CMRxRecon: An open cardiac MRI dataset for the competition of accelerated image reconstruction

Cardiac magnetic resonance imaging (CMR) has emerged as a valuable diagnostic tool for cardiac diseases. However, a limitation of CMR is its slow imaging speed, which causes patient discomfort and introduces artifacts in the images. There has been growing interest in deep learning-based CMR imaging algorithms that can reconstruct high-quality images from highly under-sampled k-space data. However, the development of deep learning methods requires large training datasets, which have not been publicly available for CMR. To address this gap, we released a dataset that includes multi-contrast, multi-view, multi-slice and multi-coil CMR imaging data from 300 subjects. Imaging studies include cardiac cine and mapping sequences. Manual segmentations of the myocardium and chambers of all the subjects are also provided within the dataset. Scripts of state-of-the-art reconstruction algorithms were also provided as a point of reference. Our aim is to facilitate the advancement of state-of-the-art CMR image reconstruction by introducing standardized evaluation criteria and making the dataset freely accessible to the research community. Researchers can access the dataset at https://www.synapse.org/#!Synapse:syn51471091/wiki/.

A Reliable and Interpretable Framework of Multi-view Learning for Liver Fibrosis Staging

Staging of liver fibrosis is important in the diagnosis and treatment planning of patients suffering from liver diseases. Current deep learning-based methods using abdominal magnetic resonance imaging (MRI) usually take a sub-region of the liver as an input, which nevertheless could miss critical information. To explore richer representations, we formulate this task as a multi-view learning problem and employ multiple sub-regions of the liver. Previously, features or predictions are usually combined in an implicit manner, and uncertainty-aware methods have been proposed. However, these methods could be challenged to capture cross-view representations, which can be important in the accurate prediction of staging. Therefore, we propose a reliable multi-view learning method with interpretable combination rules, which can model global representations to improve the accuracy of predictions. Specifically, the proposed method estimates uncertainties based on subjective logic to improve reliability, and an explicit combination rule is applied based on Dempster-Shafer's evidence theory with good power of interpretability. Moreover, a data-efficient transformer is introduced to capture representations in the global view. Results evaluated on enhanced MRI data show that our method delivers superior performance over existing multi-view learning methods.

BayeSeg: Bayesian Modeling for Medical Image Segmentation with Interpretable Generalizability

Due to the cross-domain distribution shift aroused from diverse medical imaging systems, many deep learning segmentation methods fail to perform well on unseen data, which limits their real-world applicability. Recent works have shown the benefits of extracting domain-invariant representations on domain generalization. However, the interpretability of domain-invariant features remains a great challenge. To address this problem, we propose an interpretable Bayesian framework (BayeSeg) through Bayesian modeling of image and label statistics to enhance model generalizability for medical image segmentation. Specifically, we first decompose an image into a spatial-correlated variable and a spatial-variant variable, assigning hierarchical Bayesian priors to explicitly force them to model the domain-stable shape and domain-specific appearance information respectively. Then, we model the segmentation as a locally smooth variable only related to the shape. Finally, we develop a variational Bayesian framework to infer the posterior distributions of these explainable variables. The framework is implemented with neural networks, and thus is referred to as deep Bayesian segmentation. Quantitative and qualitative experimental results on prostate segmentation and cardiac segmentation tasks have shown the effectiveness of our proposed method. Moreover, we investigated the interpretability of BayeSeg by explaining the posteriors and analyzed certain factors that affect the generalization ability through further ablation studies. Our code will be released via https://zmiclab.github.io/projects.html, once the manuscript is accepted for publication.

Aligning Multi-Sequence CMR Towards Fully Automated Myocardial Pathology Segmentation

Myocardial pathology segmentation (MyoPS) is critical for the risk stratification and treatment planning of myocardial infarction (MI). Multi-sequence cardiac magnetic resonance (MS-CMR) images can provide valuable information. For instance, balanced steady-state free precession cine sequences present clear anatomical boundaries, while late gadolinium enhancement and T2-weighted CMR sequences visualize myocardial scar and edema of MI, respectively. Existing methods usually fuse anatomical and pathological information from different CMR sequences for MyoPS, but assume that these images have been spatially aligned. However, MS-CMR images are usually unaligned due to the respiratory motions in clinical practices, which poses additional challenges for MyoPS. This work presents an automatic MyoPS framework for unaligned MS-CMR images. Specifically, we design a combined computing model for simultaneous image registration and information fusion, which aggregates multi-sequence features into a common space to extract anatomical structures (i.e., myocardium). Consequently, we can highlight the informative regions in the common space via the extracted myocardium to improve MyoPS performance, considering the spatial relationship between myocardial pathologies and myocardium. Experiments on a private MS-CMR dataset and a public dataset from the MYOPS2020 challenge show that our framework could achieve promising performance for fully automatic MyoPS.

Unsupervised Cardiac Segmentation Utilizing Synthesized Images from Anatomical Labels

Cardiac segmentation is in great demand for clinical practice. Due to the enormous labor of manual delineation, unsupervised segmentation is desired. The ill-posed optimization problem of this task is inherently challenging, requiring well-designed constraints. In this work, we propose an unsupervised framework for multi-class segmentation with both intensity and shape constraints. Firstly, we extend a conventional non-convex energy function as an intensity constraint and implement it with U-Net. For shape constraint, synthetic images are generated from anatomical labels via image-to-image translation, as shape supervision for the segmentation network. Moreover, augmentation invariance is applied to facilitate the segmentation network to learn the latent features in terms of shape. We evaluated the proposed framework using the public datasets from MICCAI2019 MSCMR Challenge and achieved promising results on cardiac MRIs with Dice scores of 0.5737, 0.7796, and 0.6287 in Myo, LV, and RV, respectively.

Multi-Target Landmark Detection with Incomplete Images via Reinforcement Learning and Shape Prior

Medical images are generally acquired with limited field-of-view (FOV), which could lead to incomplete regions of interest (ROI), and thus impose a great challenge on medical image analysis. This is particularly evident for the learning-based multi-target landmark detection, where algorithms could be misleading to learn primarily the variation of background due to the varying FOV, failing the detection of targets. Based on learning a navigation policy, instead of predicting targets directly, reinforcement learning (RL)-based methods have the potential totackle this challenge in an efficient manner. Inspired by this, in this work we propose a multi-agent RL framework for simultaneous multi-target landmark detection. This framework is aimed to learn from incomplete or (and) complete images to form an implicit knowledge of global structure, which is consolidated during the training stage for the detection of targets from either complete or incomplete test images. To further explicitly exploit the global structural information from incomplete images, we propose to embed a shape model into the RL process. With this prior knowledge, the proposed RL model can not only localize dozens of targetssimultaneously, but also work effectively and robustly in the presence of incomplete images. We validated the applicability and efficacy of the proposed method on various multi-target detection tasks with incomplete images from practical clinics, using body dual-energy X-ray absorptiometry (DXA), cardiac MRI and head CT datasets. Results showed that our method could predict whole set of landmarks with incomplete training images up to 80% missing proportion (average distance error 2.29 cm on body DXA), and could detect unseen landmarks in regions with missing image information outside FOV of target images (average distance error 6.84 mm on 3D half-head CT).

ZScribbleSeg: Zen and the Art of Scribble Supervised Medical Image Segmentation

Curating a large scale fully-annotated dataset can be both labour-intensive and expertise-demanding, especially for medical images. To alleviate this problem, we propose to utilize solely scribble annotations for weakly supervised segmentation. Existing solutions mainly leverage selective losses computed solely on annotated areas and generate pseudo gold standard segmentation by propagating labels to adjacent areas. However, these methods could suffer from the inaccurate and sometimes unrealistic pseudo segmentation due to the insufficient supervision and incomplete shape features. Different from previous efforts, we first investigate the principle of ''good scribble annotations'', which leads to efficient scribble forms via supervision maximization and randomness simulation. Furthermore, we introduce regularization terms to encode the spatial relationship and shape prior, where a new formulation is developed to estimate the mixture ratios of label classes. These ratios are critical in identifying the unlabeled pixels for each class and correcting erroneous predictions, thus the accurate estimation lays the foundation for the incorporation of spatial prior. Finally, we integrate the efficient scribble supervision with the prior into a unified framework, denoted as ZScribbleSeg, and apply the method to multiple scenarios. Leveraging only scribble annotations, ZScribbleSeg set new state-of-the-arts on four segmentation tasks using ACDC, MSCMRseg, MyoPS and PPSS datasets.

MyoPS-Net: Myocardial Pathology Segmentation with Flexible Combination of Multi-Sequence CMR Images

Myocardial pathology segmentation (MyoPS) can be a prerequisite for the accurate diagnosis and treatment planning of myocardial infarction. However, achieving this segmentation is challenging, mainly due to the inadequate and indistinct information from an image. In this work, we develop an end-to-end deep neural network, referred to as MyoPS-Net, to flexibly combine five-sequence cardiac magnetic resonance (CMR) images for MyoPS. To extract precise and adequate information, we design an effective yet flexible architecture to extract and fuse cross-modal features. This architecture can tackle different numbers of CMR images and complex combinations of modalities, with output branches targeting specific pathologies. To impose anatomical knowledge on the segmentation results, we first propose a module to regularize myocardium consistency and localize the pathologies, and then introduce an inclusiveness loss to utilize relations between myocardial scars and edema. We evaluated the proposed MyoPS-Net on two datasets, i.e., a private one consisting of 50 paired multi-sequence CMR images and a public one from MICCAI2020 MyoPS Challenge. Experimental results showed that MyoPS-Net could achieve state-of-the-art performance in various scenarios. Note that in practical clinics, the subjects may not have full sequences, such as missing LGE CMR or mapping CMR scans. We therefore conducted extensive experiments to investigate the performance of the proposed method in dealing with such complex combinations of different CMR sequences. Results proved the superiority and generalizability of MyoPS-Net, and more importantly, indicated a practical clinical application.

$\mathcal{X}$-Metric: An N-Dimensional Information-Theoretic Framework for Groupwise Registration and Deep Combined Computing

This paper presents a generic probabilistic framework for estimating the statistical dependency and finding the anatomical correspondences among an arbitrary number of medical images. The method builds on a novel formulation of the $N$-dimensional joint intensity distribution by representing the common anatomy as latent variables and estimating the appearance model with nonparametric estimators. Through connection to maximum likelihood and the expectation-maximization algorithm, an information\hyp{}theoretic metric called $\mathcal{X}$-metric and a co-registration algorithm named $\mathcal{X}$-CoReg are induced, allowing groupwise registration of the $N$ observed images with computational complexity of $\mathcal{O}(N)$. Moreover, the method naturally extends for a weakly-supervised scenario where anatomical labels of certain images are provided. This leads to a combined\hyp{}computing framework implemented with deep learning, which performs registration and segmentation simultaneously and collaboratively in an end-to-end fashion. Extensive experiments were conducted to demonstrate the versatility and applicability of our model, including multimodal groupwise registration, motion correction for dynamic contrast enhanced magnetic resonance images, and deep combined computing for multimodal medical images. Results show the superiority of our method in various applications in terms of both accuracy and efficiency, highlighting the advantage of the proposed representation of the imaging process.

Multi-Modality Cardiac Image Computing: A Survey

Multi-modality cardiac imaging plays a key role in the management of patients with cardiovascular diseases. It allows a combination of complementary anatomical, morphological and functional information, increases diagnosis accuracy, and improves the efficacy of cardiovascular interventions and clinical outcomes. Fully-automated processing and quantitative analysis of multi-modality cardiac images could have a direct impact on clinical research and evidence-based patient management. However, these require overcoming significant challenges including inter-modality misalignment and finding optimal methods to integrate information from different modalities. This paper aims to provide a comprehensive review of multi-modality imaging in cardiology, the computing methods, the validation strategies, the related clinical workflows and future perspectives. For the computing methodologies, we have a favored focus on the three tasks, i.e., registration, fusion and segmentation, which generally involve multi-modality imaging data, \textit{either combining information from different modalities or transferring information across modalities}. The review highlights that multi-modality cardiac imaging data has the potential of wide applicability in the clinic, such as trans-aortic valve implantation guidance, myocardial viability assessment, and catheter ablation therapy and its patient selection. Nevertheless, many challenges remain unsolved, such as missing modality, combination of imaging and non-imaging data, and uniform analysis and representation of different modalities. There is also work to do in defining how the well-developed techniques fit in clinical workflows and how much additional and relevant information they introduce. These problems are likely to continue to be an active field of research and the questions to be answered in the future.