Segmentation of the mitral annulus is an important step in many cardiac applications. Current methods to delineate the mitral annulus often require extensive user interaction. Several methods have been proposed to automate mitral annulus segmentation, but often use methods which require sampling 2D planes from the 3D volume, discarding some of the contextual information contained in the original 3D volume. We propose a new 4D mitral annulus segmentation method based on 3D CNN regression of Fourier coefficients describing the shape of predicted annulus. Our model predicts a set of ten coefficients for each of the three image axes, which can then be used to sample annulus coordinates through the inverse Fourier transform. We acquired a dataset of 90 cases from diagnostic imaging of mitral valve patients, with corresponding annulus segmentations. This was split into training, validation and test sets of 75, 5, and 10 cases respectively. Following training, our model achieves a curve-to-curve accuracy of 5.5 ± 2.2 mm on the test set, with training accuracy of 0.46 ± 0.21 mm. Our model achieves accuracy similar to current state-of-the-art methods, and can achieve inference speed of 40 frames-per-second, which is suitable for use in real-time image guidance applications.
KEYWORDS: Modeling and simulation, Cardiac imaging, Heart, 3D modeling, Silicon, Data modeling, Surgery, Pathology, Modeling, 3D image processing, Hemodynamics
Mitral valve disease affects 2% of the Canadian population and 10% of those over the age of 75. Mitral valve regurgitation is a common valve disease often requiring surgical intervention for repair or replacement. Repair is often preferred over replacement, as it is associated with improved outcomes. Current mitral valve repair training is typically limited primarily to intraoperative experience. Additionally, the outcome of complex repair procedures is often unknown preoperatively, and is particularly true of new, off-pump repair techniques. Further challenges include identifying the most effective repair technique based on patient pathology, as multiple approaches exist. We present a hemodynamically accurate mitral valve phantom for testing previously validated patient specific pathological mitral valves. The device can be used for surgical resident training as well as complex procedure planning. The simulator is validated using pressure measurements across the mitral valve demonstrating realistic hemodynamics across a range of heart rates , and by evaluating valve function using 2D and 3D transesophageal echocardiography (TEE).
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