Unveiling Fairness Biases in Deep Learning-Based Brain MRI Reconstruction

Deep learning (DL) reconstruction particularly of MRI has led to improvements in image fidelity and reduction of acquisition time. In neuroimaging, DL methods can reconstruct high-quality images from undersampled data. However, it is essential to consider fairness in DL algorithms, particularly in terms of demographic characteristics. This study presents the first fairness analysis in a DL-based brain MRI reconstruction model. The model utilises the U-Net architecture for image reconstruction and explores the presence and sources of unfairness by implementing baseline Empirical Risk Minimisation (ERM) and rebalancing strategies. Model performance is evaluated using image reconstruction metrics. Our findings reveal statistically significant performance biases between the gender and age subgroups. Surprisingly, data imbalance and training discrimination are not the main sources of bias. This analysis provides insights of fairness in DL-based image reconstruction and aims to improve equity in medical AI applications.

Temporal Uncertainty Localization to Enable Human-in-the-loop Analysis of Dynamic Contrast-enhanced Cardiac MRI Datasets

Dynamic contrast-enhanced (DCE) cardiac magnetic resonance imaging (CMRI) is a widely used modality for diagnosing myocardial blood flow (perfusion) abnormalities. During a typical free-breathing DCE-CMRI scan, close to 300 time-resolved images of myocardial perfusion are acquired at various contrast "wash in/out" phases. Manual segmentation of myocardial contours in each time-frame of a DCE image series can be tedious and time-consuming, particularly when non-rigid motion correction has failed or is unavailable. While deep neural networks (DNNs) have shown promise for analyzing DCE-CMRI datasets, a "dynamic quality control" (dQC) technique for reliably detecting failed segmentations is lacking. Here we propose a new space-time uncertainty metric as a dQC tool for DNN-based segmentation of free-breathing DCE-CMRI datasets by validating the proposed metric on an external dataset and establishing a human-in-the-loop framework to improve the segmentation results. In the proposed approach, we referred the top 10% most uncertain segmentations as detected by our dQC tool to the human expert for refinement. This approach resulted in a significant increase in the Dice score (p<0.001) and a notable decrease in the number of images with failed segmentation (16.2% to 11.3%) whereas the alternative approach of randomly selecting the same number of segmentations for human referral did not achieve any significant improvement. Our results suggest that the proposed dQC framework has the potential to accurately identify poor-quality segmentations and may enable efficient DNN-based analysis of DCE-CMRI in a human-in-the-loop pipeline for clinical interpretation and reporting of dynamic CMRI datasets.

Semi-supervised Pathology Segmentation with Disentangled Representations

Automated pathology segmentation remains a valuable diagnostic tool in clinical practice. However, collecting training data is challenging. Semi-supervised approaches by combining labelled and unlabelled data can offer a solution to data scarcity. An approach to semi-supervised learning relies on reconstruction objectives (as self-supervision objectives) that learns in a joint fashion suitable representations for the task. Here, we propose Anatomy-Pathology Disentanglement Network (APD-Net), a pathology segmentation model that attempts to learn jointly for the first time: disentanglement of anatomy, modality, and pathology. The model is trained in a semi-supervised fashion with new reconstruction losses directly aiming to improve pathology segmentation with limited annotations. In addition, a joint optimization strategy is proposed to fully take advantage of the available annotations. We evaluate our methods with two private cardiac infarction segmentation datasets with LGE-MRI scans. APD-Net can perform pathology segmentation with few annotations, maintain performance with different amounts of supervision, and outperform related deep learning methods.

Disentangle, align and fuse for multimodal and zero-shot image segmentation

Magnetic resonance (MR) protocols rely on several sequences to properly assess pathology and organ status. Yet, despite advances in image analysis we tend to treat each sequence, here termed modality, in isolation. Taking advantage of the information shared between modalities (largely an organ's anatomy) is beneficial for multi-modality multi-input processing and learning. However, we must overcome inherent anatomical misregistrations and disparities in signal intensity across the modalities to claim this benefit. We present a method that offers improved segmentation accuracy of the modality of interest (over a single input model), by learning to leverage information present in other modalities, enabling semi-supervised and zero shot learning. Core to our method is learning a disentangled decomposition into anatomical and imaging factors. Shared anatomical factors from the different inputs are jointly processed and fused to extract more accurate segmentation masks. Image misregistrations are corrected with a Spatial Transformer Network, that non-linearly aligns the anatomical factors. The imaging factor captures signal intensity characteristics across different modality data, and is used for image reconstruction, enabling semi-supervised learning. Temporal and slice pairing between inputs are learned dynamically. We demonstrate applications in Late Gadolinium Enhanced (LGE) and Blood Oxygenation Level Dependent (BOLD) cardiac segmentation, as well as in T2 abdominal segmentation.

Factorised Representation Learning in Cardiac Image Analysis

Typically, a medical image offers spatial information on the anatomy (and pathology) modulated by imaging specific characteristics. Many imaging modalities including Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) can be interpreted in this way. We can venture further and consider that a medical image naturally factors into some spatial factors depicting anatomy and factors that denote the imaging characteristics. Here, we explicitly learn this decomposed (factorised) representation of imaging data, focusing in particular on cardiac images. We propose Spatial Decomposition Network (SDNet), which factorises 2D medical images into spatial anatomical factors and non-spatial imaging factors. We demonstrate that this high-level representation is ideally suited for several medical image analysis tasks, such as semi-supervised segmentation, multi-task segmentation and regression, and image-to-image synthesis. Specifically, we show that our model can match the performance of fully supervised segmentation models, using only a fraction of the labelled images. Critically, we show that our factorised representation also benefits from supervision obtained either when we use auxiliary tasks to train the model in a multi-task setting (e.g. regressing to known cardiac indices), or when aggregating multimodal data from different sources (e.g. pooling together MRI and CT data). To explore the properties of the learned factorisation, we perform latent-space arithmetic and show that we can synthesise CT from MR and vice versa, by swapping the modality factors. We also demonstrate that the factor holding image specific information can be used to predict the input modality with high accuracy.

Factorised spatial representation learning: application in semi-supervised myocardial segmentation

The success and generalisation of deep learning algorithms heavily depend on learning good feature representations. In medical imaging this entails representing anatomical information, as well as properties related to the specific imaging setting. Anatomical information is required to perform further analysis, whereas imaging information is key to disentangle scanner variability and potential artefacts. The ability to factorise these would allow for training algorithms only on the relevant information according to the task. To date, such factorisation has not been attempted. In this paper, we propose a methodology of latent space factorisation relying on the cycle-consistency principle. As an example application, we consider cardiac MR segmentation, where we separate information related to the myocardium from other features related to imaging and surrounding substructures. We demonstrate the proposed method's utility in a semi-supervised setting: we use very few labelled images together with many unlabelled images to train a myocardium segmentation neural network. Specifically, we achieve comparable performance to fully supervised networks using a fraction of labelled images in experiments on ACDC and a dataset from Edinburgh Imaging Facility QMRI. Code will be made available at https://github.com/agis85/spatial_factorisation.