PDFF-CNN: An attention-guided dynamic multi-orientation feature fusion method for gestational age prediction on imbalanced fetal brain MRI dataset

Background: Fetal brain magnetic resonance imaging (MRI)-based gestational age prediction has been widely used to characterize normal fetal brain development and diagnose congenital brain malformations. Purpose: The uncertainty of fetal position and external interference leads to variable localization and direction of the fetal brain. In addition, pregnant women typically concentrate on receiving MRI scans during the fetal anomaly scanning week, leading to an imbalanced distribution of fetal brain MRI data. The above-mentioned problems pose great challenges for deep learning-based fetal brain MRI gestational age prediction. Methods: In this study, a pyramid squeeze attention (PSA)-guided dynamic feature fusion CNN (PDFF-CNN) is proposed to robustly predict gestational ages from fetal brain MRI images on an imbalanced dataset. PDFF-CNN contains four components: transformation module, feature extraction module, dynamic feature fusion module, and balanced mean square error (MSE) loss. The transformation and feature extraction modules are employed by using the PSA to learn multiscale and multi-orientation feature representations in a parallel weight-sharing Siamese network. The dynamic feature fusion module automatically learns the weights of feature vectors generated in the feature extraction module to dynamically fuse multiscale and multi-orientation brain sulci and gyri features. Considering the fact of the imbalanced dataset, the balanced MSE loss is used to mitigate the negative impact of imbalanced data distribution on gestational age prediction performance. Results: Evaluated on an imbalanced fetal brain MRI dataset of 1327 routine clinical T2-weighted MRI images from 157 subjects, PDFF-CNN achieved promising gestational age prediction performance with an overall mean absolute error of 0.848 weeks and an R-2 of 0.904. Furthermore, the attention activation maps of PDFF-CNN were derived, which revealed regional features that contributed to gestational age prediction at each gestational stage. Conclusions: These results suggest that the proposed PDFF-CNN might have broad clinical applicability in guiding treatment interventions and delivery planning, which has the potential to be helpful with prenatal diagnosis.