Left Atrial Appendage Segmentation Using Fully Convolutional Neural Networks and Modified Three-Dimensional Conditional Random Fields

Thrombosis has become a global disease threatening human health. The left atrial appendage (LAA) is a major source of thrombosis in patients with atrial fibrillation (AF). Positive correlation exists between LAA volume and AF risk. LAA morphology has been suggested to influence thromboembolic risk in AF patients and to help predict thromboembolic events in low-risk patient groups. Automatic segmentation of LAA can greatly help physicians diagnose AF. In consideration of the large anatomical variations of the LAA, we proposed a robust method for automatic LAA segmentation on computed tomographic angiography (CTA) data using fully convolutional neural networks with three-dimensional (3–D) conditional random fields (CRFs). After manual localization of ROI of LAA, we adopted the FCN in natural image segmentation and transferred their learned models by fine-tuning the networks to segment each 2–D LAA slice. Subsequently, we used a modified dense 3–D CRF that accounts for the 3–D spatial information and larger contextual information to refine the segmentations of all slices. Our method was evaluated on 150 sets of CTA data using five-fold cross validation. Compared with manual annotation, we obtained a mean dice overlap of $\text{94.76}\%$ and a mean volume overlap of $\text{91.10}\%$ with a computation time of less than 40 s per volume. Experimental results demonstrated the robustness of our method in dealing with large anatomical variations and computational efficiency for adoption in a daily clinical routine.)