-time cardiac MRI.

CMRxRecon: An open cardiac MRI dataset for the competition of accelerated image reconstruction

Cardiac magnetic resonance imaging (CMR) has emerged as a valuable diagnostic tool for cardiac diseases. However, a limitation of CMR is its slow imaging speed, which causes patient discomfort and introduces artifacts in the images. There has been growing interest in deep learning-based CMR imaging algorithms that can reconstruct high-quality images from highly under-sampled k-space data. However, the development of deep learning methods requires large training datasets, which have not been publicly available for CMR. To address this gap, we released a dataset that includes multi-contrast, multi-view, multi-slice and multi-coil CMR imaging data from 300 subjects. Imaging studies include cardiac cine and mapping sequences. Manual segmentations of the myocardium and chambers of all the subjects are also provided within the dataset. Scripts of state-of-the-art reconstruction algorithms were also provided as a point of reference. Our aim is to facilitate the advancement of state-of-the-art CMR image reconstruction by introducing standardized evaluation criteria and making the dataset freely accessible to the research community. Researchers can access the dataset at https://www.synapse.org/#!Synapse:syn51471091/wiki/.

One for Multiple: Physics-informed Synthetic Data Boosts Generalizable Deep Learning for Fast MRI Reconstruction

Magnetic resonance imaging (MRI) is a principal radiological modality that provides radiation-free, abundant, and diverse information about the whole human body for medical diagnosis, but suffers from prolonged scan time. The scan time can be significantly reduced through k-space undersampling but the introduced artifacts need to be removed in image reconstruction. Although deep learning (DL) has emerged as a powerful tool for image reconstruction in fast MRI, its potential in multiple imaging scenarios remains largely untapped. This is because not only collecting large-scale and diverse realistic training data is generally costly and privacy-restricted, but also existing DL methods are hard to handle the practically inevitable mismatch between training and target data. Here, we present a Physics-Informed Synthetic data learning framework for Fast MRI, called PISF, which is the first to enable generalizable DL for multi-scenario MRI reconstruction using solely one trained model. For a 2D image, the reconstruction is separated into many 1D basic problems and starts with the 1D data synthesis, to facilitate generalization. We demonstrate that training DL models on synthetic data, integrated with enhanced learning techniques, can achieve comparable or even better in vivo MRI reconstruction compared to models trained on a matched realistic dataset, reducing the demand for real-world MRI data by up to 96%. Moreover, our PISF shows impressive generalizability in multi-vendor multi-center imaging. Its excellent adaptability to patients has been verified through 10 experienced doctors' evaluations. PISF provides a feasible and cost-effective way to markedly boost the widespread usage of DL in various fast MRI applications, while freeing from the intractable ethical and practical considerations of in vivo human data acquisitions.

The Extreme Cardiac MRI Analysis Challenge under Respiratory Motion (CMRxMotion)

The quality of cardiac magnetic resonance (CMR) imaging is susceptible to respiratory motion artifacts. The model robustness of automated segmentation techniques in face of real-world respiratory motion artifacts is unclear. This manuscript describes the design of extreme cardiac MRI analysis challenge under respiratory motion (CMRxMotion Challenge). The challenge aims to establish a public benchmark dataset to assess the effects of respiratory motion on image quality and examine the robustness of segmentation models. The challenge recruited 40 healthy volunteers to perform different breath-hold behaviors during one imaging visit, obtaining paired cine imaging with artifacts. Radiologists assessed the image quality and annotated the level of respiratory motion artifacts. For those images with diagnostic quality, radiologists further segmented the left ventricle, left ventricle myocardium and right ventricle. The images of training set (20 volunteers) along with the annotations are released to the challenge participants, to develop an automated image quality assessment model (Task 1) and an automated segmentation model (Task 2). The images of validation set (5 volunteers) are released to the challenge participants but the annotations are withheld for online evaluation of submitted predictions. Both the images and annotations of the test set (15 volunteers) were withheld and only used for offline evaluation of submitted containerized dockers. The image quality assessment task is quantitatively evaluated by the Cohen's kappa statistics and the segmentation task is evaluated by the Dice scores and Hausdorff distances.

Transformer-empowered Multi-scale Contextual Matching and Aggregation for Multi-contrast MRI Super-resolution

Magnetic resonance imaging (MRI) can present multi-contrast images of the same anatomical structures, enabling multi-contrast super-resolution (SR) techniques. Compared with SR reconstruction using a single-contrast, multi-contrast SR reconstruction is promising to yield SR images with higher quality by leveraging diverse yet complementary information embedded in different imaging modalities. However, existing methods still have two shortcomings: (1) they neglect that the multi-contrast features at different scales contain different anatomical details and hence lack effective mechanisms to match and fuse these features for better reconstruction; and (2) they are still deficient in capturing long-range dependencies, which are essential for the regions with complicated anatomical structures. We propose a novel network to comprehensively address these problems by developing a set of innovative Transformer-empowered multi-scale contextual matching and aggregation techniques; we call it McMRSR. Firstly, we tame transformers to model long-range dependencies in both reference and target images. Then, a new multi-scale contextual matching method is proposed to capture corresponding contexts from reference features at different scales. Furthermore, we introduce a multi-scale aggregation mechanism to gradually and interactively aggregate multi-scale matched features for reconstructing the target SR MR image. Extensive experiments demonstrate that our network outperforms state-of-the-art approaches and has great potential to be applied in clinical practice. Codes are available at https://github.com/XAIMI-Lab/McMRSR.

High-Resolution Pelvic MRI Reconstruction Using a Generative Adversarial Network with Attention and Cyclic Loss

Magnetic resonance imaging (MRI) is an important medical imaging modality, but its acquisition speed is quite slow due to the physiological limitations. Recently, super-resolution methods have shown excellent performance in accelerating MRI. In some circumstances, it is difficult to obtain high-resolution images even with prolonged scan time. Therefore, we proposed a novel super-resolution method that uses a generative adversarial network (GAN) with cyclic loss and attention mechanism to generate high-resolution MR images from low-resolution MR images by a factor of 2. We implemented our model on pelvic images from healthy subjects as training and validation data, while those data from patients were used for testing. The MR dataset was obtained using different imaging sequences, including T2, T2W SPAIR, and mDIXON-W. Four methods, i.e., BICUBIC, SRCNN, SRGAN, and EDSR were used for comparison. Structural similarity, peak signal to noise ratio, root mean square error, and variance inflation factor were used as calculation indicators to evaluate the performances of the proposed method. Various experimental results showed that our method can better restore the details of the high-resolution MR image as compared to the other methods. In addition, the reconstructed high-resolution MR image can provide better lesion textures in the tumor patients, which is promising to be used in clinical diagnosis.

Transfer Learning Enhanced Generative Adversarial Networks for Multi-Channel MRI Reconstruction

Deep learning based generative adversarial networks (GAN) can effectively perform image reconstruction with under-sampled MR data. In general, a large number of training samples are required to improve the reconstruction performance of a certain model. However, in real clinical applications, it is difficult to obtain tens of thousands of raw patient data to train the model since saving k-space data is not in the routine clinical flow. Therefore, enhancing the generalizability of a network based on small samples is urgently needed. In this study, three novel applications were explored based on parallel imaging combined with the GAN model (PI-GAN) and transfer learning. The model was pre-trained with public Calgary brain images and then fine-tuned for use in (1) patients with tumors in our center; (2) different anatomies, including knee and liver; (3) different k-space sampling masks with acceleration factors (AFs) of 2 and 6. As for the brain tumor dataset, the transfer learning results could remove the artifacts found in PI-GAN and yield smoother brain edges. The transfer learning results for the knee and liver were superior to those of the PI-GAN model trained with its own dataset using a smaller number of training cases. However, the learning procedure converged more slowly in the knee datasets compared to the learning in the brain tumor datasets. The reconstruction performance was improved by transfer learning both in the models with AFs of 2 and 6. Of these two models, the one with AF=2 showed better results. The results also showed that transfer learning with the pre-trained model could solve the problem of inconsistency between the training and test datasets and facilitate generalization to unseen data.