Cardiac Segmentation on CT Images through Shape-Aware Contour Attentions

Cardiac segmentation of atriums, ventricles, and myocardium in computed tomography (CT) images is an important first-line task for presymptomatic cardiovascular disease diagnosis. In several recent studies, deep learning models have shown significant breakthroughs in medical image segmentation tasks. Unlike other organs such as the lungs and liver, the cardiac organ consists of multiple substructures, i.e., ventricles, atriums, aortas, arteries, veins, and myocardium. These cardiac substructures are proximate to each other and have indiscernible boundaries (i.e., homogeneous intensity values), making it difficult for the segmentation network focus on the boundaries between the substructures. In this paper, to improve the segmentation accuracy between proximate organs, we introduce a novel model to exploit shape and boundary-aware features. We primarily propose a shape-aware attention module, that exploits distance regression, which can guide the model to focus on the edges between substructures so that it can outperform the conventional contour-based attention method. In the experiments, we used the Multi-Modality Whole Heart Segmentation dataset that has 20 CT cardiac images for training and validation, and 40 CT cardiac images for testing. The experimental results show that the proposed network produces more accurate results than state-of-the-art networks by improving the Dice similarity coefficient score by 4.97%. Our proposed shape-aware contour attention mechanism demonstrates that distance transformation and boundary features improve the actual attention map to strengthen the responses in the boundary area. Moreover, our proposed method significantly reduces the false-positive responses of the final output, resulting in accurate segmentation.