Automatic segmentation of multiple cardiovascular structures from cardiac computed tomography angiography images using deep learning.

OBJECTIVES:To develop, demonstrate and evaluate an automated deep learning method for multiple cardiovascular structure segmentation. BACKGROUND:Segmentation of cardiovascular images is resource-intensive. We design an automated deep learning method for the segmentation of multiple structures from Coronary Computed Tomography Angiography (CCTA) images. METHODS:Images from a multicenter registry of patients that underwent clinically-indicated CCTA were used. The proximal ascending and descending aorta (PAA, DA), superior and inferior vena cavae (SVC, IVC), pulmonary artery (PA), coronary sinus (CS), right ventricular wall (RVW) and left atrial wall (LAW) were annotated as ground truth. The U-net-derived deep learning model was trained, validated and tested in a 70:20:10 split. RESULTS:The dataset comprised 206 patients, with 5.130 billion pixels. Mean age was 59.9 ± 9.4 yrs., and was 42.7% female. An overall median Dice score of 0.820 (0.782, 0.843) was achieved. Median Dice scores for PAA, DA, SVC, IVC, PA, CS, RVW and LAW were 0.969 (0.979, 0.988), 0.953 (0.955, 0.983), 0.937 (0.934, 0.965), 0.903 (0.897, 0.948), 0.775 (0.724, 0.925), 0.720 (0.642, 0.809), 0.685 (0.631, 0.761) and 0.625 (0.596, 0.749) respectively. Apart from the CS, there were no significant differences in performance between sexes or age groups. CONCLUSIONS:An automated deep learning model demonstrated segmentation of multiple cardiovascular structures from CCTA images with reasonable overall accuracy when evaluated on a pixel level

DeepVox and SAVE-CT: a contrast- and dose-independent 3D deep learning approach for thoracic aorta segmentation and aneurysm prediction using computed tomography scans

Thoracic aortic aneurysm (TAA) is a fatal disease which potentially leads to dissection or rupture through progressive enlargement of the aorta. It is usually asymptomatic and screening recommendation are limited. The gold-standard evaluation is performed by computed tomography angiography (CTA) and radiologists time-consuming assessment. Scans for other indications could help on this screening, however if acquired without contrast enhancement or with low dose protocol, it can make the clinical evaluation difficult, besides increasing the scans quantity for the radiologists. In this study, it was selected 587 unique CT scans including control and TAA patients, acquired with low and standard dose protocols, with or without contrast enhancement. A novel segmentation model, DeepVox, exhibited dice score coefficients of 0.932 and 0.897 for development and test sets, respectively, with faster training speed in comparison to models reported in the literature. The novel TAA classification model, SAVE-CT, presented accuracies of 0.930 and 0.922 for development and test sets, respectively, using only the binary segmentation mask from DeepVox as input, without hand-engineered features. These two models together are a potential approach for TAA screening, as they can handle variable number of slices as input, handling thoracic and thoracoabdominal sequences, in a fully automated contrast- and dose-independent evaluation. This may assist to decrease TAA mortality and prioritize the evaluation queue of patients for radiologists.Comment: 23 pages, 4 figures, 7 table

Thoracic aorta calcium detection and quantification using convolutional neural networks in a large cohort of intermediate-risk patients

Arterial calcification is an independent predictor of cardiovascular disease (CVD) events whereas thoracic aorta calcium (TAC) detection might anticipate extracoronary outcomes. In this work, we trained six convolutional neural networks (CNNs) to detect aortic calcifications and to automate the TAC score assessment in intermediate CVD risk patients. Cardiac computed tomography images from 1415 patients were analyzed together with their aortic geometry previously assessed. Orthogonal patches centered in each aortic candidate lesion were reconstructed and a dataset with 19,790 images (61% positives) was built. Three single-input 2D CNNs were trained using axial, coronal and sagittal patches together with two multi-input 2.5D CNNs combining the orthogonal patches and identifying their best regional combination (BRC) in terms of lesion location. Aortic calcifications were concentrated in the descending (66%) and aortic arch (26%) portions. The BRC of axial patches to detect ascending or aortic arch lesions and sagittal images for the descending portion had the best performance: 0.954 F1-Score, 98.4% sensitivity, 87% of the subjects correctly classified in their TAC category and an average false positive TAC score per patient of 30. A CNN that combined axial and sagittal patches depending on the candidate aortic location ensured an accurate TAC score prediction.Fil: Guilenea, Federico Nicolás. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; ArgentinaFil: Casciaro, Mariano Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; ArgentinaFil: Pascaner, Ariel Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; ArgentinaFil: Soulat, Gilles. Hopital Europeen Georges Pompidou; FranciaFil: Mousseaux, Elie. Hopital Europeen Georges Pompidou; FranciaFil: Craiem, Damian. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentin

Validation of an AI-based algorithm for measurement of the thoracic aortic diameter in low-dose chest CT

OBJECTIVES: To evaluate the performance of artificial intelligence (AI) software for automatic thoracic aortic diameter assessment in a heterogeneous cohort with low-dose, non-contrast chest computed tomography (CT).MATERIALS AND METHODS: Participants of the Imaging in Lifelines (ImaLife) study who underwent low-dose, non-contrast chest CT (August 2017-May 2022) were included using random samples of 80 participants &lt;50y, ≥80y, and with thoracic aortic diameter ≥40 mm. AI-based aortic diameters at eight guideline compliant positions were compared with manual measurements. In 90 examinations (30 per group) diameters were reassessed for intra- and inter-reader variability, which was compared to discrepancy of the AI system using Bland-Altman analysis, paired samples t-testing and linear mixed models.RESULTS: We analyzed 240 participants (63 ± 16 years; 50 % men). AI evaluation failed in 11 cases due to incorrect segmentation (4.6 %), leaving 229 cases for analysis. No difference was found in aortic diameter between manual and automatic measurements (32.7 ± 6.4 mm vs 32.7 ± 6.0 mm, p = 0.70). Bland-Altman analysis yielded no systematic bias and a repeatability coefficient of 4.0 mm for AI. Mean discrepancy of AI (1.3 ± 1.6 mm) was comparable to inter-reader variability (1.4 ± 1.4 mm); only at the proximal aortic arch showed AI higher discrepancy (2.0 ± 1.8 mm vs 0.9 ± 0.9 mm, p &lt; 0.001). No difference between AI discrepancy and inter-reader variability was found for any subgroup (all: p &gt; 0.05).CONCLUSION: The AI software can accurately measure thoracic aortic diameters, with discrepancy to a human reader similar to inter-reader variability in a range from normal to dilated aortas.</p

Optimization of CT scanning protocol of Type B aortic dissection follow-up through 3D printed model

This research aims to develop and evaluate a human tissue-like material 3D printed model used as a phantom in determining optimized scanning parameters to reduce the radiation dose for Type B aortic dissection patients after thoracic endovascular aortic repair. The results show that radiation risk for follow-up Type B aortic dissection patients can be potentially reduced. Further, the value of using 3D printed model in studying CT scanning protocols was further validated

A biomechanical approach for real-time tracking of lung tumors during External Beam Radiation Therapy (EBRT)

Lung cancer is the most common cause of cancer related death in both men and women. Radiation therapy is widely used for lung cancer treatment. However, this method can be challenging due to respiratory motion. Motion modeling is a popular method for respiratory motion compensation, while biomechanics-based motion models are believed to be more robust and accurate as they are based on the physics of motion. In this study, we aim to develop a biomechanics-based lung tumor tracking algorithm which can be used during External Beam Radiation Therapy (EBRT). An accelerated lung biomechanical model can be used during EBRT only if its boundary conditions (BCs) are defined in a way that they can be updated in real-time. As such, we have developed a lung finite element (FE) model in conjunction with a Neural Networks (NNs) based method for predicting the BCs of the lung model from chest surface motion data. To develop the lung FE model for tumor motion prediction, thoracic 4D CT images of lung cancer patients were processed to capture the lung and diaphragm geometry, trans-pulmonary pressure, and diaphragm motion. Next, the chest surface motion was obtained through tracking the motion of the ribcage in 4D CT images. This was performed to simulate surface motion data that can be acquired using optical tracking systems. Finally, two feedforward NNs were developed, one for estimating the trans-pulmonary pressure and another for estimating the diaphragm motion from chest surface motion data. The algorithm development consists of four steps of: 1) Automatic segmentation of the lungs and diaphragm, 2) diaphragm motion modelling using Principal Component Analysis (PCA), 3) Developing the lung FE model, and 4) Using two NNs to estimate the trans-pulmonary pressure values and diaphragm motion from chest surface motion data. The results indicate that the Dice similarity coefficient between actual and simulated tumor volumes ranges from 0.76±0.04 to 0.91±0.01, which is favorable. As such, real-time lung tumor tracking during EBRT using the proposed algorithm is feasible. Hence, further clinical studies involving lung cancer patients to assess the algorithm performance are justified