On the accuracy of the segmentation process and transcatheter heart valve dimensions in TAVI patients

Accurate segmentation of medical images is critical for generating patient-specific models suitable for computational analyses, particularly in the context of transcatheter aortic valve implantation (TAVI). This study aimed to quantify the accuracy of the segmentation process from medical images of TAVI patients to understand the uncertainty in patient-specific geometries. We also quantified discrepancies between actual and CT-related diameter measurements due to artifacts and intra-observer variability. Segmentation accuracy was assessed using both synthetic phantom models and patient-specific data. The impact of voxelization and CT scanner resolution on segmentation accuracy was evaluated, while the intersection over union (IoU) metric was used to compare the consistency of different segmentation methodologies. The voxelization process introduced a marginal error (<1%) in phantom models relative to CAD models. CT scanner resolution impacted segmented model accuracy only after a 7.5-fold increase in voxel size compared to the baseline medical image. IoU analysis revealed higher segmentation accuracy for calcification (93.4 ± 3.1 %) compared to the aortic wall (85.4 ± 8.4 %) and native valve leaflets (75.5 ± 6.3 %). Discrepancies in THV diameter measurements highlighted a ∼5 % error due to metallic artifacts, with variability among observers and at different THV heights. Errors due to voxel size, segmentation methodologies and CT-related artifacts can impact the reliability of patient-specific geometries and ultimately computational predictions used to asses clinical outcomes and enhance decision-making. This study underscores the importance of accurate segmentation and its standardization for patient-specific modeling of TAVI simulations.