Automatic segmentation of the left ventricle in echocardiographic images using convolutional neural networks

Background: Two-dimensional echocardiography (2D echo) is the most widely used non-invasive imaging modality due to its fast acquisition time, low cost, and high temporal resolution. Boundary identification of left ventricle (LV) in 2D echo, i.e., image segmentation, is the first step to calculate relevant clinical parameters. Currently, LV segmentation in 2D echo is primarily conducted semi-manually. A fully-automatic segmentation of the LV wall needs further development. Methods: We evaluated the performance of the state-of-the-art convolutional neural networks (CNNs) for the segmentation of 2D echo images from 6 standard projections of the LV. We used two segmentation algorithms: U-net and segAN. The models were trained using an in-house dataset, which consists of 1,649 porcine images from 6 to 8 different pigs. In addition, a transfer learning approach was used for the segmentation of long-axis projections by training models with our database based on the previously trained weights obtained from Cardiac Acquisitions for Multi-structure Ultrasound Segmentation (CAMUS) dataset. The models were tested on a separate set of images from two other pigs by computing several metrics. The segmentation process was combined with a 3D reconstruction framework to quantify the physiological indices such as LV volumes and ejection fraction (EF). Results: The average dice metric for the LV cavity was 0.90 and 0.91 for the U-net and segAN, respectively, which was higher than 0.82 for the level-set (P value: 3.31x10(-25)). The average Hausdorff distance for the LV cavity was 2.71 mm and 2.82 mm for the U-net and segAN, respectively, which was lower than 3.64 mm for the level-set (P value: 4.86x10(-16)). The LV shapes and volumes obtained using the CNN segmentation models were in good agreement with the results segmented by the experts. In addition, the differences of the calculated physiological parameters between two 3D reconstruction models segmented by the experts and CNNs were less than 15%. Conclusions: The results showed that both CNN models achieve higher performance on LV segmentation than the level-set method. The error of the reconstruction from automatic segmentation compared to the expert segmentation is less than 15%, which is within the 20% error of echo compared to the gold standard.