Automated Quantification of Simple and Complex Aortic Flow Using 2D Phase Contrast MRI

Medicina, vol. 60, pp. 1618

Abstract

(1) Background and Objectives: Flow assessment using cardiovascular magnetic resonance (CMR) provides important implications in determining physiologic parameters and clinically important markers. However, post-processing of CMR images remains labor- and time-intensive. This study aims to assess the validity and repeatability of fully automated segmentation of phase contrast velocity-encoded aortic root plane. (2) Materials and Methods: Aortic root images from 125 patients are segmented by artificial intelligence (AI), developed using convolutional neural networks and trained with a multicentre cohort of 160 subjects. Derived simple flow indices (forward and backward flow, systolic flow and velocity) and complex indices (aortic maximum area, systolic flow reversal ratio, flow displacement, and its angle change) were compared with those derived from manual contours. (3) Results: AI-derived simple flow indices yielded excellent repeatability compared to human segmentation (p < 0.001), with an insignificant level of bias. Complex flow indices feature good to excellent repeatability (p < 0.001), with insignificant levels of bias except flow displacement angle change and systolic retrograde flow yielding significant levels of bias (p < 0.001 and p < 0.05, respectively). (4) Conclusions: Automated flow quantification using aortic root images is comparable to human segmentation and has good to excellent repeatability. However, flow helicity and systolic retrograde flow are associated with a significant level of bias. Overall, all parameters show clinical repeatability.

Authors 21

1. Rui Li

   University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

   Affiliation as printed

   Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK

   Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK

2. Hosamadin S. Assadi

   University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

   Affiliation as printed

   Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK

   Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK

3. Xiaodan Zhao

   National Heart Centre Singapore

   Affiliation as printed

   National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore

4. Zia Mehmood

   Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

   Affiliation as printed

   Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK

5. Ciaran Grafton‐Clarke

   Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

   Affiliation as printed

   Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK

6. Vaishali Limbachia

   Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

   Affiliation as printed

   Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK

7. Rimma Hall

   Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

   Affiliation as printed

   Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK

8. Bahman Kasmai

   University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

   Affiliation as printed

   Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK

   Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK

9. Marina L. Hughes

   University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

   Affiliation as printed

   Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK

   Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK

10. Kurian Thampi

    Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK

11. Marianna Stamatelatou

    Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK

12. Peter Swoboda

    University of Leeds

    Affiliation as printed

    Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK

13. Andrew J. Swift

    Sheffield Teaching Hospitals NHS Foundation Trust · University of Sheffield

    Affiliation as printed

    Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK

    Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK

14. Samer Alabed

    Sheffield Teaching Hospitals NHS Foundation Trust · University of Sheffield

    Affiliation as printed

    Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK

    Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK

15. Sunil Nair

    Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK

16. Hilmar Spohr

    Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK

17. Yashoda Gurung-Koney

    Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK

18. Rob J. van der Geest Aachen Department of Radiology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands

19. Vassilios S. Vassiliou

    University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK

    Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK

20. Liang Zhong

    National University of Singapore · Duke-NUS Medical School · National Heart Centre Singapore

    Affiliation as printed

    Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore

    National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore

21. Pankaj Garg corresponding

    University of East Anglia · University of Leeds · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust · Sheffield Teaching Hospitals NHS Foundation Trust

    Affiliation as printed

    Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK

    Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK

    Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK