Automated segmentation of the aorta from phase contrast MR images: Validation against expert tracing in healthy volunteers and in patients with a dilated aorta

Purpose:

To assess if segmentation of the aorta can be accurately achieved using the modulus image of phase contrast (PC) magnetic resonance (MR) acquisitions.

Materials and Methods:

PC image sequences containing both the ascending and descending aorta of 52 subjects were acquired using three different MR scanners. An automated segmentation technique, based on a 2D+t deformable surface that takes into account the features of PC aortic images, such as flow‐related effects, was developed. The study was designed to: 1) assess the variability of our approach and its robustness to the type of MR scanner, and 2) determine its sensitivity to aortic dilation and its accuracy against an expert manual tracing.

Results:

Interobserver variability in the lumen area was 0.59 ± 0.92% for the automated approach versus 10.09 ± 8.29% for manual segmentation. The mean Dice overlap measure was 0.945 ± 0.014. The method was robust to the aortic size and highly correlated (r = 0.99) with the manual tracing in terms of aortic area and diameter.

Conclusion:

A fast and robust automated segmentation of the aortic lumen was developed and successfully tested on images provided by various MR scanners and acquired on healthy volunteers as well as on patients with a dilated aorta. J. Magn. Reson. Imaging 2010;31:881–888. ©2010 Wiley‐Liss, Inc.     

Estimation of aortic pulse wave transit time in cardiovascular magnetic resonance using complex wavelet cross-spectrum analysis

Background

Aortic pulse wave velocity (PWV), which substantially increases with arterial stiffness and aging, is a major predictor of cardiovascular mortality. It is commonly estimated using applanation tonometry at carotid and femoral arterial sites (cfPWV). More recently, several cardiovascular magnetic resonance (CMR) studies have focused on the measurement of aortic arch PWV (archPWV). Although the excellent anatomical coverage of CMR offers reliable segmental measurement of arterial length, accurate transit time (TT) determination remains a challenge. Recently, it has been demonstrated that Fourier-based methods were more robust to low temporal resolution than time-based approaches.

Methods

We developed a wavelet-based method, which enables temporal localization of signal frequencies, to estimate TT from ascending and descending aortic CMR flow curves. This method (archPWV_WU) combines the robustness of Fourier-based methods to low temporal resolution with the possibility to restrict the analysis to the reflectionless systolic upslope. We compared this method with Fourier-based (archPWV_F) and time domain upslope (archPWV_TU) methods in relation to linear correlations with age, cfPWV and effects of decreasing temporal resolution by factors of 2, 3 and 4. We studied 71 healthy subjects (45 ± 15 years, 29 females) who underwent CMR velocity acquisitions and cfPWV measurements.

Results

Comparison with age resulted in the highest correlation for the wavelet-based method (archPWV_WU:r = 0.84,p < 0.001; archPWV_TU:r = 0.74,p < 0.001; archPWV_F:r = 0.63,p < 0.001). Associations with cfPWV resulted in the highest correlations for upslope techniques whether based on wavelet (archPWV_WU:r = 0.58,p < 0.001) or time (archPWV_TU:r = 0.58,p < 0.001) approach. Furthermore, while decreasing temporal resolution by 4-fold induced only a minor decrease in correlation of both archPWV_WU (r decreased from 0.84 to 0.80) and archPWV_F (r decreased from 0.63 to 0.51) with age, it induced a major decrease for the archPWV_TU age relationship (r decreased from 0.74 to 0.38).

Conclusions

By CMR, measurement of aortic arch flow TT using systolic upslopes resulted in a better correlation with age and cfPWV, as compared to the Fourier-based approach applied on the entire cardiac cycle. Furthermore, methods based on harmonic decomposition were less affected by low temporal resolution. Since the proposed wavelet approach combines these two advantages, it might help to overcome current technical limitations related to CMR temporal resolution and evaluation of patients with highly stiff arteries.     

Consistency of aortic distensibility and pulse wave velocity estimates with respect to the Bramwell-Hill theoretical model: a cardiovascular magnetic resonance study

Background

Arterial stiffness is considered as an independent predictor of cardiovascular mortality, and is increasingly used in clinical practice. This study aimed at evaluating the consistency of the automated estimation of regional and local aortic stiffness indices from cardiovascular magnetic resonance (CMR) data.

Results

Forty-six healthy subjects underwent carotid-femoral pulse wave velocity measurements (CF_PWV) by applanation tonometry and CMR with steady-state free-precession and phase contrast acquisitions at the level of the aortic arch. These data were used for the automated evaluation of the aortic arch pulse wave velocity (Arch_PWV), and the ascending aorta distensibility (AA_Distc, AA_Distb), which were estimated from ascending aorta strain (AA_Strain) combined with either carotid or brachial pulse pressure. The local ascending aorta pulse wave velocity AA_PWVc and AA_PWVb were estimated respectively from these carotid and brachial derived distensibility indices according to the Bramwell-Hill theoretical model, and were compared with the Arch_PWV. In addition, a reproducibility analysis of AA_PWV measurement and its comparison with the standard CF_PWV was performed. Characterization according to the Bramwell-Hill equation resulted in good correlations between Arch_PWV and both local distensibility indices AA_Distc (r = 0.71, p < 0.001) and AA_Distb (r = 0.60, p < 0.001); and between Arch_PWV and both theoretical local indices AA_PWVc (r = 0.78, p < 0.001) and AA_PWVb (r = 0.78, p < 0.001). Furthermore, the Arch_PWV was well related to CF_PWV (r = 0.69, p < 0.001) and its estimation was highly reproducible (inter-operator variability: 7.1%).

Conclusions

The present work confirmed the consistency and robustness of the regional index Arch_PWV and the local indices AA_Distc and AA_Distb according to the theoretical model, as well as to the well established measurement of CF_PWV, demonstrating the relevance of the regional and local CMR indices.     

Volumetric quantification of myocardial perfusion using analysis of multi-detector computed tomography 3D datasets: comparison with nuclear perfusion imaging

Background  

Although the ability of multi-detector computed tomography (MDCT) to detect perfusion abnormalities associated with acute and chronic myocardial infarction (MI) has been demonstrated, this methodology is based on visual interpretation of selected 2D slices.     

Robust assessment of the transmural extent of myocardial infarction in late gadolinium-enhanced MRI studies using appropriate angular and circumferential subdivision of the myocardium

A computer-assisted method is proposed to estimate transmural extent of myocardial infarction. In 40 patients with chronic myocardial infarction and 3 control subjects, late gadolinium enhancement images were acquired with magnetic resonance imaging. Segmental infarct transmural extent was visually assessed by two experts on a 5-point scale. A fuzzy c-means algorithm was applied on both the cavity and myocardium to estimate an enhancement index for 12 sub-regions of each segment. A threshold was defined on a training database (n=29) to establish the transmurality extent of each sub-segment and was applied to the validation database (n=14). Inter-observer reproducibility reached an absolute agreement (Aa) of 85% and a kappa value (kappa) of 0.83 when considering the whole training database; Aa decreased to 62% and kappa to 0.68 when excluding homogeneous segments. On the validation database, segments were subdivided into three angular sub-segments. Then, inter-observer visual reproducibility reached Aa of 93% and kappa of 0.92. Moreover, the absolute comparison of each expert with the computer-assisted method yielded Aa higher than 88% and kappa higher than 0.86. The computer-assisted method quantifies infarct transmurality without defining remote and infarcted regions, and the transmural extent is accurately characterized when dividing each segment into three angular sub-segments.     

Automated left ventricular diastolic function evaluation from phase-contrast cardiovascular magnetic resonance and comparison with Doppler echocardiography

Background

Early detection of diastolic dysfunction is crucial for patients with incipient heart failure. Although this evaluation could be performed from phase-contrast (PC) cardiovascular magnetic resonance (CMR) data, its usefulness in clinical routine is not yet established, mainly because the interpretation of such data remains mostly based on manual post-processing. Accordingly, our goal was to develop a robust process to automatically estimate velocity and flow rate-related diastolic parameters from PC-CMR data and to test the consistency of these parameters against echocardiography as well as their ability to characterize left ventricular (LV) diastolic dysfunction.

Results

We studied 35 controls and 18 patients with severe aortic valve stenosis and preserved LV ejection fraction who had PC-CMR and Doppler echocardiography exams on the same day. PC-CMR mitral flow and myocardial velocity data were analyzed using custom software for semi-automated extraction of diastolic parameters. Inter-operator reproducibility of flow pattern segmentation and functional parameters was assessed on a sub-group of 30 subjects. The mean percentage of overlap between the transmitral flow segmentations performed by two independent operators was 99.7 ± 1.6%, resulting in a small variability (<1.96 ± 2.95%) in functional parameter measurement. For maximal myocardial longitudinal velocities, the inter-operator variability was 4.25 ± 5.89%. The MR diastolic parameters varied significantly in patients as opposed to controls (p < 0.0002). Both velocity and flow rate diastolic parameters were consistent with echocardiographic values (r > 0.71) and receiver operating characteristic (ROC) analysis revealed their ability to separate patients from controls, with sensitivity > 0.80, specificity > 0.80 and accuracy > 0.85. Slight superiority in terms of correlation with echocardiography (r = 0.81) and accuracy to detect LV abnormalities (sensitivity > 0.83, specificity > 0.91 and accuracy > 0.89) was found for the PC-CMR flow-rate related parameters.

Conclusions

A fast and reproducible technique for flow and myocardial PC-CMR data analysis was successfully used on controls and patients to extract consistent velocity-related diastolic parameters, as well as flow rate-related parameters. This technique provides a valuable addition to established CMR tools in the evaluation and the management of patients with diastolic dysfunction.     

Value of multidetector computed tomography evaluation of myocardial perfusion in the assessment of ischemic heart disease: comparison with nuclear perfusion imaging

MDCT-derived myocardial perfusion has not yet been validated against accepted standards. We developed a technique for quantification of myocardial perfusion from MDCT images and studied its diagnostic value against SPECT myocardial perfusion imaging (MPI). Ninety-eight patients were studied. Abnormal perfusion was detected by comparing normalized segmental x-ray attenuation against values obtained in 20 control subjects. Disagreement with resting MPI was investigated in relationship to MDCT image quality, severity of MPI abnormalities, and stress MPI findings. Resting MPI detected mild or worse abnormalities in 20/78 patients. MDCT detected abnormalities in 15/20 patients (sensitivity of 0.75). Most abnormalities missed by MDCT analysis were graded as mild on MPI. Additional abnormalities found in 16/78 patients were not confirmed on resting MPI (specificity of 0.72). However, 8 of these 16 apparently false positive MDCT perfusion tests had abnormal stress MPI; of these 8 patients, 7 had optimal MDCT image quality, while in 6/8 remaining patients, image quality was suboptimal. When compared with resting MPI, MDCT detected perfusion abnormalities with high accuracy. Moreover, half of MDCT perfusion abnormalities not confirmed by resting MPI were associated with abnormal stress MPI. Importantly, this information can be obtained without additional radiation dose or contrast agent.