Confidence Matters: Uncertainty Quantification and Precision Assessment of Deep Learning-based CMR Biomarker Estimates Using Scan-rescan Data

Cardiovascular magnetic resonance (CMR), including cine imaging, is a reference standard for the noninvasive assessment of cardiac morphology and ventricular function. Cine CMR interpretation integrates qualitative visual assessment with quantitative measurements of ventricular volumes, ejection fraction, myocardial mass, wall thickness, and regional wall motion. Current medical vision-language models (VLMs) cannot reliably derive quantitative measurements from multidimensional cine images without analysis tools. We present CineMR, a tool-augmented VLM that invokes cardiac image-analysis tools and integrates their outputs into interleaved reasoning for quantitative CMR assessment. We also construct a multi-cohort visual question answering benchmark covering quantitative metric extraction, multiclass diagnosis, and differential diagnosis, together with tools for segmentation, phase selection, volumetry, morphometry, and regional wall motion analysis. CineMR is trained with supervised fine-tuning (SFT) on tool-interaction traces followed by Group Relative Policy Optimization (GRPO) with conditional tool-use rewards. On the multi-cohort cine CMR benchmark, CineMR achieves 35.9% pass@1 and 58.9% pass@4, compared with 1.5% pass@1 for the Qwen3-VL-8B backbone and 0.0% and 7.0% pass@1 for LLaVA-Med v1.5 and MedGemma-4B, respectively. Correct tool invocation reaches 99.8% after GRPO, up from 78.9% after SFT. Live tool outputs improve ventricular measurement accuracy by 20.4--23.7% over direct model predictions, and removing all tools reduces pass@1 from 35.9% to 27.9%. These results highlight the importance of reliable tool use for quantitative cine CMR reasoning and support CineMR as a promising approach for assistive cardiac image assessment. Code, benchmark resources, and model weights are available at https://github.com/AI-MIND-Lab/CineMR.

Atlas-based approaches allow high-quality, patient-specific shape reconstructions of cardiac anatomy from sparse and/or noisy data such as point clouds. However, these methods are mainly prior-driven, so the impact of uncertainty can be large, limiting their clinical reliability. We propose a probabilistic framework for uncertainty-aware cardiac shape reconstruction that combines Deep Signed Distance Functions (DeepSDFs) with Markov Chain Monte Carlo (MCMC) sampling. Cardiac geometries are modeled implicitly as zero-level sets of a neural network conditioned on learned latent codes, enabling multi-surface reconstruction of the left and right ventricles. By interpreting the reconstruction loss as a log-likelihood, we perform Bayesian inference in the latent space to obtain both maximum a posteriori (MAP) and posterior-sampled reconstructions. Experiments on a public cardiac dataset show that our approach produces accurate reconstructions and well-calibrated uncertainty estimates.

Quantitative MRI (qMRI) provides standardised tissue parameter maps, but the reliability of deep learning-based qMRI mapping methods is often not explicitly characterised. In this work we systematically evaluate uncertainty maps for quantitative MRI derived from multiple inferences of a data-consistent diffusion model-based qMRI framework. Evaluation on synthetic test data assessed error-awareness, high-error detection, selective prediction, and Gaussian interval calibration. Diffusion model-derived uncertainty was positively associated with the mapping error, while risk-coverage analysis showed that excluding high-uncertainty voxels reduced the retained error. However, the raw uncertainty was poorly calibrated for quantitative interval interpretation. Calibration was substantially improved using a post-hoc procedure combining prediction-value-dependent bias correction with scalar uncertainty scaling. Qualitative evaluation on a healthy volunteer showed spatially meaningful uncertainty patterns. These results indicate that diffusion model-derived uncertainty is informative for reliability assessment and selective prediction, but requires calibration for quantitative interval interpretation.