  Recent development of quantitative myocardial blood flow (MBF) mapping allows
direct evaluation of absolute myocardial perfusion, by computing pixel-wise
flow maps. Clinical studies suggest quantitative evaluation would be more
desirable for objectivity and efficiency. Objective assessment can be further
facilitated by segmenting the myocardium and automatically generating reports
following the AHA model. This will free user interaction for analysis and lead
to a 'one-click' solution to improve workflow. This paper proposes a deep
neural network based computational workflow for inline myocardial perfusion
analysis. Adenosine stress and rest perfusion scans were acquired from three
hospitals. Training set included N=1,825 perfusion series from 1,034 patients.
Independent test set included 200 scans from 105 patients. Data were
consecutively acquired at each site. A convolution neural net (CNN) model was
trained to provide segmentation for LV cavity, myocardium and right ventricular
by processing incoming 2D+T perfusion Gd series. Model outputs were compared to
manual ground-truth for accuracy of segmentation and flow measures derived on
global and per-sector basis. The trained models were integrated onto MR
scanners for effective inference. Segmentation accuracy and myocardial flow
measures were compared between CNN models and manual ground-truth. The mean
Dice ratio of CNN derived myocardium was 0.93 +/- 0.04. Both global flow and
per-sector values showed no significant difference, compared to manual results.
The AHA 16 segment model was automatically generated and reported on the MR
scanner. As a result, the fully automated analysis of perfusion flow mapping
was achieved. This solution was integrated on the MR scanner, enabling
'one-click' analysis and reporting of myocardial blood flow.
