Understanding Benefits and Pitfalls of Current Methods for the Segmentation of Undersampled MRI Data

MR imaging is a valuable diagnostic tool allowing to non-invasively visualize patient anatomy and pathology with high soft-tissue contrast. However, MRI acquisition is typically time-consuming, leading to patient discomfort and increased costs to the healthcare system. Recent years have seen substantial research effort into the development of methods that allow for accelerated MRI acquisition while still obtaining a reconstruction that appears similar to the fully-sampled MR image. However, for many applications a perfectly reconstructed MR image may not be necessary, particularly, when the primary goal is a downstream task such as segmentation. This has led to growing interest in methods that aim to perform segmentation directly on accelerated MRI data. Despite recent advances, existing methods have largely been developed in isolation, without direct comparison to one another, often using separate or private datasets, and lacking unified evaluation standards. To date, no high-quality, comprehensive comparison of these methods exists, and the optimal strategy for segmenting accelerated MR data remains unknown. This paper provides the first unified benchmark for the segmentation of undersampled MRI data comparing 7 approaches. A particular focus is placed on comparing \textit{one-stage approaches}, that combine reconstruction and segmentation into a unified model, with \textit{two-stage approaches}, that utilize established MRI reconstruction methods followed by a segmentation network. We test these methods on two MRI datasets that include multi-coil k-space data as well as a human-annotated segmentation ground-truth. We find that simple two-stage methods that consider data-consistency lead to the best segmentation scores, surpassing complex specialized methods that are developed specifically for this task.

CUTE-MRI: Conformalized Uncertainty-based framework for Time-adaptivE MRI

Magnetic Resonance Imaging (MRI) offers unparalleled soft-tissue contrast but is fundamentally limited by long acquisition times. While deep learning-based accelerated MRI can dramatically shorten scan times, the reconstruction from undersampled data introduces ambiguity resulting from an ill-posed problem with infinitely many possible solutions that propagates to downstream clinical tasks. This uncertainty is usually ignored during the acquisition process as acceleration factors are often fixed a priori, resulting in scans that are either unnecessarily long or of insufficient quality for a given clinical endpoint. This work introduces a dynamic, uncertainty-aware acquisition framework that adjusts scan time on a per-subject basis. Our method leverages a probabilistic reconstruction model to estimate image uncertainty, which is then propagated through a full analysis pipeline to a quantitative metric of interest (e.g., patellar cartilage volume or cardiac ejection fraction). We use conformal prediction to transform this uncertainty into a rigorous, calibrated confidence interval for the metric. During acquisition, the system iteratively samples k-space, updates the reconstruction, and evaluates the confidence interval. The scan terminates automatically once the uncertainty meets a user-predefined precision target. We validate our framework on both knee and cardiac MRI datasets. Our results demonstrate that this adaptive approach reduces scan times compared to fixed protocols while providing formal statistical guarantees on the precision of the final image. This framework moves beyond fixed acceleration factors, enabling patient-specific acquisitions that balance scan efficiency with diagnostic confidence, a critical step towards personalized and resource-efficient MRI.

Segmentation-guided MRI reconstruction for meaningfully diverse reconstructions

Inverse problems, such as accelerated MRI reconstruction, are ill-posed and an infinite amount of possible and plausible solutions exist. This may not only lead to uncertainty in the reconstructed image but also in downstream tasks such as semantic segmentation. This uncertainty, however, is mostly not analyzed in the literature, even though probabilistic reconstruction models are commonly used. These models can be prone to ignore plausible but unlikely solutions like rare pathologies. Building on MRI reconstruction approaches based on diffusion models, we add guidance to the diffusion process during inference, generating two meaningfully diverse reconstructions corresponding to an upper and lower bound segmentation. The reconstruction uncertainty can then be quantified by the difference between these bounds, which we coin the 'uncertainty boundary'. We analyzed the behavior of the upper and lower bound segmentations for a wide range of acceleration factors and found the uncertainty boundary to be both more reliable and more accurate compared to repeated sampling. Code is available at https://github.com/NikolasMorshuis/SGR

Adversarial Robustness of MR Image Reconstruction under Realistic Perturbations

Deep Learning (DL) methods have shown promising results for solving ill-posed inverse problems such as MR image reconstruction from undersampled $k$-space data. However, these approaches currently have no guarantees for reconstruction quality and the reliability of such algorithms is only poorly understood. Adversarial attacks offer a valuable tool to understand possible failure modes and worst case performance of DL-based reconstruction algorithms. In this paper we describe adversarial attacks on multi-coil $k$-space measurements and evaluate them on the recently proposed E2E-VarNet and a simpler UNet-based model. In contrast to prior work, the attacks are targeted to specifically alter diagnostically relevant regions. Using two realistic attack models (adversarial $k$-space noise and adversarial rotations) we are able to show that current state-of-the-art DL-based reconstruction algorithms are indeed sensitive to such perturbations to a degree where relevant diagnostic information may be lost. Surprisingly, in our experiments the UNet and the more sophisticated E2E-VarNet were similarly sensitive to such attacks. Our findings add further to the evidence that caution must be exercised as DL-based methods move closer to clinical practice.