Automatic segmentation of the aortic root in CT angiography of candidate patients for transcatheter aortic valve implantation
- 474 Downloads
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.
KeywordsAortic 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.
- 3.Boykov Y, Kolmogorov V (2003) Computing geodesics and minimal surfaces via graph cuts. In: Proceedings of the ninth IEEE international conference on Computer Vision, vol 2. IEEE Computer Society, Washington, pp 26–33Google Scholar
- 12.Kurkure U, Avila-Montes OC, Kakadiaris IA (2008) Automated segmentation of thoracic aorta in non-contrast CT images. 2008 5th IEEE Int Symp Biomed Imaging From Nano to Macro. doi: 10.1109/ISBI.2008.4540924
- 13.Lavi G, Lessick J, Johnson PC, Khullar D (2004) Single-seeded coronary artery tracking in CT angiography. Nucl Sci Symp Conf Rec 5:3308–3311Google Scholar
- 17.Vahanian A, Alfieri O, Al-Attar N et al (2008) Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percu. Eur Heart J 29:1463–1470. doi: 10.1093/eurheartj/ehn183 PubMedCrossRefGoogle Scholar
- 20.Ye J, Cheung A, Lichtenstein SV et al. (2010) Transapical transcatheter aortic valve implantation: follow-up to 3 years. J Thorac Cardiovasc Surg 139:1107–13, 1113.e1. doi 10.1016/j.jtcvs.2009.10.056