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Meritxell Bach Cuadra

Publications and source records attributed to Meritxell Bach Cuadra.

At least 55 records · Page 3Linked to original sources

Domain generalization in fetal brain MRI segmentation \\with multi-reconstruction augmentation

Quantitative analysis of in utero human brain development is crucial for abnormal characterization. Magnetic resonance image (MRI) segmentation is therefore an asset for quantitative analysis. However, the development of automated segmentation methods is hampered by the scarce availability of fetal brain MRI annotated datasets and the limited variability within these cohorts. In this context, we propose to leverage the power of fetal brain MRI super-resolution (SR) reconstruction methods to generate multiple reconstructions of a single subject with different parameters, thus as an efficient tuning-free data augmentation strategy. Overall, the latter significantly improves the generalization of segmentation methods over SR pipelines.

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Self-Supervised Isotropic Superresolution Fetal Brain MRI

Superresolution T2-weighted fetal-brain magnetic-resonance imaging (FBMRI) traditionally relies on the availability of several orthogonal low-resolution series of 2-dimensional thick slices (volumes). In practice, only a few low-resolution volumes are acquired. Thus, optimization-based image-reconstruction methods require strong regularization using hand-crafted regularizers (e.g., TV). Yet, due to in utero fetal motion and the rapidly changing fetal brain anatomy, the acquisition of the high-resolution images that are required to train supervised learning methods is difficult. In this paper, we sidestep this difficulty by providing a proof of concept of a self-supervised single-volume superresolution framework for T2-weighted FBMRI (SAIR). We validate SAIR quantitatively in a motion-free simulated environment. Our results for different noise levels and resolution ratios suggest that SAIR is comparable to multiple-volume superresolution reconstruction methods. We also evaluate SAIR qualitatively on clinical FBMRI data. The results suggest SAIR could be incorporated into current reconstruction pipelines.

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Novel structural-scale uncertainty measures and error retention curves: application to multiple sclerosis

This paper focuses on the uncertainty estimation for white matter lesions (WML) segmentation in magnetic resonance imaging (MRI). On one side, voxel-scale segmentation errors cause the erroneous delineation of the lesions; on the other side, lesion-scale detection errors lead to wrong lesion counts. Both of these factors are clinically relevant for the assessment of multiple sclerosis patients. This work aims to compare the ability of different voxel- and lesion-scale uncertainty measures to capture errors related to segmentation and lesion detection, respectively. Our main contributions are (i) proposing new measures of lesion-scale uncertainty that do not utilise voxel-scale uncertainties; (ii) extending an error retention curves analysis framework for evaluation of lesion-scale uncertainty measures. Our results obtained on the multi-center testing set of 58 patients demonstrate that the proposed lesion-scale measure achieves the best performance among the analysed measures. All code implementations are provided at https://github.com/NataliiaMolch/MS_WML_uncs

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Spatio-temporal motion correction and iterative reconstruction of in-utero fetal fMRI

Resting-state functional Magnetic Resonance Imaging (fMRI) is a powerful imaging technique for studying functional development of the brain in utero. However, unpredictable and excessive movement of fetuses have limited its clinical applicability. Previous studies have focused primarily on the accurate estimation of the motion parameters employing a single step 3D interpolation at each individual time frame to recover a motion-free 4D fMRI image. Using only information from a 3D spatial neighborhood neglects the temporal structure of fMRI and useful information from neighboring timepoints. Here, we propose a novel technique based on four dimensional iterative reconstruction of the motion scattered fMRI slices. Quantitative evaluation of the proposed method on a cohort of real clinical fetal fMRI data indicates improvement of reconstruction quality compared to the conventional 3D interpolation approaches.

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Shifts 2.0: Extending The Dataset of Real Distributional Shifts

Distributional shift, or the mismatch between training and deployment data, is a significant obstacle to the usage of machine learning in high-stakes industrial applications, such as autonomous driving and medicine. This creates a need to be able to assess how robustly ML models generalize as well as the quality of their uncertainty estimates. Standard ML baseline datasets do not allow these properties to be assessed, as the training, validation and test data are often identically distributed. Recently, a range of dedicated benchmarks have appeared, featuring both distributionally matched and shifted data. Among these benchmarks, the Shifts dataset stands out in terms of the diversity of tasks as well as the data modalities it features. While most of the benchmarks are heavily dominated by 2D image classification tasks, Shifts contains tabular weather forecasting, machine translation, and vehicle motion prediction tasks. This enables the robustness properties of models to be assessed on a diverse set of industrial-scale tasks and either universal or directly applicable task-specific conclusions to be reached. In this paper, we extend the Shifts Dataset with two datasets sourced from industrial, high-risk applications of high societal importance. Specifically, we consider the tasks of segmentation of white matter Multiple Sclerosis lesions in 3D magnetic resonance brain images and the estimation of power consumption in marine cargo vessels. Both tasks feature ubiquitous distributional shifts and a strict safety requirement due to the high cost of errors. These new datasets will allow researchers to further explore robust generalization and uncertainty estimation in new situations. In this work, we provide a description of the dataset and baseline results for both tasks.

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Validation and Generalizability of Self-Supervised Image Reconstruction Methods for Undersampled MRI

Deep learning methods have become the state of the art for undersampled MR reconstruction. Particularly for cases where it is infeasible or impossible for ground truth, fully sampled data to be acquired, self-supervised machine learning methods for reconstruction are becoming increasingly used. However potential issues in the validation of such methods, as well as their generalizability, remain underexplored. In this paper, we investigate important aspects of the validation of self-supervised algorithms for reconstruction of undersampled MR images: quantitative evaluation of prospective reconstructions, potential differences between prospective and retrospective reconstructions, suitability of commonly used quantitative metrics, and generalizability. Two self-supervised algorithms based on self-supervised denoising and the deep image prior were investigated. These methods are compared to a least squares fitting and a compressed sensing reconstruction using in-vivo and phantom data. Their generalizability was tested with prospectively under-sampled data from experimental conditions different to the training. We show that prospective reconstructions can exhibit significant distortion relative to retrospective reconstructions/ground truth. Furthermore, pixel-wise quantitative metrics may not capture differences in perceptual quality accurately, in contrast to a perceptual metric. In addition, all methods showed potential for generalization; however, generalizability is more affected by changes in anatomy/contrast than other changes. We further showed that no-reference image metrics correspond well with human rating of image quality for studying generalizability. Finally, we showed that a well-tuned compressed sensing reconstruction and learned denoising perform similarly on all data.

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Slice estimation in diffusion MRI of neonatal and fetal brains in image and spherical harmonics domains using autoencoders

Diffusion MRI (dMRI) of the developing brain can provide valuable insights into the white matter development. However, slice thickness in fetal dMRI is typically high (i.e., 3-5 mm) to freeze the in-plane motion, which reduces the sensitivity of the dMRI signal to the underlying anatomy. In this study, we aim at overcoming this problem by using autoencoders to learn unsupervised efficient representations of brain slices in a latent space, using raw dMRI signals and their spherical harmonics (SH) representation. We first learn and quantitatively validate the autoencoders on the developing Human Connectome Project pre-term newborn data, and further test the method on fetal data. Our results show that the autoencoder in the signal domain better synthesized the raw signal. Interestingly, the fractional anisotropy and, to a lesser extent, the mean diffusivity, are best recovered in missing slices by using the autoencoder trained with SH coefficients. A comparison was performed with the same maps reconstructed using an autoencoder trained with raw signals, as well as conventional interpolation methods of raw signals and SH coefficients. From these results, we conclude that the recovery of missing/corrupted slices should be performed in the signal domain if the raw signal is aimed to be recovered, and in the SH domain if diffusion tensor properties (i.e., fractional anisotropy) are targeted. Notably, the trained autoencoders were able to generalize to fetal dMRI data acquired using a much smaller number of diffusion gradients and a lower b-value, where we qualitatively show the consistency of the estimated diffusion tensor maps.

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Towards automated brain aneurysm detection in TOF-MRA: open data, weak labels, and anatomical knowledge

Brain aneurysm detection in Time-Of-Flight Magnetic Resonance Angiography (TOF-MRA) has undergone drastic improvements with the advent of Deep Learning (DL). However, performances of supervised DL models heavily rely on the quantity of labeled samples, which are extremely costly to obtain. Here, we present a DL model for aneurysm detection that overcomes the issue with ''weak'' labels: oversized annotations which are considerably faster to create. Our weak labels resulted to be four times faster to generate than their voxel-wise counterparts. In addition, our model leverages prior anatomical knowledge by focusing only on plausible locations for aneurysm occurrence. We frst train and evaluate our model through cross-validation on an in-house TOF-MRA dataset comprising 284 subjects (170 females / 127 healthy controls / 157 patients with 198 aneurysms). On this dataset, our best model achieved a sensitivity of 83%, with False Positive (FP) rate of 0.8 per patient. To assess model generalizability, we then participated in a challenge for aneurysm detection with TOF-MRA data (93 patients, 20 controls, 125 aneurysms). On the public challenge, sensitivity was 68% (FP rate=2.5), ranking 4th/18 on the open leaderboard. We found no signifcant diference in sensitivity between aneurysm risk-of-rupture groups (p=0.75), locations (p=0.72), or sizes (p=0.15). Data, code and model weights are released under permissive licenses. We demonstrate that weak labels and anatomical knowledge can alleviate the necessity for prohibitively expensive voxel-wise annotations.

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Multi-dimensional topological loss for cortical plate segmentation in fetal brain MRI

The fetal cortical plate (CP) undergoes drastic morphological changes during the in utero development. Therefore, CP growth and folding patterns are key indicator in the assessment of the brain development and maturation. Magnetic resonance imaging (MRI) offers specific insights for the analysis of quantitative imaging biomarkers. Nonetheless, accurate and, more importantly, topologically correct MR image segmentation remains the key baseline to such analysis. In this study, we propose a deep learning segmentation framework for automatic and morphologically consistent segmentation of the CP in fetal brain MRI. Our contribution is two fold. First, we generalized a multi-dimensional topological loss function in order to enhance the topological accuracy. Second, we introduced hole ratio, a new topology-based validation measure that quantifies the size of the topological defects taking into account the size of the structure of interest. Using two publicly available datasets, we quantitatively evaluated our proposed method based on three complementary metrics which are overlap-, distance- and topology-based on 27 fetal brains. Our results evidence that our topology-integrative framework outperforms state-of-the-art training loss functions on super-resolution reconstructed clinical MRI, not only in shape correctness but also in the classical evaluation metrics. Furthermore, results on additional 31 out-of-domain SR reconstructions from clinical acquisitions were qualitatively assessed by three experts. The experts' consensus ranked our TopoCP method as the best segmentation in 100\% of the cases with a high inter-expert agreement. Overall, both quantitative and qualitative results, on a wide range of gestational ages and number of cases, support the generalizability and added value of our topology-guided framework for fetal CP segmentation.

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Fetal Brain Tissue Annotation and Segmentation Challenge Results

In-utero fetal MRI is emerging as an important tool in the diagnosis and analysis of the developing human brain. Automatic segmentation of the developing fetal brain is a vital step in the quantitative analysis of prenatal neurodevelopment both in the research and clinical context. However, manual segmentation of cerebral structures is time-consuming and prone to error and inter-observer variability. Therefore, we organized the Fetal Tissue Annotation (FeTA) Challenge in 2021 in order to encourage the development of automatic segmentation algorithms on an international level. The challenge utilized FeTA Dataset, an open dataset of fetal brain MRI reconstructions segmented into seven different tissues (external cerebrospinal fluid, grey matter, white matter, ventricles, cerebellum, brainstem, deep grey matter). 20 international teams participated in this challenge, submitting a total of 21 algorithms for evaluation. In this paper, we provide a detailed analysis of the results from both a technical and clinical perspective. All participants relied on deep learning methods, mainly U-Nets, with some variability present in the network architecture, optimization, and image pre- and post-processing. The majority of teams used existing medical imaging deep learning frameworks. The main differences between the submissions were the fine tuning done during training, and the specific pre- and post-processing steps performed. The challenge results showed that almost all submissions performed similarly. Four of the top five teams used ensemble learning methods. However, one team's algorithm performed significantly superior to the other submissions, and consisted of an asymmetrical U-Net network architecture. This paper provides a first of its kind benchmark for future automatic multi-tissue segmentation algorithms for the developing human brain in utero.

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Cortical lesions, central vein sign, and paramagnetic rim lesions in multiple sclerosis: emerging machine learning techniques and future avenues

The current multiple sclerosis (MS) diagnostic criteria lack specificity, and this may lead to misdiagnosis, which remains an issue in present-day clinical practice. In addition, conventional biomarkers only moderately correlate with MS disease progression. Recently, advanced MS lesional imaging biomarkers such as cortical lesions (CL), the central vein sign (CVS), and paramagnetic rim lesions (PRL), visible in specialized magnetic resonance imaging (MRI) sequences, have shown higher specificity in differential diagnosis. Moreover, studies have shown that CL and PRL are potential prognostic biomarkers, the former correlating with cognitive impairments and the latter with early disability progression. As machine learning-based methods have achieved extraordinary performance in the assessment of conventional imaging biomarkers, such as white matter lesion segmentation, several automated or semi-automated methods have been proposed for CL, CVS, and PRL as well. In the present review, we first introduce these advanced MS imaging biomarkers and their imaging methods. Subsequently, we describe the corresponding machine learning-based methods that were used to tackle these clinical questions, putting them into context with respect to the challenges they are still facing, including non-standardized MRI protocols, limited datasets, and moderate inter-rater variability. We conclude by presenting the current limitations that prevent their broader deployment and suggesting future research directions.

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4D iterative reconstruction of brain fMRI in the moving fetus

Resting-state functional Magnetic Resonance Imaging (fMRI) is a powerful imaging technique for studying functional development of the brain in utero. However, unpredictable and excessive movement of fetuses has limited clinical application since it causes substantial signal fluctuations which can systematically alter observed patterns of functional connectivity. Previous studies have focused on the accurate estimation of the motion parameters in case of large fetal head movement and used a 3D single step interpolation approach at each timepoint to recover motion-free fMRI images. This does not guarantee that the reconstructed image corresponds to the minimum error representation of fMRI time series given the acquired data. Here, we propose a novel technique based on four dimensional iterative reconstruction of the scattered slices acquired during fetal fMRI. The accuracy of the proposed method was quantitatively evaluated on a group of real clinical fMRI fetuses. The results indicate improvements of reconstruction quality compared to the conventional 3D interpolation approach.

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Synthetic magnetic resonance images for domain adaptation: Application to fetal brain tissue segmentation

The quantitative assessment of the developing human brain in utero is crucial to fully understand neurodevelopment. Thus, automated multi-tissue fetal brain segmentation algorithms are being developed, which in turn require annotated data to be trained. However, the available annotated fetal brain datasets are limited in number and heterogeneity, hampering domain adaptation strategies for robust segmentation. In this context, we use FaBiAN, a Fetal Brain magnetic resonance Acquisition Numerical phantom, to simulate various realistic magnetic resonance images of the fetal brain along with its class labels. We demonstrate that these multiple synthetic annotated data, generated at no cost and further reconstructed using the target super-resolution technique, can be successfully used for domain adaptation of a deep learning method that segments seven brain tissues. Overall, the accuracy of the segmentation is significantly enhanced, especially in the cortical gray matter, the white matter, the cerebellum, the deep gray matter and the brain stem.

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FaBiAN: A Fetal Brain magnetic resonance Acquisition Numerical phantom

Accurate characterization of in utero human brain maturation is critical as it involves complex and interconnected structural and functional processes that may influence health later in life. Magnetic resonance imaging is a powerful tool to investigate equivocal neurological patterns during fetal development. However, the number of acquisitions of satisfactory quality available in this cohort of sensitive subjects remains scarce, thus hindering the validation of advanced image processing techniques. Numerical phantoms can mitigate these limitations by providing a controlled environment with a known ground truth. In this work, we present FaBiAN, an open-source Fetal Brain magnetic resonance Acquisition Numerical phantom that simulates clinical T2-weighted fast spin echo sequences of the fetal brain. This unique tool is based on a general, flexible and realistic setup that includes stochastic fetal movements, thus providing images of the fetal brain throughout maturation comparable to clinical acquisitions. We demonstrate its value to evaluate the robustness and optimize the accuracy of an algorithm for super-resolution fetal brain magnetic resonance imaging from simulated motion-corrupted 2D low-resolution series as compared to a synthetic high-resolution reference volume. We also show that the images generated can complement clinical datasets to support data-intensive deep learning methods for fetal brain tissue segmentation.

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An automatic multi-tissue human fetal brain segmentation benchmark using the Fetal Tissue Annotation Dataset

It is critical to quantitatively analyse the developing human fetal brain in order to fully understand neurodevelopment in both normal fetuses and those with congenital disorders. To facilitate this analysis, automatic multi-tissue fetal brain segmentation algorithms are needed, which in turn requires open databases of segmented fetal brains. Here we introduce a publicly available database of 50 manually segmented pathological and non-pathological fetal magnetic resonance brain volume reconstructions across a range of gestational ages (20 to 33 weeks) into 7 different tissue categories (external cerebrospinal fluid, grey matter, white matter, ventricles, cerebellum, deep grey matter, brainstem/spinal cord). In addition, we quantitatively evaluate the accuracy of several automatic multi-tissue segmentation algorithms of the developing human fetal brain. Four research groups participated, submitting a total of 10 algorithms, demonstrating the benefits the database for the development of automatic algorithms.

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An anatomically-informed 3D CNN for brain aneurysm classification with weak labels

A commonly adopted approach to carry out detection tasks in medical imaging is to rely on an initial segmentation. However, this approach strongly depends on voxel-wise annotations which are repetitive and time-consuming to draw for medical experts. An interesting alternative to voxel-wise masks are so-called "weak" labels: these can either be coarse or oversized annotations that are less precise, but noticeably faster to create. In this work, we address the task of brain aneurysm detection as a patch-wise binary classification with weak labels, in contrast to related studies that rather use supervised segmentation methods and voxel-wise delineations. Our approach comes with the non-trivial challenge of the data set creation: as for most focal diseases, anomalous patches (with aneurysm) are outnumbered by those showing no anomaly, and the two classes usually have different spatial distributions. To tackle this frequent scenario of inherently imbalanced, spatially skewed data sets, we propose a novel, anatomically-driven approach by using a multi-scale and multi-input 3D Convolutional Neural Network (CNN). We apply our model to 214 subjects (83 patients, 131 controls) who underwent Time-Of-Flight Magnetic Resonance Angiography (TOF-MRA) and presented a total of 111 unruptured cerebral aneurysms. We compare two strategies for negative patch sampling that have an increasing level of difficulty for the network and we show how this choice can strongly affect the results. To assess whether the added spatial information helps improving performances, we compare our anatomically-informed CNN with a baseline, spatially-agnostic CNN. When considering the more realistic and challenging scenario including vessel-like negative patches, the former model attains the highest classification results (accuracy$\simeq$95\%, AUROC$\simeq$0.95, AUPR$\simeq$0.71), thus outperforming the baseline.

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Segmentation of the cortical plate in fetal brain MRI with a topological loss

The fetal cortical plate undergoes drastic morphological changes throughout early in utero development that can be observed using magnetic resonance (MR) imaging. An accurate MR image segmentation, and more importantly a topologically correct delineation of the cortical gray matter, is a key baseline to perform further quantitative analysis of brain development. In this paper, we propose for the first time the integration of a topological constraint, as an additional loss function, to enhance the morphological consistency of a deep learning-based segmentation of the fetal cortical plate. We quantitatively evaluate our method on 18 fetal brain atlases ranging from 21 to 38 weeks of gestation, showing the significant benefits of our method through all gestational ages as compared to a baseline method. Furthermore, qualitative evaluation by three different experts on 130 randomly selected slices from 26 clinical MRIs evidences the out-performance of our method independently of the MR reconstruction quality.

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Automated Detection of Cortical Lesions in Multiple Sclerosis Patients with 7T MRI

The automated detection of cortical lesions (CLs) in patients with multiple sclerosis (MS) is a challenging task that, despite its clinical relevance, has received very little attention. Accurate detection of the small and scarce lesions requires specialized sequences and high or ultra-high field MRI. For supervised training based on multimodal structural MRI at 7T, two experts generated ground truth segmentation masks of 60 patients with 2014 CLs. We implemented a simplified 3D U-Net with three resolution levels (3D U-Net-). By increasing the complexity of the task (adding brain tissue segmentation), while randomly dropping input channels during training, we improved the performance compared to the baseline. Considering a minimum lesion size of 0.75 μL, we achieved a lesion-wise cortical lesion detection rate of 67% and a false positive rate of 42%. However, 393 (24%) of the lesions reported as false positives were post-hoc confirmed as potential or definite lesions by an expert. This indicates the potential of the proposed method to support experts in the tedious process of CL manual segmentation.

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