Abstract

Recent developments in artificial intelligence have generated increasing interest to deploy automated image analysis for diagnostic imaging and large-scale clinical applications. However, inaccuracy from automated methods could lead to incorrect conclusions, diagnoses or even harm to patients. Manual inspection for potential inaccuracies is labor-intensive and time-consuming, hampering progress towards fast and accurate clinical reporting in high volumes. To promote reliable fully-automated image analysis, we propose a quality control-driven (QCD) segmentation framework. It is an ensemble of neural networks that integrate image analysis and quality control. The novelty of this framework is the selection of the most optimal segmentation based on predicted segmentation accuracy, on-the-fly. Additionally, this framework visualizes segmentation agreement to provide traceability of the quality control process. In this work, we demonstrated the utility of the framework in cardiovascular magnetic resonance T1-mapping - a quantitative technique for myocardial tissue characterization. The framework achieved near-perfect agreement with expert image analysts in estimating myocardial T1 value (r=0.987,p<.0005; mean absolute error (MAE)=11.3ms), with accurate segmentation quality prediction (Dice coefficient prediction MAE=0.0339) and classification (accuracy=0.99), and a fast average processing time of 0.39 second/image. In summary, the QCD framework can generate high-throughput automated image analysis with speed and accuracy that is highly desirable for large-scale clinical applications.

Highlights

  • Cardiovascular diseases (CVDs) are among the leading causes of death worldwide, killing more than 15 million people in 2016 alone (WHO, 2017)

  • We demonstrate that the quality control-driven (QCD) framework is generalizable by applying it to left ventricular segmentation of T1-mapping images

  • The neural networks and the Dice similarity coefficient (DSC) predictors were trained on 1906 Cardiovascular magnetic resonance (CMR) T1 maps, and were subsequently evaluated on previously unseen validation data of 220 T1 maps

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Summary

Introduction

Cardiovascular diseases (CVDs) are among the leading causes of death worldwide, killing more than 15 million people in 2016 alone (WHO, 2017). Cardiovascular magnetic resonance (CMR) is one of the major non-invasive imaging modalities for comprehensive investigation of the heart in current clinical practice. Quantitative T1 mapping is an emerging CMR technique for advanced myocardial tissue characterization on a pixel-by-pixel level (Moon et al, 2013; Messroghli et al, 2017), and can detect disease beyond conventional CMR methods, such as late gadolinium enhancement (LGE) imaging. CMR T1 mapping is increasingly used in large-scale clinical studies (Petersen et al, 2013; Kramer et al, 2015) to study various cardiac diseases, including the UK Biobank imaging component (Petersen et al, 2013), which aims to scan 100,000 participants by 2021 (with > 48, 000 datasets acquired already)

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