Automated Threshold-Based 3D Segmentation Versus Short-Axis Planimetry for Assessment of Global Left Ventricular Function with Dual-Source MDCT

• Published in: American journal of roentgenology (1976) Vol. 190; no. 2; pp. 308 - 314
• Main Authors: Juergens, Kai Uwe, Seifarth, Harald, Range, Felix, Wienbeck, Susanne, Wenker, Mirja, Heindel, Walter, Fischbach, Roman
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01.02.2008; American Roentgen Ray Society
• Subjects: Adult; Aged; Aged, 80 and over; Algorithms; Artificial Intelligence; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular system; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary heart disease; Female; Heart; Humans; Imaging, Three-Dimensional - methods; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Pattern Recognition, Automated - methods; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiographic Image Enhancement - methods; Radiographic Image Interpretation, Computer-Assisted - methods; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed - instrumentation; Tomography, X-Ray Computed - methods; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Human; Radiodiagnosis; Papillary muscle; Coronary arteriography; Systolic volume; End diastolic volume; Coronary heart disease; Left ventricle; Multidetector scanner; Interindividual comparison; Medical imagery; Computerized axial tomography; Hemodynamics; Left ventricle performance; Comparative study; Ejection fraction
• ISSN: 0361-803X; 1546-3141; 1546-3141
• DOI: 10.2214/AJR.07.2283

The purpose of this study was to evaluate software for threshold-based 3D segmentation of the left ventricle in comparison with traditional 2D short axis-based planimetry (Simpson method) for measurement of left ventricular (LV) volume and global function with state-of-the-art dual-source CT. Fifty patients with known or suspected coronary artery disease underwent coronary CT angiography. LV end-diastolic, end-systolic, and stroke volumes and ejection fraction were determined from axial images to which 3D segmentation had been applied and from short-axis reformations from 2D planimetry. Interobserver variability was assessed for both approaches. Threshold-based 3D LV segmentation had excellent correlation with 2D short-axis results (end-diastolic volume, R = 0.99; end-systolic volume, R = 0.99; stroke volume, R = 0.90; ejection fraction, R = 0.97; p < 0.0001). Bland-Altman analyses revealed systematic underestimation of LV end-diastolic volume (-7.4 +/- 8.9 mL) and LV end-systolic volume (-7.0 +/- 4.4 mL) with the 3D segmentation approach and 2.8 +/- 3.3% overestimation of LV ejection fraction. Interobserver variation with 3D segmentation analysis was significantly (p < 0.001) less (e.g., LV ejection fraction, 0.1 +/- 1.7%) than with the 2D technique, and mean analysis time was significantly shorter (172 +/- 20 vs 248 +/- 29 seconds; p < 0.05). Automated threshold-based 3D segmentation enables accurate and reproducible dual-source CT assessment of LV volume and function with excellent correlation with results of 2D short-axis analysis. Exclusion of papillary muscles from LV volume results in small systematic differences in quantitative values.