A deep learning approach with temporal consistency for automatic myocardial segmentation of quantitative myocardial contrast echocardiography.

Quantitative myocardial contrast echocardiography (MCE) has been proved to be valuable in detecting myocardial ischemia. During quantitative MCE analysis, myocardial segmentation is a critical step in determining accurate region of interests (ROIs). However, traditional myocardial segmentation mainly relies on manual tracing of myocardial contours, which is time-consuming and laborious. To solve this problem, we propose a fully automatic myocardial segmentation framework that can segment myocardial regions in MCE accurately without human intervention. A total of 100 patients' MCE sequences were divided into a training set and a test set according to a 7: 3 proportion for analysis. We proposed a bi-directional training schema, which incorporated temporal information of forward and backward direction among frames in MCE sequences to ensure temporal consistency by combining convolutional neural network with recurrent neural network. Experiment results demonstrated that compared with a traditional segmentation model (U-net) and the model considering only forward temporal information (U-net + forward), our framework achieved the highest segmentation precision in Dice coefficient (U-net vs U-net + forward vs our framework: 0.78 ± 0.07 vs 0.79 ± 0.07 vs 0.81 ± 0.07, p < 0.01), Intersection over Union (0.65 ± 0.09 vs 0.66 ± 0.09 vs 0.68 ± 0.09, p < 0.01), and lowest Hausdorff Distance (32.68 ± 14.6 vs 28.69 ± 13.18 vs 27.59 ± 12.82 pixel point, p < 0.01). In the visual grading study, the performance of our framework was the best among these three models (52.47 ± 4.29 vs 54.53 ± 5.10 vs 57.30 ± 4.73, p < 0.01). A case report on a randomly selected subject for perfusion analysis showed that the perfusion parameters generated by using myocardial segmentation of our proposed framework were similar to that of the expert annotation. The proposed framework could generate more precise myocardial segmentation when compared with traditional methods. The perfusion parameters generated by these myocardial segmentations have a good similarity to that of manual annotation, suggesting that it has the potential to be utilized in routine clinical practice.