Towards Full Automation of Geometry Extraction for Biomechanical Analysis of Abdominal Aortic Aneurysm; Neural Network-Based versus Classical Methodologies

Abstract

Background: For the clinical adoption of stress-based rupture risk estimation in abdominal aortic aneurysms (AAAs), a fully automated pipeline, from clinical imaging to biomechanical stress computation, is essential. To this end, we investigated the impact of AI-based image segmentation methods on stress computation results in the walls of AAAs. We compared wall stress distributions and magnitudes calculated from geometry models obtained from classical semi-automated segmentation versus automated neural network-based segmentation. Method: 16 different AAA contrast-enhanced computed tomography (CT) images were semi-automatically segmented by an analyst, taking between 15 and 40 minutes of human effort per patient, depending on image quality. The same images were automatically segmented using PRAEVAorta2 commercial software by NUREA (https://www.nurea-soft.com/), developed based on artificial intelligence (AI) algorithms, and automatically post-processed with an in-house MATLAB code, requiring only 1-2 minutes of computer time per patient. Aneurysm wall stress calculations were automatically performed using the BioPARR software (https://bioparr.mech.uwa.edu.au/). Results: Compared to the classical semi-automated segmentation, the automatic neural network-based segmentation leads to equivalent stress distributions, and slightly higher peak and 99th percentile maximum principal stress values. However, our statistical analysis indicated that the differences in AAA wall stress obtained using the two segmentation methods are not statistically significant and fall well within the typical range of inter-analyst and intra-analyst variability. Conclusions: Our findings are a steppingstone toward a fully automated pipeline for biomechanical analysis of AAAs, starting with CT scans and concluding with wall stress assessment.