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PurposeTo demonstrate the feasibility and performance of a fully automated deep learning framework to estimate myocardial strain from short-axis cardiac MRI-tagged images.Materials and methodsIn this retrospective cross-sectional study, 4508 cases from the U.K. Biobank were split randomly into 3244 training cases, 812 validation cases, and 452 test cases. Ground truth myocardial landmarks were defined and tracked by manual initialization and correction of deformable image registration using previously validated software with five readers. The fully automatic framework consisted of (a) a convolutional neural network (CNN) for localization and (b) a combination of a recurrent neural network (RNN) and a CNN to detect and track the myocardial landmarks through the image sequence for each slice. Radial and circumferential strain were then calculated from the motion of the landmarks and averaged on a slice basis.ResultsWithin the test set, myocardial end-systolic circumferential Green strain errors were -0.001 ± 0.025, -0.001 ± 0.021, and 0.004 ± 0.035 in the basal, mid-, and apical slices, respectively (mean ± standard deviation of differences between predicted and manual strain). The framework reproduced significant reductions in circumferential strain in participants with diabetes, hypertensive participants, and participants with a previous heart attack. Typical processing time was approximately 260 frames (approximately 13 slices) per second on a GPU with 12 GB RAM compared with 6-8 minutes per slice for the manual analysis.ConclusionThe fully automated combined RNN and CNN framework for analysis of myocardial strain enabled unbiased strain evaluation in a high-throughput workflow, with similar ability to distinguish impairment due to diabetes, hypertension, and previous heart attack.Published under a CC BY 4.0 license. Supplemental material is available for this article.

Original publication




Journal article


Radiology. Cardiothoracic imaging

Publication Date





Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King's College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.).