Intraventricular vector flow mapping (iVFM) seeks to enhance and quantify color Doppler in cardiac imaging. In this study, we propose novel alternatives to the traditional iVFM optimization scheme by utilizing physics-informed neural networks (PINNs) and a physics-guided nnU-Net-based supervised approach. When evaluated on simulated color Doppler images derived from a patient-specific computational fluid dynamics model and in vivo Doppler acquisitions, both approaches demonstrate comparable reconstruction performance to the original iVFM algorithm. The efficiency of PINNs is boosted through dual-stage optimization and pre-optimized weights. On the other hand, the nnU-Net method excels in generalizability and real-time capabilities. Notably, nnU-Net shows superior robustness on sparse and truncated Doppler data while maintaining independence from explicit boundary conditions. Overall, our results highlight the effectiveness of these methods in reconstructing intraventricular vector blood flow. The study also suggests potential applications of PINNs in ultrafast color Doppler imaging and the incorporation of fluid dynamics equations to derive biomarkers for cardiovascular diseases based on blood flow.

Color Doppler echocardiography is a widely used non-invasive imaging modality that provides real-time information about the intracardiac blood flow. In an apical long-axis view of the left ventricle, color Doppler is subject to phase wrapping, or aliasing, especially during cardiac filling and ejection. When setting up quantitative methods based on color Doppler, it is necessary to correct this wrapping artifact. We developed an unfolded primal-dual network to unwrap (dealias) color Doppler echocardiographic images and compared its effectiveness against two state-of-the-art segmentation approaches based on nnU-Net and transformer models. We trained and evaluated the performance of each method on an in-house dataset and found that the nnU-Net-based method provided the best dealiased results, followed by the primal-dual approach and the transformer-based technique. Noteworthy, the primal-dual network, which had significantly fewer trainable parameters, performed competitively with respect to the other two methods, demonstrating the high potential of deep unfolding methods. Our results suggest that deep learning-based methods can effectively remove aliasing artifacts in color Doppler echocardiographic images, outperforming DeAN, a state-of-the-art semi-automatic technique. Overall, our results show that deep learning-based methods have the potential to effectively preprocess color Doppler images for downstream quantitative analysis.

Deep learning-based methods have spearheaded the automatic analysis of echocardiographic images, taking advantage of the publication of multiple open access datasets annotated by experts (CAMUS being one of the largest public databases). However, these models are still considered unreliable by clinicians due to unresolved issues concerning i) the temporal consistency of their predictions, and ii) their ability to generalize across datasets. In this context, we propose a comprehensive comparison between the current best performing methods in medical/echocardiographic image segmentation, with a particular focus on temporal consistency and cross-dataset aspects. We introduce a new private dataset, named CARDINAL, of apical two-chamber and apical four-chamber sequences, with reference segmentation over the full cardiac cycle. We show that the proposed 3D nnU-Net outperforms alternative 2D and recurrent segmentation methods. We also report that the best models trained on CARDINAL, when tested on CAMUS without any fine-tuning, still manage to perform competitively with respect to prior methods. Overall, the experimental results suggest that with sufficient training data, 3D nnU-Net could become the first automated tool to finally meet the standards of an everyday clinical device.