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Carotid Ultrasound Boundary Study (CUBS): Technical considerations on an open multi-center analysis of computerized measurement systems for intima-media thickness measurement on common carotid artery longitudinal B-mode ultrasound scans. Comput Biol Med 2022; 144:105333. [DOI: 10.1016/j.compbiomed.2022.105333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/02/2022] [Accepted: 02/16/2022] [Indexed: 01/17/2023]
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Meiburger KM, Zahnd G, Faita F, Loizou CP, Carvalho C, Steinman DA, Gibello L, Bruno RM, Marzola F, Clarenbach R, Francesconi M, Nicolaides AN, Campilho A, Ghotbi R, Kyriacou E, Navab N, Griffin M, Panayiotou AG, Gherardini R, Varetto G, Bianchini E, Pattichis CS, Ghiadoni L, Rouco J, Molinari F. Carotid Ultrasound Boundary Study (CUBS): An Open Multicenter Analysis of Computerized Intima-Media Thickness Measurement Systems and Their Clinical Impact. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2442-2455. [PMID: 33941415 DOI: 10.1016/j.ultrasmedbio.2021.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
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/fpv535fss7.1.
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Affiliation(s)
- Kristen M Meiburger
- PolitoBIOmed Lab, Biolab, Department of Electronics and Communications, Politecnico di Torino, Torino, Italy.
| | - Guillaume Zahnd
- Computer Aided Medical Procedures, Technische Universität München, München, Germany
| | - Francesco Faita
- Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy
| | - Christos P Loizou
- Department of Computer Science, University of Cyprus, Nicosia, Cyprus
| | | | - David A Steinman
- Biomedical Simulation Lab, Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Lorenzo Gibello
- Dipartimento di Scienze Chirurgiche, University of Torino, Torino, Italy
| | - Rosa Maria Bruno
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; INSERM U970, Paris Cardiovascular Research Centre-PARCC and Université de Paris, Paris, France
| | - Francesco Marzola
- PolitoBIOmed Lab, Biolab, Department of Electronics and Communications, Politecnico di Torino, Torino, Italy
| | | | - Martina Francesconi
- Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Aurelio Campilho
- INESC Technology and Science, Porto, Portugal; FEUP-Faculty of Engineering, University of Porto, Porto, Portugal
| | - Reza Ghotbi
- INSERM U970, Paris Cardiovascular Research Centre-PARCC and Université de Paris, Paris, France
| | - Efthyvoulos Kyriacou
- Department of Computer Science and Engineering, Frederick University, Limassol, Cyprus
| | - Nassir Navab
- Computer Aided Medical Procedures, Technische Universität München, München, Germany; Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maura Griffin
- The Vascular Screening and Diagnostic Centre, Nicosia, Cyprus
| | - Andrie G Panayiotou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Rachele Gherardini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gianfranco Varetto
- Dipartimento di Scienze Chirurgiche, University of Torino, Torino, Italy
| | - Elisabetta Bianchini
- Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy
| | - Constantinos S Pattichis
- Department of Computer Science and Biomedical Engineering Research Center, University of Cyprus, Nicosia, Cyprus
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - José Rouco
- Research Center of Information and Communication Technologies, UDC, A Coruña, Spain; Department of Computer Science, University of A Coruña, A Coruña, Spain
| | - Filippo Molinari
- PolitoBIOmed Lab, Biolab, Department of Electronics and Communications, Politecnico di Torino, Torino, Italy
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Kumar PK, Araki T, Rajan J, Laird JR, Nicolaides A, Suri JS. State-of-the-art review on automated lumen and adventitial border delineation and its measurements in carotid ultrasound. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 163:155-168. [PMID: 30119850 DOI: 10.1016/j.cmpb.2018.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 04/29/2018] [Accepted: 05/09/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Accurate, reliable, efficient, and precise measurements of the lumen geometry of the common carotid artery (CCA) are important for (a) managing the progression/regression of atherosclerotic build-up and (b) the risk of stroke. The image-based degree of stenosis in the carotid artery and the plaque burden can be predicted using the automated carotid lumen diameter (LD)/inter-adventitial diameter (IAD) measurements from B-mode ultrasound images. The objective of this review is to present the state-of-the-art methods and systems for the measurement of LD/IAD in CCA based on automated or semi-automated strategies. Further, the performance of these systems is compared based on various metrics for its measurements. METHODS The automated algorithms proposed for the segmentation of carotid lumen are broadly classified into two different categories as: region-based and boundary-based. These techniques are discussed in detail specifying their pros and cons. Further, we discuss the challenges encountered in the segmentation process along with its quantitative assessment. Lastly, we present stenosis quantification and risk stratification strategies. RESULTS Even though, we have found more boundary-based approaches compared to region-based approaches in the literature, however, the region-based strategy yield more satisfactory performance. Novel risk stratification strategies are presented. On a patient database containing 203 patients, 9 patients are identified as high risk patients, whereas 27 patients are identified as medium risk patients. CONCLUSIONS We have presented different techniques for the lumen segmentation of the common carotid artery from B-mode ultrasound images and measurement of lumen diameter and inter-adventitial diameter. We believe that the issue regarding boundary-based techniques can be compensated by taking regional statistics embedded with boundary-based information.
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Affiliation(s)
- P Krishna Kumar
- Department of Computer Science and Engineering, National Institute of Technology Calicut, Kerala, India
| | - Tadashi Araki
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Jeny Rajan
- Department of Computer Science and Engineering, National Institute of Technology Karnataka, Surathkal, India
| | - John R Laird
- Heart and Vascular Institute, Adventist Health, St. Helena, CA, USA
| | | | - Jasjit S Suri
- Stroke Monitoring Division, AtheroPoint, Roseville, CA, USA; Department of Electrical Engineering, University of Idaho (Affl.), ID, USA.
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Rouco J, Carvalho C, Domingues A, Azevedo E, Campilho A. A robust anisotropic edge detection method for carotid ultrasound image processing. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.procs.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Wivern: a Web-Based System Enabling Computer-Aided Diagnosis and Interdisciplinary Expert Collaboration for Vascular Research. J Med Biol Eng 2017. [DOI: 10.1007/s40846-017-0256-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ikeda N, Dey N, Sharma A, Gupta A, Bose S, Acharjee S, Shafique S, Cuadrado-Godia E, Araki T, Saba L, Laird JR, Nicolaides A, Suri JS. Automated segmental-IMT measurement in thin/thick plaque with bulb presence in carotid ultrasound from multiple scanners: Stroke risk assessment. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 141:73-81. [PMID: 28241970 DOI: 10.1016/j.cmpb.2017.01.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/20/2016] [Accepted: 01/17/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Standardization of the carotid IMT requires a reference marker in ultrasound scans. It has been shown previously that manual reference marker and manually created carotid segments are used for measuring IMT in these segments. Manual methods are tedious, time consuming, subjective, and prone to errors. Bulb edge can be considered as a reference marker for measurements of the cIMT. However, bulb edge can be difficult to locate in ultrasound scans due to: (a) low signal to noise ratio in the bulb region as compared to common carotid artery region; (b) uncertainty of bulb location in craniocaudal direction; and (c) variability in carotid bulb shape and size. This paper presents an automated system (a class of AtheroEdge™ system from AtheroPoint™, Roseville, CA, USA) for locating the bulb edge as a reference marker and further develop segmental-IMT (sIMT) which measures IMT in 10mm segments (namely: s1, s2 and s3) proximal to the bulb edge. METHODS The patented methodology uses an integrated approach which combines carotid geometry and pixel-classification paradigms. The system first finds the bulb edge and then measures the sIMT proximal to the bulb edge. The system also estimates IMT in bulb region (bIMT). The 649 image database consists of varying plaque (light, moderate to heavy), image resolutions, shapes, sizes and ethnicity. RESULTS Our results show that the IMT contributions in different carotid segments are as follows: bulb-IMT 34%, s1-IMT 29.46%, s2-IMT 11.48%, and s3-IMT 12.75%, respectively. We compare our automated results against reader's tracings demonstrating the following performance: mean lumen-intima error: 0.01235 ± 0.01224mm, mean media-adventitia error: 0.020933 ± 0.01539mm and mean IMT error: 0.01063 ± 0.0031mm. Our system's Precision of Merit is: 98.23%, coefficient of correlation between automated and Reader's IMT is: 0.998 (p-value < 0.0001). These numbers are improved compared to previous publications by Suri's group which is automated multi-resolution conventional cIMT. CONCLUSIONS Our fully automated bulb detection system reports 92.67% precision against ideal bulb edge locations as marked by the reader in the bulb transition zone.
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Affiliation(s)
- Nobutaka Ikeda
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi Meguro-ku, Tokyo, Japan
| | - Nilanjan Dey
- Point of Care Devices, Global Biomedical Technologies, Inc., Roseville, CA, USA
| | - Aditya Sharma
- Cardiovascular Medicine, University of Virginia, VA, USA
| | - Ajay Gupta
- Department of Radiology, Brain and Mind Research Institute, Weill Cornell Medical College, NY, USA
| | - Soumyo Bose
- Point of Care Devices, Global Biomedical Technologies, Inc., Roseville, CA, USA
| | - Suvojit Acharjee
- Point of Care Devices, Global Biomedical Technologies, Inc., Roseville, CA, USA
| | - Shoaib Shafique
- CorVasc Vascular Laboratory, 8433 Harcourt Rd #100, Indianapolis, IN, USA
| | | | - Tadashi Araki
- Division of Cardiovascular Medicine, Centre for Global Health and Medicine (NCGM), 1-21-1 Toyama Shinjuku-ku, Tokyo, Japan
| | - Luca Saba
- Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari - Polo di Monserrato, Università di Cagliari, s.s. 554 Monserrato, Cagliari 09045, Italy
| | - John R Laird
- UC Davis Vascular Center, University of California, Davis, CA, USA
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre, London, and Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - Jasjit S Suri
- Point of Care Devices, Global Biomedical Technologies, Inc., Roseville, CA, USA; Diagnostic and Monitoring Division, AtheroPoint™ LLC, Roseville, CA, USA; Electrical Engineering Department (Aff.), Idaho State University, ID, USA.
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Accurate lumen diameter measurement in curved vessels in carotid ultrasound: an iterative scale-space and spatial transformation approach. Med Biol Eng Comput 2016; 55:1415-1434. [PMID: 27943087 DOI: 10.1007/s11517-016-1601-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
Abstract
Monitoring of cerebrovascular diseases via carotid ultrasound has started to become a routine. The measurement of image-based lumen diameter (LD) or inter-adventitial diameter (IAD) is a promising approach for quantification of the degree of stenosis. The manual measurements of LD/IAD are not reliable, subjective and slow. The curvature associated with the vessels along with non-uniformity in the plaque growth poses further challenges. This study uses a novel and generalized approach for automated LD and IAD measurement based on a combination of spatial transformation and scale-space. In this iterative procedure, the scale-space is first used to get the lumen axis which is then used with spatial image transformation paradigm to get a transformed image. The scale-space is then reapplied to retrieve the lumen region and boundary in the transformed framework. Then, inverse transformation is applied to display the results in original image framework. Two hundred and two patients' left and right common carotid artery (404 carotid images) B-mode ultrasound images were retrospectively analyzed. The validation of our algorithm has done against the two manual expert tracings. The coefficient of correlation between the two manual tracings for LD was 0.98 (p < 0.0001) and 0.99 (p < 0.0001), respectively. The precision of merit between the manual expert tracings and the automated system was 97.7 and 98.7%, respectively. The experimental analysis demonstrated superior performance of the proposed method over conventional approaches. Several statistical tests demonstrated the stability and reliability of the automated system.
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Hunt BE, Flavin DC, Bauschatz E, Whitney HM. Accuracy and robustness of a simple algorithm to measure vessel diameter from B-mode ultrasound images. J Appl Physiol (1985) 2016; 120:1374-9. [PMID: 27055985 DOI: 10.1152/japplphysiol.00355.2015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 04/04/2016] [Indexed: 11/22/2022] Open
Abstract
Measurement of changes in arterial vessel diameter can be used to assess the state of cardiovascular health, but the use of such measurements as biomarkers is contingent upon the accuracy and robustness of the measurement. This work presents a simple algorithm for measuring diameter from B-mode images derived from vascular ultrasound. The algorithm is based upon Gaussian curve fitting and a Viterbi search process. We assessed the accuracy of the algorithm by measuring the diameter of a digital reference object (DRO) and ultrasound-derived images of a carotid artery. We also assessed the robustness of the algorithm by manipulating the quality of the image. Across a broad range of signal-to-noise ratio and with varying image edge error, the algorithm measured vessel diameter within 0.7% of the creation dimensions of the DRO. This was a similar level of difference (0.8%) to when an ultrasound image was used. When SNR dropped to 18 dB, measurement error increased to 1.3%. When edge position was varied by as much as 10%, measurement error was well maintained between 0.68 and 0.75%. All these errors fall well within the margin of error established by the medical physics community for quantitative ultrasound measurements. We conclude that this simple algorithm provides consistent and accurate measurement of lumen diameter from B-mode images across a broad range of image quality.
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Affiliation(s)
- Brian E Hunt
- Department of Applied Health Science, Wheaton College, Wheaton, Illinois; and
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Automatic Lumen Detection on Longitudinal Ultrasound B-Mode Images of the Carotid Using Phase Symmetry. SENSORS 2016; 16:s16030350. [PMID: 27005631 PMCID: PMC4813925 DOI: 10.3390/s16030350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 11/17/2022]
Abstract
This article describes a method that improves the performance of previous approaches for the automatic detection of the common carotid artery (CCA) lumen centerline on longitudinal B-mode ultrasound images. We propose to detect several lumen centerline candidates using local symmetry analysis based on local phase information of dark structures at an appropriate scale. These candidates are analyzed with selection mechanisms that use symmetry, contrast or intensity features in combination with position-based heuristics. Several experimental results are provided to evaluate the robustness and performance of the proposed method in comparison with previous approaches. These results lead to the conclusion that our proposal is robust to noise, lumen artifacts, contrast variations and that is able to deal with the presence of CCA-like structures, significantly improving the performance of our previous approach, from 87.5% ± 0.7% of correct detections to 98.3% ± 0.3% in a set of 200 images.
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Rocha R, Silva J, Campilho A. Automatic detection of the carotid lumen axis in B-mode ultrasound images. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 115:110-118. [PMID: 24810736 DOI: 10.1016/j.cmpb.2014.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 03/25/2014] [Accepted: 04/07/2014] [Indexed: 06/03/2023]
Abstract
A new approach is introduced for the automatic detection of the lumen axis of the common carotid artery in B-mode ultrasound images. The image is smoothed using a Gaussian filter and then a dynamic programming scheme extracts the dominant paths of local minima of the intensity and the dominant paths of local maxima of the gradient magnitude with the gradient pointing downwards. Since these paths are possible estimates of the lumen axis and the far wall of a blood vessel, respectively, they are grouped together into pairs. Then, a pattern of two features is computed from each pair of paths and used as input to a linear discriminant classifier in order to select the pair of paths that correspond to the common carotid artery. The estimated lumen axis is the path of local minima of the intensity that belongs to the selected pair of paths. The proposed method is suited to real time processing, no user interaction is required and the number of parameters is minimal and easy to determine. The validation was performed using two datasets, with a total of 199 images, and has shown a success rate of 99.5% (100% if only the carotid regions for which a ground truth is available are considered). The datasets have a large diversity of images, including cases of arteries with plaque and images with heavy noise, text or other graphical markings inside the artery region.
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Affiliation(s)
- Rui Rocha
- INESC TEC - INESC Technology and Science, Porto, Portugal; ISEP - Inst. Sup. de Eng. do Porto, Portugal.
| | - Jorge Silva
- INESC TEC - INESC Technology and Science, Porto, Portugal; FEUP - Fac. de Eng. da Univ. do Porto, Portugal
| | - Aurélio Campilho
- INESC TEC - INESC Technology and Science, Porto, Portugal; FEUP - Fac. de Eng. da Univ. do Porto, Portugal
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Acharya UR, Mookiah MRK, Vinitha Sree S, Afonso D, Sanches J, Shafique S, Nicolaides A, Pedro LM, Fernandes E Fernandes J, Suri JS. Atherosclerotic plaque tissue characterization in 2D ultrasound longitudinal carotid scans for automated classification: a paradigm for stroke risk assessment. Med Biol Eng Comput 2013; 51:513-23. [PMID: 23292291 DOI: 10.1007/s11517-012-1019-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 12/17/2012] [Indexed: 11/25/2022]
Abstract
In the case of carotid atherosclerosis, to avoid unnecessary surgeries in asymptomatic patients, it is necessary to develop a technique to effectively differentiate symptomatic and asymptomatic plaques. In this paper, we have presented a data mining framework that characterizes the textural differences in these two classes using several grayscale features based on a novel combination of trace transform and fuzzy texture. The features extracted from the delineated plaque regions in B-mode ultrasound images were used to train several classifiers in order to prepare them for classification of new test plaques. Our CAD system was evaluated using two different databases consisting of 146 (44 symptomatic to 102 asymptomatic) and 346 (196 symptomatic and 150 asymptomatic) images. Both these databases differ in the way the ground truth was determined. We obtained classification accuracies of 93.1 and 85.3 %, respectively. The techniques are low cost, easily implementable, objective, and non-invasive. For more objective analysis, we have also developed novel integrated indices using a combination of significant features.
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Affiliation(s)
- U Rajendra Acharya
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Clementi, Singapore.
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