PSIRNet: Deep Learning-based Free-breathing Rapid Acquisition Late Enhancement Imaging

Purpose: To develop and evaluate a deep learning (DL) method for free-breathing phase-sensitive inversion recovery (PSIR) late gadolinium enhancement (LGE) cardiac MRI that produces diagnostic-quality images from a single acquisition over two heartbeats, eliminating the need for 8 to 24 motion-corrected (MOCO) signal averages. Materials and Methods: Raw data comprising 800,653 slices from 55,917 patients, acquired on 1.5T and 3T scanners across multiple sites from 2016 to 2024, were used in this retrospective study. Data were split by patient: 640,000 slices (42,822 patients) for training and the remainder for validation and testing, without overlap. The training and testing data were from different institutions. PSIRNet, a physics-guided DL network with 845 million parameters, was trained end-to-end to reconstruct PSIR images with surface coil correction from a single interleaved IR/PD acquisition over two heartbeats. Reconstruction quality was evaluated using SSIM, PSNR, and NRMSE against MOCO PSIR references. Two expert cardiologists performed an independent qualitative assessment, scoring image quality on a 5-point Likert scale across bright blood, dark blood, and wideband LGE variants. Paired superiority and equivalence (margin = 0.25 Likert points) were tested using exact Wilcoxon signed-rank tests at a significance level of 0.05 using R version 4.5.2. Results: Both readers rated single-average PSIRNet reconstructions superior to MOCO PSIR for dark blood LGE (conservative P = .002); for bright blood and wideband, one reader rated it superior and the other confirmed equivalence (all P < .001). Inference required approximately 100 msec per slice versus more than 5 sec for MOCO PSIR. Conclusion: PSIRNet produces diagnostic-quality free-breathing PSIR LGE images from a single acquisition, enabling 8- to 24-fold reduction in acquisition time.

Imaging Transformer for MRI Denoising: a Scalable Model Architecture that enables SNR << 1 Imaging

Purpose: To propose a flexible and scalable imaging transformer (IT) architecture with three attention modules for multi-dimensional imaging data and apply it to MRI denoising with very low input SNR. Methods: Three independent attention modules were developed: spatial local, spatial global, and frame attentions. They capture long-range signal correlation and bring back the locality of information in images. An attention-cell-block design processes 5D tensors ([B, C, F, H, W]) for 2D, 2D+T, and 3D image data. A High Resolution (HRNet) backbone was built to hold IT blocks. Training dataset consists of 206,677 cine series and test datasets had 7,267 series. Ten input SNR levels from 0.05 to 8.0 were tested. IT models were compared to seven convolutional and transformer baselines. To test scalability, four IT models 27m to 218m parameters were trained. Two senior cardiologists reviewed IT model outputs from which the EF was measured and compared against the ground-truth. Results: IT models significantly outperformed other models over the tested SNR levels. The performance gap was most prominent at low SNR levels. The IT-218m model had the highest SSIM and PSNR, restoring good image quality and anatomical details even at SNR 0.2. Two experts agreed at this SNR or above, the IT model output gave the same clinical interpretation as the ground-truth. The model produced images that had accurate EF measurements compared to ground-truth values. Conclusions: Imaging transformer model offers strong performance, scalability, and versatility for MR denoising. It recovers image quality suitable for confident clinical reading and accurate EF measurement, even at very low input SNR of 0.2.

Bayesian Uncertainty Estimation by Hamiltonian Monte Carlo: Applications to Cardiac MRI Segmentation

Deep learning (DL)-based methods have achieved state-of-the-art performance for a wide range of medical image segmentation tasks. Nevertheless, recent studies show that deep neural networks (DNNs) can be miscalibrated and overconfident, leading to "silent failures" that are risky} for clinical applications. Bayesian statistics provide an intuitive approach to DL failure detection, based on posterior probability estimation. However, Bayesian DL, and in particular the posterior estimation, is intractable for large medical image segmentation DNNs. To tackle this challenge, we propose a Bayesian learning framework by Hamiltonian Monte Carlo (HMC), tempered by cold posterior (CP) to accommodate medical data augmentation, named HMC-CP. For HMC computation, we further propose a cyclical annealing strategy, which captures both local and global geometries of the posterior distribution, enabling highly efficient Bayesian DNN training with the same computational budget requirements as training a single DNN. The resulting Bayesian DNN outputs an ensemble segmentation along with the segmentation uncertainty. We evaluate the proposed HMC-CP extensively on cardiac magnetic resonance image (MRI) segmentation, using in-domain steady-state free precession (SSFP) cine images as well as out-of-domain datasets of quantitative $T_1$ and $T_2$ mapping.