We consider the problem of segmenting the left ventricular (LV) myocardium on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) scans of which only some of the scans have scar tissue. We propose ScarGAN to simulate scar tissue on healthy myocardium using chained generative adversarial networks (GAN). Our novel approach factorizes the simulation process into 3 steps: (1) a mask generator to simulate the shape of the scar tissue; (2) a domain-specific heuristic to produce the initial simulated scar tissue from the mask; (3) a refining generator to add details to the simulated scar tissue. Unlike other approaches that generate samples from scratch, we simulate scar tissue on normal scans resulting in highly realistic samples. We show that experienced radiologists are unable to distinguish between real and simulated scar tissue. Training a U-Net with additional scans with scar tissue simulated by ScarGAN increases the percentage of scar pixels in LV myocardium prediction from 75.9% to 80.5%.
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