Rapid automatic segmentation of abnormal tissue in late gadolinium enhancement cardiovascular magnetic resonance images for improved management of long-standing persistent atrial fibrillation

Giannakidis, A. ORCID: 0000-0001-7403-923X, Nyktari, E., Keegan, J., Pierce, I., Suman Horduna, I., Haldar, S., Pennell, D.J., Mohiaddin, R., Wong, T. and Firmin, D.N., 2015. Rapid automatic segmentation of abnormal tissue in late gadolinium enhancement cardiovascular magnetic resonance images for improved management of long-standing persistent atrial fibrillation. BioMedical Engineering OnLine, 14: 88. ISSN 1475-925X

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Abstract

Background: Atrial fibrillation (AF) is the most common heart rhythm disorder. In order for late Gd enhancement cardiovascular magnetic resonance (LGE CMR) to ameliorate the AF management, the ready availability of the accurate enhancement segmentation is required. However, the computer-aided segmentation of enhancement in LGE CMR of AF is still an open question. Additionally, the number of centres that have reported successful application of LGE CMR to guide clinical AF strategies remains low, while the debate on LGE CMR’s diagnostic ability for AF still holds. The aim of this study is to propose a method that reliably distinguishes enhanced (abnormal) from non-enhanced (healthy) tissue within the left atrial wall of (pre-ablation and 3 months post-ablation) LGE CMR data-sets from long-standing persistent AF patients studied at our centre.

Methods: Enhancement segmentation was achieved by employing thresholds benchmarked against the statistics of the whole left atrial blood-pool (LABP). The test-set cross-validation mechanism was applied to determine the input feature representation and algorithm that best predict enhancement threshold levels.

Results: Global normalized intensity threshold levels T PRE = 1 1/4 and T POST = 1 5/8 were found to segment enhancement in data-sets acquired pre-ablation and at 3 months post-ablation, respectively. The segmentation results were corroborated by using visual inspection of LGE CMR brightness levels and one endocardial bipolar voltage map. The measured extent of pre-ablation fibrosis fell within the normal range for the specific arrhythmia phenotype. 3D volume renderings of segmented post-ablation enhancement emulated the expected ablation lesion patterns. By comparing our technique with other related approaches that proposed different threshold levels (although they also relied on reference regions from within the LABP) for segmenting enhancement in LGE CMR data-sets of AF patients, we illustrated that the cut-off levels employed by other centres may not be usable for clinical studies performed in our centre.

Conclusions: The proposed technique has great potential for successful employment in the AF management within our centre. It provides a highly desirable validation of the LGE CMR technique for AF studies. Inter-centre differences in the CMR acquisition protocol and image analysis strategy inevitably impede the selection of a universally optimal algorithm for segmentation of enhancement in AF studies.

Item Type: Journal article
Publication Title: BioMedical Engineering OnLine
Creators: Giannakidis, A., Nyktari, E., Keegan, J., Pierce, I., Suman Horduna, I., Haldar, S., Pennell, D.J., Mohiaddin, R., Wong, T. and Firmin, D.N.
Publisher: BioMed Central
Date: 7 October 2015
Volume: 14
ISSN: 1475-925X
Identifiers:
NumberType
10.1186/s12938-015-0083-8DOI
83Publisher Item Identifier
Rights: © Giannakidis et al. 2015. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License.
Divisions: Schools > School of Science and Technology
Depositing User: Jonathan Gallacher
Date Added: 16 Mar 2018 09:07
Last Modified: 16 Mar 2018 09:07
URI: http://irep.ntu.ac.uk/id/eprint/33004

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