A level set framework with a shape and motion prior for segmentation and region tracking in echocardiography

Automated peak prominence-based iterative Dijkstras algorithm for segmentation of B-mode echocardiograms

We present a user-initialized, automated segmentation method for use with echocardiograms (echo). The method uses an iterative Dijkstra's algorithm, a strategic node selection, and a novel cost matrix formulation based on intensity peak prominence, termed the Prominence Iterative Dijkstras algorithm, or ProID. ProID is initialized with three user-input clicks per time-series scan. ProID was tested using artificial echo images representing five different systems. Results showed accurate LV contours and volume estimations as compared to the ground-truth for all systems. Using the CAMUS dataset, we demonstrate ProID maintained similar Dice similarity scores to other automated methods. ProID was then used to analyze a clinical cohort of 66 pediatric patients, including normal and diseased hearts. Output segmentations, end-diastolic, end-systolic volumes, and ejection fraction were compared against manual segmentations from two expert readers. ProID maintained an average Dice score of 0.93 when comparing against manual segmentation. Comparing the two expert readers, the manual segmentations maintained a score of 0.93 which increased to 0.95 when they used ProID. Thus, ProID reduced the inter-operator variability across the expert readers. Overall, this work demonstrates ProID yields accurate boundaries across age groups, disease states, and echo platforms with low computational cost and no need for training data.

Shape constraint function for artery tracking in ultrasound images

Ultrasound guided regional anesthesia (UGRA) has emerged as a powerful technique for pain management in the operating theatre. It uses ultrasound imaging to visualize anatomical structures, the needle insertion and the delivery of the anesthetic around the targeted nerve block. Detection of the nerves is a difficult task, however, due to the poor quality of the ultrasound images. Recent developments in pattern recognition and machine learning have heightened the need for computer aided systems in many applications. This type of system can improve UGRA practice. In many imaging situations nerves are not salient in images. Generally, practitioners rely on the arteries as key anatomical structures to confirm the positions of the nerves, making artery tracking an important aspect for UGRA procedure. However, artery tracking in a noisy environment is a challenging problem, due to the instability of the features. This paper proposes a new method for real-time artery tracking in ultrasound images. It is based on shape information to correct tracker location errors. A new objective function is proposed, which defines an artery as an elliptical shape, enabling its robust fitting in a noisy environment. This approach is incorporated in two well-known tracking algorithms, and shows a systematic improvement over the original trackers. Evaluations were performed on 71 videos of different axillary nerve blocks. The results obtained demonstrated the validity of the proposed method.

Automatic Respiratory Gating Hepatic DCEUS-based Dual-phase Multi-parametric Functional Perfusion Imaging using a Derivative Principal Component Analysis

Purpose: Angiogenesis in liver cancers can be characterized by hepatic functional perfusion imaging (FPI) on the basis of dynamic contrast-enhanced ultrasound (DCEUS). However, accuracy is limited by breathing motion which results in out-of-plane image artifacts. Current hepatic FPI studies do not correct for these artifacts and lack the evaluation of correction accuracy. Thus, a hepatic DCEUS-based dual-phase multi-parametric FPI (DM-FPI) scheme using a derivative principal component analysis (PCA) respiratory gating is proposed to overcome these limitations.

Materials and Methods: By considering severe 3D out-of-plane respiratory motions, the proposed scheme's accuracy was verified with in vitro DCEUS experiments in a flow model mimicking a hepatic vein. The feasibility was further demonstrated by considering in vivo DCEUS measurements in normal rabbit livers, and hepatic cavernous hemangioma and hepatocellular carcinoma in patients. After respiratory kinetics was extracted through PCA of DCEUS sequences under free-breathing condition, dual-phase respiratory gating microbubble kinetics was identified by using a derivative PCA zero-crossing dual-phase detection, respectively. Six dual-phase hemodynamic parameters were estimated from the dual-phase microbubble kinetics and DM-FPI was then reconstructed via color-coding to quantify 2.5D angiogenic hemodynamic distribution for live tumors.

Results: Compared with no respiratory gating, the mean square error of respiratory gating DM-FPI decreased by 1893.9 ± 965.4 (p < 0.05), and mean noise coefficients decreased by 17.5 ± 7.1 (p < 0.05), whereas correlation coefficients improved by 0.4 ± 0.2 (p < 0.01). DM-FPI observably removed severe respiratory motion artifacts on PFI and markedly enhanced the accuracy and robustness both in vitro and in vivo.

Conclusions: DM-FPI precisely characterized and distinguished the heterogeneous angiogenic hemodynamics about perfusion volume, blood flow and flow rate within two anatomical sections in the normal liver, and in benign and malignant hepatic tumors. DCEUS-based DM-FPI scheme might be a useful tool to help clinicians diagnose and provide suitable therapies for liver tumors.

DCEUS-based focal parametric perfusion imaging of microvessel with single-pixel resolution and high contrast

This study aimed to develop a focal microvascular contrast-enhanced ultrasonic parametric perfusion imaging (PPI) scheme to overcome the tradeoff between the resolution, contrast, and accuracy of focal PPI in the tumor. Its resolution was limited by the low signal-to-clutter ratio (SCR) of time-intensity-curves (TICs) induced by multiple limitations, which deteriorated the accuracy and contrast of focal PPI. The scheme was verified by the in-vivo perfusion experiments. Single-pixel TICs were first extracted to ensure PPI with the highest resolution. The SCR of focal TICs in the tumor was improved using respiratory motion compensation combined with detrended fluctuation analysis. The entire and focal PPIs of six perfusion parameters were then accurately created after filtrating the valid TICs and targeted perfusion parameters. Compared with those of the conventional PPIs, the axial and lateral resolutions of focal PPIs were improved by 30.29% (p < .05) and 32.77% (p < .05), respectively; the average contrast and accuracy evaluated by SCR improved by 7.24 ± 4.90 dB (p < .05) and 5.18 ± 1.28 dB (p < .05), respectively. The edge, morphostructure, inhomogeneous hyper-enhanced distribution, and ring-like perfusion features in intratumoral microvessel were accurately distinguished and highlighted by the focal PPIs. The developed focal PPI can assist clinicians in making confirmed diagnoses and in providing appropriate therapeutic strategies for liver tumor.

Three-Dimensional Model-Based Segmentation in Echocardiography Using High Temporal Tissue and Blood Flow Information

Accurate 3-D surface segmentation is a challenging task in echocardiography because of the relatively low image quality. We introduce a new method for 3-D segmentation of the endocardium involving temporal decorrelation of echo signals originating from tissue and blood using radiofrequency (RF) signals acquired in 3-D Doppler mode. Temporal features were extracted in 3-D Doppler mode, where a sequence of RF lines is recorded for each image line. Each set of RF lines is highly correlated because of the high pulse repetition frequency. However, for high blood flow, the RF signals will decorrelate over time in contrast to the endocardium, which will remain relatively highly correlated over time. These decorrelation features permit differentiation between myocardial tissue and blood flow. We describe an implementation of a 3-D segmentation model in which temporal information is used as external constraint. The model was validated in a phantom and in vivo in healthy volunteers (n = 5). The phantom study revealed that the model successfully segmented the artificial blood lumen even for low flow velocity and illustrated the sensitivity of the segmentations to flow rate. In healthy volunteers, high Dice similarity indices indicate that 3-D segmentation of the endocardial border in vivo is feasible.

Simultaneous Analysis of 2D Echo Views for Left Atrial Segmentation and Disease Detection

We propose a joint information approach for automatic analysis of 2D echocardiography (echo) data. The approach combines a priori images, their segmentations and patient diagnostic information within a unified framework to determine various clinical parameters, such as cardiac chamber volumes, and cardiac disease labels. The main idea behind the approach is to employ joint Independent Component Analysis of both echo image intensity information and corresponding segmentation labels to generate models that jointly describe the image and label space of echo patients on multiple apical views, instead of independently. These models are then both used for segmentation and volume estimation of cardiac chambers such as the left atrium and for detecting pathological abnormalities such as mitral regurgitation. We validate the approach on a large cohort of echoes obtained from 6,993 studies. We report performance of the proposed approach in estimation of the left-atrium volume and detection of mitral-regurgitation severity. A correlation coefficient of 0.87 was achieved for volume estimation of the left atrium when compared to the clinical report. Moreover, we classified patients that suffer from moderate or severe mitral regurgitation with an average accuracy of 82%.

Improved myocardial motion estimation combining tissue Doppler and B-mode echocardiographic images

We propose a technique for myocardial motion estimation based on image registration using both B-mode echocardiographic images and tissue Doppler sequences acquired interleaved. The velocity field is modeled continuously using B-splines and the spatiotemporal transform is constrained to be diffeomorphic. Images before scan conversion are used to improve the accuracy of the estimation. The similarity measure includes a model of the speckle pattern distribution of B-mode images. It also penalizes the disagreement between tissue Doppler velocities and the estimated velocity field. Registration accuracy is evaluated and compared to other alternatives using a realistic synthetic dataset, obtaining mean displacement errors of about 1 mm. Finally, the method is demonstrated on data acquired from six volunteers, both at rest and during exercise. Robustness is tested against low image quality and fast heart rates during exercise. Results show that our method provides a robust motion estimate in these situations.

New developments in paediatric cardiac functional ultrasound imaging

Ultrasound imaging can be used to estimate the morphology as well as the motion and deformation of tissues. If the interrogated tissue is actively deforming, this deformation is directly related to its function and quantification of this deformation is normally referred as 'strain imaging'. Tissue can also be deformed by applying an internal or external force and the resulting, induced deformation is a function of the mechanical tissue characteristics. In combination with the load applied, these strain maps can be used to estimate or reconstruct the mechanical properties of tissue. This technique was named 'elastography' by Ophir et al. in 1991. Elastography can be used for atherosclerotic plaque characterisation, while the contractility of the heart or skeletal muscles can be assessed with strain imaging. Rather than using the conventional video format (DICOM) image information, radio frequency (RF)-based ultrasound methods enable estimation of the deformation at higher resolution and with higher precision than commercial methods using Doppler (tissue Doppler imaging) or video image data (2D speckle tracking methods). However, the improvement in accuracy is mainly achieved when measuring strain along the ultrasound beam direction, so it has to be considered a 1D technique. Recently, this method has been extended to multiple directions and precision further improved by using spatial compounding of data acquired at multiple beam steered angles. Using similar techniques, the blood velocity and flow can be determined. RF-based techniques are also beneficial for automated segmentation of the ventricular cavities. In this paper, new developments in different techniques of quantifying cardiac function by strain imaging, automated segmentation, and methods of performing blood flow imaging are reviewed and their application in paediatric cardiology is discussed.

An efficient, scalable, and adaptable framework for solving generic systems of level-set PDEs

In the last decade, level-set methods have been actively developed for applications in image registration, segmentation, tracking, and reconstruction. However, the development of a wide variety of level-set PDEs and their numerical discretization schemes, coupled with hybrid combinations of PDE terms, stopping criteria, and reinitialization strategies, has created a software logistics problem. In the absence of an integrative design, current toolkits support only specific types of level-set implementations which restrict future algorithm development since extensions require significant code duplication and effort. In the new NIH/NLM Insight Toolkit (ITK) v4 architecture, we implemented a level-set software design that is flexible to different numerical (continuous, discrete, and sparse) and grid representations (point, mesh, and image-based). Given that a generic PDE is a summation of different terms, we used a set of linked containers to which level-set terms can be added or deleted at any point in the evolution process. This container-based approach allows the user to explore and customize terms in the level-set equation at compile-time in a flexible manner. The framework is optimized so that repeated computations of common intensity functions (e.g., gradient and Hessians) across multiple terms is eliminated. The framework further enables the evolution of multiple level-sets for multi-object segmentation and processing of large datasets. For doing so, we restrict level-set domains to subsets of the image domain and use multithreading strategies to process groups of subdomains or level-set functions. Users can also select from a variety of reinitialization policies and stopping criteria. Finally, we developed a visualization framework that shows the evolution of a level-set in real-time to help guide algorithm development and parameter optimization. We demonstrate the power of our new framework using confocal microscopy images of cells in a developing zebrafish embryo.

Ultrasound bio-microscopic image segmentation for evaluation of zebrafish cardiac function

Zebrafish can fully regenerate their myocardium after ventricular resection without evidence of scars. This extraordinary regenerative ability provides an excellent model system to study the activation of the regenerative potential for human heart tissue. In addition to the morphology, it is vital to understand the cardiac function of zebrafish. To characterize adult zebrafish cardiac function, an ultrasound biomicroscope (UBM) was customized for real-time imaging of the zebrafish heart (about 1 mm in diameter) at a resolution of around 37 μm. Moreover, we developed an image segmentation algorithm to track the cardiac boundary and measure the dynamic size of the zebrafish heart for further quantification of zebrafish cardiac function. The effectiveness and accuracy of the proposed segmentation algorithm were verified on a tissuemimicking phantom and in vivo zebrafish echocardiography. The quantitative evaluation demonstrated that the accuracy of the proposed algorithm is comparable to the manual delineation by experts.

Semi-automatic segmentation software for quantitative clinical brain glioblastoma evaluation

RATIONALE AND OBJECTIVES

Quantitative measurement provides essential information about disease progression and treatment response in patients with glioblastoma multiforme (GBM). The goal of this article is to present and validate a software pipeline for semi-automatic GBM segmentation, called AFINITI (Assisted Follow-up in NeuroImaging of Therapeutic Intervention), using clinical data from GBM patients.

MATERIALS AND METHODS

Our software adopts the current state-of-the-art tumor segmentation algorithms and combines them into one clinically usable pipeline. Both the advantages of the traditional voxel-based and the deformable shape-based segmentation are embedded into the software pipeline. The former provides an automatic tumor segmentation scheme based on T1- and T2-weighted magnetic resonance (MR) brain data, and the latter refines the segmentation results with minimal manual input.

RESULTS

Twenty-six clinical MR brain images of GBM patients were processed and compared with manual results. The results can be visualized using the embedded graphic user interface.

CONCLUSION

Validation results using clinical GBM data showed high correlation between the AFINITI results and manual annotation. Compared to the voxel-wise segmentation, AFINITI yielded more accurate results in segmenting the enhanced GBM from multimodality MR imaging data. The proposed pipeline could be used as additional information to interpret MR brain images in neuroradiology.

Ultrasound image segmentation and tissue characterization

Ultrasound image segmentation deals with delineating the boundaries of structures, as a step towards semi-automated or fully automated measurement of dimensions or for characterizing tissue regions. Ultrasound tissue characterization (UTC) is driven by knowledge of the physics of ultrasound and its interactions with biological tissue, and has traditionally used signal modelling and analysis to characterize and differentiate between healthy and diseased tissue. Thus, both aim to enhance the capabilities of ultrasound as a quantitative tool in clinical medicine, and the two end goals can be the same, namely to characterize the health of tissue. This article reviews both research topics, and finds that the two fields are becoming more tightly coupled, even though there are key challenges to overcome in each area, influenced by factors such as more open software-based ultrasound system architectures, increased computational power, and advances in imaging transducer design.

Cardiac disease recognition in echocardiograms using spatio-temporal statistical models

In this paper we present a method of automatic disease recognition by using statistical spatio-temporal disease models in cardiac echo videos. Starting from echo videos of known viewpoints as training data, we form a statistical model of shape and motion information within a cardiac cycle for each disease. Specifically, an active shape model (ASM) is used to model shape and texture information in an echo frame. The motion information derived by tracking ASMs through a heart cycle is then represented compactly using eigen-motion features to constitute a joint spatio-temporal statistical model per disease class and observation viewpoint. Each of these models is then fit to a new cardiac echo video of an unknown disease, and the best fitting model is used to label the disease class. Results are presented that show the method can discriminate patients with hypokinesia from normal patients.

Characterizing spatio-temporal patterns for disease discrimination in cardiac echo videos

Disease-specific understanding of echocardiographic sequences requires accurate characterization of spatio-temporal motion patterns. In this paper we present a method of automatic extraction and matching of spatio-temporal patterns from cardiac echo videos. Specifically, we extract cardiac regions (chambers and walls) using a variation of multiscale normalized cuts that combines motion estimates from deformable models with image intensity. We then derive spatio-temporal trajectories of region measurements such as wall motion, volume and thickness. The region trajectories are then matched to infer the similarities in disease labels of patients. Validation results on patient data sets collected from many hospitals are presented.

Evaluation of a cardiac ultrasound segmentation algorithm using a phantom

This paper evaluates the performance of a level set algorithm for segmenting the endocardium in short-axis ultrasound images. The evaluation is carried out using an anthropomorphic ultrasound phantom. Details of the phantom design, including comparison of the ultrasound parameters with in-vitro measurements, are included. In addition to measuring segmentation accuracy, the effectiveness of the energy minimization scheme is also determined. It is argued that using the phantom along with global minimization algorithms (simulated annealing and random search) makes is possible to assess the minimization strategy.

Cell-based two-region competition algorithm with a map framework for boundary delineation of a series of 2D ultrasound images

To ensure the delineated boundaries of a series of 2-D images closely following the visually perceivable edges with high boundary coherence between consecutive slices, a cell-based two-region competition algorithm based on a maximum a posteriori (MAP) framework is proposed. It deforms the region boundary in a cell-by-cell fashion through a cell-based two-region competition process. The cell-based deformation is guided by a cell-based MAP framework with a posterior function characterizing the distribution of the cell means in each region, the salience and shape complexity of the region boundary and the boundary coherence of the consecutive slices. The proposed algorithm has been validated using 10 series of breast sonograms, including seven compression series and three freehand series. The compression series contains two carcinoma and five fibroadenoma cases and the freehand series contains two carcinoma and one fibroadenoma cases. The results show that >70% of the derived boundaries fall within the span of the manually delineated boundaries. The robustness of the proposed algorithm to the variation of regions-of-interest is confirmed by the Friedman tests and the p-values of which are 0.517 and 0.352 for the compression and freehand series groups, respectively. The Pearson's correlations between the lesion sizes derived by the proposed algorithm and those defined by the average manually delineated boundaries are all higher than 0.990. The overlapping and difference ratios between the derived boundaries and the average manually delineated boundaries are mostly higher than 0.90 and lower than 0.13, respectively. For both series groups, all assessments conclude that the boundaries derived by the proposed algorithm be comparable to those delineated manually. Moreover, it is shown that the proposed algorithm is superior to the Chan and Vese level set method based on the paired-sample t-tests on the performance indices at a 5% significance level.

Statistical modeling of the radio-frequency signal for partially- and fully-developed speckle based on a generalized gaussian model with application to echocardiography

We have shown previously that the statistics of the radio-frequency (RF) signals may be faithfully modeled through the so-called K(RF) distribution, in situations ranging from fully to partially-developed speckle. We demonstrate in this paper that the generalized Gaussian provides a reliable and computationally convenient approximation of the K(RF). The performance of the parameters estimators for the two distributions is evaluated and compared in terms of their bias and variance through numerical simulations. This framework is applied to the modeling of echocardiographic data. The ability of the generalized Gaussian to model RF signals from cardiac tissues (myocardium) and blood regions is demonstrated on data acquired in vivo.

Quantitative characterization of metastatic disease in the spine. Part I. Semiautomated segmentation using atlas-based deformable registration and the level set method

Quantitative assessment of metastatic disease in bone is often considered immeasurable and, as such, patients with skeletal metastases are often excluded from clinical trials. In order to effectively quantify the impact of metastatic tumor involvement in the spine, accurate segmentation of the vertebra is required. Manual segmentation can be accurate but involves extensive and time-consuming user interaction. Potential solutions to automating segmentation of metastatically involved vertebrae are demons deformable image registration and level set methods. The purpose of this study was to develop a semiautomated method to accurately segment tumor-bearing vertebrae using the aforementioned techniques. By maintaining morphology of an atlas, the demons-level set composite algorithm was able to accurately differentiate between trans-cortical tumors and surrounding soft tissue of identical intensity. The algorithm successfully segmented both the vertebral body and trabecular centrum of tumor-involved and healthy vertebrae. This work validates our approach as equivalent in accuracy to an experienced user.

A hybrid multi-scale model for thyroid nodule boundary detection on ultrasound images

A hybrid model for thyroid nodule boundary detection on ultrasound images is introduced. The segmentation model combines the advantages of the "á trous" wavelet transform to detect sharp gray-level variations and the efficiency of the Hough transform to discriminate the region of interest within an environment with excessive structural noise. The proposed method comprise three major steps: a wavelet edge detection procedure for speckle reduction and edge map estimation, based on local maxima representation. Subsequently, a multiscale structure model is utilised in order to acquire a contour representation by means of local maxima chaining with similar attributes to form significant structures. Finally, the Hough transform is employed with 'a priori' knowledge related to the nodule's shape in order to distinguish the nodule's contour from adjacent structures. The comparative study between our automatic method and manual delineations demonstrated that the boundaries extracted by the hybrid model are closely correlated with that of the physicians. The proposed hybrid method can be of value to thyroid nodules' shape-based classification and as an educational tool for inexperienced radiologists.

Statistics of the radio-frequency signal based on K distribution with application to echocardiography

We study in this paper the statistics of the radio frequency (RF) signal in the case of partially developed speckle. Using the K distribution framework, we give the probability density function of the associated distribution, the corresponding moments, and estimators for the parameters of the distribution. The consistency of the proposed estimators is evaluated in terms of their bias and variance through numerical simulations. The ability of the proposed distribution to model RF echographic signals from cardiac tissues is evaluated from data acquired in vivo.