Journal Papers

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Hesper, Tobias, Evgeny Bulat, Sarah Bixby, Alireza Akhondi-Asl, Onur Afacan, Patricia Miller, Garrett Bowen, Simon Warfield, and Young-Jo Kim. (2017) 2017. “Both 3-T DGEMRIC and Acetabular-Femoral T2 Difference May Detect Cartilage Damage at the Chondrolabral Junction”. Clin Orthop Relat Res 475 (4): 1058-65. https://doi.org/10.1007/s11999-016-5136-1.
BACKGROUND: In addition to case reports of gadolinium-related toxicities, there are increasing theoretical concerns about the use of gadolinium for MR imaging. As a result, there is increasing interest in noncontrast imaging techniques for biochemical cartilage assessment. Among them, T2 mapping holds promise because of its simplicity, but its biophysical interpretation has been controversial. QUESTIONS/PURPOSES: We sought to determine whether (1) 3-T delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T2 mapping are both capable of detecting cartilage damage at the chondrolabral junction in patients with femoroacetabular impingement (FAI); and (2) whether there is a correlation between these two techniques for acetabular and femoral head cartilage assessment. METHODS: Thirty-one patients with hip-related symptoms resulting from FAI underwent a preoperative 3-T MRI of their hip that included dGEMRIC and T2 mapping (symptomatic group, 16 women, 15 men; mean age, 27 ± 8 years). Ten volunteers with no symptoms according to the WOMAC served as a control (asymptomatic group, seven women, three men; mean age, 28 ± 3 years). After morphologic cartilage assessment, acetabular and femoral head cartilages were graded according to the modified Outerbridge grading criteria. In the midsagittal plane, single-observer analyses of precontrast T1 values (volunteers), the dGEMRIC index (T1Gd, patients), and T2 mapping values (everyone) were compared in acetabular and corresponding femoral head cartilage at the chondrolabral junction of each hip by region-of-interest analysis. RESULTS: In the symptomatic group, T1Gd and T2 values were lower in the acetabular cartilage compared with corresponding femoral head cartilage (T1Gd: 515 ± 165 ms versus 650 ± 191 ms, p < 0.001; T2: 39 ± 8 ms versus 46 ± 10 ms, p < 0.001). In contrast, the asymptomatic group demonstrated no differences in T1 and T2 values for the acetabular and femoral cartilages with the numbers available (T1: 861 ± 130 ms versus 860 ± 182 ms, p = 0.98; T2: 43 ± 7 ms versus 42 ± 6 ms, p = 0.73). No correlation with the numbers available was noted between the modified Outerbridge grade and T1, T1Gd, or T2 as well as between T2 and either T1 or T1Gd. CONCLUSIONS: Without the need for contrast media application, T2 mapping may be a viable alternative to dGEMRIC when assessing hip cartilage at the chondrolabral junction. However, acquisition-related phenomena as well as regional variations in the microstructure of hip cartilage necessitate an internal femoral head cartilage control when interpreting these results. LEVEL OF EVIDENCE: Level IV, diagnostic study.
Mitsouras, Dimitris, Robert Mulkern, Onur Afacan, Dana Brooks, and Frank Rybicki. (2007) 2007. “Basis Function Cross-Correlations for Robust K-Space Sample Density Compensation, With Application to the Design of Radiofrequency Excitations”. Magn Reson Med 57 (2): 338-52. https://doi.org/10.1002/mrm.21125.
The problem of k-space sample density compensation is restated as the normalization of the independent information that can be expressed by the ensemble of Fourier basis functions corresponding to the trajectory. Specifically, multiple samples (complex exponential functions) may be contributing to each independent information element (independent basis function). Normalization can be accomplished by solving a linear system based on the cross-correlation matrix of the underlying Fourier basis functions. The solution to this system is straightforward and can be obtained without resorting to discretization since the cross-correlations of Fourier basis functions are analytically known. Furthermore, no restrictions are placed on the k-space trajectory and its point-spread function. Additionally, the linear system can be used to elucidate key trade-offs involved in k-space trajectory design. The approach can be used to compensate samples acquired for image reconstruction or designed for low flip angle radiofrequency (RF) excitation. Here it is demonstrated for the latter application, using reversed spiral trajectories. In this case the linear system approach enables one to easily incorporate additional constraints such as smoothness to the solution. For typical RF excitation durations (<20 ms) it is shown that density compensation can even be achieved without numerical iteration.

A

Alic, Taner, Sinan Zehir, Meryem Yalcinkaya, Emre Deniz, Harun Emre Kiran, and Onur Afacan. (2025) 2025. “Artificial Intelligence-Assisted Accurate Diagnosis of Anterior Cruciate Ligament Tears Using Customized CNN and YOLOv9.”. Frontiers in Radiology 5: 1691048. https://doi.org/10.3389/fradi.2025.1691048.

BACKGROUND: Accurate diagnosis of anterior cruciate ligament (ACL) tears on magnetic resonance imaging (MRI) is critical for timely treatment planning. Deep learning (DL) approaches have shown promise in assisting clinicians, but many prior studies are limited by small datasets, lack of surgical confirmation, or exclusion of partial tears.

AIM: To evaluate the performance of multiple convolutional neural network (CNN) architectures, including a proposed CustomCNN, for ACL tear detection using a surgically validated dataset.

METHODS: A total of 8,086 proton density-weighted sagittal knee MRI slices were obtained from patients whose ACL status (intact, partial, or complete tear) was confirmed arthroscopically. Eleven deep learning models, including CustomCNN, DenseNet121, and InceptionResNetV2, were trained and evaluated with strict patient-level separation to avoid data leakage. Model performance was assessed using accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC).

RESULTS: The CustomCNN model achieved the highest diagnostic performance, with an accuracy of 91.5% (95% CI: 89.5-93.1), sensitivity of 92.4% (95% CI: 90.4-94.2), and an AUC of 0.913. The inclusion of both partial and complete tears enhanced clinical relevance, and patient-level splitting reduced the risk of inflated metrics from correlated slices. Compared with previous reports, the proposed approach demonstrated competitive results while addressing key methodological limitations.

CONCLUSION: The CustomCNN model enables rapid and reliable detection of ACL tears, including partial lesions, and may serve as a valuable decision-support tool for radiologists and orthopedic surgeons. The use of a surgically validated dataset and rigorous methodology enhances clinical credibility. Future work should expand to multicenter datasets, diverse MRI protocols, and prospective reader studies to establish generalizability and facilitate integration into real-world workflows.

Stamm, Aymeric, Jolene Singh, Onur Afacan, and Simon Warfield. (2015) 2015. “Analytic Quantification of Bias and Variance of Coil Sensitivity Profile Estimators for Improved Image Reconstruction in MRI”. Med Image Comput Comput Assist Interv 9350: 684-91. https://doi.org/10.1007/978-3-319-24571-3_82.
Magnetic resonance (MR) imaging provides a unique in-vivo capability of visualizing tissue in the human brain non-invasively, which has tremendously improved patient care over the past decades. However, there are still prominent artifacts, such as intensity inhomogeneities due to the use of an array of receiving coils (RC) to measure the MR signal or noise amplification due to accelerated imaging strategies. It is critical to mitigate these artifacts for both visual inspection and quantitative analysis. The cornerstone to address this issue pertains to the knowledge of coil sensitivity profiles (CSP) of the RCs, which describe how the measured complex signal decays with the distance to the RC. Existing methods for CSP estimation share a number of limitations: (i) they primarily focus on CSP magnitude, while it is known that the solution to the MR image reconstruction problem involves complex CSPs and (ii) they only provide point estimates of the CSPs, which makes the task of optimizing the parameters and acquisition protocol for their estimation difficult. In this paper, we propose a novel statistical framework for estimating complex-valued CSPs. We define a CSP estimator that uses spatial smoothing and additional body coil data for phase normalization. The main contribution is to provide detailed information on the statistical distribution of the CSP estimator, which yields automatic determination of the optimal degree of smoothing for ensuring minimal bias and provides guidelines to the optimal acquisition strategy.
Scherrer, Benoit, Onur Afacan, Maxime Taquet, Sanjay Prabhu, Ali Gholipour, and Simon Warfield. (2015) 2015. “Accelerated High Spatial Resolution Diffusion-Weighted Imaging”. Inf Process Med Imaging 24: 69-81. https://doi.org/10.1007/978-3-319-19992-4_6.
Acquisition of a series of anisotropically oversampled acquisitions (so-called anisotropic "snapshots") and reconstruction in the image space has recently been proposed to increase the spatial resolution in diffusion weighted imaging (DWI), providing a theoretical 8x acceleration at equal signal-to-noise ratio (SNR) compared to conventional dense k-space sampling. However, in most works, each DW image is reconstructed separately and the fact that the DW images constitute different views of the same anatomy is ignored. In addition, current approaches are limited by their inability to reconstruct a high resolution (HR) acquisition from snapshots with different subsets of diffusion gradients: an isotropic HR gradient image cannot be reconstructed if one .of its anisotropic snapshots is missing, for example due to intra-scan motion, even if other snapshots for this gradient were successfully acquired. In this work, we propose a novel multi-snapshot DWI reconstruction technique that simultaneously achieves HR reconstruction and local tissue model estimation while enabling reconstruction from snapshots containing different subsets of diffusion gradients, providing increased robustness to patient motion and potential for acceleration. Our approach is formalized as a joint probabilistic model with missing observations, from which interactions between missing snapshots, HR reconstruction and a generic tissue model naturally emerge. We evaluate our approach with synthetic simulations, simulated multi-snapshot scenario and in vivo multi-snapshot imaging. We show that (1) our combined approach ultimately provides both better HR reconstruction and better tissue model estimation and (2) the error in the case of missing snapshots can be quantified. Our novel multi-snapshot technique will enable improved high spatial characterization of the brain connectivity and microstructure in vivo.

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Pier, Danielle, Ali Gholipour, Onur Afacan, Clemente Velasco-Annis, Sean Clancy, Kush Kapur, Judy Estroff, and Simon Warfield. 2016. “3D Super-Resolution Motion-Corrected MRI: Validation of Fetal Posterior Fossa Measurements”. J Neuroimaging 26 (5): 539-44. https://doi.org/10.1111/jon.12342.
PURPOSE: Current diagnosis of fetal posterior fossa anomalies by sonography and conventional MRI is limited by fetal position, motion, and by two-dimensional (2D), rather than three-dimensional (3D), representation. In this study, we aimed to validate the use of a novel magnetic resonance imaging (MRI) technique, 3D super-resolution motion-corrected MRI, to image the fetal posterior fossa. METHODS: From a database of pregnant women who received fetal MRIs at our institution, images of 49 normal fetal brains were reconstructed. Six measurements of the cerebellum, vermis, and pons were obtained for all cases on 2D conventional and 3D reconstructed MRI, and the agreement between the two methods was determined using concordance correlation coefficients. Concordance of axial and coronal measurements of the transcerebellar diameter was also assessed within each method. RESULTS: Between the two methods, the concordance of measurements was high for all six structures (P < .001), and was highest for larger structures such as the transcerebellar diameter. Within each method, agreement of axial and coronal measurements of the transcerebellar diameter was superior in 3D reconstructed MRI compared to 2D conventional MRI (P < .001). CONCLUSIONS: This comparison study validates the use of 3D super-resolution motion-corrected MRI for imaging the fetal posterior fossa, as this technique results in linear measurements that have high concordance with 2D conventional MRI measurements. Lengths of the transcerebellar diameter measured within a 3D reconstruction are more concordant between imaging planes, as they correct for fetal motion and orthogonal slice acquisition. This technique will facilitate further study of fetal abnormalities of the posterior fossa.
Villarini, Barbara, Hykoush Asaturyan, Sila Kurugol, Onur Afacan, Jimmy Bell, and Louise Thomas. (2021) 2021. “3D Deep Learning for Anatomical Structure Segmentation in Multiple Imaging Modalities”. Proc IEEE Int Symp Comput Based Med Syst 2021: 166-71. https://doi.org/10.1109/cbms52027.2021.00066.
Accurate, quantitative segmentation of anatomical structures in radiological scans, such as Magnetic Resonance Imaging (MRI) and Computer Tomography (CT), can produce significant biomarkers and can be integrated into computer-aided assisted diagnosis (CADx) systems to support the interpretation of medical images from multi-protocol scanners. However, there are serious challenges towards developing robust automated segmentation techniques, including high variations in anatomical structure and size, the presence of edge-based artefacts, and heavy un-controlled breathing that can produce blurred motion-based artefacts. This paper presents a novel computing approach for automatic organ and muscle segmentation in medical images from multiple modalities by harnessing the advantages of deep learning techniques in a two-part process. (1) a 3D encoder-decoder, Rb-UNet, builds a localisation model and a 3D Tiramisu network generates a boundary-preserving segmentation model for each target structure; (2) the fully trained Rb-UNet predicts a 3D bounding box encapsulating the target structure of interest, after which the fully trained Tiramisu model performs segmentation to reveal detailed organ or muscle boundaries. The proposed approach is evaluated on six different datasets, including MRI, Dynamic Contrast Enhanced (DCE) MRI and CT scans targeting the pancreas, liver, kidneys and psoas-muscle and achieves quantitative measures of mean Dice similarity coefficient (DSC) that surpass or are comparable with the state-of-the-art. A qualitative evaluation performed by two independent radiologists verified the preservation of detailed organ and muscle boundaries.