Shape-aware Segmentation of the Placenta in BOLD Fetal MRI Time Series

Blood oxygen level dependent (BOLD) MRI time series with maternal hyperoxia can assess placental oxygenation and function. Measuring precise BOLD changes in the placenta requires accurate temporal placental segmentation and is confounded by fetal and maternal motion, contractions, and hyperoxia-induced intensity changes. Current BOLD placenta segmentation methods warp a manually annotated subject-specific template to the entire time series. However, as the placenta is a thin, elongated, and highly non-rigid organ subject to large deformations and obfuscated edges, existing work cannot accurately segment the placental shape, especially near boundaries. In this work, we propose a machine learning segmentation framework for placental BOLD MRI and apply it to segmenting each volume in a time series. We use a placental-boundary weighted loss formulation and perform a comprehensive evaluation across several popular segmentation objectives. Our model is trained and tested on a cohort of 91 subjects containing healthy fetuses, fetuses with fetal growth restriction, and mothers with high BMI. Biomedically, our model performs reliably in segmenting volumes in both normoxic and hyperoxic points in the BOLD time series. We further find that boundary-weighting increases placental segmentation performance by 8.3% and 6.0% Dice coefficient for the cross-entropy and signed distance transform objectives, respectively. Our code and trained model is available at https://github.com/mabulnaga/automatic-placenta-segmentation.

Quantifying white matter hyperintensity and brain volumes in heterogeneous clinical and low-field portable MRI

Brain atrophy and white matter hyperintensity (WMH) are critical neuroimaging features for ascertaining brain injury in cerebrovascular disease and multiple sclerosis. Automated segmentation and quantification is desirable but existing methods require high-resolution MRI with good signal-to-noise ratio (SNR). This precludes application to clinical and low-field portable MRI (pMRI) scans, thus hampering large-scale tracking of atrophy and WMH progression, especially in underserved areas where pMRI has huge potential. Here we present a method that segments white matter hyperintensity and 36 brain regions from scans of any resolution and contrast (including pMRI) without retraining. We show results on six public datasets and on a private dataset with paired high- and low-field scans (3T and 64mT), where we attain strong correlation between the WMH ($\rho$=.85) and hippocampal volumes (r=.89) estimated at both fields. Our method is publicly available as part of FreeSurfer, at: http://surfer.nmr.mgh.harvard.edu/fswiki/WMH-SynthSeg.

Fully Convolutional Slice-to-Volume Reconstruction for Single-Stack MRI

In magnetic resonance imaging (MRI), slice-to-volume reconstruction (SVR) refers to computational reconstruction of an unknown 3D magnetic resonance volume from stacks of 2D slices corrupted by motion. While promising, current SVR methods require multiple slice stacks for accurate 3D reconstruction, leading to long scans and limiting their use in time-sensitive applications such as fetal fMRI. Here, we propose a SVR method that overcomes the shortcomings of previous work and produces state-of-the-art reconstructions in the presence of extreme inter-slice motion. Inspired by the recent success of single-view depth estimation methods, we formulate SVR as a single-stack motion estimation task and train a fully convolutional network to predict a motion stack for a given slice stack, producing a 3D reconstruction as a byproduct of the predicted motion. Extensive experiments on the SVR of adult and fetal brains demonstrate that our fully convolutional method is twice as accurate as previous SVR methods. Our code is available at github.com/seannz/svr.

A Framework for Interpretability in Machine Learning for Medical Imaging

Interpretability for machine learning models in medical imaging (MLMI) is an important direction of research. However, there is a general sense of murkiness in what interpretability means. Why does the need for interpretability in MLMI arise? What goals does one actually seek to address when interpretability is needed? To answer these questions, we identify a need to formalize the goals and elements of interpretability in MLMI. By reasoning about real-world tasks and goals common in both medical image analysis and its intersection with machine learning, we identify four core elements of interpretability: localization, visual recognizability, physical attribution, and transparency. Overall, this paper formalizes interpretability needs in the context of medical imaging, and our applied perspective clarifies concrete MLMI-specific goals and considerations in order to guide method design and improve real-world usage. Our goal is to provide practical and didactic information for model designers and practitioners, inspire developers of models in the medical imaging field to reason more deeply about what interpretability is achieving, and suggest future directions of interpretability research.

Diffeomorphic Multi-Resolution Deep Learning Registration for Applications in Breast MRI

In breast surgical planning, accurate registration of MR images across patient positions has the potential to improve the localisation of tumours during breast cancer treatment. While learning-based registration methods have recently become the state-of-the-art approach for most medical image registration tasks, these methods have yet to make inroads into breast image registration due to certain difficulties-the lack of rich texture information in breast MR images and the need for the deformations to be diffeomophic. In this work, we propose learning strategies for breast MR image registration that are amenable to diffeomorphic constraints, together with early experimental results from in-silico and in-vivo experiments. One key contribution of this work is a registration network which produces superior registration outcomes for breast images in addition to providing diffeomorphic guarantees.

SUD$^2$: Supervision by Denoising Diffusion Models for Image Reconstruction

Many imaging inverse problems$\unicode{x2014}$such as image-dependent in-painting and dehazing$\unicode{x2014}$are challenging because their forward models are unknown or depend on unknown latent parameters. While one can solve such problems by training a neural network with vast quantities of paired training data, such paired training data is often unavailable. In this paper, we propose a generalized framework for training image reconstruction networks when paired training data is scarce. In particular, we demonstrate the ability of image denoising algorithms and, by extension, denoising diffusion models to supervise network training in the absence of paired training data.

Automatic Segmentation of the Placenta in BOLD MRI Time Series

Blood oxygen level dependent (BOLD) MRI with maternal hyperoxia can assess oxygen transport within the placenta and has emerged as a promising tool to study placental function. Measuring signal changes over time requires segmenting the placenta in each volume of the time series. Due to the large number of volumes in the BOLD time series, existing studies rely on registration to map all volumes to a manually segmented template. As the placenta can undergo large deformation due to fetal motion, maternal motion, and contractions, this approach often results in a large number of discarded volumes, where the registration approach fails. In this work, we propose a machine learning model based on a U-Net neural network architecture to automatically segment the placenta in BOLD MRI and apply it to segmenting each volume in a time series. We use a boundary-weighted loss function to accurately capture the placental shape. Our model is trained and tested on a cohort of 91 subjects containing healthy fetuses, fetuses with fetal growth restriction, and mothers with high BMI. We achieve a Dice score of 0.83+/-0.04 when matching with ground truth labels and our model performs reliably in segmenting volumes in both normoxic and hyperoxic points in the BOLD time series. Our code and trained model are available at https://github.com/mabulnaga/automatic-placenta-segmentation.

SuperWarp: Supervised Learning and Warping on U-Net for Invariant Subvoxel-Precise Registration

In recent years, learning-based image registration methods have gradually moved away from direct supervision with target warps to instead use self-supervision, with excellent results in several registration benchmarks. These approaches utilize a loss function that penalizes the intensity differences between the fixed and moving images, along with a suitable regularizer on the deformation. In this paper, we argue that the relative failure of supervised registration approaches can in part be blamed on the use of regular U-Nets, which are jointly tasked with feature extraction, feature matching, and estimation of deformation. We introduce one simple but crucial modification to the U-Net that disentangles feature extraction and matching from deformation prediction, allowing the U-Net to warp the features, across levels, as the deformation field is evolved. With this modification, direct supervision using target warps begins to outperform self-supervision approaches that require segmentations, presenting new directions for registration when images do not have segmentations. We hope that our findings in this preliminary workshop paper will re-ignite research interest in supervised image registration techniques. Our code is publicly available from https://github.com/balbasty/superwarp.

SUD: Supervision by Denoising for Medical Image Segmentation

Training a fully convolutional network for semantic segmentation typically requires a large, labeled dataset with little label noise if good generalization is to be guaranteed. For many segmentation problems, however, data with pixel- or voxel-level labeling accuracy are scarce due to the cost of manual labeling. This problem is exacerbated in domains where manual annotation is difficult, resulting in large amounts of variability in the labeling even across domain experts. Therefore, training segmentation networks to generalize better by learning from both labeled and unlabeled images (called semi-supervised learning) is problem of both practical and theoretical interest. However, traditional semi-supervised learning methods for segmentation often necessitate hand-crafting a differentiable regularizer specific to a given segmentation problem, which can be extremely time-consuming. In this work, we propose "supervision by denoising" (SUD), a framework that enables us to supervise segmentation models using their denoised output as targets. SUD unifies temporal ensembling and spatial denoising techniques under a spatio-temporal denoising framework and alternates denoising and network weight update in an optimization framework for semi-supervision. We validate SUD on three tasks-kidney and tumor (3D), and brain (3D) segmentation, and cortical parcellation (2D)-demonstrating a significant improvement in the Dice overlap and the Hausdorff distance of segmentations over supervised-only and temporal ensemble baselines.