Towards Reliable and Reproducible Fetal Brain Biometry: A Deep Learning Approach Using MRI

We present E(3)-Pose, a novel fast pose estimation method that jointly and explicitly models rotation equivariance and object symmetry. Our work is motivated by the challenging problem of accounting for fetal head motion during a diagnostic MRI scan. We aim to enable automatic adaptive prescription of diagnostic 2D MRI slices with 6-DoF head pose estimation, supported by rapid low-resolution 3D MRI volumes acquired before each 2D slice. Existing pose estimation methods struggle to generalize to clinical volumes due to pose ambiguities induced by inherent anatomical symmetries, as well as low resolution, noise, and artifacts. In contrast, E(3)-Pose captures anatomical symmetries and rigid pose equivariance by construction, and yields robust estimates of the fetal head pose. Our experiments on publicly available and representative clinical fetal MRI datasets demonstrate the superior robustness and generalization of our method across domains. Crucially, E(3)-Pose achieves state-of-the-art accuracy on clinical MRI volumes, supporting future clinical translation. Our implementation is publicly available at github.com/MedicalVisionGroup/E3-Pose.

Accurate segmentation of fetal brain tissues in Magnetic Resonance Imaging (MRI) is critical for early diagnosis of congenital abnormalities and improving prenatal care. However, the task remains difficult because of fetal motion, low tissue contrast, and major anatomical variability throughout gestational ages, particularly in segmenting complex structures such as white matter, gray matter, lateral ventricles, deep gray matter, extra-cerebrospinal fluid, cerebellum, and brainstem. As a solution to these difficulties, this research introduces a novel deep learning model that combines a ResNet-34 encoder with a lightweight decoder leveraging multi-layer perceptron (MLP) modules for adaptive feature refinement. This design specifically enhances the model's ability to preserve anatomical boundaries and mitigate segmentation errors caused by motion artifacts and intensity inhomogeneities. Computational efficiency is achieved by reducing parameter count, employing bilinear upsampling instead of transposed convolutions, and optimizing the decoder for speed without sacrificing accuracy. Trained and validated on the FeTA 2021 dataset using 5-fold cross-validation, the proposed model outperforms baseline architectures such as UNet, UNet++, DeepLabV3, and DeepLabV3+, achieving an average Accuracy of 97.37% with a mean Dice Similarity Coefficient (DSC) of 90.33%, mean Intersection over Union (IoU) of 86.93%, and Precision of 90.83%. Additionally, its fast inference time and reduced computational load make it well-suited for integration into real-time clinical workflows.

Prenatal germinal matrix-intraventricular hemorrhage (GMH-IVH) is a leading cause of infant mortality and neurodevelopmental impairment, yet its manual diagnosis and lesion segmentation on fetal brain MRI are labor-intensive and error-prone. Although supervised deep learning offers potential for automation, it typically requires large amounts of annotated GMH-IVH data, which are challenging to obtain for such a rare condition (0.5-0.9 per 1000 pregnancies). To address these problems, an annotation-free deep learning framework, FreeHemoSeg, was developed for automated detection and segmentation of GMH-IVH without any real patient annotations. Instead of learning from expert labels, FreeHemoSeg was trained on pseudo GMH-IVH images synthesized from normal fetal data guided by medical priors. The framework was evaluated in a retrospective multicentre study of 1,674 stacks of 2D T2-weighted MRI from 558 pregnant women, using data from one hospital for internal training and validation and two hospitals for external validation. FreeHemoSeg achieved the highest diagnostic and segmentation performance in both internal validation (AUROC: 0.959; AUPR: 0.928; sensitivity: 0.914; specificity: 0.966; DSC: 0.559) and external validation (AUROC: 0.930; AUPR: 0.884; sensitivity: 0.824; specificity: 0.943; DSC: 0.512), outperforming a supervised model trained on limited empirical data and unsupervised anomaly detection methods. Moreover, FreeHemoSeg assistance improved radiologists' sensitivity (from 0.882 to 0.941-1.000) and diagnostic confidence, while reducing interpretation time by 16.0-52.7%. We anticipate its immediate utility in supporting earlier diagnosis, prognostic counselling, and perinatal planning for fetal GMH-IVH. Code: https://github.com/Arktis2022/FreeHemoSeg.