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Assessment of Bi-Ventricular and Bi-Atrial Areas Using Four-Chamber Cine Cardiovascular Magnetic Resonance Imaging: Fully Automated Segmentation with a U-Net Convolutional Neural Network. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031401. [PMID: 35162424 PMCID: PMC8834677 DOI: 10.3390/ijerph19031401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/18/2022] [Accepted: 01/26/2022] [Indexed: 02/04/2023]
Abstract
Four-chamber (4CH) cine cardiovascular magnetic resonance imaging (CMR) facilitates simultaneous evaluation of cardiac chambers; however, manual segmentation is time-consuming and subjective in practice. We evaluated deep learning based on a U-Net convolutional neural network (CNN) for fully automated segmentation of the four cardiac chambers using 4CH cine CMR. Cine CMR datasets from patients were randomly assigned for training (1400 images from 70 patients), validation (600 images from 30 patients), and testing (1000 images from 50 patients). We validated manual and automated segmentation based on the U-Net CNN using the dice similarity coefficient (DSC) and Spearman’s rank correlation coefficient (ρ); p < 0.05 was statistically significant. The overall median DSC showed high similarity (0.89). Automated segmentation correlated strongly with manual segmentation in all chambers—the left and right ventricles, and the left and right atria (end-diastolic area: ρ = 0.88, 0.76, 0.92, and 0.87; end-systolic area: ρ = 0.81, 0.81, 0.92, and 0.83, respectively; p < 0.01). The area under the curve for the left ventricle, left atrium, right ventricle, and right atrium showed high scores (0.96, 0.99, 0.88, and 0.96, respectively). Fully automated segmentation could facilitate simultaneous evaluation and detection of enlargement of the four cardiac chambers without any time-consuming analysis.
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Yamasaki Y, Abe K, Kamitani T, Hosokawa K, Kawakubo M, Sagiyama K, Hida T, Matsuura Y, Murayama Y, Funatsu R, Tsutsui H, Yabuuchi H. Balloon pulmonary angioplasty improves right atrial reservoir and conduit functions in chronic thromboembolic pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2020; 21:855-862. [PMID: 32359071 DOI: 10.1093/ehjci/jeaa064] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/26/2020] [Accepted: 03/20/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Right atrial (RA) function largely contributes to the maintenance of right ventricular (RV) function. This study investigated the effect of balloon pulmonary angioplasty (BPA) on RA functions in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) using cardiac magnetic resonance imaging (CMRI). METHODS AND RESULTS CMRI and RV catheterization were performed before BPA sessions and at the follow-up periods in 29 CTEPH patients. Reservoir [RA longitudinal strain (RA-LS)], passive conduit [RA early LS rate (LSR)], and active (RA late LSR) phases were assessed by using cine CMRI and a feature-tracking algorithm. The relationships between the changes in RA functions and in brain natriuretic peptide (BNP) were evaluated in both the dilated and non-dilated RA groups. RA-LS (32.4% vs. 42.7%), RA LSR (6.3% vs. 8.3%), and RA early LSR (-2.3% vs. -4.3%) were improved after BPA, whereas no significant change was seen in RA late LSR. The changes in RA peak LS and in RA early LSR were significantly correlated with the changes in BNP (ΔRA-LS: r = -0.63, ΔRA-early LSR: r = 0.65) and pulmonary vascular resistance (PVR) (ΔRA-LS: r = -0.69, ΔRA-early LSR: r = 0.66) in the nondilated RA group. CONCLUSION The RA reservoir and passive conduit functions were impaired in inoperable CTEPH, whereas RA active function was preserved. BPA markedly reversed these impaired functions. The improvements in RA reservoir and conduit functions were significantly correlated with the changes in BNP levels and PVR in CTEPH patients with normal RA sizes.
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Affiliation(s)
- Yuzo Yamasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kazuya Hosokawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Masateru Kawakubo
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Koji Sagiyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tomoyuki Hida
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yuko Matsuura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yuriko Murayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Ryohei Funatsu
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hidetake Yabuuchi
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Kawakubo M, Nagao M, Ishizaki U, Shiina Y, Inai K, Yamasaki Y, Yoneyama M, Sakai S. Feature-Tracking MRI Fractal Analysis of Right Ventricular Remodeling in Adults with Congenitally Corrected Transposition of the Great Arteries. Radiol Cardiothorac Imaging 2019; 1:e190026. [PMID: 33778517 DOI: 10.1148/ryct.2019190026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/22/2019] [Accepted: 08/01/2019] [Indexed: 11/11/2022]
Abstract
Purpose To assess a recently available technique for quantification of right ventricular (RV) trabeculae that is based on fractal analysis performed by using cardiac MRI feature tracking, in patients with congenitally corrected transposition of the great arteries (cc-TGA). Materials and Methods A total of 19 patients (eight men, 11 women; mean age, 35 years ± 10 [standard deviation]) with consecutive cc-TGA who underwent cardiac MRI were enrolled in the study. For analysis, patients were divided into two groups: six patients (four men, two women; mean age, 34 years ± 14) with an end-systolic RV volume index higher than 72 mL/m2 (indicative of adverse RV remodeling) and 13 patients (four men, nine women; mean age, 36 years ± 9) in whom this index was lower than or equal to 72 mL/m2 (indicative of adapted RV). The following outcomes were quantified in the midsection of the RV: fractional fractal dimension (FD) and diastolic FD, circumferential strain, and radial strain. Receiver operating characteristic (ROC) analysis was performed to determine the cutoff FD values for the detection of adverse RV remodeling. Correlations among fractional FD, diastolic FD, circumferential strain, and radial strain were calculated by using Pearson correlation coefficient (r) analysis. Results The following ROC values were identified for fractional and diastolic FD: cutoff, 0.09 and 1.39, respectively; area under the ROC curve, 0.95 and 0.68, respectively; sensitivity, 1.00 and 0.33, respectively; and specificity, 0.92 and 1.00, respectively. Fractional FD correlated with circumferential strain and radial strain (r = -0.70 and 0.69, respectively; P < .01), as did diastolic FD (r = 0.37 and -0.38, respectively; P < .05). Conclusion The fractional FD derived from cardiac MRI feature-tracking analysis correlates with adverse RV remodeling, including a changed strain pattern and trabeculae, in patients with cc-TGA.© RSNA, 2019.
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Affiliation(s)
- Masateru Kawakubo
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
| | - Michinobu Nagao
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
| | - Umiko Ishizaki
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
| | - Yumi Shiina
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
| | - Kei Inai
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
| | - Yuzo Yamasaki
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
| | - Masami Yoneyama
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
| | - Shuji Sakai
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
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Clinical usefulness of right ventricular 3D area strain in the assessment of treatment effects of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: comparison with 2D feature-tracking MRI. Eur Radiol 2019; 29:4583-4592. [PMID: 30790024 DOI: 10.1007/s00330-019-6008-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/15/2018] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the usefulness of right ventricular (RV) area strain analysis via cardiac MRI (CMRI) as a tool for assessing the treatment effects of balloon pulmonary angioplasty (BPA) in inoperable chronic thromboembolic pulmonary hypertension (CTEPH), RV area strain was compared to two-dimensional (2D) strain with feature-tracking MRI (FTMRI) before and after BPA. METHODS We retrospectively analyzed 21 CTEPH patients who underwent BPA. End-systolic global area strain (GAS), longitudinal strain (LS), circumferential strain (CS), and radial strain (RS) were measured before and after BPA. Changes in GAS and RV ejection fraction (RVEF) values after BPA were defined as ΔGAS and ΔRVEF. Receiver operating characteristic (ROC) analyses were performed to determine the optimal cutoff of the strain at after BPA for detection of improved patients with decreased mean pulmonary artery pressure (mPAP) less than 30 mmHg and increased RVEF more than 50%. RESULTS ROC analysis revealed the optimal cutoffs of strains (GAS, LS, CS, and RS) for identifying improved patients with mPAP < 30 mmHg (cutoff (%) = - 41.2, - 13.8, - 16.7, and 14.4: area under the curve, 0.75, 0.56, 0.65, and 0.75) and patients with RVEF > 50% (cutoff (%) = - 37.2, - 29.5, - 2.9, and 14.4: area under the curve, 0.81, 0.60, 0.56, and 0.56). CONCLUSIONS Area strain analysis via CMRI may be a more useful tool for assessing the treatment effects of BPA in patients with CTEPH than 2D strains with FTMRI. KEY POINTS • Area strain values can detect improvement of right ventricular (RV) pressure and function after balloon pulmonary angioplasty (BPA) equally or more accurately than two-dimensional strains. • Area strain analysis is a useful analytical method that reflects improvements in complex RV myocardial deformation by BPA. • Area strain analysis is a robust method with reproducibility equivalent to that of 2D strain analysis.
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Kutty S, Shang Q, Joseph N, Kowallick JT, Schuster A, Steinmetz M, Danford DA, Beerbaum P, Sarikouch S. Abnormal right atrial performance in repaired tetralogy of Fallot: A CMR feature tracking analysis. Int J Cardiol 2017; 248:136-142. [PMID: 28712562 DOI: 10.1016/j.ijcard.2017.06.121] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/01/2017] [Accepted: 06/22/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND We hypothesized that right atrial (RA) performance is abnormal in repaired tetralogy of Fallot (TOF). METHODS TOF patients were prospectively enrolled for cardiovascular magnetic resonance (CMR), echocardiography and exercise stress following a standardized 14-center protocol. Peak RA longitudinal strain (RALS) and right ventricular longitudinal strain (RVLS) were measured using CMR feature tracking (FT) and correlated to RA and RV end diastolic volumes (EDVi) and ejection fraction (EF). RESULTS The cohort had 311 subjects: 171 TOF (94 male, age 18.2±8years) and 140 healthy controls (69 male, 16.4±11years). RAEDVi, RALS, RVEDVi, RVLS, RAEF, and RVEF in TOF were 60.8±17.1ml/m2, 13.6±5.7%, 120.3±30.3ml/m2, 12.3±4.2%, 32.5±9.9% and 51.2±8.4% and differed from respective indices in controls: 51.7±15.7ml/m2, 27±10.1%, 74±19.0ml/m2, 18.5±5.3%, 54±8% and 62.5±5.5% (p<0.001). RAEDVi and RALS correlated with RVLS (p=0.004, <0.001, r=0.2,0.3). RAEDVi was higher in older TOF, while RALS did not increase with age. RAEDVi but not RALS correlated with RV systolic pressure(r=0.2, 0). Neither RAEDVi nor RALS was associated with tricuspid regurgitation grade or peak oxygen uptake (r=0.1, 0). Positive correlation was observed for RVEDVi with RAEDVi (p=0.035, r=0.2) and a trend toward negative correlation with RALS (p=0.09, r=0.1). CONCLUSION RALS, RAEDVi and RAEF are abnormal in TOF. Reduced RALS indicates decreased RA reservoir function. Because they correlate with other functional RV indices, these abnormalities may represent RA diastolic burden from chronic RV dysfunction in TOF. The young cohort age might explain the absence of RALS correlation to tricuspid regurgitation and peak oxygen uptake.
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Affiliation(s)
- Shelby Kutty
- University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States.
| | - Quanliang Shang
- University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States; Department of Radiology, Central South University, China
| | - Navya Joseph
- University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States
| | - Johannes T Kowallick
- Department of Cardiology, Pneumology, and the Institute for Radiology, Georg-August-University Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology, Pneumology, and the Institute for Radiology, Georg-August-University Göttingen, Göttingen, Germany
| | - Michael Steinmetz
- Department of Cardiology, Pneumology, and the Institute for Radiology, Georg-August-University Göttingen, Göttingen, Germany
| | - David A Danford
- University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States
| | - Phillip Beerbaum
- Department of Pediatric Cardiology and Intensive Care, Hanover Medical School, Hanover, Germany
| | - Samir Sarikouch
- Department of Cardiothoracic Surgery, Hanover Medical School, Hanover, Germany
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Reiber JHC, De Sutter J, Schoenhagen P, Stillman AE, Vande Veire NRL. Cardiovascular imaging 2016 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2017; 33:761-770. [PMID: 28315986 PMCID: PMC5406479 DOI: 10.1007/s10554-017-1111-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Johan H C Reiber
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands.
| | - Johan De Sutter
- Department of Cardiology, AZ Maria Middelares Gent and University Gent, Ghent, Belgium
| | - Paul Schoenhagen
- Department of Radiology, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Arthur E Stillman
- Department of Radiology, Emory University Hospital, Atlanta, GA, USA
| | - Nico R L Vande Veire
- Department of Cardiology, AZ Maria Middelares Gent and Free University Brussels, Brussels, Belgium
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