Statistical Distance-Guided Unsupervised Domain Adaptation for Automated Multi-Class Cardiovascular Magnetic Resonance Image Quality Assessment

This study proposes an attention-based statistical distance-guided unsupervised domain adaptation model for multi-class cardiovascular magnetic resonance (CMR) image quality assessment. The proposed model consists of a feature extractor, a label predictor and a statistical distance estimator. An annotated dataset as the source set and an unlabeled dataset as the target set with different statistical distributions are considered inputs. The statistical distance estimator approximates the Wasserstein distance between the extracted feature vectors from the source and target data in a mini-batch. The label predictor predicts data labels of source data and uses a combinational loss function for training, which includes cross entropy and centre loss functions plus the estimated value of the distance estimator. Four datasets, including imaging and k-space data, were used to evaluate the proposed model in identifying four common CMR imaging artefacts: respiratory and cardiac motions, Gibbs ringing and Aliasing. The results of the extensive experiments showed that the proposed model, both in image and k-space analysis, has an acceptable performance in covering the domain shift between the source and target sets. The model explainability evaluations and the ablation studies confirmed the proper functioning and effectiveness of all the model's modules. The proposed model outperformed the previous studies regarding performance and the number of examined artefacts. The proposed model can be used for CMR post-imaging quality control or in large-scale cohort studies for image and k-space quality assessment due to the appropriate performance in domain shift coverage without a tedious data-labelling process.

Multiple Teachers-Meticulous Student: A Domain Adaptive Meta-Knowledge Distillation Model for Medical Image Classification

Background: Image classification can be considered one of the key pillars of medical image analysis. Deep learning (DL) faces challenges that prevent its practical applications despite the remarkable improvement in medical image classification. The data distribution differences can lead to a drop in the efficiency of DL, known as the domain shift problem. Besides, requiring bulk annotated data for model training, the large size of models, and the privacy-preserving of patients are other challenges of using DL in medical image classification. This study presents a strategy that can address the mentioned issues simultaneously. Method: The proposed domain adaptive model based on knowledge distillation can classify images by receiving limited annotated data of different distributions. The designed multiple teachers-meticulous student model trains a student network that tries to solve the challenges by receiving the parameters of several teacher networks. The proposed model was evaluated using six available datasets of different distributions by defining the respiratory motion artefact detection task. Results: The results of extensive experiments using several datasets show the superiority of the proposed model in addressing the domain shift problem and lack of access to bulk annotated data. Besides, the privacy preservation of patients by receiving only the teacher network parameters instead of the original data and consolidating the knowledge of several DL models into a model with almost similar performance are other advantages of the proposed model. Conclusions: The proposed model can pave the way for practical clinical applications of deep classification methods by achieving the mentioned objectives simultaneously.

An End-to-End Deep Learning Generative Framework for Refinable Shape Matching and Generation

Generative modelling for shapes is a prerequisite for In-Silico Clinical Trials (ISCTs), which aim to cost-effectively validate medical device interventions using synthetic anatomical shapes, often represented as 3D surface meshes. However, constructing AI models to generate shapes closely resembling the real mesh samples is challenging due to variable vertex counts, connectivities, and the lack of dense vertex-wise correspondences across the training data. Employing graph representations for meshes, we develop a novel unsupervised geometric deep-learning model to establish refinable shape correspondences in a latent space, construct a population-derived atlas and generate realistic synthetic shapes. We additionally extend our proposed base model to a joint shape generative-clustering multi-atlas framework to incorporate further variability and preserve more details in the generated shapes. Experimental results using liver and left-ventricular models demonstrate the approach's applicability to computational medicine, highlighting its suitability for ISCTs through a comparative analysis.

GS-EMA: Integrating Gradient Surgery Exponential Moving Average with Boundary-Aware Contrastive Learning for Enhanced Domain Generalization in Aneurysm Segmentation

The automated segmentation of cerebral aneurysms is pivotal for accurate diagnosis and treatment planning. Confronted with significant domain shifts and class imbalance in 3D Rotational Angiography (3DRA) data from various medical institutions, the task becomes challenging. These shifts include differences in image appearance, intensity distribution, resolution, and aneurysm size, all of which complicate the segmentation process. To tackle these issues, we propose a novel domain generalization strategy that employs gradient surgery exponential moving average (GS-EMA) optimization technique coupled with boundary-aware contrastive learning (BACL). Our approach is distinct in its ability to adapt to new, unseen domains by learning domain-invariant features, thereby improving the robustness and accuracy of aneurysm segmentation across diverse clinical datasets. The results demonstrate that our proposed approach can extract more domain-invariant features, minimizing over-segmentation and capturing more complete aneurysm structures.

Unsupervised Domain Adaptation for Brain Vessel Segmentation through Transwarp Contrastive Learning

Unsupervised domain adaptation (UDA) aims to align the labelled source distribution with the unlabelled target distribution to obtain domain-invariant predictive models. Since cross-modality medical data exhibit significant intra and inter-domain shifts and most are unlabelled, UDA is more important while challenging in medical image analysis. This paper proposes a simple yet potent contrastive learning framework for UDA to narrow the inter-domain gap between labelled source and unlabelled target distribution. Our method is validated on cerebral vessel datasets. Experimental results show that our approach can learn latent features from labelled 3DRA modality data and improve vessel segmentation performance in unlabelled MRA modality data.

Multi-view Hybrid Graph Convolutional Network for Volume-to-mesh Reconstruction in Cardiovascular MRI

Cardiovascular magnetic resonance imaging is emerging as a crucial tool to examine cardiac morphology and function. Essential to this endeavour are anatomical 3D surface and volumetric meshes derived from CMR images, which facilitate computational anatomy studies, biomarker discovery, and in-silico simulations. However, conventional surface mesh generation methods, such as active shape models and multi-atlas segmentation, are highly time-consuming and require complex processing pipelines to generate simulation-ready 3D meshes. In response, we introduce HybridVNet, a novel architecture for direct image-to-mesh extraction seamlessly integrating standard convolutional neural networks with graph convolutions, which we prove can efficiently handle surface and volumetric meshes by encoding them as graph structures. To further enhance accuracy, we propose a multiview HybridVNet architecture which processes both long axis and short axis CMR, showing that it can increase the performance of cardiac MR mesh generation. Our model combines traditional convolutional networks with variational graph generative models, deep supervision and mesh-specific regularisation. Experiments on a comprehensive dataset from the UK Biobank confirm the potential of HybridVNet to significantly advance cardiac imaging and computational cardiology by efficiently generating high-fidelity and simulation ready meshes from CMR images.

Learned Local Attention Maps for Synthesising Vessel Segmentations

Magnetic resonance angiography (MRA) is an imaging modality for visualising blood vessels. It is useful for several diagnostic applications and for assessing the risk of adverse events such as haemorrhagic stroke (resulting from the rupture of aneurysms in blood vessels). However, MRAs are not acquired routinely, hence, an approach to synthesise blood vessel segmentations from more routinely acquired MR contrasts such as T1 and T2, would be useful. We present an encoder-decoder model for synthesising segmentations of the main cerebral arteries in the circle of Willis (CoW) from only T2 MRI. We propose a two-phase multi-objective learning approach, which captures both global and local features. It uses learned local attention maps generated by dilating the segmentation labels, which forces the network to only extract information from the T2 MRI relevant to synthesising the CoW. Our synthetic vessel segmentations generated from only T2 MRI achieved a mean Dice score of $0.79 \pm 0.03$ in testing, compared to state-of-the-art segmentation networks such as transformer U-Net ($0.71 \pm 0.04$) and nnU-net($0.68 \pm 0.05$), while using only a fraction of the parameters. The main qualitative difference between our synthetic vessel segmentations and the comparative models was in the sharper resolution of the CoW vessel segments, especially in the posterior circulation.

Shape-guided Conditional Latent Diffusion Models for Synthesising Brain Vasculature

The Circle of Willis (CoW) is the part of cerebral vasculature responsible for delivering blood to the brain. Understanding the diverse anatomical variations and configurations of the CoW is paramount to advance research on cerebrovascular diseases and refine clinical interventions. However, comprehensive investigation of less prevalent CoW variations remains challenging because of the dominance of a few commonly occurring configurations. We propose a novel generative approach utilising a conditional latent diffusion model with shape and anatomical guidance to generate realistic 3D CoW segmentations, including different phenotypical variations. Our conditional latent diffusion model incorporates shape guidance to better preserve vessel continuity and demonstrates superior performance when compared to alternative generative models, including conditional variants of 3D GAN and 3D VAE. We observed that our model generated CoW variants that are more realistic and demonstrate higher visual fidelity than competing approaches with an FID score 53\% better than the best-performing GAN-based model.

GSMorph: Gradient Surgery for cine-MRI Cardiac Deformable Registration

Deep learning-based deformable registration methods have been widely investigated in diverse medical applications. Learning-based deformable registration relies on weighted objective functions trading off registration accuracy and smoothness of the deformation field. Therefore, they inevitably require tuning the hyperparameter for optimal registration performance. Tuning the hyperparameters is highly computationally expensive and introduces undesired dependencies on domain knowledge. In this study, we construct a registration model based on the gradient surgery mechanism, named GSMorph, to achieve a hyperparameter-free balance on multiple losses. In GSMorph, we reformulate the optimization procedure by projecting the gradient of similarity loss orthogonally to the plane associated with the smoothness constraint, rather than additionally introducing a hyperparameter to balance these two competing terms. Furthermore, our method is model-agnostic and can be merged into any deep registration network without introducing extra parameters or slowing down inference. In this study, We compared our method with state-of-the-art (SOTA) deformable registration approaches over two publicly available cardiac MRI datasets. GSMorph proves superior to five SOTA learning-based registration models and two conventional registration techniques, SyN and Demons, on both registration accuracy and smoothness.

A Conditional Flow Variational Autoencoder for Controllable Synthesis of Virtual Populations of Anatomy

Generating virtual populations (VPs) of anatomy is essential for conducting in-silico trials of medical devices. Typically, the generated VP should capture sufficient variability while remaining plausible, and should reflect specific characteristics and patient demographics observed in real populations. It is desirable in several applications to synthesize VPs in a \textit{controlled} manner, where relevant covariates are used to conditionally synthesise virtual populations that fit specific target patient populations/characteristics. We propose to equip a conditional variational autoencoder (cVAE) with normalizing flows to boost the flexibility and complexity of the approximate posterior learned, leading to enhanced flexibility for controllable synthesis of VPs of anatomical structures. We demonstrate the performance of our conditional-flow VAE using a dataset of cardiac left ventricles acquired from 2360 patients, with associated demographic information and clinical measurements (used as covariates/conditioning information). The obtained results indicate the superiority of the proposed method for conditional synthesis of virtual populations of cardiac left ventricles relative to a cVAE. Conditional synthesis performance was assessed in terms of generalisation and specificity errors, and in terms of the ability to preserve clinical relevant biomarkers in the synthesised VPs, I.e. left ventricular blood pool and myocardial volume, relative to the observed real population.