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Finnegan RN, Quinn A, Booth J, Belous G, Hardcastle N, Stewart M, Griffiths B, Carroll S, Thwaites DI. Cardiac substructure delineation in radiation therapy - A state-of-the-art review. J Med Imaging Radiat Oncol 2024. [PMID: 38757728 DOI: 10.1111/1754-9485.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
Delineation of cardiac substructures is crucial for a better understanding of radiation-related cardiotoxicities and to facilitate accurate and precise cardiac dose calculation for developing and applying risk models. This review examines recent advancements in cardiac substructure delineation in the radiation therapy (RT) context, aiming to provide a comprehensive overview of the current level of knowledge, challenges and future directions in this evolving field. Imaging used for RT planning presents challenges in reliably visualising cardiac anatomy. Although cardiac atlases and contouring guidelines aid in standardisation and reduction of variability, significant uncertainties remain in defining cardiac anatomy. Coupled with the inherent complexity of the heart, this necessitates auto-contouring for consistent large-scale data analysis and improved efficiency in prospective applications. Auto-contouring models, developed primarily for breast and lung cancer RT, have demonstrated performance comparable to manual contouring, marking a significant milestone in the evolution of cardiac delineation practices. Nevertheless, several key concerns require further investigation. There is an unmet need for expanding cardiac auto-contouring models to encompass a broader range of cancer sites. A shift in focus is needed from ensuring accuracy to enhancing the robustness and accessibility of auto-contouring models. Addressing these challenges is paramount for the integration of cardiac substructure delineation and associated risk models into routine clinical practice, thereby improving the safety of RT for future cancer patients.
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Affiliation(s)
- Robert N Finnegan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Quinn
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jeremy Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Gregg Belous
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Maegan Stewart
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Griffiths
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Susan Carroll
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - David I Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
- Radiotherapy Research Group, Leeds Institute of Medical Research, St James's Hospital and University of Leeds, Leeds, UK
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2
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Daios S, Anastasiou V, Bazmpani MA, Angelopoulou SM, Karamitsos T, Zegkos T, Didagelos M, Savopoulos C, Ziakas A, Kamperidis V. Moving from left ventricular ejection fraction to deformation imaging in mitral valve regurgitation. Curr Probl Cardiol 2024; 49:102432. [PMID: 38309543 DOI: 10.1016/j.cpcardiol.2024.102432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
The increasing prevalence of valvular heart diseases, specifically mitral regurgitation (MR), underscores the need for a careful and timely approach to intervention. Severe MR, whether primary or secondary, when left untreated leads to adverse outcomes, emphasizing the critical role of a timely surgical or transcatheter intervention. While left ventricular ejection fraction (LVEF) remains the guideline-recommended measure for assessing left ventricle damage, emerging evidence raises concerns regarding its reliability in MR due to its volume-dependent nature. This review summarizes the existing literature on the role of LVEF and deformation imaging techniques, emphasizing the latter's potential in providing a more accurate evaluation of intrinsic myocardial function. Moreover, it advocates the need for an integrated approach that combines traditional with emerging measures, aiming to optimize the management of patients with MR. It attempts to highlight the need for future research to validate the clinical application of deformation imaging techniques through large-scale studies.
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Affiliation(s)
- Stylianos Daios
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Vasileios Anastasiou
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Maria-Anna Bazmpani
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Stella-Maria Angelopoulou
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Theodoros Karamitsos
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Thomas Zegkos
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Matthaios Didagelos
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Christos Savopoulos
- First Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Antonios Ziakas
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Vasileios Kamperidis
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece.
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3
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Stoltzfus MT, Capodarco MD, Anamika F, Gupta V, Jain R. Cardiac MRI: An Overview of Physical Principles With Highlights of Clinical Applications and Technological Advancements. Cureus 2024; 16:e55519. [PMID: 38576652 PMCID: PMC10990965 DOI: 10.7759/cureus.55519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
The purpose of this review is to serve as a concise learning tool for clinicians interested in quickly learning more about cardiac magnetic resonance imaging (CMR) and its physical principles. There is heavy coverage of the basic physical fundamentals of CMR as well as updates on the history, clinical indications, cost-effectiveness, role of artificial intelligence in CMR, and examples of common late gadolinium enhancement (LGE) patterns. This literature review was performed by searching the PubMed database for the most up-to-date literature regarding these topics. Relevant, less up-to-date articles, covering the history and physics of CMR, were also obtained from the PubMed database. Clinical indications for CMR include adult congenital heart disease, cardiac ischemia, cardiomyopathies, and heart failure. CMR has a projected cost-benefit ratio of 0.58, leading to potential savings for patients. Despite its utility, CMR has some drawbacks including long image processing times, large space requirements for equipment, and patient discomfort during imaging. Artificial intelligence-based algorithms can address some of these drawbacks by decreasing image processing times and may have reliable diagnostic capabilities. CMR is quickly rising as a high-resolution, non-invasive cardiac imaging modality with an increasing number of clinical indications. Thanks to technological advancements, especially in artificial intelligence, the benefits of CMR often outweigh its drawbacks.
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Affiliation(s)
| | - Matthew D Capodarco
- Radiology, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
| | - Fnu Anamika
- Internal Medicine, University College of Medical Sciences, New Delhi, IND
| | - Vasu Gupta
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Rohit Jain
- Internal Medicine, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
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4
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Dattani A, Brady EM, Kanagala P, Stoma S, Parke KS, Marsh AM, Singh A, Arnold JR, Moss AJ, Zhao L, Cvijic ME, Fronheiser M, Du S, Costet P, Schafer P, Carayannopoulos L, Chang CP, Gordon D, Ramirez-Valle F, Jerosch-Herold M, Nelson CP, Squire IB, Ng LL, Gulsin GS, McCann GP. Is atrial fibrillation in HFpEF a distinct phenotype? Insights from multiparametric MRI and circulating biomarkers. BMC Cardiovasc Disord 2024; 24:94. [PMID: 38326736 PMCID: PMC10848361 DOI: 10.1186/s12872-024-03734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) frequently co-exist. There is a limited understanding on whether this coexistence is associated with distinct alterations in myocardial remodelling and mechanics. We aimed to determine if patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) represent a distinct phenotype. METHODS In this secondary analysis of adults with HFpEF (NCT03050593), participants were comprehensively phenotyped with stress cardiac MRI, echocardiography and plasma fibroinflammatory biomarkers, and were followed for the composite endpoint (HF hospitalisation or death) at a median of 8.5 years. Those with AF were compared to sinus rhythm (SR) and unsupervised cluster analysis was performed to explore possible phenotypes. RESULTS 136 subjects were included (SR = 75, AF = 61). The AF group was older (76 ± 8 vs. 70 ± 10 years) with less diabetes (36% vs. 61%) compared to the SR group and had higher left atrial (LA) volumes (61 ± 30 vs. 39 ± 15 mL/m2, p < 0.001), lower LA ejection fraction (EF) (31 ± 15 vs. 51 ± 12%, p < 0.001), worse left ventricular (LV) systolic function (LVEF 63 ± 8 vs. 68 ± 8%, p = 0.002; global longitudinal strain 13.6 ± 2.9 vs. 14.7 ± 2.4%, p = 0.003) but higher LV peak early diastolic strain rates (0.73 ± 0.28 vs. 0.53 ± 0.17 1/s, p < 0.001). The AF group had higher levels of syndecan-1, matrix metalloproteinase-2, proBNP, angiopoietin-2 and pentraxin-3, but lower level of interleukin-8. No difference in clinical outcomes was observed between the groups. Three distinct clusters were identified with the poorest outcomes (Log-rank p = 0.029) in cluster 2 (hypertensive and fibroinflammatory) which had equal representation of SR and AF. CONCLUSIONS Presence of AF in HFpEF is associated with cardiac structural and functional changes together with altered expression of several fibro-inflammatory biomarkers. Distinct phenotypes exist in HFpEF which may have differing clinical outcomes.
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Affiliation(s)
- Abhishek Dattani
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | | | - Svetlana Stoma
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Kelly S Parke
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Anna-Marie Marsh
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Jayanth R Arnold
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Alastair J Moss
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Lei Zhao
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | - Shuyan Du
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | | | | | | | | | | | - Christopher P Nelson
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Iain B Squire
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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5
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Dattani A, Singh A, McCann GP, Gulsin GS. Myocardial Calcium Handling in Type 2 Diabetes: A Novel Therapeutic Target. J Cardiovasc Dev Dis 2023; 11:12. [PMID: 38248882 PMCID: PMC10817027 DOI: 10.3390/jcdd11010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Type 2 diabetes (T2D) is a multisystem disease with rapidly increasing global prevalence. Heart failure has emerged as a major complication of T2D. Dysregulated myocardial calcium handling is evident in the failing heart and this may be a key driver of cardiomyopathy in T2D, but until recently this has only been demonstrated in animal models. In this review, we describe the physiological concepts behind calcium handling within the cardiomyocyte and the application of novel imaging techniques for the quantification of myocardial calcium uptake. We take an in-depth look at the evidence for the impairment of calcium handling in T2D using pre-clinical models as well as in vivo studies, following which we discuss potential novel therapeutic approaches targeting dysregulated myocardial calcium handling in T2D.
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Affiliation(s)
- Abhishek Dattani
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (A.S.); (G.P.M.); (G.S.G.)
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6
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Chen Z, Bai J, Lu Y. Dilated convolution network with edge fusion block and directional feature maps for cardiac MRI segmentation. Front Physiol 2023; 14:1027076. [PMID: 36776975 PMCID: PMC9909347 DOI: 10.3389/fphys.2023.1027076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/13/2023] [Indexed: 01/27/2023] Open
Abstract
Cardiac magnetic resonance imaging (MRI) segmentation task refers to the accurate segmentation of ventricle and myocardium, which is a prerequisite for evaluating the soundness of cardiac function. With the development of deep learning in medical imaging, more and more heart segmentation methods based on deep learning have been proposed. Due to the fuzzy boundary and uneven intensity distribution of cardiac MRI, some existing methods do not make full use of multi-scale characteristic information and have the problem of ambiguity between classes. In this paper, we propose a dilated convolution network with edge fusion block and directional feature maps for cardiac MRI segmentation. The network uses feature fusion module to preserve boundary information, and adopts the direction field module to obtain the feature maps to improve the original segmentation features. Firstly, multi-scale feature information is obtained and fused through dilated convolutional layers of different scales while downsampling. Secondly, in the decoding stage, the edge fusion block integrates the edge features into the side output of the encoder and concatenates them with the upsampled features. Finally, the concatenated features utilize the direction field to improve the original segmentation features and generate the final result. Our propose method conducts comprehensive comparative experiments on the automated cardiac diagnosis challenge (ACDC) and myocardial pathological segmentation (MyoPS) datasets. The results show that the proposed cardiac MRI segmentation method has better performance compared to other existing methods.
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Affiliation(s)
- Zhensen Chen
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Information Technology, Jinan University, Guangzhou, China,College of Information Science and Technology, Jinan University, Guangzhou, China
| | - Jieyun Bai
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Information Technology, Jinan University, Guangzhou, China,College of Information Science and Technology, Jinan University, Guangzhou, China,*Correspondence: Jieyun Bai, ; Yaosheng Lu,
| | - Yaosheng Lu
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Information Technology, Jinan University, Guangzhou, China,College of Information Science and Technology, Jinan University, Guangzhou, China,*Correspondence: Jieyun Bai, ; Yaosheng Lu,
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7
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Ciyamala Kushbu S, Inbamalar TM. Making Semi-Automatic Segmentation Method to be Automatic Using Deep Learning for Biventricular Segmentation. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2022. [DOI: 10.1166/jmihi.2022.3927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Ventricular Segmentation or Delineation of Cardiac Magnetic Resonance Imaging (CMRI) is significant in obtaining the cardiac contractile function, which in turn is taken as input for diagnosing Cardio Vascular Diseases (CVD). Many automatic and semi-automatic methods were evolved to
meet the constraints of diagnosing CVDs. Among these, semi-automatic methods require user intervention for delineation of ventricles, which consumes time and leads to intra and inter-observability, as with manual delineation. Thus, the automatic method is suggested by most of the researchers
to address the above-stated problem. We proposed Saliency-based Active contour U-Net (SACU-Net) for automatic bi-ventricular segmentation which is found to surpass the existing highest developed methods regarding closeness to the gold standard. Three schemes are used by our proposed algorithm,
namely 1. Saliency Detection Scheme for Region of Interest (ROI) Localization to concentrate only on Object of Interest, 2. Drop-out embedded U-net for Initial Contour evolution that performs initial segmentation and 3. Local-Global-based Regional active Contour (LGRAC) to fine-tune and avoid
leaking, merging of ventricles during Delineation. We used three datasets namely Automatic Cardiac Diagnosing Challenge (ACDC) of MICCAI 2017, Right Ventricular Segmentation Challenge (RVSC) of MICCAI 2012, and Sunny Brook (SB) of MICCAI 2009 dataset to test the adaptability nature of our
algorithm over different scanner resolutions and protocols. 100 and 50 CMRI Images of ACDC were used for training and testing respectively which obtained average Dice Coefficient (DC) metric of 0.963, 0.934, and 0.948 for Left Ventricular Cavity (LVC), Left Ventricular Myocardium (LVM), and
Right Ventricular Cavity (RVC) respectively. 32 and 16 CMRI Images of RVSC are used for preparing and experimenting respectively, which obtained an average DC metric of 0.95 for RVC.30 and 15 CMRI Images of SB are used for preparing and experimenting respectively, which obtained average DC
metric of 0.96 and 0.97 for LVC and LVM, respectively. Hausdorff Distance (HD) Metrics are also calculated to learn the distance of proposed delineated ventricles to reach the gold standard. The above resultant metrics show the robustness of our proposed SACU-Net in the segmentation of ventricles
of CMRI than previous methods.
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Affiliation(s)
- S. Ciyamala Kushbu
- Department of Information and Communication Engineering, Anna University, Chennai 25, Tamilnadu, India
| | - T. M. Inbamalar
- Department of Electronics and Communication Engineering, R.M.K. Engineering College, Tiruvallur 601206, Tamilnadu, India
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8
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Yang X, Zhang Y, Lo B, Wu D, Liao H, Zhang YT. DBAN: Adversarial Network With Multi-Scale Features for Cardiac MRI Segmentation. IEEE J Biomed Health Inform 2021; 25:2018-2028. [PMID: 33006934 DOI: 10.1109/jbhi.2020.3028463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With the development of medical artificial intelligence, automatic magnetic resonance image (MRI) segmentation method is quite desirable. Inspired by the power of deep neural networks, a novel deep adversarial network, dilated block adversarial network (DBAN), is proposed to perform left ventricle, right ventricle, and myocardium segmentation in short-axis cardiac MRI. DBAN contains a segmentor along with a discriminator. In the segmentor, the dilated block (DB) is proposed to capture, and aggregate multi-scale features. The segmentor can produce segmentation probability maps while the discriminator can differentiate the segmentation probability map, and the ground truth at the pixel level. In addition, confidence probability maps generated by the discriminator can guide the segmentor to modify segmentation probability maps. Extensive experiments demonstrate that DBAN has achieved the state-of-the-art performance on the ACDC dataset. Quantitative analyses indicate that cardiac function indices from DBAN are similar to those from clinical experts. Therefore, DBAN can be a potential candidate for short-axis cardiac MRI segmentation in clinical applications.
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9
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Menacho Medina K, Seraphim A, Katekaru D, Abdel-Gadir A, Han Y, Westwood M, Walker JM, Moon JC, Herrey AS. Noninvasive rapid cardiac magnetic resonance for the assessment of cardiomyopathies in low-middle income countries. Expert Rev Cardiovasc Ther 2021; 19:387-398. [PMID: 33836619 DOI: 10.1080/14779072.2021.1915130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Cardiac Magnetic Resonance (CMR) is a crucial diagnostic imaging test that redefines diagnosis and enables targeted therapies, but the access to CMR is limited in low-middle Income Countries (LMICs) even though cardiovascular disease is an emergent primary cause of mortality in LMICs. New abbreviated CMR protocols can be less expensive, faster, whilst maintaining accuracy, potentially leading to a higher utilization in LMICs.Areas covered: This article will review cardiovascular disease in LMICs and the current role of CMR in cardiac diagnosis and enable targeted therapy, discussing the main obstacles to prevent the adoption of CMR in LMICs. We will then review the potential utility of abbreviated, cost-effective CMR protocols to improve cardiac diagnosis and care, the clinical indications of the exam, current evidence and future directions.Expert opinion: Rapid CMR protocols, provided that they are utilized in potentially high yield cases, could reduce cost and increase effectiveness. The adoption of these protocols, their integration into care pathways, and prioritizing key treatable diagnoses can potentially improve patient care. Several LMIC countries are now pioneering these approaches and the application of rapid CMR protocols appears to have a bright future if delivered effectively.
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Affiliation(s)
- Katia Menacho Medina
- Institute of Cardiovascular Science, University College London, London, UK.,Barts Heart Centre, Saint Bartholomew's Hospital, London, UK
| | - Andreas Seraphim
- Institute of Cardiovascular Science, University College London, London, UK.,Barts Heart Centre, Saint Bartholomew's Hospital, London, UK
| | | | - Amna Abdel-Gadir
- Institute of Cardiovascular Science, University College London, London, UK
| | - Yuchi Han
- Departments of Medicine (Cardiovascular Division) and Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Westwood
- Barts Heart Centre, Saint Bartholomew's Hospital, London, UK
| | - J Malcolm Walker
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiology Department, University College London Hospitals NHS Foundation Trust, London, UK.,The Hatter Cardiovascular Institute, University College London Hospital, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK.,Barts Heart Centre, Saint Bartholomew's Hospital, London, UK
| | - Anna S Herrey
- Institute of Cardiovascular Science, University College London, London, UK.,Barts Heart Centre, Saint Bartholomew's Hospital, London, UK
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10
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Tandon A, Mohan N, Jensen C, Burkhardt BEU, Gooty V, Castellanos DA, McKenzie PL, Zahr RA, Bhattaru A, Abdulkarim M, Amir-Khalili A, Sojoudi A, Rodriguez SM, Dillenbeck J, Greil GF, Hussain T. Retraining Convolutional Neural Networks for Specialized Cardiovascular Imaging Tasks: Lessons from Tetralogy of Fallot. Pediatr Cardiol 2021; 42:578-589. [PMID: 33394116 PMCID: PMC7990832 DOI: 10.1007/s00246-020-02518-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/03/2020] [Indexed: 12/19/2022]
Abstract
Ventricular contouring of cardiac magnetic resonance imaging is the gold standard for volumetric analysis for repaired tetralogy of Fallot (rTOF), but can be time-consuming and subject to variability. A convolutional neural network (CNN) ventricular contouring algorithm was developed to generate contours for mostly structural normal hearts. We aimed to improve this algorithm for use in rTOF and propose a more comprehensive method of evaluating algorithm performance. We evaluated the performance of a ventricular contouring CNN, that was trained on mostly structurally normal hearts, on rTOF patients. We then created an updated CNN by adding rTOF training cases and evaluated the new algorithm's performance generating contours for both the left and right ventricles (LV and RV) on new testing data. Algorithm performance was evaluated with spatial metrics (Dice Similarity Coefficient (DSC), Hausdorff distance, and average Hausdorff distance) and volumetric comparisons (e.g., differences in RV volumes). The original Mostly Structurally Normal (MSN) algorithm was better at contouring the LV than the RV in patients with rTOF. After retraining the algorithm, the new MSN + rTOF algorithm showed improvements for LV epicardial and RV endocardial contours on testing data to which it was naïve (N = 30; e.g., DSC 0.883 vs. 0.905 for LV epicardium at end diastole, p < 0.0001) and improvements in RV end-diastolic volumetrics (median %error 8.1 vs 11.4, p = 0.0022). Even with a small number of cases, CNN-based contouring for rTOF can be improved. This work should be extended to other forms of congenital heart disease with more extreme structural abnormalities. Aspects of this work have already been implemented in clinical practice, representing rapid clinical translation. The combined use of both spatial and volumetric comparisons yielded insights into algorithm errors.
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Affiliation(s)
- Animesh Tandon
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Department of Radiology, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
| | - Navina Mohan
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Cory Jensen
- Circle Cardiovascular Imaging, Calgary, AB Canada
| | - Barbara E. U. Burkhardt
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
- Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children’s- Hospital Zurich, Zurich, Switzerland
| | - Vasu Gooty
- Department of Pediatrics, LeBonheur Children’s Hospital and University of Tennessee, Memphis, TN USA
| | - Daniel A. Castellanos
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
| | - Paige L. McKenzie
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Riad Abou Zahr
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Abhijit Bhattaru
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
| | - Mubeena Abdulkarim
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
| | | | | | - Stephen M. Rodriguez
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Jeanne Dillenbeck
- Department of Radiology, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Gerald F. Greil
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Department of Radiology, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
| | - Tarique Hussain
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Department of Radiology, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
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11
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Chew PG, Swoboda PP, Ferguson C, Garg P, Cook AL, Ibeggazene S, Brown LAE, Craven TP, Foley JR, Fent GJ, Saunderson CE, Higgins DM, Plein S, Birch KM, Greenwood JP. Feasibility and reproducibility of a cardiovascular magnetic resonance free-breathing, multi-shot, navigated image acquisition technique for ventricular volume quantification during continuous exercise. Quant Imaging Med Surg 2020; 10:1837-1851. [PMID: 32879861 DOI: 10.21037/qims-20-117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Cardiovascular magnetic resonance (CMR) image acquisition techniques during exercise typically requires either transient cessation of exercise or complex post-processing, potentially compromising clinical utility. We evaluated the feasibility and reproducibility of a navigated image acquisition method for ventricular volumes assessment during continuous physical exercise. Methods Ten healthy volunteers underwent supine cycle ergometer (Lode) exercise CMR on two separate occasions using a free-breathing, multi-shot, navigated, balanced steady-state free precession cine pulse sequence. Images were acquired at 3-stages, baseline and during steady-state exercise at 55% and 75% maximal heart rate (HRmax), based on a prior supine cardiopulmonary exercise test. Intra-and inter-observer variability and inter-scan reproducibility were derived. Clinical feasibility was tested in a separate cohort of patients with severe mitral regurgitation (n=6). Results End-diastolic volume (EDV) of both LV and RV decreased during exercise at 55% and 75% HRmax, although a reduction in RVEDV index was only observed at 75% HRmax. Ejection fractions (EF) for both ventricles were significantly higher at 75% HRmax compared to their respective baselines (LVEF 68%±3% vs. 58%±5%, P=0.001; RVEF 66%±4% vs. 58%±7%, P=0.02). Intra-observer and inter-observer reproducibility of LV parameters was excellent at all 3-stages. Although measurements of RVESV were more variable during exercise, the reproducibility of both RVEF and RV cardiac index was excellent (CV <10%). Inter-scan LV and RV ejection fraction were highly reproducible at all 3 stages, although inter-scan reproducibility of indexed RVESV was only moderate. The protocol was well tolerated by all patients. Conclusions Exercise CMR using a free-breathing, multi-shot, navigated cine imaging method allows simultaneous assessment of left and right ventricular volumes during continuous exercise. Intra- and inter-observer reproducibility were excellent. Inter-scan LV and RV ejection fraction were also highly reproducible.
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Affiliation(s)
- Pei G Chew
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Carrie Ferguson
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Abigail L Cook
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Said Ibeggazene
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Louise A E Brown
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Thomas P Craven
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - James R Foley
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Graham J Fent
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Christopher E Saunderson
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Karen M Birch
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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12
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Budai A, Suhai FI, Csorba K, Toth A, Szabo L, Vago H, Merkely B. Fully automatic segmentation of right and left ventricle on short-axis cardiac MRI images. Comput Med Imaging Graph 2020; 85:101786. [PMID: 32866695 DOI: 10.1016/j.compmedimag.2020.101786] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/11/2020] [Accepted: 08/15/2020] [Indexed: 11/18/2022]
Abstract
Cardiac magnetic resonance imaging (CMR) is a widely used non-invasive imaging modality for evaluating cardiovascular diseases. CMR is the gold standard method for left and right ventricular functional assessment due to its ability to characterize myocardial structure and function and low intra- and inter-observer variability. However the post-processing segmentation during the functional evaluation is time-consuming and challenging. A fully automated segmentation method can assist the experts; therefore, they can do more efficient work. In this paper, a regression-based fully automated method is presented for the right- and left ventricle segmentation. For training and evaluation, our dataset contained MRI short-axis scans of 5570 patients, who underwent CMR examinations at Heart and Vascular Center, Semmelweis University Budapest. Our approach is novel and after training the state-of-the-art algorithm on our dataset, our algorithm proved to be superior on both of the ventricles. The evaluation metrics were the Dice index, Hausdorff distance and volume related parameters. We have achieved average Dice index for the left endocardium: 0.927, left epicardium: 0.940 and right endocardium: 0.873 on our dataset. We have also compared the performance of the algorithm to the human-level segmentation on both ventricles and it is similar to experienced readers for the left, and comparable for the right ventricle. We also evaluated the proposed algorithm on the ACDC dataset, which is publicly available, with and without transfer learning. The results on ACDC were also satisfying and similar to human observers. Our method is lightweight, fast to train and does not require more than 2 GB GPU memory for execution and training.
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Affiliation(s)
- Adam Budai
- Department of Automation and Applied Informatics, Budapest University of Technology and Economics, Magyar tudósok krt. 2. (Bldg. Q.), Budapest, H-1117, Hungary.
| | - Ferenc I Suhai
- Heart and Vascular Center, Semmelweis University, Városmajor street 68., H-1112, Budapest, Hungary
| | - Kristof Csorba
- Department of Automation and Applied Informatics, Budapest University of Technology and Economics, Magyar tudósok krt. 2. (Bldg. Q.), Budapest, H-1117, Hungary
| | - Attila Toth
- Heart and Vascular Center, Semmelweis University, Városmajor street 68., H-1112, Budapest, Hungary
| | - Liliana Szabo
- Heart and Vascular Center, Semmelweis University, Városmajor street 68., H-1112, Budapest, Hungary
| | - Hajnalka Vago
- Heart and Vascular Center, Semmelweis University, Városmajor street 68., H-1112, Budapest, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor street 68., H-1112, Budapest, Hungary
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13
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Nakaoka H, Tsuda E, Morita Y, Kurosaki K. Cardiac Function by Magnetic Resonance Imaging in Coronary Artery Occlusions After Kawasaki Disease. Circ J 2020; 84:792-798. [DOI: 10.1253/circj.cj-19-0511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideyuki Nakaoka
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Etsuko Tsuda
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center
| | - Kenichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
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14
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Luo G, Dong S, Wang W, Wang K, Cao S, Tam C, Zhang H, Howey J, Ohorodnyk P, Li S. Commensal correlation network between segmentation and direct area estimation for bi-ventricle quantification. Med Image Anal 2020; 59:101591. [DOI: 10.1016/j.media.2019.101591] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/25/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
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15
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Duan J, Bello G, Schlemper J, Bai W, Dawes TJW, Biffi C, de Marvao A, Doumoud G, O'Regan DP, Rueckert D. Automatic 3D Bi-Ventricular Segmentation of Cardiac Images by a Shape-Refined Multi- Task Deep Learning Approach. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:2151-2164. [PMID: 30676949 PMCID: PMC6728160 DOI: 10.1109/tmi.2019.2894322] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Deep learning approaches have achieved state-of-the-art performance in cardiac magnetic resonance (CMR) image segmentation. However, most approaches have focused on learning image intensity features for segmentation, whereas the incorporation of anatomical shape priors has received less attention. In this paper, we combine a multi-task deep learning approach with atlas propagation to develop a shape-refined bi-ventricular segmentation pipeline for short-axis CMR volumetric images. The pipeline first employs a fully convolutional network (FCN) that learns segmentation and landmark localization tasks simultaneously. The architecture of the proposed FCN uses a 2.5D representation, thus combining the computational advantage of 2D FCNs networks and the capability of addressing 3D spatial consistency without compromising segmentation accuracy. Moreover, a refinement step is designed to explicitly impose shape prior knowledge and improve segmentation quality. This step is effective for overcoming image artifacts (e.g., due to different breath-hold positions and large slice thickness), which preclude the creation of anatomically meaningful 3D cardiac shapes. The pipeline is fully automated, due to network's ability to infer landmarks, which are then used downstream in the pipeline to initialize atlas propagation. We validate the pipeline on 1831 healthy subjects and 649 subjects with pulmonary hypertension. Extensive numerical experiments on the two datasets demonstrate that our proposed method is robust and capable of producing accurate, high-resolution, and anatomically smooth bi-ventricular 3D models, despite the presence of artifacts in input CMR volumes.
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16
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Cardiac Magnetic Resonance Imaging and Transthoracic Echocardiography: Investigation of Concordance between the Two Methods for Measurement of the Cardiac Chamber. ACTA ACUST UNITED AC 2019; 55:medicina55060260. [PMID: 31181857 PMCID: PMC6631713 DOI: 10.3390/medicina55060260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/26/2022]
Abstract
Background and objectives: Cardiac magnetic resonance (CMR) imaging is the gold standard method for the detection of ventricular volumes and myocardial edema/scar. Transthoracic echocardiography (TTE) imaging is primarily used in the evaluation of cardiac functions and chamber dimensions. This study aims to investigate whether the chamber diameter measurements are concordant with each other in the same patient group who underwent TTE and CMR. Materials and Methods: The study included 41 patients who underwent TTE and CMR imaging. Ventricular and atrial diameter measurements from TTE-derived standard parasternal long axis and apical four-chamber views and CMR-derived three- and four-chamber views were recorded. The concordance between the two methods was compared using intra-class correlation coefficients (ICC) and Bland–Altman plots. Results: Of the patients, 25 (61%) were male and the mean age was 48.12 ± 16.79. The mean ICC for LVDD between CMR observers was 0.957 (95% CI: 0.918–0.978), while the mean ICC between CMR and TTE measurements were 0.849 (95% CI: 0.709–0.922) and 0.836 (95% CI: 0.684–0.915), respectively. The mean ICC for the right ventricle between CMR observers was 0.985 (95% CI: 0.971–0.992), while the mean ICC between CMR and TTE measurements were 0.869 (95% CI: 0.755–0.930) and 0.892 (95% CI: 0.799–0.942), respectively. Passing–Bablok Regression and Bland–Altman plots indicated high concordance between the two methods. Conclusions: TTE and CMR indicated high concordance in chamber diameter measurements for which the CMR should be considered in patients for whom optimal evaluation with TTE could not be performed due to their limitations.
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17
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Liu J, Xie H, Zhang S, Gu L. Multi-sequence myocardium segmentation with cross-constrained shape and neural network-based initialization. Comput Med Imaging Graph 2019; 71:49-57. [DOI: 10.1016/j.compmedimag.2018.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/25/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
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18
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Bai W, Sinclair M, Tarroni G, Oktay O, Rajchl M, Vaillant G, Lee AM, Aung N, Lukaschuk E, Sanghvi MM, Zemrak F, Fung K, Paiva JM, Carapella V, Kim YJ, Suzuki H, Kainz B, Matthews PM, Petersen SE, Piechnik SK, Neubauer S, Glocker B, Rueckert D. Automated cardiovascular magnetic resonance image analysis with fully convolutional networks. J Cardiovasc Magn Reson 2018. [PMID: 30217194 DOI: 10.1186/s12968‐018‐0471‐x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular resonance (CMR) imaging is a standard imaging modality for assessing cardiovascular diseases (CVDs), the leading cause of death globally. CMR enables accurate quantification of the cardiac chamber volume, ejection fraction and myocardial mass, providing information for diagnosis and monitoring of CVDs. However, for years, clinicians have been relying on manual approaches for CMR image analysis, which is time consuming and prone to subjective errors. It is a major clinical challenge to automatically derive quantitative and clinically relevant information from CMR images. METHODS Deep neural networks have shown a great potential in image pattern recognition and segmentation for a variety of tasks. Here we demonstrate an automated analysis method for CMR images, which is based on a fully convolutional network (FCN). The network is trained and evaluated on a large-scale dataset from the UK Biobank, consisting of 4,875 subjects with 93,500 pixelwise annotated images. The performance of the method has been evaluated using a number of technical metrics, including the Dice metric, mean contour distance and Hausdorff distance, as well as clinically relevant measures, including left ventricle (LV) end-diastolic volume (LVEDV) and end-systolic volume (LVESV), LV mass (LVM); right ventricle (RV) end-diastolic volume (RVEDV) and end-systolic volume (RVESV). RESULTS By combining FCN with a large-scale annotated dataset, the proposed automated method achieves a high performance in segmenting the LV and RV on short-axis CMR images and the left atrium (LA) and right atrium (RA) on long-axis CMR images. On a short-axis image test set of 600 subjects, it achieves an average Dice metric of 0.94 for the LV cavity, 0.88 for the LV myocardium and 0.90 for the RV cavity. The mean absolute difference between automated measurement and manual measurement is 6.1 mL for LVEDV, 5.3 mL for LVESV, 6.9 gram for LVM, 8.5 mL for RVEDV and 7.2 mL for RVESV. On long-axis image test sets, the average Dice metric is 0.93 for the LA cavity (2-chamber view), 0.95 for the LA cavity (4-chamber view) and 0.96 for the RA cavity (4-chamber view). The performance is comparable to human inter-observer variability. CONCLUSIONS We show that an automated method achieves a performance on par with human experts in analysing CMR images and deriving clinically relevant measures.
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Affiliation(s)
- Wenjia Bai
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK.
| | - Matthew Sinclair
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Giacomo Tarroni
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Ozan Oktay
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Martin Rajchl
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Ghislain Vaillant
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Aaron M Lee
- NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Nay Aung
- NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Elena Lukaschuk
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Mihir M Sanghvi
- NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Filip Zemrak
- NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Kenneth Fung
- NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Jose Miguel Paiva
- NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Valentina Carapella
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Young Jin Kim
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Hideaki Suzuki
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Bernhard Kainz
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Paul M Matthews
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Steffen E Petersen
- NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ben Glocker
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
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19
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Bai W, Sinclair M, Tarroni G, Oktay O, Rajchl M, Vaillant G, Lee AM, Aung N, Lukaschuk E, Sanghvi MM, Zemrak F, Fung K, Paiva JM, Carapella V, Kim YJ, Suzuki H, Kainz B, Matthews PM, Petersen SE, Piechnik SK, Neubauer S, Glocker B, Rueckert D. Automated cardiovascular magnetic resonance image analysis with fully convolutional networks. J Cardiovasc Magn Reson 2018; 20:65. [PMID: 30217194 PMCID: PMC6138894 DOI: 10.1186/s12968-018-0471-x] [Citation(s) in RCA: 342] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 06/20/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cardiovascular resonance (CMR) imaging is a standard imaging modality for assessing cardiovascular diseases (CVDs), the leading cause of death globally. CMR enables accurate quantification of the cardiac chamber volume, ejection fraction and myocardial mass, providing information for diagnosis and monitoring of CVDs. However, for years, clinicians have been relying on manual approaches for CMR image analysis, which is time consuming and prone to subjective errors. It is a major clinical challenge to automatically derive quantitative and clinically relevant information from CMR images. METHODS Deep neural networks have shown a great potential in image pattern recognition and segmentation for a variety of tasks. Here we demonstrate an automated analysis method for CMR images, which is based on a fully convolutional network (FCN). The network is trained and evaluated on a large-scale dataset from the UK Biobank, consisting of 4,875 subjects with 93,500 pixelwise annotated images. The performance of the method has been evaluated using a number of technical metrics, including the Dice metric, mean contour distance and Hausdorff distance, as well as clinically relevant measures, including left ventricle (LV) end-diastolic volume (LVEDV) and end-systolic volume (LVESV), LV mass (LVM); right ventricle (RV) end-diastolic volume (RVEDV) and end-systolic volume (RVESV). RESULTS By combining FCN with a large-scale annotated dataset, the proposed automated method achieves a high performance in segmenting the LV and RV on short-axis CMR images and the left atrium (LA) and right atrium (RA) on long-axis CMR images. On a short-axis image test set of 600 subjects, it achieves an average Dice metric of 0.94 for the LV cavity, 0.88 for the LV myocardium and 0.90 for the RV cavity. The mean absolute difference between automated measurement and manual measurement is 6.1 mL for LVEDV, 5.3 mL for LVESV, 6.9 gram for LVM, 8.5 mL for RVEDV and 7.2 mL for RVESV. On long-axis image test sets, the average Dice metric is 0.93 for the LA cavity (2-chamber view), 0.95 for the LA cavity (4-chamber view) and 0.96 for the RA cavity (4-chamber view). The performance is comparable to human inter-observer variability. CONCLUSIONS We show that an automated method achieves a performance on par with human experts in analysing CMR images and deriving clinically relevant measures.
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Affiliation(s)
- Wenjia Bai
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Matthew Sinclair
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Giacomo Tarroni
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Ozan Oktay
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Martin Rajchl
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Ghislain Vaillant
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Aaron M. Lee
- NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Nay Aung
- NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Elena Lukaschuk
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Mihir M. Sanghvi
- NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Filip Zemrak
- NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Kenneth Fung
- NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Jose Miguel Paiva
- NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Valentina Carapella
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Young Jin Kim
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Hideaki Suzuki
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Bernhard Kainz
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Paul M. Matthews
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Steffen E. Petersen
- NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Stefan K. Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ben Glocker
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
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20
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Chew PG, Bounford K, Plein S, Schlosshan D, Greenwood JP. Multimodality imaging for the quantitative assessment of mitral regurgitation. Quant Imaging Med Surg 2018; 8:342-359. [PMID: 29774187 DOI: 10.21037/qims.2018.04.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The natural history of mitral regurgitation (MR) results in significant morbidity and mortality. Innovations in non-invasive imaging have provided new insights into the pathophysiology and quantification of MR, in addition to early detection of left ventricular (LV) dysfunction and prognostic assessment in asymptomatic patients. Transthoracic (TTE) and transesophageal (TOE) echocardiography are the mainstay for diagnosis, assessment and serial surveillance. However, the advance from 2D to 3D imaging leads to improved assessment and characterization of mitral valve (MV) disease. Cardiovascular magnetic resonance (CMR) is increasingly used for MR quantitation and can provide an alternative imaging method if echocardiography is suboptimal or inconclusive. Other techniques such as exercise echocardiography, tissue Doppler imaging and speckle-tracking echocardiography can further offer complementary information on prognosis. This review summarises the current evidence for state-of-the-art cardiovascular imaging for the investigation of MR. Whilst advanced echocardiographic techniques are superior in the evaluation of complex MV anatomy, CMR appears the most accurate technique for the quantification of MR severity. Integration of multimodality imaging for the assessment of MR utilises the advantages of each imaging technique and offers the most comprehensive assessment of MR.
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Affiliation(s)
- Pei G Chew
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | | | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
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21
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Francis R, Lewis C. Myocardial biopsy: techniques and indications. Heart 2017; 104:950-958. [PMID: 29032361 DOI: 10.1136/heartjnl-2017-311382] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 08/15/2017] [Accepted: 09/17/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
| | - Clive Lewis
- Transplant Unit, Papworth Hospital, Cambridge, UK
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