Automatic segmentation and quantification of the cardiac structures from non-contrast-enhanced cardiac CT scans

Rahil Shahzad, Daniel Bos, Ricardo P.J. Budde, Karlijn Pellikaan, Wiro J. Niessen, Aad Van Der Lugt, Theo Van Walsum

    Research output: Contribution to journalArticleScientificpeer-review

    16 Citations (Scopus)


    Early structural changes to the heart, including the chambers and the coronary arteries, provide important information on pre-clinical heart disease like cardiac failure. Currently, contrast-enhanced cardiac computed tomography angiography (CCTA) is the preferred modality for the visualization of the cardiac chambers and the coronaries. In clinical practice not every patient undergoes a CCTA scan; many patients receive only a non-contrast-enhanced calcium scoring CT scan (CTCS), which has less radiation dose and does not require the administration of contrast agent. Quantifying cardiac structures in such images is challenging, as they lack the contrast present in CCTA scans. Such quantification would however be relevant, as it enables population based studies with only a CTCS scan. The purpose of this work is therefore to investigate the feasibility of automatic segmentation and quantification of cardiac structures viz whole heart, left atrium, left ventricle, right atrium, right ventricle and aortic root from CTCS scans. A fully automatic multi- atlas-based segmentation approach is used to segment the cardiac structures. Results show that the segmentation overlap between the automatic method and that of the reference standard have a Dice similarity coefficient of 0.91 on average for the cardiac chambers. The mean surface-to-surface distance error over all the cardiac structures is 1.4±1.7 mm. The automatically obtained cardiac chamber volumes using the CTCS scans have an excellent correlation when compared to the volumes in corresponding CCTA scans, a Pearson correlation coefficient (R) of 0.95 is obtained. Our fully automatic method enables large-scale assessment of cardiac structures on non-contrastenhanced CT scans.

    Original languageEnglish
    Pages (from-to)3798-3813
    Number of pages16
    JournalPhysics in Medicine and Biology
    Issue number9
    Publication statusPublished - 11 Apr 2017


    • cardiac segmentation
    • computed tomography
    • image registration
    • multi-atlas-based segmentation


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