title: Automated quantification of mitral valve anatomy using anatomical intelligence in three-dimensional echocardiography.
abstract: BACKGROUND
  Quantitative analysis of mitral valve morphology with three-dimensional (3D) transesophageal echocardiography (TEE) provides anatomic information that can assist clinical decision-making. However, routine use of mitral valve quantification has been hindered by tedious workflow and high operator-dependence. The purpose of this paper was to evaluate the feasibility, accuracy and efficiency of a novel computer-learning algorithm using anatomical intelligence in ultrasound (AIUS) to automatically detect and quantitatively assess the mitral valve anatomy.
  
  
  METHODS
  A novice operator used AIUS to quantitatively assess mitral valve anatomy on the 3D TEE images of 55 patients (33 with mitral valve prolapse, 11 with functional mitral regurgitation, and 11 normal valves). The results were compared to that of manual mitral valve quantification by an experienced 3D echocardiographer and, in the 24 patients who underwent mitral valve repair, the surgical findings. Time consumption and reproducibility of AIUS were compared to the manual method.
  
  
  RESULTS
  AIUS mitral valve quantification was feasible in 52 patients (95%). There were excellent agreements between AIUS and expert manual quantification for all mitral valve anatomic parameters (r=0.85-0.99, p<0.05). AIUS accurately classified surgically defined location of prolapse in 139 of 144 segments analyzed (97%). AIUS improved the intra- [intraclass-correlation coefficient (ICC)=0.91-0.99] and inter-observer (ICC=0.86-0.98) variability of novice users, surpassing the manual approach (intra-observer ICC=0.32-0.95; inter-observer ICC=0.45-0.93), yet requiring significantly less time (144±24s vs. 770±89s, p<0.0001).
  
  
  CONCLUSIONS
  Anatomic intelligence in 3D TEE image can provide accurate, reproducible, and rapid quantification of the mitral valve anatomy.
authors.affiliation: Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong; Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Chun-Na
authors.initials: CN
authors.lastname: Jin
authors.affiliation: Philips Healthcare, Andover, MA, USA.
authors.forename: Ivan S
authors.initials: IS
authors.lastname: Salgo
authors.affiliation: Philips Healthcare, Andover, MA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Schneider
authors.affiliation: Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong; Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Wei
authors.initials: W
authors.lastname: Feng
authors.affiliation: Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong; Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Fan-Xia
authors.initials: FX
authors.lastname: Meng
authors.affiliation: Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong; Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Kevin Ka-Ho
authors.initials: KK
authors.lastname: Kam
authors.affiliation: Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong; Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Wai-Kin
authors.initials: WK
authors.lastname: Chi
authors.affiliation: Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong; Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Chak-Yu
authors.initials: CY
authors.lastname: So
authors.affiliation: Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong; Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Chris
authors.initials: C
authors.lastname: Chan
authors.affiliation: Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong; Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Jing-Ping
authors.initials: JP
authors.lastname: Sun
authors.affiliation: Department of Computer Science, University of Hong Kong, Hong Kong.
authors.forename: Gary
authors.initials: G
authors.lastname: Tsui
authors.affiliation: Department of Computer Science, University of Hong Kong, Hong Kong.
authors.forename: Kwan-Yee Kenneth
authors.initials: KY
authors.lastname: Wong
authors.affiliation: Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Philips Healthcare, Andover, MA, USA; Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Cheuk-Man
authors.initials: CM
authors.lastname: Yu
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Song
authors.initials: S
authors.lastname: Wan
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Randolph
authors.initials: R
authors.lastname: Wong
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Underwood
authors.affiliation: Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Au
authors.affiliation: Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Siu-Keung
authors.initials: SK
authors.lastname: Ng
authors.affiliation: Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong; Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. Electronic address: alexpwlee@cuhk.edu.hk.
authors.forename: Alex Pui-Wai
authors.initials: AP
authors.lastname: Lee
mesh_terms: D000465:Algorithms; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results
keywords: Computer imaging; Mitral valve; Three-dimensional echocardiography; Transesophageal echocardiography