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.

$k$-$t$ CLAIR: Self-Consistency Guided Multi-Prior Learning for Dynamic Parallel MR Image Reconstruction

Cardiac magnetic resonance imaging (CMR) has been widely used in clinical practice for the medical diagnosis of cardiac diseases. However, the long acquisition time hinders its development in real-time applications. Here, we propose a novel self-consistency guided multi-prior learning framework named $k$-$t$ CLAIR to exploit spatiotemporal correlations from highly undersampled data for accelerated dynamic parallel MRI reconstruction. The $k$-$t$ CLAIR progressively reconstructs faithful images by leveraging multiple complementary priors learned in the $x$-$t$, $x$-$f$, and $k$-$t$ domains in an iterative fashion, as dynamic MRI exhibits high spatiotemporal redundancy. Additionally, $k$-$t$ CLAIR incorporates calibration information for prior learning, resulting in a more consistent reconstruction. Experimental results on cardiac cine and T1W/T2W images demonstrate that $k$-$t$ CLAIR achieves high-quality dynamic MR reconstruction in terms of both quantitative and qualitative performance.

CartiMorph: a framework for automated knee articular cartilage morphometrics

We introduce CartiMorph, a framework for automated knee articular cartilage morphometrics. It takes an image as input and generates quantitative metrics for cartilage subregions, including the percentage of full-thickness cartilage loss (FCL), mean thickness, surface area, and volume. CartiMorph leverages the power of deep learning models for hierarchical image feature representation. Deep learning models were trained and validated for tissue segmentation, template construction, and template-to-image registration. We established methods for surface-normal-based cartilage thickness mapping, FCL estimation, and rule-based cartilage parcellation. Our cartilage thickness map showed less error in thin and peripheral regions. We evaluated the effectiveness of the adopted segmentation model by comparing the quantitative metrics obtained from model segmentation and those from manual segmentation. The root-mean-squared deviation of the FCL measurements was less than 8%, and strong correlations were observed for the mean thickness (Pearson's correlation coefficient $\rho \in [0.82,0.97]$), surface area ($\rho \in [0.82,0.98]$) and volume ($\rho \in [0.89,0.98]$) measurements. We compared our FCL measurements with those from a previous study and found that our measurements deviated less from the ground truths. We observed superior performance of the proposed rule-based cartilage parcellation method compared with the atlas-based approach. CartiMorph has the potential to promote imaging biomarkers discovery for knee osteoarthritis.

An Uncertainty Aided Framework for Learning based Liver $T_1ρ$ Mapping and Analysis

Objective: Quantitative $T_1\rho$ imaging has potential for assessment of biochemical alterations of liver pathologies. Deep learning methods have been employed to accelerate quantitative $T_1\rho$ imaging. To employ artificial intelligence-based quantitative imaging methods in complicated clinical environment, it is valuable to estimate the uncertainty of the predicated $T_1\rho$ values to provide the confidence level of the quantification results. The uncertainty should also be utilized to aid the post-hoc quantitative analysis and model learning tasks. Approach: To address this need, we propose a parametric map refinement approach for learning-based $T_1\rho$ mapping and train the model in a probabilistic way to model the uncertainty. We also propose to utilize the uncertainty map to spatially weight the training of an improved $T_1\rho$ mapping network to further improve the mapping performance and to remove pixels with unreliable $T_1\rho$ values in the region of interest. The framework was tested on a dataset of 51 patients with different liver fibrosis stages. Main results: Our results indicate that the learning-based map refinement method leads to a relative mapping error of less than 3% and provides uncertainty estimation simultaneously. The estimated uncertainty reflects the actual error level, and it can be used to further reduce relative $T_1\rho$ mapping error to 2.60% as well as removing unreliable pixels in the region of interest effectively. Significance: Our studies demonstrate the proposed approach has potential to provide a learning-based quantitative MRI system for trustworthy $T_1\rho$ mapping of the liver.

CAMP-Net: Context-Aware Multi-Prior Network for Accelerated MRI Reconstruction

Despite promising advances in deep learning-based MRI reconstruction methods, restoring high-frequency image details and textures remains a challenging problem for accelerated MRI. To tackle this challenge, we propose a novel context-aware multi-prior network (CAMP-Net) for MRI reconstruction. CAMP-Net leverages the complementary nature of multiple prior knowledge and explores data redundancy between adjacent slices in the hybrid domain to improve image quality. It incorporates three interleaved modules respectively for image enhancement, k-space restoration, and calibration consistency to jointly learn context-aware multiple priors in an end-to-end fashion. The image enhancement module learns a coil-combined image prior to suppress noise-like artifacts, while the k-space restoration module explores multi-coil k-space correlations to recover high-frequency details. The calibration consistency module embeds the known physical properties of MRI acquisition to ensure consistency of k-space correlations extracted from measurements and the artifact-free image intermediate. The resulting low- and high-frequency reconstructions are hierarchically aggregated in a frequency fusion module and iteratively refined to progressively reconstruct the final image. We evaluated the generalizability and robustness of our method on three large public datasets with various accelerations and sampling patterns. Comprehensive experiments demonstrate that CAMP-Net outperforms state-of-the-art methods in terms of reconstruction quality and quantitative $T_2$ mapping.

Uncertainty-weighted Multi-tasking for $T_{1ρ}$ and T$_2$ Mapping in the Liver with Self-supervised Learning

Multi-parametric mapping of MRI relaxations in liver has the potential of revealing pathological information of the liver. A self-supervised learning based multi-parametric mapping method is proposed to map T$T_{1\rho}$ and T$_2$ simultaneously, by utilising the relaxation constraint in the learning process. Data noise of different mapping tasks is utilised to make the model uncertainty-aware, which adaptively weight different mapping tasks during learning. The method was examined on a dataset of 51 patients with non-alcoholic fatter liver disease. Results showed that the proposed method can produce comparable parametric maps to the traditional multi-contrast pixel wise fitting method, with a reduced number of images and less computation time. The uncertainty weighting also improves the model performance. It has the potential of accelerating MRI quantitative imaging.

Unsupervised Domain Adaptation for Automated Knee Osteoarthritis Phenotype Classification

Purpose: The aim of this study was to demonstrate the utility of unsupervised domain adaptation (UDA) in automated knee osteoarthritis (OA) phenotype classification using a small dataset (n=50). Materials and Methods: For this retrospective study, we collected 3,166 three-dimensional (3D) double-echo steady-state magnetic resonance (MR) images from the Osteoarthritis Initiative dataset and 50 3D turbo/fast spin-echo MR images from our institute (in 2020 and 2021) as the source and target datasets, respectively. For each patient, the degree of knee OA was initially graded according to the MRI Osteoarthritis Knee Score (MOAKS) before being converted to binary OA phenotype labels. The proposed UDA pipeline included (a) pre-processing, which involved automatic segmentation and region-of-interest cropping; (b) source classifier training, which involved pre-training phenotype classifiers on the source dataset; (c) target encoder adaptation, which involved unsupervised adaption of the source encoder to the target encoder and (d) target classifier validation, which involved statistical analysis of the target classification performance evaluated by the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity and accuracy. Additionally, a classifier was trained without UDA for comparison. Results: The target classifier trained with UDA achieved improved AUROC, sensitivity, specificity and accuracy for both knee OA phenotypes compared with the classifier trained without UDA. Conclusion: The proposed UDA approach improves the performance of automated knee OA phenotype classification for small target datasets by utilising a large, high-quality source dataset for training. The results successfully demonstrated the advantages of the UDA approach in classification on small datasets.

Uncertainty-Aware Self-supervised Neural Network for Liver $T_{1ρ}$ Mapping with Relaxation Constraint

$T_{1\rho}$ mapping is a promising quantitative MRI technique for the non-invasive assessment of tissue properties. Learning-based approaches can map $T_{1\rho}$ from a reduced number of $T_{1\rho}$ weighted images, but requires significant amounts of high quality training data. Moreover, existing methods do not provide the confidence level of the $T_{1\rho}$ estimation. To address these problems, we proposed a self-supervised learning neural network that learns a $T_{1\rho}$ mapping using the relaxation constraint in the learning process. Epistemic uncertainty and aleatoric uncertainty are modelled for the $T_{1\rho}$ quantification network to provide a Bayesian confidence estimation of the $T_{1\rho}$ mapping. The uncertainty estimation can also regularize the model to prevent it from learning imperfect data. We conducted experiments on $T_{1\rho}$ data collected from 52 patients with non-alcoholic fatty liver disease. The results showed that our method outperformed the existing methods for $T_{1\rho}$ quantification of the liver using as few as two $T_{1\rho}$-weighted images. Our uncertainty estimation provided a feasible way of modelling the confidence of the self-supervised learning based $T_{1\rho}$ estimation, which is consistent with the reality in liver $T_{1\rho}$ imaging.

Denoising of Three-Dimensional Fast Spin Echo Magnetic Resonance Images of Knee Joints using Spatial-Variant Noise-Relevant Residual Learning of Convolution Neural Network

Two-dimensional (2D) fast spin echo (FSE) techniques play a central role in the clinical magnetic resonance imaging (MRI) of knee joints. Moreover, three-dimensional (3D) FSE provides high-isotropic-resolution magnetic resonance (MR) images of knee joints, but it has a reduced signal-to-noise ratio compared to 2D FSE. Deep-learning denoising methods are a promising approach for denoising MR images, but they are often trained using synthetic noise due to challenges in obtaining true noise distributions for MR images. In this study, inherent true noise information from 2-NEX acquisition was used to develop a deep-learning model based on residual learning of convolutional neural network (CNN), and this model was used to suppress the noise in 3D FSE MR images of knee joints. The proposed CNN used two-step residual learning over parallel transporting and residual blocks and was designed to comprehensively learn real noise features from 2-NEX training data. The results of an ablation study validated the network design. The new method achieved improved denoising performance of 3D FSE knee MR images compared with current state-of-the-art methods, based on the peak signal-to-noise ratio and structural similarity index measure. The improved image quality after denoising using the new method was verified by radiological evaluation. A deep CNN using the inherent spatial-varying noise information in 2-NEX acquisitions was developed. This method showed promise for clinical MRI assessments of the knee, and has potential applications for the assessment of other anatomical structures.