AutOmatic floW planning for fetaL MRI (OWL)

Two subsequent deep learning networks, one localizing the fetal chest and one identifying a set of landmarks on a coronal whole-uterus balanced steady-state free precession scan, were trained on 167 and 71 fetal datasets across field strengths, acquisition parameters, and gestational ages and implemented in a real-time setup. Next, a phase-contrast sequence was modified to use the identified landmarks for planning. The OWL pipeline was evaluated retrospectively in 10 datasets and prospectively in 7 fetal subjects (gestational ages between 36+3 and 39+3 weeks). The prospective cases were additionally manually planned to enable direct comparison both qualitatively, by scoring the planning quality, and quantitatively, by comparing the indexed flow measurements. OWL enabled real-time fully automatic planning of the 2D phase-contrast scans in all but one of the prospective participants. The fetal body localization achieved an overall Dice score of 0.94+-0.05 and the cardiac landmark detection accuracy was 5.77+-2.91 mm for the descending aorta, 4.32+-2.44 mm for the spine, and 4.94+-3.82 mm for the umbilical vein. For the prospective cases, overall planning quality was 2.73/4 for the automated scans, compared to 3.0/4 for manual planning, and the flow quantitative evaluation showed a mean difference of -1.8% (range -14.2% to 14.9%) by comparing the indexed flow measurements obtained from gated automatic and manual acquisitions. Real-time automated planning of 2D phase-contrast MRI was effectively accomplished for 2 major vessels of the fetal vasculature. While demonstrated here on 0.55T, the achieved method has wider implications, and training across multiple field strengths enables generalization. OWL thereby presents an important step towards extending access to this modality beyond specialised centres.