IMR Press / RCM / Volume 23 / Issue 12 / DOI: 10.31083/j.rcm2312412
Open Access Original Research
Quantification of Epicardial Adipose Tissue Volume and Attenuation for Cardiac CT Scans Using Deep Learning in a Single Multi-Task Framework
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1 Barts Heart Centre, Barts Health National Health Service (NHS) Trust, EC1A 4NP London, UK
2 National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, E1 4NS London, UK
3 Health Data Research UK, NW1 2BE London, UK
4 Georgetown University School of Medicine, Washington, DC 20007, USA
5 Duke University Hospital, Durham, North Carolina, NC 27710, USA
6 Montefiore Medical Centre, Bronx, NY 10467, USA
7 Northeastern University, Boston, MA 02115, USA
8 MedStar Heart and Vascular Institute, Washington, DC 20010, USA
9 Veterans Affairs Medical Center, Washington, DC 20422, USA
10 The Alan Turing Institute, NW1 2BE London, UK
*Correspondence: musa.abdulkareem@nhs.net (Musa Abdulkareem)
These authors contributed equally.
Academic Editor: Zhonghua Sun
Rev. Cardiovasc. Med. 2022, 23(12), 412; https://doi.org/10.31083/j.rcm2312412
Submitted: 19 July 2022 | Revised: 21 October 2022 | Accepted: 26 October 2022 | Published: 20 December 2022
(This article belongs to the Special Issue New Advances in Cardiac CT Angiography)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: Recent studies have shown that epicardial adipose tissue (EAT) is an independent atrial fibrillation (AF) prognostic marker and has influence on the myocardial function. In computed tomography (CT), EAT volume (EATv) and density (EATd) are parameters that are often used to quantify EAT. While increased EATv has been found to correlate with the prevalence and the recurrence of AF after ablation therapy, higher EATd correlates with inflammation due to arrest of lipid maturation and with high risk of plaque presence and plaque progression. Automation of the quantification task diminishes the variability in readings introduced by different observers in manual quantification and results in high reproducibility of studies and less time-consuming analysis. Our objective is to develop a fully automated quantification of EATv and EATd using a deep learning (DL) framework. Methods: We proposed a framework that consists of image classification and segmentation DL models and performs the task of selecting images with EAT from all the CT images acquired for a patient, and the task of segmenting the EAT from the output images of the preceding task. EATv and EATd are estimated using the segmentation masks to define the region of interest. For our experiments, a 300-patient dataset was divided into two subsets, each consisting of 150 patients: Dataset 1 (41,979 CT slices) for training the DL models, and Dataset 2 (36,428 CT slices) for evaluating the quantification of EATv and EATd. Results: The classification model achieved accuracies of 98% for precision, recall and F1 scores, and the segmentation model achieved accuracies in terms of mean (± std.) and median dice similarity coefficient scores of 0.844 (± 0.19) and 0.84, respectively. Using the evaluation set (Dataset 2), our approach resulted in a Pearson correlation coefficient of 0.971 (R2 = 0.943) between the label and predicted EATv, and the correlation coefficient of 0.972 (R2 = 0.945) between the label and predicted EATd. Conclusions: We proposed a framework that provides a fast and robust strategy for accurate EAT segmentation, and volume (EATv) and attenuation (EATd) quantification tasks. The framework will be useful to clinicians and other practitioners for carrying out reproducible EAT quantification at patient level or for large cohorts and high-throughput projects.

Keywords
deep learning
CT
epicardial adipose tissue
EAT
volume
attenuation
density
Funding
EP/P001009/1/National Institute for Health Research (NIHR) Biomedical Research Centre at Barts
AI4VBH/London Medical Imaging and AI Center for Value-Based Healthcare
825903/European Union’s Horizon 2020 research and in-novation programme
Figures
Fig. 1.
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