Echocardiography (echo), or cardiac ultrasound, is the most widely used imaging modality for cardiac form and function due to its relatively low cost, rapid acquisition time, and non-invasive nature. However, ultrasound acquisitions are often limited by artifacts and noise that hinder diagnostic interpretation in clinical settings. Existing methodologies for denoising echos consist solely of traditional filtering-based algorithms or deep learning methods developed on radio-frequency (RF) signals which prevents clinical applicability and scalability. To address these limitations, we introduce the first deep generative model capable of simulating ultrasound noise developed on B-mode data. Using this generative model, we develop a synthetic dataset of paired clean and noisy echo images to train a downstream model for real-world image denoising and demonstrate state-of-the-art performance in both internal and external experiments. In both held-out test sets, our method results in echo images with higher gCNR in comparison to noisy image counterparts and images derived from a comparable method which is consistent with provided visual comparisons. Our experiments showcase the potential of our method for future clinical use to improve the quality of echo acquisitions. To encourage further research into the field, we release our source code and model weights at https://github.com/echonet/image_quality.
Background and Purpose: Functional assessment of the left ventricle using gated myocardial perfusion (MPS) single-photon emission computed tomography relies on the precise extraction of the left ventricular contours while simultaneously ensuring the security of patient data. Methods: In this paper, we introduce the integration of Federated Domain Adaptation with TimeSformer, named 'FedDA-TSformer' for left ventricle segmentation using MPS. FedDA-TSformer captures spatial and temporal features in gated MPS images, leveraging spatial attention, temporal attention, and federated learning for improved domain adaptation while ensuring patient data security. In detail, we employed Divide-Space-Time-Attention mechanism to extract spatio-temporal correlations from the multi-centered MPS datasets, ensuring that predictions are spatio-temporally consistent. To achieve domain adaptation, we align the model output on MPS from three different centers using local maximum mean discrepancy (LMMD) loss. This approach effectively addresses the dual requirements of federated learning and domain adaptation, enhancing the model's performance during training with multi-site datasets while ensuring the protection of data from different hospitals. Results: Our FedDA-TSformer was trained and evaluated using MPS datasets collected from three hospitals, comprising a total of 150 subjects. Each subject's cardiac cycle was divided into eight gates. The model achieved Dice Similarity Coefficients (DSC) of 0.842 and 0.907 for left ventricular (LV) endocardium and epicardium segmentation, respectively. Conclusion: Our proposed FedDA-TSformer model addresses the challenge of multi-center generalization, ensures patient data privacy protection, and demonstrates effectiveness in left ventricular (LV) segmentation.
Accurate segmentation of the Left Ventricle (LV) holds substantial importance due to its implications in disease detection, regional analysis, and the development of complex models for cardiac surgical planning. CMR is a golden standard for diagnosis of serveral cardiac diseases. LV in CMR comprises of three distinct sections: Basal, Mid-Ventricle, and Apical. This research focuses on the precise segmentation of the LV from Cardiac MRI (CMR) scans, joining with the capabilities of Machine Learning (ML). The central challenge in this research revolves around the absence of a set of parameters applicable to all three types of LV slices. Parameters optimized for basal slices often fall short when applied to mid-ventricular and apical slices, and vice versa. To handle this issue, a new method is proposed to enhance LV segmentation. The proposed method involves using distinct sets of parameters for each type of slice, resulting in a two-phase segmentation approach. The initial phase categorizes images into three groups based on the type of LV slice, while the second phase aims to segment CMR images using parameters derived from the preceding phase. A publicly available dataset (Automated Cardiac Diagnosis Challenge (ACDC)) is used. 10-Fold Cross Validation is used and it achieved a mean score of 0.9228. Comprehensive testing indicates that the best parameter set for a particular type of slice does not perform adequately for the other slice types. All results show that the proposed approach fills a critical void in parameter standardization through a two-phase segmentation model for the LV, aiming to not only improve the accuracy of cardiac image analysis but also contribute advancements to the field of LV segmentation.
Echocardiography has become an indispensable clinical imaging modality for general heart health assessment. From calculating biomarkers such as ejection fraction to the probability of a patient's heart failure, accurate segmentation of the heart structures allows doctors to assess the heart's condition and devise treatments with greater precision and accuracy. However, achieving accurate and reliable left ventricle segmentation is time-consuming and challenging due to different reasons. Hence, clinicians often rely on segmenting the left ventricular (LV) in two specific echocardiogram frames to make a diagnosis. This limited coverage in manual LV segmentation poses a challenge for developing automatic LV segmentation with high temporal consistency, as the resulting dataset is typically annotated sparsely. In response to this challenge, this work introduces SimLVSeg, a novel paradigm that enables video-based networks for consistent LV segmentation from sparsely annotated echocardiogram videos. SimLVSeg consists of self-supervised pre-training with temporal masking, followed by weakly supervised learning tailored for LV segmentation from sparse annotations. We demonstrate how SimLVSeg outperforms the state-of-the-art solutions by achieving a 93.32% (95%CI 93.21-93.43%) dice score on the largest 2D+time echocardiography dataset (EchoNet-Dynamic) while being more efficient. SimLVSeg is compatible with two types of video segmentation networks: 2D super image and 3D segmentation. To show the effectiveness of our approach, we provide extensive ablation studies, including pre-training settings and various deep learning backbones. We further conduct an out-of-distribution test to showcase SimLVSeg's generalizability on unseen distribution (CAMUS dataset). The code is publicly available at https://github.com/fadamsyah/SimLVSeg.
Synthetic digital twins based on medical data accelerate the acquisition, labelling and decision making procedure in digital healthcare. A core part of digital healthcare twins is model-based data synthesis, which permits the generation of realistic medical signals without requiring to cope with the modelling complexity of anatomical and biochemical phenomena producing them in reality. Unfortunately, algorithms for cardiac data synthesis have been so far scarcely studied in the literature. An important imaging modality in the cardiac examination is three-directional CINE multi-slice myocardial velocity mapping (3Dir MVM), which provides a quantitative assessment of cardiac motion in three orthogonal directions of the left ventricle. The long acquisition time and complex acquisition produce make it more urgent to produce synthetic digital twins of this imaging modality. In this study, we propose a hybrid deep learning (HDL) network, especially for synthetic 3Dir MVM data. Our algorithm is featured by a hybrid UNet and a Generative Adversarial Network with a foreground-background generation scheme. The experimental results show that from temporally down-sampled magnitude CINE images (six times), our proposed algorithm can still successfully synthesise high temporal resolution 3Dir MVM CMR data (PSNR=42.32) with precise left ventricle segmentation (DICE=0.92). These performance scores indicate that our proposed HDL algorithm can be implemented in real-world digital twins for myocardial velocity mapping data simulation. To the best of our knowledge, this work is the first one in the literature investigating digital twins of the 3Dir MVM CMR, which has shown great potential for improving the efficiency of clinical studies via synthesised cardiac data.
Contrastive learning has proven useful in many applications where access to labelled data is limited. The lack of annotated data is particularly problematic in medical image segmentation as it is difficult to have clinical experts manually annotate large volumes of data such as cardiac structures in ultrasound images of the heart. In this paper, We propose a self supervised contrastive learning method to segment the left ventricle from echocardiography when limited annotated images exist. Furthermore, we study the effect of contrastive pretraining on two well-known segmentation networks, UNet and DeepLabV3. Our results show that contrastive pretraining helps improve the performance on left ventricle segmentation, particularly when annotated data is scarce. We show how to achieve comparable results to state-of-the-art fully supervised algorithms when we train our models in a self-supervised fashion followed by fine-tuning on just 5\% of the data. We show that our solution outperforms what is currently published on a large public dataset (EchoNet-Dynamic) achieving a Dice score of 0.9252. We also compare the performance of our solution on another smaller dataset (CAMUS) to demonstrate the generalizability of our proposed solution. The code is available at (https://github.com/BioMedIA-MBZUAI/contrastive-echo).
Temporal patterns of cardiac motion provide important information for cardiac disease diagnosis. This pattern could be obtained by three-directional CINE multi-slice left ventricular myocardial velocity mapping (3Dir MVM), which is a cardiac MR technique providing magnitude and phase information of the myocardial motion simultaneously. However, long acquisition time limits the usage of this technique by causing breathing artifacts, while shortening the time causes low temporal resolution and may provide an inaccurate assessment of cardiac motion. In this study, we proposed a frame synthesis algorithm to increase the temporal resolution of 3Dir MVM data. Our algorithm is featured by 1) three attention-based encoders which accept magnitude images, phase images, and myocardium segmentation masks respectively as inputs; 2) three decoders that output the interpolated frames and corresponding myocardium segmentation results; and 3) loss functions highlighting myocardium pixels. Our algorithm can not only increase the temporal resolution 3Dir MVMs, but can also generates the myocardium segmentation results at the same time.
Domain shift refers to the difference in the data distribution of two datasets, normally between the training set and the test set for machine learning algorithms. Domain shift is a serious problem for generalization of machine learning models and it is well-established that a domain shift between the training and test sets may cause a drastic drop in the model's performance. In medical imaging, there can be many sources of domain shift such as different scanners or scan protocols, different pathologies in the patient population, anatomical differences in the patient population (e.g. men vs women) etc. Therefore, in order to train models that have good generalization performance, it is important to be aware of the domain shift problem, its potential causes and to devise ways to address it. In this paper, we study the effect of domain shift on left and right ventricle blood pool segmentation in short axis cardiac MR images. Our dataset contains short axis images from 4 different MR scanners and 3 different pathology groups. The training is performed with nnUNet. The results show that scanner differences cause a greater drop in performance compared to changing the pathology group, and that the impact of domain shift is greater on right ventricle segmentation compared to left ventricle segmentation. Increasing the number of training subjects increased cross-scanner performance more than in-scanner performance at small training set sizes, but this difference in improvement decreased with larger training set sizes. Training models using data from multiple scanners improved cross-domain performance.
The morphological structure of left ventricle segmented from cardiac magnetic resonance images can be used to calculate key clinical parameters, and it is of great significance to the accurate and efficient diagnosis of cardiovascular diseases. Compared with traditional methods, the segmentation algorithms based on fully convolutional neural network greatly improve the accuracy of semantic segmentation. For the problem of left ventricular segmentation, a new fully convolutional neural network structure named MS-FCN is proposed in this paper. The MS-FCN network employs a multi-scale pooling module to ensure that the network maximises the feature extraction ability and uses a dense connectivity decoder to refine the boundaries of the object. Based on the Sunnybrook cine-MR dataset provided by the MICCAI 2009 challenge, numerical experiments demonstrate that our proposed model has obtained state-of-the-art segmentation results: the Dice score of our method reaches 0.93 on the endocardium, and 0.96 on the epicardium.
Left ventricle segmentation and morphological assessment are essential for improving diagnosis and our understanding of cardiomyopathy, which in turn is imperative for reducing risk of myocardial infarctions in patients. Convolutional neural network (CNN) based methods for cardiac magnetic resonance (CMR) image segmentation rely on supervision with pixel-level annotations, and may not generalize well to images from a different domain. These methods are typically sensitive to variations in imaging protocols and data acquisition. Since annotating multi-sequence CMR images is tedious and subject to inter- and intra-observer variations, developing methods that can automatically adapt from one domain to the target domain is of great interest. In this paper, we propose an approach for domain adaptation in multi-sequence CMR segmentation task using transfer learning that combines multi-source image information. We first train an encoder-decoder CNN on T2-weighted and balanced-Steady State Free Precession (bSSFP) MR images with pixel-level annotation and fine-tune the same network with a limited number of Late Gadolinium Enhanced-MR (LGE-MR) subjects, to adapt the domain features. The domain-adapted network was trained with just four LGE-MR training samples and obtained an average Dice score of $\sim$85.0\% on the test set comprises of 40 LGE-MR subjects. The proposed method significantly outperformed a network without adaptation trained from scratch on the same set of LGE-MR training data.
Segmentation of the Left ventricle (LV) is a crucial step for quantitative measurements such as area, volume, and ejection fraction. However, the automatic LV segmentation in 2D echocardiographic images is a challenging task due to ill-defined borders, and operator dependence issues (insufficient reproducibility). U-net, which is a well-known architecture in medical image segmentation, addressed this problem through an encoder-decoder path. Despite outstanding overall performance, U-net ignores the contribution of all semantic strengths in the segmentation procedure. In the present study, we have proposed a novel architecture to tackle this drawback. Feature maps in all levels of the decoder path of U-net are concatenated, their depths are equalized, and up-sampled to a fixed dimension. This stack of feature maps would be the input of the semantic segmentation layer. The proposed network yielded state-of-the-art results when comparing with results from U-net, dilated U-net, and deeplabv3, using the same dataset. An average Dice Metric (DM) of 0.945, Hausdorff Distance (HD) of 1.62, Jaccard Coefficient (JC) of 0.97, and Mean Absolute Distance (MAD) of 1.32 are achieved. The correlation graph, bland-altman analysis, and box plot showed a great agreement between automatic and manually calculated volume, area, and length.
This study investigates a curriculum-style strategy for semi-supervised CNN segmentation, which devises a regression network to learn image-level information such as the size of a target region. These regressions are used to effectively regularize the segmentation network, constraining softmax predictions of the unlabeled images to match the inferred label distributions. Our framework is based on inequality constraints that tolerate uncertainties with inferred knowledge, e.g., regressed region size, and can be employed for a large variety of region attributes. We evaluated our proposed strategy for left ventricle segmentation in magnetic resonance images (MRI), and compared it to standard proposal-based semi-supervision strategies. Our strategy leverages unlabeled data in more efficiently, and achieves very competitive results, approaching the performance of full-supervision.
Prognostic tumor growth modeling via volumetric medical imaging observations can potentially lead to better outcomes of tumor treatment and surgical planning. Recent advances of convolutional networks have demonstrated higher accuracy than traditional mathematical models in predicting future tumor volumes. This indicates that deep learning-based techniques may have great potentials on addressing such problem. However, current 2D patch-based modeling approaches cannot make full use of the spatio-temporal imaging context of the tumor's longitudinal 4D (3D + time) data. Moreover, they are incapable to predict clinically-relevant tumor properties, other than volumes. In this paper, we exploit to formulate the tumor growth process through convolutional Long Short-Term Memory (ConvLSTM) that extract tumor's static imaging appearances and capture its temporal dynamic changes within a single network. We extend ConvLSTM into the spatio-temporal domain (ST-ConvLSTM) by jointly learning the inter-slice 3D contexts and the longitudinal or temporal dynamics from multiple patient studies. Our approach can incorporate other non-imaging patient information in an end-to-end trainable manner. Experiments are conducted on the largest 4D longitudinal tumor dataset of 33 patients to date. Results validate that the ST-ConvLSTM produces a Dice score of 83.2%+-5.1% and a RVD of 11.2%+-10.8%, both significantly outperforming (p<0.05) other compared methods of linear model, ConvLSTM, and generative adversarial network (GAN) under the metric of predicting future tumor volumes. Additionally, our new method enables the prediction of both cell density and CT intensity numbers. Last, we demonstrate the generalizability of ST-ConvLSTM by employing it in 4D medical image segmentation task, which achieves an averaged Dice score of 86.3+-1.2% for left-ventricle segmentation in 4D ultrasound with 3 seconds per patient.
We present a novel method to explicitly incorporate topological prior knowledge into deep learning based segmentation, which is, to our knowledge, the first work to do so. Our method uses the concept of persistent homology, a tool from topological data analysis, to capture high-level topological characteristics of segmentation results in a way which is differentiable with respect to the pixelwise probability of being assigned to a given class. The topological prior knowledge consists of the sequence of desired Betti numbers of the segmentation. As a proof-of-concept we demonstrate our approach by applying it to the problem of left-ventricle segmentation of cardiac MR images of 500 subjects from the UK Biobank dataset, where we show that it improves segmentation performance in terms of topological correctness without sacrificing pixelwise accuracy.
Differentiable programming is able to combine different functions or programs in a processing pipeline with the goal of applying end-to-end learning or optimization. A significant impediment is the non-differentiable nature of some algorithms. We propose to use synthetic gradients (SG) to overcome this difficulty. SG uses the universal function approximation property of neural networks. We apply SG to combine convolutional neural network (CNN) with dynamic programming (DP) in end-to-end learning for segmenting left ventricle from short axis view of heart MRI. Our experiments show that end-to-end combination of CNN and DP requires fewer labeled images to achieve a significantly better segmentation accuracy than using only CNN.
Quantitative assessment of left ventricle (LV) function from cine MRI has significant diagnostic and prognostic value for cardiovascular disease patients. The temporal movement of LV provides essential information on the contracting/relaxing pattern of heart, which is keenly evaluated by clinical experts in clinical practice. Inspired by the expert way of viewing Cine MRI, we propose a new CNN module that is able to incorporate the temporal information into LV segmentation from cine MRI. In the proposed CNN, the optical flow (OF) between neighboring frames is integrated and aggregated at feature level, such that temporal coherence in cardiac motion can be taken into account during segmentation. The proposed module is integrated into the U-net architecture without need of additional training. Furthermore, dilated convolution is introduced to improve the spatial accuracy of segmentation. Trained and tested on the Cardiac Atlas database, the proposed network resulted in a Dice index of 95% and an average perpendicular distance of 0.9 pixels for the middle LV contour, significantly outperforming the original U-net that processes each frame individually. Notably, the proposed method improved the temporal coherence of LV segmentation results, especially at the LV apex and base where the cardiac motion is difficult to follow.
Segmentation of the left ventricle and quantification of various cardiac contractile functions is crucial for the timely diagnosis and treatment of cardiovascular diseases. Traditionally, the two tasks have been tackled independently. Here we propose a convolutional neural network based multi-task learning approach to perform both tasks simultaneously, such that, the network learns better representation of the data with improved generalization performance. Probabilistic formulation of the problem enables learning the task uncertainties during the training, which are used to automatically compute the weights for the tasks. We performed a five fold cross-validation of the myocardium segmentation obtained from the proposed multi-task network on 97 patient 4-dimensional cardiac cine-MRI datasets available through the STACOM LV segmentation challenge against the provided gold-standard myocardium segmentation, obtaining a Dice overlap of $0.849 \pm 0.036$ and mean surface distance of $0.274 \pm 0.083$ mm, while simultaneously estimating the myocardial area with mean absolute difference error of $205\pm198$ mm$^2$.
In the United States, heart disease is the leading cause of death for both men and women, accounting for 610,000 deaths each year [1]. Physicians use Magnetic Resonance Imaging (MRI) scans to take images of the heart in order to non-invasively estimate its structural and functional parameters for cardiovascular diagnosis and disease management. The end-systolic volume (ESV) and end-diastolic volume (EDV) of the left ventricle (LV), and the ejection fraction (EF) are indicators of heart disease. These measures can be derived from the segmented contours of the LV; thus, consistent and accurate segmentation of the LV from MRI images are critical to the accuracy of the ESV, EDV, and EF, and to non-invasive cardiac disease detection. In this work, various image preprocessing techniques, model configurations using the U-Net deep learning architecture, postprocessing methods, and approaches for volume estimation are investigated. An end-to-end analytics pipeline with multiple stages is provided for automated LV segmentation and volume estimation. First, image data are reformatted and processed from DICOM and NIfTI formats to raw images in array format. Secondly, raw images are processed with multiple image preprocessing methods and cropped to include only the Region of Interest (ROI). Thirdly, preprocessed images are segmented using U-Net models. Lastly, post processing of segmented images to remove extra contours along with intelligent slice and frame selection are applied, followed by calculation of the ESV, EDV, and EF. This analytics pipeline is implemented and runs on a distributed computing environment with a GPU cluster at the San Diego Supercomputer Center at UCSD.
Precise segmentation of the left ventricle (LV) within cardiac MRI images is a prerequisite for the quantitative measurement of heart function. However, this task is challenging due to the limited availability of labeled data and motion artifacts from cardiac imaging. In this work, we present an iterative segmentation algorithm for LV delineation. By coupling deep learning with a novel dynamic-based labeling scheme, we present a new methodology where a policy model is learned to guide an agent to travel over the the image, tracing out a boundary of the ROI -- using the magnitude difference of the Poincar\'e map as a stopping criterion. Our method is evaluated on two datasets, namely the Sunnybrook Cardiac Dataset (SCD) and data from the STACOM 2011 LV segmentation challenge. Our method outperforms the previous research over many metrics. In order to demonstrate the transferability of our method we present encouraging results over the STACOM 2011 data, when using a model trained on the SCD dataset.
Multi-atlas segmentation approach is one of the most widely-used image segmentation techniques in biomedical applications. There are two major challenges in this category of methods, i.e., atlas selection and label fusion. In this paper, we propose a novel multi-atlas segmentation method that formulates multi-atlas segmentation in a deep learning framework for better solving these challenges. The proposed method, dubbed deep fusion net (DFN), is a deep architecture that integrates a feature extraction subnet and a non-local patch-based label fusion (NL-PLF) subnet in a single network. The network parameters are learned by end-to-end training for automatically learning deep features that enable optimal performance in a NL-PLF framework. The learned deep features are further utilized in defining a similarity measure for atlas selection. By evaluating on two public cardiac MR datasets of SATA-13 and LV-09 for left ventricle segmentation, our approach achieved 0.833 in averaged Dice metric (ADM) on SATA-13 dataset and 0.95 in ADM for epicardium segmentation on LV-09 dataset, comparing favorably with the other automatic left ventricle segmentation methods. We also tested our approach on Cardiac Atlas Project (CAP) testing set of MICCAI 2013 SATA Segmentation Challenge, and our method achieved 0.815 in ADM, ranking highest at the time of writing.