PMID- 33394116
OWN - NLM
STAT- MEDLINE
DCOM- 20210526
LR  - 20210526
IS  - 1432-1971 (Electronic)
IS  - 0172-0643 (Print)
IS  - 0172-0643 (Linking)
VI  - 42
IP  - 3
DP  - 2021 Mar
TI  - Retraining Convolutional Neural Networks for Specialized Cardiovascular Imaging 
      Tasks: Lessons from Tetralogy of Fallot.
PG  - 578-589
LID - 10.1007/s00246-020-02518-5 [doi]
AB  - Ventricular contouring of cardiac magnetic resonance imaging is the gold standard 
      for volumetric analysis for repaired tetralogy of Fallot (rTOF), but can be 
      time-consuming and subject to variability. A convolutional neural network (CNN) 
      ventricular contouring algorithm was developed to generate contours for mostly 
      structural normal hearts. We aimed to improve this algorithm for use in rTOF and 
      propose a more comprehensive method of evaluating algorithm performance. We 
      evaluated the performance of a ventricular contouring CNN, that was trained on 
      mostly structurally normal hearts, on rTOF patients. We then created an updated 
      CNN by adding rTOF training cases and evaluated the new algorithm's performance 
      generating contours for both the left and right ventricles (LV and RV) on new 
      testing data. Algorithm performance was evaluated with spatial metrics (Dice 
      Similarity Coefficient (DSC), Hausdorff distance, and average Hausdorff distance) 
      and volumetric comparisons (e.g., differences in RV volumes). The original Mostly 
      Structurally Normal (MSN) algorithm was better at contouring the LV than the RV 
      in patients with rTOF. After retraining the algorithm, the new MSN + rTOF 
      algorithm showed improvements for LV epicardial and RV endocardial contours on 
      testing data to which it was naive (N = 30; e.g., DSC 0.883 vs. 0.905 for LV 
      epicardium at end diastole, p < 0.0001) and improvements in RV end-diastolic 
      volumetrics (median %error 8.1 vs 11.4, p = 0.0022). Even with a small number of 
      cases, CNN-based contouring for rTOF can be improved. This work should be 
      extended to other forms of congenital heart disease with more extreme structural 
      abnormalities. Aspects of this work have already been implemented in clinical 
      practice, representing rapid clinical translation. The combined use of both 
      spatial and volumetric comparisons yielded insights into algorithm errors.
FAU - Tandon, Animesh
AU  - Tandon A
AUID- ORCID: 0000-0001-9769-8801
AD  - Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District 
      Dr, Dallas, TX, 75235, USA. tandon.animesh@gmail.com.
AD  - Department of Radiology, UT Southwestern Medical Center, 1935 Medical District 
      Dr, Dallas, TX, 75235, USA. tandon.animesh@gmail.com.
AD  - Division of Cardiology, Children's Health Children's Medical Center Dallas, 
      Dallas, TX, USA. tandon.animesh@gmail.com.
FAU - Mohan, Navina
AU  - Mohan N
AUID- ORCID: 0000-0002-6320-9579
AD  - Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District 
      Dr, Dallas, TX, 75235, USA.
FAU - Jensen, Cory
AU  - Jensen C
AD  - Circle Cardiovascular Imaging, Calgary, AB, Canada.
FAU - Burkhardt, Barbara E U
AU  - Burkhardt BEU
AUID- ORCID: 0000-0002-0412-9958
AD  - Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District 
      Dr, Dallas, TX, 75235, USA.
AD  - Division of Cardiology, Children's Health Children's Medical Center Dallas, 
      Dallas, TX, USA.
AD  - Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University 
      Children's- Hospital Zurich, Zurich, Switzerland.
FAU - Gooty, Vasu
AU  - Gooty V
AUID- ORCID: 0000-0002-1826-3568
AD  - Department of Pediatrics, LeBonheur Children's Hospital and University of 
      Tennessee, Memphis, TN, USA.
FAU - Castellanos, Daniel A
AU  - Castellanos DA
AUID- ORCID: 0000-0003-1188-5257
AD  - Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District 
      Dr, Dallas, TX, 75235, USA.
AD  - Division of Cardiology, Children's Health Children's Medical Center Dallas, 
      Dallas, TX, USA.
FAU - McKenzie, Paige L
AU  - McKenzie PL
AUID- ORCID: 0000-0002-5324-8507
AD  - Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District 
      Dr, Dallas, TX, 75235, USA.
FAU - Zahr, Riad Abou
AU  - Zahr RA
AUID- ORCID: 0000-0001-5208-5331
AD  - Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District 
      Dr, Dallas, TX, 75235, USA.
AD  - Division of Cardiology, Children's Health Children's Medical Center Dallas, 
      Dallas, TX, USA.
AD  - King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
FAU - Bhattaru, Abhijit
AU  - Bhattaru A
AUID- ORCID: 0000-0002-1383-1992
AD  - Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District 
      Dr, Dallas, TX, 75235, USA.
AD  - Division of Cardiology, Children's Health Children's Medical Center Dallas, 
      Dallas, TX, USA.
FAU - Abdulkarim, Mubeena
AU  - Abdulkarim M
AUID- ORCID: 0000-0002-1607-8537
AD  - Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District 
      Dr, Dallas, TX, 75235, USA.
AD  - Division of Cardiology, Children's Health Children's Medical Center Dallas, 
      Dallas, TX, USA.
FAU - Amir-Khalili, Alborz
AU  - Amir-Khalili A
AUID- ORCID: 0000-0003-1499-829X
AD  - Circle Cardiovascular Imaging, Calgary, AB, Canada.
FAU - Sojoudi, Alireza
AU  - Sojoudi A
AUID- ORCID: 0000-0002-2727-8091
AD  - Circle Cardiovascular Imaging, Calgary, AB, Canada.
FAU - Rodriguez, Stephen M
AU  - Rodriguez SM
AD  - Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District 
      Dr, Dallas, TX, 75235, USA.
FAU - Dillenbeck, Jeanne
AU  - Dillenbeck J
AD  - Department of Radiology, UT Southwestern Medical Center, 1935 Medical District 
      Dr, Dallas, TX, 75235, USA.
FAU - Greil, Gerald F
AU  - Greil GF
AUID- ORCID: 0000-0001-7288-6566
AD  - Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District 
      Dr, Dallas, TX, 75235, USA.
AD  - Department of Radiology, UT Southwestern Medical Center, 1935 Medical District 
      Dr, Dallas, TX, 75235, USA.
AD  - Division of Cardiology, Children's Health Children's Medical Center Dallas, 
      Dallas, TX, USA.
FAU - Hussain, Tarique
AU  - Hussain T
AUID- ORCID: 0000-0003-4091-992X
AD  - Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District 
      Dr, Dallas, TX, 75235, USA.
AD  - Department of Radiology, UT Southwestern Medical Center, 1935 Medical District 
      Dr, Dallas, TX, 75235, USA.
AD  - Division of Cardiology, Children's Health Children's Medical Center Dallas, 
      Dallas, TX, USA.
LA  - eng
PT  - Journal Article
DEP - 20210104
PL  - United States
TA  - Pediatr Cardiol
JT  - Pediatric cardiology
JID - 8003849
SB  - IM
MH  - Adult
MH  - *Algorithms
MH  - Case-Control Studies
MH  - Female
MH  - Heart Ventricles/anatomy & histology/*diagnostic imaging
MH  - Humans
MH  - Magnetic Resonance Imaging/methods
MH  - Male
MH  - *Neural Networks, Computer
MH  - Tetralogy of Fallot/*diagnostic imaging
PMC - PMC7990832
OTO - NOTNLM
OT  - Congenital heart disease
OT  - Convolutional neural network
OT  - Machine learning
OT  - Tetralogy of fallot
OT  - Ventricular contouring
COIS- CJ, AAK, and AS are employees of Circle Cardiovascular Imaging, Calgary, CA. AT 
      has ownership interests: modest: NVIDIA; significant: Amazon, Alphabet. All other 
      authors report no relevant relationships with industry. Circle Cardiovascular 
      Imaging did not have control over inclusion of any data or data analysis.
EDAT- 2021/01/05 06:00
MHDA- 2021/05/27 06:00
PMCR- 2021/01/04
CRDT- 2021/01/04 12:14
PHST- 2020/09/13 00:00 [received]
PHST- 2020/12/03 00:00 [accepted]
PHST- 2021/01/05 06:00 [pubmed]
PHST- 2021/05/27 06:00 [medline]
PHST- 2021/01/04 12:14 [entrez]
PHST- 2021/01/04 00:00 [pmc-release]
AID - 10.1007/s00246-020-02518-5 [pii]
AID - 2518 [pii]
AID - 10.1007/s00246-020-02518-5 [doi]
PST - ppublish
SO  - Pediatr Cardiol. 2021 Mar;42(3):578-589. doi: 10.1007/s00246-020-02518-5. Epub 
      2021 Jan 4.