Deep learning motion correction of quantitative stress perfusion cardiovascular magnetic resonance

Background: Quantitative stress perfusion cardiovascular magnetic resonance (CMR) is a powerful tool for assessing myocardial ischemia. Motion correction is essential for accurate pixel-wise mapping but traditional registration-based methods are slow and sensitive to acquisition variability, limiting robustness and scalability. Methods: We developed an unsupervised deep learning-based motion correction pipeline that replaces iterative registration with efficient one-shot estimation. The method corrects motion in three steps and uses robust principal component analysis to reduce contrast-related effects. It aligns the perfusion series and auxiliary images (arterial input function and proton density-weighted series). Models were trained and validated on multivendor data from 201 patients, with 38 held out for testing. Performance was assessed via temporal alignment and quantitative perfusion values, compared to a previously published registration-based method. Results: The deep learning approach significantly improved temporal smoothness of time-intensity curves (p<0.001). Myocardial alignment (Dice = 0.92 (0.04) and 0.91 (0.05)) was comparable to the baseline and superior to before registration (Dice = 0.80 (0.09), p<0.001). Perfusion maps showed reduced motion, with lower standard deviation in the myocardium (0.52 (0.39) ml/min/g) compared to baseline (0.55 (0.44) ml/min/g). Processing time was reduced 15-fold. Conclusion: This deep learning pipeline enables fast, robust motion correction for stress perfusion CMR, improving accuracy across dynamic and auxiliary images. Trained on multivendor data, it generalizes across sequences and may facilitate broader clinical adoption of quantitative perfusion imaging.