Automated Assessment of the Pulmonary Artery-to-Ascending Aorta Ratio in Fetal Cardiac Ultrasound Screening Using Artificial Intelligence

The three-vessel view (3VV) is a standardized transverse scanning plane used in fetal cardiac ultrasound screening to measure the absolute and relative diameters of the pulmonary artery (PA), ascending aorta (Ao), and superior vena cava, as required. The PA/Ao ratio is used to support the diagnosis of congenital heart disease (CHD). However, vascular diameters are measured manually by examiners, which causes intra- and interobserver variability in clinical practice. In the present study, we aimed to develop an artificial intelligence-based method for the standardized and quantitative evaluation of 3VV. In total, 315 cases and 20 examiners were included in this study. We used the object-detection software YOLOv7 for the automated extraction of 3VV images and compared three segmentation algorithms: DeepLabv3+, UNet3+, and SegFormer. Using the PA/Ao ratios based on vascular segmentation, YOLOv7 plus UNet3+ yielded the most appropriate classification for normal fetuses and those with CHD. Furthermore, YOLOv7 plus UNet3+ achieved an arithmetic mean value of 0.883 for the area under the receiver operating characteristic curve, which was higher than 0.749 for residents and 0.808 for fellows. Our automated method may support unskilled examiners in performing quantitative and objective assessments of 3VV images during fetal cardiac ultrasound screening.