Placenta volume measured from 3D ultrasound (3DUS) images is an important tool for tracking the growth trajectory and is associated with pregnancy outcomes. Manual segmentation is the gold standard, but it is time-consuming and subjective. Although fully automated deep learning algorithms perform well, they do not always yield high-quality results for each case. Interactive segmentation models could address this issue. However, there is limited work on interactive segmentation models for the placenta. Despite their segmentation accuracy, these methods may not be feasible for clinical use as they require relatively large computational power which may be especially prohibitive in low-resource environments, or on mobile devices. In this paper, we propose a lightweight interactive segmentation model aiming for clinical use to interactively segment the placenta from 3DUS images in real-time. The proposed model adopts the segmentation from our fully automated model for initialization and is designed in a human-in-the-loop manner to achieve iterative improvements. The Dice score and normalized surface Dice are used as evaluation metrics. The results show that our model can achieve superior performance in segmentation compared to state-of-the-art models while using significantly fewer parameters. Additionally, the proposed model is much faster for inference and robust to poor initial masks. The code is available at https://github.com/MedICL-VU/PRISM-placenta.
Placenta volume measurement from 3D ultrasound images is critical for predicting pregnancy outcomes, and manual annotation is the gold standard. However, such manual annotation is expensive and time-consuming. Automated segmentation algorithms can often successfully segment the placenta, but these methods may not consistently produce robust segmentations suitable for practical use. Recently, inspired by the Segment Anything Model (SAM), deep learning-based interactive segmentation models have been widely applied in the medical imaging domain. These models produce a segmentation from visual prompts provided to indicate the target region, which may offer a feasible solution for practical use. However, none of these models are specifically designed for interactively segmenting 3D ultrasound images, which remain challenging due to the inherent noise of this modality. In this paper, we evaluate publicly available state-of-the-art 3D interactive segmentation models in contrast to a human-in-the-loop approach for the placenta segmentation task. The Dice score, normalized surface Dice, averaged symmetric surface distance, and 95-percent Hausdorff distance are used as evaluation metrics. We consider a Dice score of 0.95 a successful segmentation. Our results indicate that the human-in-the-loop segmentation model reaches this standard. Moreover, we assess the efficiency of the human-in-the-loop model as a function of the amount of prompts. Our results demonstrate that the human-in-the-loop model is both effective and efficient for interactive placenta segmentation. The code is available at \url{https://github.com/MedICL-VU/PRISM-placenta}.
Purpose: Ultrasound is the most commonly used medical imaging modality for diagnosis and screening in clinical practice. Due to its safety profile, noninvasive nature and portability, ultrasound is the primary imaging modality for fetal assessment in pregnancy. Current ultrasound processing methods are either manual or semi-automatic and are therefore laborious, time-consuming and prone to errors, and automation would go a long way in addressing these challenges. Automated identification of placental changes at earlier gestation could facilitate potential therapies for conditions such as fetal growth restriction and pre-eclampsia that are currently detected only at late gestational age, potentially preventing perinatal morbidity and mortality. Methods: We propose an automatic three-dimensional multi-modal (B-mode and power Doppler) ultrasound segmentation of the human placenta using deep learning combined with different fusion strategies.We collected data containing Bmode and power Doppler ultrasound scans for 400 studies. Results: We evaluated different fusion strategies and state-of-the-art image segmentation networks for placenta segmentation based on standard overlap- and boundary-based metrics. We found that multimodal information in the form of B-mode and power Doppler scans outperform any single modality. Furthermore, we found that B-mode and power Doppler input scans fused at the data level provide the best results with a mean Dice Similarity Coefficient (DSC) of 0.849. Conclusion: We conclude that the multi-modal approach of combining B-mode and power Doppler scans is effective in segmenting the placenta from 3D ultrasound scans in a fully automated manner and is robust to quality variation of the datasets.
[Purpose] To develop a fully automated semantic placenta segmentation model that integrates the U-Net and SegNeXt architectures through ensemble learning. [Methods] A total of 218 pregnant women with suspected placental anomalies who underwent magnetic resonance imaging (MRI) were enrolled, yielding 1090 annotated images for developing a deep learning model for placental segmentation. The images were standardized and divided into training and test sets. The performance of PlaNet-S, which integrates U-Net and SegNeXt within an ensemble framework, was assessed using Intersection over Union (IoU) and counting connected components (CCC) against the U-Net model. [Results] PlaNet-S had significantly higher IoU (0.73 +/- 0.13) than that of U-Net (0.78 +/- 0.010) (p<0.01). The CCC for PlaNet-S was significantly higher than that for U-Net (p<0.01), matching the ground truth in 86.0\% and 56.7\% of the cases, respectively. [Conclusion]PlaNet-S performed better than the traditional U-Net in placental segmentation tasks. This model addresses the challenges of time-consuming physician-assisted manual segmentation and offers the potential for diverse applications in placental imaging analyses.
Blood oxygen level dependent (BOLD) MRI time series with maternal hyperoxia can assess placental oxygenation and function. Measuring precise BOLD changes in the placenta requires accurate temporal placental segmentation and is confounded by fetal and maternal motion, contractions, and hyperoxia-induced intensity changes. Current BOLD placenta segmentation methods warp a manually annotated subject-specific template to the entire time series. However, as the placenta is a thin, elongated, and highly non-rigid organ subject to large deformations and obfuscated edges, existing work cannot accurately segment the placental shape, especially near boundaries. In this work, we propose a machine learning segmentation framework for placental BOLD MRI and apply it to segmenting each volume in a time series. We use a placental-boundary weighted loss formulation and perform a comprehensive evaluation across several popular segmentation objectives. Our model is trained and tested on a cohort of 91 subjects containing healthy fetuses, fetuses with fetal growth restriction, and mothers with high BMI. Biomedically, our model performs reliably in segmenting volumes in both normoxic and hyperoxic points in the BOLD time series. We further find that boundary-weighting increases placental segmentation performance by 8.3% and 6.0% Dice coefficient for the cross-entropy and signed distance transform objectives, respectively. Our code and trained model is available at https://github.com/mabulnaga/automatic-placenta-segmentation.
The placenta plays a crucial role in fetal development. Automated 3D placenta segmentation from fetal EPI MRI holds promise for advancing prenatal care. This paper proposes an effective semi-supervised learning method for improving placenta segmentation in fetal EPI MRI time series. We employ consistency regularization loss that promotes consistency under spatial transformation of the same image and temporal consistency across nearby images in a time series. The experimental results show that the method improves the overall segmentation accuracy and provides better performance for outliers and hard samples. The evaluation also indicates that our method improves the temporal coherency of the prediction, which could lead to more accurate computation of temporal placental biomarkers. This work contributes to the study of the placenta and prenatal clinical decision-making. Code is available at https://github.com/firstmover/cr-seg.
Deep learning techniques depend on large datasets whose annotation is time-consuming. To reduce annotation burden, the self-training (ST) and active-learning (AL) methods have been developed as well as methods that combine them in an iterative fashion. However, it remains unclear when each method is the most useful, and when it is advantageous to combine them. In this paper, we propose a new method that combines ST with AL using Test-Time Augmentations (TTA). First, TTA is performed on an initial teacher network. Then, cases for annotation are selected based on the lowest estimated Dice score. Cases with high estimated scores are used as soft pseudo-labels for ST. The selected annotated cases are trained with existing annotated cases and ST cases with border slices annotations. We demonstrate the method on MRI fetal body and placenta segmentation tasks with different data variability characteristics. Our results indicate that ST is highly effective for both tasks, boosting performance for in-distribution (ID) and out-of-distribution (OOD) data. However, while self-training improved the performance of single-sequence fetal body segmentation when combined with AL, it slightly deteriorated performance of multi-sequence placenta segmentation on ID data. AL was helpful for the high variability placenta data, but did not improve upon random selection for the single-sequence body data. For fetal body segmentation sequence transfer, combining AL with ST following ST iteration yielded a Dice of 0.961 with only 6 original scans and 2 new sequence scans. Results using only 15 high-variability placenta cases were similar to those using 50 cases. Code is available at: https://github.com/Bella31/TTA-quality-estimation-ST-AL
Volumetric measurements of fetal structures in MRI are time consuming and error prone and therefore require automatic segmentation. Placenta segmentation and accurate fetal brain segmentation for gyrification assessment are particularly challenging because of the placenta fuzzy boundaries and the fetal brain cortex complex foldings. In this paper, we study the use of the Contour Dice loss for both problems and compare it to other boundary losses and to the combined Dice and Cross-Entropy loss. The loss is computed efficiently for each slice via erosion, dilation and XOR operators. We describe a new formulation of the loss akin to the Contour Dice metric. The combination of the Dice loss and the Contour Dice yielded the best performance for placenta segmentation. For fetal brain segmentation, the best performing loss was the combined Dice with Cross-Entropy loss followed by the Dice with Contour Dice loss, which performed better than other boundary losses.
Blood oxygen level dependent (BOLD) MRI with maternal hyperoxia can assess oxygen transport within the placenta and has emerged as a promising tool to study placental function. Measuring signal changes over time requires segmenting the placenta in each volume of the time series. Due to the large number of volumes in the BOLD time series, existing studies rely on registration to map all volumes to a manually segmented template. As the placenta can undergo large deformation due to fetal motion, maternal motion, and contractions, this approach often results in a large number of discarded volumes, where the registration approach fails. In this work, we propose a machine learning model based on a U-Net neural network architecture to automatically segment the placenta in BOLD MRI and apply it to segmenting each volume in a time series. We use a boundary-weighted loss function to accurately capture the placental shape. Our model is trained and tested on a cohort of 91 subjects containing healthy fetuses, fetuses with fetal growth restriction, and mothers with high BMI. We achieve a Dice score of 0.83+/-0.04 when matching with ground truth labels and our model performs reliably in segmenting volumes in both normoxic and hyperoxic points in the BOLD time series. Our code and trained model are available at https://github.com/mabulnaga/automatic-placenta-segmentation.
Automatic segmentation of the placenta in fetal ultrasound (US) is challenging due to the (i) high diversity of placenta appearance, (ii) the restricted quality in US resulting in highly variable reference annotations, and (iii) the limited field-of-view of US prohibiting whole placenta assessment at late gestation. In this work, we address these three challenges with a multi-task learning approach that combines the classification of placental location (e.g., anterior, posterior) and semantic placenta segmentation in a single convolutional neural network. Through the classification task the model can learn from larger and more diverse datasets while improving the accuracy of the segmentation task in particular in limited training set conditions. With this approach we investigate the variability in annotations from multiple raters and show that our automatic segmentations (Dice of 0.86 for anterior and 0.83 for posterior placentas) achieve human-level performance as compared to intra- and inter-observer variability. Lastly, our approach can deliver whole placenta segmentation using a multi-view US acquisition pipeline consisting of three stages: multi-probe image acquisition, image fusion and image segmentation. This results in high quality segmentation of larger structures such as the placenta in US with reduced image artifacts which are beyond the field-of-view of single probes.
Accurate medical image segmentation is essential for diagnosis, surgical planning and many other applications. Convolutional Neural Networks (CNNs) have become the state-of-the-art automatic segmentation methods. However, fully automatic results may still need to be refined to become accurate and robust enough for clinical use. We propose a deep learning-based interactive segmentation method to improve the results obtained by an automatic CNN and to reduce user interactions during refinement for higher accuracy. We use one CNN to obtain an initial automatic segmentation, on which user interactions are added to indicate mis-segmentations. Another CNN takes as input the user interactions with the initial segmentation and gives a refined result. We propose to combine user interactions with CNNs through geodesic distance transforms, and propose a resolution-preserving network that gives a better dense prediction. In addition, we integrate user interactions as hard constraints into a back-propagatable Conditional Random Field. We validated the proposed framework in the context of 2D placenta segmentation from fetal MRI and 3D brain tumor segmentation from FLAIR images. Experimental results show our method achieves a large improvement from automatic CNNs, and obtains comparable and even higher accuracy with fewer user interventions and less time compared with traditional interactive methods.