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CT evaluation prior to transapical aortic valve replacement: semi-automatic versus manual image segmentation

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Abstract

To compare the performance of semi-automatic versus manual segmentation for ECG-triggered cardiovascular computed tomography (CT) examinations prior to transcatheter aortic valve replacement (TAVR), with focus on the speed and precision of experienced versus inexperienced observers. The preoperative ECG-triggered CT data of 30 consecutive patients who were scheduled for TAVR were included. All datasets were separately evaluated by two radiologists with 1 and 5 years of experience (novice and expert, respectively) in cardiovascular CT using an evaluation software program with or without a semi-automatic TAVR workflow. The time expended for data loading and all segmentation steps required for the implantation planning were assessed. Inter-software as well as inter-observer reliability analysis was performed. The CT datasets were successfully evaluated, with mean duration between 520.4 ± 117.6 s and 693.2 ± 159.5 s. The three most time-consuming steps were the 3D volume rendering, the measurement of aorta diameter and the sizing of the aortic annulus. Using semi-automatic segmentation, a novice could evaluate CT data approximately 12.3 % faster than with manual segmentation, and an expert could evaluate CT data approximately 10.3 % faster [mean differences of 85.4 ± 83.8 s (p < 0.001) and 59.8 ± 101 s (p < 0.001), respectively]. The inter-software reliability for a novice was slightly lower than for an expert; however, the reliability for a novice and expert was excellent (ICC 0.92, 95 % CI 0.75–0.97/ICC 0.96, 95 % CI 0.91–0.98). Automatic aortic annulus detection failed in two patients (6.7 %). The study revealed excellent inter-software and inter-observer reliability, with a mean ICC of 0.95. TAVR evaluation can be accomplished significantly faster with semi-automatic rather than with manual segmentation, with comparable exactness, showing a benefit for experienced and inexperienced observers.

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Abbreviations

3D VRT:

3D volume-rendering technique

AS:

Aortic valve stenosis

cMPR:

Curved multiplanar reconstruction

CT:

Computed tomography

ECG:

Electrocardiogram

ED:

Effective diameter

ICC:

Intraclass correlation coefficient

TAVR:

Transcatheter aortic valve replacement

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Acknowledgments

The authors of this manuscript declare a cooperation contract between the Department of Interventional and Diagnostic Radiology of the Heart Center in Leipzig and the Siemens Company (Siemens AG, Healthcare, Erlangen, Germany), which supported the study and provided the required equipment and software.

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None.

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Authors and Affiliations

  1. Department of Interventional and Diagnostic Radiology, University of Leipzig – Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany

    Borek Foldyna, Camelia Jungert, Christian Luecke, Matthias Grothoff, Stefan Nitzsche, Matthias Gutberlet & Lukas Lehmkuhl

  2. Department of Cardiac Surgery, University of Leipzig – Heart Center, Leipzig, Germany

    Konstantin von Aspern & Friedrich Wilhelm Mohr

  3. Siemens Healthcare – Imaging & Therapy, Erlangen, Germany

    Sonja Boehmer-Lasthaus & Eva Maria Rueth

Authors
  1. Borek Foldyna
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  2. Camelia Jungert
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  3. Christian Luecke
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  4. Konstantin von Aspern
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  5. Sonja Boehmer-Lasthaus
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  6. Eva Maria Rueth
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  7. Matthias Grothoff
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  8. Stefan Nitzsche
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  9. Matthias Gutberlet
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  10. Friedrich Wilhelm Mohr
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  11. Lukas Lehmkuhl
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Correspondence to Borek Foldyna.

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Foldyna, B., Jungert, C., Luecke, C. et al. CT evaluation prior to transapical aortic valve replacement: semi-automatic versus manual image segmentation. Int J Cardiovasc Imaging 31, 1233–1242 (2015). https://doi.org/10.1007/s10554-015-0662-6

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  • DOI: https://doi.org/10.1007/s10554-015-0662-6

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