To deform or not: treatment-aware longitudinal registration for breast DCE-MRI during neoadjuvant chemotherapy via unsupervised keypoints detection

Clinicians compare breast DCE-MRI after neoadjuvant chemotherapy (NAC) with pre-treatment scans to evaluate the response to NAC. Clinical evidence supports that accurate longitudinal deformable registration without deforming treated tumor regions is key to quantifying tumor changes. We propose a conditional pyramid registration network based on unsupervised keypoint detection and selective volume-preserving to quantify changes over time. In this approach, we extract the structural and the abnormal keypoints from DCE-MRI, apply the structural keypoints for the registration algorithm to restrict large deformation, and employ volume-preserving loss based on abnormal keypoints to keep the volume of the tumor unchanged after registration. We use a clinical dataset with 1630 MRI scans from 314 patients treated with NAC. The results demonstrate that our method registers with better performance and better volume preservation of the tumors. Furthermore, a local-global-combining biomarker based on the proposed method achieves high accuracy in pathological complete response (pCR) prediction, indicating that predictive information exists outside tumor regions. The biomarkers could potentially be used to avoid unnecessary surgeries for certain patients. It may be valuable for clinicians and/or computer systems to conduct follow-up tumor segmentation and response prediction on images registered by our method. Our code is available on .