Fully automated segmentation and tracking of the intima media thickness in ultrasound video sequences of the common carotid artery

Abstract—The robust identification and measurement of the intima media thickness (IMT) has a high clinical relevance because it represents one of the most precise predictors used in the assessment of potential future cardiovascular events. To facilitate the analysis of arterial wall thickening in serial clinical investigations, in this paper we have developed a novel fully automatic algorithm for the segmentation, measurement, and tracking of the intima media complex (IMC) in B-mode ultrasound video sequences. The proposed algorithm entails a two-stage image analysis process that initially addresses the segmentation of the IMC in the first frame of the ultrasound video sequence using a model-based approach; in the second step, a novel customized tracking procedure is applied to robustly detect the IMC in the subsequent frames. For the video tracking procedure, we introduce a spatially coherent algorithm called adaptive normalized correlation that prevents the tracking process from converging to wrong arterial interfaces. This represents the main contribution of this paper and was developed to deal with inconsistencies in the appearance of the IMC over the cardiac cycle. The quantitative evaluation has been carried out on 40 ultrasound video sequences of the common carotid artery (CCA) by comparing the results returned by the developed algorithm with respect to ground truth data that has been manually annotated by clinical experts. The measured IMTmean ± standard deviation recorded by the proposed algorithm is 0.60 mm ± 0.10, with a mean coefficient of variation (CV) of 2.05%, whereas the corresponding result obtained for the manually annotated ground truth data is 0.60 mm ± 0.11 with a mean CV equal to 5.60%. The numerical results reported in this paper indicate that the proposed algorithm is able to correctly segment and track the IMC in ultrasound CCA video sequences, and we were encouraged by the stability of our technique when applied to data captured under different imaging conditions. Future clinical studies will focus on the evaluation of patients that are affected by advanced cardiovascular conditions such as focal thickening and arterial plaques

Automating Carotid Intima-Media Thickness Video Interpretation with Convolutional Neural Networks

Cardiovascular disease (CVD) is the leading cause of mortality yet largely preventable, but the key to prevention is to identify at-risk individuals before adverse events. For predicting individual CVD risk, carotid intima-media thickness (CIMT), a noninvasive ultrasound method, has proven to be valuable, offering several advantages over CT coronary artery calcium score. However, each CIMT examination includes several ultrasound videos, and interpreting each of these CIMT videos involves three operations: (1) select three end-diastolic ultrasound frames (EUF) in the video, (2) localize a region of interest (ROI) in each selected frame, and (3) trace the lumen-intima interface and the media-adventitia interface in each ROI to measure CIMT. These operations are tedious, laborious, and time consuming, a serious limitation that hinders the widespread utilization of CIMT in clinical practice. To overcome this limitation, this paper presents a new system to automate CIMT video interpretation. Our extensive experiments demonstrate that the suggested system significantly outperforms the state-of-the-art methods. The superior performance is attributable to our unified framework based on convolutional neural networks (CNNs) coupled with our informative image representation and effective post-processing of the CNN outputs, which are uniquely designed for each of the above three operations.Comment: J. Y. Shin, N. Tajbakhsh, R. T. Hurst, C. B. Kendall, and J. Liang. Automating carotid intima-media thickness video interpretation with convolutional neural networks. CVPR 2016, pp 2526-2535; N. Tajbakhsh, J. Y. Shin, R. T. Hurst, C. B. Kendall, and J. Liang. Automatic interpretation of CIMT videos using convolutional neural networks. Deep Learning for Medical Image Analysis, Academic Press, 201

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

Automatic segmentation of the lumen of the carotid artery in ultrasound B-mode images

A new algorithm is proposed for the segmentation of the lumen and bifurcation boundaries of the carotid artery in B-mode ultrasound images. It uses the hipoechogenic characteristics of the lumen for the identification of the carotid boundaries and the echogenic characteristics for the identification of the bifurcation boundaries. The image to be segmented is processed with the application of an anisotropic diffusion filter for speckle removal and morphologic operators are employed in the detection of the artery. The obtained information is then used in the definition of two initial contours, one corresponding to the lumen and the other to the bifurcation boundaries, for the posterior application of the Chan-vese level set segmentation model. A set of longitudinal B-mode images of the common carotid artery (CCA) was acquired with a GE Healthcare Vivid-e ultrasound system (GE Healthcare, United Kingdom). All the acquired images include a part of the CCA and of the bifurcation that separates the CCA into the internal and external carotid arteries. In order to achieve the uppermost robustness in the imaging acquisition process, i.e., images with high contrast and low speckle noise, the scanner was adjusted differently for each acquisition and according to the medical exam. The obtained results prove that we were able to successfully apply a carotid segmentation technique based on cervical ultrasonography. The main advantage of the new segmentation method relies on the automatic identification of the carotid lumen, overcoming the limitations of the traditional methods

Deep learning-based carotid media-adventitia and lumen-intima boundary segmentation from three-dimensional ultrasound images

Purpose: Quantification of carotid plaques has been shown to be important for assessing as well as monitoring the progression and regression of carotid atherosclerosis. Various metrics have been proposed and methods of measurements ranging from manual tracing to automated segmentations have also been investigated. Of those metrics, quantification of carotid plaques by measuring vessel-wall-volume (VWV) using the segmented media-adventitia (MAB) and lumen-intima (LIB) boundaries has been shown to be sensitive to temporal changes in carotid plaque burden. Thus, semi-automatic MAB and LIB segmentation methods are required to help generate VWV measurements with high accuracy and less user interaction. Methods: In this paper, we propose a semiautomatic segmentation method based on deep learning to segment the MAB and LIB from carotid three-dimensional ultrasound (3DUS) images. For the MAB segmentation, we convert the segmentation problem to a pixel-by-pixel classification problem. A dynamic convolutional neural network (Dynamic CNN) is proposed to classify the patches generated by sliding a window along the norm line of the initial contour where the CNN model is fine-tuned dynamically in each test task. The LIB is segmented by applying a region-of-interest of carotid images to a U-Net model, which allows the network to be trained end-to-end for pixel-wise classification. Results: A total of 144 3DUS images were used in this development, and a threefold cross-validation technique was used for evaluation of the proposed algorithm. The proposed algorithm-generated accuracy was significantly higher than the previous methods but with less user interactions. Comparing the algorithm segmentation results with manual segmentations by an expert showed that the average Dice similarity coefficients (DSC) were 96.46 ± 2.22% and 92.84 ± 4.46% for the MAB and LIB, respectively, while only an average of 34 s (vs 1.13, 2.8 and 4.4 min in previous methods) was required to segment a 3DUS image. The interobserver experiment indicated that the DSC was 96.14 ± 1.87% between algorithm-generated MAB contours of two observers\u27 initialization. Conclusions: Our results showed that the proposed carotid plaque segmentation method obtains high accuracy and repeatability with less user interactions, suggesting that the method could be used in clinical practice to measure VWV and monitor the progression and regression of carotid plaques

Classification approach for diagnosis of arteriosclerosis using B-mode ultrasound carotid images

Tese de mestrado. Engenharia Biomédica. Faculdade de Engenharia. Universidade do Porto. 201

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.

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