Improved segmentation of multiple cavities of the heart in wide-view 3-D transesophageal echocardiograms

A. Haak, B. (Ben) Ren, H.W. (Harriët) Mulder, G. Vegas-Sanchez-Ferrero, Gerard van Burken, A.F.W. Steen, van der, M. Stralen, van, J.P.W. Pluim, T. Walsum, van, Johannes G. Bosch

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Minimally invasive interventions in the heart such as in electrophysiology are becoming more and more important in clinical practice. Currently, preoperative computed tomography angiography (CTA) is used to provide anatomic information during electrophysiology interventions, but this does not provide real-time feedback and burdens the patient with additional radiation and side effects of the contrast agent. Three-dimensional transesophageal echocardiography (TEE) is an excellent modality for visualization of anatomic structures and instruments in real time, but some cavities, especially the left atrium, suffer from the limited coverage of the 3-D TEE volumes. This leads to difficulty in segmenting the left atrium. We propose replacing or complementing pre-operative CTA imaging with wide-view TEE. We tested this proposal on 20 patients for which TEE image volumes covering the left atrium and CTA images were acquired. The TEE images were manually registered, and wide-view volumes were generated. Five heart cavities in single-view and wide-view TEE were segmented and compared with atlas based-segmentations derived from the CTA images. We found that the segmentation accuracy (Dice coefficients) improved relative to segmentation of single-view images by 5, 15 and 9 percentage points for the left atrium, right atrium and aorta, respectively. Average anatomic coverage was improved by 2, 29, 62 and 49 percentage points for the right ventricle, left atrium, right atrium and aorta, respectively. This finding confirms that wide-view 3-D TEE can be useful in supporting electrophysiology interventions.
Original languageEnglish
Pages (from-to)1991-2000
JournalUltrasound in Medicine and Biology
Issue number7
Publication statusPublished - Jul 2015


  • Transesophageal echocardiography
  • Segmentation
  • Gamma mixture model
  • Expectation maximization
  • Ultrasound
  • Active shape model
  • Electrophysiology


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