Deep learning-based multi-stage postoperative type-b aortic dissection segmentation using global-local fusion learning

Objective. Type-b aortic dissection (AD) is a life-threatening cardiovascular disease and the primary treatment is thoracic endovascular aortic repair (TEVAR). Due to the lack of a rapid and accurate segmentation technique, the patient-specific postoperative AD model is unavailable in clinical practice, resulting in impracticable 3D morphological and hemodynamic analyses during TEVAR assessment. This work aims to construct a deep learning-based segmentation framework for postoperative type-b AD. Approach. The segmentation is performed in a two-stage manner. A multi-class segmentation of the contrast-enhanced aorta, thrombus (TH), and branch vessels (BV) is achieved in the first stage based on the cropped image patches. True lumen (TL) and false lumen (FL) are extracted from a straightened image containing the entire aorta in the second stage. A global-local fusion learning mechanism is designed to improve the segmentation of TH and BR by compensating for the missing contextual features of the cropped images in the first stage. Results. The experiments are conducted on a multi-center dataset comprising 133 patients with 306 follow-up images. Our framework achieves the state-of-the-art dice similarity coefficient (DSC) of 0.962, 0.921, 0.811, and 0.884 for TL, FL, TH, and BV, respectively. The global-local fusion learning mechanism increases the DSC of TH and BV by 2.3% (p < 0.05) and 1.4% (p < 0.05), respectively, based on the baseline. Segmenting TH in stage 1 can achieve significantly better DSC for FL (0.921 ± 0.055 versus 0.857 ± 0.220, p < 0.01) and TH (0.811 ± 0.137 versus 0.797 ± 0.146, p < 0.05) than in stage 2. Our framework supports more accurate vascular volume quantifications compared with previous segmentation model, especially for the patients with enlarged TH+FL after TEVAR, and shows good generalizability to different hospital settings. Significance. Our framework can quickly provide accurate patient-specific AD models, supporting the clinical practice of 3D morphological and hemodynamic analyses for quantitative and more comprehensive patient-specific TEVAR assessments.