Fully Automatic Segmentation and Objective Assessment of Atrial Scars for Longstanding Persistent Atrial Fibrillation Patients Using Late Gadolinium-Enhanced MRI

Purpose: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is correlated with increased morbidity and mortality. It is associated with atrial fibrosis, which may be assessed non-invasively using late gadolinium-enhanced (LGE) magnetic resonance imaging (MRI) where scar tissue is visualised as a region of signal enhancement. In this study, we proposed a novel fully automatic pipeline to achieve an accurate and objective atrial scarring segmentation and assessment of LGE MRI scans for the AF patients. Methods: Our fully automatic pipeline uniquely combined: (1) a multi-atlas based whole heart segmentation (MA-WHS) to determine the cardiac anatomy from an MRI Roadmap acquisition which is then mapped to LGE MRI, and (2) a super-pixel and supervised learning based approach to delineate the distribution and extent of atrial scarring in LGE MRI. Results: Both our MA-WHS and atrial scarring segmentation showed accurate delineations of cardiac anatomy (mean Dice = 89%) and atrial scarring (mean Dice =79%) respectively compared to the established ground truth from manual segmentation. Compared with previously studied methods with manual interventions, our innovative pipeline demonstrated comparable results, but was computed fully automatically. Conclusion: The proposed segmentation methods allow LGE MRI to be used as an objective assessment tool for localisation, visualisation and quantification of atrial scarring.