A Deep Learning Pipeline for Assessing Ventricular Volumes from a Cardiac MRI Registry of Patients with Single Ventricle Physiology.

Journal: Radiology. Artificial intelligence
PMID: 38166332

Abstract

Purpose To develop an end-to-end deep learning (DL) pipeline for automated ventricular segmentation of cardiac MRI data from a multicenter registry of patients with Fontan circulation (Fontan Outcomes Registry Using CMR Examinations [FORCE]). Materials and Methods This retrospective study used 250 cardiac MRI examinations (November 2007-December 2022) from 13 institutions for training, validation, and testing. The pipeline contained three DL models: a classifier to identify short-axis cine stacks and two U-Net 3+ models for image cropping and segmentation. The automated segmentations were evaluated on the test set ( = 50) by using the Dice score. Volumetric and functional metrics derived from DL and ground truth manual segmentations were compared using Bland-Altman and intraclass correlation analysis. The pipeline was further qualitatively evaluated on 475 unseen examinations. Results There were acceptable limits of agreement (LOA) and minimal biases between the ground truth and DL end-diastolic volume (EDV) (bias: -0.6 mL/m, LOA: -20.6 to 19.5 mL/m) and end-systolic volume (ESV) (bias: -1.1 mL/m, LOA: -18.1 to 15.9 mL/m), with high intraclass correlation coefficients (ICCs > 0.97) and Dice scores (EDV, 0.91 and ESV, 0.86). There was moderate agreement for ventricular mass (bias: -1.9 g/m, LOA: -17.3 to 13.5 g/m) and an ICC of 0.94. There was also acceptable agreement for stroke volume (bias: 0.6 mL/m, LOA: -17.2 to 18.3 mL/m) and ejection fraction (bias: 0.6%, LOA: -12.2% to 13.4%), with high ICCs (>0.81). The pipeline achieved satisfactory segmentation in 68% of the 475 unseen examinations, while 26% needed minor adjustments, 5% needed major adjustments, and in 0.4%, the cropping model failed. Conclusion The DL pipeline can provide fast standardized segmentation for patients with single ventricle physiology across multiple centers. This pipeline can be applied to all cardiac MRI examinations in the FORCE registry. Cardiac, Adults and Pediatrics, MR Imaging, Congenital, Volume Analysis, Segmentation, Quantification © RSNA, 2023.

Authors

  • Tina Yao
    From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.).
  • Nicole St Clair
    From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.).
  • Gabriel F Miller
    From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.).
  • Adam L Dorfman
    From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.).
  • Mark A Fogel
    From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.).
  • Sunil Ghelani
    From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.).
  • Rajesh Krishnamurthy
    From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.).
  • Christopher Z Lam
    From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.).
  • Michael Quail
    UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH, UK.
  • Joshua D Robinson
    Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
  • David Schidlow
    From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.).
  • Timothy C Slesnick
    Emory University School of Medicine, Atlanta, GA, USA.
  • Justin Weigand
    From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.).
  • Jennifer A Steeden
    UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom.
  • Rahul H Rathod
    Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.
  • Vivek Muthurangu
    UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom.

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