Fetal MRI

Uterine contractions in fetal MRI are typically identified manually and discarded, limiting insights into contraction dynamics. We formalize Uterine Contractile Activity Detection (UCAD) as a weakly-supervised learning problem and introduce STORK, a multi-instance learning model trained on dynamic MRI series using only coarse, series-level labels. STORK factorizes 3D spatio-temporal convolutions into parallel branches across temporal hyperplanes to capture coherent tissue motion without the cost of full 4D convolutions. Per-frame embeddings, combining intensity and Demons-estimated displacement fields, are aggregated by a linear mean-pooling head. This ensures that frame-level contraction scores can be recovered post-hoc without frame-level training supervision. Evaluated on around 700 multi-vendor dynamic fetal MRI series, STORK achieves a series-level AUROC of 95.0% and AUPRC of 94.6%, substantially outperforming 3D ResNet and ConvNeXt baselines. Grad-CAM analysis suggests that the model draws on predictive features extending beyond the placenta into the uterine tissue, offering an automated tool for richer phenotyping of uterine behavior.

Magnetic Resonance Imaging (MRI) is widely regarded as the optimal sensor for fetal brain analysis due to its superior soft-tissue contrast and anatomical detail. However, its high cost and operational burden make it invasive and difficult to obtain at scale. Ultrasound (US), in contrast, is cheap, safe, and routinely acquired, and as a result it has produced substantially larger datasets and a growing ecosystem of pretrained models. This asymmetry raises a natural question: Can we teach a US-only model to understand fetal MRI from only a limited set of examples? The standard recipe, training a foundation model on subject-to-subject paired MRI-US scans, is not viable since no such paired fetal dataset is publicly available. In this paper we address this gap with Weakly Aligned Spatiotemporal Pairs (WASP), a framework that formulates cross-modal correspondence as an entropic Optimal Transport problem driven by clinical metadata, in particular Gestational Age (GA) and diagnostic planes, enabling the fitting of a lightweight alignment module that lifts MRI representations into the US latent space, without fine-tuning the backbone. Empirically, WASP yields its largest gains when MRI is unseen by the model during pretraining (on USFM, GA estimation error drops from 21.9 to 17.4 days and standard plane classification accuracy climbs from 61.9% to 69.0%), while providing smaller, backbone-dependent refinements for backbones pretrained on both modalities (e.g., BioMedParse GA estimation error from 6.5 to 6.0 days and SAM-Med2d plane accuracy from 83.3% to 88.1%). Code is available at https://github.com/miccunifi/WASP.

Fetal cardiac MRI (fCMR) provides valuable diagnostic information complementary to echocardiography, particularly for complex congenital heart disease (CHD). Dynamic cine imaging captures cardiac motion essential for assessment of cardiac function; however, the reconstruction of 3D+time cine volumes from 2D+time acquired slices remains challenging due to unpredictable fetal motion and the absence of automated and robust processing tools suitable for clinical deployment. We present the SPARC pipeline (Slice-to-volume Pipeline for Automated Reconstruction of gated 3D+time fetal Cardiac MRI) which combines physics-informed slice-to-volume reconstruction (SVR) of Doppler ultrasound (DUS) gated stacks of slices, assisted by deep learning (DL) models for thoracic segmentation and anatomical reorientation. The proposed SVR algorithm achieves a tenfold reduction in reconstruction time relative to existing frame-wise approaches ($4.8 \pm 1.0$ vs $49.0 \pm 14.1$ min, $p < 0.0001$) while improving the reconstruction quality. Thoracic segmentation performance using ensemble aggregation exceeded inter-rater agreement (Dice $84.7 \pm 3.9\%$ vs $81.4 \pm 7.7\%$, $p<0.05$), while anatomical reorientation achieved a success rate of $90.1\%$. End-to-end evaluation on a large held-out clinical cohort ($n = 121$) demonstrated fully automatic processing in $82.6\%$ of cases with a mean runtime of $7.1 \pm 1.3$ min, compatible with clinical deployment. The complete SPARC pipeline is publicly available as a Docker container https://hub.docker.com/r/aboutill/sparc and is currently deployed at our institution as a clinical research tool.

Automated biometric analysis of fetal brain MRI enables reproducible, observer-independent quantitative assessment, yet existing methods are often restricted to few measurements or evaluated only on healthy cases. We assemble and evaluate an automated biometric analysis pipeline that localizes 22 anatomical landmarks on NeSVoR-reconstructed 3D volumes and derives 11 clinically relevant measurements spanning supratentorial, ventricular, cerebellar, and midline structures. We compare two landmark localization models, H3DE-Net and SCN, on a heterogeneous cohort of 122 acquisitions (both healthy controls and range pathologies). Localization accuracy was assessed with a linear mixed-effects model, agreement with normative growth trajectories with calibrated centile charts, and diagnostic utility with a decision tree classifying VM severity. H3DE-Net achieved significantly lower localization error than SCN across all landmarks (mean 1.36 mm vs. 3.58 mm in HC and 1.90 mm vs. 4.13 mm in PC; p < 0.001), and outperformed a GA-based regression baseline in 7 of 11 measurements. H3DE-Net measurements yielded higher classification AUC in every diagnostic group, with the clearest advantage in separating healthy controls from VM. Decision tree thresholds for ventricular width fell near the clinical 10 mm and 15 mm cut-offs used to define and grade VM.

Fetal brain biometry is essential for quantitative assessment of brain development, supporting gestational age estimation, developmental monitoring, and detection of abnormalities. In clinical practice, measurements are manually performed, making them time-consuming and prone to variability. While automated approaches have been proposed, reproducible methods remain limited, particularly those providing anatomically interpretable landmark localization. We present a fully automated deep learning-based framework for reliable and reproducible brain biometry from 3D super-resolution-reconstructed fetal brain MRI. The proposed four-step pipeline derives biometric parameters by jointly estimating linear measurements and their corresponding anatomical landmarks. A 3D convolutional neural network is trained to regress landmark coordinates from brain segmentation label maps, followed by measurement-specific geometric optimization to refine landmark positions and compute measurements. The pipeline is evaluated on two publicly available fetal MRI datasets comprising 150 volumes (gestational age range: 20-37 weeks) acquired across different scanners and protocols, assessing five key biometric measurements across varying acquisition settings and providing a comprehensive evaluation of both measurement accuracy and landmark localization using quantitative metrics and visual assessment. Compared with the only available automated pipeline, the proposed method achieves comparable or improved accuracy for most measurements. In conclusion, we introduce a straightforward pipeline for reliable biometry estimations, with efficiency, interpretability and scalability that support integration into clinical workflows.

Slice-to-volume reconstruction (SVR) is the standard method for obtaining high-resolution (HR) 3D fetal brain volumes from motion-corrupted 2D MRI slice stacks acquired in multiple orientations. Existing SVR methods are optimized and validated only for clinical-range echo times (TEs), limiting their use at non-clinical TEs and making them incompatible with quantitative T2 mapping, a protocol- and center-independent biomarker of fetal brain maturation requiring HR reconstructions across multiple TEs. We present PRIME-SVR, the first implicit neural representation (INR) framework for joint HR reconstruction from multi-echo MRI. A single fully connected network models a continuous function from spatial coordinates to signal intensities across TEs, while a second network estimates slice-specific acquisition degradations. Cross-TE coherence is enforced via a Bloch equation-derived regularization penalizing deviations from expected T2 decay, with adaptive weighting that strengthens coupling for degraded stacks. The method is fully self-supervised. We validate PRIME-SVR on 39 in vivo fetal acquisitions (13 subjects x 3 TEs) from two centers, two vendors, and two field strengths (1.5 T and 0.55 T). Compared to state-of-the-art SVR, PRIME-SVR improves reconstruction sharpness by 47%, anatomical accuracy by 30%, and cross-TE structural consistency by 14%. It enables reconstruction at late TEs previously inaccessible to SVR, yielding the first 0.8 mm isotropic T2 maps at 0.55 T and the first T2 maps derived from INR-based SVR. PRIME-SVR also accelerates quantitative imaging by reducing the data needed for multi-TE reconstruction, cutting acquisition from 15 to 10 minutes while keeping T2 accuracy within 1.7% in white and deep gray matter, or to 5 minutes with a mean T2 error of 2.3% for high-quality acquisitions.

Preterm birth is associated with significant mortality and a risk for lifelong morbidity. The complex multifactorial aetiology hampers accurate prediction and thus optimal care. A pipeline consisting of bespoke machine learning methods for data imputation, feature selection, and regression models to predict gestational age (GA) at birth was developed and evaluated from comprehensive multi-modal morphological and functional fetal MRI data from 333 control cases and 93 preterm birth cases. The GA at birth predictions were classified into term and preterm categories and their accuracy, sensitivity, and specificity were reported. An ablation study was performed to further validate the design of the pipeline. Performance was evaluated using stratified 10-fold cross-validation. The pipeline achieves an R2 score of 0.13 and a mean absolute error of 2.74 weeks. It also achieves a 0.77 accuracy, 0.59 sensitivity, and 0.82 specificity across folds. The predominant features selected by the pipeline include cervical length and statistics derived from placental T2* values. The confluence of fast, motion-robust and multi-modal fetal MRI techniques and machine learning prediction allowed the prediction of the gestation at birth. This information is essential for any pregnancy. To the best of our knowledge, preterm birth had only been addressed as a classification problem in the literature. Therefore, this work provides a proof of concept. Future work will increase the cohort size to allow for finer stratification within the preterm birth cohort. Our code is available at https://github.com/dfajardorojas/ml-for-preterm-birth-.

Spatio-temporal fetal brain atlases are important for characterizing normative neurodevelopment and identifying congenital anomalies. However, existing atlas construction pipelines necessitate days for slice-to-volume reconstruction (SVR) to generate high-resolution 3D brain volumes and several additional days for iterative volume registration, thereby rendering atlas construction from large-scale cohorts prohibitively impractical. We address these limitations with INFANiTE, an Implicit Neural Representation (INR) framework for high-resolution Fetal brain spatio-temporal Atlas learNing from clinical Thick-slicE MRI scans, bypassing both the costly SVR and the iterative non-rigid registration steps entirely, thereby substantially accelerating atlas construction. Extensive experiments demonstrate that INFANiTE outperforms existing baselines in subject consistency, reference fidelity, intrinsic quality and biological plausibility, even under challenging sparse-data settings. Additionally, INFANiTE reduces the end-to-end processing time (i.e., from raw scans to the final atlas) from days to hours compared to the traditional 3D volume-based pipeline (e.g., SyGN), facilitating large-scale population-level fetal brain analysis. Code: https://github.com/hu2274898/INFANiTE

This article presents a novel approach to keyframe detection in ultrasound videos, with a particular focus on fetal brain imaging. The proposed model is a composite neural network architecture that combines a Convolutional Neural Network (CNN) with a Recurrent Neural Network (RNN). The CNN extracts spatial features from individual video frames, while the RNN captures temporal dependencies between consecutive frames within each video sequence. The proposed model may improve the efficiency and accuracy of fetal brain ultrasound analysis, thereby supporting earlier detection, diagnosis, and treatment planning for selected fetal brain conditions.

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.

Automated analysis of articulated bodies is crucial in medical imaging. Existing surface-based models often ignore internal volumetric structures and rely on deformation methods that lack anatomical consistency guarantees. To address this problem, we introduce a differentiable volumetric body model based on the Skinned Multi-Person Linear (SMPL) formulation, driven by a new Kinematic Tree-based Log-Euclidean PolyRigid (KTPolyRigid) transform. KTPolyRigid resolves Lie algebra ambiguities associated with large, non-local articulated motions, and encourages smooth, bijective volumetric mappings. Evaluated on 53 fetal MRI volumes, KTPolyRigid yields deformation fields with significantly fewer folding artifacts. Furthermore, our framework enables robust groupwise image registration and a label-efficient, template-based segmentation of fetal organs. It provides a robust foundation for standardized volumetric analysis of articulated bodies in medical imaging.

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.

Fetal brain tissue segmentation from magnetic resonance imaging (MRI) is crucial for studying neurodevelopment, but remains challenging due to data heterogeneity and limited annotations. Domain randomization (DR) has recently emerged as a promising strategy for single-source domain generalization by synthesizing training images with randomized artifacts, contrast, and resolution. In this work, we investigate how to maximize the out-of-domain (OOD) generalization of DR-based methods. We evaluate several synthetic data generation strategies for DR, with a particular focus on our recently proposed framework, FetalSynthSeg. We show that simple Gaussian mixture-based intensity modeling outperforms more complex physics-based simulations, and that intensity clustering (subdividing tissue classes based on intensity) improves OOD robustness. Evaluated on 348 fetal subjects from four sites spanning 0.55-3T and both T1w and T2w contrasts, FetalSynthSeg reaches state-of-the-art performance on several FeTA 2024 testing datasets (80-85 Dice score) and, for the first time, offers robust segmentation on modalities other than T2w for fetal brain segmentation (80 Dice on dHCP-T1w dataset). Compared with state-of-the-art methods such as BOUNTI, nnU-Net ensemble, and the FeTA 2024 winner, FetalSynthSeg delivers comparable or superior accuracy while maintaining strong robustness across domain shifts. Our code, model weights, and Docker image ready for easy inference are available at https://hub.docker.com/r/vzalevskyi/fetalsynthseg.

Deep learning has shown significant value in medical image registration for motion correction; however, current techniques are either limited by the type and range of motion they can handle or require iterative inference and/or retraining for new imaging data. To address these limitations, we introduce UniMo, a Unified Motion Correction framework that uses deep neural networks to correct various types of motion in medical imaging. UniMo uses an alternating optimization scheme with a unified loss function to train an integrated model of 1) an equivariant neural network for global rigid motion correction and 2) an encoder-decoder network for local deformations. It features a geometric deformation augmenter that 1) enhances the robustness of global motion correction by addressing local deformations, whether caused by non-rigid motion or geometric distortions, and 2) generates augmented data to improve training. As a hybrid model that uses both image intensities and shapes, UniMo is robust to appearance variations and generalizes to various imaging modalities without retraining. We trained and tested UniMo for motion tracking in fetal magnetic resonance imaging, which is challenging due to 1) both large rigid and non-rigid motion and 2) large variations in image appearance. We then tested the trained model, without retraining, on three public datasets: MedMNIST, lung CT, and BraTS. UniMo surpassed existing motion correction methods in accuracy and, notably, enabled one-time training on a single modality while maintaining high stability and adaptability across multiple unseen imaging datasets. By offering a unified solution to motion correction, UniMo marks a significant advance in challenging applications with a mixture of bulk motion and local deformations. Code is available at https://github.com/IntelligentImaging/UNIMO