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

Hypothesis Validation of Far-Wall Brightness in Carotid-Artery Ultrasound for Feature-Based IMT Measurement Using a Combination of Level-Set Segmentation and Registration

Intima-media thickness (IMT) is now being considered as an indicator of atherosclerosis. Our group has developed several feature-based IMT measurement algorithms such as the Completely Automated Layer EXtraction (CALEX) (which is a class of patented AtheroEdge Systems from Global Biomedical Technologies, Inc., CA, USA). These methods are based on the hypothesis that the highest pixel intensities are in the far wall of the common carotid artery (CCA) or the internal carotid artery (ICA). In this paper, we verify that this hypothesis holds true for B-mode longitudinal ultrasound (US) images of the carotid wall. This patented methodology consists of generating the composite image (the arithmetic sum of images) from the database by first registering the carotid image frames with respect to a nearly straight carotid-artery frame from the same database using: 1) B-spline-based nonrigid registration and 2) affine registration. Prior to registration, we segment the carotid-artery lumen using a level-set-based algorithm followed by morphological image processing. The binary lumen images are registered, and the transformations are applied to the original grayscale CCA images. We evaluated our technique using a database of 200 common carotid images of normal and pathologic carotids. The composite image presented the highest intensity distribution in the far wall of the CCA/ICA, validating our hypothesis. We have also demonstrated the accuracy and improvement in the IMT segmentation result with our CALEX 3.0 system. The CALEX system, when run on newly acquired US images, shows the IMT error of about 30 mu m. Thus, we have shown that the CALEX algorithm is able to exploit the far-wall brightness for accurate IMT measurements

Association of automated carotid IMT measurement and HbA1c in Japanese patients with coronary artery disease

AIMS: The purpose of this study was to evaluate whether carotid IMT (cIMT) identified using automated software is associated with HbA1c in Japanese patients with coronary artery disease. METHODS: 370 consecutive patients (males 218; median age 69 years±11) who underwent carotid-US and first coronary angiography were prospectively analyzed. After ultrasonographic examinations were performed, the plaque score (PS) was calculated and automated IMT analysis was obtained with a dedicated algorithm. Pearson correlation analysis was performed to calculate the association between automated IMT, PS and HbA1c. RESULTS: The mean value of cIMT was 1.00±0.47mm for the right carotid and 1.04±0.49mm for the left carotid; the average bilateral value was 1.02±0.43mm. No significant difference of cIMT was detected between men and women. We found a direct correlation between cIMT values and HbA1c (p=0.0007) whereas the plaque score did not correlate with the HbA1c values (p>0.05) CONCLUSION: The results of our study confirm that automated cIMT values and levels of HbA1c in Japanese patients with coronary artery disease are correlated whereas the plaque score does not show a statistically significant correlation

The SEDIGISM survey: First Data Release and overview of the Galactic structure

The SEDIGISM (Structure, Excitation and Dynamics of the Inner Galactic Interstellar Medium) survey used the APEX telescope to map 84 deg$^2$ of the Galactic plane between ℓ = −60° and +31° in several molecular transitions, including $^{13}$CO (2 – 1) and C$^{18}$O (2 – 1), thus probing the moderately dense (∼10$^3$ cm$^{-3}$) component of the interstellar medium. With an angular resolution of 30 arcsec and a typical 1σ sensitivity of 0.8–1.0 K at 0.25 km s$^{-1}$ velocity resolution, it gives access to a wide range of structures, from individual star-forming clumps to giant molecular clouds and complexes. The coverage includes a good fraction of the first and fourth Galactic quadrants, allowing us to constrain the large-scale distribution of cold molecular gas in the inner Galaxy. In this paper, we provide an updated overview of the full survey and the data reduction procedures used. We also assess the quality of these data and describe the data products that are being made publicly available as part of this First Data Release (DR1). We present integrated maps and position–velocity maps of the molecular gas and use these to investigate the correlation between the molecular gas and the large-scale structural features of the Milky Way such as the spiral arms, Galactic bar and Galactic Centre. We find that approximately 60 per cent of the molecular gas is associated with the spiral arms and these appear as strong intensity peaks in the derived Galactocentric distribution. We also find strong peaks in intensity at specific longitudes that correspond to the Galactic Centre and well-known star-forming complexes, revealing that the $^{13}$CO emission is concentrated in a small number of complexes rather than evenly distributed along spiral arms

Kinematics and stability of high-mass protostellar disk candidates at sub-arcsecond resolution

Context. The fragmentation mode of high-mass molecular clumps and the accretion processes that form the most massive stars (M & 8 M) are still not well understood. A growing number of case studies have found massive young stellar objects (MYSOs) to harbour disk-like structures, painting a picture that the formation of high-mass stars may proceed through disk accretion, similar to that of lower mass stars. However, the properties of such structures have yet to be uniformly and systematically characterised. Massive disks are prone to fragmentation via gravitational instabilities due to high gas densities and accretion rates. Therefore, it is important to study the stability of such disks in order to put into context the role of disk fragmentation in setting the final stellar mass distribution in high-mass star forming regions. Aims. The aim of this work is to uniformly study the kinematic properties of a large sample of MYSOs and characterise the stability of possible circumstellar disks against gravitational fragmentation. Methods. We have undertaken a large observational program (CORE) making use of interferometric observations from the Northern Extended Millimetre Array (NOEMA) for a sample of 20 luminous (L > 104 L) protostellar objects in the 1.37 mm wavelength regime in both continuum and spectral line emission, reaching 0.400 resolution (800 au at 2 kpc). Results. We present the gas kinematics of the full sample and detect dense gas emission surrounding 15 regions within the CORE sample. Using the dense gas tracer CH3CN, we find velocity gradients across 13 cores perpendicular to the directions of bipolar molecular outflows, making them excellent disk candidates. The extent of the CH3CN emission tracing the disk candidates varies from 1800 − 8500 au. Analysing the free-fall to rotational timescales, we find that the sources are rotationally supported. The rotation profiles of some disk candidates are well described by differential rotation while for others the profiles are poorly resolved. Fitting the velocity profiles with a Keplerian model, we find protostellar masses in the range of ∼ 10 − 25 M. Modelling the level population of CH3CN (12K − 11K) K = 0 − 6 lines we present temperature maps and find median temperature in the range 70–210 K with a diversity in distributions. Radial profiles of the specific angular momentum (j) for the best disk candidates span a range of 1–2 orders of magnitude, on average ∼ 10−3 km s−1 pc, and follow j ∝ r 1.7, consistent with a poorly resolved rotating and infalling envelope/disk model. Studying the Toomre stability of the disk candidates, we find almost all (11 out of 13) disk candidates to be prone to fragmentation due to gravitational instabilities at the scales probed by our observations, as a result of their high disk to stellar mass ratio. In particular, disks with masses greater than ∼ 10 − 20% of the mass of their host (proto)stars are Toomre unstable, and more luminous YSOs tend to have disks that are more massive compared to their host star and hence more prone to fragmentation. Conclusions. In this work, we show that most disk structures around high-mass YSOs are prone to disk fragmentation early in their formation due to their high disk to stellar mass ratio. This impacts the accretion evolution of high-mass protostars which will have significant implications for the formation of the most massive stars

Automated measurement of carotid artery intima-media thickness

Atherosclerosis is a degenerative process that, during years, leads to the accumulation of lipids and other blood-borne materials into the arterial walls.1 The most important consequences correlated to the progression of atherosclerosis are: (1) the narrowing of the artery lumen, (2) the thickening of the wall, (3) the loss of elasticity, and (4) the reduction of the artery blood flo

Common variable immunodeficiency--a case report and review.

Annals of the Academy of Medicine Singapore172254-25