Multi-Structure Segmentation of Type B Aortic Dissection from CT Images with U-Net

Type B aortic dissection (TBAD) is a life-threatening condition in which a tear in the intimal layer separates the aortic wall into a true and a false lumen. Assessment of the lumen, the intimal flap, and false-lumen thrombosis from CT images is important for risk analysis and treatment planning. This work applied U-Net-based deep neural networks to the automatic segmentation of these structures in TBAD. We collected 46 CT scans from 20 patients, with voxel-wise annotations of three structures: the aortic lumen, the intimal flap, and the thrombus. We explored four models: two convolutional networks, nnU-Net 2D and 3D, and two transformer-based architectures, TransUNet 2D and 3D. We observed that (1) for both nnU-Net and TransUNet, the 3D models outperformed their 2D counterparts on all three structures. The difference was small for the aortic lumen but large for the thin flap and the thrombus. The best model, nnU-Net 3D, reached a DSC of 93.05% for the lumen, 50.22% for the flap, and 69.94% for the thrombus. (2) The intimal flap was the most difficult structure for all models. Even the best 3D models showed large thrombus boundary errors in a few scans. These results provide a baseline for developing more advanced models for accurate segmentation of these structures in TBAD.