Improved Tagged Cardiac MRI Myocardium Strain Analysis by Leveraging Cine Segmentation

Abstract Background and objectives: Tagged MR images provide an effective way for regional analysis of the myocardium strain. A reliable myocardium strain analysis requires both correct segmentation and accurate motion tracking of the myocardium during the cardiac cycle. While many algorithms have been proposed for accurate tracking of the myocardium in tagged MR images, little focus has been placed on ensuring correct segmentation of the tagged myocardium during the cardiac cycle. Myocardial strain analysis is usually done by segmenting the myocardium in end-diastole, generating a mesh from the segmentation, propagating the mesh through the cardiac cycle using the output deformation field from motion tracking, and measuring strain on the deforming mesh. Due to the imposed tag strips on the anatomy, identification of the myocardium boundaries is challenging in tagged MR images. As a result, there is no guarantee that the propagated mesh is annotating the myocardium accurately through the cardiac cycle. Moreover, clinical studies indicate that incorrect myocardium annotation can result in overestimation of myocardial strains. Methods: We introduce a method to improve reliability of strain analysis by proposing a mesh which correctly segments the myocardium in tagged MRI by leveraging the available cine MRI segmentation. In particular, we generate a series of mesh proposals using the cine MRI segmentation and find the propagated mesh proposal which gives the most accurate full-cycle myocardium segmentation. Results: The mesh selection algorithm was tested on 22 2D MRI scans of diseased and healthy hearts. The proposed algorithm provided more accurate whole-cycle myocardium segmentation compared to the propagated end-diastolic mesh. Regional myocardium strain was measured for 10 3D MRI scans of healthy volunteers using the proposed mesh and the end-diastolic mesh. The measured strain using the proposed mesh was more similar to the expected myocardium strain for a healthy heart than the measured strain using the end-diastolic mesh. Conclusion: The proposed approach provides accurate whole-cycle tagged myocardium segmentation and more reliable myocardium strain analysis.