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Automated Threshold-Based 3D Segmentation Versus Short-Axis Planimetry for Assessment of Global Left Ventricular Function with Dual-Source MDCT

¹ Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Straße 33, D-48149 Muenster, Germany.
² Department of Cardiology and Angiology, University of Muenster, Muenster, Germany.
³ Department of Radiology, Asklepios Clinic Altona, Hamburg, Germany.

OBJECTIVE. The purpose of this study was to evaluate software for threshold-based 3D segmentation of the left ventricle in comparison with traditional 2D short axis–based planimetry (Simpson method) for measurement of left ventricular (LV) volume and global function with state-of-the-art dual-source CT.

SUBJECTS AND METHODS. Fifty patients with known or suspected coronary artery disease underwent coronary CT angiography. LV end-diastolic, end-systolic, and stroke volumes and ejection fraction were determined from axial images to which 3D segmentation had been applied and from short-axis reformations from 2D planimetry. Interobserver variability was assessed for both approaches.

RESULTS. Threshold-based 3D LV segmentation had excellent correlation with 2D short-axis results (end-diastolic volume, R = 0.99; end-systolic volume, R = 0.99; stroke volume, R = 0.90; ejection fraction, R = 0.97; p < 0.0001). Bland-Altman analyses revealed systematic underestimation of LV end-diastolic volume (–7.4 ± 8.9 mL) and LV end-systolic volume (–7.0 ± 4.4 mL) with the 3D segmentation approach and 2.8 ± 3.3% overestimation of LV ejection fraction. Interobserver variation with 3D segmentation analysis was significantly (p < 0.001) less (e.g., LV ejection fraction, 0.1 ± 1.7%) than with the 2D technique, and mean analysis time was significantly shorter (172 ± 20 vs 248 ± 29 seconds; p < 0.05).

CONCLUSION. Automated threshold-based 3D segmentation enables accurate and reproducible dual-source CT assessment of LV volume and function with excellent correlation with results of 2D short-axis analysis. Exclusion of papillary muscles from LV volume results in small systematic differences in quantitative values.

Keywords: dual-source CT • left ventricular function • short axis–based planimetry • Simpson method • threshold 3D segmentation algorithm