CT evaluation prior to transapical aortic valve replacement: semi-automatic versus manual image segmentation

  • Borek Foldyna
  • Camelia Jungert
  • Christian Luecke
  • Konstantin von Aspern
  • Sonja Boehmer-Lasthaus
  • Eva Maria Rueth
  • Matthias Grothoff
  • Stefan Nitzsche
  • Matthias Gutberlet
  • Friedrich Wilhelm Mohr
  • Lukas Lehmkuhl
Original Paper


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.


Transapical valve replacement Aortic valve Computed tomography Data segmentation Data evaluation Experienced versus inexperienced users Efficiency 



3D volume-rendering technique


Aortic valve stenosis


Curved multiplanar reconstruction


Computed tomography




Effective diameter


Intraclass correlation coefficient


Transcatheter aortic valve replacement



The authors of this manuscript declare a cooperation contract between the Department of Interventional and Diagnostic Radiology of the Heart Center in Leipzig and the Siemens Company (Siemens AG, Healthcare, Erlangen, Germany), which supported the study and provided the required equipment and software.

Conflict of interest



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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Borek Foldyna
    • 1
  • Camelia Jungert
    • 1
  • Christian Luecke
    • 1
  • Konstantin von Aspern
    • 2
  • Sonja Boehmer-Lasthaus
    • 3
  • Eva Maria Rueth
    • 3
  • Matthias Grothoff
    • 1
  • Stefan Nitzsche
    • 1
  • Matthias Gutberlet
    • 1
  • Friedrich Wilhelm Mohr
    • 2
  • Lukas Lehmkuhl
    • 1
  1. 1.Department of Interventional and Diagnostic RadiologyUniversity of Leipzig – Heart CenterLeipzigGermany
  2. 2.Department of Cardiac SurgeryUniversity of Leipzig – Heart CenterLeipzigGermany
  3. 3.Siemens Healthcare – Imaging & TherapyErlangenGermany

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