title: Improved Segmentation of Multiple Cavities of the Heart in Wide-View 3-D Transesophageal Echocardiograms.
abstract: Minimally invasive interventions in the heart such as in electrophysiology are becoming more and more important in clinical practice. Currently, preoperative computed tomography angiography (CTA) is used to provide anatomic information during electrophysiology interventions, but this does not provide real-time feedback and burdens the patient with additional radiation and side effects of the contrast agent. Three-dimensional transesophageal echocardiography (TEE) is an excellent modality for visualization of anatomic structures and instruments in real time, but some cavities, especially the left atrium, suffer from the limited coverage of the 3-D TEE volumes. This leads to difficulty in segmenting the left atrium. We propose replacing or complementing pre-operative CTA imaging with wide-view TEE. We tested this proposal on 20 patients for which TEE image volumes covering the left atrium and CTA images were acquired. The TEE images were manually registered, and wide-view volumes were generated. Five heart cavities in single-view and wide-view TEE were segmented and compared with atlas based-segmentations derived from the CTA images. We found that the segmentation accuracy (Dice coefficients) improved relative to segmentation of single-view images by 5, 15 and 9 percentage points for the left atrium, right atrium and aorta, respectively. Average anatomic coverage was improved by 2, 29, 62 and 49 percentage points for the right ventricle, left atrium, right atrium and aorta, respectively. This finding confirms that wide-view 3-D TEE can be useful in supporting electrophysiology interventions.
authors: Department of Biomedical Engineering of the Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors: Alexander
authors: A
authors: Haak
authors: Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors: Ben
authors: B
authors: Ren
authors: Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Harriët W
authors: HW
authors: Mulder
authors: Applied Chest Imaging Laboratory (ACIL), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors: Gonzalo
authors: G
authors: Vegas-Sánchez-Ferrero
authors: Department of Biomedical Engineering of the Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors: Gerard
authors: G
authors: van Burken
authors: Department of Biomedical Engineering of the Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors: Antonius F W
authors: AF
authors: van der Steen
authors: Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Marijn
authors: M
authors: van Stralen
authors: Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Josien P W
authors: JP
authors: Pluim
authors: Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology, Erasmus MC, Rotterdam, The Netherlands.
authors: Theo
authors: T
authors: van Walsum
authors: Department of Biomedical Engineering of the Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. Electronic address: j.bosch@erasmusmc.nl.
authors: Johannes G
authors: JG
authors: Bosch
mesh_terms: D000369:Aged, 80 and over; D000465:Algorithms; D003199:Computer Systems; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D010363:Pattern Recognition, Automated / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Active shape model; Electrophysiology; Expectation maximization; Gamma mixture model; Segmentation; Transesophageal echocardiography; Ultrasound