Journal
CLINICAL RESEARCH IN CARDIOLOGY
Volume 112, Issue 3, Pages 363-378Publisher
SPRINGER HEIDELBERG
DOI: 10.1007/s00392-022-02088-x
Keywords
Arrhythmogenic right ventricular cardiomyopathy; Cardiac magnetic resonance imaging; Deep learning; Automatic segmentation
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This study applies automatic deep learning-based segmentation for right and left ventricular CMR assessment and combines it with manual correction to accurately classify subjects suspected of ARVC according to CMR TFC.
Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is diagnosed according to the Task Force Criteria (TFC) in which cardiovascular magnetic resonance (CMR) imaging plays an important role. Our study aims to apply an automatic deep learning-based segmentation for right and left ventricular CMR assessment and evaluate this approach for classification of the CMR TFC. Methods We included 227 subjects suspected of ARVC who underwent CMR. Subjects were classified into (1) ARVC patients fulfilling TFC; (2) at-risk family members; and (3) controls. To perform automatic segmentation, a Bayesian Dilated Residual Neural Network was trained and tested. Performance of automatic versus manual segmentation was assessed using Dice-coefficient and Hausdorff distance. Since automatic segmentation is most challenging in basal slices, manual correction of the automatic segmentation in the most basal slice was simulated (automatic(-basal)). CMR TFC calculated using manual and automatic(-basal) segmentation were compared using Cohen's Kappa (kappa). Results Automatic segmentation was trained on CMRs of 70 subjects (39.6 +/- 18.1 years, 47% female) and tested on 157 subjects (36.9 +/- 17.6 years, 59% female). Dice-coefficient and Hausdorff distance showed good agreement between manual and automatic segmentations (>= 0.89 and <= 10.6 mm, respectively) which further improved after simulated correction of the most basal slice (>= 0.92 and <= 9.2 mm, p < 0.001). Pearson correlation of volumetric and functional CMR measurements was good to excellent (automatic (r = 0.78-0.99, p < 0.001) and automatic(-basal) (r = 0.88-0.99, p < 0.001) measurements). CMR TFC classification using automatic(-basal) segmentations was comparable to manual segmentations (kappa 0.98 +/- 0.02) with comparable diagnostic performance. Conclusions Combining automatic segmentation of CMRs with correction of the most basal slice results in accurate CMR TFC classification of subjects suspected of ARVC.
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