The impact of training image quality with a novel protocol on artificial intelligence-based LGE-MRI image segmentation for potential atrial fibrillation management

Abstract

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting up to 2 % of the population. Catheter ablation is a promising treatment for AF, particularly for paroxysmal AF patients, but it often has high recurrence rates. Developing in silico models of patients' atria during the ablation procedure using cardiac MRI data may help reduce these rates.

Objective

This study aims to develop an effective automated deep learning-based segmentation pipeline by compiling a specialized dataset and employing standardized labeling protocols to improve segmentation accuracy and efficiency. In doing so, we aim to achieve the highest possible accuracy and generalization ability while minimizing the burden on clinicians involved in manual data segmentation.

Methods

We collected LGE-MRI data from VMRC and the cDEMRIS database. Two specialists manually labeled the data using standardized protocols to reduce subjective errors. Neural network (nnU-Net and smpU-Net++) performance was evaluated using statistical tests, including sensitivity and specificity analysis. A new database of LGE-MRI images, based on manual segmentation, was created (VMRC).

Results

Our approach with consistent labeling protocols achieved a Dice coefficient of 92.4 % ± 0.8 % for the cavity and 64.5 % ± 1.9 % for LA walls. Using the pre-trained RIFE model, we attained a Dice score of approximately 89.1 % ± 1.6 % for atrial LGE-MRI imputation, outperforming classical methods. Sensitivity and specificity values demonstrated substantial enhancement in the performance of neural networks trained with the new protocol.

Conclusion

Standardized labeling and RIFE applications significantly improved machine learning tool efficiency for constructing 3D LA models. This novel approach supports integrating state-of-the-art machine learning methods into broader in silico pipelines for predicting ablation outcomes in AF patients.