Reproducibility of Aorta Segmentation on 4D Flow MRI in Healthy Volunteers

Background Hemodynamic aorta parameters can be derived from 4D flow MRI, but this requires lumen segmentation. In both commercially available and research 4D flow MRI software tools, lumen segmentation is mostly (semi-)automatically performed and subsequently manually improved by an observer. Since the segmentation variability, together with 4D flow MRI data and image processing algorithms, will contribute to the reproducibility of patient-specific flow properties, the observer's lumen segmentation reproducibility and repeatability needs to be assessed. Purpose To determine the interexamination, interobserver reproducibility, and intraobserver repeatability of aortic lumen segmentation on 4D flow MRI. Study Type Prospective and retrospective. Population A healthy volunteer cohort of 10 subjects who underwent 4D flow MRI twice. Also, a clinical cohort of six subjects who underwent 4D flow MRI once. Field Strength/Sequence 3T; time-resolved three-directional and 3D velocity-encoded sequence (4D flow MRI). Assessment The thoracic aorta was segmented on the 4D flow MRI in five systolic phases. By positioning six planes perpendicular to a segmentation's centerline, the aorta was divided into five segments. The volume, surface area, centerline length, maximal diameter, and curvature radius were determined for each segment. Statistical Tests To assess the reproducibility, the coefficient of variation (COV), Pearson correlation coefficient (r), and intraclass correlation coefficient (ICC) were calculated. Results The interexamination and interobserver reproducibility and intraobserver repeatability were comparable for each parameter. For both cohorts there was very good reproducibility and repeatability for volume, surface area, and centerline length (COV = 10-32%, r = 0.54-0.95 and ICC = 0.65-0.99), excellent reproducibility and repeatability for maximal diameter (COV = 3-11%, r = 0.94-0.99, ICC = 0.94-0.99), and good reproducibility and repeatability for curvature radius (COV = 25-62%, r = 0.73-0.95, ICC = 0.84-0.97). Data Conclusion This study demonstrated no major reproducibility and repeatability limitations for 4D flow MRI aortic lumen segmentation. Level of Evidence 3 Technical Efficacy Stage 2

Automated summary

This study assessed the interexamination, interobserver reproducibility, and intraobserver repeatability of aortic lumen segmentation on 4D flow MRI. The results showed comparable reproducibility and repeatability for each parameter. Excellent reproducibility and repeatability were observed for maximal diameter, while good reproducibility and repeatability were found for curvature radius.