Deep Learning Pipeline for Fully Automated Myocardial Infarct Segmentation from Clinical Cardiac MR Scans

Purpose: To develop and evaluate a deep learning-based method that allows to perform myocardial infarct segmentation in a fully-automated way. Materials and Methods: For this retrospective study, a cascaded framework of two and three-dimensional convolutional neural networks (CNNs), specialized on identifying ischemic myocardial scars on late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) images, was trained on an in-house training dataset consisting of 144 examinations. On a separate test dataset from the same institution, including images from 152 examinations obtained between 2021 and 2023, a quantitative comparison between artificial intelligence (AI)-based segmentations and manual segmentations was performed. Further, qualitative assessment of segmentation accuracy was evaluated for both human and AI-generated contours by two CMR experts in a blinded experiment. Results: Excellent agreement could be found between manually and automatically calculated infarct volumes ($\rho_c$ = 0.9). The qualitative evaluation showed that compared to human-based measurements, the experts rated the AI-based segmentations to better represent the actual extent of infarction significantly (p < 0.001) more often (33.4% AI, 25.1% human, 41.5% equal). On the contrary, for segmentation of microvascular obstruction (MVO), manual measurements were still preferred (11.3% AI, 55.6% human, 33.1% equal). Conclusion: This fully-automated segmentation pipeline enables CMR infarct size to be calculated in a very short time and without requiring any pre-processing of the input images while matching the segmentation quality of trained human observers. In a blinded experiment, experts preferred automated infarct segmentations more often than manual segmentations, paving the way for a potential clinical application.

Deep Gaussian mixture model for unsupervised image segmentation

The recent emergence of deep learning has led to a great deal of work on designing supervised deep semantic segmentation algorithms. As in many tasks sufficient pixel-level labels are very difficult to obtain, we propose a method which combines a Gaussian mixture model (GMM) with unsupervised deep learning techniques. In the standard GMM the pixel values with each sub-region are modelled by a Gaussian distribution. In order to identify the different regions, the parameter vector that minimizes the negative log-likelihood (NLL) function regarding the GMM has to be approximated. For this task, usually iterative optimization methods such as the expectation-maximization (EM) algorithm are used. In this paper, we propose to estimate these parameters directly from the image using a convolutional neural network (CNN). We thus change the iterative procedure in the EM algorithm replacing the expectation-step by a gradient-step with regard to the networks parameters. This means that the network is trained to minimize the NLL function of the GMM which comes with at least two advantages. As once trained, the network is able to predict label probabilities very quickly compared with time consuming iterative optimization methods. Secondly, due to the deep image prior our method is able to partially overcome one of the main disadvantages of GMM, which is not taking into account correlation between neighboring pixels, as it assumes independence between them. We demonstrate the advantages of our method in various experiments on the example of myocardial infarct segmentation on multi-sequence MRI images.

Error correcting 2D-3D cascaded network for myocardial infarct scar segmentation on late gadolinium enhancement cardiac magnetic resonance images

Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging is considered the in vivo reference standard for assessing infarct size (IS) and microvascular obstruction (MVO) in ST-elevation myocardial infarction (STEMI) patients. However, the exact quantification of those markers of myocardial infarct severity remains challenging and very time-consuming. As LGE distribution patterns can be quite complex and hard to delineate from the blood pool or epicardial fat, automatic segmentation of LGE CMR images is challenging. In this work, we propose a cascaded framework of two-dimensional and three-dimensional convolutional neural networks (CNNs) which enables to calculate the extent of myocardial infarction in a fully automated way. By artificially generating segmentation errors which are characteristic for 2D CNNs during training of the cascaded framework we are enforcing the detection and correction of 2D segmentation errors and hence improve the segmentation accuracy of the entire method. The proposed method was trained and evaluated in a five-fold cross validation using the training dataset from the EMIDEC challenge. We perform comparative experiments where our framework outperforms state-of-the-art methods of the EMIDEC challenge, as well as 2D and 3D nnU-Net. Furthermore, in extensive ablation studies we show the advantages that come with the proposed error correcting cascaded method.