Computer-aided quantification of non-contrast 3D black blood MRI as an efficient alternative to reference standard manual CT angiography measurements of abdominal aortic aneurysms

Background: Non-contrast 3D black blood MRI is a promising tool for abdominal aortic aneurysm (AAA) surveillance, permitting accurate aneurysm diameter measurements needed for patient management. Purpose: To evaluate whether automated AAA volume and diameter measurements obtained from computeraided segmentation of non-contrast 3D black blood MRI are accurate, and whether they can supplant reference standard manual measurements from contrast-enhanced CT angiography (CTA). Materials and Methods: Thirty AAA patients (mean age, 71.9 +/- 7.9 years) were recruited between 2014 and 2017. Participants underwent both non-contrast black blood MRI and CTA within 3 months of each other. Semiautomatic (computer-aided) MRI and CTA segmentations utilizing deformable registration methods were compared against manual segmentations of the same modality using the Dice similarity coefficient (DSC). AAA lumen and total aneurysm volumes and AAA maximum diameter, quantified automatically from these segmentations, were compared against manual measurements using Pearson correlation and Bland-Altman analyses. Finally, automated measurements from non-contrast 3D black blood MRI were evaluated against manual CTA measurements using the Wilcoxon test, Pearson correlation and Bland-Altman analyses. Results: Semi-automatic segmentations had excellent agreement with manual segmentations (lumen DSC: 0.91 +/- 0.03 and 0.94 +/- 0.03; total aneurysm DSC: 0.92 +/- 0.02 and 0.94 +/- 0.03, for black blood MRI and CTA, respectively). Automated volume and maximum diameter measurements also had excellent correlation to their manual counterparts for both black blood MRI (volume: r = 0.99, P < 0.001; diameter: r = 0.97, P < 0.001) and CTA (volume: r = 0.99, P < 0.001; diameter: r = 0.97, P < 0.001). Compared to manual CTA measurements, bias and limits of agreement (LOA) for automated MRI measurements (lumen volume: 1.49, [-4.19 7.17] cm(3); outer wall volume: -2.46, [-14.05 9.13] cm(3); maximal diameter: 0.08, [-6.51 6.67] mm) were largely equivalent to those of manual MRI measurements, particularly for maximum AAA diameter (lumen volume: 0.73, [-6.47 7.93] cm(3); outer wall volume: 0.98, [-10.54 12.5] cm(3); maximal diameter: 0.08, [-3.67 3.83] mm). Conclusion: Semi-automatic segmentation of non-contrast 3D black blood MRI efficiently provides reproducible morphologic AAA assessment yielding accurate AAA diameters and volumes with no clinically relevant differences compared to either automatic or manual measurements based on CTA.

Automated summary

Automatic segmentation of non-contrast 3D black blood MRI efficiently provides reproducible morphologic AAA assessment yielding accurate AAA diameters and volumes with no clinically relevant differences compared to either automatic or manual measurements based on CTA.