Deep End-to-end Adaptive k-Space Sampling, Reconstruction, and Registration for Dynamic MRI

Dynamic MRI enables a range of clinical applications, including cardiac function assessment, organ motion tracking, and radiotherapy guidance. However, fully sampling the dynamic k-space data is often infeasible due to time constraints and physiological motion such as respiratory and cardiac motion. This necessitates undersampling, which degrades the quality of reconstructed images. Poor image quality not only hinders visualization but also impairs the estimation of deformation fields, crucial for registering dynamic (moving) images to a static reference image. This registration enables tasks such as motion correction, treatment planning, and quantitative analysis in applications like cardiac imaging and MR-guided radiotherapy. To overcome the challenges posed by undersampling and motion, we introduce an end-to-end deep learning (DL) framework that integrates adaptive dynamic k-space sampling, reconstruction, and registration. Our approach begins with a DL-based adaptive sampling strategy, optimizing dynamic k-space acquisition to capture the most relevant data for each specific case. This is followed by a DL-based reconstruction module that produces images optimized for accurate deformation field estimation from the undersampled moving data. Finally, a registration module estimates the deformation fields aligning the reconstructed dynamic images with a static reference. The proposed framework is independent of specific reconstruction and registration modules allowing for plug-and-play integration of these components. The entire framework is jointly trained using a combination of supervised and unsupervised loss functions, enabling end-to-end optimization for improved performance across all components. Through controlled experiments and ablation studies, we validate each component, demonstrating that each choice contributes to robust motion estimation from undersampled dynamic data.

Deep Multi-contrast Cardiac MRI Reconstruction via vSHARP with Auxiliary Refinement Network

Cardiac MRI (CMRI) is a cornerstone imaging modality that provides in-depth insights into cardiac structure and function. Multi-contrast CMRI (MCCMRI), which acquires sequences with varying contrast weightings, significantly enhances diagnostic capabilities by capturing a wide range of cardiac tissue characteristics. However, MCCMRI is often constrained by lengthy acquisition times and susceptibility to motion artifacts. To mitigate these challenges, accelerated imaging techniques that use k-space undersampling via different sampling schemes at acceleration factors have been developed to shorten scan durations. In this context, we propose a deep learning-based reconstruction method for 2D dynamic multi-contrast, multi-scheme, and multi-acceleration MRI. Our approach integrates the state-of-the-art vSHARP model, which utilizes half-quadratic variable splitting and ADMM optimization, with a Variational Network serving as an Auxiliary Refinement Network (ARN) to better adapt to the diverse nature of MCCMRI data. Specifically, the subsampled k-space data is fed into the ARN, which produces an initial prediction for the denoising step used by vSHARP. This, along with the subsampled k-space, is then used by vSHARP to generate high-quality 2D sequence predictions. Our method outperforms traditional reconstruction techniques and other vSHARP-based models.

Ordinal Learning: Longitudinal Attention Alignment Model for Predicting Time to Future Breast Cancer Events from Mammograms

Precision breast cancer (BC) risk assessment is crucial for developing individualized screening and prevention. Despite the promising potential of recent mammogram (MG) based deep learning models in predicting BC risk, they mostly overlook the 'time-to-future-event' ordering among patients and exhibit limited explorations into how they track history changes in breast tissue, thereby limiting their clinical application. In this work, we propose a novel method, named OA-BreaCR, to precisely model the ordinal relationship of the time to and between BC events while incorporating longitudinal breast tissue changes in a more explainable manner. We validate our method on public EMBED and inhouse datasets, comparing with existing BC risk prediction and time prediction methods. Our ordinal learning method OA-BreaCR outperforms existing methods in both BC risk and time-to-future-event prediction tasks. Additionally, ordinal heatmap visualizations show the model's attention over time. Our findings underscore the importance of interpretable and precise risk assessment for enhancing BC screening and prevention efforts. The code will be accessible to the public.

The state-of-the-art in Cardiac MRI Reconstruction: Results of the CMRxRecon Challenge in MICCAI 2023

Cardiac MRI, crucial for evaluating heart structure and function, faces limitations like slow imaging and motion artifacts. Undersampling reconstruction, especially data-driven algorithms, has emerged as a promising solution to accelerate scans and enhance imaging performance using highly under-sampled data. Nevertheless, the scarcity of publicly available cardiac k-space datasets and evaluation platform hinder the development of data-driven reconstruction algorithms. To address this issue, we organized the Cardiac MRI Reconstruction Challenge (CMRxRecon) in 2023, in collaboration with the 26th International Conference on MICCAI. CMRxRecon presented an extensive k-space dataset comprising cine and mapping raw data, accompanied by detailed annotations of cardiac anatomical structures. With overwhelming participation, the challenge attracted more than 285 teams and over 600 participants. Among them, 22 teams successfully submitted Docker containers for the testing phase, with 7 teams submitted for both cine and mapping tasks. All teams use deep learning based approaches, indicating that deep learning has predominately become a promising solution for the problem. The first-place winner of both tasks utilizes the E2E-VarNet architecture as backbones. In contrast, U-Net is still the most popular backbone for both multi-coil and single-coil reconstructions. This paper provides a comprehensive overview of the challenge design, presents a summary of the submitted results, reviews the employed methods, and offers an in-depth discussion that aims to inspire future advancements in cardiac MRI reconstruction models. The summary emphasizes the effective strategies observed in Cardiac MRI reconstruction, including backbone architecture, loss function, pre-processing techniques, physical modeling, and model complexity, thereby providing valuable insights for further developments in this field.

End-to-end Adaptive Dynamic Subsampling and Reconstruction for Cardiac MRI

Accelerating dynamic MRI is essential for enhancing clinical applications, such as adaptive radiotherapy, and improving patient comfort. Traditional deep learning (DL) approaches for accelerated dynamic MRI reconstruction typically rely on predefined or random subsampling patterns, applied uniformly across all temporal phases. This standard practice overlooks the potential benefits of leveraging temporal correlations and lacks the adaptability required for case-specific subsampling optimization, which holds the potential for maximizing reconstruction quality. Addressing this gap, we present a novel end-to-end framework for adaptive dynamic MRI subsampling and reconstruction. Our pipeline integrates a DL-based adaptive sampler, generating case-specific dynamic subsampling patterns, trained end-to-end with a state-of-the-art 2D dynamic reconstruction network, namely vSHARP, which effectively reconstructs the adaptive dynamic subsampled data into a moving image. Our method is assessed using dynamic cine cardiac MRI data, comparing its performance against vSHARP models that employ common subsampling trajectories, and pipelines trained to optimize dataset-specific sampling schemes alongside vSHARP reconstruction. Our results indicate superior reconstruction quality, particularly at high accelerations.

Equivariant Multiscale Learned Invertible Reconstruction for Cone Beam CT

Cone Beam CT (CBCT) is an essential imaging modality nowadays, but the image quality of CBCT still lags behind the high quality standards established by the conventional Computed Tomography. We propose LIRE+, a learned iterative scheme for fast and memory-efficient CBCT reconstruction, which is a substantially faster and more parameter-efficient alternative to the recently proposed LIRE method. LIRE+ is a rotationally-equivariant multiscale learned invertible primal-dual iterative scheme for CBCT reconstruction. Memory usage is optimized by relying on simple reversible residual networks in primal/dual cells and patch-wise computations inside the cells during forward and backward passes, while increased inference speed is achieved by making the primal-dual scheme multiscale so that the reconstruction process starts at low resolution and with low resolution primal/dual latent vectors. A LIRE+ model was trained and validated on a set of 260 + 22 thorax CT scans and tested using a set of 142 thorax CT scans with additional evaluation with and without finetuning on an out-of-distribution set of 79 Head and Neck (HN) CT scans. Our method surpasses classical and deep learning baselines, including LIRE, on the thorax test set. For a similar inference time and with only 37 % of the parameter budget, LIRE+ achieves a +0.2 dB PSNR improvement over LIRE, while being able to match the performance of LIRE in 45 % less inference time and with 28 % of the parameter budget. Rotational equivariance ensures robustness of LIRE+ to patient orientation, while LIRE and other deep learning baselines suffer from substantial performance degradation when patient orientation is unusual. On the HN dataset in the absence of finetuning, LIRE+ is generally comparable to LIRE in performance apart from a few outlier cases, whereas after identical finetuning LIRE+ demonstates a +1.02 dB PSNR improvement over LIRE.

To deform or not: treatment-aware longitudinal registration for breast DCE-MRI during neoadjuvant chemotherapy via unsupervised keypoints detection

Clinicians compare breast DCE-MRI after neoadjuvant chemotherapy (NAC) with pre-treatment scans to evaluate the response to NAC. Clinical evidence supports that accurate longitudinal deformable registration without deforming treated tumor regions is key to quantifying tumor changes. We propose a conditional pyramid registration network based on unsupervised keypoint detection and selective volume-preserving to quantify changes over time. In this approach, we extract the structural and the abnormal keypoints from DCE-MRI, apply the structural keypoints for the registration algorithm to restrict large deformation, and employ volume-preserving loss based on abnormal keypoints to keep the volume of the tumor unchanged after registration. We use a clinical dataset with 1630 MRI scans from 314 patients treated with NAC. The results demonstrate that our method registers with better performance and better volume preservation of the tumors. Furthermore, a local-global-combining biomarker based on the proposed method achieves high accuracy in pathological complete response (pCR) prediction, indicating that predictive information exists outside tumor regions. The biomarkers could potentially be used to avoid unnecessary surgeries for certain patients. It may be valuable for clinicians and/or computer systems to conduct follow-up tumor segmentation and response prediction on images registered by our method. Our code is available on \url{https://github.com/fiy2W/Treatment-aware-Longitudinal-Registration}.

Nodule detection and generation on chest X-rays: NODE21 Challenge

Pulmonary nodules may be an early manifestation of lung cancer, the leading cause of cancer-related deaths among both men and women. Numerous studies have established that deep learning methods can yield high-performance levels in the detection of lung nodules in chest X-rays. However, the lack of gold-standard public datasets slows down the progression of the research and prevents benchmarking of methods for this task. To address this, we organized a public research challenge, NODE21, aimed at the detection and generation of lung nodules in chest X-rays. While the detection track assesses state-of-the-art nodule detection systems, the generation track determines the utility of nodule generation algorithms to augment training data and hence improve the performance of the detection systems. This paper summarizes the results of the NODE21 challenge and performs extensive additional experiments to examine the impact of the synthetically generated nodule training images on the detection algorithm performance.

JSSL: Joint Supervised and Self-supervised Learning for MRI Reconstruction

Magnetic Resonance Imaging represents an important diagnostic modality; however, its inherently slow acquisition process poses challenges in obtaining fully sampled k-space data under motion in clinical scenarios such as abdominal, cardiac, and prostate imaging. In the absence of fully sampled acquisitions, which can serve as ground truth data, training deep learning algorithms in a supervised manner to predict the underlying ground truth image becomes an impossible task. To address this limitation, self-supervised methods have emerged as a viable alternative, leveraging available subsampled k-space data to train deep learning networks for MRI reconstruction. Nevertheless, these self-supervised approaches often fall short when compared to supervised methodologies. In this paper, we introduce JSSL (Joint Supervised and Self-supervised Learning), a novel training approach for deep learning-based MRI reconstruction algorithms aimed at enhancing reconstruction quality in scenarios where target dataset(s) containing fully sampled k-space measurements are unavailable. Our proposed method operates by simultaneously training a model in a self-supervised learning setting, using subsampled data from the target dataset(s), and in a supervised learning manner, utilizing data from other datasets, referred to as proxy datasets, where fully sampled k-space data is accessible. To demonstrate the efficacy of JSSL, we utilized subsampled prostate parallel MRI measurements as the target dataset, while employing fully sampled brain and knee k-space acquisitions as proxy datasets. Our results showcase a substantial improvement over conventional self-supervised training methods, thereby underscoring the effectiveness of our joint approach. We provide a theoretical motivation for JSSL and establish a practical "rule-of-thumb" for selecting the most appropriate training approach for deep MRI reconstruction.

Kandinsky Conformal Prediction: Efficient Calibration of Image Segmentation Algorithms

Image segmentation algorithms can be understood as a collection of pixel classifiers, for which the outcomes of nearby pixels are correlated. Classifier models can be calibrated using Inductive Conformal Prediction, but this requires holding back a sufficiently large calibration dataset for computing the distribution of non-conformity scores of the model's predictions. If one only requires only marginal calibration on the image level, this calibration set consists of all individual pixels in the images available for calibration. However, if the goal is to attain proper calibration for each individual pixel classifier, the calibration set consists of individual images. In a scenario where data are scarce (such as the medical domain), it may not always be possible to set aside sufficiently many images for this pixel-level calibration. The method we propose, dubbed ``Kandinsky calibration'', makes use of the spatial structure present in the distribution of natural images to simultaneously calibrate the classifiers of ``similar'' pixels. This can be seen as an intermediate approach between marginal (imagewise) and conditional (pixelwise) calibration, where non-conformity scores are aggregated over similar image regions, thereby making more efficient use of the images available for calibration. We run experiments on segmentation algorithms trained and calibrated on subsets of the public MS-COCO and Medical Decathlon datasets, demonstrating that Kandinsky calibration method can significantly improve the coverage. When compared to both pixelwise and imagewise calibration on little data, the Kandinsky method achieves much lower coverage errors, indicating the data efficiency of the Kandinsky calibration.