Ω-Net (Omega-Net): Fully Automatic, Multi-View Cardiac MR Detection, Orientation, and Segmentation with Deep Neural Networks

Pixelwise segmentation of the left ventricular (LV) myocardium and the four cardiac chambers in 2-D steady state free precession (SSFP) cine sequences is an essential preprocessing step for a wide range of analyses. Variability in contrast, appearance, orientation, and placement of the heart between patients, clinical views, scanners, and protocols makes fully automatic semantic segmentation a notoriously difficult problem. Here, we present ${\Omega}$-Net (Omega-Net): a novel convolutional neural network (CNN) architecture for simultaneous localization, transformation into a canonical orientation, and semantic segmentation. First, an initial segmentation is performed on the input image, second, the features learned during this initial segmentation are used to predict the parameters needed to transform the input image into a canonical orientation, and third, a final segmentation is performed on the transformed image. In this work, ${\Omega}$-Nets of varying depths were trained to detect five foreground classes in any of three clinical views (short axis, SA, four-chamber, 4C, two-chamber, 2C), without prior knowledge of the view being segmented. The architecture was trained on a cohort of patients with hypertrophic cardiomyopathy and healthy control subjects. Network performance as measured by weighted foreground intersection-over-union (IoU) was substantially improved in the best-performing ${\Omega}$- Net compared with U-Net segmentation without localization or orientation. In addition, {\Omega}-Net was retrained from scratch on the 2017 MICCAI ACDC dataset, and achieves state-of-the-art results on the LV and RV bloodpools, and performed slightly worse in segmentation of the LV myocardium. We conclude this architecture represents a substantive advancement over prior approaches, with implications for biomedical image segmentation more generally.

Label-driven weakly-supervised learning for multimodal deformable image registration

Spatially aligning medical images from different modalities remains a challenging task, especially for intraoperative applications that require fast and robust algorithms. We propose a weakly-supervised, label-driven formulation for learning 3D voxel correspondence from higher-level label correspondence, thereby bypassing classical intensity-based image similarity measures. During training, a convolutional neural network is optimised by outputting a dense displacement field (DDF) that warps a set of available anatomical labels from the moving image to match their corresponding counterparts in the fixed image. These label pairs, including solid organs, ducts, vessels, point landmarks and other ad hoc structures, are only required at training time and can be spatially aligned by minimising a cross-entropy function of the warped moving label and the fixed label. During inference, the trained network takes a new image pair to predict an optimal DDF, resulting in a fully-automatic, label-free, real-time and deformable registration. For interventional applications where large global transformation prevails, we also propose a neural network architecture to jointly optimise the global- and local displacements. Experiment results are presented based on cross-validating registrations of 111 pairs of T2-weighted magnetic resonance images and 3D transrectal ultrasound images from prostate cancer patients with a total of over 4000 anatomical labels, yielding a median target registration error of 4.2 mm on landmark centroids and a median Dice of 0.88 on prostate glands.

Intraoperative Organ Motion Models with an Ensemble of Conditional Generative Adversarial Networks

In this paper, we describe how a patient-specific, ultrasound-probe-induced prostate motion model can be directly generated from a single preoperative MR image. Our motion model allows for sampling from the conditional distribution of dense displacement fields, is encoded by a generative neural network conditioned on a medical image, and accepts random noise as additional input. The generative network is trained by a minimax optimisation with a second discriminative neural network, tasked to distinguish generated samples from training motion data. In this work, we propose that 1) jointly optimising a third conditioning neural network that pre-processes the input image, can effectively extract patient-specific features for conditioning; and 2) combining multiple generative models trained separately with heuristically pre-disjointed training data sets can adequately mitigate the problem of mode collapse. Trained with diagnostic T2-weighted MR images from 143 real patients and 73,216 3D dense displacement fields from finite element simulations of intraoperative prostate motion due to transrectal ultrasound probe pressure, the proposed models produced physically-plausible patient-specific motion of prostate glands. The ability to capture biomechanically simulated motion was evaluated using two errors representing generalisability and specificity of the model. The median values, calculated from a 10-fold cross-validation, were 2.8+/-0.3 mm and 1.7+/-0.1 mm, respectively. We conclude that the introduced approach demonstrates the feasibility of applying state-of-the-art machine learning algorithms to generate organ motion models from patient images, and shows significant promise for future research.

Freehand Ultrasound Image Simulation with Spatially-Conditioned Generative Adversarial Networks

Sonography synthesis has a wide range of applications, including medical procedure simulation, clinical training and multimodality image registration. In this paper, we propose a machine learning approach to simulate ultrasound images at given 3D spatial locations (relative to the patient anatomy), based on conditional generative adversarial networks (GANs). In particular, we introduce a novel neural network architecture that can sample anatomically accurate images conditionally on spatial position of the (real or mock) freehand ultrasound probe. To ensure an effective and efficient spatial information assimilation, the proposed spatially-conditioned GANs take calibrated pixel coordinates in global physical space as conditioning input, and utilise residual network units and shortcuts of conditioning data in the GANs' discriminator and generator, respectively. Using optically tracked B-mode ultrasound images, acquired by an experienced sonographer on a fetus phantom, we demonstrate the feasibility of the proposed method by two sets of quantitative results: distances were calculated between corresponding anatomical landmarks identified in the held-out ultrasound images and the simulated data at the same locations unseen to the networks; a usability study was carried out to distinguish the simulated data from the real images. In summary, we present what we believe are state-of-the-art visually realistic ultrasound images, simulated by the proposed GAN architecture that is stable to train and capable of generating plausibly diverse image samples.

Temporal HeartNet: Towards Human-Level Automatic Analysis of Fetal Cardiac Screening Video

We present an automatic method to describe clinically useful information about scanning, and to guide image interpretation in ultrasound (US) videos of the fetal heart. Our method is able to jointly predict the visibility, viewing plane, location and orientation of the fetal heart at the frame level. The contributions of the paper are three-fold: (i) a convolutional neural network architecture is developed for a multi-task prediction, which is computed by sliding a 3x3 window spatially through convolutional maps. (ii) an anchor mechanism and Intersection over Union (IoU) loss are applied for improving localization accuracy. (iii) a recurrent architecture is designed to recursively compute regional convolutional features temporally over sequential frames, allowing each prediction to be conditioned on the whole video. This results in a spatial-temporal model that precisely describes detailed heart parameters in challenging US videos. We report results on a real-world clinical dataset, where our method achieves performance on par with expert annotations.

Feature Tracking Cardiac Magnetic Resonance via Deep Learning and Spline Optimization

Feature tracking Cardiac Magnetic Resonance (CMR) has recently emerged as an area of interest for quantification of regional cardiac function from balanced, steady state free precession (SSFP) cine sequences. However, currently available techniques lack full automation, limiting reproducibility. We propose a fully automated technique whereby a CMR image sequence is first segmented with a deep, fully convolutional neural network (CNN) architecture, and quadratic basis splines are fitted simultaneously across all cardiac frames using least squares optimization. Experiments are performed using data from 42 patients with hypertrophic cardiomyopathy (HCM) and 21 healthy control subjects. In terms of segmentation, we compared state-of-the-art CNN frameworks, U-Net and dilated convolution architectures, with and without temporal context, using cross validation with three folds. Performance relative to expert manual segmentation was similar across all networks: pixel accuracy was ~97%, intersection-over-union (IoU) across all classes was ~87%, and IoU across foreground classes only was ~85%. Endocardial left ventricular circumferential strain calculated from the proposed pipeline was significantly different in control and disease subjects (-25.3% vs -29.1%, p = 0.006), in agreement with the current clinical literature.

Quantification of Ultrasonic Texture heterogeneity via Volumetric Stochastic Modeling for Tissue Characterization

Intensity variations in image texture can provide powerful quantitative information about physical properties of biological tissue. However, tissue patterns can vary according to the utilized imaging system and are intrinsically correlated to the scale of analysis. In the case of ultrasound, the Nakagami distribution is a general model of the ultrasonic backscattering envelope under various scattering conditions and densities where it can be employed for characterizing image texture, but the subtle intra-heterogeneities within a given mass are difficult to capture via this model as it works at a single spatial scale. This paper proposes a locally adaptive 3D multi-resolution Nakagami-based fractal feature descriptor that extends Nakagami-based texture analysis to accommodate subtle speckle spatial frequency tissue intensity variability in volumetric scans. Local textural fractal descriptors - which are invariant to affine intensity changes - are extracted from volumetric patches at different spatial resolutions from voxel lattice-based generated shape and scale Nakagami parameters. Using ultrasound radio-frequency datasets we found that after applying an adaptive fractal decomposition label transfer approach on top of the generated Nakagami voxels, tissue characterization results were superior to the state of art. Experimental results on real 3D ultrasonic pre-clinical and clinical datasets suggest that describing tumor intra-heterogeneity via this descriptor may facilitate improved prediction of therapy response and disease characterization.