Foldyna Borek, Jungert Camelia, Luecke Christian, von Aspern Konstantin, Boehmer-Lasthaus Sonja, Rueth Eva Maria, Grothoff Matthias, Nitzsche Stefan, Gutberlet Matthias, Mohr Friedrich Wilhelm, Lehmkuhl Lukas
Department of Interventional and Diagnostic Radiology, University of Leipzig - Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany,
Int J Cardiovasc Imaging. 2015 Aug;31(6):1233-42. doi: 10.1007/s10554-015-0662-6. Epub 2015 Apr 19.
To compare the performance of semi-automatic versus manual segmentation for ECG-triggered cardiovascular computed tomography (CT) examinations prior to transcatheter aortic valve replacement (TAVR), with focus on the speed and precision of experienced versus inexperienced observers. The preoperative ECG-triggered CT data of 30 consecutive patients who were scheduled for TAVR were included. All datasets were separately evaluated by two radiologists with 1 and 5 years of experience (novice and expert, respectively) in cardiovascular CT using an evaluation software program with or without a semi-automatic TAVR workflow. The time expended for data loading and all segmentation steps required for the implantation planning were assessed. Inter-software as well as inter-observer reliability analysis was performed. The CT datasets were successfully evaluated, with mean duration between 520.4 ± 117.6 s and 693.2 ± 159.5 s. The three most time-consuming steps were the 3D volume rendering, the measurement of aorta diameter and the sizing of the aortic annulus. Using semi-automatic segmentation, a novice could evaluate CT data approximately 12.3% faster than with manual segmentation, and an expert could evaluate CT data approximately 10.3% faster [mean differences of 85.4 ± 83.8 s (p < 0.001) and 59.8 ± 101 s (p < 0.001), respectively]. The inter-software reliability for a novice was slightly lower than for an expert; however, the reliability for a novice and expert was excellent (ICC 0.92, 95% CI 0.75-0.97/ICC 0.96, 95% CI 0.91-0.98). Automatic aortic annulus detection failed in two patients (6.7%). The study revealed excellent inter-software and inter-observer reliability, with a mean ICC of 0.95. TAVR evaluation can be accomplished significantly faster with semi-automatic rather than with manual segmentation, with comparable exactness, showing a benefit for experienced and inexperienced observers.
比较经导管主动脉瓣置换术（TAVR）前心电图触发的心血管计算机断层扫描（CT）检查中半自动分割与手动分割的性能，重点关注经验丰富和经验不足的观察者的速度和精度。纳入了30例计划进行TAVR的连续患者的术前心电图触发CT数据。两名分别具有1年和5年心血管CT经验的放射科医生（分别为新手和专家）使用带有或不带有半自动TAVR工作流程的评估软件程序对所有数据集进行单独评估。评估了数据加载时间以及植入计划所需的所有分割步骤的时间。进行了软件间以及观察者间的可靠性分析。CT数据集成功评估，平均持续时间在520.4±117.6秒和693.2±159.5秒之间。三个最耗时的步骤是三维容积再现、主动脉直径测量和主动脉瓣环大小测量。使用半自动分割时，新手评估CT数据的速度比手动分割快约12.3%，专家评估CT数据的速度快约10.3%[平均差异分别为85.4±83.8秒（p<0.001）和59.8±101秒（p<0.001）]。新手的软件间可靠性略低于专家；然而，新手和专家的可靠性都非常好（组内相关系数0.92，95%可信区间0.75-0.97/组内相关系数0.96，95%可信区间0.91-0.98）。两名患者（6.7%）的自动主动脉瓣环检测失败。该研究显示软件间和观察者间可靠性极佳，平均组内相关系数为0.95。与手动分割相比，半自动分割可显著更快地完成TAVR评估，准确性相当，对经验丰富和经验不足的观察者均有益处。
