Maximizing domain generalization in fetal brain tissue segmentation: the role of synthetic data generation, intensity clustering and real image fine-tuning

Fetal brain tissue segmentation in magnetic resonance imaging (MRI) is a crucial tool that supports the understanding of neurodevelopment, yet it faces challenges due to the heterogeneity of data coming from different scanners and settings, and due to data scarcity. Recent approaches based on domain randomization, like SynthSeg, have shown a great potential for single source domain generalization, by simulating images with randomized contrast and image resolution from the label maps. In this work, we investigate how to maximize the out-of-domain (OOD) generalization potential of SynthSeg-based methods in fetal brain MRI. Specifically, when studying data generation, we demonstrate that the simple Gaussian mixture models used in SynthSeg enable more robust OOD generalization than physics-informed generation methods. We also investigate how intensity clustering can help create more faithful synthetic images, and observe that it is key to achieving a non-trivial OOD generalization capability when few label classes are available. Finally, by combining for the first time SynthSeg with modern fine-tuning approaches based on weight averaging, we show that fine-tuning a model pre-trained on synthetic data on a few real image-segmentation pairs in a new domain can lead to improvements in the target domain, but also in other domains. We summarize our findings as five key recommendations that we believe can guide practitioners who would like to develop SynthSeg-based approaches in other organs or modalities.

Improving cross-domain brain tissue segmentation in fetal MRI with synthetic data

Segmentation of fetal brain tissue from magnetic resonance imaging (MRI) plays a crucial role in the study of in utero neurodevelopment. However, automated tools face substantial domain shift challenges as they must be robust to highly heterogeneous clinical data, often limited in numbers and lacking annotations. Indeed, high variability of the fetal brain morphology, MRI acquisition parameters, and superresolution reconstruction (SR) algorithms adversely affect the model's performance when evaluated out-of-domain. In this work, we introduce FetalSynthSeg, a domain randomization method to segment fetal brain MRI, inspired by SynthSeg. Our results show that models trained solely on synthetic data outperform models trained on real data in out-ofdomain settings, validated on a 120-subject cross-domain dataset. Furthermore, we extend our evaluation to 40 subjects acquired using lowfield (0.55T) MRI and reconstructed with novel SR models, showcasing robustness across different magnetic field strengths and SR algorithms. Leveraging a generative synthetic approach, we tackle the domain shift problem in fetal brain MRI and offer compelling prospects for applications in fields with limited and highly heterogeneous data.

Learning to sample in Cartesian MRI

Despite its exceptional soft tissue contrast, Magnetic Resonance Imaging (MRI) faces the challenge of long scanning times compared to other modalities like X-ray radiography. Shortening scanning times is crucial in clinical settings, as it increases patient comfort, decreases examination costs and improves throughput. Recent advances in compressed sensing (CS) and deep learning allow accelerated MRI acquisition by reconstructing high-quality images from undersampled data. While reconstruction algorithms have received most of the focus, designing acquisition trajectories to optimize reconstruction quality remains an open question. This thesis explores two approaches to address this gap in the context of Cartesian MRI. First, we propose two algorithms, lazy LBCS and stochastic LBCS, that significantly improve upon G\"ozc\"u et al.'s greedy learning-based CS (LBCS) approach. These algorithms scale to large, clinically relevant scenarios like multi-coil 3D MR and dynamic MRI, previously inaccessible to LBCS. Additionally, we demonstrate that generative adversarial networks (GANs) can serve as a natural criterion for adaptive sampling by leveraging variance in the measurement domain to guide acquisition. Second, we delve into the underlying structures or assumptions that enable mask design algorithms to perform well in practice. Our experiments reveal that state-of-the-art deep reinforcement learning (RL) approaches, while capable of adaptation and long-horizon planning, offer only marginal improvements over stochastic LBCS, which is neither adaptive nor does long-term planning. Altogether, our findings suggest that stochastic LBCS and similar methods represent promising alternatives to deep RL. They shine in particular by their scalability and computational efficiency and could be key in the deployment of optimized acquisition trajectories in Cartesian MRI.

FetMRQC: an open-source machine learning framework for multi-centric fetal brain MRI quality control

Fetal brain MRI is becoming an increasingly relevant complement to neurosonography for perinatal diagnosis, allowing fundamental insights into fetal brain development throughout gestation. However, uncontrolled fetal motion and heterogeneity in acquisition protocols lead to data of variable quality, potentially biasing the outcome of subsequent studies. We present FetMRQC, an open-source machine-learning framework for automated image quality assessment and quality control that is robust to domain shifts induced by the heterogeneity of clinical data. FetMRQC extracts an ensemble of quality metrics from unprocessed anatomical MRI and combines them to predict experts' ratings using random forests. We validate our framework on a pioneeringly large and diverse dataset of more than 1600 manually rated fetal brain T2-weighted images from four clinical centers and 13 different scanners. Our study shows that FetMRQC's predictions generalize well to unseen data while being interpretable. FetMRQC is a step towards more robust fetal brain neuroimaging, which has the potential to shed new insights on the developing human brain.

FetMRQC: Automated Quality Control for fetal brain MRI

Quality control (QC) has long been considered essential to guarantee the reliability of neuroimaging studies. It is particularly important for fetal brain MRI, where large and unpredictable fetal motion can lead to substantial artifacts in the acquired images. Existing methods for fetal brain quality assessment operate at the \textit{slice} level, and fail to get a comprehensive picture of the quality of an image, that can only be achieved by looking at the \textit{entire} brain volume. In this work, we propose FetMRQC, a machine learning framework for automated image quality assessment tailored to fetal brain MRI, which extracts an ensemble of quality metrics that are then used to predict experts' ratings. Based on the manual ratings of more than 1000 low-resolution stacks acquired across two different institutions, we show that, compared with existing quality metrics, FetMRQC is able to generalize out-of-domain, while being interpretable and data efficient. We also release a novel manual quality rating tool designed to facilitate and optimize quality rating of fetal brain images. Our tool, along with all the code to generate, train and evaluate the model will be released upon acceptance of the paper.

Simulation-based parameter optimization for fetal brain MRI super-resolution reconstruction

In utero fetal brain magnetic resonance images are inherently limited in spatial resolution due to stochastic motion of the fetus. Super-resolution reconstruction methods have become the go-to approach to compute an isotropic motion-free volume of the fetal brain from low-resolution series of 2D thick slices. Such pipelines often rely on an optimization problem with a data fidelity and a regularization term, balanced by a hyperparameter $\alpha$. The lack of ground truth images makes it difficult to adapt $\alpha$ to a given setting of interest in a quantitative manner. In this work, we propose a simulation-based approach to tune $\alpha$ for a given acquisition setting. We focus on two key aspects: the magnetic field strength (1.5T and 3T) and number of LR series used for reconstruction. Our results show that the optimal $\alpha$ significantly improves the performance compared to the default value, across two commonly used SR pipelines. Qualitative validation on clinical data confirms the importance of tuning this parameter to the setting of interest.

Scalable Learning-Based Sampling Optimization for Compressive Dynamic MRI

Slow acquisition has been one of the historical problems in dynamic magnetic resonance imaging (dMRI), but the rise of compressed sensing (CS) has brought numerous algorithms that successfully achieve high acceleration rates. While CS proposes random sampling for data acquisition, practical CS applications to dMRI have typically relied on random variable-density (VD) sampling patterns, where masks are drawn from probabilistic models, which preferably sample from the center of the Fourier domain. In contrast to this model-driven approach, we propose the first data-driven, scalable framework for optimizing sampling patterns in dMRI. Through a greedy algorithm, this approach allows the data to directly govern the search for a mask that exhibits good empirical performance. Previous greedy approach, designed for static MRI, required very intensive computations, prohibiting their direct application to dMRI, and we address this issue by resorting to a stochastic greedy algorithm that exploits only a fraction of resources compared to the previous approach without sacrificing the reconstruction accuracy. A thorough comparison on in vivo datasets shows the inefficiency of model-based approaches in terms of sampling performance and suggests that our data-driven sampling approach could fully enable the potential of CS applied to dMRI.