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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.

Background. Fully automatic analysis of myocardial perfusion MRI datasets enables rapid and objective reporting of stress/rest studies in patients with suspected ischemic heart disease. Developing deep learning techniques that can analyze multi-center datasets despite limited training data and variations in software and hardware is an ongoing challenge. Methods. Datasets from 3 medical centers acquired at 3T (n = 150 subjects) were included: an internal dataset (inD; n = 95) and two external datasets (exDs; n = 55) used for evaluating the robustness of the trained deep neural network (DNN) models against differences in pulse sequence (exD-1) and scanner vendor (exD-2). A subset of inD (n = 85) was used for training/validation of a pool of DNNs for segmentation, all using the same spatiotemporal U-Net architecture and hyperparameters but with different parameter initializations. We employed a space-time sliding-patch analysis approach that automatically yields a pixel-wise "uncertainty map" as a byproduct of the segmentation process. In our approach, a given test case is segmented by all members of the DNN pool and the resulting uncertainty maps are leveraged to automatically select the "best" one among the pool of solutions. Results. The proposed DAUGS analysis approach performed similarly to the established approach on the internal dataset (p = n.s.) whereas it significantly outperformed on the external datasets (p < 0.005 for exD-1 and exD-2). Moreover, the number of image series with "failed" segmentation was significantly lower for the proposed vs. the established approach (4.3% vs. 17.1%, p < 0.0005). Conclusions. The proposed DAUGS analysis approach has the potential to improve the robustness of deep learning methods for segmentation of multi-center stress perfusion datasets with variations in the choice of pulse sequence, site location or scanner vendor., Comment: Accepted for publication in JCMR, 2024

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., Comment: Accepted for publication in MICCAI 2023

PURPOSE: To present and assess an outlier mitigation method that makes free-running volumetric cardiovascular MRI (CMR) more robust to motion. METHODS: The proposed method, called compressive recovery with outlier rejection (CORe), models outliers in the measured data as an additive auxiliary variable. We enforce MR physics-guided group sparsity on the auxiliary variable, and jointly estimate it along with the image using an iterative algorithm. For evaluation, CORe is first compared to traditional compressed sensing (CS), robust regression (RR), and an existing outlier rejection method using two simulation studies. Then, CORe is compared to CS using seven three-dimensional (3D) cine, 12 rest four-dimensional (4D) flow, and eight stress 4D flow imaging datasets. RESULTS: Our simulation studies show that CORe outperforms CS, RR, and the existing outlier rejection method in terms of normalized mean square error and structural similarity index across 55 different realizations. The expert reader evaluation of 3D cine images demonstrates that CORe is more effective in suppressing artifacts while maintaining or improving image sharpness. Finally, 4D flow images show that CORe yields more reliable and consistent flow measurements, especially in the presence of involuntary subject motion or exercise stress. CONCLUSION: An outlier rejection method is presented and tested using simulated and measured data. This method can help suppress motion artifacts in a wide range of free-running CMR applications. CODE & DATA: Implementation code and datasets are available on GitHub at http://github.com/OSU-MR/motion-robust-CMR

Background: Several studies have shown that both respiratory and cardiac motion can be extracted from the Pilot Tone (PT) signal successfully. However, most of these studies were performed in healthy volunteers. In addition, validating PT using ECG as a reference can be problematic because both PT and ECG tend to be unreliable in patients with arrhythmias. Purpose: We seek to evaluate the accuracy and reliability of the cardiac and respiratory signals extracted from PT in patients clinically referred for cardiovascular MRI with the image-derived signals as the reference. Methods: Twenty-three patients were scanned on a 1.5 T scanner using balanced steady-state free-precession real-time (RT) cine sequence. The PT signal was generated by a built-in PT transmitter integrated within the body array coil. For comparison, commercial ECG and BioMatrix (BM) respiratory sensor signals were synchronously recorded. Results: The respiratory motion extracted from PT correlated positively with the image-derived respiratory signal in all cases and showed a stronger correlation (absolute coefficient: 0.95+-0.09) than BM (0.72+-0.24). For the cardiac signal, PT trigger jitter (standard deviation of PT trigger locations relative to ECG triggers) ranged from 6.6 to 83.3 ms, with a median of 21.8 ms. The mean absolute difference between the PT and corresponding ECG cardiac cycle duration was less than 5% of the averaged ECG RR interval for 21 out of 23 patients. Overall, the performance of PT-based trigger extraction was comparable to that of ECG. We did not observe significant linear dependence (p>0.28) of PT delay and PT jitter on the patients' BMI or cardiac cycle duration. Conclusions: This study demonstrates the potential of PT to monitor both respiratory and cardiac motion in patients clinically referred for cardiovascular MRI.

Purpose: To develop a fully automatic method for extraction and directionality determination of respiratory signal in free-breathing, real-time (RT) cardiac MRI. Methods: The respiratory signal is extracted by a principal component analysis method from RT cine images. Then, a two-step procedure is used to determine the directionality (sign) of the respiratory signal. First, the signal polarity of all slices is made consistent with a reference slice. Second, a global sign correction is performed by maximizing the correlation of the respiratory signal with the zeroth-moment center curve. The proposed method is evaluated in multi-slice RT cine from eleven volunteers and two patients. The motion in a manually selected region-of-interest is used as reference. Results: The extracted respiratory signal using the proposed method exhibits high, positive correlation with the reference in all cases and is more robust compared to a recently proposed method. To demonstrate its clinical utility, the method is used to identify heartbeats from inspiratory and expiratory phases and, in turn, to account for respiration-induced changes in the cardiac output. Conclusions: The proposed method enables fully automatic extraction and directionality determinations of respiratory signal from RT cardiac cine images, allowing accurate cardiac function quantification.

Cardiovascular MRI (CMR) is a non-invasive imaging modality that provides excellent soft-tissue contrast without the use of ionizing radiation. Physiological motions and limited speed of MRI data acquisition necessitate development of accelerated methods, which typically rely on undersampling. Recovering diagnostic quality CMR images from highly undersampled data has been an active area of research. Recently, several data acquisition and processing methods have been proposed to accelerate CMR. The availability of data to objectively evaluate and compare different reconstruction methods could expedite innovation and promote clinical translation of these methods. In this work, we introduce an open-access dataset, called OCMR, that provides multi-coil k-space data from 53 fully sampled and 212 prospectively undersampled cardiac cine series.

Purpose: To develop and validate an acquisition and processing technique that enables fully self-gated 4D flow imaging with whole-heart coverage in a fixed five-minute scan. Theory and Methods: The data are acquired continuously using Cartesian sampling and sorted into respiratory and cardiac bins using the self-gating signal. The reconstruction is performed using a recently proposed Bayesian method called ReVEAL4D. ReVEAL4D is validated using data from eight healthy volunteers and two patients and compared with a compressed sensing technique, L1-SENSE. Results: Healthy subjects -- Compared to 2D phase-contrast MRI (2D-PC), flow quantification from ReVEAL4D shows no significant bias. In contrast, the peak velocity and peak flow rate for L1-SENSE are significantly underestimated. Compared to traditional parallel MRI-based 4D flow imaging, ReVEAL4D demonstrates small but significant biases in net flow and peak flow rate, with no significant bias in peak velocity. All three indices are significantly and more markedly underestimated by L1-SENSE. Patients -- Flow quantification from ReVEAL4D agrees well with the 2D-PC reference. In contrast, L1-SENSE markedly underestimated peak velocity. Conclusions: The combination of highly accelerated five-minute Cartesian acquisition, self-gating, and ReVEAL4D enables whole-heart 4D flow imaging with accurate flow quantification.

In real-time (RT) cardiac cine imaging, a stack of 2D slices is collected sequentially under free-breathing conditions. A complete heartbeat from each slice is then used for cardiac function quantification. The inter-slice respiratory mismatch can compromise accurate quantification of cardiac function. Methods based on principal components analysis (PCA) have been proposed to extract the respiratory signal from RT cardiac cine, but these methods cannot resolve the inter-slice sign ambiguity of the respiratory signal. In this work, we propose a fully automatic sign correction procedure based on the similarity of neighboring slices and correlation to the center-of-mass curve. The proposed method is evaluated in eleven volunteers, with ten slices per volunteer. The motion in a manually selected region-of-interest (ROI) is used as a reference. The results show that the extracted respiratory signal has a high, positive correlation with the reference in all cases. The qualitative assessment of images also shows that the proposed approach can accurately identify heartbeats, one from each slice, belonging to the same respiratory phase. This approach can improve cardiac function quantification for RT cine without manual intervention., Comment: IEEE ISBI 2020, International Symposium on Biomedical Imaging

Accurate measurement of spatially variant noise in dynamic magnetic resonance (MR) images acquired using parallel imaging methods is problematic. We propose a new method based on the random matrix theory to accurately assess the noise level. The method is validated using numerical simulation and in-vivo dynamic cardiac MR images., Comment: This paper has been withdrawn by the authors, due to a crucial error in Eqn. 2

Dimensional reduction of high dimensional data can be achieved by keeping only the relevant eigenmodes after principal component analysis. However, differentiating relevant eigenmodes from the random noise eigenmodes is problematic. A new method based on the random matrix theory and a statistical goodness-of-fit test is proposed in this paper. It is validated by numerical simulations and applied to real-time magnetic resonance cardiac cine images., Comment: 7 pages, 5 figures