Contrast-Free CMR-based Transcatheter Aortic Valve Implantation Planning: Aortic Annulus and Coronary Ostias detection

Motivation: Contrast-enhanced CT is the gold-standard for TAVI planning but is not suitable for patients with kidney disease. Contrast-free MRI-guided planning is a reliable alternative, offering similar accuracy and implantation success. Goal(s): Propose a fully-automated pipeline for TAVI planning using contrast-free MRI. Segmenting the Aortic Annulus and identifying the coronary ostias. Approach: AA Segmentation: Segment the aorta, apply an aorta unfolding method to detect the hinge easily and fold it back to obtain the AA virtual plane. Coronary Ostia: Aorta+coronaries segmentation and identify the intersection points. Results: MAE AA diameter of 2.279±0.922mm, AA axial direction RMSE of 2.671±1.111mm and ostium MAE of 2.24±1.63mm. Impact: Our CMR based TAVI planning algorithm advances by automating pre-procedural assessments without iodinated contrast. For the AA segmentation, the double-network architecture and the unwrapping technique effectively address the challenge of segmenting a virtual plane. Blind tests reafirm our results.