Fully automatic segmentation of left atrium and pulmonary veins in late gadolinium-enhanced MRI: Towards objective atrial scar assessment

Qian Tao, Esra Gucuk Ipek, Rahil Shahzad, Floris F. Berendsen, Saman Nazarian, Rob J. van der Geest

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Purpose: To realize objective atrial scar assessment, this study aimed to develop a fully automatic method to segment the left atrium (LA) and pulmonary veins (PV) from late gadolinium-enhanced (LGE) magnetic resonance imaging (MRI). The extent and distribution of atrial scar, visualized by LGE-MRI, provides important information for clinical treatment of atrial fibrillation (AF) patients. Materials and Methods: Forty-six AF patients (age 62 ± 8, 14 female) who underwent cardiac MRI prior to RF ablation were included. A contrast-enhanced MR angiography (MRA) sequence was acquired for anatomy assessment followed by an LGE sequence for LA scar assessment. A fully automatic segmentation method was proposed consisting of two stages: 1) global segmentation by multiatlas registration; and 2) local refinement by 3D level-set. These automatic segmentation results were compared with manual segmentation. Results: The LA and PVs were automatically segmented in all subjects. Compared with manual segmentation, the method yielded a surface-to-surface distance of 1.49 ± 0.65 mm in the LA region when using both MRA and LGE, and 1.80 ± 0.93 mm when using LGE alone (P < 0.05). In the PV regions, the distance was 2.13 ± 0.67 mm and 2.46 ± 1.81 mm (P < 0.05), respectively. The difference between automatic and manual segmentation was comparable to the interobserver difference (P = 0.8 in LA region and P = 0.7 in PV region). Conclusion: We developed a fully automatic method for LA and PV segmentation from LGE-MRI, with comparable performance to a human observer. Inclusion of an MRA sequence further improves the segmentation accuracy. The method leads to automatic generation of a patient-specific model, and potentially enables objective atrial scar assessment for AF patients. J. Magn. Reson. Imaging 2016;44:346–354.

Original languageEnglish (US)
Pages (from-to)346-354
Number of pages9
JournalJournal of Magnetic Resonance Imaging
Issue number2
StatePublished - Aug 1 2016


  • MRA
  • automatic segmentation
  • left atrium
  • pulmonary veins

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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