One-Click CT-Based Pipeline for Regional Quantification of Aortic Valve Fibrocalcific Degeneration

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PURPOSE: Aortic Stenosis (AS) involves progressive fibrocalcific degeneration of the aortic valve. Current imaging methods for valve tissue quantification remain semi-automated and lack detailed spatial tissue characterization. We present a CT-based pipeline that fully automates the quantification of fibrotic and calcific components and enables semi-automated regional tissue analysis. METHODS: We developed a standardized pipeline that performs automatic multiplanar reconstruction of pre-TAVI cardiac CT scans, automatic fibrocalcific volume quantification, and semi-automated regional volume assessment requiring only a single user input. We evaluated the accuracy of the pipeline by comparing each module with manual analyses performed independently by two radiologists with different levels of expertise. Agreement between automated and manual results was assessed using Bland-Altman analysis and standard similarity metrics. RESULTS: We analyzed 25 patients with severe AS (13 females/12 males; median age 82 years, IQR 78-86). The pipeline processed for each patient in ≤ 2.5 min. Multiplanar reconstruction showed an angular error of 5.38° (IQR 3.29-8.33) between the expert user and the pipeline. Bland-Altman analysis revealed minimal bias for fibrocalcific volume and density, comparable to inter-user variability. Expert-pipeline Dice coefficients for regional divisions were high (0.86-0.89), and entropy of fibrocalcific ratio demonstrated substantial tissue heterogeneity among patients. CONCLUSION: The proposed pipeline enables accurate assessment of aortic valve disease severity by integrating fibrotic and calcific quantification with spatial distribution, offering potential to inform TAVI planning and clinical decision-making with minimal user input and analysis time. TRIAL REGISTRATION: NCT06029400, registered on 1 September 2023.

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