Learning Three-Dimensional Aortic Root Assessment Based on Sparse Annotations

Purpose: Analyzing the anatomy of the aorta and left ventricular outflow tract (LVOT) is crucial for risk assessment and planning of transcatheter aortic valve implantation (TAVI). A comprehensive analysis of the aortic root and LVOT requires the extraction of the patient-individual anatomy via segmentation. Deep learning has shown good performance on various segmentation tasks. If this is formulated as a supervised problem, large amounts of annotated data are required for training. Therefore, minimizing the annotation complexity is desirable. Approach: We propose two-dimensional (2D) cross-sectional annotation and point cloud-based surface reconstruction to train a fully automatic 3D segmentation network for the aortic root and the LVOT. Our sparse annotation scheme enables easy and fast training data generation for tubular structures such as the aortic root. From the segmentation results, we derive clinically relevant parameters for TAVI planning. Results: The proposed 2D cross-sectional annotation results in high inter-observer agreement [Dice similarity coefficient (DSC): 0.94]. The segmentation model achieves a DSC of 0.90 and an average surface distance of 0.96 mm. Our approach achieves an aortic annulus maximum diameter difference between prediction and annotation of 0.45 mm (inter-observer variance: 0.25 mm). Conclusions: The presented approach facilitates reproducible annotations. The annotations allow for training accurate segmentation models of the aortic root and LVOT. The segmentation results facilitate reproducible and quantifiable measurements for TAVI planning.