Automated 4-dimensional regional myocardial strain evaluation using cardiac computed tomography

Zvi Peled, Yechiel Lamash, Shemy Carasso, Anath Fischer, Agmon Yoram, Mutlak Diab, Aronson Doron, Bolotin Gil, Lessick Jonathan

Research output: Contribution to journalArticlepeer-review


Evaluation of myocardial regional function is generally performed by visual “eyeballing” which is highly subjective. A robust quantifiable parameter of regional function is required to provide an objective, repeatable and comparable measure of myocardial performance. We aimed to evaluate the clinical utility of novel regional myocardial strain software from cardiac computed tomography (CT) datasets. 93 consecutive patients who had undergone retrospectively gated cardiac CT were evaluated by the software, which utilizes a finite element based tracking algorithm through the cardiac cycle. Circumferential (CS), longitudinal (LS) and radial (RS) strains were calculated for each of 16 myocardial segments and compared to a visual assessment, carried out by an experienced cardiologist on cine movies of standard “echo” views derived from the CT data. A subset of 37 cases was compared to speckle strain by echocardiography. The automated software performed successfully in 93/106 cases, with minimal human interaction. Peak CS, LS and RS all differentiated well between normal, hypokinetic and akinetic segments. Peak strains for akinetic segments were generally post-systolic, peaking at 50 ± 17% of the RR interval compared to 43 ± 9% for normokinetic segments. Using ROC analysis to test the ability to differentiate between normal and abnormal segments, the area under the curve was 0.84 ± 0.01 for CS, 0.80 ± 0.02 for RS and 0.68 ± 0.02 for LS. There was a moderate agreement with speckle strain. Automated 4D regional strain analysis of CT datasets shows a good correspondence to visual analysis and successfully differentiates between normal and abnormal segments, thus providing an objective quantifiable map of myocardial regional function.

Original languageEnglish
Pages (from-to)149-159
Number of pages11
JournalInternational Journal of Cardiovascular Imaging
Issue number1
StatePublished - 1 Jan 2020


  • Cardiac computed tomography
  • Deformation imaging
  • Regional myocardial function
  • Systolic function

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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