Automatic Segmentation of the Left Ventricle in Apical Four-Chamber View on Transesophageal Echocardiography Based on...

Background/Objectives: The automatic left ventricle segmentation in transesophageal echocardiography (TEE) is of significant importance. In this paper, we constructed a large-scale TEE apical four-chamber view (A4CV) image dataset and proposed an automatic left ventricular segmentation method for the TEE A4CV based on the UNeXt deep neural network. Methods: UNeXt, a variant of U-Net integrating a multilayer perceptron, was employed for left ventricle segmentation in the TEE A4CV because it could yield promising segmentation performance while reducing both the number of network parameters and computational complexity. We also compared the proposed method with U-Net, TransUNet, and Attention U-Net models. Standard TEE A4CV videos were collected from 60 patients undergoing cardiac surgery, from the onset of anesthesia to the conclusion of the procedure. After preprocessing, a dataset comprising 3000 TEE images and their corresponding labels was generated. The dataset was randomly divided into training, validation, and test sets in an 8:1:1 ratio on the patient level. The training and validation sets were used to train the UNeXt, U-Net, TransUNet, and Attention U-Net models for left ventricular segmentation. The dice similarity coefficient (DSC) and Intersection over Union (IoU) were used to evaluate the segmentation performance of each model, and the Kruskal-Wallis test was employed to analyze the significance of DSC differences. Results: On the test set, the UNeXt model achieved an average DSC of 88.60%, outperforming U-Net (87.76%), TransUNet (85.75%, p < 0.05), and Attention U-Net (79.98%; p < 0.05). Additionally, the UNeXt model had a smaller number of parameters (1.47 million) and floating point operations (2.28 giga) as well as a shorter average inference time per image (141.73 ms), compared to U-Net (185.12 ms), TransUNet (209.08 ms), and Attention U-Net (201.13 ms). The average IoU of UNeXt (77.60%) was also higher than that of U-Net (76.61%), TransUNet (77.35%), and Attention U-Net (68.86%). Conclusions: This study pioneered the construction of a large-scale TEE A4CV dataset and the application of UNeXt to left ventricle segmentation in the TEE A4CV. The proposed method may be used for automatic segmentation of the left ventricle in the TEE A4CV.