title: CT evaluation prior to transapical aortic valve replacement: semi-automatic versus manual image segmentation.
abstract: To compare the performance of semi-automatic versus manual segmentation for ECG-triggered cardiovascular computed tomography (CT) examinations prior to transcatheter aortic valve replacement (TAVR), with focus on the speed and precision of experienced versus inexperienced observers. The preoperative ECG-triggered CT data of 30 consecutive patients who were scheduled for TAVR were included. All datasets were separately evaluated by two radiologists with 1 and 5 years of experience (novice and expert, respectively) in cardiovascular CT using an evaluation software program with or without a semi-automatic TAVR workflow. The time expended for data loading and all segmentation steps required for the implantation planning were assessed. Inter-software as well as inter-observer reliability analysis was performed. The CT datasets were successfully evaluated, with mean duration between 520.4 ± 117.6 s and 693.2 ± 159.5 s. The three most time-consuming steps were the 3D volume rendering, the measurement of aorta diameter and the sizing of the aortic annulus. Using semi-automatic segmentation, a novice could evaluate CT data approximately 12.3% faster than with manual segmentation, and an expert could evaluate CT data approximately 10.3% faster [mean differences of 85.4 ± 83.8 s (p < 0.001) and 59.8 ± 101 s (p < 0.001), respectively]. The inter-software reliability for a novice was slightly lower than for an expert; however, the reliability for a novice and expert was excellent (ICC 0.92, 95% CI 0.75-0.97/ICC 0.96, 95% CI 0.91-0.98). Automatic aortic annulus detection failed in two patients (6.7%). The study revealed excellent inter-software and inter-observer reliability, with a mean ICC of 0.95. TAVR evaluation can be accomplished significantly faster with semi-automatic rather than with manual segmentation, with comparable exactness, showing a benefit for experienced and inexperienced observers.
authors.affiliation: Department of Interventional and Diagnostic Radiology, University of Leipzig - Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany, b.foldyna@gmail.com.
authors.forename: Borek
authors.initials: B
authors.lastname: Foldyna
authors.forename: Camelia
authors.initials: C
authors.lastname: Jungert
authors.forename: Christian
authors.initials: C
authors.lastname: Luecke
authors.forename: Konstantin
authors.initials: K
authors.lastname: von Aspern
authors.forename: Sonja
authors.initials: S
authors.lastname: Boehmer-Lasthaus
authors.forename: Eva Maria
authors.initials: EM
authors.lastname: Rueth
authors.forename: Matthias
authors.initials: M
authors.lastname: Grothoff
authors.forename: Stefan
authors.initials: S
authors.lastname: Nitzsche
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
authors.forename: Friedrich Wilhelm
authors.initials: FW
authors.lastname: Mohr
authors.forename: Lukas
authors.initials: L
authors.lastname: Lehmkuhl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D001331:Automation; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D002983:Clinical Competence; D004562:Electrocardiography; D005260:Female; D005858:Germany; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D015588:Observer Variation; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012984:Software; D013997:Time Factors; D057188:Workflow