Gadolinium-based contrast agents (GBCAs) are widely used in magnetic resonance imaging (MRI) to enhance lesion detection and characterisation, particularly in the field of neuro-oncology. Nevertheless, concerns regarding gadolinium retention and accumulation in brain and body tissues, most notably for diseases that require close monitoring and frequent GBCA injection, have led to the need for strategies to reduce dosage. In this study, a deep learning framework is proposed for the virtual contrast enhancement of full-dose post-contrast T1-weighted MRI images from corresponding low-dose acquisitions. The contribution of the presented model is its utilisation of longitudinal information, which is achieved by incorporating a prior full-dose MRI examination from the same patient. A comparative evaluation against a non-longitudinal single session model demonstrated that the longitudinal approach significantly improves image quality across multiple reconstruction metrics. Furthermore, experiments with varying simulated contrast doses confirmed the robustness of the proposed method. These results emphasize the potential of integrating prior imaging history into deep learning-based virtual contrast enhancement pipelines to reduce GBCA usage without compromising diagnostic utility, thus paving the way for safer, more sustainable longitudinal monitoring in clinical MRI practice.

Contrast-enhancement pattern analysis is critical in breast magnetic resonance imaging (MRI) to distinguish benign from probably malignant tumors. However, contrast-enhanced image acquisitions are time-consuming and very expensive. As an alternative to physical acquisition, this paper proposes a comprehensive pipeline for the generation of accurate long-term (late) contrast-enhanced breast MRI from the early counterpart. The proposed strategy focuses on preserving the contrast agent pattern in the enhanced regions while maintaining visual properties in the entire synthesized images. To that end, a novel loss function that leverages the biological behavior of contrast agent (CA) in tissue, given by the Time-Intensity (TI) enhancement curve, is proposed to optimize a pixel-attention based generative model. In addition, unlike traditional normalization and standardization methods, we developed a new normalization strategy that maintains the contrast enhancement pattern across the image sequences at multiple timestamps. This ensures the prevalence of the CA pattern after image preprocessing, unlike conventional approaches. Furthermore, in order to objectively evaluate the clinical quality of the synthesized images, two metrics are also introduced to measure the differences between the TI curves of enhanced regions of the acquired and synthesized images. The experimental results showed that the proposed strategy generates images that significantly outperform diagnostic quality in contrast-enhanced regions while maintaining the spatial features of the entire image. This results suggest a potential use of synthetic late enhanced images generated via deep learning in clinical scenarios.

Recently, deep learning (DL)-based methods have been proposed for the computational reduction of gadolinium-based contrast agents (GBCAs) to mitigate adverse side effects while preserving diagnostic value. Currently, the two main challenges for these approaches are the accurate prediction of contrast enhancement and the synthesis of realistic images. In this work, we address both challenges by utilizing the contrast signal encoded in the subtraction images of pre-contrast and post-contrast image pairs. To avoid the synthesis of any noise or artifacts and solely focus on contrast signal extraction and enhancement from low-dose subtraction images, we train our DL model using noise-free standard-dose subtraction images as targets. As a result, our model predicts the contrast enhancement signal only; thereby enabling synthesization of images beyond the standard dose. Furthermore, we adapt the embedding idea of recent diffusion-based models to condition our model on physical parameters affecting the contrast enhancement behavior. We demonstrate the effectiveness of our approach on synthetic and real datasets using various scanners, field strengths, and contrast agents.

The segmentation of the abdominal aorta in non-contrast CT images is a non-trivial task for computer-assisted endovascular navigation, particularly in scenarios where contrast agents are unsuitable. While state-of-the-art deep learning segmentation models have been proposed recently for this task, they are trained on manually annotated strong labels. However, the inherent ambiguity in the boundary of the aorta in non-contrast CT may undermine the reliability of strong labels, leading to potential overfitting risks. This paper introduces a Gaussian-based pseudo label, integrated into conventional deep learning models through deep supervision, to achieve Morphological Attention (MA) enhancement. As the Gaussian pseudo label retains the morphological features of the aorta without explicitly representing its boundary distribution, we suggest that it preserves aortic morphology during training while mitigating the negative impact of ambiguous boundaries, reducing the risk of overfitting. It is introduced in various 2D/3D deep learning models and validated on our local data set of 30 non-contrast CT volumes comprising 5749 CT slices. The results underscore the effectiveness of MA in preserving the morphological characteristics of the aorta and addressing overfitting concerns, thereby enhancing the performance of the models.

Deep learning has the potential to revolutionize medical practice by automating and performing important tasks like detecting and delineating the size and locations of cancers in medical images. However, most deep learning models rely on augmentation techniques that treat medical images as natural images. For contrast-enhanced Computed Tomography (CT) images in particular, the signals producing the voxel intensities have physical meaning, which is lost during preprocessing and augmentation when treating such images as natural images. To address this, we propose a novel preprocessing and intensity augmentation scheme inspired by how radiologists leverage multiple viewing windows when evaluating CT images. Our proposed method, window shifting, randomly places the viewing windows around the region of interest during training. This approach improves liver lesion segmentation performance and robustness on images with poorly timed contrast agent. Our method outperforms classical intensity augmentations as well as the intensity augmentation pipeline of the popular nn-UNet on multiple datasets.

Despite its benefits for tumour detection and treatment, the administration of contrast agents in dynamic contrast-enhanced MRI (DCE-MRI) is associated with a range of issues, including their invasiveness, bioaccumulation, and a risk of nephrogenic systemic fibrosis. This study explores the feasibility of producing synthetic contrast enhancements by translating pre-contrast T1-weighted fat-saturated breast MRI to their corresponding first DCE-MRI sequence leveraging the capabilities of a generative adversarial network (GAN). Additionally, we introduce a Scaled Aggregate Measure (SAMe) designed for quantitatively evaluating the quality of synthetic data in a principled manner and serving as a basis for selecting the optimal generative model. We assess the generated DCE-MRI data using quantitative image quality metrics and apply them to the downstream task of 3D breast tumour segmentation. Our results highlight the potential of post-contrast DCE-MRI synthesis in enhancing the robustness of breast tumour segmentation models via data augmentation.

This paper develops a new vascular respiratory motion compensation algorithm, Motion-Related Compensation (MRC), to conduct vascular respiratory motion compensation by extrapolating the correlation between invisible vascular and visible non-vascular. Robot-assisted vascular intervention can significantly reduce the radiation exposure of surgeons. In robot-assisted image-guided intervention, blood vessels are constantly moving/deforming due to respiration, and they are invisible in the X-ray images unless contrast agents are injected. The vascular respiratory motion compensation technique predicts 2D vascular roadmaps in live X-ray images. When blood vessels are visible after contrast agents injection, vascular respiratory motion compensation is conducted based on the sparse Lucas-Kanade feature tracker. An MRC model is trained to learn the correlation between vascular and non-vascular motions. During the intervention, the invisible blood vessels are predicted with visible tissues and the trained MRC model. Moreover, a Gaussian-based outlier filter is adopted for refinement. Experiments on in-vivo data sets show that the proposed method can yield vascular respiratory motion compensation in 0.032 sec, with an average error 1.086 mm. Our real-time and accurate vascular respiratory motion compensation approach contributes to modern vascular intervention and surgical robots.

Deep learning has shown superb performance in detecting objects and classifying images, ensuring a great promise for analyzing medical imaging. Translating the success of deep learning to medical imaging, in which doctors need to understand the underlying process, requires the capability to interpret and explain the prediction of neural networks. Interpretability of deep neural networks often relies on estimating the importance of input features (e.g., pixels) with respect to the outcome (e.g., class probability). However, a number of importance estimators (also known as saliency maps) have been developed and it is unclear which ones are more relevant for medical imaging applications. In the present work, we investigated the performance of several importance estimators in explaining the classification of computed tomography (CT) images by a convolutional deep network, using three distinct evaluation metrics. First, the model-centric fidelity measures a decrease in the model accuracy when certain inputs are perturbed. Second, concordance between importance scores and the expert-defined segmentation masks is measured on a pixel level by a receiver operating characteristic (ROC) curves. Third, we measure a region-wise overlap between a XRAI-based map and the segmentation mask by Dice Similarity Coefficients (DSC). Overall, two versions of SmoothGrad topped the fidelity and ROC rankings, whereas both Integrated Gradients and SmoothGrad excelled in DSC evaluation. Interestingly, there was a critical discrepancy between model-centric (fidelity) and human-centric (ROC and DSC) evaluation. Expert expectation and intuition embedded in segmentation maps does not necessarily align with how the model arrived at its prediction. Understanding this difference in interpretability would help harnessing the power of deep learning in medicine.

A team of researchers who developed the technology, including doctors at UVA Health, reports the success of the approach in a new article in the scientific journal Circulation. The team compared its AI approach, known as Virtual Native Enhancement (VNE), with contrast-enhanced CMR scans now used to monitor hypertrophic cardiomyopathy, the most common genetic heart condition. The researchers found that VNE produced higher-quality images and better captured evidence of scar in the heart, all without the need for injecting the standard contrast agent required for CMR. "This is a potentially important advance, especially if it can be expanded to other patient groups," said researcher Christopher Kramer, MD, the chief of the Division of Cardiovascular Medicine at UVA Health, Virginia's only designated Center of Excellence by the Hypertrophic Cardiomyopathy Association. "Being able to identify scar in the heart, an important contributor to progression to heart failure and sudden cardiac death, without contrast, would be highly significant. CMR scans would be done without contrast, saving cost and any risk, albeit low, from the contrast agent."

Accurate MR-to-CT synthesis is a requirement for MR-only workflows in radiotherapy (RT) treatment planning. In recent years, deep learning-based approaches have shown impressive results in this field. However, to prevent downstream errors in RT treatment planning, it is important that deep learning models are only applied to data for which they are trained and that generated synthetic CT (sCT) images do not contain severe errors. For this, a mechanism for online quality control should be in place. In this work, we use an ensemble of sCT generators and assess their disagreement as a measure of uncertainty of the results. We show that this uncertainty measure can be used for two kinds of online quality control. First, to detect input images that are outside the expected distribution of MR images. Second, to identify sCT images that were generated from suitable MR images but potentially contain errors. Such automatic online quality control for sCT generation is likely to become an integral part of MR-only RT workflows.