Automated identification of myocardial perfusion defects in dynamic cardiac computed tomography using deep learning

Purpose: The purpose of this study was to develop and evaluate deep convolutional neural network (CNN) models for quantifying myocardial blood flow (MBF) as well as for identifying myocardial perfusion defects in dynamic cardiac computed tomography (CT) images.Methods: Adenosine stress cardiac CT perfusion data acquired from 156 patients having or being suspected with coronary artery disease were considered for model development and validation. U-net-based deep CNN models were developed to segment the aorta and myocardium and to localize anatomical landmarks. Color-coded MBF maps were obtained in short-axis slices from the apex to the base level and were used to train a deep CNN classifier. Three binary classification models were built for the detection of perfusion defect in the left anterior descending artery (LAD), the right coronary artery (RCA), and the left circumflex artery (LCX) territories.Results: Mean Dice scores were 0.94 (+/- 0.07) and 0.86 (+/- 0.06) for the aorta and myocardial deep learning-based segmentations, respectively. With the localization U-net, mean distance errors were 3.5 (+/- 3.5) mm and 3.8 (+/- 2.4) mm for the basal and apical center points, respectively. The classification models identified perfusion defects with the accuracy of mean area under the receiver operating curve (AUROC) values of 0.959 (+/- 0.023) for LAD, 0.949 (+/- 0.016) for RCA, and 0.957 (+/- 0.021) for LCX.Conclusion: The presented method has the potential to fully automate the quantification of MBF and subsequently identify the main coronary artery territories with myocardial perfusion defects in dynamic cardiac CT perfusion.