Generalized super-resolution 4D Flow MRI $\unicode{x2013}$ using ensemble learning to extend across the cardiovascular system

4D Flow Magnetic Resonance Imaging (4D Flow MRI) is a non-invasive measurement technique capable of quantifying blood flow across the cardiovascular system. While practical use is limited by spatial resolution and image noise, incorporation of trained super-resolution (SR) networks has potential to enhance image quality post-scan. However, these efforts have predominantly been restricted to narrowly defined cardiovascular domains, with limited exploration of how SR performance extends across the cardiovascular system; a task aggravated by contrasting hemodynamic conditions apparent across the cardiovasculature. The aim of our study was to explore the generalizability of SR 4D Flow MRI using a combination of heterogeneous training sets and dedicated ensemble learning. With synthetic training data generated across three disparate domains (cardiac, aortic, cerebrovascular), varying convolutional base and ensemble learners were evaluated as a function of domain and architecture, quantifying performance on both in-silico and acquired in-vivo data from the same three domains. Results show that both bagging and stacking ensembling enhance SR performance across domains, accurately predicting high-resolution velocities from low-resolution input data in-silico. Likewise, optimized networks successfully recover native resolution velocities from downsampled in-vivo data, as well as show qualitative potential in generating denoised SR-images from clinical level input data. In conclusion, our work presents a viable approach for generalized SR 4D Flow MRI, with ensemble learning extending utility across various clinical areas of interest.

Estimation of Cardiac Valve Annuli Motion with Deep Learning

Valve annuli motion and morphology, measured from non-invasive imaging, can be used to gain a better understanding of healthy and pathological heart function. Measurements such as long-axis strain as well as peak strain rates provide markers of systolic function. Likewise, early and late-diastolic filling velocities are used as indicators of diastolic function. Quantifying global strains, however, requires a fast and precise method of tracking long-axis motion throughout the cardiac cycle. Valve landmarks such as the insertion of leaflets into the myocardial wall provide features that can be tracked to measure global long-axis motion. Feature tracking methods require initialisation, which can be time-consuming in studies with large cohorts. Therefore, this study developed and trained a neural network to identify ten features from unlabeled long-axis MR images: six mitral valve points from three long-axis views, two aortic valve points and two tricuspid valve points. This study used manual annotations of valve landmarks in standard 2-, 3- and 4-chamber long-axis images collected in clinical scans to train the network. The accuracy in the identification of these ten features, in pixel distance, was compared with the accuracy of two commonly used feature tracking methods as well as the inter-observer variability of manual annotations. Clinical measures, such as valve landmark strain and motion between end-diastole and end-systole, are also presented to illustrate the utility and robustness of the method.