Original Research Automated Interventricular Septum Segmentation for Black-Blood Myocardial T2* Measurement in Thalassemia Qian Zheng, PhD, 1,2 Yanqiu Feng, PhD, 1 * Xiaping Wei, BS, 1 Meiyan Feng, MS, 1 Wufan Chen, MS, 1 Zhentai Lu, PhD, 1 Yikai Xu, MD, 3 Hongwen Chen, MD, 4 and Taigang He, PhD 5,6 Purpose: To develop and validate an automated segmen- tation method that extracts the interventricular septum (IS) from myocardial black-blood images for the T2* mea- surement in thalassemia patients. Materials and Methods: A total of 144 thalassemia major patients (age range, 11–51 years; 73 males) were scanned with a black-blood multi-echo gradient-echo sequence using a 1.5 Tesla Siemens Sonata system (flip angle 20  , sampling bandwidth 810 Hz/pixel, voxel size 1.56  1.56  10 mm 3 and variable fields of view (20–30)  40 cm 2 depending on patient size). The improved Chan-Vese model with an automated initialization by the circular Hough transformation was implemented to segment the endocar- dial and epicardial margins of the left ventricle (LV). Conse- quently, the IS was extracted by analyzing the anatomical relation between the LV and the blood pool of the right ven- tricle, identified by intensity thresholding. The proposed automated IS segmentation (AISS) method was compared with the conventional manual method by using the Bland- Altman analysis and the coefficient of variation (CoV). Results: The T2* measurements using the AISS method were in good agreement with those manually measured by experienced observers with a mean difference of 1.71% and a CoV of 4.15% (P < 0.001). Conclusion: Black-blood myocardial T2* measurement can be fully automated with the proposed AISS method. Key Words: magnetic resonance (MR); myocardial T2*; black-blood imaging; iron overload; automated septum segmentation J. Magn. Reson. Imaging 2014;00:000–000. V C 2014 Wiley Periodicals, Inc. REGULAR BLOOD TRANSFUSION has greatly pro- longed survival and improved the quality of life for patients with hematological conditions, in particular those with thalassemia major (1,2). However, multiple transfusion therapy can result in progressive accumu- lation of iron, which can cause damage in many organs, particularly the liver, heart, and endocrine organs, ultimately leading to increased morbidity and mortality (2,3). Chelation therapy can remove exces- sive tissue iron from the body and reduce the risk of organ failure in these patients (4). Still, iron-induced cardiac dysfunction remains the leading cause of death in thalassemia patients (5), thus accurate and robust measurement of myocardial iron concentration is clinically vital for managing the treatment and assessing the prognosis in thalassemia patients (6). Myocardial iron deposits can be measured by using endomyocardial biopsy (7,8), but which is invasive with the risk of complications and uncertainty owing to the inhomogeneous myocardial iron distribution and quantification errors caused by very small biopsy samples (9,10). The iron content in the epicardium was found higher than that in the endocardium, and no systematic variation between segments (11). Mag- netic resonance has been established as a noninva- sive approach for detecting myocardial iron content (MIC) in various patients with iron overload (12,13). A single-slice breathhold bright-blood T2* method (14) has demonstrated good interstudy and intercenter reproducibilities (13,15,16) in MIC assessment and is widely used due to its speed, sensitivity, and wide 1 School of Biomedical Engineering, Southern Medical University, Guangzhou, China. 2 Zhengzhou University of Light Industry, Zhengzhou, China. 3 Department of Diagnostic Imaging Center, Nanfang Hospital, South- ern Medical University, Guangzhou, China. 4 Medical Apparatus and Equipment Department, Nanfang Hospital, Southern Medical University, Guangzhou, China. 5 Cardiovascular Sciences Research Centre, St George’s, University of London, London, United Kingdom. 6 Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom. This article was published online on 27 May 2014. An error was subse- quently identified. This notice is included in the online and print ver- sions to indicate that both have been corrected 10 September 2014. Contract grant sponsor: the National Basic Research Program of China; Contract grant number: 2010CB732502; Contract grant spon- sor: the National Natural Science Funds of China; Contract grant number: 81371539; Contract grant sponsor: the British Heart Foun- dation; Contract grant number: FS/08/26225. *Address reprint requests to: Y.F., School of Biomedical Engineering, Southern Medical University, Guangzhou, China. E-mail: foree@163. com Received January 7, 2014; Accepted April 28, 2014. DOI 10.1002/jmri.24662 View this article online at wileyonlinelibrary.com. JOURNAL OF MAGNETIC RESONANCE IMAGING 00:00–00 (2014) CME V C 2014 Wiley Periodicals, Inc. 1