Aortic Valve Tract Segmentation From 3D-TEE Using Shape-Based B-Spline Explicit Active Surfaces

A novel semi-automatic algorithm for aortic valve (AV) wall segmentation is presented for 3D transesophageal echocardiography (TEE) datasets. The proposed methodology uses a 3D cylindrical formulation of the B-spline Explicit Active Surfaces (BEAS) framework in a dual-stage energy evolution process, comprising a threshold-based and a localized region-based stage. Hereto, intensity and shape-based features are combined to accurately delineate the AV wall from the ascending aorta (AA) to the left ventricular outflow tract (LVOT). Shape-prior information is included using a profile-based statistical shape model (SSM), and embedded in BEAS through two novel regularization terms: one confining the segmented AV profiles to shapes seen in the SSM (hard regularization) and another penalizing according to the profile's degree of likelihood (soft regularization). The proposed energy functional takes thus advantage of the intensity data in regions with strong image content, while complementing it with shape knowledge in regions with nearly absent image data. The proposed algorithm has been validated in 20 3D-TEE datasets with both stenotic and non-stenotic valves. It was shown to be accurate, robust and computationally efficient, taking less than 1 second to segment the AV wall from the AA to the LVOT with an average accuracy of 0.78 mm. Semi-automatically extracted measurements at four relevant anatomical levels (LVOT, aortic annulus, sinuses of Valsalva and sinotubular junction) showed an excellent agreement with experts' ones, with a higher reproducibility than manually-extracted measures.