Informatics in Radiology: Postprocessing Pitfalls in Using CT for Automatic and Semiautomatic Determination of Global Left Ventricular Function

Abstract

Recent advances in technical capabilities of computed tomographic (CT) scanners, including an increasing number of detector rows, improved spatial and temporal resolution, and the development of retrospective gating, have allowed the acquisition of four-dimensional (4D) datasets of the beating heart. As a result, the heart can be visualized in different phases and CT datasets can be used to assess cardiac function. Many software packages currently exist that allow automatic or semiautomatic evaluation of left ventricular function on the basis of 4D CT datasets. The level of automation varies from extensive, completely manual segmentation by the user to fully automatic evaluation of left ventricular function without any user interaction. Although the reproducibility of functional parameter assessment is reported to be high and intersoftware variability low for larger groups of patients, significant differences can exist among measurements obtained with different software tools from the same dataset. Thus, careful review of automatically or semiautomatically obtained results is required.

Semiautomatic three-dimensional CT ventricular volumetry in patients with congenital heart disease: agreement between two methods with different user interaction

“…Currently, a simplified endocardial contouring method using 2D short-axis or, less frequently, axial cine MRI is regarded as the reference standard. However, the method is limited by considerable errors resulting from inclusion of the papillary muscles and trabeculations as part of the ventricular volume and inaccurate determination of the atrioventricular and semilunar valve planes [1,4,[14][15][16][17]. The former error results in overestimation of ventricular volumes and underestimation of ejection fraction (EF) and ventricular mass.…”

“…In this study, 3D cardiac CT data were used for ventricular volumetry rather than 2D cardiac MRI data in order to take advantage of a 3D threshold-based segmentation approach. 3D cardiac CT data were frequently downgraded to reformatted 2D data in previous studies [1,[6][7][8][21][22][23]. Compared with MRI ventricular volumetry, CT ventricular volumetry tends to overestimate ventricular volumes [20,23].…”

“…In addition, method 2 failed to segment LV ESV in three patients. A semi-or automatic-segmentation method is often problematic in cases of valve opening, ventricular septal defect, or other complex ventricular morphology, thereby necessitating manual corrections for accurate segmentation [1,8]. On the contrary, the ability of manual correction in method 1 was invaluable in the achievement of a clinically acceptable level of accurately segmented LV and RV volumes in patients with CHD.…”

“…Cardiac MRI is currently regarded as the reference standard of this measurement. Cardiac CT using state-of-the-art imaging techniques has recently been used for ventricular volumetry and is suggested as an alternative imaging modality to cardiac MRI, offering more accurate values and easier postprocessing mainly due to better image quality [1][2][3].…”

New Imaging-Based Tools for the Assessment of Ventricular Function in Ischemic Heart Diseases

“…16 Currently accessible multidetector computed tomography (MDCT) and dual-source computed tomography (DSCT) scanners offer a high spatial and temporal resolution with faster gantry rotation, enabling the 3D reconstruction of the heart. 17 Several studies were performed comparing global function parameters determined by MDCT with other investigation techniques results. Sarwar et al compared the LV global analysis of contrast-enhanced 64-slice MDCT with CMR in ST-elevation myocardial infarction following primary PCI treatment.…”