Deep Learning Pipeline for Fully Automated Myocardial Infarct Segmentation from Clinical Cardiac MR Scans

Purpose: To develop and evaluate a deep learning-based method that allows to perform myocardial infarct segmentation in a fully-automated way. Materials and Methods: For this retrospective study, a cascaded framework of two and three-dimensional convolutional neural networks (CNNs), specialized on identifying ischemic myocardial scars on late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) images, was trained on an in-house training dataset consisting of 144 examinations. On a separate test dataset from the same institution, including images from 152 examinations obtained between 2021 and 2023, a quantitative comparison between artificial intelligence (AI)-based segmentations and manual segmentations was performed. Further, qualitative assessment of segmentation accuracy was evaluated for both human and AI-generated contours by two CMR experts in a blinded experiment. Results: Excellent agreement could be found between manually and automatically calculated infarct volumes ($\rho_c$ = 0.9). The qualitative evaluation showed that compared to human-based measurements, the experts rated the AI-based segmentations to better represent the actual extent of infarction significantly (p < 0.001) more often (33.4% AI, 25.1% human, 41.5% equal). On the contrary, for segmentation of microvascular obstruction (MVO), manual measurements were still preferred (11.3% AI, 55.6% human, 33.1% equal). Conclusion: This fully-automated segmentation pipeline enables CMR infarct size to be calculated in a very short time and without requiring any pre-processing of the input images while matching the segmentation quality of trained human observers. In a blinded experiment, experts preferred automated infarct segmentations more often than manual segmentations, paving the way for a potential clinical application.