Automated Cardiac Reorientation and Slice Extraction in Cine Coronary CT Angiography: Agreement with Cardiovascular Magnetic Resonance

Visualization of coronary computed tomography angiography (CCTA) in standard cardiac planes requires reorientation of the three-dimensional image volume because the heart is double-oblique relative to the axial scan plane. To standardize this process across multi-phase cine CCTA, we developed an automated framework that segments cardiac structures and detects anatomic landmarks to define a patient-specific cardiac coordinate system. Landmark-derived left ventricular (LV) long-axis and LV-to-right ventricular transverse vectors were used to compute a rotation matrix for reorienting all 20 cine CCTA volumes. Six fixed slice planes were then defined to extract three long-axis (LAX) and three short-axis (SAX) slices at each phase. Matched CCTA and cardiac magnetic resonance (MR) slices were compared in 25 patients at diastasis, end-diastole (ED), and end-systole (ES), using automated segmentation-derived measurements of the combined LV cavity and LV myocardium area (LV + LVM). Agreement was evaluated with intraclass correlation coefficients (ICCs), Bland–Altman analysis, and repeated-measures mixed-effects models. ICCs were 0.927 (95% CI, 0.895 to 0.950) at diastasis, 0.950 (95% CI, 0.928 to 0.966) at ED, and 0.919 (95% CI, 0.887 to 0.943) at ES. Bland–Altman analysis showed small CT-positive biases of 1.05, 0.47, and 1.86 cm2 at diastasis, ED, and ES, corresponding to relative biases of 2.8%, 1.2%, and 5.8% of the phase-specific mean MR LV + LVM area. Mixed-effects models showed no statistically significant phase-level bias at diastasis or ED, whereas ES showed a small but significant CT-positive bias. These findings support automated CCTA reorientation as an interpretable framework for reproducible LAX/SAX slice extraction and future quantitative functional cine CCTA analysis.