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Singh VK, Yousef Kalafi E, Cheah E, Wang S, Wang J, Ozturk A, Li Q, Eldar YC, Samir AE, Kumar V. HaTU-Net: Harmonic Attention Network for Automated Ovarian Ultrasound Quantification in Assisted Pregnancy. Diagnostics (Basel) 2022; 12:diagnostics12123213. [PMID: 36553220 PMCID: PMC9777827 DOI: 10.3390/diagnostics12123213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Antral follicle Count (AFC) is a non-invasive biomarker used to assess ovarian reserves through transvaginal ultrasound (TVUS) imaging. Antral follicles' diameter is usually in the range of 2-10 mm. The primary aim of ovarian reserve monitoring is to measure the size of ovarian follicles and the number of antral follicles. Manual follicle measurement is inhibited by operator time, expertise and the subjectivity of delineating the two axes of the follicles. This necessitates an automated framework capable of quantifying follicle size and count in a clinical setting. This paper proposes a novel Harmonic Attention-based U-Net network, HaTU-Net, to precisely segment the ovary and follicles in ultrasound images. We replace the standard convolution operation with a harmonic block that convolves the features with a window-based discrete cosine transform (DCT). Additionally, we proposed a harmonic attention mechanism that helps to promote the extraction of rich features. The suggested technique allows for capturing the most relevant features, such as boundaries, shape, and textural patterns, in the presence of various noise sources (i.e., shadows, poor contrast between tissues, and speckle noise). We evaluated the proposed model on our in-house private dataset of 197 patients undergoing TransVaginal UltraSound (TVUS) exam. The experimental results on an independent test set confirm that HaTU-Net achieved a Dice coefficient score of 90% for ovaries and 81% for antral follicles, an improvement of 2% and 10%, respectively, when compared to a standard U-Net. Further, we accurately measure the follicle size, yielding the recall, and precision rates of 91.01% and 76.49%, respectively.
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Affiliation(s)
- Vivek Kumar Singh
- Center for Ultrasound Research & Translation at the Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA 02114, USA
| | - Elham Yousef Kalafi
- Center for Ultrasound Research & Translation at the Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA 02114, USA
| | - Eugene Cheah
- Center for Ultrasound Research & Translation at the Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA 02114, USA
| | - Shuhang Wang
- Center for Ultrasound Research & Translation at the Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA 02114, USA
| | - Jingchao Wang
- Department of Ultrasound, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Arinc Ozturk
- Center for Ultrasound Research & Translation at the Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA 02114, USA
| | - Qian Li
- Center for Ultrasound Research & Translation at the Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA 02114, USA
| | - Yonina C. Eldar
- Faculty of Mathematics and Computer Science, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Anthony E. Samir
- Center for Ultrasound Research & Translation at the Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA 02114, USA
| | - Viksit Kumar
- Center for Ultrasound Research & Translation at the Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA 02114, USA
- Correspondence:
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Evaluation of oocyte maturity using artificial intelligence quantification of follicle volume biomarker by three-dimensional ultrasound: a preliminary study. Reprod Biomed Online 2022; 45:1197-1206. [DOI: 10.1016/j.rbmo.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/20/2022]
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Esteves SC, Conforti A, Sunkara SK, Carbone L, Picarelli S, Vaiarelli A, Cimadomo D, Rienzi L, Ubaldi FM, Zullo F, Andersen CY, Orvieto R, Humaidan P, Alviggi C. Improving Reporting of Clinical Studies Using the POSEIDON Criteria: POSORT Guidelines. Front Endocrinol (Lausanne) 2021; 12:587051. [PMID: 33815269 PMCID: PMC8017440 DOI: 10.3389/fendo.2021.587051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/19/2021] [Indexed: 12/19/2022] Open
Abstract
The POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) criteria were developed to help clinicians identify and classify low-prognosis patients undergoing assisted reproductive technology (ART) and provide guidance for possible therapeutic strategies to overcome infertility. Since its introduction, the number of published studies using the POSEIDON criteria has increased steadily. However, a critical analysis of existing evidence indicates inconsistent and incomplete reporting of critical outcomes. Therefore, we developed guidelines to help researchers improve the quality of reporting in studies applying the POSEIDON criteria. We also discuss the advantages of using the POSEIDON criteria in ART clinical studies and elaborate on possible study designs and critical endpoints. Our ultimate goal is to advance the knowledge concerning the clinical use of the POSEIDON criteria to patients, clinicians, and the infertility community.
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Affiliation(s)
- Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
- Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | - Sesh K. Sunkara
- Department of Women’s Health, Faculty of Life Sciences, King’s College London, London, United Kingdom
| | - Luigi Carbone
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | - Silvia Picarelli
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | | | | | - Laura Rienzi
- Center for Reproductive Medicine, GENERA, Rome, Italy
| | | | - Fulvio Zullo
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, Faculty of Health and Medical Sciences, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Peter Humaidan
- Faculty of Health, Aarhus University, Aarhus, Denmark
- Fertility Clinic Skive, Skive Regional Hospital, Skive, Denmark
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
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Liang X, Fang J, Li H, Yang X, Ni D, Zeng F, Chen Z. CR-Unet-Based Ultrasonic Follicle Monitoring to Reduce Diameter Variability and Generate Area Automatically as a Novel Biomarker for Follicular Maturity. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3125-3134. [PMID: 32839052 DOI: 10.1016/j.ultrasmedbio.2020.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
Follicle size is closely related to ovarian function and is an important biomarker in transvaginal ultrasound examinations for assessing follicular maturity during an assisted reproduction cycle. However, manual measurement is time consuming and subject to high inter- and intra- observer variability. Based on the deep learning model CR-Unet described in our previous study, the aim of our present study was to investigate further the feasibility of using this model in clinical practice by validating its performance in reducing the inter- and intra-observer variability of follicle diameter measurement. This study also investigated whether follicular area is a better biomarker than diameter in assessing follicular maturity. Data on 106 ovaries and 230 follicles collected from 80 cases of single follicular cycles and 26 cases of multiple follicular cycles constituted the validation set. Intra-observer variability was 0.973 and 0.982 for the senior sonographer and junior sonographer in single follicular cycles and 0.979 (0.971, 0.985) and 0.920 (0.892, 0.943) in multiple follicular cycles, respectively, while CR-Unet had no intra-group variation. Bland-Altman plot analysis indicated that the 95% limits of agreement between senior sonographer and CR-Unet (-2.1 to 1.1 mm, -2.02 to 0.75 mm) were smaller than those between senior sonographer and junior sonographer (-1.51 to 1.15 mm, -2.1 to 1.56 mm) in single and multiple follicular cycles. The average operating times of diameter measurement taken by the junior sonographer, senior sonographer and CR-Unet were 7.54 ± 1.8, 4.87 ± 0.84 and 1.66 ± 0.76 s, respectively (p < 0.001). Correlation analysis indicated that both manual and automated follicular area correlated better with follicular volume than diameter. The deep learning algorithm and the new biomarker of follicular area hold potential for clinical application of ultrasonic follicular monitoring.
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Affiliation(s)
- Xiaowen Liang
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jinghui Fang
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haoming Li
- Medical Ultrasound Image Computing (MUSIC) Lab, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Xin Yang
- Department of Computer Science and Engineering, Chinese University of Hong Kong, Hong Kong, China
| | - Dong Ni
- Medical Ultrasound Image Computing (MUSIC) Lab, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Fengyi Zeng
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhiyi Chen
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Abdallah A, Shawki H, Abdel-Rasheed M, Salem S, Hosni M. Role of 3-D Transvaginal Ultrasonography in Women Undergoing in Vitro Fertilization/Intra-cytoplasmic Sperm Injection. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1424-1427. [PMID: 32217031 DOI: 10.1016/j.ultrasmedbio.2020.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/28/2020] [Accepted: 02/11/2020] [Indexed: 06/10/2023]
Abstract
Both 2-D and 3-D transvaginal ultrasonography are effective imaging modalities for assessment of ovarian reserve. Our aim was to compare both modalities in assessment of ovarian reserve of women undergoing in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI). Fifty women were scheduled according to their menstrual cycle to be examined by both 2-D and 3-D transvaginal ultrasonography. We found that the average time for computerized analysis of the 3-D ultrasound data was significantly shorter than that for analysis of the 2-D ultrasound data, for both total antral follicle count and ovarian volume. However, there were no statistically significant differences between the methods in total antral follicle count and ovarian volume. We conclude that, where available, 3-D ultrasonography can be used for assessment of ovarian reserve in addition to the biochemical marker, particularly in overcrowded in vitro fertilization centers that need to save time.
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Affiliation(s)
- Ameer Abdallah
- Obstetrics and Gynecology Department, Minia University, El Minia, Egypt
| | - Hossam Shawki
- Obstetrics and Gynecology Department, Minia University, El Minia, Egypt
| | - Mazen Abdel-Rasheed
- Reproductive Health Research Department, National Research Centre, Cairo, Egypt.
| | - Sondos Salem
- Reproductive Health Research Department, National Research Centre, Cairo, Egypt
| | - Mahmoud Hosni
- Obstetrics and Gynecology Department, Minia University, El Minia, Egypt
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