242 research outputs found
Motion corrected fetal body magnetic resonance imaging provides reliable 3D lung volumes in normal and abnormal fetuses
Objectives: To calculate 3D-segmented total lung volume (TLV) in fetuses with thoracic anomalies using deformable slice-to-volume registration (DSVR) with comparison to 2D-manual segmentation. To establish a normogram of TLV calculated by DSVR in healthy control fetuses.
Methods: A pilot study at a single regional fetal medicine referral centre included 16 magnetic resonance imaging (MRI) datasets of fetuses (22–32 weeks gestational age). Diagnosis was CDH (n = 6), CPAM (n = 2), and healthy controls (n = 8). Deformable slice-to-volume registration was used for reconstruction of 3D isotropic (0.85 mm) volumes of the fetal body followed by semi-automated lung segmentation. 3D TLV were compared to traditional 2D-based volumetry. Abnormal cases referenced to a normogram produced from 100 normal fetuses whose TLV was calculated by DSVR only.
Results: Deformable slice-to-volume registration-derived TLV values have high correlation with the 2D-based measurements but with a consistently lower volume; bias −1.44 cm3 [95% limits: −2.6 to −0.3] with improved resolution to exclude hilar structures even in cases of motion corruption or very low lung volumes.
Conclusions: Deformable slice-to-volume registration for fetal lung MRI aids analysis of motion corrupted scans and does not suffer from the interpolation error inherent to 2D-segmentation. It increases information content of acquired data in terms of visualising organs in 3D space and quantification of volumes, which may improve counselling and surgical planning
Motion corrected 3D reconstruction of the fetal thorax from prenatal MRI
In this paper we present a semi-automatic method for analysis of the fetal thorax in genuine three-dimensional volumes. After one initial click we localize the spine and accurately determine the volume of the fetal lung from high resolution volumetric images reconstructed from motion corrupted prenatal Magnetic Resonance Imaging (MRI). We compare the current state-of-the-art method of segmenting the lung in a slice-by-slice manner with the most recent multi-scan reconstruction methods. We use fast rotation invariant spherical harmonics image descriptors with Classification Forest ensemble learning methods to extract the spinal cord and show an efficient way to generate a segmentation prior for the fetal lung from this information for two different MRI field strengths. The spinal cord can be segmented with a DICE coefficient of 0.89 and the automatic lung segmentation has been evaluated with a DICE coefficient of 0.87. We evaluate our method on 29 fetuses with a gestational age (GA) between 20 and 38 weeks and show that our computed segmentations and the manual ground truth correlate well with the recorded values in literature
Automated template-based brain localization and extraction for fetal brain MRI reconstruction.
Most fetal brain MRI reconstruction algorithms rely only on brain tissue-relevant voxels of low-resolution (LR) images to enhance the quality of inter-slice motion correction and image reconstruction. Consequently the fetal brain needs to be localized and extracted as a first step, which is usually a laborious and time consuming manual or semi-automatic task. We have proposed in this work to use age-matched template images as prior knowledge to automatize brain localization and extraction. This has been achieved through a novel automatic brain localization and extraction method based on robust template-to-slice block matching and deformable slice-to-template registration. Our template-based approach has also enabled the reconstruction of fetal brain images in standard radiological anatomical planes in a common coordinate space. We have integrated this approach into our new reconstruction pipeline that involves intensity normalization, inter-slice motion correction, and super-resolution (SR) reconstruction. To this end we have adopted a novel approach based on projection of every slice of the LR brain masks into the template space using a fusion strategy. This has enabled the refinement of brain masks in the LR images at each motion correction iteration. The overall brain localization and extraction algorithm has shown to produce brain masks that are very close to manually drawn brain masks, showing an average Dice overlap measure of 94.5%. We have also demonstrated that adopting a slice-to-template registration and propagation of the brain mask slice-by-slice leads to a significant improvement in brain extraction performance compared to global rigid brain extraction and consequently in the quality of the final reconstructed images. Ratings performed by two expert observers show that the proposed pipeline can achieve similar reconstruction quality to reference reconstruction based on manual slice-by-slice brain extraction. The proposed brain mask refinement and reconstruction method has shown to provide promising results in automatic fetal brain MRI segmentation and volumetry in 26 fetuses with gestational age range of 23 to 38 weeks
Brain development in fetal growth restriction: A volumetric approach using fetal MRI
Fetal growth restriction is the failure of a fetus to achieve its full growth potential, resulting in
a neonate that is small for its gestational age. The aetiology of fetal growth restriction is
varied and fetal growth restriction secondary to placental insufficiency is attributed to a
failure of trophoblast invasion leading to under perfusion of the uteroplacental bed. In
response to the adverse conditions in-utero, fetuses tend to compensate by increasing blood
flow to the essential organs such as the brain, heart, and adrenals, at the expense of other
organs (cerebral redistribution). As a consequence, growth tends to be asymmetric, with
maintenance of the head growth velocity while the other growth parameters tail off; an effect
which is also known as the ‘brain sparing effect’. Despite this apparent brain sparing effect,
children who were growth restricted in utero are at increased risk of developmental delay
and behavioural problems.
30 growth restricted and 48 normally grown fetuses were recruited into this study and were
imaged using both conventional ultrasound with Doppler assessment, as well as fetal MRI
with ssFSE sequences through the feto-placental unit and fetal brain. A dynamic approach
was taken when imaging the fetal brain to compensate for the presence of fetal motion. MR
imaging of the feto-placental unit detected significant differences in placental appearance,
significantly smaller volumes of intra-abdominal and intra-thoracic organs, and significantly
smaller regional brain growth among growth restricted fetuses.
MR studies of the placenta in fetal growth restriction demonstrated a placental phenotype in
growth restricted pregnancies that is characterised by smaller placental volumes, a
significant increase in the placental volume affected by apparent pathology on MRI and a
thickened, globular placenta. Although placental volume increased with gestation in both
groups, the placental volume remained significantly smaller in the growth restricted fetuses
(p = 0.003). There was also a significant correlation between the percentage of placental
volume affected by abnormal heterogeneity and the severity of fetal growth restriction (r =
0.82, p < 0.001), and an increase in the maximal placental thickness to placental volume
ratio above the 95th centile for gestational age was associated with fetal and early neonatal
mortality (relative risk = 7, 95%CI = 2.96 – 16.55, p < 0.001) (figure 3.6)
MR studies of fetal intra-thoracic and intra-abdominal volumes showed that although the
volume of the intra-thoracic and intra-abdonimal organs (heart, lungs, thymus, liver and
kidney) increased as gestation increased in both groups, the volumes of all three structures
remained smaller in growth restricted fetuses (p < 0.01) (Figures 4.7 - 4.9) compared with
normally grown fetuses.
MR studies of the fetal brain demonstrated smaller intracranial volume, total brain volume
and cerebellar volume in growth restricted fetuses. In addition, growth restricted fetuses with
early onset fetal growth restriction demonstrated smaller vermis height and a corresponding
increase in the tegmento-vermian angle. Growth restricted fetuses also demonstrated a
disproportionate decrease in extra- and intra-cerebral fluid.
This thesis showed evidence of changes in regional and global organ growth in growth
restricted fetuses using high resolution fetal MRI. It is hoped that future imaging studies
could offer useful insights into the origins and clinical significance of these findings and its
consequences for later neurodevelopment
Fetal body MRI and its application to fetal and neonatal treatment: an illustrative review
This Review depicts the evolving role of MRI in the diagnosis and prognostication of anomalies of the fetal body, here including head and neck, thorax, abdomen and spine. A review of the current literature on the latest developments in antenatal imaging for diagnosis and prognostication of congenital anomalies is coupled with illustrative cases in true radiological planes with viewable three-dimensional video models that show the potential of post-acquisition reconstruction protocols. We discuss the benefits and limitations of fetal MRI, from anomaly detection, to classification and prognostication, and defines the role of imaging in the decision to proceed to fetal intervention, across the breadth of included conditions. We also consider the current capabilities of ultrasound and explore how MRI and ultrasound can complement each other in the future of fetal imaging
Novel Image Processing Methods for Improved Fetal Brain MRI
Fetal magnetic resonance imaging (MRI) has been increasingly used as a powerful complement
imaging modality to ultrasound imaging (US) for the clinical evaluation of prenatal
abnormalities. Specifically, clinical application of fetal MRI has been significantly improved in
the nineties by hardware and software advances with the development of ultrafast multi-slice
T2-weighted (T2w) acquisition sequences able to freeze the unpredictable fetal motion and
provide excellent soft-tissue contrast. Fetal motion is indeed the major challenge in fetal
MRI and slice acquisition time should be kept as short as possible. As a result, typical fetal
MRI examination involves the acquisition of a set of orthogonally planned scans of thick
two-dimensional slices, largely free of intra-slice motion artifacts. The poor resolution in
the slice-select dimension as well as possible motion occurring between slices limits further
quantitative data analysis, which is the key for a better understanding of the developing
brain but also the key for the determination of operator-independent biomarkers that might
significantly facilitate fetal diagnosis and prognosis.
To this end, several research groups have developed in the past ten years advanced image
processing methods, often denoted by motion-robust super-resolution (SR) techniques, to
reconstruct from a set of clinical low-resolution (LR) scans, a high-resolution (HR) motion-free
volume. SR problem is usually modeled as a linear inverse problem describing the imaging
degradation due to acquisition and fetal motion. Typically, such approaches consist in iterating
between slice motion estimation that estimates the motion parameters and SR that recovers
the HR image given the estimated degradation model. This thesis focuses on the development
of novel advanced image processing methods, which have enabled the design of a completely
automated reconstruction pipeline for fetal MRI. The proposed techniques help in improving
state-of-the-art fetal MRI reconstruction in terms of efficiency, robustness and minimized
user-interactions, with the ultimate goal of being translated to the clinical environment.
The first part focuses on the development of a more efficient Total Variation (TV)-regularized
optimization algorithm for the SR problem. The algorithm uses recent advances in convex optimization
with a novel adaptive regularization strategy to offer simultaneously fast, accurate
and robust solutions to the fetal image recovery problem. Extensive validations on both
simulated fetal and real clinical data show the proposed algorithm is highly robust in front of
motion artifacts and that it offers the best trade-off between speed and accuracy for fetal MRI
recovery as in comparison with state-of-the art methods.
The second part focuses on the development of a novel automatic brain localization and
extraction approach based on template-to-slice block matching and deformable slice-totemplate
registration. Asmost fetal brain MRI reconstruction algorithms rely only on brain
tissue-relevant voxels of low-resolution (LR) images to enhance the quality of inter-slice motion
correction and image reconstruction, the fetal brain needs to be localized and extracted as
a first step. These tasks generally necessitate user interaction, manually or semi-automatically
done. Our methods have enabled the design of completely automated reconstruction pipeline
that involves intensity normalization, inter-slice motion estimation, and super-resolution.
Quantitative evaluation on clinical MRI scans shows that our approach produces brain masks
that are very close to manually drawn brain masks, and ratings performed by two expert
observers show that the proposed pipeline achieves similar reconstruction quality to reference
reconstruction based on manual slice-by-slice brain extraction without any further effort.
The third part investigates the possibility of automatic cortical folding quantification, one of
the best biomarkers of brain maturation, by combining our automatic reconstruction pipeline
with a state-of-the-art fetal brain tissue segmentation method and existing automated tools
provided for adult brain’s cortical folding quantification. Results indicate that our reconstruction
pipeline can provide HR MR images with sufficient quality that enable the use of surface
tessellation and active surface algorithms similar to those developed for adults to extract
meaningful information about fetal brain maturation.
Finally, the last part presents new methodological improvements of the reconstruction
pipeline aiming at improving the quality of the image for quantitative data analysis, whose
accuracy is highly dependent on the quality and resolution of the reconstructed image. In
particular, it presents a more consistent and global magnetic bias field correction method
which takes advantage of the super-resolution framework to provide a final reconstructed
image quasi free of the smooth bias field. Then, it presents a new TV SR algorithm that uses
the Huber norm in the data fidelity term to be more robust to non-Gaussian outliers. It
also presents the design of a novel joint reconstruction-segmentation framework and the
development of a novel TV SR algorithm driven by segmentation to produce images with
enhanced edge information that could ultimately improve their segmentation. Finally, it
preliminary investigates the capability of increasing the resolution in the in-plane dimensions
using SR to ultimately reduce the partial volume effect
Brain growth and development in fetuses with congenital heart disease
Introduction and Objectives: In the current era of excellent surgical results for
congenital heart disease (CHD), focus has become directed on quality of life for
these children. Previous studies have shown that neurodevelopmental outcome in
CHD is impaired. The mechanisms are incompletely understood but there is
increasing evidence that the origins of this are in fetal life. This thesis aims to
describe the in utero brain growth in a cohort of fetuses with CHD and relate this to
the circulatory abnormalities and fetal Doppler parameters.
Methods: Pregnant women with a fetus with CHD were prospectively recruited. The
congenital heart defect was phenotyped using fetal echocardiography and patients
subdivided into three physiological groups on the basis of the anticipated abnormality
of cerebral blood flow and oxygen delivery: (1) isolated reduced flow to the brain; 2)
reduced oxygen saturation of cerebral blood flow; (3) combination of reduced oxygen
and flow. Fetal brain MRI was performed. In addition to standard biometric
measurements, snapshot to volume reconstruction (SVR) was used to construct a
3D data set from the oversampled raw data. From these 3D volumes the total brain
volume and ventricular volumes were measured by manual segmentation. Serial
measurements of fetal growth were also made and umbilical artery and middle
cerebral artery Doppler parameters were analysed.
Results: 29 women were included; comparison was made with 83 normal MRI
controls. Fetuses with CHD were found to have smaller brain volumes compared to
controls when adjusting for advancing gestation (p<0.01). This difference becomes
more pronounced with advancing gestation, suggesting a slower rate of in utero
brain growth. Measurements of growth found that the fetuses with CHD were smaller
throughout gestation with a highly significant difference at the later growth scan.
(p<0.001). Cerebral and umbilical artery Doppler data showed evidence of reduced
cerebrovascular resistance in fetuses with CHD but did not show a difference in the
umbilical artery Doppler.
Conclusion: Fetuses with CHD have evidence of impaired brain growth with
advancing pregnancy and an increased rate of overall growth restriction. Doppler
evidence of cerebral vasodilation supports the mechanism of reduced oxygen
delivery as an underlying cause.Open Acces
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