Background
Methods
Dataset
CMR studies
Post-processing of CMR data
Image segmentation using fully convolutional networks
FCN architecture
FCN training procedure
Deep convolutional generative adversarial networks to synthesize CMR images
DCGAN architecture
DCGAN training procedure
DCGAN post-processing
Network training and testing
Fully convolutional networks using real dataset
Fully convolutional networks using synthetically augmented dataset
U-Net architecture
Commercially available segmentation software
Metrics for performance verification
Generalizability to additional training and test subjects
Statistical methods
Results
Characteristics of the Cohort
n | Min | Max | Mean | Median | |
---|---|---|---|---|---|
LVEDV (mL) | |||||
Aortic Arch Anomaly | 2 | 87.39 | 196.09 | 141.74 | 141.74 |
Cardiomyopathy | 8 | 82.55 | 179.02 | 114.37 | 93.66 |
Coronary Artery Disease | 9 | 21.43 | 123.24 | 79.72 | 89.55 |
DORV | 9 | 10.23 | 126.6 | 44.8 | 40.05 |
Pulmonary Stenosis/Atresia | 4 | 88.74 | 130.22 | 101.83 | 94.18 |
TGA | 9 | 39.18 | 167.03 | 113.35 | 133.77 |
TOF | 20 | 18.32 | 153.68 | 87.55 | 92.19 |
Truncus arteriosus | 3 | 70.23 | 201.44 | 124.13 | 100.73 |
All | 64 | 10.23 | 201.44 | 91.72 | 89.41 |
LVESV (mL) | |||||
Aortic Arch Anomaly | 2 | 22.06 | 68.3 | 45.18 | 45.18 |
Cardiomyopathy | 8 | 15.07 | 80.2 | 41.1 | 32.5 |
Coronary Artery Disease | 9 | 8.28 | 58.6 | 28.99 | 29.76 |
DORV | 9 | 4.18 | 43.33 | 17.4 | 17.7 |
Pulmonary Stenosis/Atresia | 4 | 31.56 | 53.28 | 38.25 | 34.09 |
TGA | 9 | 15.94 | 68.86 | 45.62 | 46.71 |
TOF | 20 | 5.95 | 69.01 | 34.21 | 33.22 |
Truncus arteriosus | 3 | 27.88 | 90.48 | 55.28 | 47.47 |
All | 64 | 4.18 | 90.48 | 35.16 | 31.66 |
RVEDV (mL) | |||||
Aortic Arch Anomaly | 2 | 100.34 | 215.08 | 157.71 | 157.71 |
Cardiomyopathy | 8 | 78.94 | 180.94 | 121.31 | 114.3 |
Coronary Artery Disease | 9 | 20.13 | 171.28 | 92.35 | 106.01 |
DORV | 9 | 25.31 | 236.22 | 80.0 | 69.72 |
Pulmonary Stenosis/Atresia | 4 | 126.2 | 264.54 | 176.92 | 158.48 |
TGA | 9 | 42.58 | 179.98 | 121.33 | 138.93 |
TOF | 20 | 28.63 | 265.7 | 137.12 | 129.67 |
Truncus arteriosus | 3 | 99.15 | 201.42 | 147.0 | 140.43 |
All | 64 | 20.13 | 265.7 | 122.19 | 115.43 |
RVESV (mL) | |||||
Aortic Arch Anomaly | 2 | 38.43 | 101.04 | 69.73 | 69.73 |
Cardiomyopathy | 8 | 13.27 | 86.81 | 45.25 | 36.43 |
Coronary Artery Disease | 9 | 8.49 | 70.26 | 34.04 | 33.57 |
DORV | 9 | 6.37 | 112.31 | 35.91 | 34.51 |
Pulmonary Stenosis/Atresia | 4 | 49.04 | 129.65 | 80.72 | 72.09 |
TGA | 9 | 15.93 | 84.68 | 50.08 | 41.52 |
TOF | 20 | 13.56 | 136.99 | 63.74 | 59.21 |
Truncus arteriosus | 3 | 43.3 | 73.47 | 56.37 | 52.34 |
All | 64 | 6.37 | 136.99 | 52.32 | 46.07 |
n | Min | Max | Mean | Median | |
---|---|---|---|---|---|
Age (years) | |||||
Aortic Arch Anomaly | 2 | 17.9 | 18.3 | 18.1 | 18.1 |
Cardiomyopathy | 8 | 9.4 | 17.1 | 13.6 | 13.9 |
Coronary Artery Disease | 9 | 1.1 | 19.8 | 9.8 | 11.5 |
DORV | 9 | 0.5 | 13 | 6.9 | 7.5 |
Pulmonary Stenosis/Atresia | 4 | 8.6 | 16.5 | 12.9 | 13.2 |
TGA | 9 | 2.7 | 18.9 | 11.2 | 11.7 |
TOF | 20 | 0.4 | 20.2 | 10.9 | 11.9 |
Truncus arteriosus | 3 | 10.3 | 23.3 | 15 | 11.3 |
All | 64 | 0.4 | 23.3 | 11.1 | 12 |
Weight (kg) | |||||
Aortic Arch Anomaly | 2 | 49.0 | 62.6 | 55.8 | 55.8 |
Cardiomyopathy | 8 | 43.8 | 114.5 | 71.3 | 62.6 |
Coronary Artery Disease | 9 | 12 | 79.3 | 36.9 | 43.3 |
DORV | 9 | 7.1 | 63.0 | 23.3 | 23.0 |
Pulmonary Stenosis/Atresia | 4 | 35.5 | 54.5 | 47.1 | 49.1 |
TGA | 9 | 13 | 63 | 41.3 | 49.1 |
TOF | 20 | 3.5 | 124.3 | 42.8 | 38.4 |
Truncus arteriosus | 3 | 25.0 | 70.5 | 41.5 | 29.0 |
All | 64 | 3.5 | 124.3 | 43.2 | 43.6 |
Height (cm) | |||||
Aortic Arch Anomaly | 2 | 142.0 | 179.0 | 160.5 | 160.5 |
Cardiomyopathy | 8 | 137.0 | 181.0 | 160.0 | 160.0 |
Coronary Artery Disease | 9 | 97.0 | 169.4 | 144.5 | 155.0 |
DORV | 9 | 64.5 | 153.0 | 109.4 | 121.0 |
Pulmonary Stenosis/Atresia | 4 | 136.0 | 162.0 | 152.3 | 155.5 |
TGA | 9 | 88.0 | 172.0 | 138.1 | 148.0 |
TOF | 20 | 57.5 | 174.0 | 133.8 | 142.0 |
Truncus arteriosus | 3 | 133.0 | 173.0 | 153.0 | 153.0 |
All | 64 | 57.5 | 181.0 | 138.4 | 145.0 |
Real and synthetically generated CMR images
Segmentation performance
Segmentation performance for nearest-neighbor down-sampling
Dice (%) | Jaccard (%) | HD (mm) | MCD (mm) | \({\text{R}}_{{{\text{vol}}}}^{2} (\%)\) | |
---|---|---|---|---|---|
LVED | |||||
FCN | 86.5 (22.2) | 80.7 (23.5) | 6.9 (12.1) | 2.3 (6.4) | 98.5 |
FCN-SAD | 90.6 (13.8) | 84.9 (16.5) | 5.0 (7.4) | 1.7 (3.8) | 99.3 |
cvi42 | 73.2 (34.3) | 66.5 (33.0) | 7.5 (13.6) | 3.4 (10.8) | 78.6 |
U-Net | 84.5 (24.4) | 78.4 (25.4) | 7.2 (10.2) | 3.3 (8.5) | 93.4 |
U-Net-SAD | 87.1 (21.9) | 81.4 (22.6) | 6.7 (10.8) | 2.3 (7.1) | 97.9 |
LVES | |||||
FCN | 83.2 (20.9) | 75.1 (22.5) | 6.9 (12.0) | 2.7 (7.4) | 93.0 |
FCN-SAD | 85.0 (18.8) | 77.3 (21.2) | 6.3 (9.4) | 2.5 (5.6) | 96.6 |
cvi42 | 71.0 (32.2) | 62.6 (30.5) | 7.9 (15.3) | 4.0 (13.3) | 76.6 |
U-Net | 79.4 (25.2) | 71.2 (26.1) | 7.1 (10.1) | 2.7 (6.8) | 82.2 |
U-Net-SAD | 82.3 (20.9) | 73.8 (22.5) | 7.6 (11.9) | 2.5 (6.7) | 92.3 |
RVED | |||||
FCN | 80.3 (24.0) | 71.9 (24.9) | 14.2 (15.7) | 6.6 (13.6) | 87.0 |
FCN-SAD | 84.4 (20.2) | 76.7 (21.5) | 10.7 (11.5) | 3.8 (6.5) | 95.9 |
cvi42 | 54.3 (40.9) | 47.8 (37.8) | 15.8 (17.8) | 5.6 (9.0) | 31.9 |
U-Net | 77.7 (27.1) | 69.6 (27.9) | 15.1 (19.3) | 5.7 (14.2) | 84.2 |
U-Net-SAD | 81.8 (22.5) | 73.7 (23.7) | 12.3 (14.1) | 4.1 (7.1) | 93.4 |
RVES | |||||
FCN | 74.7 (24.5) | 64.4 (24.9) | 13.6 (19.9) | 6.1 (16.3) | 87.6 |
FCN-SAD | 79.2 (20.1) | 69.1 (21.6) | 11.2 (12.5) | 4.1 (7.6) | 93.3 |
cvi42 | 53.7 (38.0) | 45.5 (34.0) | 12.9 (12.5) | 4.7 (5.8) | 64.3 |
U-Net | 71.3 (28.1) | 61.4 (27.7) | 14.6 (19.0) | 6.1 (16.0) | 88.4 |
U-Net-SAD | 74.8 (24.8) | 64.6 (24.9) | 12.1 (13.0) | 4.2 (6.6) | 88.7 |
Sensitivity (%) | Specificity (%) | PPV (%) | NPV (%) | |
---|---|---|---|---|
LVED | ||||
FCN | 85.7 (22.7) | 99.9 (0.4) | 89.5 (21.9) | 99.8 (0.3) |
FCN-SAD | 91.7 (13.4) | 99.9 (0.2) | 90.9 (15.5) | 99.9 (0.2) |
cvi42 | 79.5 (35.7) | 99.6 (0.7) | 69.8 (34.2) | 99.7 (0.6) |
U-Net | 83.0 (25.9) | 99.9 (0.1) | 89.7 (21.9) | 99.8 (0.3) |
U-Net-SAD | 86.8 (22.2) | 99.9 (0.2) | 89.2 (22.0) | 99.8 (0.2) |
LVES | ||||
FCN | 82.9 (22.7) | 99.9 (0.2) | 86.4 (22.4) | 99.8 (0.2) |
FCN-SAD | 88.5 (19.0) | 99.9 (0.3) | 84.7 (20.8) | 99.9 (0.1) |
cvi42 | 79.6 (33.8) | 99.7 (0.6) | 67.0 (32.5) | 99.8 (0.3) |
U-Net | 79.0 (27.5) | 99.9 (0.2) | 84.1 (26.0) | 99.8 (0.2) |
U-Net-SAD | 82.1 (23.4) | 99.9 (0.2) | 87.1 (20.6) | 99.8 (0.2) |
RVED | ||||
FCN | 79.6 (25.4) | 99.7 (0.3) | 84.4 (22.6) | 99.6 (0.6) |
FCN-SAD | 84.9 (21.5) | 99.7 (0.4) | 86.2 (20.3) | 99.7 (0.4) |
cvi42 | 53.1 (41.3) | 99.7 (0.5) | 60.2 (42.4) | 99.0 (1.1) |
U-Net | 77.0 (29.4) | 99.7 (0.4) | 84.1 (23.5) | 99.6 (0.6) |
U-Net-SAD | 81.0 (24.6) | 99.8 (0.3) | 86.3 (20.6) | 99.6 (0.5) |
RVES | ||||
FCN | 75.0 (26.6) | 99.7 (0.4) | 79.5 (25.1) | 99.7 (0.3) |
FCN-SAD | 83.5 (20.0) | 99.6 (0.6) | 79.0 (23.0) | 99.8 (0.2) |
cvi42 | 54.3 (39.5) | 99.7 (0.5) | 57.3 (39.0) | 99.4 (0.7) |
U-Net | 70.8 (30.3) | 99.8 (0.4) | 77.7 (27.8) | 99.7 (0.4) |
U-Net-SAD | 74.2 (27.1) | 99.8 (0.3) | 80.3 (24.3) | 99.7 (0.3) |
FCN | FCN-SAD | cvi42 | U-Net | U-Net-SAD | |
---|---|---|---|---|---|
Absolute difference | |||||
LVEDV (mL) | 4.6 (4.0) | 2.9 (3.1) | 12.8 (18.8) | 8.3 (9.3) | 5.3 (4.7) |
LVESV (mL) | 3.6 (3.9) | 2.7 (2.5) | 6.3 (7.3) | 5.3 (6.5) | 3.9 (3.9) |
RVEDV (mL) | 12.0 (18.7) | 7.7 (9.8) | 30.3 (40.6) | 12.6 (20.7) | 9.4 (12.6) |
RVESV (mL) | 6.7 (8.3) | 5.4 (5.6) | 9.8 (15.1) | 6.7 (7.7) | 5.7 (8.3) |
LVSV (mL) | 3.7 (3.6) | 2.2 (1.8) | 10.5 (17.7) | 4.1 (4.7) | 3.0 (2.8) |
RVSV (mL) | 9.6 (13.1) | 6.0 (6.8) | 22.4 (28.3) | 10.6 (15.8) | 6.9 (7.6) |
LVEF (%) | 4.1 (4.9) | 2.8 (1.9) | 107.8 (613.3) | 4.8 (6.5) | 5.4 (14.1) |
RVEF (%) | 4.1 (3.0) | 3.7 (3.0) | 48.5 (193.0) | 4.5 (4.8) | 3.5 (3.3) |
Relative difference | |||||
LVEDV (%) | 7.1 (11.4) | 4.0 (5.7) | 21.1 (32.5) | 10.7 (16.4) | 8.1 (15.6) |
LVESV (%) | 12.8 (14.1) | 9.5 (7.6) | 28.9 (56.9) | 17.1 (19.5) | 13.5 (16.9) |
RVEDV (%) | 10.4 (14.1) | 7.4 (8.7) | 27.0 (28.5) | 12.1 (18.2) | 8.8 (10.7) |
RVESV (%) | 13.9 (15.6) | 12.5 (12.4) | 24.9 (28.4) | 14.7 (16.3) | 11.2 (11.6) |
LVSV (%) | 8.8 (13.4) | 5.1 (6.8) | 26.7 (35.2) | 9.9 (16.6) | 8.3 (16.1) |
RVSV (%) | 13.5 (14.3) | 9.4 (9.0) | 32.6 (32.5) | 15.8 (20.0) | 11.1 (12.1) |
LVEF (%) | 6.9 (8.1) | 4.6 (2.9) | 182.2 (1036.0) | 7.8 (10.8) | 9.2 (23.8) |
RVEF (%) | 7.1 (5.3) | 6.4 (5.2) | 89.3 (366.3) | 7.4 (7.5) | 5.7 (5.0) |
FCN | FCN-SAD | cvi42 | U-Net | U-Net-SAD | |
---|---|---|---|---|---|
P-value | |||||
LVEDV | 7.428e−6 | 4.438e−3 | 0.289 | 1.278e−4 | 9.886e−4 |
LVESV | 1.440e−4 | 0.397 | 0.015 | 1.284e−3 | 8.218e−4 |
RVEDV | 0.01 | 0.123 | 5.181e−5 | 3.026e−2 | 4.666e−3 |
RVESV | 0.054 | 0.548 | 3.912e−3 | 5.535e−4 | 4.136e−3 |
ICC | |||||
LVEDV | 0.992 | 0.996 | 0.893 | 0.964 | 0.989 |
LVESV | 0.962 | 0.982 | 0.893 | 0.896 | 0.957 |
RVEDV | 0.931 | 0.979 | 0.643 | 0.921 | 0.964 |
RVESV | 0.936 | 0.967 | 0.819 | 0.937 | 0.936 |
Segmentation performance for bi-cubical down-sampling
Dice (%) | Jaccard (%) | Rel. volume difference (%) | \({\text{R}}_{{{\text{vol}}}}^{2} (\%)\) | t-test p-value | |
---|---|---|---|---|---|
LVED | |||||
FCN | 88.5 (18.4) | 82.6 (20.3) | 6.0 (10.3) | 98.5 | 0.0147 |
FCN-SAD | 91.0 (14.9) | 85.8 (17.0) | 4.6 (6.1) | 99.2 | 0.2739 |
U-Net | 85.5 (23.0) | 79.5 (24.0) | 10.7 (17.7) | 89.8 | 4.755e−3 |
U-Net-SAD | 87.4 (21.1) | 81.7 (22.3) | 8.3 (15.9) | 97.7 | 0.443e−3 |
LVES | |||||
FCN | 83.1 (22.6) | 75.6 (23.8) | 10.1 (9.3) | 95.7 | 0.0786 |
FCN-SAD | 86.8 (16.5) | 79.4 (18.9) | 7.9 (5.1) | 97.8 | 0.0945 |
U-Net | 81.6 (22.6) | 73.4 (23.8) | 23.4 (39.9) | 79.1 | 9.913e−4 |
U-Net-SAD | 83.9 (20.7) | 76.1 (22.0) | 15.6 (27.0) | 93.3 | 3.786e−4 |
RVED | |||||
FCN | 80.9 (22.9) | 72.6 (24.3) | 9.3 (14.2) | 87.7 | 0.0159 |
FCN-SAD | 84.7 (18.8) | 76.8 (20.8) | 6.8 (8.6) | 94.9 | 0.0858 |
U-Net | 76.5 (29.5) | 69.0 (29.6) | 12.4 (17.9) | 81.8 | 0.0134 |
U-Net-SAD | 81.8 (22.8) | 73.8 (24.4) | 9.7 (12.4) | 91.8 | 0.0251 |
RVES | |||||
FCN | 77.2 (22.8) | 67.2 (23.6) | 13.6 (15.6) | 90.6 | 0.0226 |
FCN-SAD | 80.6 (19.7) | 70.9 (21.2) | 11.0 (13.8) | 92.9 | 0.6585 |
U-Net | 70.2 (30.4) | 60.9 (29.4) | 18.5 (19.9) | 82.6 | 0.151e−3 |
U-Net-SAD | 74.8 (25.5) | 64.9 (25.6) | 13.8 (15.4) | 88.1 | 1.783e−3 |
Segmentation performance for cvi42
Segmentation performance for U-Net with nearest-neighbor down-sampling
Segmentation performance for U-Net with bi-cubical down-sampling
Segmentation performance for FCN-2.0 and FCN-SAD-2.0
Dice (%) | Jaccard (%) | HD (mm) | MCD (mm) | |
---|---|---|---|---|
LVED | ||||
FCN-2.0 | 86.7 (22.7) | 81.1 (23.7) | 7.1 (13.0) | 3.1 (10.4) |
FCN-SAD-2.0 | 91.3 (15.1) | 86.2 (16.6) | 5.2 (9.1) | 2.0 (7.8) |
LVES | ||||
FCN-2.0 | 82.8 (23.1) | 75.3 (24.2) | 8.3 (17.8) | 3.6 (12.4) |
FCN-SAD-2.0 | 86.7 (17.6) | 79.6 (19.6) | 6.0 (10.9) | 2.7 (10.0) |
RVED | ||||
FCN-2.0 | 80.8 (22.7) | 72.3 (24.0) | 14.3 (18.9) | 5.8 (14.7) |
FCN-SAD-2.0 | 84.5 (18.8) | 76.5 (20.6) | 12.1 (16.0) | 4.2 (9.1) |
RVES | ||||
FCN-2.0 | 72.4 (26.8) | 62.2 (26.5) | 15.8 (21.3) | 7.4 (17.9) |
FCN-SAD-2.0 | 77.0 (22.8) | 66.9 (23.7) | 13.4 (16.4) | 4.6 (8.6) |