Endometrium segmentation on transvaginal ultrasound image using key-point discriminator

Segment anything with inception module for automated segmentation of endometrium in ultrasound images

Purpose

Accurate segmentation of the endometrium in ultrasound images is essential for gynecological diagnostics and treatment planning. Manual segmentation methods are time-consuming and subjective, prompting the exploration of automated solutions. We introduce "segment anything with inception module" (SAIM), a specialized adaptation of the segment anything model, tailored specifically for the segmentation of endometrium structures in ultrasound images.

Approach

SAIM incorporates enhancements to the image encoder structure and integrates point prompts to guide the segmentation process. We utilized ultrasound images from patients undergoing hysteroscopic surgery in the gynecological department to train and evaluate the model.

Results

Our study demonstrates SAIM's superior segmentation performance through quantitative and qualitative evaluations, surpassing existing automated methods. SAIM achieves a dice similarity coefficient of 76.31% and an intersection over union score of 63.71%, outperforming traditional task-specific deep learning models and other SAM-based foundation models.

Conclusions

The proposed SAIM achieves high segmentation accuracy, providing high diagnostic precision and efficiency. Furthermore, it is potentially an efficient tool for junior medical professionals in education and diagnosis.

A three-path network with multi-scale selective feature fusion, edge-inspiring and edge-guiding for liver tumor segmentation

Automatic liver tumor segmentation is one of the most important tasks in computer-aided diagnosis and treatment. Deep learning techniques have gained increasing popularity for medical image segmentation in recent years. However, due to the various shapes, sizes, and obscure boundaries of tumors, it is still difficult to automatically extract tumor regions from CT images. Based on the complementarity of edge detection and region segmentation, a three-path structure with multi-scale selective feature fusion (MSFF) module, multi-channel feature fusion (MFF) module, edge-inspiring (EI) module, and edge-guiding (EG) module is proposed in this paper. The MSFF module includes the process of generation, fusion, and selection of multi-scale features, which can adaptively correct the response weights in multiple branches to filter redundant information. The MFF module integrates richer hierarchical features to capture targets at different scales. The EI module aggregates high-level semantic information at different levels to obtain fine edge semantics, which is injected into the EG module for representation learning of segmentation features. Experiments on the LiTs2017 dataset show that our proposed method achieves a Dice index of 85.55% and a Jaccard index of 81.11%, which are higher than what can be obtained by the current state-of-the-art methods. Cross-dataset validation experiments conducted on 3Dircadb and Clinical datasets show the generalization and robustness of the proposed method by achieving dice indices of 80.14% and 81.68%, respectively.

Evolving the Era of 5D Ultrasound? A Systematic Literature Review on the Applications for Artificial Intelligence Ultrasound Imaging in Obstetrics and Gynecology

Artificial intelligence (AI) has gained prominence in medical imaging, particularly in obstetrics and gynecology (OB/GYN), where ultrasound (US) is the preferred method. It is considered cost effective and easily accessible but is time consuming and hindered by the need for specialized training. To overcome these limitations, AI models have been proposed for automated plane acquisition, anatomical measurements, and pathology detection. This study aims to overview recent literature on AI applications in OB/GYN US imaging, highlighting their benefits and limitations. For the methodology, a systematic literature search was performed in the PubMed and Cochrane Library databases. Matching abstracts were screened based on the PICOS (Participants, Intervention or Exposure, Comparison, Outcome, Study type) scheme. Articles with full text copies were distributed to the sections of OB/GYN and their research topics. As a result, this review includes 189 articles published from 1994 to 2023. Among these, 148 focus on obstetrics and 41 on gynecology. AI-assisted US applications span fetal biometry, echocardiography, or neurosonography, as well as the identification of adnexal and breast masses, and assessment of the endometrium and pelvic floor. To conclude, the applications for AI-assisted US in OB/GYN are abundant, especially in the subspecialty of obstetrics. However, while most studies focus on common application fields such as fetal biometry, this review outlines emerging and still experimental fields to promote further research.

Anatomically Guided Cross-Domain Repair and Screening for Ultrasound Fetal Biometry

Ultrasound based estimation of fetal biometry is extensively used to diagnose prenatal abnormalities and to monitor fetal growth, for which accurate segmentation of the fetal anatomy is a crucial prerequisite. Although deep neural network-based models have achieved encouraging results on this task, inevitable distribution shifts in ultrasound images can still result in severe performance drop in real world deployment scenarios. In this article, we propose a complete ultrasound fetal examination system to deal with this troublesome problem by repairing and screening the anatomically implausible results. Our system consists of three main components: A routine segmentation network, a fetal anatomical key points guided repair network, and a shape-coding based selective screener. Guided by the anatomical key points, our repair network has stronger cross-domain repair capabilities, which can substantially improve the outputs of the segmentation network. By quantifying the distance between an arbitrary segmentation mask to its corresponding anatomical shape class, the proposed shape-coding based selective screener can then effectively reject the entire implausible results that cannot be fully repaired. Extensive experiments demonstrate that our proposed framework has strong anatomical guarantee and outperforms other methods in three different cross-domain scenarios.

Artificial Intelligence in the Assessment of Female Reproductive Function Using Ultrasound: A Review

The incidence of infertility is continuously increasing nearly all over the world in recent years, and novel methods for accurate assessment are of great need. Artificial Intelligence (AI) has gradually become an effective supplementary method for the assessment of female reproductive function. It has been used in clinical follicular monitoring, optimum timing for transplantation, and prediction of pregnancy outcome. Some literatures summarize the use of AI in this field, but few of them focus on the assessment of female reproductive function by AI-aided ultrasound. In this review, we mainly discussed the applicability, feasibility, and value of clinical application of AI in ultrasound to monitor follicles, assess endometrial receptivity, and predict the pregnancy outcome of in vitro fertilization and embryo transfer (IVF-ET). The limitations, challenges, and future trends of ultrasound combined with AI in providing efficient and individualized evaluation of female reproductive function had also been mentioned.

Automatic Measurement of Endometrial Thickness From Transvaginal Ultrasound Images

Purpose: Endometrial thickness is one of the most important indicators in endometrial disease screening and diagnosis. Herein, we propose a method for automated measurement of endometrial thickness from transvaginal ultrasound images.

Methods: Accurate automated measurement of endometrial thickness relies on endometrium segmentation from transvaginal ultrasound images that usually have ambiguous boundaries and heterogeneous textures. Therefore, a two-step method was developed for automated measurement of endometrial thickness. First, a semantic segmentation method was developed based on deep learning, to segment the endometrium from 2D transvaginal ultrasound images. Second, we estimated endometrial thickness from the segmented results, using a largest inscribed circle searching method. Overall, 8,119 images (size: 852 × 1136 pixels) from 467 cases were used to train and validate the proposed method.

Results: We achieved an average Dice coefficient of 0.82 for endometrium segmentation using a validation dataset of 1,059 images from 71 cases. With validation using 3,210 images from 214 cases, 89.3% of endometrial thickness errors were within the clinically accepted range of ±2 mm.

Conclusion: Endometrial thickness can be automatically and accurately estimated from transvaginal ultrasound images for clinical screening and diagnosis.

Development and Validation of a Deep Learning Model to Quantify Interstitial Fibrosis and Tubular Atrophy From Kidney Ultrasonography Images

IMPORTANCE

Interstitial fibrosis and tubular atrophy (IFTA) is a strong indicator of decline in kidney function and is measured using histopathological assessment of kidney biopsy core. At present, a noninvasive test to assess IFTA is not available.

OBJECTIVE

To develop and validate a deep learning (DL) algorithm to quantify IFTA from kidney ultrasonography images.

DESIGN, SETTING, AND PARTICIPANTS

This was a single-center diagnostic study of consecutive patients who underwent native kidney biopsy at John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, between January 1, 2014, and December 31, 2018. A DL algorithm was trained, validated, and tested to classify IFTA from kidney ultrasonography images. Of 6135 Crimmins-filtered ultrasonography images, 5523 were used for training (5122 images) and validation (401 images), and 612 were used to test the accuracy of the DL system. Kidney segmentation was performed using the UNet architecture, and classification was performed using a convolution neural network-based feature extractor and extreme gradient boosting. IFTA scored by a nephropathologist on trichrome stained kidney biopsy slide was used as the reference standard. IFTA was divided into 4 grades (grade 1, 0%-24%; grade 2, 25%-49%; grade 3, 50%-74%; and grade 4, 75%-100%). Data analysis was performed from December 2019 to May 2020.

MAIN OUTCOMES AND MEASURES

Prediction of IFTA grade was measured using the metrics precision, recall, accuracy, and F1 score.

RESULTS

This study included 352 patients (mean [SD] age 47.43 [14.37] years), of whom 193 (54.82%) were women. There were 159 patients with IFTA grade 1 (2701 ultrasonography images), 74 patients with IFTA grade 2 (1239 ultrasonography images), 41 patients with IFTA grade 3 (701 ultrasonography images), and 78 patients with IFTA grade 4 (1494 ultrasonography images). Kidney ultrasonography images were segmented with 91% accuracy. In the independent test set, the point estimates for performance matrices showed precision of 0.8927 (95% CI, 0.8682-0.9172), recall of 0.8037 (95% CI, 0.7722-0.8352), accuracy of 0.8675 (95% CI, 0.8406-0.8944), and an F1 score of 0.8389 (95% CI, 0.8098-0.8680) at the image level. Corresponding estimates at the patient level were precision of 0.9003 (95% CI, 0.8644-0.9362), recall of 0.8421 (95% CI, 0.7984-0.8858), accuracy of 0.8955 (95% CI, 0.8589-0.9321), and an F1 score of 0.8639 (95% CI, 0.8228-0.9049). Accuracy at the patient level was highest for IFTA grade 1 and IFTA grade 4. The accuracy (approximately 90%) remained high irrespective of the timing of ultrasonography studies and the biopsy diagnosis. The predictive performance of the DL system did not show significant improvement when combined with baseline clinical characteristics.

CONCLUSIONS AND RELEVANCE

These findings suggest that a DL algorithm can accurately and independently predict IFTA from kidney ultrasonography images.

Technology trends and applications of deep learning in ultrasonography: image quality enhancement, diagnostic support, and improving workflow efficiency

In this review of the most recent applications of deep learning to ultrasound imaging, the architectures of deep learning networks are briefly explained for the medical imaging applications of classification, detection, segmentation, and generation. Ultrasonography applications for image processing and diagnosis are then reviewed and summarized, along with some representative imaging studies of the breast, thyroid, heart, kidney, liver, and fetal head. Efforts towards workflow enhancement are also reviewed, with an emphasis on view recognition, scanning guide, image quality assessment, and quantification and measurement. Finally some future prospects are presented regarding image quality enhancement, diagnostic support, and improvements in workflow efficiency, along with remarks on hurdles, benefits, and necessary collaborations.