Sandro Queirós1, Christophe Dubois2, Pedro Morais3, Tom Adriaenssens4, Jaime C Fonseca5, João L Vilaça6, Jan D'hooge7. 1. Dept. of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal; Algoritmi Center, School of Engineering, University of Minho, Guimarães, Portugal. Electronic address: sandroqueiros@med.uminho.pt. 2. Dept. of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Dept. of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium. Electronic address: christophe.dubois@uzleuven.be. 3. Dept. of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal; INEGI, Faculty of Engineering, University of Porto, Porto, Portugal. Electronic address: pedromorais@med.uminho.pt. 4. Dept. of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Dept. of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium. Electronic address: tom.adriaenssens@uzleuven.be. 5. Algoritmi Center, School of Engineering, University of Minho, Guimarães, Portugal. Electronic address: jaime@dei.uminho.pt. 6. ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal; DIGARC - Polytechnic Institute of Cávado and Ave, Barcelos, Portugal. Electronic address: jvilaca@ipca.pt. 7. Dept. of Cardiovascular Sciences, KU Leuven, Leuven, Belgium. Electronic address: jan.dhooge@uzleuven.be.
Abstract
BACKGROUND: Accurate imaging assessment of aortic annulus (AoA) dimension is paramount to decide on the correct transcatheter heart valve (THV) size for patients undergoing transcatheter aortic valve implantation (TAVI). We evaluated the feasibility and accuracy of a novel automatic framework for multidetector row computed tomography (MDCT)-based TAVI planning. METHODS: Among 122 consecutive patients undergoing TAVI and retrospectively reviewed for this study, 104 patients with preoperative MDCT of sufficient quality were enrolled and analyzed with the proposed software. Fully automatic (FA) and semi-automatic (SA) AoA measurements were compared to manual measurements, with both automated and manual-based interobserver variability (IOV) being assessed. Finally, the effect of these measures on hypothetically selected THV size was evaluated against the implanted size, as well as with respect to manually-derived sizes. RESULTS: FA analysis was feasible in 92.3% of the cases, increasing to 100% if using the SA approach. Automatically-extracted measurements showed excellent agreement with manually-derived ones, with small biases and narrow limits of agreement, and comparable to the interobserver agreement. The SA approach presented a statistically lower IOV than manual analysis, showing the potential to reduce interobserver sizing disagreements. Moreover, the automated approaches displayed close agreement with the implanted sizes, similar to the ones obtained by the experts. CONCLUSION: The proposed automatic framework provides an accurate and robust tool for AoA measurements and THV sizing in patients undergoing TAVI.
BACKGROUND: Accurate imaging assessment of aortic annulus (AoA) dimension is paramount to decide on the correct transcatheter heart valve (THV) size for patients undergoing transcatheter aortic valve implantation (TAVI). We evaluated the feasibility and accuracy of a novel automatic framework for multidetector row computed tomography (MDCT)-based TAVI planning. METHODS: Among 122 consecutive patients undergoing TAVI and retrospectively reviewed for this study, 104 patients with preoperative MDCT of sufficient quality were enrolled and analyzed with the proposed software. Fully automatic (FA) and semi-automatic (SA) AoA measurements were compared to manual measurements, with both automated and manual-based interobserver variability (IOV) being assessed. Finally, the effect of these measures on hypothetically selected THV size was evaluated against the implanted size, as well as with respect to manually-derived sizes. RESULTS: FA analysis was feasible in 92.3% of the cases, increasing to 100% if using the SA approach. Automatically-extracted measurements showed excellent agreement with manually-derived ones, with small biases and narrow limits of agreement, and comparable to the interobserver agreement. The SA approach presented a statistically lower IOV than manual analysis, showing the potential to reduce interobserver sizing disagreements. Moreover, the automated approaches displayed close agreement with the implanted sizes, similar to the ones obtained by the experts. CONCLUSION: The proposed automatic framework provides an accurate and robust tool for AoA measurements and THV sizing in patients undergoing TAVI.
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