Yu, Tina Gwoing (Memorial University of Newfoundland) | Chiu, Tsung-Hong (Chang Gung Memorial Hospital) | Wijngaard, Jeroen van den (Academic Medical Center) | Hsieh, T'sang-T'ang (Chang Gung Memorial Hospital) | Weserhof, Berend E (Academic Medical Center) | Tseng, Enson (McLaren Regiional Hospital)
The propagation of blood flow along the fetoplacental arterial system has been hypothesized to have a compensatory response to placental anomalies that may result in fetal stress. When the placenta generates increased resistance, the umbilical artery blood flow would decrease and in the worst scenario become absent, which will lead to fetal asphyxia and hypoxia. To compensate for the decreased oxygen supply from maternal placenta, the fetal middle cerebral arteries would become dilated leading to an increased diastolic flow, hence more oxygen. This compensatory phase , however, only lasts for a certain period of time, after which the hypoxia may lead to fetal demise or long term irreversible organ damages. In high-risk pregnancies, Doppler ultrasound technology is commonly used to monitor the fetoplacental arterial blood flow to assess fetal well being. If the anomalies occur prior to the end of the 40-week of gestation, surgical or aggressive medical intervention might be necessary to save the fetal life. Timing this intervention, however, is complex due to the fine balancing act to minimize potential risks from prematurity and organ damage vs. rescuing a fetal life through cesarean section or aggressive medical treatment or natural delivery at the earliest possible gestational age. A reasonable goal is to allow the pregnancy to continue to the point just before fetal damage occurs. To achieve that goal, various testing criteria, e.g. venous Doppler and fetal heart rate, have been used to identify de-compensation. In this work, we conducted computer simulation of the fetoplacental arterial blood flow of a Systemic Lupus Erythematosus (SLE) pregnancy based on Doppler blood flow readings taken during the 10-day period prior to the delivery. The simulation suggests that timing the delivery based on either Doppler waveform readings or fetal heart rates give similar pregnancy outcome.
Ultrasound diagnosis is routinely used in obstetrics and gynecology for fetal biometry, and owing to its time-consuming process, there has been a great demand for automatic estimation. However, the automated analysis of ultrasound images is complicated because they are patient-specific, operator-dependent, and machine-specific. Among various types of fetal biometry, the accurate estimation of abdominal circumference (AC) is especially difficult to perform automatically because the abdomen has low contrast against surroundings, non-uniform contrast, and irregular shape compared to other parameters.We propose a method for the automatic estimation of the fetal AC from 2D ultrasound data through a specially designed convolutional neural network (CNN), which takes account of doctors' decision process, anatomical structure, and the characteristics of the ultrasound image. The proposed method uses CNN to classify ultrasound images (stomach bubble, amniotic fluid, and umbilical vein) and Hough transformation for measuring AC. We test the proposed method using clinical ultrasound data acquired from 56 pregnant women. Experimental results show that, with relatively small training samples, the proposed CNN provides sufficient classification results for AC estimation through the Hough transformation. The proposed method automatically estimates AC from ultrasound images. The method is quantitatively evaluated, and shows stable performance in most cases and even for ultrasound images deteriorated by shadowing artifacts. As a result of experiments for our acceptance check, the accuracies are 0.809 and 0.771 with the expert 1 and expert 2, respectively, while the accuracy between the two experts is 0.905. However, for cases of oversized fetus, when the amniotic fluid is not observed or the abdominal area is distorted, it could not correctly estimate AC.
Fidon, Lucas, Aertsen, Michael, Mufti, Nada, Deprest, Thomas, Emam, Doaa, Guffens, Frédéric, Schwartz, Ernst, Ebner, Michael, Prayer, Daniela, Kasprian, Gregor, David, Anna L., Melbourne, Andrew, Ourselin, Sébastien, Deprest, Jan, Langs, Georg, Vercauteren, Tom
The performance of deep neural networks typically increases with the number of training images. However, not all images have the same importance towards improved performance and robustness. In fetal brain MRI, abnormalities exacerbate the variability of the developing brain anatomy compared to non-pathological cases. A small number of abnormal cases, as is typically available in clinical datasets used for training, are unlikely to fairly represent the rich variability of abnormal developing brains. This leads machine learning systems trained by maximizing the average performance to be biased toward non-pathological cases. This problem was recently referred to as hidden stratification. To be suited for clinical use, automatic segmentation methods need to reliably achieve high-quality segmentation outcomes also for pathological cases. In this paper, we show that the state-of-the-art deep learning pipeline nnU-Net has difficulties to generalize to unseen abnormal cases. To mitigate this problem, we propose to train a deep neural network to minimize a percentile of the distribution of per-volume loss over the dataset. We show that this can be achieved by using Distributionally Robust Optimization (DRO). DRO automatically reweights the training samples with lower performance, encouraging nnU-Net to perform more consistently on all cases. We validated our approach using a dataset of 368 fetal brain T2w MRIs, including 124 MRIs of open spina bifida cases and 51 MRIs of cases with other severe abnormalities of brain development.
In this paper, we propose an end-to-end multi-task neural network called FetalNet with an attention mechanism and stacked module for spatio-temporal fetal ultrasound scan video analysis. Fetal biometric measurement is a standard examination during pregnancy used for the fetus growth monitoring and estimation of gestational age and fetal weight. The main goal in fetal ultrasound scan video analysis is to find proper standard planes to measure the fetal head, abdomen and femur. Due to natural high speckle noise and shadows in ultrasound data, medical expertise and sonographic experience are required to find the appropriate acquisition plane and perform accurate measurements of the fetus. In addition, existing computer-aided methods for fetal US biometric measurement address only one single image frame without considering temporal features. To address these shortcomings, we propose an end-to-end multi-task neural network for spatio-temporal ultrasound scan video analysis to simultaneously localize, classify and measure the fetal body parts. We propose a new encoder-decoder segmentation architecture that incorporates a classification branch. Additionally, we employ an attention mechanism with a stacked module to learn salient maps to suppress irrelevant US regions and efficient scan plane localization. We trained on the fetal ultrasound video comes from routine examinations of 700 different patients. Our method called FetalNet outperforms existing state-of-the-art methods in both classification and segmentation in fetal ultrasound video recordings.
During the millions of pregnancies that occur in the United States every year, expectant moms learn oodles about their developing fetuses over months of gestation. But the placenta, a vital and temporary organ that shelters the fetus--delivering life-sustaining nutrients and oxygen, getting rid of toxic by-products and modulating the immune system to protect the pregnancy--largely remains a mystery. A team of Children's National Health System research scientists is beginning to provide insights about the poorly understood placenta. Using three-dimensional (3D) magnetic resonance imaging (MRI), the research team characterized the shape, volume, morphometry and texture of placentas during pregnancy and, using a novel framework, predicted with high accuracy which pregnancies would be complicated by fetal growth restriction (FGR). "When the placenta fails to carry out its essential duties, both the health of the mother and fetus can suffer and, in extreme cases, the fetus can die.