“Global” cardiac atherosclerotic burden assessed by artificial intelligence-based versus manual segmentation in 18F-sodium fluoride PET/CT scans: Head-to-head comparison
Journal article, 2022

Background: Artificial intelligence (AI) is known to provide effective means to accelerate and facilitate clinical and research processes. So in this study it was aimed to compare a AI-based method for cardiac segmentation in positron emission tomography/computed tomography (PET/CT) scans with manual segmentation to assess global cardiac atherosclerosis burden. Methods: A trained convolutional neural network (CNN) was used for cardiac segmentation in 18F-sodium fluoride PET/CT scans of 29 healthy volunteers and 20 angina pectoris patients and compared with manual segmentation. Parameters for segmented volume (Vol) and mean, maximal, and total standardized uptake values (SUVmean, SUVmax, SUVtotal) were analyzed by Bland-Altman Limits of Agreement. Repeatability with AI-based assessment of the same scans is 100%. Repeatability (same conditions, same operator) and reproducibility (same conditions, two different operators) of manual segmentation was examined by re-segmentation in 25 randomly selected scans. Results: Mean (± SD) values with manual vs. CNN-based segmentation were Vol 617.65 ± 154.99 mL vs 625.26 ± 153.55 mL (P =.21), SUVmean 0.69 ± 0.15 vs 0.69 ± 0.15 (P =.26), SUVmax 2.68 ± 0.86 vs 2.77 ± 1.05 (P =.34), and SUVtotal 425.51 ± 138.93 vs 427.91 ± 132.68 (P =.62). Limits of agreement were − 89.42 to 74.2, − 0.02 to 0.02, − 1.52 to 1.32, and − 68.02 to 63.21, respectively. Manual segmentation lasted typically 30 minutes vs about one minute with the CNN-based approach. The maximal deviation at manual re-segmentation was for the four parameters 0% to 0.5% with the same and 0% to 1% with different operators. Conclusion: The CNN-based method was faster and provided values for Vol, SUVmean, SUVmax, and SUVtotal comparable to the manually obtained ones. This AI-based segmentation approach appears to offer a more reproducible and much faster substitute for slow and cumbersome manual segmentation of the heart.


sodium fluoride

artificial intelligence





Reza Piri

Odense Universitetshospital

University of Southern Denmark

L. Edenbrandt

Sahlgrenska University Hospital

University of Gothenburg

Måns Larsson

Eigenvision AB

Olof Enqvist

Imaging and Image Analysis

Eigenvision AB

Sofie Skovrup

Odense Universitetshospital

Kasper Karmark Iversen

Amtssygehuset i Gentofte

Babak Saboury

Hospital of the University of Pennsylvania

University of Maryland

NIH Clinical Center (CC)

Abass Alavi

Hospital of the University of Pennsylvania

Oke Gerke

Odense Universitetshospital

University of Southern Denmark

P. F. Hoilund-Carlsen

Odense Universitetshospital

University of Southern Denmark

Journal of Nuclear Cardiology

1071-3581 (ISSN) 1532-6551 (eISSN)

Vol. 29 5 2531-2539

Subject Categories

Medical Laboratory and Measurements Technologies

Radiology, Nuclear Medicine and Medical Imaging

Medical Image Processing





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