Error correcting 2D-3D cascaded network for myocardial infarct scar segmentation on late gadolinium enhancement cardiac magnetic resonance images

Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging is considered the in vivo reference standard for assessing infarct size (IS) and microvascular obstruction (MVO) in ST-elevation myocardial infarction (STEMI) patients. However, the exact quantification of those markers of myocardial infarct severity remains challenging and very time-consuming. As LGE distribution patterns can be quite complex and hard to delineate from the blood pool or epicardial fat, automatic segmentation of LGE CMR images is challenging. In this work, we propose a cascaded framework of two-dimensional and three-dimensional convolutional neural networks (CNNs) which enables to calculate the extent of myocardial infarction in a fully automated way. By artificially generating segmentation errors which are characteristic for 2D CNNs during training of the cascaded framework we are enforcing the detection and correction of 2D segmentation errors and hence improve the segmentation accuracy of the entire method. The proposed method was trained and evaluated in a five-fold cross validation using the training dataset from the EMIDEC challenge. We perform comparative experiments where our framework outperforms state-of-the-art methods of the EMIDEC challenge, as well as 2D and 3D nnU-Net. Furthermore, in extensive ablation studies we show the advantages that come with the proposed error correcting cascaded method.