Anatomically-Informed Deep Learning on Contrast-Enhanced Cardiac MRI for Scar Segmentation and Clinical Feature Extraction
This addresses the need for reliable, automated analysis of cardiac scarring in medical imaging, though it appears incremental as it builds on existing deep learning approaches with anatomical constraints.
The authors tackled the problem of automating scar and fibrosis segmentation from cardiac MRI, which is typically manual and variable, by developing an anatomically-informed deep learning method that achieved high accuracy (e.g., 96% for LV segmentation) and close agreement with expert-derived clinical features.
Visualizing disease-induced scarring and fibrosis in the heart on cardiac magnetic resonance (CMR) imaging with contrast enhancement (LGE) is paramount in characterizing disease progression and quantifying pathophysiological substrates of arrhythmias. However, segmentation and scar/fibrosis identification from LGE-CMR is an intensive manual process prone to large inter-observer variability. Here, we present a novel fully-automated anatomically-informed deep learning solution for left ventricle (LV) and scar/fibrosis segmentation and clinical feature extraction from LGE-CMR. The technology involves three cascading convolutional neural networks that segment myocardium and scar/fibrosis from raw LGE-CMR images and constrain these segmentations within anatomical guidelines, thus facilitating seamless derivation of clinically-significant parameters. In addition to available LGE-CMR images, training used "LGE-like" synthetically enhanced cine scans. Results show excellent agreement with those of trained experts in terms of segmentation (balanced accuracy of $96\%$ and $75\%$ for LV and scar segmentation), clinical features ($2\%$ difference in mean scar-to-LV wall volume fraction), and anatomical fidelity. Our segmentation technology is extendable to other computer vision medical applications and to problems requiring guidelines adherence of predicted outputs.