Lost in Tracking: Uncertainty-guided Cardiac Cine MRI Segmentation at Right Ventricle Base

Accurate biventricular segmentation of cardiac magnetic resonance (CMR) cine images is essential for the clinical evaluation of heart function. However, compared to left ventricle (LV), right ventricle (RV) segmentation is still more challenging and less reproducible. Degenerate performance frequently occurs at the RV base, where the in-plane anatomical structures are complex (with atria, valve, and aorta) and vary due to the strong interplanar motion. In this work, we propose to address the currently unsolved issues in CMR segmentation, specifically at the RV base, with two strategies: first, we complemented the public resource by reannotating the RV base in the ACDC dataset, with refined delineation of the right ventricle outflow tract (RVOT), under the guidance of an expert cardiologist. Second, we proposed a novel dual encoder U-Net architecture that leverages temporal incoherence to inform the segmentation when interplanar motions occur. The inter-planar motion is characterized by loss-of-tracking, via Bayesian uncertainty of a motion-tracking model. Our experiments showed that our method significantly improved RV base segmentation taking into account temporal incoherence. Furthermore, we investigated the reproducibility of deep learning-based segmentation and showed that the combination of consistent annotation and loss of tracking could enhance the reproducibility of RV segmentation, potentially facilitating a large number of clinical studies focusing on RV.

Temporal Uncertainty Localization to Enable Human-in-the-loop Analysis of Dynamic Contrast-enhanced Cardiac MRI Datasets

Dynamic contrast-enhanced (DCE) cardiac magnetic resonance imaging (CMRI) is a widely used modality for diagnosing myocardial blood flow (perfusion) abnormalities. During a typical free-breathing DCE-CMRI scan, close to 300 time-resolved images of myocardial perfusion are acquired at various contrast "wash in/out" phases. Manual segmentation of myocardial contours in each time-frame of a DCE image series can be tedious and time-consuming, particularly when non-rigid motion correction has failed or is unavailable. While deep neural networks (DNNs) have shown promise for analyzing DCE-CMRI datasets, a "dynamic quality control" (dQC) technique for reliably detecting failed segmentations is lacking. Here we propose a new space-time uncertainty metric as a dQC tool for DNN-based segmentation of free-breathing DCE-CMRI datasets by validating the proposed metric on an external dataset and establishing a human-in-the-loop framework to improve the segmentation results. In the proposed approach, we referred the top 10% most uncertain segmentations as detected by our dQC tool to the human expert for refinement. This approach resulted in a significant increase in the Dice score (p<0.001) and a notable decrease in the number of images with failed segmentation (16.2% to 11.3%) whereas the alternative approach of randomly selecting the same number of segmentations for human referral did not achieve any significant improvement. Our results suggest that the proposed dQC framework has the potential to accurately identify poor-quality segmentations and may enable efficient DNN-based analysis of DCE-CMRI in a human-in-the-loop pipeline for clinical interpretation and reporting of dynamic CMRI datasets.