Automatic segmentation of the aortic root in CT angiography of candidate patients for transcatheter aortic valve implantation

  • M. A. Elattar
  • E. M. Wiegerinck
  • R. N. Planken
  • E. vanbavel
  • H. C. van Assen
  • J. BaanJr.
  • H. A. Marquering
Original Article


Transcatheter aortic valve implantation is a minimal-invasive intervention for implanting prosthetic valves in patients with aortic stenosis. Accurate automated sizing for planning and patient selection is expected to reduce adverse effects such as paravalvular leakage and stroke. Segmentation of the aortic root in CTA is pivotal to enable automated sizing and planning. We present a fully automated segmentation algorithm to extract the aortic root from CTA volumes consisting of a number of steps: first, the volume of interest is automatically detected, and the centerline through the ascending aorta and aortic root centerline are determined. Subsequently, high intensities due to calcifications are masked. Next, the aortic root is represented in cylindrical coordinates. Finally, the aortic root is segmented using 3D normalized cuts. The method was validated against manual delineations by calculating Dice coefficients and average distance error in 20 patients. The method successfully segmented the aortic root in all 20 cases. The mean Dice coefficient was 0.95 ± 0.03, and the mean radial absolute error was 0.74 ± 0.39 mm, where the interobserver Dice coefficient was 0.95 ± 0.03 and the mean error was 0.68 ± 0.34 mm. The proposed algorithm showed accurate results compared to manual segmentations.


Aortic root Medical image segmentation Normalized cut TAVI CTA 



The authors wish to thank for the support from the Technology Foundation STW, The Netherlands, under Grant 11630.


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Copyright information

© International Federation for Medical and Biological Engineering 2014

Authors and Affiliations

  • M. A. Elattar
    • 1
  • E. M. Wiegerinck
    • 2
  • R. N. Planken
    • 3
  • E. vanbavel
    • 1
  • H. C. van Assen
    • 4
  • J. BaanJr.
    • 2
  • H. A. Marquering
    • 1
    • 3
  1. 1.Department of Biomedical Engineering and Physics, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Department of Cardiology, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  3. 3.Department of Radiology, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  4. 4.Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands

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