Shape Constrained CNN for Cardiac MR Segmentation with Simultaneous Prediction of Shape and Pose Parameters

Semantic segmentation using convolutional neural networks (CNNs) is the state-of-the-art for many medical segmentation tasks including left ventricle (LV) segmentation in cardiac MR images. However, a drawback is that these CNNs lack explicit shape constraints, occasionally resulting in unrealistic segmentations. In this paper, we perform LV and myocardial segmentation by regression of pose and shape parameters derived from a statistical shape model. The integrated shape model regularizes predicted segmentations and guarantees realistic shapes. Furthermore, in contrast to semantic segmentation, it allows direct calculation of regional measures such as myocardial thickness. We enforce robustness of shape and pose prediction by simultaneously constructing a segmentation distance map during training. We evaluated the proposed method in a fivefold cross validation on a in-house clinical dataset with 75 subjects containing a total of 1539 delineated short-axis slices covering LV from apex to base, and achieved a correlation of 99% for LV area, 94% for myocardial area, 98% for LV dimensions and 88% for regional wall thicknesses. The method was additionally validated on the LVQuan18 and LVQuan19 public datasets and achieved state-of-the-art results.