WASP: Weakly Aligned Spatiotemporal Pairs for Fetal Brain MRI-Ultrasound Learning

Assessment of ventriculomegaly (VM) on fetal brain ultrasound relies primarily on measuring lateral ventricular atrial width on standard planes, which is operator-dependent and may not fully reflect the overall ventricular enlargement. Fetal brain MRI provides more reliable volumetric information but is costly and less accessible for routine use. To address these limitations, we propose VIFBA, an ultrasound video-based framework for fetal brain assessment that predicts MRI-derived lateral ventricular volume, classifies VM severity, and identifies potential non-VM fetal brain abnormalities. Our contribution is three-fold. First, we introduce a joint-embedding predictive architecture (JEPA)-inspired tube latent prediction objective that leverages spatio-temporal coherence in ultrasound videos to enhance representation learning. Second, we develop a contrastive cross-modal alignment strategy that transfers structural information from MRI to ultrasound during training, while requiring ultrasound alone at inference. Third, we augment VIFBA with a training-free vision-language model and retrieval augmentation to verify uncertain predictions and identify potential non-VM fetal brain abnormalities. We validated VIFBA on a large dataset comprising 857 cases (3,196 videos) with paired fetal brain ultrasound and MRI examinations. On held-out test data, VIFBA achieved an MAE of 0.5909 mL and Pearson correlation coefficient of 0.9907 for ventricular volume regression, 0.9400 accuracy for VM severity classification, and an F1 score of 0.7764 for multi-abnormality classification, substantially outperforming single-task baselines, video-based strong competitors, and state-of-the-art foundation models. By enabling MRI-informed volumetric assessment from routine ultrasound alone, VIFBA offers a practical and potentially broadly deployable pathway toward accurate and affordable prenatal brain screening.

Three-dimensional fetal brain ultrasound offers non-ionizing, cost-effective imaging with rich spatial information for comprehensive anatomical assessment, yet its development remains limited by scarce data and annotations. In contrast, fetal brain magnetic resonance imaging has advanced further, supported by larger datasets and mature analysis methods. To leverage these resources, anatomical label maps provide a promising modality-invariant bridge for transferring knowledge from fetal brain magnetic resonance imaging to ultrasound. However, generating ultrasound images from label maps remains challenging because anatomy is tightly entangled with ultrasound appearance. To address this challenge, we separate anatomical correspondence learning from ultrasound appearance adaptation at both the data and model levels. Specifically, we propose the anatomy wavelet residual network, a two-stage framework combining wavelet diffusion and residual refinement. The first stage learns to generate volumes from label maps using atlas pairs in the wavelet domain, while the second stage learns bounded residual corrections from real clinical ultrasound in the image domain. This separation enables realistic synthesis with consistent preservation of normal and abnormal anatomy. Experiments on real fetal brain ultrasound show that our method outperforms representative synthesis methods, with normalized cross correlation of 0.518 versus 0.482 and Fréchet Inception Distance of 8.905 versus 13.319 for the strongest baseline. Beyond synthesis quality, volumes generated from fetal brain magnetic resonance imaging label maps also improve downstream segmentation, particularly for severe abnormal cases. Overall, these results highlight the potential of the proposed framework to leverage rich fetal brain magnetic resonance imaging resources for advancing three-dimensional ultrasound analysis.

Ultrasound is widely used in obstetric care due to its safety, accessibility, and real-time imaging. However, interpretation remains operator-dependent and susceptible to noise and artifacts. Deep learning models have shown strong performance to solve these problem, but they typically require large annotated datasets that are difficult to obtain in clinical ultrasound. Foundation models (FMs) offer an alternative, using a large number of ultrasound images to learn transferable representations that can generalize with limited labeled data. This work presents a comprehensive benchmark of ultrasound-specific FMs for fetal plane classification. We evaluated four ultrasound FMs (USFM, MOFO, UltraSAM, FetalCLIP) against two CNN baselines (ResNet50, EfficientNet-V2) and a ViT (DINOv3) pretrained on natural images. We trained all models under two complementary settings: full fine-tuning and linear probing with a frozen encoder. All models were trained using 5-fold patient-level cross-validation on a Spanish fetal ultrasound dataset and tested on both in-domain data and an external African cohort to assess cross-population generalization. We found that FetalCLIP achieved the best results in the linear probing setting (F1 = 0.9261 for in-domain, F1 = 0.9731 for out-of-domain), while USFM performed best in the full fine-tuning setting (F1 = 0.9476 for in-domain, F1 = 0.9515 for out-of-domain). MOFO and UltraSAM degraded most in both settings, underperforming natural image pretrained models in some cases. These findings highlight how the choice of pretrained model strongly affects fetal plane classification performance, since different pretraining objectives lead to different levels of transferability.