Fully Automated Assessment of Cardiac Chamber Volumes and Myocardial Mass on Non-Contrast Chest CT with a Deep Learning Model: Validation Against Cardiac MR

<b>Background</b>: To validate the automated quantification of cardiac chamber volumes and myocardial mass on non-contrast chest CT using cardiac MR (CMR) as a reference. <b>Methods</b>: We retrospectively included 53 consecutive patients who received non-contrast chest CT and CMR within three weeks. A deep learning model created cardiac segmentations on axial soft-tissue reconstructions from CT, covering all four cardiac chambers and the left ventricular myocardium. Segmentations on CMR cine short-axis and long-axis images served as a reference. Standard estimates of diagnostic accuracy were calculated for ventricular volumes at end-diastole and end-systole (LVEDV, LVESV, RVEDV, RVESV), left ventricular mass (LVM), and atrial volumes (LA, RA) at ventricular end-diastole. A qualitative assessment noted segmentation issues. <b>Results</b>: The deep learning model generated CT measurements for 52 of the 53 patients (98%). Based on CMR measurements, the average LVEDV was 166 ± 64 mL, RVEDV was 144 ± 51 mL, and LVM was 115 ± 39 g. The CT measurements correlated well with CMR measurements for LVEDV, LVESV, and LVM (ICC = 0.85, ICC = 0.84, and ICC = 0.91; all <i>p</i> < 0.001) and RVEDV and RVESV (ICC = 0.79 and ICC= 0.78; both <i>p</i> < 0.001), and moderately well with LA and RA (ICC = 0.74 and ICC = 0.61; both <i>p</i> < 0.001). Absolute agreements likewise favored LVEDV, LVM, and RVEDV. ECG-gating did not relevantly influence the results. The CT results correctly identified 7/15 LV and 1/1 RV as dilated (one and six false positives, respectively). Major qualitative issues were found in three cases (6%). <b>Conclusions</b>: Automated cardiac chamber volume and myocardial mass quantification on non-contrast chest CT produced viable measurements in this retrospective sample. <b>Relevance Statement</b>: An automated cardiac assessment on non-contrast chest CT provides quantitative morphological data on the heart, enabling a preliminary organ evaluation that aids in incidentally identifying at-risk patients who may benefit from a more targeted diagnostic workup.