Medical Image Analysis

Accurate measurement of intra-cardiac blood oxygen (O2) saturation is essential for cardiovascular assessment, yet current methods require invasive catheterization. T2-based cardiac magnetic resonance imaging (CMRI) enables non-invasive O2 quantification, but deep learning automation is constrained by scarce annotated data. We propose a unified self-supervised learning (SSL) framework integrating cine CMRI and T2 oximetry CMRI to learn generalizable representations without labels. Our approach pre-trains ResNet and vision transformer encoders using contrastive learning and masked image modeling on over 48,000 cardiac images. Pre-trained encoders are fine-tuned for O2 saturation regression with uncertainty quantification to enhance clinical trustworthiness. Our SSL framework significantly outperforms traditional radiomics and supervised baselines, with SimCLR pre-trained ResNet achieving a mean absolute error of 3.70, representing over 15\% improvement. These findings demonstrate SSL's potential to address annotation bottlenecks in non-invasive cardiac diagnostics.

Accurate prenatal screening from ultrasound imaging is severely constrained by the extreme spatial heterogeneity of fetal structures and the data scarcity inherent to rare congenital anomalies. To overcome these computational bottlenecks, we present RadarMAE, a data-efficient self-supervised representation learning framework tailored for fetal ultrasound analysis. By employing a novel, structure-aware masking strategy, RadarMAE enables robust pre-training on highly limited clinical datasets. Benchmarking the framework on first-trimester screening for trisomy 21 (Down syndrome), our model achieved exceptional diagnostic performance on an internal cohort, with an area under the curve (AUC) of 0.99, 97% accuracy, 94% sensitivity, and 98% specificity. Crucially, through domain-adversarial adaptation, the framework demonstrates robust cross-institutional generalization under extreme source-target data imbalance, bounding performance degradation to less than or equal to 0.04 across all key metrics in external testing. Furthermore, by integrating spatial registration with explainable AI, we constructed the first population-level facial risk atlas for trisomy 21. This data-driven interpretability framework validates standard clinical markers while revealing the comparable diagnostic weight of underutilized features, such as mandibular dysmorphology. Ultimately, this approach provides a scalable, transparent, and high-performance solution for equitable prenatal diagnostics and phenotypic biomarker discovery.

Background: Segmentation of the left ventricular myocardium, left ventricular cavity, and right ventricular cavity on short-axis cine cardiac magnetic resonance (CMR) images is essential for quantifying cardiac structure and function. However, existing automated segmentation tools are limited by small training datasets, narrow disease coverage, restrictive input format requirements, and the absence of anatomical plausibility constraints, hindering their clinical adoption. Methods: We constructed the largest annotated CMR short-axis segmentation dataset to date, comprising 1,555 subjects from 12 centers with five cardiac disease types and full cardiac cycle annotations totaling 319,175 labeled images. A MedNeXt-L model was trained using a 2D slice-by-slice strategy with full field-of-view input, eliminating dependencies on 3D volumes, temporal sequences, or region-of-interest(ROI) localization. A deterministic three-step post-processing pipeline was designed to enforce anatomical priors: connected component constraint, containment relationship constraint, and gap-filling constraint. The model was validated on an internal test set (310 subjects) and three independent public external datasets (ACDC, M&Ms1, M and Ms2; 855 subjects from 6 additional centers across 3 countries), spanning 15 cardiac disease categories-10 of which were never encountered during training. Results: The model achieved mean Dice similarity coefficients (DSC) of 0.913 {+/-} 0.037 and 0.911 {+/-} 0.040 on internal and external test sets, respectively, with a cross-domain performance gap of only 0.002. Post-processing eliminated all containment violations (7.5% [->] 0%) and gap errors (1.8% [->] 0%) while reducing fragment rates by 85.5% (9.0% [->] 1.3%). Zero-shot generalization to 10 unseen disease categories yielded DSC values ranging from 0.899 to 0.921. Automated clinical functional parameters demonstrated excellent agreement with manual measurements for left ventricular indices and right ventricular volumes (intraclass correlation coefficients [≥] 0.977). Conclusions: CorSeg-CineSAX provides a robust, open-source framework for fully automatic CMR short-axis segmentation across diverse clinical scenarios. All source code and pre-trained weights are publicly available at https://github.com/RunhaoXu2003/CorSeg.

Timely detection of fetal distress during labor is a central pursuit of modern obstetric care. The primary measure used in this regard is fetal heart rate and contraction monitoring (echocardiotocography or CTG), which provides a continuous signal during labor. The vast majority of machine learning applications to CTG assume access to a 30 to 60 minute window just prior to delivery, which makes an untenable assumption that the timing of delivery is known. In this work, we reframe the problem as a time-to-event prediction task. We develop deep time-to-event models to predict the joint probability of imminent delivery and fetal acidosis, a biomarker of fetal hypoxia collected from umbilical cord gas after delivery. We develop a framework for this problem, drawing on deep discrete-time survival methods and marked point processes, adapting each to this particular setting (i.e., continuous physiological signals, fully observed events, partially observed labels). One approach dubbed Marked DeepHit accurately estimates delivery within one hour at multiple elapsed-time landmarks, with test-set AUROC of 0.837 [95% CI 0.692--0.970] and 0.935 [0.858--0.964] at 6 and 12 hours into labor, respectively. We find that these models also achieve competitive performance near delivery time compared to prior models trained specifically on the end of tracing, and outperform other clinical feature-based proposals, both on internal and external validation at a second site. These results give a proof-of-principle to support future prospective deployment of AI-EFM during labor.

Deep segmentation networks can degrade sharply when an expected MRI sequence is unavailable at inference. We present NeuroMesh, a bottleneck controller that combines a gated recurrent unit (GRU) with a graphconvolutional edge-activation mask, designed to adapt a U-Net-style segmentation backbone to missing input. We evaluate NeuroMesh in a pilot study using a 30-patient subset of the BraTS 2020 benchmark (22 training, 4 validation, and 4 held-out test patients) under a prespecified frozentest protocol. On the frozen test set, NeuroMesh has higher tumor-core and enhancing-tumor Dice than a plain U-Net in most evaluated missing-modality conditions, but wholetumor Dice falls from 0.596 to 0.108 when FLAIR is missing, compared with 0.604 to 0.545 for the plain U-Net. Direct analysis of the predicted edge-activation mask shows negligible change across modality-availability conditions. A parameter-light static-gating control reproduces the FLAIR failure mode without recurrence, a failure-signal input, or graph-structured machinery. These results do not support the intended interpretation that the trained controller performs input-conditional topology rewiring at the scale of this pilot. Instead, they expose a discrepancy between architectural intent and realized behavior and identify a specific missing-modality failure mode that warrants further investigation. Given the small validation and test sets, the findings are descriptive and do not establish clinical or population-level generalization.

Cardiac imaging enables quantitative assessment of cardiac structure and function but remains constrained by cost, infrastructure and specialist expertise. In contrast, electrocardiogram (ECG) is widely accessible yet underexploited, despite encoding latent information about cardiac physiology. Here we introduce visionECG, a conditional flow matching framework that learns a probabilistic mapping between two biological distributions - the space of cardiac electrical signals and the space of cardiac geometries. Using 71,132 paired ECG and cardiac mesh sequence datasets from the UK Biobank, with external assessment in 5,000 patients with ECG-echocardiogram pairs, the model reconstructs quantitatively accurate spatiotemporal representations of the left ventricle using ECG inputs and basic demographic information alone. These reconstructions enable discrimination of structural abnormalities and disease labels, provide visualisations of functional abnormalities, and support flexible quantification of both global and regional parameters. By reframing the ECG as a generative source of patient-specific left ventricular geometry and motion, this work establishes a scalable framework for translating low-dimensional signals into high-dimensional, physiologically grounded structured representations.

Accurate rectal tumor segmentation using magnetic resonance imaging (MRI) is paramount for effective treatment planning. It allows for volumetric and other quantitative tumor assessments, potentially aiding in prognostication and treatment response evaluation. Manual delineation of rectal tumors and surrounding structures is time-consuming and typically. Over the past few years, deep learning has shown strong results in automated tumor segmentation in MRI. Current studies on automated rectal tumor segmentation, however, focus solely on tumoral regions without considering the rectal anatomical entities and often lack a solid multicenter external validation. In this study, we improved rectal tumor segmentation by incorporating anomaly maps derived from anatomical inpainting. This inpainting was implemented using a U-Net-based model trained to reconstruct a healthy rectum and mesorectum from prostate T2-weighted images (T2WI). The rectal anomaly maps were generated from the difference between the original rectal and reconstructed pseudo-healthy slices during inference. The derived anomaly maps were used in the downstream tumor segmentation tasks by fusing them as an additional input channel (AAnnUNet). Alternative methods for integrating rectal anatomical knowledge were evaluated as baselines, including Multi-Target nnUNet (MTnnUNet), which added rectum and mesorectum segmentation as auxiliary tasks, and Multi-Channel nnUNet (MCnnUNet), which utilized rectum and mesorectum masks as an additional input channel. As part of this study, we benchmarked nine models for rectal tumor segmentation on a large multicenter dataset of preoperative T2WI as the baseline and nnUNet outperformed the other eight models on the external dataset. The MTnnUNet demonstrated improvements in both supervised and semi-supervised settings (AI-generated rectum and mesoretum were used) compared to nnUNet, while the MCnnUNet showed benefits only in the semi-supervised setting. Importantly, anomaly maps were strongly associated with tumoral regions, and their integration within AAnnUNet led to the best tumor segmentation results across both settings. The effectiveness of AAnnUNet demonstrated the value of the anomaly maps, indicating a promising direction for improving rectal tumor segmentation and model robustness for multicenter data.

Text-driven medical image segmentation demands unified models based on multi-modal learning, capable of processing diverse imaging modalities while providing spatially reliable prediction estimates for clinical practice. Nevertheless, existing vision-language model solutions suffer from poor domain generalization and exhibit limited capability for uncertainty estimation to model the cumulative unreliability of cross-modal alignment across network layers. In this paper, we propose UniMedSeg, a unified vision-language framework for multi-modal medical image segmentation built upon frozen pre-trained vision-language backbones. Our framework incorporates modality-aware adaptation, cross-layer uncertainty-guided encoding, and a frequency-spatial dual-prompt decoder, wherein the progressive uncertainty propagation mechanism of the encoder suppresses misleading cross-modal features, whereas the decoder disentangles anatomical structure and boundary details in the frequency domain under dual textual prompts. Auxiliary losses further sharpen boundary representations and calibrate pixel-wise uncertainty maps. Extensive experiments demonstrate that UniMedSeg preserves competitive in-domain segmentation performance, improves domain generalization, and yields clinically useful spatial risk estimation.

With the increasing ability to record neuroimaging with higher spatial and temporal resolution, there is a growing need for methods that reduce these high-dimensional representations into latent low-dimensional structures that are discriminative and/or predictive of behavior, disease, or in general experimental context. We propose a metric learning framework to extract meaningful latent structures from high-dimensional fMRI data. This method learns the latent embeddings that reduce the intra-group variability while maximizing the inter-group variability. In addition, our method leverages advances in few-shot learning approaches to adapt to small sample-size fMRI datasets, allowing one to learn the latent structure from just a few samples per context. We evaluate our work on two publicly available fMRI datasets and report superior results compared to popular alternative approaches such as Principal Component Analysis (84.7% vs. 60%; 21.8% vs. 8.3%). We provide the Python code as open-source at Github.

Congenital heart disease (CHD) is the most commonly diagnosed birth defect. T2w black blood MRI provides optimal vessel visualisation, aiding prenatal CHD diagnosis. Common clinical practice involves manual segmentation of fetal heart and vessels for visualisation and reporting purposes. We propose an automated multi-label fetal cardiac vessels deep learning segmentation approach for T2w black blood MRI. Our network is trained using single-label manual segmentations obtained through current clinical practice, combined with a multi-label anatomical atlas with desired multi-label segmentation protocol. Our framework combines deep learning label propagation with 3D residual U-Net segmentation to produce high-quality multi-label output well adapted to the individual subject anatomy. We train and evaluate the network using forty fetal subjects with suspected coarctation of the aorta, achieving a dice score of 0.79 {+/-} 0.02 for the fetal cardiac vessels region. The proposed network outperforms the label propagation and achieves a statistically equivalent performance to a 3D residual U-Net trained exclusively on manual single-label data (p-value>0.05). This multi-label framework therefore represents an advancement over the single-label approach, providing label-specific anatomical information, particularly useful for assessing specific anomaly areas in CHD.

Computational pathology is revolutionizing the field of pathology by integrating advanced computer vision and machine learning technologies into diagnostic workflows. It offers unprecedented opportunities for improved efficiency in treatment decisions by allowing pathologists to achieve higher precision and objectivity in disease classification, tumor microenvironment description and identification of new biomarkers. However, the potential of computational pathology in personalized medicine comes with significant challenges, particularly in annotating whole slide images (WSI), which is time-consuming, costly and subject to inter-observer variability. To address these challenges, Self-Supervised Learning (SSL) has emerged as a promising solution to learn representations from histology patches and leverage large volumes of unlabelled WSI. Recently, Masked Image Modeling (MIM) as a SSL framework has emerged and is now considered to outperform purely contrastive learning paradigms. In this work, we therefore explore the application of MIM to histology using iBOT, a self-supervised transformer-based framework. Through a wide range of 17 downstream tasks over seven cancer indications, both at the slide and patch levels, we provide recommendations on the pre-training of large models for histology data using MIM. First, we demonstrate that in-domain pre-training with iBOT outperforms both ImageNet pre-training and a model pre-trained with a purely contrastive learning objective, MoCo v2. Second, we show that Vision Transformers (ViT) models, when scaled appropriately, have the capability to learn pan-cancer representations that benefit a large variety of downstream tasks. Finally, our iBOT ViT-Base model (80 million parameters), pre-trained on more than 40 million histology images from 16 different cancer types, achieves state-of-the-art performance in most weakly-supervised WSI classification tasks compared to other SSL frameworks available in the literature. This paves the way for the development of a foundation model for histopathology. Our code, models and features are publicly available at https://github.com/owkin/HistoSSLscaling.

Mapping hierarchical brain networks within traditional Euclidean space causes significant structural distortion, undermining neuroimaging diagnostic frameworks. While hyperbolic models like the Poincare ball preserve these nested topologies, they demand heavy computational overhead due to intricate Mobius operations and curved geodesics. This paper introduces a highly efficient non-Euclidean framework for analyzing neurocognitive decline utilizing the Beltrami-Klein ball model. By projecting hyperbolic geodesics as Euclidean straight lines, this approach converts complex distance calculations into simple dot products, radically reducing processing demands. We validated our methodology against state-of-the-art Poincare and Lorentz baselines using datasets for Schizophrenia, Parkinsons Disease, and Alzheimers Disease. The Klein-based framework demonstrates superior performance, delivering both higher diagnostic precision and accelerated processing velocities across all three neurocognitive disorders.

Deep learning (DL)-based image synthesis has recently gained enormous interest in medical imaging, allowing for generating multi-contrast data and therefore, the recovery of missing samples from interrupted or artefact-distorted acquisitions. However, the accuracy of DL models heavily relies on the representativeness of the training datasets naturally characterized by their distributions, experimental setups or preprocessing schemes. These complicate generalizing DL models across multi-site heterogeneous data sets while maintaining the confidentiality of the data. One of the possible solutions is to employ federated learning (FL), which enables the collaborative training of a DL model in a decentralized manner, demanding the involved sites to share only the characteristics of the models without transferring their sensitive medical data. The paper presents a DL-based magnetic resonance (MR) data translation in a FL way. We introduce a new aggregation strategy called FedBAdam that couples two state-of-the-art methods with complementary strengths by incorporating momentum in the aggregation scheme and skipping the batch normalization layers. The work comprehensively validates 10 FL-based strategies for an image-to-image multi-contrast MR translation, considering healthy and tumorous brain scans from five different institutions. Our study has revealed that the FedBAdam shows superior results in terms of mean squared error and structural similarity index over personalized methods, like the FedMRI, and standard FL-based aggregation techniques, such as the FedAvg or FedProx, considering multi-site multi-vendor heterogeneous environment. The FedBAdam has prevented the overfitting of the model and gradually reached the optimal model parameters, exhibiting no oscillations.

IntroductionCerebral amyloid angiopathy (CAA) is characterized by amyloid-beta deposition in cortical and leptomeningeal vessels and associated with cognitive impairment and hemorrhage. Current neuropathological assessments rely on semiquantitative grading and lack vessel-level resolution and scalability. Existing computational pathology approaches also fail to capture individual vessel morphology and spatial amyloid distribution across whole-slide images (WSIs). To address this gap, we developed a deep learning framework for reproducible, quantitative analysis of CAA in WSIs. MethodsWe analyzed 20 postmortem brain tissue sections from the frontal (n = 10) and occipital cortices (n = 10) of 10 individuals with Alzheimers disease pathology obtained from the University of Pittsburgh Alzheimers Disease Research Center, which served as the internal development cohort. An independent external cohort consisted of 10 sections (5 frontal and 5 occipital samples) from 5 individuals obtained from the University of Kentucky Alzheimers Disease Research Center. We trained and compared three semantic segmentation architectures, a standard U-Net, a dual-attention residual U-Net (DA-ResUNet), and a Swin Transformer-based U-Net (Swin-UNet), using the internal development cohort with slide-level five-fold cross-validation. All models were evaluated on the independent external cohort to assess generalization under domain shift. Based on segmentation performance and computational efficiency, we selected one architecture to generate whole-slide composite segmentation masks for vessel walls, amyloid deposits, and tissue compartments. These masks were subsequently used for deterministic vessel detection, morphometric measurements, and quantification of vascular and perivascular amyloid features through post-processing analysis. ResultsAll three architectures achieved high segmentation accuracy on the internal cohort, with Dice scores above 90% across vessel walls, amyloid deposits, gray matter, and leptomeninges. The Swin-UNet showed marginally higher performance for vessel segmentation, whereas the DA-ResUNet provided more balanced accuracy and computational efficiency and was selected for downstream analysis. External cohort evaluation demonstrated robust generalization, with attention-enhanced models outperforming the standard U-Net under domain shift. Using the selected model, the pipeline reliably detected valid vessels, excluded non-vascular artifacts, and enabled deterministic extraction of vessel morphometry, vascular and perivascular amyloid burden, and identification of circumferential CAA involvement at the vessel level. DiscussionThis framework provides a scalable, interpretable solution for vessel-level CAA analysis, supporting robust geometric and spatial characterization of cerebrovascular pathology and enabling future integration with clinical and genetic studies. Beyond CAA, the modular design allows extension to other vascular pathologies, including arteriolosclerosis, in WSIs, facilitating broader investigation of cerebrovascular disease mechanisms.

Large data initiatives and high-powered brain imaging analyses require the pooling of MR images acquired across multiple scanners, often using different protocols. Prospective cross-site harmonization often involves the use of a phantom or traveling subjects. However, as more datasets are becoming publicly available, there is a growing need for retrospective harmonization, pooling data from sites not originally coordinated together. Several retrospective harmonization techniques have shown promise in removing cross-site image variation. However, most unsupervised methods cannot distinguish between image-acquisition based variability and cross-site population variability, so they require that datasets contain subjects or patient groups with similar clinical or demographic information. To overcome this limitation, we consider cross-site MRI image harmonization as a style transfer problem rather than a domain transfer problem. Using a fully unsupervised deep-learning framework based on a generative adversarial network (GAN), we show that MR images can be harmonized by inserting the style information encoded from a reference image directly, without knowing their site/scanner labels a priori. We trained our model using data from five large-scale multi-site datasets with varied demographics. Results demonstrated that our styleencoding model can harmonize MR images, and match intensity profiles, successfully, without relying on traveling subjects. This model also avoids the need to control for clinical, diagnostic, or demographic information. Moreover, we further demonstrated that if we included diverse enough images into the training set, our method successfully harmonized MR images collected from unseen scanners and protocols, suggesting a promising novel tool for ongoing collaborative studies.

Histological staining is vital in clinical pathology for visualizing tissue structures. However, these techniques are laborious and time-consuming. Digital virtual staining offers a promising solution, but existing methods typically rely on Generative Adversarial Networks (GANs), which may suffer from artifacts and mode collapse. Motivated by the success of diffusion models, we present DUST, a novel Diffusion-based Unified framework for versatile Stain Transfer in histopathology. To enhance domain awareness and task-specific performance, we propose a dual encoding strategy that integrates the stain types of both the source and target domains. Additionally, we introduce a dynamic dual-output head to address the unstable intensity issue encountered with conventional DDPM implementations. Validated on a curated fourstain kidney histopathological dataset (H&E, MT, PAS, and PASM), DUST demonstrates superior versatile stain transfer capabilities. Our research highlights the potential of diffusion models to advance virtual staining, paving the way for more efficient digital pathology analyses.

Purpose: To develop and evaluate a recurrent neural network that operates directly on undersampled golden-angle radial k-space, enabling low-latency cardiac cine reconstruction for interventional cardiac MRI (iCMR). Methods: KOSTAL (K-space Optimized Spatial Temporal Architecture for Low latency) combines a per-coil k-space convolutional gated recurrent unit (convGRU), which learns a mask-conditioned view-sharing rule over the accumulated k-space, with an image-space recurrent module. It was trained and tested on the open-access multi-coil OCMR dataset using 10 simulated golden-angle spokes per frame against a 1000-spoke reference. Ablations varied recurrent module architecture and placement; temporal behavior was assessed using a imaging-plane transition test. Generalization was evaluated without retraining in 23 pediatric patients prospectively scanned during free-breathing using a radial golden-angle bSSFP sequence with binned XD-GRASP and clinical breath-held cine serving as references. Results: At 10 spokes per frame, KOSTAL reached a median SSIM of 0.907 (gridding: 0.622) in under 34 ms of processing time per frame. Image quality (IQ) matched gridded results formed from 7-11 times more spokes. Recurrence in k-space rather than image space accounted for most of this gain (0.891 versus [≤]0.650). IQ recovered from an abrupt plane transition in 75 ms, versus 303 ms for 200-spoke gridding. KOSTAL had the best agreement with the binned reference and the highest long-axis CNR. KOSTAL accurately tracked left-ventricular blood-pool volume (end-diastolic volume bias -0.7 mL) with a shorter lag (71 ms) than iterative reconstruction (239-287 ms). Conclusion: Learned, mask-conditioned recurrence in k-space yields high image quality at a latency compatible with interventional guidance.

In medical image classification tasks like the detection of diabetic retinopathy from retinal fundus images, it is highly desirable to get visual explanations for the decisions of black-box deep neural networks (DNNs). However, gradient-based saliency methods often fail to highlight the diseased image regions reliably. On the other hand, adversarially robust models have more interpretable gradients than plain models but suffer typically from a significant drop in accuracy, which is unacceptable for clinical practice. Here, we show that one can get the best of both worlds by ensembling a plain and an adversarially robust model: maintaining high accuracy but having improved visual explanations. Also, our ensemble produces meaningful visual counterfactuals which are complementary to existing saliency-based techniques. Code is available under https://github.com/valentyn1boreiko/Fundus_VCEs.

In studying the brains functional connectivity and its associations with clinically observed assessments, novel learning frameworks modeling its network properties in conjunction with assessment variables are crucial to uncover variable-specific patterns via meaningful encoding and reconstruction. We present a generative framework for modeling human brain functional connectivity features while retaining key network metrics and differences associated with demographic and cognitive variables. A conditional graph variational autoencoder is employed to encode static functional network connectivity (sFNC) features into a latent representation, which is then utilized for the dual purpose of reconstructing sFNC data conditioned on variables such as biological sex or fluid intelligence, and identifying discriminative connectivity features associated with the conditioning variables in the latent space. Using over 20,000 subjects from the UK Biobank, our model demonstrates high-fidelity reconstructions that preserve condition-specific network patterns, while the latent space captures interpretable patterns associated with these variables. The group differences in latent space are highlighted by one-hot probing of the latent dimensions and forward mapping to connectivity patterns. This approach provides a scalable, network-informed framework for studying brain functional connectivity and its associations with individual differences, offering potential applications in characterizing functional signatures for mental health conditions via clinically observed assessment variables. AUTHOR SUMMARYTo enable the modeling of the brain functional connectivity network for encoding and reconstructing assessment-specific differences, we propose a conditional graph-based generative framework for modeling human brain functional connectivity while accounting for demographic and cognitive differences. Using a conditional graph variational autoencoder, our approach learns interpretable latent representations of functional connectivity networks derived from fMRI data. Evaluated on over 20,000 UK Biobank subjects, the model accurately reconstructs connectivity patterns outperforming baseline architectures and preserves differences associated with biological sex and fluid intelligence. By probing the latent space and mapping latent dimensions back to brain networks, we identify condition-specific connectivity features in an interpretable manner. This work provides a scalable, network-informed approach for studying individual differences in functional brain organization.

The function of the human heart is characterised by complex patterns of motion that change throughout our lifespan due to accumulated damage across biological scales. Understanding the drivers of cardiac ageing is key to developing strategies for attenuating age-related processes. The motion of the surface of the heart can be conceived as a graph of connected points in space moving through time. Here we develop a generalisable framework for modelling three-dimensional motion as a graph and apply it to a task of predicting biological age. Using sequences of segmented cardiac imaging from 5064 participants in UK Biobank we train a graph neural network (GNN) to learn motion traits that predict healthy ageing. The GNN outperformed (mean absolute error, MAE = 4.74 years) a comparator dense neural network and boosting methods (MAE = 4.90 years and 5.08 years, respectively). We produce human-intelligible explanations of the predictions and using the trained model we also assess the effect of hypertension on biological age. This work shows how graph representations of complex motion can efficiently predict biologically meaningful outcomes.