Shape-driven segmentation of the arterial wall in intravascular ultrasound images

Segmentation of arterial wall boundaries from intravascular images is an important problem for many applications in the study of plaque characteristics, mechanical properties of the arterial wall, its 3D reconstruction, and its measurements such as lumen size, lumen radius, and wall radius. We present a shape-driven approach to segmentation of the arterial wall from intravascular ultrasound images in the rectangular domain. In a properly built shape space using training data, we constrain the lumen and media-adventitia contours to a smooth, closed geometry, which increases the segmentation quality without any tradeoff with a regularizer term. In addition to a shape prior, we utilize an intensity prior through a non-parametric probability density based image energy, with global image measurements rather than pointwise measurements used in previous methods. Furthermore, a detection step is included to address the challenges introduced to the segmentation process by side branches and calcifications. All these features greatly enhance our segmentation method. The tests of our algorithm on a large dataset demonstrate the effectiveness of our approach

Shape-driven segmentation of the arterial wall in intravascular ultrasound images

Segmentation of arterial wall boundaries from intravascular images is an important problem for many applications in the study of plaque characteristics, mechanical properties of the arterial wall, its 3D reconstruction, and its measurements such as lumen size, lumen radius, and wall radius. We present a shape-driven approach to segmentation of the arterial wall from intravascular ultrasound images in the rectangular domain. In a properly built shape space using training data, we constrain the lumen and media-adventitia contours to a smooth, closed geometry, which increases the segmentation quality without any tradeoff with a regularizer term. In addition to a shape prior, we utilize an intensity prior through a non-parametric probability density based image energy, with global image measurements rather than pointwise measurements used in previous methods. Furthermore, a detection step is included to address the challenges introduced to the segmentation process by side branches and calcifications. All these features greatly enhance our segmentation method. The tests of our algorithm on a large dataset demonstrate the effectiveness of our approach

AUTOMATED QUANTITATIVE ASSESSMENT OF CORONARY CALCIFICATION USING INTRAVASCULAR ULTRASOUND

Coronary calcification represents a challenge in the treatment of coronary artery disease by stent placement. It negatively affects stent expansion and has been related to future adverse cardiac events. Intravascular ultrasound (IVUS) is known for its high sensitivity in detecting coronary calcification. At present, automated quantification of calcium as detected by IVUS is not available. For this reason, we developed and validated an optimized framework for accurate automated detection and quantification of calcified plaque in coronary atherosclerosis as seen by IVUS. Calcified lesions were detected by training a supported vector classifier per IVUS A-line on manually annotated IVUS images, followed by post-processing using regional information. We applied our framework to 35 IVUS pullbacks from each of the three commonly used IVUS systems. Cross-validation accuracy for each system was >0.9, and the testing accuracy was 0.87, 0.89 and 0.89 for the three systems. Using the detection result, we propose an IVUS calcium score, based on the fraction of calcium-positive A-lines in a pullback segment, to quantify the extent of calcified plaque. The high accuracy of the proposed classifier suggests that it may provide a robust and accurate tool to assess the presence and amount of coronary calcification and, thus, may play a role in imageguided coronary interventions. (E-mail: [email protected]

Lumen-intima and media-adventitia segmentation in IVUS images using supervised classifications of arterial layers and morphological structures

Background: Intravascular ultrasound (IVUS) provides axial grey-scale images of blood vessels. The large number of images require automatic analysis, specifically to identify the lumen and outer vessel wall. However, the high amount of noise, the presence of artifacts and anatomical structures, such as bifurcations, calcifications and fibrotic plaques, usually hinder the proper automatic segmentation of the vessel wall. Methods: Lumen, media, adventitia and surrounding tissues are automatically detected using Support Vector Machines (SVMs). The classification performance of the SVMs vary according to the kind of structure present within each region of the image. Random Forest (RF) is used to detect different morphological structures and to modify the initial layer classification depending on the detected structure. The resulting classification maps are fed into a segmentation method based on deformable contours to detect lumen-intima (LI) and media-adventitia (MA) interfaces. Results: The modifications in the layer classifications according to the presence of structures proved to be effective improving LI and MA segmentations. The proposed method reaches a Jaccard Measure (JM) of 0.88 ± 0.08 for LI segmentation, compared with 0.88 ± 0.05 of a semiautomatic method. When looking at MA, our method reaches a JM of 0.84 ± 0.09, and outperforms previous automatic methods in terms of HD, with 0.51mm ± 0.30. Conclusions: A simple modification to the arterial layer classification produces results that match and improve state-of-the-art fully-automatic segmentation methods for LI and MA in 20MHz IVUS images. For LI segmentation, the proposed automatic method performs accurately as semi-automatic methods. For MA segmentation, our method matched the quality of state-of-the-art automatic methods described in the literature. Furthermore, our implementation is modular and open-source, allowing for future extensions and improvements.Fil: Lo Vercio, Lucas. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; ArgentinaFil: del Fresno, Mirta Mariana. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; ArgentinaFil: Larrabide, Ignacio. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentin

Computer Vision Techniques for Transcatheter Intervention

Minimally invasive transcatheter technologies have demonstrated substantial promise for the diagnosis and treatment of cardiovascular diseases. For example, TAVI is an alternative to AVR for the treatment of severe aortic stenosis and TAFA is widely used for the treatment and cure of atrial fibrillation. In addition, catheter-based IVUS and OCT imaging of coronary arteries provides important information about the coronary lumen, wall and plaque characteristics. Qualitative and quantitative analysis of these cross-sectional image data will be beneficial for the evaluation and treatment of coronary artery diseases such as atherosclerosis. In all the phases (preoperative, intraoperative, and postoperative) during the transcatheter intervention procedure, computer vision techniques (e.g., image segmentation, motion tracking) have been largely applied in the field to accomplish tasks like annulus measurement, valve selection, catheter placement control, and vessel centerline extraction. This provides beneficial guidance for the clinicians in surgical planning, disease diagnosis, and treatment assessment. In this paper, we present a systematical review on these state-of-the-art methods.We aim to give a comprehensive overview for researchers in the area of computer vision on the subject of transcatheter intervention. Research in medical computing is multi-disciplinary due to its nature, and hence it is important to understand the application domain, clinical background, and imaging modality so that methods and quantitative measurements derived from analyzing the imaging data are appropriate and meaningful. We thus provide an overview on background information of transcatheter intervention procedures, as well as a review of the computer vision techniques and methodologies applied in this area

Calcium identification and scoring based on echocardiography imaging

Currently, an echocardiography expert is needed to identify calcium in the aortic valve, and a cardiac CT-Scan image is needed for calcium quantification. When performing a CT-scan, the patient is subject to radiation, and therefore the number of CT-scans that can be performed should be limited, restricting the patient's monitoring. Computer Vision (CV) has opened new opportunities for improved efficiency when extracting knowledge from an image. Applying CV techniques on echocardiography imaging may reduce the medical workload for identifying the calcium and quantifying it, helping doctors to maintain a better tracking of their patients. In our approach, we developed a simple technique to identify and extract the calcium pixel count from echocardiography imaging, by using CV. Based on anonymized real patient echocardiographic images, this approach enables semi-automatic calcium identification. As the brightness of echocardiography images (with the highest intensity corresponding to calcium) vary depending on the acquisition settings, we performed echocardiographic adaptive image binarization. Given that blood maintains the same intensity on echocardiographic images – being always the darker region – we used blood structures in the image to create an adaptive threshold for binarization. After binarization, the region of interest (ROI) with calcium, was interactively selected by an echocardiography expert and extracted, allowing us to compute a calcium pixel count, corresponding to the spatial amount of calcium. The results obtained from our experiments are encouraging. With our technique, from echocardiographic images collected for the same patient with different acquisition settings and different brightness, we were able to obtain a calcium pixel count, where pixels values show an absolute pixel value margin of error of 3 (on a scale from 0 to 255), that correlated well with human expert assessment of calcium area for the same images.Atualmente, é necessário um perito em ecocardiografia para identificar o cálcio na válvula aórtica, e é necessária uma imagem Tomográfica Computorizada (TAC) cardíaca para a quantificação do cálcio. Ao realizar uma TAC, o paciente é sujeito a radiação, pelo que o número de TACs que podem ser realizadas deve ser limitado, restringindo a monitorização do paciente. A Visão por Computador (VC) abriu novas oportunidades para uma maior eficiência na extração de conhecimentos de uma imagem. A aplicação de técnicas de VC na ecocardiografia pode reduzir a carga de trabalho médico para identificar o cálcio e quantificálo, ajudando os médicos a manter um melhor acompanhamento dos seus pacientes. Na nossa abordagem, desenvolvemos uma técnica simples para identificar e extrair o número de pixéis de cálcio da ecocardiografia, através da utilização de VC. Com base em ecocardiografias anónimas de doentes reais, esta abordagem permite a identificação semiautomática do cálcio. Como o brilho das imagens de ecocardiografia (com a intensidade mais elevada corresponde ao cálcio) varia consoante os parâmetros de aquisição, realizámos a binarização das ecocardiografias de forma adaptativa. Dado que o sangue mantém a mesma intensidade nas ecocardiografias - sendo sempre a região mais escura - utilizámos estruturas sanguíneas na imagem para criar um limiar adaptativo para a binarização. Após a binarização, a região de interesse (ROI) com cálcio, foi selecionada interactivamente por um especialista em ecocardiografia e extraída, permitindo-nos calcular o número de pixéis de cálcio, correspondente à quantidade espacial de cálcio. Os resultados obtidos com as nossas experiências são encorajadores. Com a nossa técnica, a partir de ecocardiografias recolhidas para o mesmo paciente com diferentes configurações de aquisição e diferentes brilhos, conseguimos obter uma contagem de pixéis de cálcio, onde os valores de pixéis mostram uma margem de erro absoluta de 3 (numa escala de 0 a 255), que se correlacionou bem com a avaliação humana perita da área de cálcio para as mesmas imagens

Ultrasound imaging operation capture and image analysis for speckle noise reduction and detection of shadows

Ultrasound is becoming increasingly important in medicine, both as a diagnostic tool and as a therapeutic modality. At present, experienced sonographers observe trainees as they generate hundreds of images, constantly providing them feedback and eventually deciding if they have the appropriate skills and knowledge to perform ultrasound independently. This research seeks to advance towards developing an automated system capable of assessing the motion of an ultrasound transducer and differentiate between a novice, an intermediate and an expert sonographer. The research in this thesis synchronizes the ultrasound images with three depth sensors (Microsoft Kinect) placed on the top, left and right side of the patient to ensure the visibility of the ultrasound probe. Videos obtained from the three categories of sonographers are manually labeled and compared using Studiocode Development Environment to complete the items on the medical form checklist. Next, this thesis investigates and applies well known techniques used to smooth and suppress speckle noise in ultrasound images by using quality metrics to test their performance and show the benefits each one can contribute. Finally, this thesis investigates the problem of shadow detection in ultrasound imaging and proposes to detect shadows automatically with an ultrasound confidence map using a random walks algorithm. The results show that the proposed algorithm achieves an accuracy of automatic detection of up to 85%, based on both the expert and manual segmentation

Recent Trends in Artificial Intelligence-Assisted Coronary Atherosclerotic Plaque Characterization

Coronary artery disease is a major cause of morbidity and mortality worldwide. Its underlying histopathology is the atherosclerotic plaque, which comprises lipid, fibrous and—when chronic—calcium components. Intravascular ultrasound (IVUS) and intravascular optical coherence tomography (IVOCT) performed during invasive coronary angiography are reference standards for characterizing the atherosclerotic plaque. Fine image spatial resolution attainable with contemporary coronary computed tomographic angiography (CCTA) has enabled noninvasive plaque assessment, including identifying features associated with vulnerable plaques known to presage acute coronary events. Manual interpretation of IVUS, IVOCT and CCTA images demands scarce physician expertise and high time cost. This has motivated recent research into and development of artificial intelligence (AI)-assisted methods for image processing, feature extraction, plaque identification and characterization. We performed parallel searches of the medical and technical literature from 1995 to 2021 focusing respectively on human plaque characterization using various imaging modalities and the use of AI-assisted computer aided diagnosis (CAD) to detect and classify atherosclerotic plaques, including their composition and the presence of high-risk features denoting vulnerable plaques. A total of 122 publications were selected for evaluation and the analysis was summarized in terms of data sources, methods—machine versus deep learning—and performance metrics. Trends in AI-assisted plaque characterization are detailed and prospective research challenges discussed. Future directions for the development of accurate and efficient CAD systems to characterize plaque noninvasively using CCTA are proposed.</jats:p

Automatic segmentation of cross-sectional coronary arterial images

We present a novel approach to segment coronary cross-sectional images acquired using catheterization imaging techniques, i.e. intra-vascular ultrasound (IVUS) and optical coherence tomography (OCT). The proposed approach combines cross-sectional segmentation with longitudinal tracking in order to tackle various forms of imaging artifacts and to achieve consistent segmentation. A node-weighted directed graph is constructed on two consecutive cross-sectional frames with embedded shape constraints within individual cross-sections or frames and between consecutive frames. The intra-frame constraints are derived from a set of training samples and are embedded in both graph construction and its cost function. The inter-frame constraints are imposed by tracking the borders of interest across multiple frames. The coronary images are transformed from Cartesian coordinates to polar coordinates. Graph partition can then be formulated as searching an optimal interface in the node-weighted directed graph without user initialization. It also allows efficient parametrization of the border using radial basis function (RBF) and thus reduces the tracking of a large number of border points to a very few RBF centers. Moreover, we carry out supervised column-wise tissue classification in order to automatically optimize the feature selection. Instead of empirically assigning weights to different feature detectors, we dynamically and automatically adapt those weighting depending on the tissue compositions in each individual column of pixels

Deep Learning in Cardiology

The medical field is creating large amount of data that physicians are unable to decipher and use efficiently. Moreover, rule-based expert systems are inefficient in solving complicated medical tasks or for creating insights using big data. Deep learning has emerged as a more accurate and effective technology in a wide range of medical problems such as diagnosis, prediction and intervention. Deep learning is a representation learning method that consists of layers that transform the data non-linearly, thus, revealing hierarchical relationships and structures. In this review we survey deep learning application papers that use structured data, signal and imaging modalities from cardiology. We discuss the advantages and limitations of applying deep learning in cardiology that also apply in medicine in general, while proposing certain directions as the most viable for clinical use.Comment: 27 pages, 2 figures, 10 table