Search

Since the rise of deep learning, new medical segmentation methods have rapidly been proposed with extremely promising results, often reporting marginal improvements on the previous state-of-the-art (SOTA) method. However, on visual inspection errors are often revealed, such as topological mistakes (e.g. holes or folds), that are not detected using traditional evaluation metrics. Incorrect topology can often lead to errors in clinically required downstream image processing tasks. Therefore, there is a need for new methods to focus on ensuring segmentations are topologically correct. In this work, we present TEDS-Net: a segmentation network that preserves anatomical topology whilst maintaining segmentation performance that is competitive with SOTA baselines. Further, we show how current SOTA segmentation methods can introduce problematic topological errors. TEDS-Net achieves anatomically plausible segmentation by using learnt topology-preserving fields to deform a prior. Traditionally, topology-preserving fields are described in the continuous domain and begin to break down when working in the discrete domain. Here, we introduce additional modifications that more strictly enforce topology preservation. We illustrate our method on an open-source medical heart dataset, performing both single and multi-structure segmentation, and show that the generated fields contain no folding voxels, which corresponds to full topology preservation on individual structures whilst vastly outperforming the other baselines on overall scene topology. The code is available at: https://github.com/mwyburd/TEDS-Net., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Three-dimensional (3D) ultrasound imaging has contributed to our understanding of fetal developmental processes by providing rich contextual information of the inherently 3D anatomies. However, its use is limited in clinical settings, due to the high purchasing costs and limited diagnostic practicality. Freehand 2D ultrasound imaging, in contrast, is routinely used in standard obstetric exams, but inherently lacks a 3D representation of the anatomies, which limits its potential for more advanced assessment. Such full representations are challenging to recover even with external tracking devices due to internal fetal movement which is independent from the operator-led trajectory of the probe. Capitalizing on the flexibility offered by freehand 2D ultrasound acquisition, we propose ImplicitVol to reconstruct 3D volumes from non-sensor-tracked 2D ultrasound sweeps. Conventionally, reconstructions are performed on a discrete voxel grid. We, however, employ a deep neural network to represent, for the first time, the reconstructed volume as an implicit function. Specifically, ImplicitVol takes a set of 2D images as input, predicts their locations in 3D space, jointly refines the inferred locations, and learns a full volumetric reconstruction. When testing natively-acquired and volume-sampled 2D ultrasound video sequences collected from different manufacturers, the 3D volumes reconstructed by ImplicitVol show significantly better visual and semantic quality than the existing interpolation-based reconstruction approaches. The inherent continuity of implicit representation also enables ImplicitVol to reconstruct the volume to arbitrarily high resolutions. As formulated, ImplicitVol has the potential to integrate seamlessly into the clinical workflow, while providing richer information for diagnosis and evaluation of the developing brain., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Maturation of the human fetal brain should follow precisely scheduled structural growth and folding of the cerebral cortex for optimal postnatal function 1 . We present a normative digital atlas of fetal brain maturation based on a prospective international cohort of healthy pregnant women 2 , selected using World Health Organization recommendations for growth standards 3 . Their fetuses were accurately dated in the first trimester, with satisfactory growth and neurodevelopment from early pregnancy to 2 years of age 4,5 . The atlas was produced using 1,059 optimal quality, three-dimensional ultrasound brain volumes from 899 of the fetuses and an automated analysis pipeline 6-8 . The atlas corresponds structurally to published magnetic resonance images 9 , but with finer anatomical details in deep grey matter. The between-study site variability represented less than 8.0% of the total variance of all brain measures, supporting pooling data from the eight study sites to produce patterns of normative maturation. We have thereby generated an average representation of each cerebral hemisphere between 14 and 31 weeks' gestation with quantification of intracranial volume variability and growth patterns. Emergent asymmetries were detectable from as early as 14 weeks, with peak asymmetries in regions associated with language development and functional lateralization between 20 and 26 weeks' gestation. These patterns were validated in 1,487 three-dimensional brain volumes from 1,295 different fetuses in the same cohort. We provide a unique spatiotemporal benchmark of fetal brain maturation from a large cohort with normative postnatal growth and neurodevelopment., (© 2023. The Author(s).)

Objective: Obesity is a significant risk factor for adverse outcomes following coronavirus infection (COVID-19). However, BMI fails to capture differences in the body fat distribution, the critical driver of metabolic health. Conventional statistical methodologies lack functionality to investigate the causality between fat distribution and disease outcomes. Methods: We applied Bayesian network (BN) modelling to explore the mechanistic link between body fat deposition and hospitalisation risk in 459 participants with COVID-19 (395 non-hospitalised and 64 hospitalised). MRI-derived measures of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and liver fat were included. Conditional probability queries were performed to estimate the probability of hospitalisation after fixing the value of specific network variables. Results: The probability of hospitalisation was 18% higher in people living with obesity than those with normal weight, with elevated VAT being the primary determinant of obesity-related risk. Across all BMI categories, elevated VAT and liver fat (>10%) were associated with a 39% mean increase in the probability of hospitalisation. Among those with normal weight, reducing liver fat content from >10% to <5% reduced hospitalisation risk by 29%. Conclusion: Body fat distribution is a critical determinant of COVID-19 hospitalisation risk. BN modelling and probabilistic inferences assist our understanding of the mechanistic associations between imaging-derived phenotypes and COVID-19 hospitalisation risk., Competing Interests: TW is a shareholder and employee at Perspectum; HT-B is a shareholder and employee at Perspectum; MB is a shareholder and executive at Perspectum; DC received investigator-initiated research funding from AstraZeneca plc and Novo Nordisk A/S; and JD is the Scientific Director at the Centre for Sustainable Health Research University, Quebec, Canada. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Waddell, Namburete, Duckworth, Eichert, Thomaides-Brears, Cuthbertson, Despres and Brady.)

Combining deep learning image analysis methods and large-scale imaging datasets offers many opportunities to neuroscience imaging and epidemiology. However, despite these opportunities and the success of deep learning when applied to a range of neuroimaging tasks and domains, significant barriers continue to limit the impact of large-scale datasets and analysis tools. Here, we examine the main challenges and the approaches that have been explored to overcome them. We focus on issues relating to data availability, interpretability, evaluation, and logistical challenges and discuss the problems that still need to be tackled to enable the success of "big data" deep learning approaches beyond research., Competing Interests: Declaration of interests M.J. receives royalties from licensing of FSL to non-academic, commercial parties., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Acquisition of high quality manual annotations is vital for the development of segmentation algorithms. However, to create them we require a substantial amount of expert time and knowledge. Large numbers of labels are required to train convolutional neural networks due to the vast number of parameters that must be learned in the optimisation process. Here, we develop the STAMP algorithm to allow the simultaneous training and pruning of a UNet architecture for medical image segmentation with targeted channelwise dropout to make the network robust to the pruning. We demonstrate the technique across segmentation tasks and imaging modalities. It is then shown that, through online pruning, we are able to train networks to have much higher performance than the equivalent standard UNet models while reducing their size by more than 85% in terms of parameters. This has the potential to allow networks to be directly trained on datasets where very low numbers of labels are available., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Mark Jenkinson receives royalties from licencing of FSL to non-academic, commercial parties., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Research on segmentation of the hippocampus in magnetic resonance images through deep learning convolutional neural networks (CNNs) shows promising results, suggesting that these methods can identify small structural abnormalities of the hippocampus, which are among the earliest and most frequent brain changes associated with Alzheimer disease (AD). However, CNNs typically achieve the highest accuracy on datasets acquired from the same domain as the training dataset. Transfer learning allows domain adaptation through further training on a limited dataset. In this study, we applied transfer learning on a network called spatial warping network segmentation (SWANS), developed and trained in a previous study. We used MR images of patients with clinical diagnoses of mild cognitive impairment (MCI) and AD, segmented by two different raters. By using transfer learning techniques, we developed four new models, using different training methods. Testing was performed using 26% of the original dataset, which was excluded from training as a hold-out test set. In addition, 10% of the overall training dataset was used as a hold-out validation set. Results showed that all the new models achieved better hippocampal segmentation quality than the baseline SWANS model (p s  < .001), with high similarity to the manual segmentations (mean dice [best model] = 0.878 ± 0.003). The best model was chosen based on visual assessment and volume percentage error (VPE). The increased precision in estimating hippocampal volumes allows the detection of small hippocampal abnormalities already present in the MCI phase (SD = [3.9 ± 0.6]%), which may be crucial for early diagnosis., (© 2022 The Authors. Human Brain Mapping published by Wiley Periodicals LLC.)

The quantification of subcortical volume development from 3D fetal ultrasound can provide important diagnostic information during pregnancy monitoring. However, manual segmentation of subcortical structures in ultrasound volumes is time-consuming and challenging due to low soft tissue contrast, speckle and shadowing artifacts. For this reason, we developed a convolutional neural network (CNN) for the automated segmentation of the choroid plexus (CP), lateral posterior ventricle horns (LPVH), cavum septum pellucidum et vergae (CSPV), and cerebellum (CB) from 3D ultrasound. As ground-truth labels are scarce and expensive to obtain, we applied few-shot learning, in which only a small number of manual annotations (n = 9) are used to train a CNN. We compared training a CNN with only a few individually annotated volumes versus many weakly labelled volumes obtained from atlas-based segmentations. This showed that segmentation performance close to intra-observer variability can be obtained with only a handful of manual annotations. Finally, the trained models were applied to a large number (n = 278) of ultrasound image volumes of a diverse, healthy population, obtaining novel US-specific growth curves of the respective structures during the second trimester of gestation., (Copyright © 2022. Published by Elsevier Inc.)

In fetal neurosonography, aligning two-dimensional (2D) ultrasound scans to their corresponding plane in the three-dimensional (3D) space remains a challenging task. In this paper, we propose a convolutional neural network that predicts the position of 2D ultrasound fetal brain scans in 3D atlas space. Instead of purely supervised learning that requires heavy annotations for each 2D scan, we train the model by sampling 2D slices from 3D fetal brain volumes, and target the model to predict the inverse of the sampling process, resembling the idea of self-supervised learning. We propose a model that takes a set of images as input, and learns to compare them in pairs. The pairwise comparison is weighted by the attention module based on its contribution to the prediction, which is learnt implicitly during training. The feature representation for each image is thus computed by incorporating the relative position information to all the other images in the set, and is later used for the final prediction. We benchmark our model on 2D slices sampled from 3D fetal brain volumes at 18-22 weeks' gestational age. Using three evaluation metrics, namely, Euclidean distance, plane angles and normalized cross correlation, which account for both the geometric and appearance discrepancy between the ground-truth and prediction, in all these metrics, our model outperforms a baseline model by as much as 23%, when the number of input images increases. We further demonstrate that our model generalizes to (i) real 2D standard transthalamic plane images, achieving comparable performance as human annotations, as well as (ii) video sequences of 2D freehand fetal brain scans., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Increasingly large MRI neuroimaging datasets are becoming available, including many highly multi-site multi-scanner datasets. Combining the data from the different scanners is vital for increased statistical power; however, this leads to an increase in variance due to nonbiological factors such as the differences in acquisition protocols and hardware, which can mask signals of interest. We propose a deep learning based training scheme, inspired by domain adaptation techniques, which uses an iterative update approach to aim to create scanner-invariant features while simultaneously maintaining performance on the main task of interest, thus reducing the influence of scanner on network predictions. We demonstrate the framework for regression, classification and segmentation tasks with two different network architectures. We show that not only can the framework harmonise many-site datasets but it can also adapt to many data scenarios, including biased datasets and limited training labels. Finally, we show that the framework can be extended for the removal of other known confounds in addition to scanner. The overall framework is therefore flexible and should be applicable to a wide range of neuroimaging studies., (Copyright © 2020. Published by Elsevier Inc.)

Objectives: Presumably, changes in fetal circulation contribute to the delay in maturation of the cortex in fetuses with congenital heart defect (CHD). The aim of the current study is to analyze fetal brain development based on hemodynamic differences, using novel brain-age prediction software., Methods: We have performed detailed neurosonography, including acquiring 3D volumes, prospectively in cases with isolated CHD from 20 weeks onwards. An algorithm that assesses the degree of fetal brain-age automatically was used to compare CHD cases to controls. We stratified CHD cases according to flow and oxygenation profiles by lesion physiology and performed subgroup analyses., Results: A total of 616 ultrasound volumes of 162 CHD cases and 75 controls were analyzed. Significant differences in maturation of the cortex were observed in cases with normal blood flow toward the brain (-3.8 days, 95%CI [-5.5; -2.0], P = <.001) and low (-4.0 days, 95% CI [-6.7; -1.2] P = <.05; hypoplastic left heart syndrome[HLHS]) and mixed (-4.4 days, 95%CI [-6.4; -2.5] p = <.001) oxygen saturation in the ascending aorta (TGA) and in cardiac mixing (eg, Fallot) cases., Conclusion: The current study shows significant delay in brain-age in TGA and Fallot cases as compared to control cases. However, the small differences found in this study questions the clinical relevance., (© 2020 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.)

Both normal ageing and neurodegenerative diseases cause morphological changes to the brain. Age-related brain changes are subtle, nonlinear, and spatially and temporally heterogenous, both within a subject and across a population. Machine learning models are particularly suited to capture these patterns and can produce a model that is sensitive to changes of interest, despite the large variety in healthy brain appearance. In this paper, the power of convolutional neural networks (CNNs) and the rich UK Biobank dataset, the largest database currently available, are harnessed to address the problem of predicting brain age. We developed a 3D CNN architecture to predict chronological age, using a training dataset of 12,802 T1-weighted MRI images and a further 6,885 images for testing. The proposed method shows competitive performance on age prediction, but, most importantly, the CNN prediction errors Δ BrainAge =Age Predicted -Age True correlated significantly with many clinical measurements from the UK Biobank in the female and male groups. In addition, having used images from only one imaging modality in this experiment, we examined the relationship between Δ BrainAge and the image-derived phenotypes (IDPs) from all other imaging modalities in the UK Biobank, showing correlations consistent with known patterns of ageing. Furthermore, we show that the use of nonlinearly registered images to train CNNs can lead to the network being driven by artefacts of the registration process and missing subtle indicators of ageing, limiting the clinical relevance. Due to the longitudinal aspect of the UK Biobank study, in the future it will be possible to explore whether the Δ BrainAge from models such as this network were predictive of any health outcomes., (Copyright © 2020. Published by Elsevier Inc.)

Fetal brain magnetic resonance imaging (MRI) offers exquisite images of the developing brain but is not suitable for second-trimester anomaly screening, for which ultrasound (US) is employed. Although expert sonographers are adept at reading US images, MR images which closely resemble anatomical images are much easier for non-experts to interpret. Thus in this article we propose to generate MR-like images directly from clinical US images. In medical image analysis such a capability is potentially useful as well, for instance for automatic US-MRI registration and fusion. The proposed model is end-to-end trainable and self-supervised without any external annotations. Specifically, based on an assumption that the US and MRI data share a similar anatomical latent space, we first utilise a network to extract the shared latent features, which are then used for MRI synthesis. Since paired data is unavailable for our study (and rare in practice), pixel-level constraints are infeasible to apply. We instead propose to enforce the distributions to be statistically indistinguishable, by adversarial learning in both the image domain and feature space. To regularise the anatomical structures between US and MRI during synthesis, we further propose an adversarial structural constraint. A new cross-modal attention technique is proposed to utilise non-local spatial information, by encouraging multi-modal knowledge fusion and propagation. We extend the approach to consider the case where 3D auxiliary information (e.g., 3D neighbours and a 3D location index) from volumetric data is also available, and show that this improves image synthesis. The proposed approach is evaluated quantitatively and qualitatively with comparison to real fetal MR images and other approaches to synthesis, demonstrating its feasibility of synthesising realistic MR images.

Introduction: Congenital heart defects are associated with neurodevelopmental delay. It is hypothesized that fetuses affected by congenital heart defect have altered cerebral oxygen perfusion and are therefore prone to delay in cortical maturation. The aim of this study was to determine the difference in fetal brain age between consecutive congenital heart defect cases and controls in the second and third trimester using ultrasound., Material and Methods: Since 2014, we have included 90 isolated severe congenital heart defect cases in the Heart And Neurodevelopment (HAND)-study. Every 4 weeks, detailed neurosonography was performed in these fetuses, including the recording of a 3D volume of the fetal brain, from 20 weeks onwards. In all, 75 healthy fetuses underwent the same protocol to serve as a control group. The volumes were analyzed by automated age prediction software which determines gestational age by the assessment of cortical maturation., Results: In total, 477 volumes were analyzed using the age prediction software (199 volumes of 90 congenital heart defect cases; 278 volumes of 75 controls). Of these, 16 (3.2%) volume recordings were excluded because of imaging quality. The age distribution was 19-33 weeks. Mixed model analysis showed that the age predicted by brain maturation was 3 days delayed compared with the control group (P = .002)., Conclusions: This study shows that fetuses with isolated cases of congenital heart defects show some delay in cortical maturation as compared with healthy control cases. The clinical relevance of this small difference is debatable. This finding was consistent throughout pregnancy and did not progress during the third trimester., (© 2019 Nordic Federation of Societies of Obstetrics and Gynecology.)

Methods for aligning 3D fetal neurosonography images must be robust to (i) intensity variations, (ii) anatomical and age-specific differences within the fetal population, and (iii) the variations in fetal position. To this end, we propose a multi-task fully convolutional neural network (FCN) architecture to address the problem of 3D fetal brain localization, structural segmentation, and alignment to a referential coordinate system. Instead of treating these tasks as independent problems, we optimize the network by simultaneously learning features shared within the input data pertaining to the correlated tasks, and later branching out into task-specific output streams. Brain alignment is achieved by defining a parametric coordinate system based on skull boundaries, location of the eye sockets, and head pose, as predicted from intracranial structures. This information is used to estimate an affine transformation to align a volumetric image to the skull-based coordinate system. Co-alignment of 140 fetal ultrasound volumes (age range: 26.0 ± 4.4 weeks) was achieved with high brain overlap and low eye localization error, regardless of gestational age or head size. The automatically co-aligned volumes show good structural correspondence between fetal anatomies., (Copyright © 2018. Published by Elsevier B.V.)