Automated Quantification of Bileaflet Mechanical Heart Valve Leaflet Angles in CT Images

Cardiac computed tomography (CT) is a valuable tool for functional mechanical heart valve (MHV) assessment. An important aspect of bileaflet MHV assessment is evaluation and measurement of leaflet opening and closing angles. Performed manually, however, it is a laborious and time consuming task. In this paper, we propose an automated approach for bileaflet MHV leaflet angle computation. This method consists of four steps. After a one click selection of the MHV region on an axial image, an automatic MHV extraction using thresholding, and a connected component analysis based on voxel intensities is performed. Then, the MHV component (valve ring and two leaflets) positions are identified using random sample consensus and least square fitting. Finally, the angles are automatically computed based on the orientation of the components in each timeframe. Five multiphase CT scans from patients with a bileaflet MHV containing between 14 and 17 timepoints were used for development and another 15 were used for evaluation. The detected MHV components were scored for their overlap with real components as successful or unsuccessful. For successful results, the angles were compared to those measured by a radiologist. Qualitatively evaluated on a data set of 222 images, a total of 398 out of 444 angle computations (89.6%) were rated as successful. Compared to the angles measured by the radiologist, the successful angles showed a mean difference of 0.54° ± 3.63° from the manual calculations. The method provides a high success rate and an accurate computation of leaflet opening angles compared to manual measurements.