Modeling 3D Cardiac Contraction and Relaxation With Point Cloud Deformation Networks.

Global single-valued biomarkers, such as ejection fraction, are widely used in clinical practice to assess cardiac function. However, they only approximate the heart's true 3D deformation process, thus limiting diagnostic accuracy and the understanding of cardiac mechanics. Metrics based on 3D shape have been proposed to alleviate these shortcomings. In this work, we present the Point Cloud Deformation Network (PCD-Net) as a novel geometric deep learning approach for direct modeling of 3D cardiac mechanics of the biventricular anatomy between the extreme ends of the cardiac cycle. Its encoder-decoder architecture combines a low-dimensional latent space with recent advances in point cloud deep learning for effective multi-scale feature learning directly on flexible and memory-efficient point cloud representations of the cardiac anatomy. We first evaluate the PCD-Net's predictive ability for both cardiac contraction and relaxation on a large U.K. Biobank dataset of over 10,000 subjects and find average Chamfer distances between the predicted and ground truth anatomies below the pixel resolution of the underlying image acquisition. We then show the PCD-Net's suitability to act as a normality model of 3D cardiac mechanics and capture subpopulation-specific differences between normal subjects and myocardial infarction (MI) patients. Next, we highlight the PCD-Net's interpretability by visualizing abnormal phenotypes between predicted normal 3D shapes and corresponding observed ones. Finally, we demonstrate that the PCD-Net's learned 3D deformation encodings outperform multiple clinical and machine learning benchmarks by 11% in terms of area under the receiver operating characteristic curve for the tasks of prevalent MI detection and incident MI prediction and by 7% in terms of Harrell's concordance index for MI survival analysis.

Towards Enabling Cardiac Digital Twins of Myocardial Infarction Using Deep Computational Models for Inverse Inference.

Cardiac digital twins (CDTs) have the potential to offer individualized evaluation of cardiac function in a non-invasive manner, making them a promising approach for personalized diagnosis and treatment planning of myocardial infarction (MI). The inference of accurate myocardial tissue properties is crucial in creating a reliable CDT of MI. In this work, we investigate the feasibility of inferring myocardial tissue properties from the electrocardiogram (ECG) within a CDT platform. The platform integrates multi-modal data, such as cardiac MRI and ECG, to enhance the accuracy and reliability of the inferred tissue properties. We perform a sensitivity analysis based on computer simulations, systematically exploring the effects of infarct location, size, degree of transmurality, and electrical activity alteration on the simulated QRS complex of ECG, to establish the limits of the approach. We subsequently present a novel deep computational model, comprising a dual-branch variational autoencoder and an inference model, to infer infarct location and distribution from the simulated QRS. The proposed model achieves mean Dice scores of 0.457 ± 0.317 and 0.302 ± 0.273 for the inference of left ventricle scars and border zone, respectively. The sensitivity analysis enhances our understanding of the complex relationship between infarct characteristics and electrophysiological features. The in silico experimental results show that the model can effectively capture the relationship for the inverse inference, with promising potential for clinical application in the future. The code is available at https: //github.com/lileitech/MI_inverse_inference.

3D Shape-Based Myocardial Infarction Prediction Using Point Cloud Classification Networks.

Myocardial infarction (MI) is one of the most prevalent cardiovascular diseases with associated clinical decision-making typically based on single-valued imaging biomarkers. However, such metrics only approximate the complex 3D structure and physiology of the heart and hence hinder a better understanding and prediction of MI outcomes. In this work, we investigate the utility of complete 3D cardiac shapes in the form of point clouds for an improved detection of MI events. To this end, we propose a fully automatic multi-step pipeline consisting of a 3D cardiac surface reconstruction step followed by a point cloud classification network. Our method utilizes recent advances in geometric deep learning on point clouds to enable direct and efficient multi-scale learning on high-resolution surface models of the cardiac anatomy. We evaluate our approach on 1068 UK Biobank subjects for the tasks of prevalent MI detection and incident MI prediction and find improvements of ∼13% and ∼5% respectively over clinical benchmarks. Furthermore, we analyze the role of each ventricle and cardiac phase for 3D shape-based MI detection and conduct a visual analysis of the morphological and physiological patterns typically associated with MI outcomes.Clinical relevance- The presented approach enables the fast and fully automatic pathology-specific analysis of full 3D cardiac shapes. It can thus be employed as a real-time diagnostic tool in clinical practice to discover and visualize more intricate biomarkers than currently used single-valued metrics and improve predictive accuracy of myocardial infarction.

Multi-class point cloud completion networks for 3D cardiac anatomy reconstruction from cine magnetic resonance images.

Cine magnetic resonance imaging (MRI) is the current gold standard for the assessment of cardiac anatomy and function. However, it typically only acquires a set of two-dimensional (2D) slices of the underlying three-dimensional (3D) anatomy of the heart, thus limiting the understanding and analysis of both healthy and pathological cardiac morphology and physiology. In this paper, we propose a novel fully automatic surface reconstruction pipeline capable of reconstructing multi-class 3D cardiac anatomy meshes from raw cine MRI acquisitions. Its key component is a multi-class point cloud completion network (PCCN) capable of correcting both the sparsity and misalignment issues of the 3D reconstruction task in a unified model. We first evaluate the PCCN on a large synthetic dataset of biventricular anatomies and observe Chamfer distances between reconstructed and gold standard anatomies below or similar to the underlying image resolution for multiple levels of slice misalignment. Furthermore, we find a reduction in reconstruction error compared to a benchmark 3D U-Net by 32% and 24% in terms of Hausdorff distance and mean surface distance, respectively. We then apply the PCCN as part of our automated reconstruction pipeline to 1000 subjects from the UK Biobank study in a cross-domain transfer setting and demonstrate its ability to reconstruct accurate and topologically plausible biventricular heart meshes with clinical metrics comparable to the previous literature. Finally, we investigate the robustness of our proposed approach and observe its capacity to successfully handle multiple common outlier conditions.

Deep Learning Segmentation of the Right Ventricle in Cardiac MRI: The M&Ms Challenge.

In recent years, several deep learning models have been proposed to accurately quantify and diagnose cardiac pathologies. These automated tools heavily rely on the accurate segmentation of cardiac structures in MRI images. However, segmentation of the right ventricle is challenging due to its highly complex shape and ill-defined borders. Hence, there is a need for new methods to handle such structure's geometrical and textural complexities, notably in the presence of pathologies such as Dilated Right Ventricle, Tricuspid Regurgitation, Arrhythmogenesis, Tetralogy of Fallot, and Inter-atrial Communication. The last MICCAI challenge on right ventricle segmentation was held in 2012 and included only 48 cases from a single clinical center. As part of the 12th Workshop on Statistical Atlases and Computational Models of the Heart (STACOM 2021), the M&Ms-2 challenge was organized to promote the interest of the research community around right ventricle segmentation in multi-disease, multi-view, and multi-center cardiac MRI. Three hundred sixty CMR cases, including short-axis and long-axis 4-chamber views, were collected from three Spanish hospitals using nine different scanners from three different vendors, and included a diverse set of right and left ventricle pathologies. The solutions provided by the participants show that nnU-Net achieved the best results overall. However, multi-view approaches were able to capture additional information, highlighting the need to integrate multiple cardiac diseases, views, scanners, and acquisition protocols to produce reliable automatic cardiac segmentation algorithms.

The Liver Tumor Segmentation Benchmark (LiTS).

In this work, we report the set-up and results of the Liver Tumor Segmentation Benchmark (LiTS), which was organized in conjunction with the IEEE International Symposium on Biomedical Imaging (ISBI) 2017 and the International Conferences on Medical Image Computing and Computer-Assisted Intervention (MICCAI) 2017 and 2018. The image dataset is diverse and contains primary and secondary tumors with varied sizes and appearances with various lesion-to-background levels (hyper-/hypo-dense), created in collaboration with seven hospitals and research institutions. Seventy-five submitted liver and liver tumor segmentation algorithms were trained on a set of 131 computed tomography (CT) volumes and were tested on 70 unseen test images acquired from different patients. We found that not a single algorithm performed best for both liver and liver tumors in the three events. The best liver segmentation algorithm achieved a Dice score of 0.963, whereas, for tumor segmentation, the best algorithms achieved Dices scores of 0.674 (ISBI 2017), 0.702 (MICCAI 2017), and 0.739 (MICCAI 2018). Retrospectively, we performed additional analysis on liver tumor detection and revealed that not all top-performing segmentation algorithms worked well for tumor detection. The best liver tumor detection method achieved a lesion-wise recall of 0.458 (ISBI 2017), 0.515 (MICCAI 2017), and 0.554 (MICCAI 2018), indicating the need for further research. LiTS remains an active benchmark and resource for research, e.g., contributing the liver-related segmentation tasks in http://medicaldecathlon.com/. In addition, both data and online evaluation are accessible via https://competitions.codalab.org/competitions/17094.

Multi-Domain Variational Autoencoders for Combined Modeling of MRI-Based Biventricular Anatomy and ECG-Based Cardiac Electrophysiology.

Human cardiac function is characterized by a complex interplay of mechanical deformation and electrophysiological conduction. Similar to the underlying cardiac anatomy, these interconnected physiological patterns vary considerably across the human population with important implications for the effectiveness of clinical decision-making and the accuracy of computerized heart models. While many previous works have investigated this variability separately for either cardiac anatomy or physiology, this work aims to combine both aspects in a single data-driven approach and capture their intricate interdependencies in a multi-domain setting. To this end, we propose a novel multi-domain Variational Autoencoder (VAE) network to capture combined Electrocardiogram (ECG) and Magnetic Resonance Imaging (MRI)-based 3D anatomy information in a single model. Each VAE branch is specifically designed to address the particular challenges of the respective input domain, enabling efficient encoding, reconstruction, and synthesis of multi-domain cardiac signals. Our method achieves high reconstruction accuracy on a United Kingdom Biobank dataset, with Chamfer Distances between reconstructed and input anatomies below the underlying image resolution and ECG reconstructions outperforming multiple single-domain benchmarks by a considerable margin. The proposed VAE is capable of generating realistic virtual populations of arbitrary size with good alignment in clinical metrics between the synthesized and gold standard anatomies and Maximum Mean Discrepancy (MMD) scores of generated ECGs below those of comparable single-domain approaches. Furthermore, we observe the latent space of our VAE to be highly interpretable with separate components encoding different aspects of anatomical and ECG variability. Finally, we demonstrate that the combined anatomy and ECG representation improves the performance in a cardiac disease classification task by 3.9% in terms of Area Under the Receiver Operating Characteristic (AUROC) curve over the best corresponding single-domain modeling approach.

Interpretable cardiac anatomy modeling using variational mesh autoencoders.

Cardiac anatomy and function vary considerably across the human population with important implications for clinical diagnosis and treatment planning. Consequently, many computer-based approaches have been developed to capture this variability for a wide range of applications, including explainable cardiac disease detection and prediction, dimensionality reduction, cardiac shape analysis, and the generation of virtual heart populations. In this work, we propose a variational mesh autoencoder (mesh VAE) as a novel geometric deep learning approach to model such population-wide variations in cardiac shapes. It embeds multi-scale graph convolutions and mesh pooling layers in a hierarchical VAE framework to enable direct processing of surface mesh representations of the cardiac anatomy in an efficient manner. The proposed mesh VAE achieves low reconstruction errors on a dataset of 3D cardiac meshes from over 1,000 patients with acute myocardial infarction, with mean surface distances between input and reconstructed meshes below the underlying image resolution. We also find that it outperforms a voxelgrid-based deep learning benchmark in terms of both mean surface distance and Hausdorff distance while requiring considerably less memory. Furthermore, we explore the quality and interpretability of the mesh VAE's latent space and showcase its ability to improve the prediction of major adverse cardiac events over a clinical benchmark. Finally, we investigate the method's ability to generate realistic virtual populations of cardiac anatomies and find good alignment between the synthesized and gold standard mesh populations in terms of multiple clinical metrics.