Cardiac MRI

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.

Accurate 3D geometric characterization of myocardial infarction (MI) is essential for building cardiac digital twins (CDTs) to precisely simulate infarct-related electrophysiology. Late gadolinium enhancement magnetic resonance imaging (LGE MRI) is the clinical reference for locating MI, yet its reliance on contrast agents restricts use in renally impaired patients and limits longitudinal follow-ups. As an alternative, contrast-free cine MRI visualizes abnormal ventricular wall motion, which is highly indicative of the infarcted area. In this study, we propose a novel explicit geometry-motion embedded model to fully automatically reconstruct personalized, simulation-ready 3D MI geometries directly from multi-view cine MRIs. Specifically, we construct a 4D (3D + t) biventricular mesh to explicitly extract and decouple geometry-aware and motion-aware features. We further design a dual-branch module for adaptive geometry-motion fusion to capture spatiotemporal dependencies for mapping infarcted region. Furthermore, we introduce multi-scale supervision utilizing an AHA-17 segment-guided cross-attention mechanism to steer the prediction, ensuring biophysically consistent reconstruction. Experimental results on 225 cine MRIs demonstrated that the proposed 3D MI reconstruction achieved high performance with an average Dice score of 0.678 $\pm$ 0.011. In the downstream in-silico electrophysiological simulation evaluations, the results were highly consistent with the LGE-derived ground truth, highlighting the great potential of the proposed model for contrast-free scar characterization and seamless integration into CDT modeling. The code will be released publicly upon acceptance of the manuscript for publication.

Multimodal Large Language Models (MLLMs) have shown strong performance on public medical benchmarks, yet existing evaluations often remain weak proxies for clinical use, relying on isolated inputs and simplified recognition-style tasks. We introduce CardioLens, a leakage-resistant evaluation testbed for multi-sequence Cardiovascular Magnetic Resonance (CMR), constructed from private hospital archives through a rigorous report-to-QA construction and verification pipeline. CardioLens contains 473,896 slices and 13,494 verified QA pairs across 4D Cine, LGE, perfusion, and T2-weighted imaging, and evaluates three stages of CMR interpretation: image understanding, report generation, and disease diagnosis. Across 24 state-of-the-art MLLMs, CardioLens reveals a substantial clinical reality gap: models perform poorly overall, with performance degrading along the real CMR workflow. Confusion analysis further shows a category-collapse failure mode, where models default to frequent abnormal categories rather than distinguishing clinically distinct findings. To rule out MLLM-compatible input construction as the primary cause, we compare random, clinically motivated, and data-driven slice selection protocols under different slice budgets; performance changes only marginally, typically by about 1%. Explicit reasoning prompts also fail to rescue performance, often making models more conservative rather than improving visual evidence use. These results show that current MLLMs remain far from reliable CMR interpretation, where clinical decisions require integrating distributed evidence across sequences, views, and temporal phases. CardioLens provides a clinically grounded testbed for developing next-generation MLLMs toward real-world clinical deployment.

Numerous medical imaging problems must be solved under limited labels and constrained compute, yet it remains unclear whether performance gains are driven mainly by more expressive models or by better representation of clinically meaningful anatomy. We study this question through a low-data anatomy-aware benchmark for 5-class cardiac pathology prediction on the public ACDC MRI dataset. Using segmentation-derived patient descriptors from the right ventricle, myocardium, and left ventricle, we compare anatomy-specific and multi-structure representations across linear, kernel, and tree-based classifiers. We find that under limited label settings, representation dominates complexity. These results suggest that in resource-constrained healthcare settings, identifying and representing the most informative anatomy may matter more than the increasing complexity of the model alone.

Vision Transformer (ViT) models, utilizing self-attention mechanisms, have demonstrated robust generalization capabilities across various vision tasks, including image classification. However, these models, typically pretrained on general public datasets, often lack the specialized domain knowledge necessary for medical imaging applications. In this study, we investigate the adaptation of ViT models, specifically for cardiac magnetic resonance (MR) images, using an in-house dataset. We found that pretrained ViT features do not effectively transfer to the cardiac MR domain. To overcome this limitation, we introduce an adaptation strategy that utilizes image-based self-supervised contrastive learning, demonstrating superior performance compared to traditional supervised training approaches. Moreover, our adapted ViT model exhibits strong generalization to external MR datasets such as BraTS and ADNI. Through ablation studies, we further investigate the impact of batch size and dataset scale on performance. Ultimately, our adapted model achieves classification AUC exceeding 0.75 across the four most common cardiac MR sequences.

Conventional cardiac cine MRI relies on breath-hold Cartesian acquisitions, which are vulnerable to motion artifacts and can be uncomfortable or infeasible, particularly for pediatric and other noncompliant patients who cannot reliably hold their breath. Free-breathing radial acquisitions can alleviate these limitations, but robust reconstruction at high acceleration remains challenging due to prominent streak artifacts. To address these limitations, we propose Cine-DL, a clinically oriented framework that couples targeted k-space preprocessing with fast, model-based deep reconstruction. In this pipeline, raw free-breathing radial data undergo retrospective cardiac binning and respiratory gating to resolve cardiac phases and discard motion-corrupted spokes. We then introduce Streak Optimized Coil Compression (SOC), which explicitly preserves cardiac signals while suppressing peripheral interference that typically drives the streak artifacts. The resulting 2D+t cine series is reconstructed with an unrolled network that alternates a ResNet proximal operator with physics-based data consistency updates solved via conjugate gradient. We further employ a memory-efficient training strategy that reduces peak memory usage. We evaluate Cine-DL on free-breathing volunteer data against established baselines (k-t SENSE and iGRASP) and demonstrate clinical translation via hospital deployment on newly acquired patient data. Our experiments show that Cine-DL consistently improves quantitative metrics and visual fidelity, supporting a practical route toward routine, time-sensitive clinical adoption of free-breathing cine MRI.

Purpose: Real-time (RT) bSSFP MRI enables fast free-breathing cardiovascular imaging but requires 10-16 slices for functional assessment, resulting in prolonged scan times. Simultaneous multi-slice (SMS) imaging can reduce acquisition time but when combined with non-Cartesian trajectories, it relies on iterative reconstructions that preclude online use. This study investigates deep artifact suppression to facilitate rapid, online reconstruction of RT-SMS. Methods: A spiral bSSFP SMS RT sequence with two simultaneously acquired slices was implemented at 1.5 T. Reconstruction used slice separation in k-space, followed by deep artifact suppression in image space using a 3D U-Net. Ten healthy volunteers were imaged. RT-SMS image quality and reconstruction time were compared between deep artifact suppression and compressed sensing (CS) reconstructions. Left (LV) and right (RV) ventricular volumes at end diastole (EDV) and end systole (ESV) and LV mass (LVM) were compared between RT-SMS with deep artifact suppression and reference-standard breath-hold (BH) imaging. Results: The RT-SMS acquisition was ~13x faster than BH imaging (15 s vs 3 min 15 s). RT-SMS reconstruction using deep artifact suppression was ~50x faster than CS (30 s vs 24 min 55 s). Deep artifact suppression consistently outperformed CS in quantitative and qualitative image quality (p<0.001). Functional agreement between BH and RT-SMS with deep artifact suppression was good (LVEDV: -7.5 +/- 6.8 ml, LVESV: -0.9 +/- 4.2 ml, RVEDV: -6.4 +/- 8.4 ml, RVESV: 0.2 +/- 10.7 ml, LVM: -10.3 +/- 11.0 g). Conclusion: Online deep artifact suppression reconstruction for RT-SMS bSSFP CMR enables free-breathing short-axis coverage with a substantial reduction in acquisition and reconstruction time while maintaining diagnostic image quality.

Accurate 3D+t whole-heart mesh reconstruction from cine MRI is a clinically crucial yet technically challenging task. The difficulty of this task arises from two coupled factors: inherently sparse sampling of 3D cardiac anatomy by 2D image slices and the tight coupling between cardiac shape and motion. Current cardiac image-to-mesh approaches typically reconstruct only a subset of cardiac chambers or a single phase of the cardiac cycle. In this work, we propose CineMesh4D, a novel end-to-end 4D (3D+t) pipeline that directly reconstructs patient-specific whole-heart mesh from multi-view 2D cine MRI via cross-domain mapping. Specifically, we introduce a differentiable rendering loss that enables supervision of 3D+t whole-heart mesh from multi-view sparse contours of cine MRI. Furthermore, we develop a dual-context temporal block that fuses global and local cardiac temporal information to capture high-dimensional sequential patterns. In quantitative and qualitative evaluations, CineMesh4D outperforms existing approaches in terms of reconstruction quality and motion consistency, providing a practical pathway for personalized real-time cardiac assessment. The code will be publicly released once the manuscript is accepted.

Quantitative cardiac magnetic resonance imaging (MRI) enables non-invasive myocardial tissue characterization but relies on robust motion correction within these variable-length, variable-contrast image sequences. Groupwise registration, which simultaneously aligns all images, has shown greater robustness than pairwise registration for motion correction. However, current deep-learning-based groupwise registration methods cannot generalize across MRI sequences: the architecture typically encodes input data as a fixed-length channel stack, which rigidly couples network design to protocol-specific sequence length, input ordering, and contrast dynamics. At inference time, any change in imaging protocols will render the network unusable. In this work, we introduce \emph{\AnyTwoReg}, a new set-based groupwise registration framework that takes a quantitative MRI sequence as an unordered set. This set formulation fundamentally decouples network design from sequence length and input ordering. By utilizing a shared encoder and correlation-guided feature aggregation, \emph{\AnyTwoReg} constructs a permutation-invariant canonical reference for registration, and learns a permutation-equivariant mapping from images to deformation fields. Additionally, we extract contrast-insensitive image features from an existing foundation model to handle extreme contrast variations. Trained exclusively on a single public $T_1$ mapping dataset (STONE, sequence length $L=11$), \AnyTwoReg generalizes to two unseen quantitative MRI datasets (MOLLI, ASL) with variable lengths ($L \in [11, 60]$) and different contrast dynamics. It achieves strong cross-protocol generalization in a zero-shot manner, and consistently improves downstream quantitative mapping quality. Notably, while designed for quantitative MRI sequences, our framework is directly applicable to Cine MRI sequences for inter-cardiac-phase registration.

Converting free-text cardiac magnetic resonance (CMR) reports into auditable structured data remains a bottleneck for cohort assembly, longitudinal curation, and clinical decision support. We present CMR-EXTR, a lightweight framework that converts free-text CMR reports into structured data and assigns per-field confidence for quality control. A teacher-student distillation pipeline enables fully offline inference while limiting manual annotation. Uncertainty integrates three complementary principles -- distribution plausibility, sampling stability, and cross-field consistency -- to triage human review. Experiments show that CMR-EXTR achieves 99.65% variable-level accuracy, demonstrating both reliable extraction and informative confidence scores. To our knowledge, this is the first CMR-specific extraction system with integrated confidence estimation. The code is available at https://github.com/yuyi1005/CMR-EXTR.

Cardiac magnetic resonance (CMR) segmentation underpins quantitative assessment of ventricular structure and function, yet reliable delineation remains difficult due to low tissue contrast, fuzzy boundaries, and inter scan variability. We present CardiacNAS, an evolutionary neural architecture search (NAS) framework that couples a UNet like supernet with a cardiac aware search space spanning depth width, kernel size, filter size, attention, fusion, activation, dropout, and residual scaling. The search is explicitly resource aware, jointly optimizing dice similarity coefficient (DSC) and 95th percentile Hausdorff distance (HD95) versus model size and floating point operations (FLOPs) under fixed compute budgets. Candidate architectures are instantiated from the supernet, trained with proxy budgets, and evolved through crossover, mutation, and elitist selection. We evaluate on the ACDC dataset and compare against six state of the art methods, using qualitative comparisons, learning curve analyses, and design factor correlation studies. The resulting model attains 93.22% average DSC and 4.73 mm HD95 with 3.58M parameters and 14.56 GFLOPs, demonstrating a favorable accuracy efficiency trade off. Analyses indicate that searched attention and fusion choices, together with residual scaling, contribute to improved boundary fidelity and stability. CardiacNAS offers a principled, resource aware approach to deployable CMR segmentation with transparent reporting of architectural complexity and compute budgets.

We report our multi-stage framework designed for the problem of multi-class bi-atrial segmentation from 3D late gadolinium-enhanced (LGE) MRI of the human heart. The pipeline consists of a preprocessing step using multidimensional contrast limited adaptive histogram equalization (MCLAHE); coarse region segmentation from MCLAHE-enhanced and down-sampled MRI using a V-Net family model; and fine segmentation from the coarse region using another V-Net model. Asymmetric loss is adopted to optimize the model weights.

The emergence of large-scale pretrained foundation models has transformed computer vision, enabling strong performance across diverse downstream tasks. However, their potential for physics-based inverse problems, such as accelerated cardiac MRI reconstruction, remains largely underexplored. In this work, we investigate whether natural-domain foundation models can serve as effective image priors for accelerated cardiac MRI reconstruction, and compare the performance obtained against domain-specific counterparts such as BiomedCLIP. We propose an unrolled reconstruction framework that incorporates pretrained, frozen visual encoders, such as CLIP, DINOv2, and BiomedCLIP, within each cascade to guide the reconstruction process. Through extensive experiments, we show that while task-specific state-of-the-art reconstruction models such as E2E-VarNet achieve superior performance in standard in-distribution settings, foundation-model-based approaches remain competitive. More importantly, in challenging cross-domain scenarios, where models are trained on cardiac MRI and evaluated on anatomically distinct knee and brain datasets--foundation models exhibit improved robustness, particularly under high acceleration factors and limited low-frequency sampling. We further observe that natural-image-pretrained models, such as CLIP, learn highly transferable structural representations, while domain-specific pretraining (BiomedCLIP) provides modest additional gains in more ill-posed regimes. Overall, our results suggest that pretrained foundation models offer a promising source of transferable priors, enabling improved robustness and generalization in accelerated MRI reconstruction.

Cardiac Magnetic Resonance (CMR) imaging provides a comprehensive assessment of cardiac structure and function but remains constrained by high acquisition costs and reliance on expert annotations, limiting the availability of large-scale labeled datasets. In contrast, electrocardiograms (ECGs) are inexpensive, widely accessible, and offer a promising modality for conditioning the generative synthesis of cine CMR. To this end, we propose ECGFlowCMR, a novel ECG-to-CMR generative framework that integrates a Phase-Aware Masked Autoencoder (PA-MAE) and an Anatomy-Motion Disentangled Flow (AMDF) to address two fundamental challenges: (1) the cross-modal temporal mismatch between multi-beat ECG recordings and single-cycle CMR sequences, and (2) the anatomical observability gap due to the limited structural information inherent in ECGs. Extensive experiments on the UK Biobank and a proprietary clinical dataset demonstrate that ECGFlowCMR can generate realistic cine CMR sequences from ECG inputs, enabling scalable pretraining and improving performance on downstream cardiac disease classification and phenotype prediction tasks.

Reconstructing cardiac motion from CMR sequences is critical for diagnosis, prognosis, and intervention. Existing methods rely on complete CMR stacks to infer full heart motion, limiting their applicability during intervention when only sparse observations are available. We present TetHeart, the first end-to-end framework for unified 4D heart mesh recovery from both offline full-stack and intra-procedural sparse-slice observations. Our method leverages deformable tetrahedra to capture shape and motion in a coherent space shared across cardiac structures. Before a procedure, it initializes detailed, patient-specific heart meshes from high-quality full stacks, which can then be updated using whatever slices can be obtained in real-time, down to a single one during the procedure. TetHeart incorporates several key innovations: (i) an attentive slice-adaptive 2D-3D feature assembly mechanism that integrates information from arbitrary numbers of slices at any position; (ii) a distillation strategy to ensure accurate reconstruction under extreme sparsity; and (iii) a weakly supervised motion learning scheme requiring annotations only at keyframes, such as the end-diastolic and end-systolic phases. Trained and validated on three large public datasets and evaluated zero-shot on additional private interventional and public datasets without retraining, TetHeart achieves state-of-the-art accuracy and strong generalization in both pre- and intra-procedural settings. Code and dataset is available at https://github.com/Scalsol/TetHeart.