The performance and diagnostic utility of magnetic resonance imaging (MRI) in pregnancy is fundamentally constrained by fetal motion. Motion of the fetus, which is unpredictable and rapid on the scale of conventional imaging times, limits the set of viable acquisition techniques to single-shot imaging with severe compromises in signal-tonoise ratio and diagnostic contrast, and frequently results in unacceptable image quality. Surprisingly little is known about the characteristics of fetal motion during MRI and here we propose and demonstrate methods that exploit a growing repository of MRI observations of the gravid abdomen that are acquired at low spatial resolution but relatively high temporal resolution and over long durations (10-30 minutes). We estimate fetal pose per frame in MRI volumes of the pregnant abdomen via deep learning algorithms that detect key fetal landmarks. Evaluation of the proposed method shows that our framework achieves quantitatively an average error of 4.47 mm and 96.4% accuracy (with error less than 10 mm). Fetal pose estimation in MRI time series yields novel means of quantifying fetal movements in health and disease, and enables the learning of kinematic models that may enhance prospective mitigation of fetal motion artifacts during MRI acquisition.

Purpose: To demonstrate, through numerical simulations, novel designs of spatially selective radiofrequency (RF) excitations of the fetal brain by both a restricted 2D slice and 3D inner-volume selection. These designs exploit a singlechannel RF pulse, conventional gradient fields, and the spatially non-linear ΔB 0 fields of a multi-coil shim array, using an auto-differentiation optimization algorithm. Methods:The design algorithm jointly optimizes the RF pulse and the timevarying ΔB 0 fields, which is produced by a 64-channel multi-coil ΔB 0 body array to augment the RF and the linear gradient fields, using an auto-differentiation approach. Two design targets were specified, one a 4-mm thick slice with a limited in-slice extent in one dimension ("restricted slice"), and the other a 3D inner-volume selection encompassing the fetal brain ("inner volume"). The RF duration was limited to 2 ms for the restricted slice excitation and 6 ms for the inner-volume excitation.Results: Excitation profiles were achieved for both the restricted slice excitation task (one-minus-minimum magnitude, 8%) within the region of interest (ROI) and (maximum-minus-zero magnitude, 8%) in the suppressed regions and the fetal brain volume excitation task (13% and 9%, respectively). Conclusions:The proposed joint design of RF and time-varying, spatially nonlinear ΔB 0 fields achieves the target excitation profiles with short RF pulse durations and demonstrates the potential to enhance fetal MRI with multi-channel body shim arrays.

Fetal MRI is heavily constrained by unpredictable and substantial fetal motion that causes image artifacts and limits the set of viable diagnostic image contrasts. Current mitigation of motion artifacts is predominantly performed by fast, single-shot MRI and retrospective motion correction. Estimation of fetal pose in real time during MRI stands to benefit prospective methods to detect and mitigate fetal motion artifacts where inferred fetal motion is combined with online slice prescription with low-latency decision making. Current developments of deep reinforcement learning (DRL), offer a novel approach for fetal landmarks detection. In this task 15 agents are deployed to detect 15 landmarks simultaneously by DRL. The optimization is challenging, and here we propose an improved DRL that incorporates priors on physical structure of the fetal body. First, we use graph communication layers to improve the communication among agents based on a graph where each node represents a fetal-body landmark. Further, additional reward based on the distance between agents and physical structures such as the fetal limbs is used to fully exploit physical structure. Evaluation of this method on a repository of 3-mm resolution in vivo data demonstrates a mean accuracy of landmark estimation within 10 mm of ground truth as 87.3%, and a mean error of 6.9 mm. The proposed DRL for fetal pose landmark search demonstrates a potential clinical utility for online detection of fetal motion that guides real-time mitigation of motion artifacts as well as health diagnosis during MRI of the pregnant mother.

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