Deep Learning Strain Estimation: Is Physics-Based Simulation the Solution?

Myocardial strain from echocardiography is a key biomarker for cardiac function. Recent deep learning methods show strong performance for myocardial motion tracking but often lack physiological constraints, leading to temporal drift across the cardiac cycle. Consequently, tracked points may not return to their relative initial positions at the end of each cardiac cycle, producing inaccurate strain estimates and even divergence in some cases. We propose a deep learning framework that compensates for drift during myocardial tracking. We extend a state-of-the-art echocardiographic tracking method (TAS-Net) with persistent memory tokens that share information across sliding windows over full cardiac cycles. A teacher-student fine-tuning strategy on real echocardiographic data then enforces physiologically consistent cyclic motion while preserving tracking accuracy. Experiments show reduced global and regional strain drift, improved agreement with clinical references, and better test-retest reproducibility, supporting more reliable myocardial strain estimation in clinical practice.

Myocardial point tracking (MPT) has recently emerged as a promising direction for motion estimation in echocardiography, driven by advances in general-purpose point tracking methods. However, myocardial motion fundamentally differs from motion encountered in natural videos, as it arises from physiologically constrained deformation that is spatially and temporally continuous throughout the cardiac cycle. Consequently, motion trajectories typically remain locally confined despite substantial tissue deformation. Motivated by these properties, we revisit the architectural design for MPT and find that coarse initialization in commonly used two-stage coarse-to-fine architectures may be unnecessary in this domain. In this work, we propose a fine-stage-only architecture, \textbf{EchoTracker2}, which enriches pixel-precise features with local spatiotemporal context and integrates them with long-range joint temporal reasoning for robust tracking. Experimental results across in-distribution, out-of-distribution (OOD), and public synthetic datasets show that our model improves position accuracy by $6.5\%$ and reduces median trajectory error by $12.2\%$ relative to a domain-specific state-of-the-art (SOTA) model. Compared to the best general-purpose point tracking method, the improvements are $2.0\%$ and $5.3\%$, respectively. Moreover, EchoTracker2 shows better agreement with expert-derived global longitudinal strain (GLS) and enhances test-rest reproducibility. Source code will be available at: https://github.com/riponazad/ptecho.

Myocardial strain analysis of cardiac magnetic resonance (CMR) images provides an important tool for evaluating cardiac function. However, current techniques require either human-adjusted post-processing with suboptimal regional accuracy, or specialized acquisitions with limited availability. In this paper, we propose to leverage the power of generative models to synthesize high-quality motion-derived strain values from routinely acquired CMR sequences. Specifically, we develop a novel Brownian bridge diffusion model in motion space to learn the probabilistic mapping between standard CMR motion estimated from widely adopted registration methods and highly accurate motion provided by advanced strain imaging techniques. To promote the fidelity of anatomical structure in the generation process, our model is conditioned on the corresponding CMR images. We validate our method on large-scale multi-center CMR datasets including subjects of paired standard cine CMR and advanced strain imaging acquisitions. Experimental results demonstrate that our framework significantly improves the accuracy of motion prediction and strain analysis from standard CMRs compared to existing learning-based approaches. Our research represents a new paradigm for potentially developing cost-effective, clinically deployable AI tools for cardiac function assessment with enhanced strain accuracy in busy clinical workflows. Our code is publicly available at https://github.com/Rishov-MIA/Brownian-Bridge-strain-analysis.