Temporal Training Strategies for Left Atrium and Left Atrial Appendage Segmentation in Dynamic Contrast 4DCT

David Montalvo-García, Lauren Severance, Elliot R. McVeigh, María J. Ledesma-Carbayo

Dynamic contrast-enhanced cardiac CT enables time-resolved analysis of contrast filling and washout in the left atrium (LA) and left atrial appendage (LAA), with potential applications for assessing blood stasis in atrial fibrillation (AF). Accurate segmentation across all frames is required for such analysis but is challenging due to large temporal contrast variations and the use of a single annotation per registered sequence. This creates a trade-off between training for robustness and limiting label noise. In this study, we investigate how temporal training-set design affects nnUNet-based segmentation of the LA and LAA in dynamic 4DCT. We compare training using a minimal two-frame dataset reflecting standard clinical practice, a physiologically selected subset of frames, and the full 27-frame sequence. We further evaluate the impact of foreground-based normalization. Training with all frames yielded the best performance in early low-contrast phases. However, the physiologically selected subset achieved comparable performance from the filling phase onward. Applying normalization parameters derived from the full dataset improved performance of reduced datasets in low-contrast frames, but did not fully close the gap. These findings highlight the importance of temporal diversity in training data for robust segmentation in dynamic CT, while indicating that carefully selected frame subsets may provide an effective trade-off between performance and efficiency for downstream applications.