Medical image analysis on left atrial LGE MRI for atrial fibrillation studies: A review

RAS Dataset: A 3D Cardiac LGE-MRI Dataset for Segmentation of Right Atrial Cavity

The current challenge in effectively treating atrial fibrillation (AF) stems from a limited understanding of the intricate structure of the human atria. The objective and quantitative interpretation of the right atrium (RA) in late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) scans relies heavily on its precise segmentation. Leveraging the potential of artificial intelligence (AI) for RA segmentation presents a promising solution. However, the successful implementation of AI in this context necessitates access to a substantial volume of annotated LGE-MRI images for model training. In this paper, we present a comprehensive 3D cardiac dataset comprising 50 high-resolution LGE-MRI scans, each meticulously annotated at the pixel level. The annotation process underwent rigorous standardization through crowdsourcing among a panel of medical experts, ensuring the accuracy and consistency of the annotations. Our dataset represents a significant contribution to the field, providing a valuable resource for advancing RA segmentation methods.

Aligning Multi-Sequence CMR Towards Fully Automated Myocardial Pathology Segmentation

Myocardial pathology segmentation (MyoPS) is critical for the risk stratification and treatment planning of myocardial infarction (MI). Multi-sequence cardiac magnetic resonance (MS-CMR) images can provide valuable information. For instance, balanced steady-state free precession cine sequences present clear anatomical boundaries, while late gadolinium enhancement and T2-weighted CMR sequences visualize myocardial scar and edema of MI, respectively. Existing methods usually fuse anatomical and pathological information from different CMR sequences for MyoPS, but assume that these images have been spatially aligned. However, MS-CMR images are usually unaligned due to the respiratory motions in clinical practices, which poses additional challenges for MyoPS. This work presents an automatic MyoPS framework for unaligned MS-CMR images. Specifically, we design a combined computing model for simultaneous image registration and information fusion, which aggregates multi-sequence features into a common space to extract anatomical structures (i.e., myocardium). Consequently, we can highlight the informative regions in the common space via the extracted myocardium to improve MyoPS performance, considering the spatial relationship between myocardial pathologies and myocardium. Experiments on a private MS-CMR dataset and a public dataset from the MYOPS2020 challenge show that our framework could achieve promising performance for fully automatic MyoPS.

Deep learning architecture for 3D image super-resolution of late gadolinium enhanced cardiac MRI

Purpose

High-resolution late gadolinium enhanced (LGE) cardiac magnetic resonance imaging (MRI) volumes are difficult to acquire due to the limitations of the maximal breath-hold time achievable by the patient. This results in anisotropic 3D volumes of the heart with high in-plane resolution, but low-through-plane resolution. Thus, we propose a 3D convolutional neural network (CNN) approach to improve the through-plane resolution of the cardiac LGE-MRI volumes.

Approach

We present a 3D CNN-based framework with two branches: a super-resolution branch to learn the mapping between low-resolution and high-resolution LGE-MRI volumes, and a gradient branch that learns the mapping between the gradient map of low-resolution LGE-MRI volumes and the gradient map of high-resolution LGE-MRI volumes. The gradient branch provides structural guidance to the CNN-based super-resolution framework. To assess the performance of the proposed CNN-based framework, we train two CNN models with and without gradient guidance, namely, dense deep back-projection network (DBPN) and enhanced deep super-resolution network. We train and evaluate our method on the 2018 atrial segmentation challenge dataset. Additionally, we also evaluate these trained models on the left atrial and scar quantification and segmentation challenge 2022 dataset to assess their generalization ability. Finally, we investigate the effect of the proposed CNN-based super-resolution framework on the 3D segmentation of the left atrium (LA) from these cardiac LGE-MRI image volumes.

Results

Experimental results demonstrate that our proposed CNN method with gradient guidance consistently outperforms bicubic interpolation and the CNN models without gradient guidance. Furthermore, the segmentation results, evaluated using Dice score, obtained using the super-resolved images generated by our proposed method are superior to the segmentation results obtained using the images generated by bicubic interpolation (p < 0.01 ) and the CNN models without gradient guidance (p < 0.05 ).

Conclusion

The presented CNN-based super-resolution method with gradient guidance improves the through-plane resolution of the LGE-MRI volumes and the structure guidance provided by the gradient branch can be useful to aid the 3D segmentation of cardiac chambers, such as LA, from the 3D LGE-MRI images.

Automatic Multiple Articulator Segmentation in Dynamic Speech MRI Using a Protocol Adaptive Stacked Transfer Learning U-NET Model

Dynamic magnetic resonance imaging has emerged as a powerful modality for investigating upper-airway function during speech production. Analyzing the changes in the vocal tract airspace, including the position of soft-tissue articulators (e.g., the tongue and velum), enhances our understanding of speech production. The advent of various fast speech MRI protocols based on sparse sampling and constrained reconstruction has led to the creation of dynamic speech MRI datasets on the order of 80-100 image frames/second. In this paper, we propose a stacked transfer learning U-NET model to segment the deforming vocal tract in 2D mid-sagittal slices of dynamic speech MRI. Our approach leverages (a) low- and mid-level features and (b) high-level features. The low- and mid-level features are derived from models pre-trained on labeled open-source brain tumor MR and lung CT datasets, and an in-house airway labeled dataset. The high-level features are derived from labeled protocol-specific MR images. The applicability of our approach to segmenting dynamic datasets is demonstrated in data acquired from three fast speech MRI protocols: Protocol 1: 3 T-based radial acquisition scheme coupled with a non-linear temporal regularizer, where speakers were producing French speech tokens; Protocol 2: 1.5 T-based uniform density spiral acquisition scheme coupled with a temporal finite difference (FD) sparsity regularization, where speakers were producing fluent speech tokens in English, and Protocol 3: 3 T-based variable density spiral acquisition scheme coupled with manifold regularization, where speakers were producing various speech tokens from the International Phonetic Alphabetic (IPA). Segments from our approach were compared to those from an expert human user (a vocologist), and the conventional U-NET model without transfer learning. Segmentations from a second expert human user (a radiologist) were used as ground truth. Evaluations were performed using the quantitative DICE similarity metric, the Hausdorff distance metric, and segmentation count metric. This approach was successfully adapted to different speech MRI protocols with only a handful of protocol-specific images (e.g., of the order of 20 images), and provided accurate segmentations similar to those of an expert human.

LASSNet: A Four Steps Deep Neural Network for Left Atrial Segmentation and Scar Quantification

Accurate quantification of left atrium (LA) scar in patients with atrial fibrillation is essential to guide successful ablation strategies. Prior to LA scar quantification, a proper LA cavity segmentation is required to ensure exact location of scar. Both tasks can be extremely time-consuming and are subject to inter-observer disagreements when done manually. We developed and validated a deep neural network to automatically segment the LA cavity and the LA scar. The global architecture uses a multi-network sequential approach in two stages which segment the LA cavity and the LA Scar. Each stage has two steps: a region of interest Neural Network and a refined segmentation network. We analysed the performances of our network according to different parameters and applied data triaging. 200+ late gadolinium enhancement magnetic resonance images were provided by the LAScarQS 2022 Challenge. Finally, we compared our performances for scar quantification to the literature and demonstrated improved performances.

MyoPS: A benchmark of myocardial pathology segmentation combining three-sequence cardiac magnetic resonance images

Assessment of myocardial viability is essential in diagnosis and treatment management of patients suffering from myocardial infarction, and classification of pathology on the myocardium is the key to this assessment. This work defines a new task of medical image analysis, i.e., to perform myocardial pathology segmentation (MyoPS) combining three-sequence cardiac magnetic resonance (CMR) images, which was first proposed in the MyoPS challenge, in conjunction with MICCAI 2020. Note that MyoPS refers to both myocardial pathology segmentation and the challenge in this paper. The challenge provided 45 paired and pre-aligned CMR images, allowing algorithms to combine the complementary information from the three CMR sequences for pathology segmentation. In this article, we provide details of the challenge, survey the works from fifteen participants and interpret their methods according to five aspects, i.e., preprocessing, data augmentation, learning strategy, model architecture and post-processing. In addition, we analyze the results with respect to different factors, in order to examine the key obstacles and explore the potential of solutions, as well as to provide a benchmark for future research. The average Dice scores of submitted algorithms were 0.614±0.231 and 0.644±0.153 for myocardial scars and edema, respectively. We conclude that while promising results have been reported, the research is still in the early stage, and more in-depth exploration is needed before a successful application to the clinics. MyoPS data and evaluation tool continue to be publicly available upon registration via its homepage (www.sdspeople.fudan.edu.cn/zhuangxiahai/0/myops20/).

Cardiac Magnetic Resonance Image Segmentation Method Based on Multi-Scale Feature Fusion and Sequence Relationship Learning

Accurate segmentation of the left atrial structure using magnetic resonance images provides an important basis for the diagnosis of atrial fibrillation (AF) and its treatment using robotic surgery. In this study, an image segmentation method based on sequence relationship learning and multi-scale feature fusion is proposed for 3D to 2D sequence conversion in cardiac magnetic resonance images and the varying scales of left atrial structures within different slices. Firstly, a convolutional neural network layer with an attention module was designed to extract and fuse contextual information at different scales in the image, to strengthen the target features using the correlation between features in different regions within the image, and to improve the network's ability to distinguish the left atrial structure. Secondly, a recurrent neural network layer oriented to two-dimensional images was designed to capture the correlation of left atrial structures in adjacent slices by simulating the continuous relationship between sequential image slices. Finally, a combined loss function was constructed to reduce the effect of positive and negative sample imbalance and improve model stability. The Dice, IoU, and Hausdorff distance values reached 90.73%, 89.37%, and 4.803 mm, respectively, based on the LASC2013 (left atrial segmentation challenge in 2013) dataset; the corresponding values reached 92.05%, 89.41% and 9.056 mm, respectively, based on the ASC2018 (atrial segmentation challenge at 2018) dataset.

AtrialJSQnet: A New framework for joint segmentation and quantification of left atrium and scars incorporating spatial and shape information

Left atrial (LA) and atrial scar segmentation from late gadolinium enhanced magnetic resonance imaging (LGE MRI) is an important task in clinical practice. The automatic segmentation is however still challenging due to the poor image quality, the various LA shapes, the thin wall, and the surrounding enhanced regions. Previous methods normally solved the two tasks independently and ignored the intrinsic spatial relationship between LA and scars. In this work, we develop a new framework, namely AtrialJSQnet, where LA segmentation, scar projection onto the LA surface, and scar quantification are performed simultaneously in an end-to-end style. We propose a mechanism of shape attention (SA) via an implicit surface projection to utilize the inherent correlation between LA cavity and scars. In specific, the SA scheme is embedded into a multi-task architecture to perform joint LA segmentation and scar quantification. Besides, a spatial encoding (SE) loss is introduced to incorporate continuous spatial information of the target in order to reduce noisy patches in the predicted segmentation. We evaluated the proposed framework on 60 post-ablation LGE MRIs from the MICCAI2018 Atrial Segmentation Challenge. Moreover, we explored the domain generalization ability of the proposed AtrialJSQnet on 40 pre-ablation LGE MRIs from this challenge and 30 post-ablation multi-center LGE MRIs from another challenge (ISBI2012 Left Atrium Fibrosis and Scar Segmentation Challenge). Extensive experiments on public datasets demonstrated the effect of the proposed AtrialJSQnet, which achieved competitive performance over the state-of-the-art. The relatedness between LA segmentation and scar quantification was explicitly explored and has shown significant performance improvements for both tasks. The code has been released via https://zmiclab.github.io/projects.html.