Deep learning for cardiac image segmentation: A review

Deep learning has become the most widely used approach for cardiac image segmentation in recent years. In this paper, we provide a review of over 100 cardiac image segmentation papers using deep learning, which covers common imaging modalities including magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound (US) and major anatomical structures of interest (ventricles, atria and vessels). In addition, a summary of publicly available cardiac image datasets and code repositories are included to provide a base for encouraging reproducible research. Finally, we discuss the challenges and limitations with current deep learning-based approaches (scarcity of labels, model generalizability across different domains, interpretability) and suggest potential directions for future research

Improving the domain generalization and robustness of neural networks for medical imaging

Deep neural networks are powerful tools to process medical images, with great potential to accelerate clinical workflows and facilitate large-scale studies. However, in order to achieve satisfactory performance at deployment, these networks generally require massive labeled data collected from various domains (e.g., hospitals, scanners), which is rarely available in practice. The main goal of this work is to improve the domain generalization and robustness of neural networks for medical imaging when labeled data is limited. First, we develop multi-task learning methods to exploit auxiliary data to enhance networks. We first present a multi-task U-net that performs image classification and MR atrial segmentation simultaneously. We then present a shape-aware multi-view autoencoder together with a multi-view U-net, which enables extracting useful shape priors from complementary long-axis views and short-axis views in order to assist the left ventricular myocardium segmentation task on the short-axis MR images. Experimental results show that the proposed networks successfully leverage complementary information from auxiliary tasks to improve model generalization on the main segmentation task. Second, we consider utilizing unlabeled data. We first present an adversarial data augmentation method with bias fields to improve semi-supervised learning for general medical image segmentation tasks. We further explore a more challenging setting where the source and the target images are from different data distributions. We demonstrate that an unsupervised image style transfer method can bridge the domain gap, successfully transferring the knowledge learned from labeled balanced Steady-State Free Precession (bSSFP) images to unlabeled Late Gadolinium Enhancement (LGE) images, achieving state-of-the-art performance on a public multi-sequence cardiac MR segmentation challenge. For scenarios with limited training data from a single domain, we first propose a general training and testing pipeline to improve cardiac image segmentation across various unseen domains. We then present a latent space data augmentation method with a cooperative training framework to further enhance model robustness against unseen domains and imaging artifacts.Open Acces

Automated Diagnosis of Cardiovascular Diseases from Cardiac Magnetic Resonance Imaging Using Deep Learning Models: A Review

In recent years, cardiovascular diseases (CVDs) have become one of the leading causes of mortality globally. CVDs appear with minor symptoms and progressively get worse. The majority of people experience symptoms such as exhaustion, shortness of breath, ankle swelling, fluid retention, and other symptoms when starting CVD. Coronary artery disease (CAD), arrhythmia, cardiomyopathy, congenital heart defect (CHD), mitral regurgitation, and angina are the most common CVDs. Clinical methods such as blood tests, electrocardiography (ECG) signals, and medical imaging are the most effective methods used for the detection of CVDs. Among the diagnostic methods, cardiac magnetic resonance imaging (CMR) is increasingly used to diagnose, monitor the disease, plan treatment and predict CVDs. Coupled with all the advantages of CMR data, CVDs diagnosis is challenging for physicians due to many slices of data, low contrast, etc. To address these issues, deep learning (DL) techniques have been employed to the diagnosis of CVDs using CMR data, and much research is currently being conducted in this field. This review provides an overview of the studies performed in CVDs detection using CMR images and DL techniques. The introduction section examined CVDs types, diagnostic methods, and the most important medical imaging techniques. In the following, investigations to detect CVDs using CMR images and the most significant DL methods are presented. Another section discussed the challenges in diagnosing CVDs from CMR data. Next, the discussion section discusses the results of this review, and future work in CVDs diagnosis from CMR images and DL techniques are outlined. The most important findings of this study are presented in the conclusion section

LegoNet: Alternating Model Blocks for Medical Image Segmentation

Since the emergence of convolutional neural networks (CNNs), and later vision transformers (ViTs), the common paradigm for model development has always been using a set of identical block types with varying parameters/hyper-parameters. To leverage the benefits of different architectural designs (e.g. CNNs and ViTs), we propose to alternate structurally different types of blocks to generate a new architecture, mimicking how Lego blocks can be assembled together. Using two CNN-based and one SwinViT-based blocks, we investigate three variations to the so-called LegoNet that applies the new concept of block alternation for the segmentation task in medical imaging. We also study a new clinical problem which has not been investigated before, namely the right internal mammary artery (RIMA) and perivascular space segmentation from computed tomography angiography (CTA) which has demonstrated a prognostic value to major cardiovascular outcomes. We compare the model performance against popular CNN and ViT architectures using two large datasets (e.g. achieving 0.749 dice similarity coefficient (DSC) on the larger dataset). We evaluate the performance of the model on three external testing cohorts as well, where an expert clinician made corrections to the model segmented results (DSC>0.90 for the three cohorts). To assess our proposed model for suitability in clinical use, we perform intra- and inter-observer variability analysis. Finally, we investigate a joint self-supervised learning approach to assess its impact on model performance. The code and the pretrained model weights will be available upon acceptance.Comment: 12 pages, 5 figures, 4 table

Simultaneous left atrium anatomy and scar segmentations via deep learning in multiview information with attention

Three-dimensional late gadolinium enhanced (LGE) cardiac MR (CMR) of left atrial scar in patients with atrial fibrillation (AF) has recently emerged as a promising technique to stratify patients, to guide ablation therapy and to predict treatment success. This requires a segmentation of the high intensity scar tissue and also a segmentation of the left atrium (LA) anatomy, the latter usually being derived from a separate bright-blood acquisition. Performing both segmentations automatically from a single 3D LGE CMR acquisition would eliminate the need for an additional acquisition and avoid subsequent registration issues. In this paper, we propose a joint segmentation method based on multiview two-task (MVTT) recursive attention model working directly on 3D LGE CMR images to segment the LA (and proximal pulmonary veins) and to delineate the scar on the same dataset. Using our MVTT recursive attention model, both the LA anatomy and scar can be segmented accurately (mean Dice score of 93% for the LA anatomy and 87% for the scar segmentations) and efficiently (0.27 s to simultaneously segment the LA anatomy and scars directly from the 3D LGE CMR dataset with 60–68 2D slices). Compared to conventional unsupervised learning and other state-of-the-art deep learning based methods, the proposed MVTT model achieved excellent results, leading to an automatic generation of a patient-specific anatomical model combined with scar segmentation for patients in AF

Deep learning for unsupervised domain adaptation in medical imaging: Recent advancements and future perspectives

Deep learning has demonstrated remarkable performance across various tasks in medical imaging. However, these approaches primarily focus on supervised learning, assuming that the training and testing data are drawn from the same distribution. Unfortunately, this assumption may not always hold true in practice. To address these issues, unsupervised domain adaptation (UDA) techniques have been developed to transfer knowledge from a labeled domain to a related but unlabeled domain. In recent years, significant advancements have been made in UDA, resulting in a wide range of methodologies, including feature alignment, image translation, self-supervision, and disentangled representation methods, among others. In this paper, we provide a comprehensive literature review of recent deep UDA approaches in medical imaging from a technical perspective. Specifically, we categorize current UDA research in medical imaging into six groups and further divide them into finer subcategories based on the different tasks they perform. We also discuss the respective datasets used in the studies to assess the divergence between the different domains. Finally, we discuss emerging areas and provide insights and discussions on future research directions to conclude this survey.Comment: Under Revie

Deep Learning Paradigm and Its Bias for Coronary Artery Wall Segmentation in Intravascular Ultrasound Scans: A Closer Look

Background and motivation: Coronary artery disease (CAD) has the highest mortality rate; therefore, its diagnosis is vital. Intravascular ultrasound (IVUS) is a high-resolution imaging solution that can image coronary arteries, but the diagnosis software via wall segmentation and quantification has been evolving. In this study, a deep learning (DL) paradigm was explored along with its bias. Methods: Using a PRISMA model, 145 best UNet-based and non-UNet-based methods for wall segmentation were selected and analyzed for their characteristics and scientific and clinical validation. This study computed the coronary wall thickness by estimating the inner and outer borders of the coronary artery IVUS cross-sectional scans. Further, the review explored the bias in the DL system for the first time when it comes to wall segmentation in IVUS scans. Three bias methods, namely (i) ranking, (ii) radial, and (iii) regional area, were applied and compared using a Venn diagram. Finally, the study presented explainable AI (XAI) paradigms in the DL framework. Findings and conclusions: UNet provides a powerful paradigm for the segmentation of coronary walls in IVUS scans due to its ability to extract automated features at different scales in encoders, reconstruct the segmented image using decoders, and embed the variants in skip connections. Most of the research was hampered by a lack of motivation for XAI and pruned AI (PAI) models. None of the UNet models met the criteria for bias-free design. For clinical assessment and settings, it is necessary to move from a paper-to-practice approach