Automatic Segmentation Of Left Ventricle Research Articles

Fine grained automatic left ventricle segmentation via ROI based Tri-Convolutional neural networks.

The left ventricle segmentation (LVS) is crucial to the assessment of cardiac function. Globally, cardiovascular disease accounts for the majority of deaths, posing a significant health threat. In recent years, LVS has gained important attention due to its ability to measure vital parameters such as myocardial mass, end-diastolic volume, and ejection fraction. Medical professionals realize that manually segmenting data to evaluate these processes takes a lot of time, effort when diagnosing heart diseases. Yet, manually segmenting these images is labour-intensive and may reduce diagnostic accuracy. This paper, propose a combination of different deep neural networks for semantic segmentation of the left ventricle based on Tri-Convolutional Networks (Tri-ConvNets) to obtain highly accurate segmentation. CMRI images are initially pre-processed to remove noise artefacts and enhance image quality, then ROI-based extraction is done in three stages to accurately identify the LV. The extracted features are given as input to three different deep learning structures for segmenting the LV in an efficient way. The contour edges are processed in the standard ConvNet, the contour points are processed using Fully ConvNet and finally the noise free images are converted into patches to perform pixel-wise operations in ConvNets. The proposed Tri-ConvNets model achieves the Jaccard indices of 0.9491 ± 0.0188 for the sunny brook dataset and 0.9497 ± 0.0237 for the York dataset, and the dice index of 0.9419 ± 0.0178 for the ACDC dataset and 0.9414 ± 0.0247 for LVSC dataset respectively. The experimental results also reveal that the proposed Tri-ConvNets model is faster and requires minimal resources compared to state-of-the-art models.

BEAS-Net: a Shape-Prior-Based Deep Convolutional Neural Network for Robust Left Ventricular Segmentation in 2D Echocardiography.

Left ventricle (LV) segmentation of 2D echocardiography images is an essential step in the analysis of cardiac morphology and function and - more generally - diagnosis of cardiovascular diseases. Several deep learning (DL) algorithms have recently been proposed for the automatic segmentation of the LV, showing significant performance improvement over the traditional segmentation algorithms. However, unlike the traditional methods, prior information about the segmentation problem, e.g. anatomical shape information, is not usually incorporated for training the DL algorithms. This can degrade the generalization performance of the DL models on unseen images if their characteristics are somewhat different from those of the training images, e.g. low-quality testing images. In this study, a new shape-constrained deep convolutional neural network (CNN) - called BEAS-Net - is introduced for automatic LV segmentation. The BEAS-Net learns how to associate the image features, encoded by its convolutional layers, with anatomical shape-prior information derived by the B-spline explicit active surface (BEAS) algorithm to generate physiologically meaningful segmentation contours when dealing with artifactual or low-quality images. The performance of the proposed network was evaluated using three different in-vivo datasets and was compared a deep segmentation algorithm based on the U-Net model. Both networks yielded comparable results when tested on images of acceptable quality, but the BEAS-Net outperformed the benchmark DL model on artifactual and low-quality images.

Automatic left ventricle segmentation via edge‐shape feature‐based fully convolutional neural network

AbstractLeft ventricle (LV) segmentation is essential to identify the cardiac functions for treating cardiovascular disorders. Cardiovascular magnetic resonance (CMRI) imaging is a non‐invasive technique for diagnosing cardiovascular diseases. CMRI is widely used to assess the functional integrity of the left and right ventricles for detecting changes in myocardial structure. Clinical parameters of the LV are often retrieved from CMRI scans, such as LV volumes, and ejection fraction. Moreover, manually segmenting cardiac diseases and evaluating such functions is time‐consuming and difficult for medical professionals. Deep learning networks require a lot of time, cost, and knowledge. To overcome this issue, a novel Edge and Shape feature‐based Fully Convolutional Neural Network (ES‐FCN) has been proposed for automatic LV segmentation. The ES‐FCN model segments MRI images based on edge maps instead of using gray‐scale images, which accelerates the performance of the FCN. The fuzzy‐based canny edge detection algorithm leverages fuzzy logic to detect structural changes in the LV and generate binary images. Additionally, binary‐valued kernels are used for convolution operations, where the binary values are influenced by biases derived from edge map shape descriptors. In ES‐FCN, bias values are learned from ground truth segmentation. The proposed ES‐FCN model achieves the Jaccard indices of 0.9484 ± 0.0188 for the ACDC dataset and 0.9476 ± 0.0237 for the LVSC dataset, and the dice index of 0.9319 ± 0.0188 for the ACDC dataset and 0.9314 ± 0.0237 for LVSC dataset respectively. The experimental results also reveal that the proposed ES‐FCN model is faster and requires minimal resources compared to state‐of‐the‐art models.

Fully Automatic initialization and segmentation of left and right ventricles for large-scale cardiac MRI using a deeply supervised network and 3D-ASM

Background and objectiveThe sheer volume of data generated by population imaging studies is unparalleled by current capabilities to extract objective and quantitative cardiac phenotypes; subjective and time-consuming manual image analysis remains the gold standard. Automated image analytics to compute quantitative imaging biomarkers of cardiac function are desperately needed. Data volumes and their variability pose a challenge to most state-of-the-art methods for endo- and epicardial contours, which lack robustness when applied to very large datasets. Our aim is to develop an analysis pipeline for the automatic quantification of cardiac function from cine magnetic resonance imaging data. MethodThis work adopt 4,638 cardiac MRI cases coming from UK Biobank with ground truth available for left and RV contours. A hybrid and robust algorithm is proposed to improve the accuracy of automatic left and right ventricle segmentation by harnessing the localization accuracy of deep learning and the morphological accuracy of 3D-ASM (three-dimensional active shape models). The contributions of this paper are three-fold. First, a fully automatic method is proposed for left and right ventricle initialization and cardiac MRI segmentation by taking full advantage of spatiotemporal constraint. Second, a deeply supervised network is introduced to train and segment the heart. Third, the 3D-ASM image search procedure is improved by combining image intensity models with convolutional neural network (CNN) derived distance maps improving endo- and epicardial edge localization. ResultsThe proposed architecture outperformed the state of the art for cardiac MRI segmentation from UK Biobank. The statistics of RV landmarks detection errors for Triscuspid valve and RV apex are 4.17 mm and 5.58 mm separately. The overlap metric, mean contour distance, Hausdorff distance and cardiac functional parameters are calculated for the LV (Left Ventricle) and RV (Right Ventricle) contour segmentation. Bland–Altman analysis for clinical parameters shows that the results from our automated image analysis pipelines are in good agreement with results from expert manual analysis. ConclusionsOur hybrid scheme combines deep learning and statistical shape modeling for automatic segmentation of the LV/RV from cardiac MRI datasets is effective and robust and can compute cardiac functional indexes from population imaging.

Artificial Intelligence framework with traditional computer vision and deep learning approaches for optimal automatic segmentation of left ventricle with scar

Automatic segmentation of the cardiac left ventricle with scars remains a challenging and clinically significant task, as it is essential for patient diagnosis and treatment pathways. This study aimed to develop a novel framework and cost function to achieve optimal automatic segmentation of the left ventricle with scars using LGE-MRI images. To ensure the generalization of the framework, an unbiased validation protocol was established using out-of-distribution (OOD) internal and external validation cohorts, and intra-observation and inter-observer variability ground truths. The framework employs a combination of traditional computer vision techniques and deep learning, to achieve optimal segmentation results. The traditional approach uses multi-atlas techniques, active contours, and k-means methods, while the deep learning approach utilizes various deep learning techniques and networks. The study found that the traditional computer vision technique delivered more accurate results than deep learning, except in cases where there was breath misalignment error. The optimal solution of the framework achieved robust and generalized results with Dice scores of 82.8 ± 6.4% and 72.1 ± 4.6% in the internal and external OOD cohorts, respectively. The developed framework offers a high-performance solution for automatic segmentation of the left ventricle with scars using LGE-MRI. Unlike existing state-of-the-art approaches, it achieves unbiased results across different hospitals and vendors without the need for training or tuning in hospital cohorts. This framework offers a valuable tool for experts to accomplish the task of fully automatic segmentation of the left ventricle with scars based on a single-modality cardiac scan.

Automatic Left Ventricle Segmentation from Short-Axis MRI Images Using U-Net with Study of the Papillary Muscles’ Removal Effect

Automatic Left Ventricle Segmentation from Short-Axis MRI Images Using U-Net with Study of the Papillary Muscles’ Removal Effect

Slide deep reinforcement learning networks: Application for left ventricle segmentation

Automatic segmentation of the left ventricle (LV) in four-chamber view images is critical for computer-aided cardiac disease diagnosis. The complex structure of the cardiac image and the encoder-decoder networks may cause coarse segmentation results. High-accuracy LV segmentation is still a challenge with existing automatic LV segmentation methods. In this paper, we propose a slide deep reinforcement learning segmentation network for pixelwise LV segmentation. The main architecture of the slide reinforcement learning networks consists of a slider item combined state, a group of morphology transforming actions and an agent network. The specifically designed reinforcement learning state comprises an image item and a slider item, which contains both original image information and network act information. The reinforcement learning actions proposed in this paper enable accurate and fast formulation of the binary segment result for each frame by controlling the length and location of the slider. Additionally, the confidence branch proposed in our experiment provides a continuous frame series environment, and the identification algorithm avoids losing the segmentation target. The segmentation result reveals that the proposed method outperforms FCN, SegNet, U-Net and TransUnet. The IoU improved by 23.01%, 15.4%, 11.24% and 6.9%. Additionally, we demonstrate how the proposed method can be used as a semisupervised method, which is more convenient for the image annotation process.

Convolutional Neural Network Model to Segment Myocardial Infarction from MRI Images

Cardiovascular diseases (CVDs) are considered one of the leading causes of death worldwide. Myocardial infarction (MI) is one of the deadliest cardiac diseases that require more consideration. Recently, cardiac magnetic resonance imaging (MRI) has been applied as a standard technique for assessing such diseases. The segmentation of the left ventricle (LV) and myocardium from MRI images is vital in detecting MI disease at its early stages. The automatic segmentation of LV is still challenging due to the complex structures of MRI images, inhomogeneous LV shape and moving organs around the LV, such as the lungs and diaphragm. Thus, this study proposed a convolutional neural network (CNN) model for LV and myocardium segmentation to detect MI. The layers selection and hyper-parameters fine-tuning were applied before the training phase. The model showed robust performance based on the evaluation metrics such as accuracy, sensitivity, specificity, dice score coefficient (DSC), Jaccard index and intersection over union (IOU) with values of 0.86, 0.91, 0.84, 0.81, 0.69 and 0.83, respectively.

Fully Automatic Left Ventricle Segmentation Using Bilateral Lightweight Deep Neural Network.

The segmentation of the left ventricle (LV) is one of the fundamental procedures that must be performed to obtain quantitative measures of the heart, such as its volume, area, and ejection fraction. In clinical practice, the delineation of LV is still often conducted semi-automatically, leaving it open to operator subjectivity. The automatic LV segmentation from echocardiography images is a challenging task due to poorly defined boundaries and operator dependency. Recent research has demonstrated that deep learning has the capability to employ the segmentation process automatically. However, the well-known state-of-the-art segmentation models still lack in terms of accuracy and speed. This study aims to develop a single-stage lightweight segmentation model that precisely and rapidly segments the LV from 2D echocardiography images. In this research, a backbone network is used to acquire both low-level and high-level features. Two parallel blocks, known as the spatial feature unit and the channel feature unit, are employed for the enhancement and improvement of these features. The refined features are merged by an integrated unit to segment the LV. The performance of the model and the time taken to segment the LV are compared to other established segmentation models, DeepLab, FCN, and Mask RCNN. The model achieved the highest values of the dice similarity index (0.9446), intersection over union (0.8445), and accuracy (0.9742). The evaluation metrics and processing time demonstrate that the proposed model not only provides superior quantitative results but also trains and segments the LV in less time, indicating its improved performance over competing segmentation models.

Low-cost 3D-printed anthropomorphic cardiac phantom, for computed tomography automatic left ventricle segmentation and volumetry – A pilot study

IntroductionAccurate cardiac left ventricle (LV) delineation is essential to CT-derived left ventricular ejection fraction (LVEF). To evaluate dose-reduction potential, an anatomically accurate heart phantom, with realistic X-ray attenuation is required. We demonstrated and tested a custom-made phantom using 3D-printing, and examined the influence of image noise on automatically measured LV volumes MethodsA single coronary CT angiography (CCTA) dataset was segmented and converted to Standard Tessellation Language (STL) mesh, using open-source software. A 3D-printed model, with hollow left heart chambers, was printed and cavities filled with gelatinized contrast media. This was CT-scanned in an anthropomorphic chest phantom, at different exposure conditions. LV and “myocardium” noise and attenuation was measured. LV volume was automatically measured using two different methods. We calculated Spearmans’ correlation of LV volume with noise and contrast-noise ratio respectively om 486 scans of the phantom. Source images were compared to one phantom series with similar parameters. This was done using Dice coefficient on LV short-axis segmentations. ResultsPhantom “Myocardium” and LV attenuation was comparable to measurements on source images. Automatic volume measurement succeeded, with mean volume deviation to patient images less than 2 ml. There was a moderate correlation of volume with CNR, and strong correlation of volume with image noise. With papillary muscles included in LV volume, the correlation was positive, but negative when excluded. Variation of volumes was lowest at 90–100 kVp for both methods in the 486 repeat scans. The Dice coefficient was 0.87, indicating high overlap between the single phantom series and source scan. Cost of 3D-printer and materials was 400 and 30 Euro respectively. ConclusionBoth anatomically and radiologically the phantom mimicked the source scans closely. LV volumetry was reliably performed with automatic algorithms. Implications for practicePatient-specific cardiac phantoms may be produced at minimal cost and can potentially be used for other anatomies and pathologies. This enables radiographic phantom studies without need for dedicated 3D-labs or expensive commercial phantoms.

Integrated approach for fully automatic left ventricle segmentation using adaptive iteration based parametric model with deep learning in short axis cardiac MRI

Integrated approach for fully automatic left ventricle segmentation using adaptive iteration based parametric model with deep learning in short axis cardiac MRI

Combining UNet 3+ and Transformer for Left Ventricle Segmentation via Signed Distance and Focal Loss

Left ventricle (LV) segmentation of cardiac magnetic resonance (MR) images is essential for evaluating cardiac function parameters and diagnosing cardiovascular diseases (CVDs). Accurate LV segmentation remains a challenge because of the large differences in cardiac structures in different research subjects. In this work, a network based on an encoder–decoder architecture for automatic LV segmentation of short-axis cardiac MR images is proposed. It combines UNet 3+ and Transformer to jointly predict the segmentation masks and signed distance maps (SDM). UNet 3+ can extract coarse-grained semantics and fine-grained details from full scales, while a Transformer is used to extract global features from cardiac MR images. It solves the problem of low segmentation accuracy caused by blurred LV edge information. Meanwhile, the SDM provides a shape-aware representation for segmentation. The performance of the proposed network is validated on the 2018 MICCAI Left Ventricle Segmentation Challenge dataset. The five-fold cross-validation evaluation was performed on 145 clinical subjects, and the average dice metric, Jaccard coefficient, accuracy, and positive predictive value reached 0.908, 0.834, 0.979, and 0.903, respectively, showing a better performance than that of other mainstream ones.

An efficient annotated data generation method for echocardiographic image segmentation

Background:In recent years, deep learning techniques have demonstrated promising performances in echocardiography (echo) data segmentation, which constitutes a critical step in the diagnosis and prognosis of cardiovascular diseases (CVDs). However, their successful implementation requires large number and high-quality annotated samples, whose acquisition is arduous and expertise-demanding. To this end, this study aims at circumventing the tedious, time-consuming and expertise-demanding data annotation involved in deep learning-based echo data segmentation. Methods:We propose a two-phase framework for fast generation of annotated echo data needed for implementing intelligent cardiac structure segmentation systems. First, multi-size and multi-orientation cardiac structures are simulated leveraging polynomial fitting method. Second, the obtained cardiac structures are embedded onto curated endoscopic ultrasound images using Fourier Transform algorithm, resulting in pairs of annotated samples. The practical significance of the proposed framework is validated through using the generated realistic annotated images as auxiliary dataset to pretrain deep learning models for automatic segmentation of left ventricle and left ventricle wall in real echo data, respectively. Results:Extensive experimental analyses indicate that compared with training from scratch, fine-tuning after pretraining with the generated dataset always results in significant performance improvement whereby the improvement margins in terms of Dice and IoU can reach 12.9% and 7.74%, respectively. Conclusion:The proposed framework has great potential to overcome the shortage of labeled data hampering the deployment of deep learning approaches in echo data analysis.

Comparative studies of deep learning segmentation models for left ventricle segmentation.

One of the primary factors contributing to death across all age groups is cardiovascular disease. In the analysis of heart function, analyzing the left ventricle (LV) from 2D echocardiographic images is a common medical procedure for heart patients. Consistent and accurate segmentation of the LV exerts significant impact on the understanding of the normal anatomy of the heart, as well as the ability to distinguish the aberrant or diseased structure of the heart. Therefore, LV segmentation is an important and critical task in medical practice, and automated LV segmentation is a pressing need. The deep learning models have been utilized in research for automatic LV segmentation. In this work, three cutting-edge convolutional neural network architectures (SegNet, Fully Convolutional Network, and Mask R-CNN) are designed and implemented to segment the LV. In addition, an echocardiography image dataset is generated, and the amount of training data is gradually increased to measure segmentation performance using evaluation metrics. The pixel's accuracy, precision, recall, specificity, Jaccard index, and dice similarity coefficients are applied to evaluate the three models. The Mask R-CNN model outperformed the other two models in these evaluation metrics. As a result, the Mask R-CNN model is used in this study to examine the effect of training data. For 4,000 images, the network achieved 92.21% DSC value, 85.55% Jaccard index, 98.76% mean accuracy, 96.81% recall, 93.15% precision, and 96.58% specificity value. Relatively, the Mask R-CNN outperformed other architectures, and the performance achieves stability when the model is trained using more than 4,000 training images.

Automatic Left Ventricle Segmentation from Short-Axis Cardiac MRI Images Based on Fully Convolutional Neural Network.

Background: Left ventricle (LV) segmentation using a cardiac magnetic resonance imaging (MRI) dataset is critical for evaluating global and regional cardiac functions and diagnosing cardiovascular diseases. LV clinical metrics such as LV volume, LV mass and ejection fraction (EF) are frequently extracted based on the LV segmentation from short-axis MRI images. Manual segmentation to assess such functions is tedious and time-consuming for medical experts to diagnose cardiac pathologies. Therefore, a fully automated LV segmentation technique is required to assist medical experts in working more efficiently. Method: This paper proposes a fully convolutional network (FCN) architecture for automatic LV segmentation from short-axis MRI images. Several experiments were conducted in the training phase to compare the performance of the network and the U-Net model with various hyper-parameters, including optimization algorithms, epochs, learning rate, and mini-batch size. In addition, a class weighting method was introduced to avoid having a high imbalance of pixels in the classes of image’s labels since the number of background pixels was significantly higher than the number of LV and myocardium pixels. Furthermore, effective image conversion with pixel normalization was applied to obtain exact features representing target organs (LV and myocardium). The segmentation models were trained and tested on a public dataset, namely the evaluation of myocardial infarction from the delayed-enhancement cardiac MRI (EMIDEC) dataset. Results: The dice metric, Jaccard index, sensitivity, and specificity were used to evaluate the network’s performance, with values of 0.93, 0.87, 0.98, and 0.94, respectively. Based on the experimental results, the proposed network outperforms the standard U-Net model and is an advanced fully automated method in terms of segmentation performance. Conclusion: This proposed method is applicable in clinical practice for doctors to diagnose cardiac diseases from short-axis MRI images.

Fully automatic segmentation of LV from echocardiography images and calculation of ejection fraction using deep learning

Echocardiography is a widely used ultrasound imaging technique for cardiac health diagnosis. Echocardiography segmentation is a crucial process to evaluate multiple cardiac parameters like ejection fraction, heart wall thicknesses, etc. Recently machine learning techniques especially deep learning using convolution neural network models are finding increasing applications for echo image analysis including its segmentation. In this paper, we have presented a unique convolution neural network (CNN) model for automatic left ventricle (LV) segmentation of echo images. Denoising and feature extraction processes are integrated with the CNN model to enhance its prediction accuracies after training. The proposed system is trained on two-dimensional sequence images of 70 patients and tested on data of 12 patients. An automatic method for evaluation of ejection fraction is appended using the LV segmentation predictions generated by the CNN model. The performance of this CNN architecture is evaluated with recent architectures using various similarities and distance-based majors as well as ejection fraction correlation with ground truth segmentation labelled images. CNN layer visualisation methods are applied to obtain deeper insight into the trained network.

A novel approach for left ventricle segmentation in tagged MRI

Automatic left ventricle (LV) segmentation from tagged cardiac magnetic resonance imaging is significant for evaluating heart function and providing follow-up treatments in clinical medicine. However, due to the complicated cardiac structure and extra interference, it is challenging for traditional methods to delineate the LV automatically and get accurate results. Therefore, we proposed the automatic LV segmentation algorithm combined with deep learning and curriculum learning strategy. The key technologies are described as follows: firstly, local sine-wave modeling (SinMod) is practiced to track cardiac motion information, implement automatic heart location and obtain the region of interest. Secondly, U-Net is utilized as the basic model to segment the LV endocardium and epicardium. Additionally, a new curriculum learning training strategy is adopted to improve segmentation accuracy. Finally, comparative results demonstrate the superior performance of our approach to those resulting from traditional methods.

Effect of age and sex on fully automated deep learning assessment of left ventricular function, volumes, and contours in cardiac magnetic resonance imaging.

Deep learning algorithms for left ventricle (LV) segmentation are prone to bias towards the training dataset. This study assesses sex- and age-dependent performance differences when using deep learning for automatic LV segmentation. Retrospective analysis of 100 healthy subjects undergoing cardiac MRI from 2012 to 2018, with 10 men and women in the following age groups: 18-30, 31-40, 41-50, 51-60, and 61-80years old. Subjects underwent 1.5T, 2D CINE SSFP MRI. 35 pathologic cases from local clinical exams and the SCMR 2015 consensus contours dataset were also analyzed. A fully convolutional network (FCN) similar to U-Net trained on the U.K. Biobank was used to automatically segment LV endocardial and epicardial contours. FCN and manual segmentation were compared using Dice metrics and measurements of end-diastolic volume (EDV), end-systolic volume (ESV), mass (LVM), and ejection fraction (LVEF). Paired t-tests and linear regressions were used to analyze measurement differences with respect to sex and age. Dice metrics (median ± IQR) for n = 135 cases were 0.94 ± 0.04/0.87 ± 0.10 (ED endocardium/ES endocardium). Measurement biases (mean ± SD) among the healthy cohort were -0.3 ± 10.1mL for EDV, -6.7 ± 9.6mL for ESV, 4.6 ± 6.4% for LVEF, and -2.2 ± 11.0g for LVM; biases were independent of sex and age. Biases among the 35 pathologic cases were 0.1 ± 19mL for EDV, -4.8 ± 19mL for ESV, 2.0 ± 7.6% for LVEF, and 1.0 ± 20g for LVM. In conclusion, automatic segmentation by the Biobank-trained FCN was independent of age and sex. Improvements in end-systolic basal slice detection are needed to decrease bias and improve precision in ESV and LVEF.

Automatic segmentation of left ventricle using parallel end–end deep convolutional neural networks framework

Under the background of high incidence and mortality of cardiovascular diseases, the accurate and automatic left ventricle (LV) segmentation method is of essential importance for the diagnosis of the cardiovascular system. However, fully automatic LV segmentation remains challenging due to the complex structure of cardiac magnetic resonance image (MRI) and the morphological changes of LV caused by various cardiovascular diseases. In this paper, we propose a novel parallel end-to-end convolutional neural network (CNN) for LV segmentation. Our network consists of two interactive subnetworks which utilize essentially identical but formally different labels in the hope that they can learn segmentation from different perspectives. The two subnetworks take the same cardiac MRI as input and output a pair of segmentation maps in different forms. After averaging the two segmentation maps obtained from the two subnetworks, we get the final contours of the endocardium (endo) and epicardium (epi) simultaneously. The proposed method is evaluated on the dataset provided by the Left Ventricle Full Quantification Challenge of MICCAI 2019. The average Dice scores on epi, endo, and myocardium (myo) reach 0.961, 0.949, and 0.867 respectively which outperform the other methods. The experimental results show that our method has the potential for clinical application.

Automatic left ventricle segmentation in short-axis MRI using deep convolutional neural networks and central-line guided level set approach

In the clinical diagnosis of cardiovascular diseases, left ventricle (LV) segmentation in cardiac magnetic resonance images (MRI) is an indispensable procedure for doctors. To reduce the time needed for diagnosis, we develop an automatic LV segmentation method by integrating the convolutional neural network (CNN) with the level set approach. Firstly, a CNN based myocardial central-line detection algorithm was proposed to replace the manual initialization process for traditional level set approaches. Secondly, we present a novel central-line guided level set approach (CGLS) for delineating the myocardium region. In particular, we incorporate the myocardial central-line into the level set energy formulation as a constraint term. It plays two important roles in the iterative process: restricting the zero-level contour to stay around the myocardial central-line and preserving the anatomical geometry of myocardium segmentation result. In experiments, our method yields results as below: (1) 1.74 mm and 2.06 mm in terms of epicardium and endocardium perpendicular distance on MICCAI 2009 dataset, (2) 0.955 and 0.853 in terms of LV and myocardium Dice metric at the end-diastole on ACDC MICCAI 2017 dataset. The experimental data demonstrate that our method outperforms some state-of-the-art methods and achieves a good agreement with the manual segmentation results.