Motion-Guided Causal Disentanglement for Robust Multi-View Cine Cardiac MRI Diagnosis
Authors: Chuankai Xu, Cristiane De Carvalho Singulane, Mohammad Abuannadi, Stephen Chandler, Jeremy Slivnick, Karolina Zareba, Jane Cao, Vidya Nadig, +5 more
Organizations: University of Virginia, Charlottesville, VA, USA · University of Chicago, Chicago, IL, USA · Ohio State University, Columbus, OH, USA · St. Francis Hospital & Heart Center, Roslyn, NY, USA · Hartford HealthCare, Hartford, CT, USA · Instituto do Coração (InCor), São Paulo, Brazil · Atlantic Health System, Morristown, NJ, USA · Sociedad Italiana de Beneficencia (Hospital Italiano), Buenos Aires, Argentina
Abstract
Multi-view cardiac magnetic resonance (CMR) imaging provides complementary anatomical information and is widely used for noninvasive disease assessment. Recent transformer-based models have demonstrated strong representation learning capabilities for CMR analysis; however, they typically learn unified latent embeddings that entangle view-specific anatomical variations with disease-related features. Such entanglement biases classifiers toward structural attributes rather than view-invariant pathological patterns. This issue is exacerbated in low-data regimes, particularly for underrepresented cardiac conditions, where limited samples increase the susceptibility to shortcut learning and view-dependent decision boundaries. To address this, we propose a Motion-Guided View--Disease Disentanglement framework MoViD built upon a ViT-MAE backbone. The model explicitly factorizes latent representations into view-specific and disease-discriminative components using dual-branch supervised contrastive objectives and a gradient-reversal adversarial constraint that minimizes disease leakage into the view embedding. Additionally, an annotation-free temporal motion feature, derived from inter-frame difference maps, is introduced to localize the beating heart region and suppress background artifacts. A focal reweighting mechanism is incorporated into the contrastive loss to mitigate class imbalance. We evaluate the framework on a private clinical venous thrombosis dataset and two public benchmarks (M&Ms, M&Ms2). Across disease classification and cardiac segmentation tasks, our approach consistently outperforms standard transformer baselines and demonstrates competitive performance against large-scale pretrained foundation models, validating the efficacy of structural disentanglement in medical image analysis.
Cardiac magnetic resonance (CMR) imaging provides complementary information on cardiac anatomy, function, and tissue characterization across multiple sequences and views. In this work, we investigate foundation model pretraining for 2D CMR and introduce CMRVision, a CMR-specific foundation model trained using DINOv3-style self-supervised learning on a multi-center, multi-sequence cohort of 36 million CMR images. We systematically evaluate architectural and training design choices for domain-specific pretraining. CMRVision is evaluated on two downstream tasks: multi-task segmentation across cine, late gadolinium enhancement (LGE), and mapping sequences, and cine view classification. Our experiments show that CMR-specific pretraining, smaller patch sizes, and patch-level objectives consistently improve downstream performance. Across a multi-task segmentation benchmark, CMRVision achieved the strongest overall performance, outperforming prior natural-image (NI), medical-image, supervised, and CMR foundation model baselines. Improvements were modest but consistent across structures and sequences, with Dice scores ranging from 0.940-0.967 for LV and 0.855-0.905 for myocardium, and reaching 0.929 for RV, 0.920 for LA, and 0.931 for RA. The largest gains were observed for myocardium segmentation in LGE and mapping images. In a zero-shot segmentation task on unseen LGE long-axis views, the model achieved an average Dice score of 0.692, demonstrating cross-view generalization. For cine view classification, CMRVision achieved the highest average accuracy (0.906), compared to prior methods reported in the literature. These results highlight the potential of CMRVision to support robust and generalizable cardiac MRI analysis across multiple sequences and views.
Cardiac magnetic resonance imaging (CMR) produces rich sequential data such as temporal cine videos and spatial LGE/mapping stacks, yet most deep learning approaches process individual 2D slices, discarding this context. We present MR-JEPA, a self-supervised video foundation model for CMR that extends LeJEPA to 3D spatiotemporal inputs through tubelet tokenization, spatiotemporal masking augmentation, and initialization from a 2D CMR foundation model. Unlike prior CMR video models limited to cine data, MR-JEPA is pretrained on multi-sequence data (cine, LGE, mapping) from 10,505 patients across two centers without annotations. We evaluate the frozen encoder on six downstream tasks using a unified multi-view gated attention architecture: LV ejection fraction, RV ejection fraction, three myocardial strains (GLS, GCS, GRS), and four-class disease detection. MR-JEPA outperforms other compared methods on all five regression tasks, including both a domain-specific CMR model pretrained on more data with text supervision and a natural-video foundation model, achieving an LV EF MAE of 4.79% (r =0.764) and a GLS MAE of 1.87 (r=0.805), with 21-27% MAE reductions over baselines on strain tasks. For disease detection, MR-JEPA achieved a macro AUG of 0.868, remaining competitive with the domain-specific baseline despite using a fully self-supervised pretraining objective. These results demonstrate the potential of a unified video encoder for robust, multi-view utilization of diverse CMR sequences in clinical cardiac quantification and diagnosis.
Athira J. Jacob, Puneet Sharma, Dorin Comaniciu +1
Foundation models have shown strong transferability in cardiac MRI (CMR), but their effectiveness for heterogeneous multi-view and multi-sequence CMR analysis remains unclear. In this work, we explore the effectiveness of fine-tuning and combining different CMR foundation models for the Universal Multi-Sequence, Multi-Center and Multi-View CMR Segmentation (CMR-Multi) Challenge. CineMA was fine-tuned for cine and late gadolinium enhancement (LGE) segmentation across short-axis and long-axis views. For direct left-ventricular ejection fraction (LVEF) estimation, we used two recent frozen CMR foundation models to extract embedding vectors that were then combined using attention-based multiple-instance learning for LVEF regression. In the challenge validation set, cine segmentation achieved Dice scores of 0.862, 0.883, and 0.902 for short-axis, two-chamber and four-chamber cine MRI, respectively. LGE segmentation achieved Dice scores between 0.621 and 0.846 across views. The direct LVEF regression model achieved an MAE of 4.96 percentage points and a Pearson correlation of 0.91. These results indicate that foundation models can be effectively adapted and combined for multi-view CMR analysis, while accurate LGE scar segmentation remains a challenging task.