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Author(s): Pedro Morais
Sandro Queirós
Pieter De Meester
Werner Budts
João L. Vilaça
João Manuel R. S. Tavares
Jan D'hooge
Title: Fast segmentation of the Left Atrial Appendage in 3-D Transesophageal Echocardiographic images
Issue Date: 2018-12
Abstract: Left atrial appendage (LAA) has been generally described as "our most lethal attachment," being considered the major source of thromboembolism in patients with nonvalvular atrial fibrillation. Currently, LAA occlusion can be offered as a treatment for these patients, obstructing the LAA through a percutaneously delivered device. Nevertheless, correct device sizing is not straightforward, requiring manual analysis of peri-procedural images. This approach is suboptimal, time demanding, and highly variable between experts, which can result in lengthy procedures and excess manipulations. In this paper, a semiautomatic LAA segmentation technique for 3-D transesophageal echocardiography (TEE) images is presented. Specifically, the proposed technique relies on a novel segmentation pipeline where a curvilinear blind-ended model is optimized through a double stage strategy: 1) fast contour evolution using global terms and 2) contour refinement based on regional energies. To reduce its computational cost, and thus make it more attractive to real interventions, the B-spline explicit active surface framework was used. This novel method was evaluated in a clinical database of 20 patients. Manual analysis performed by two observers was used as ground truth. The 3-D segmentation results corroborated the accuracy, robustness to the variation of the parameters, and computationally attractiveness of the proposed method, taking approximately 14 s to segment the LAA with an average accuracy of similar to 0.9 mm. Moreover, a performance comparable to the interobserver variability was found. Finally, the advantages of the segmented model were evaluated, while semiautomatically extracting the clinical measurements for device selection, showing a similar accuracy but with a higher reproducibility when compared to the current practice. Overall, the proposed segmentation method shows potential for an improved planning of LAA occlusion, demonstrating its added value for normal clinical practice.
Subject: Ciências Tecnológicas, Ciências médicas e da saúde
Technological sciences, Medical and Health sciences
Scientific areas: Ciências médicas e da saúde
Medical and Health sciences
Document Type: Artigo em Revista Científica Internacional
Rights: openAccess
Appears in Collections:FEUP - Artigo em Revista Científica Internacional

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