Intima-Media Thickness: Setting a Standard for a Completely Automated Method of Ultrasound Measurement

The intima - media thickness (IMT) of the common carotid artery is a widely used clinical marker of severe cardiovascular diseases. IMT is usually manually measured on longitudinal B-Mode ultrasound images. Many computer-based techniques for IMT measurement have been proposed to overcome the limits of manual segmentation. Most of these, however, require a certain degree of user interaction. In this paper we describe a new completely automated layers extraction (CALEXia) technique for the segmentation and IMT measurement of carotid wall in ultrasound images. CALEXia is based on an integrated approach consisting of feature extraction, line fitting, and classification that enables the automated tracing of the carotid adventitial walls. IMT is then measured by relying on a fuzzy K-means classifier. We tested CALEXia on a database of 200 images. We compared CALEXia performances to those of a previously developed methodology that was based on signal analysis (CULEXsa). Three trained operators manually segmented the images and the average profiles were considered as the ground truth. The average error from CALEXia for lumen - intima (LI) and media - adventitia (MA) interface tracings were 1.46 ± 1.51 pixel (0.091 ± 0.093 mm) and 0.40 ± 0.87 pixel (0.025 ± 0.055 mm), respectively. The corresponding errors for CULEXsa were 0.55 ± 0.51 pixels (0.035 ± 0.032 mm) and 0.59 ± 0.46 pixels (0.037 ± 0.029 mm). The IMT measurement error was equal to 0.87 ± 0.56 pixel (0.054 ± 0.035 mm) for CALEXia and 0.12 ± 0.14 pixel (0.01 ± 0.01 mm) for CULEXsa. Thus, CALEXia showed limited performance in segmenting the LI interface, but outperformed CULEXsa in the MA interface and in the number of images correctly processed (10 for CALEXia and 16 for CULEXsa). Based on two complementary strategies, we anticipate fusing them for further IMT improvement

Intima-Media Thickness: Setting a Standard for a Completely Automated Method of Ultrasound Measurement

The intima – media thickness (IMT) of the common carotid artery is a widely used clinical marker of severe cardiovascular diseases. IMT is usually manually measured on longitudinal B-Mode ultrasound images. Many computer-based techniques for IMT measurement have been proposed to overcome the limits of manual segmentation. Most of these, however, require a certain degree of user interaction. In this paper we describe a new completely automated layers extraction (CALEXia) technique for the segmentation and IMT measurement of carotid wall in ultrasound images. CALEXia is based on an integrated approach consisting of feature extraction, line fitting, and classification that enables the automated tracing of the carotid adventitial walls. IMT is then measured by relying on a fuzzy K-means classifier. We tested CALEXia on a database of 200 images. We compared CALEXia performances to those of a previously developed methodology that was based on signal analysis (CULEXsa). Three trained operators manually segmented the images and the average profiles were considered as the ground truth. The average error from CALEXia for lumen – intima (LI) and media – adventitia (MA) interface tracings were 1.46 ± 1.51 pixel (0.091 ± 0.093 mm) and 0.40 ± 0.87 pixel (0.025 ± 0.055 mm), respectively. The corresponding errors for CULEXsa were 0.55 ± 0.51 pixels (0.035 ± 0.032 mm) and 0.59 ± 0.46 pixels (0.037 ± 0.029 mm). The IMT measurement error was equal to 0.87 ± 0.56 pixel (0.054 ± 0.035 mm) for CALEXia and 0.12 ± 0.14 pixel (0.01 ± 0.01 mm) for CULEXsa. Thus, CALEXia showed limited performance in segmenting the LI interface, but outperformed CULEXsa in the MA interface and in the number of images correctly processed (10 for CALEXia and 16 for CULEXsa). Based on two complementary strategies, we anticipate fusing them for further IMT improvements

Basic Science to Clinical Research: Segmentation of Ultrasound and Modelling in Clinical Informatics

The world of basic science is a world of minutia; it boils down to improving even a fraction of a percent over the baseline standard. It is a domain of peer reviewed fractions of seconds and the world of squeezing every last ounce of efficiency from a processor, a storage medium, or an algorithm. The field of health data is based on extracting knowledge from segments of data that may improve some clinical process or practice guideline to improve the time and quality of care. Clinical informatics and knowledge translation provide this information in order to reveal insights to the world of improving patient treatments, regimens, and overall outcomes. In my world of minutia, or basic science, the movement of blood served an integral role. The novel detection of sound reverberations map out the landscape for my research. I have applied my algorithms to the various anatomical structures of the heart and artery system. This serves as a basis for segmentation, active contouring, and shape priors. The algorithms presented, leverage novel applications in segmentation by using anatomical features of the heart for shape priors and the integration of optical flow models to improve tracking. The presented techniques show improvements over traditional methods in the estimation of left ventricular size and function, along with plaque estimation in the carotid artery. In my clinical world of data understanding, I have endeavoured to decipher trends in Alzheimer’s disease, Sepsis of hospital patients, and the burden of Melanoma using mathematical modelling methods. The use of decision trees, Markov models, and various clustering techniques provide insights into data sets that are otherwise hidden. Finally, I demonstrate how efficient data capture from providers can achieve rapid results and actionable information on patient medical records. This culminated in generating studies on the burden of illness and their associated costs. A selection of published works from my research in the world of basic sciences to clinical informatics has been included in this thesis to detail my transition. This is my journey from one contented realm to a turbulent one

A review of computational methods applied for identification and quantification of atherosclerotic plaques in images

Evaluation of the composition of atherosclerotic plaques in images is an important task to determine their pathophysiology. Visual analysis is still as the most basic and often approach to determine the morphology of the atherosclerotic plaques. In addition, computer-aided methods have also been developed for identification of features such as echogenicity, texture and surface in such plaques. In this article, a review of the most important methodologies that have been developed to identify the main components of atherosclerotic plaques in images is presented. Hence, computational algorithms that take into consideration the analysis of the plaques echogenicity, image processing techniques, clustering algorithms and supervised classification used for segmentation, i.e. identification, of the atherosclerotic plaque components in ultrasound, computerized tomography and magnetic resonance images are introduced. The main contribution of this paper is to provide a categorization of the most important studies related to the segmentation of atherosclerotic plaques and its components in images acquired by the most used imaging modalities. In addition, the effectiveness and drawbacks of each methodology as well as future researches concerning the segmentation and classification of the atherosclerotic lesions are also discussed

Carotid Ultrasound Boundary Study (CUBS): An Open Multicenter Analysis of Computerized Intima–Media Thickness Measurement Systems and Their Clinical Impact

[Abstract] Common carotid intima–media thickness (CIMT) is a commonly used marker for atherosclerosis and is often computed in carotid ultrasound images. An analysis of different computerized techniques for CIMT measurement and their clinical impacts on the same patient data set is lacking. Here we compared and assessed five computerized CIMT algorithms against three expert analysts’ manual measurements on a data set of 1088 patients from two centers. Inter- and intra-observer variability was assessed, and the computerized CIMT values were compared with those manually obtained. The CIMT measurements were used to assess the correlation with clinical parameters, cardiovascular event prediction through a generalized linear model and the Kaplan–Meier hazard ratio. CIMT measurements obtained with a skilled analyst's segmentation and the computerized segmentation were comparable in statistical analyses, suggesting they can be used interchangeably for CIMT quantification and clinical outcome investigation. To facilitate future studies, the entire data set used is made publicly available for the community at http://dx.doi.org/10.17632/fpv535fss7.

Carotid Ultrasound Boundary Study (CUBS): An Open Multicenter Analysis of Computerized Intima–Media Thickness Measurement Systems and Their Clinical Impact

Common carotid intima–media thickness (CIMT) is a commonly used marker for atherosclerosis and is often computed in carotid ultrasound images. An analysis of different computerized techniques for CIMT measurement and their clinical impacts on the same patient data set is lacking. Here we compared and assessed five computerized CIMT algorithms against three expert analysts’ manual measurements on a data set of 1088 patients from two centers. Inter- and intra-observer variability was assessed, and the computerized CIMT values were compared with those manually obtained. The CIMT measurements were used to assess the correlation with clinical parameters, cardiovascular event prediction through a generalized linear model and the Kaplan–Meier hazard ratio. CIMT measurements obtained with a skilled analyst's segmentation and the computerized segmentation were comparable in statistical analyses, suggesting they can be used interchangeably for CIMT quantification and clinical outcome investigation. To facilitate future studies, the entire data set used is made publicly available for the community at http://dx.doi.org/10.17632/fpv535fss7.1

Thin Cap Fibroatheroma Detection in Virtual Histology Images Using Geometric and Texture Features

Atherosclerotic plaque rupture is the most common mechanism responsible for a majority of sudden coronary deaths. The precursor lesion of plaque rupture is thought to be a thin cap fibroatheroma (TCFA), or “vulnerable plaque”. Virtual Histology-Intravascular Ultrasound (VH-IVUS) images are clinically available for visualising colour-coded coronary artery tissue. However, it has limitations in terms of providing clinically relevant information for identifying vulnerable plaque. The aim of this research is to improve the identification of TCFA using VH-IVUS images. To more accurately segment VH-IVUS images, a semi-supervised model is developed by means of hybrid K-means with Particle Swarm Optimisation (PSO) and a minimum Euclidean distance algorithm (KMPSO-mED). Another novelty of the proposed method is fusion of different geometric and informative texture features to capture the varying heterogeneity of plaque components and compute a discriminative index for TCFA plaque, while the existing research on TCFA detection has only focused on the geometric features. Three commonly used statistical texture features are extracted from VH-IVUS images: Local Binary Patterns (LBP), Grey Level Co-occurrence Matrix (GLCM), and Modified Run Length (MRL). Geometric and texture features are concatenated in order to generate complex descriptors. Finally, Back Propagation Neural Network (BPNN), kNN (K-Nearest Neighbour), and Support Vector Machine (SVM) classifiers are applied to select the best classifier for classifying plaque into TCFA and Non-TCFA. The present study proposes a fast and accurate computer-aided method for plaque type classification. The proposed method is applied to 588 VH-IVUS images obtained from 10 patients. The results prove the superiority of the proposed method, with accuracy rates of 98.61% for TCFA plaque.This research was funded by Universiti Teknologi Malaysia (UTM) under Research University Grant Vot-02G31, and the Ministry of Higher Education Malaysia (MOHE) under the Fundamental Research Grant Scheme (FRGS Vot-4F551) for the completion of the research. The work and the contribution were also supported by the project Smart Solutions in Ubiquitous Computing Environments, Grant Agency of Excellence, University of Hradec Kralove, Faculty of Informatics and Management, Czech Republic (under ID: UHK-FIM-GE-2018). Furthermore, the research is also partially supported by the Spanish Ministry of Science, Innovation and Universities with FEDER funds in the project TIN2016-75850-R

Quantifying atherosclerosis in vasculature using ultrasound imaging

Cerebrovascular disease accounts for approximately 30% of the global burden associated with cardiovascular diseases [1]. According to the World Stroke Organisation, there are approximately 13.7 million new stroke cases annually, and just under six million people will die from stroke each year [2]. The underlying cause of this disease is atherosclerosis – a vascular pathology which is characterised by thickening and hardening of blood vessel walls. When fatty substances such as cholesterol accumulate on the inner linings of an artery, they cause a progressive narrowing of the lumen referred to as a stenosis. Localisation and grading of the severity of a stenosis, is important for practitioners to assess the risk of rupture which leads to stroke. Ultrasound imaging is popular for this purpose. It is low cost, non-invasive, and permits a quick assessment of vessel geometry and stenosis by measuring the intima media thickness. Research is showing that 3D monitoring of plaque progression may provide a better indication of sites which are at risk of rupture. Various metrics have been proposed. From these, the quantification of plaques by measuring vessel wall volume (VWV) using the segmented media-adventitia boundaries (MAB) and lumen-intima boundaries (LIB) has been shown to be sensitive to temporal changes in carotid plaque burden. Thus, methods to segment these boundaries are required to help generate VWV measurements with high accuracy, less user interaction and increased robustness to variability in di↵erent user acquisition protocols.ii This work proposes three novel methods to address these requirements, to ultimately produce a highly accurate, fully automated segmentation algorithm which works on intensity-invariant data. The first method proposed was that of generating a novel, intensity-invariant representation of ultrasound data by creating phase-congruency maps from raw unprocessed radio-frequency ultrasound information. Experiments carried out showed that this representation retained the necessary anatomical structural information to facilitate segmentation, while concurrently being invariant to changes in amplitude from the user. The second method proposed was the novel application of Deep Convolutional Networks (DCN) to carotid ultrasound images to achieve fully automatic delineation of the MAB boundaries, in addition to the use of a novel fusion of amplitude and phase congruency data as an image source. Experiments carried out showed that the DCN produces highly accurate and automated results, and that the fusion of amplitude and phase yield superior results to either one alone. The third method proposed was a new geometrically constrained objective function for the network's Stochastic Gradient Descent optimisation, thus tuning it to the segmentation problem at hand, while also developing the network further to concurrently delineate both the MAB and LIB to produce vessel wall contours. Experiments carried out here also show that the novel geometric constraints improve the segmentation results on both MAB and LIB contours. In conclusion, the presented work provides significant novel contributions to field of Carotid Ultrasound segmentation, and with future work, this could lead to implementations which facilitate plaque progression analysis for the end�user