Computer assisted detection of polycystic ovary morphology in ultrasound images

Polycystic ovary syndrome (PCOS) is an endocrine abnormality with multiple diagnostic criteria due to its heterogenic manifestations. One of the diagnostic criterion includes analysis of ultrasound images of ovaries for the detection of number, size, and distribution of follicles within the ovary. This involves manual tracing of follicles on the ultrasound images to determine the presence of a polycystic ovary (PCO). A novel method that automates PCO morphology detection is described. Our algorithm involves automatic segmentation of follicles from ultrasound images, quantifying the attributes of the segmented follicles using stereology, storing follicle attributes as feature vectors, and finally classification of the feature vector into two categories. The classification categories are PCO morphology present and PCO morphology absent. An automatic PCO diagnostic tool would save considerable time spent on manual tracing of follicles and measuring the length and width of every follicle. Our procedure was able to achieve classification accuracy of 92.86% using a linear discriminant classifier. Our classifier will improve the rapidity and accuracy of PCOS diagnosis, and reduce the chance of the severe health implications that can arise from delayed diagnosis

Advancements and Breakthroughs in Ultrasound Imaging

Ultrasonic imaging is a powerful diagnostic tool available to medical practitioners, engineers and researchers today. Due to the relative safety, and the non-invasive nature, ultrasonic imaging has become one of the most rapidly advancing technologies. These rapid advances are directly related to the parallel advancements in electronics, computing, and transducer technology together with sophisticated signal processing techniques. This book focuses on state of the art developments in ultrasonic imaging applications and underlying technologies presented by leading practitioners and researchers from many parts of the world

THREE-DIMENSIONAL ANALYSIS OF COLOUR DOPPLER ULTRASOUND IMAGES: THE RELATIONSHIP OF VASCULAR FLOW TO OVARIAN STRUCTURES AND THEIR FUNCTION IN BUFFALO COWS AND BEEF CALVES

The main objective of this thesis was to develop a three-dimensional method to assess ovarian structures and relate their vascularity to their function (i.e. hormone production, oocyte quality, ovulatory capacity, etc.). This novel method uses video segments recorded after free-hand movement of the routine linear-array transducer, obtained vascularity index values are independent of speed of transducer movement, and the method does not require a-priori operator selection of images, i.e. is an objective method. In Study 1, colour Doppler ultrasonography was used to assess the ovaries of water buffalo (Bubalus bubalis) who were induced to ovulate using a gonadotropin releasing hormone analogue. Ultrasonographic examinations were performed daily to assess ovulation and subsequent corpus luteum (CL) development. Recorded cineloops were exported from the ultrasound machine and analyzed on a personal computer equipped with imaging software from two sources, Fiji (ImageJ) and Imaris. Fiji was used to perform conventional two-dimensional image analysis and Imaris was used to develop a new three-dimensional analysis method that does not require operator selection of images (i.e. objective method). Verification of the three-dimensional method was performed using two-dimensional data. Buffalo that did not ovulate within 24 hours of artificial insemination (40h from time of gonadotrophin releasing hormone analogue treatment) (n=3) tended to have lower change in vascular flow (P=0.06) to their preovulatory follicles when compared to those that ovulated (n=13) using the three-dimensional analysis method. In Study 2, power Doppler ultrasonography was used to assess the ovaries of 4-month-old prepubertal beef heifers (Bos taurus) who were superstimulated using two follicle stimulating hormone (FSH) protocols. Ultrasonographic scans were performed on the day of luteinizing hormone (LH) treatment, the day of oocyte collection, and the third and seventh day following follicular aspiration. The three-dimensional method developed in Study 1 was used to calculate vascularity indices for the four time points. Ovarian vascularity was then related to the expansion of the cumulus-oocyte-complexes that were retrieved, as well as the subsequent luteal tissue that developed following follicle aspiration. Luteal vascularity index measured at three days following follicular aspiration were related to the rise in plasma progesterone concentration over time (from 24 h following LH to day seven after aspiration) (r=0.65, P<0.01). Prepubertal calves demonstrated an increase in ovarian vascularity index under the influence of exogenous LH that was similar to adult animals. Additionally, an increased duration of superstimulation (seven days instead of four) was important for calves in the development of luteal tissue on day seven, luteal vascularity and progesterone production. In conclusion, three-dimensional image analysis of colour Doppler ultrasound images was superior to two-dimensional in detecting follicles that did not ovulate. This method using power Doppler ultrasound images was also applied to prepubertal calves undergoing superstimulation and found that luteal vascular flow was related to progesterone production following follicular aspiration

Imaging in Women\u27s Health

Women’s health is a large area of the medical field that is continuing to see growth and technological advancement. Gynecological, obstetric, and breast health are fields that are always in demand, and imaging plays a large role in caring for patients in these fields. This paper will discuss different areas of women’s health and explain how imaging can be used to assist in diagnosis and treatment. Imaging can include MRI, 2D ultrasound, 3D ultrasound, and x-ray. This paper will discuss basic gynecological health, complications that can arise in gynecological health, women’s health in college, preconception care, obstetrics, obstetric complications, breast health, post menopausal health, and other women’s health issues. Some topics discussed will be endometriosis, adenomyosis, breast cancer screening and treatment, endometrial cancer, pregnancy, pelvic floor health, and ovarian masses. It will also discuss the future of women’s health. From basic gynecological health through pregnancy, breast health and menopause, imaging is a vital tool used to help medical professionals diagnose, monitor and treat women through many stages of life

Novel Methods in the Diagnosis of PCOS: The Role of 3D Ultrasonographic Modalities

Polycystic ovary syndrome (PCOS) is a common and complicated endocrine disorder, with its diagnosis based on clinical, laboratory and imaging criteria. The latter is usually assessed via two-dimensional ultrasound; however, the advent of three-dimensional ultrasound, along with three-dimensional power Doppler (3D-PD) could offer more accurate diagnoses and further our understanding of PCOS pathophysiology. Three-dimensional ultrasound (3D-US) has already been used successfully in many fields of gynecology. It offers improved image quality with stored data that can be processed either manually or automatically to assess many parameters useful in PCOS assessment, such as ovarian volume, number of follicles and vascular indices. The examination requires minimal time as data is assessed in post-processing, thus being more tolerable for the patient. 3D-US parameters are generally increased in PCOS patients when compared to controls and 2D measurements, with studies showing improved diagnostic performance, though that remains inconclusive. 3D transrectal ultrasound is more accurate in the diagnosis of virgin PCOS patients than the modalities currently available in that subgroup. Overall, though with some limitations, 3D-US is a promising diagnostic method in the assessment of PCOS which, regardless of diagnostic accuracy, can undoubtedly offer many practical advantages, more objective and reliable measurements, potentially improving PCOS diagnosis standardization

Clarifying the role of three-dimensional transvaginal sonography in reproductive medicine: an evidenced-based appraisal

This overview describes and illustrates the clinical applications of three-dimensional transvaginal sonography in reproductive medicine. Its main applications include assessment of uterine anomalies, intrauterine pathology, tubal patency, polycystic ovaries, ovarian follicular monitoring and endometrial receptivity. It is also useful for detailed evaluation of failed and/or ectopic pregnancy. Three-dimensional color Doppler sonography provides enhanced depiction of uterine, endometrial, and ovarian vascularity

Three-dimensional imaging and reconstruction of the whole ovary and testis: a new frontier for the reproductive scientist.

AbstractThe 3D functional reconstruction of a whole organ or organism down to the single cell level and to the subcellular components and molecules is a major future scientific challenge. The recent convergence of advanced imaging techniques with an impressively increased computing power allowed early attempts to translate and combine 2D images and functional data to obtain in-silico organ 3D models. This review first describes the experimental pipeline required for organ 3D reconstruction: from the collection of 2D serial images obtained with light, confocal, light-sheet microscopy or tomography, followed by their registration, segmentation and subsequent 3D rendering. Then, we summarise the results of investigations performed so far by applying these 3D image analyses to the study of the female and male mammalian gonads. These studies highlight the importance of working towards a 3D in-silico model of the ovary and testis as a tool to gain insights into their biology during the phases of differentiation or adulthood, in normal or pathological conditions. Furthermore, the use of 3D imaging approaches opens to key technical improvements, ranging from image acquisition to optimisation and development of new processing tools, and unfolds novel possibilities for multidisciplinary research

Computer-Assisted Image Analysis of Human Ovarian Follicles: Imaging Physiologic Selection

Antral ovarian folliculogenesis involves recruitment of a cohort of small follicles, physiological selection of a dominant follicle, and ovulation. The mechanism of selection has not been precisely determined. Identification of the timing of preovulatory selection is a key component in understanding natural and peri-menopausal ovarian function, ovarian suppression for contraception, and improvement of ovarian stimulation protocols. Morphologic characteristics obtained by ultrasonography cannot be precisely quantitated by the human eye. Computer-assisted image analysis overcomes subjective human evaluation of ultrasonographic images. The objectives of this research were to assess ultrasound image attributes of human dominant (DF) and 1st subordinate (SF1) ovarian follicles during natural menstrual cycles and following discontinuation of conventional and continuous oral contraceptives (OC). We utilized sophisticated computer algorithms to elucidate an association between image attributes and physiologic status of follicles. Transvaginal ultrasonographic images obtained in 2 previous studies were used to quantify changes that occur in ovarian follicles. We detected quantitative differences between the dominant and largest subordinate follicles of ovulatory and major anovulatory follicular waves, as well as during the first wave following OC discontinuation. Differences in ultrasonographic image attributes were associated with the physiological status of follicles. Evidence of follicular dominance in follicles which develop during major ovulatory waves or following OC discontinuation can be detected prior to the time of selection manifest by differences in dominant and subordinate follicle diameters. In addition, differences in quantitative image attributes were detected between ovulatory and anovulatory DF. Follicles that develop following conventional and continuous OC administration schemes exhibit the same image characteristics. Further research is necessary to elucidate the exact correlation of follicle image attributes during all stages of development with histological characteristics, prediction of the timing of DF selection and the effects of different OC formulations on follicle development during and following OC cessation. Computer-assisted image analysis of ultrasound images has the potential to develop into a diagnostic, prognostic, and research tool for the in vivo evaluation of ovarian physiology and pathology and elucidate biologically important times such as physiologic selection, ovulation of DF and characterization of abnormal follicles (i.e., follicular cysts, luteinized unovulated follicles)

POLYCYSTIC OVARY SYNDROME COAGULATION AND METABOLIC STUDIES

The polycystic ovary syndrome (PCOS) is a heterogeneous disorder in women characterised by chronic ovulatory failure, hyperandrogenaemia, and insulin resistance. Some women are completely asymptomatic and others present with extreme menstrual disturbance, severe hirsutism, infertility and recurrent miscarriage. The pathophysiology of PCOS is not completely understood, but it is thought that insulin resistance plays a central role. In normal subjects, non-diabetic obese patients and patients with non-insulin dependent diabetes, insulin resistance is associated with elevated plasminogen activator inhibitor-1 (PAI-1) levels. PAI-1 is a glycoprotein, which inhibits the formation of plasmin (a proteolytic enzyme). Plasmin aids fibrinolysis and extracellular proteolysis. High PAI-1 and low plasmin levels increase the risk of thrombosis and impair extracellular proteolysis required in ovarian follicle growth, ovulation and embryo implantation. This study was designed to determine whether elevated plasminogen activator inhibitor-1 (PAI-1) was associated with the insulin resistance present in PCOS, investigate its possible role in the causation of anovulation and recurrent pregnancy loss in these women and ascertain whether it was an additional thrombotic risk factor so that clinicians and patients could take appropriate measures to reduce this risk In a pilot study, systemic PAI-1 activity was significantly elevated in oligomenorrhoiec women with PCOS. A larger study supported these findings, but demonstrated that obesity was a significant confounding factor, as the increase in PAI-1activity disappeared when standardised for weight. Activated Protein-C (APC) resistance was subsequently tested in these women because of the unexpected finding of an increased prevalence of a positive family history of thrombosis in women with PCOS compared with controls, but there was no increase in the prevalence of APC-resistance in PCOS. In another project, the cellular distribution of PAI-1 protein in human ovaries was described for the first time using immunohistochemistry. It was localised to the granulosa and theca cell compartments in both polycystic and normal ovaries, however there was no significant difference in the intensity of PAI-l staining between both groups on image analysis. PAI-1 messenger RNA expression was also evaluated in these biopsies by in-situ hybridisation, but no signal was detected suggesting that there was either a low overall RNA preservation in the tissues, or an insufficient sensitivity of the cocktail of oligonucleotide probes used. This study did not support the hypothesis that elevated PAI-1 was a feature of PCOS, however the in-situ location of PAI-1 protein was demonstrated for the first time in the human ovary and consistent with a previously suspected role in ovulation. The results did not support a role for PAI-1 in anovulation, recurrent miscarriage or increased thrombosis in PCOS