Computer-Assisted Algorithm for Quantification of Fibrosis by Native Cardiac CT: A Pilot Study

<b>Background/Objectives:</b> Recent advances in artificial intelligence, particularly in cardiac imaging, can potentially enhance patients' diagnosis and prognosis and identify novel imaging markers. We propose an automated, computer-aided algorithm utilizing native cardiac computed tomography (CT) imaging to identify myocardial fibrosis. This study aims to evaluate its performance compared to CMR markers of fibrosis in a cohort of patients diagnosed with breast cancer. <b>Methods:</b> The study included patients diagnosed with early HER2+ breast cancer, who presented LV dysfunction (LVEF < 50%) and myocardial fibrosis detected on CMR at the time of diagnosis. The patients were also evaluated by cardiac CT, and the extracted images were processed for the implementation of the automatic, computer-assisted algorithm, which marked as fibrosis every pixel that fell within the range of 60-90 HU. The percentage of pixels with fibrosis was subsequently compared with CMR parameters. <b>Results:</b> A total of eight patients (n = 8) were included in the study. High positive correlations between the algorithm's result and the ECV fraction (r = 0.59, <i>p</i> = 0.126) and native T1 (r = 0.6, <i>p</i> = 0.112) were observed, and a very high positive correlation with LGE of the LV(g) and the LV-LGE/LV mass percentage (r = 0.77, <i>p</i> = 0.025; r = 0.81, <i>p</i> = 0.015). A very high negative correlation was found with GLS (r = -0.77, <i>p</i> = 0.026). The algorithm presented an intraclass correlation coefficient of 1 (95% CI 0.99-1), <i>p</i> < 0.001. <b>Conclusions:</b> The present pilot study proposes a novel promising imaging marker for myocardial fibrosis, generated by an automatic algorithm based on native cardiac CT images.