Shape constrained CNN for segmentation guided prediction of myocardial shape and pose parameters in cardiac MRI

Semantic segmentation using convolutional neural networks (CNNs) is the state-of-the-art for many medical image segmentation tasks including myocardial segmentation in cardiac MR images. However, the predicted segmentation maps obtained from such standard CNN do not allow direct quantification of regional shape properties such as regional wall thickness. Furthermore, the CNNs lack explicit shape constraints, occasionally resulting in unrealistic segmentations. In this paper, we use a CNN to predict shape parameters of an underlying statistical shape model of the myocardium learned from a training set of images. Additionally, the cardiac pose is predicted, which allows to reconstruct the myocardial contours. The integrated shape model regularizes the predicted contours and guarantees realistic shapes. We enforce robustness of shape and pose prediction by simultaneously performing pixel-wise semantic segmentation during training and define two loss functions to impose consistency between the two predicted representations: one distance-based loss and one overlap-based loss. We evaluated the proposed method in a 5-fold cross validation on an in-house clinical dataset with 75 subjects and on the ACDC and LVQuan19 public datasets. We show that the two newly defined loss functions successfully increase the consistency between shape and pose parameters and semantic segmentation, which leads to a significant improvement of the reconstructed myocardial contours. Additionally, these loss functions drastically reduce the occurrence of unrealistic shapes in the semantic segmentation output.