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Fornasari A, Kuntz S, Martini C, Perini P, Cabrini E, Freyrie A, Lejay A, Chakfé N. Objective Methods to Assess Aorto-Iliac Calcifications: A Systematic Review. Diagnostics (Basel) 2024; 14:1053. [PMID: 38786352 PMCID: PMC11119820 DOI: 10.3390/diagnostics14101053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
Vascular calcifications in aorto-iliac arteries are emerging as crucial risk factors for cardiovascular diseases (CVDs) with profound clinical implications. This systematic review, following PRISMA guidelines, investigated methodologies for measuring these calcifications and explored their correlation with CVDs and clinical outcomes. Out of 698 publications, 11 studies met the inclusion criteria. In total, 7 studies utilized manual methods, while 4 studies utilized automated technologies, including artificial intelligence and deep learning for image analyses. Age, systolic blood pressure, serum calcium, and lipoprotein(a) levels were found to be independent risk factors for aortic calcification. Mortality from CVDs was correlated with abdominal aorta calcification. Patients requiring reintervention after endovascular recanalization exhibited a significantly higher volume of calcification in their iliac arteries. Conclusions: This review reveals a diverse landscape of measurement methods for aorto-iliac calcifications; however, they lack a standardized reproducibility assessment. Automatic methods employing artificial intelligence appear to offer broader applicability and are less time-consuming. Assessment of calcium scoring could be routinely employed during preoperative workups for risk stratification and detailed surgical planning. Additionally, its correlation with clinical outcomes could be useful in predicting the risk of reinterventions and amputations.
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Affiliation(s)
- Anna Fornasari
- Vascular Surgery, Cardio-Thoracic and Vascular Department, Parma University Hospital, 43126 Parma, Italy; (A.F.); (P.P.); (A.F.)
| | - Salomé Kuntz
- Vascular Surgery, Kidney Transplantation and Innovation, Department of Vascular Surgery, University Hospital of Strasbourg, 67085 Strasbourg, France (A.L.)
- Gepromed, Medical Device Hub for Patient Safety, 67085 Strasbourg, France
| | - Chiara Martini
- Department of Diagnostic, Parma University Hospital, 43126 Parma, Italy
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Paolo Perini
- Vascular Surgery, Cardio-Thoracic and Vascular Department, Parma University Hospital, 43126 Parma, Italy; (A.F.); (P.P.); (A.F.)
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Elisa Cabrini
- Vascular Surgery, Cardio-Thoracic and Vascular Department, Parma University Hospital, 43126 Parma, Italy; (A.F.); (P.P.); (A.F.)
| | - Antonio Freyrie
- Vascular Surgery, Cardio-Thoracic and Vascular Department, Parma University Hospital, 43126 Parma, Italy; (A.F.); (P.P.); (A.F.)
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Anne Lejay
- Vascular Surgery, Kidney Transplantation and Innovation, Department of Vascular Surgery, University Hospital of Strasbourg, 67085 Strasbourg, France (A.L.)
- Gepromed, Medical Device Hub for Patient Safety, 67085 Strasbourg, France
| | - Nabil Chakfé
- Vascular Surgery, Kidney Transplantation and Innovation, Department of Vascular Surgery, University Hospital of Strasbourg, 67085 Strasbourg, France (A.L.)
- Gepromed, Medical Device Hub for Patient Safety, 67085 Strasbourg, France
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2
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Summers RM, Elton DC, Lee S, Zhu Y, Liu J, Bagheri M, Sandfort V, Grayson PC, Mehta NN, Pinto PA, Linehan WM, Perez AA, Graffy PM, O'Connor SD, Pickhardt PJ. Atherosclerotic Plaque Burden on Abdominal CT: Automated Assessment With Deep Learning on Noncontrast and Contrast-enhanced Scans. Acad Radiol 2021; 28:1491-1499. [PMID: 32958429 DOI: 10.1016/j.acra.2020.08.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/06/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Abdominal aortic atherosclerotic plaque burden may have clinical significance but manual measurement is time-consuming and impractical. PURPOSE To perform external validation on an automated atherosclerotic plaque detector for noncontrast and postcontrast abdominal CT. MATERIALS AND METHODS The training data consisted of 114 noncontrast CT scans and 23 postcontrast CT urography scans. The testing data set consisted of 922 CT colonography (CTC) scans, and 1207 paired noncontrast and postcontrast CT scans from renal donors from a second institution. Reference standard data included manual plaque segmentations in the 137 training scans and manual plaque burden measurements in the 922 CTC scans. The total Agatston score and group (0-3) was determined using fully-automated deep learning software. Performance was assessed by measures of agreement, linear regression, and paired evaluations. RESULTS On CTC scans, automated Agatston scoring correlated highly with manual assessment (R2 = 0.94). On paired renal donor CT scans, automated Agatston scoring on postcontrast CT correlated highly with noncontrast CT (R2 = 0.95). When plaque burden was expressed as a group score, there was excellent agreement for both the CTC (weighted kappa 0.80 ± 0.01 [95% confidence interval: 0.78-0.83]) and renal donor (0.83 ± 0.02 [0.79-0.86]) assessments. CONCLUSION Fully automated detection, segmentation, and scoring of abdominal aortic atherosclerotic plaques on both pre- and post-contrast CT was validated and may have application for population-based studies.
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Affiliation(s)
- Ronald M Summers
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bldg. 10 Room 1C224D MSC 1182, Bethesda, MD 20892-1182.
| | - Daniel C Elton
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bldg. 10 Room 1C224D MSC 1182, Bethesda, MD 20892-1182
| | - Sungwon Lee
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bldg. 10 Room 1C224D MSC 1182, Bethesda, MD 20892-1182
| | - Yingying Zhu
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bldg. 10 Room 1C224D MSC 1182, Bethesda, MD 20892-1182
| | - Jiamin Liu
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bldg. 10 Room 1C224D MSC 1182, Bethesda, MD 20892-1182
| | - Mohammedhadi Bagheri
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bldg. 10 Room 1C224D MSC 1182, Bethesda, MD 20892-1182
| | - Veit Sandfort
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bldg. 10 Room 1C224D MSC 1182, Bethesda, MD 20892-1182
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Alberto A Perez
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peter M Graffy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Stacy D O'Connor
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Rundo L, Beer L, Ursprung S, Martin-Gonzalez P, Markowetz F, Brenton JD, Crispin-Ortuzar M, Sala E, Woitek R. Tissue-specific and interpretable sub-segmentation of whole tumour burden on CT images by unsupervised fuzzy clustering. Comput Biol Med 2020; 120:103751. [PMID: 32421652 PMCID: PMC7248575 DOI: 10.1016/j.compbiomed.2020.103751] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cancer typically exhibits genotypic and phenotypic heterogeneity, which can have prognostic significance and influence therapy response. Computed Tomography (CT)-based radiomic approaches calculate quantitative features of tumour heterogeneity at a mesoscopic level, regardless of macroscopic areas of hypo-dense (i.e., cystic/necrotic), hyper-dense (i.e., calcified), or intermediately dense (i.e., soft tissue) portions. METHOD With the goal of achieving the automated sub-segmentation of these three tissue types, we present here a two-stage computational framework based on unsupervised Fuzzy C-Means Clustering (FCM) techniques. No existing approach has specifically addressed this task so far. Our tissue-specific image sub-segmentation was tested on ovarian cancer (pelvic/ovarian and omental disease) and renal cell carcinoma CT datasets using both overlap-based and distance-based metrics for evaluation. RESULTS On all tested sub-segmentation tasks, our two-stage segmentation approach outperformed conventional segmentation techniques: fixed multi-thresholding, the Otsu method, and automatic cluster number selection heuristics for the K-means clustering algorithm. In addition, experiments showed that the integration of the spatial information into the FCM algorithm generally achieves more accurate segmentation results, whilst the kernelised FCM versions are not beneficial. The best spatial FCM configuration achieved average Dice similarity coefficient values starting from 81.94±4.76 and 83.43±3.81 for hyper-dense and hypo-dense components, respectively, for the investigated sub-segmentation tasks. CONCLUSIONS The proposed intelligent framework could be readily integrated into clinical research environments and provides robust tools for future radiomic biomarker validation.
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Affiliation(s)
- Leonardo Rundo
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, UK.
| | - Lucian Beer
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, UK; Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna 1090, Austria.
| | - Stephan Ursprung
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, UK.
| | - Paula Martin-Gonzalez
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, UK; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, UK.
| | - Florian Markowetz
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, UK; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, UK.
| | - James D Brenton
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, UK; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, UK.
| | - Mireia Crispin-Ortuzar
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, UK; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, UK.
| | - Evis Sala
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, UK.
| | - Ramona Woitek
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, UK; Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna 1090, Austria.
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Schousboe JT, Vo TN, Langsetmo L, Adabag S, Szulc P, Lewis JR, Kats AM, Taylor BC, Ensrud KE. Abdominal aortic calcification (AAC) and ankle-brachial index (ABI) predict health care costs and utilization in older men, independent of prevalent clinical cardiovascular disease and each other. Atherosclerosis 2020; 295:31-37. [PMID: 32000096 DOI: 10.1016/j.atherosclerosis.2020.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/22/2019] [Accepted: 01/15/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Abdominal aortic calcification (AAC) and low ankle-brachial index (ABI) are markers of multisite atherosclerosis. We sought to estimate their associations in older men with health care costs and utilization adjusted for each other, and after accounting for CVD risk factors and prevalent CVD diagnoses. METHODS This was an observational cohort study of 2393 community-dwelling men (mean age 73.6 years) enrolled in the Osteoporotic Fractures in Men (MrOS) study and U.S. Medicare Fee for Service (FFS). AAC was scored on baseline lateral lumbar spine X-rays using a 24-point scale. ABI was measured as the lowest ratio of arm to right or left ankle blood pressure. Health care costs, hospital stays, and SNF stays were identified from Medicare FFS claims over 36 months following the baseline visit. RESULTS Men with AAC score ≥9 (n = 519 [21.7% of analytic cohort]) had higher annualized total health care costs of $1473 (95% C.I. 293, 2654, 2017 U S. dollars) compared to those with AAC score 0-1, after multivariable adjustment. Men with ABI <0.90 (n = 154 [6.4% of analytic cohort]) had higher annualized total health care costs of $2705 (95% CI 634, 4776) compared to men with normal ABI (≥0.9 and < 1.4), after multivariable adjustment. CONCLUSIONS High levels of AAC and low ABI in older men are associated with higher subsequent health care costs, after accounting for clinical CVD risk factors, prevalent CVD diagnoses, and each other. Further investigations of whether preventing progression of peripheral vascular disease and calcification reduces subsequent health care costs are warranted.
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Affiliation(s)
- John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, Minneapolis, MN, USA; University of Minnesota, Minneapolis, MN, USA.
| | - Tien N Vo
- University of Minnesota, Minneapolis, MN, USA
| | | | | | | | - Joshua R Lewis
- Edith Cowan University, Perth, Australia; Medical School, University of Western Australia, Perth, Australia; Centre for Kidney Research, School of Public Health, The University of Sydney, Sydney, Australia
| | | | - Brent C Taylor
- University of Minnesota, Minneapolis, MN, USA; Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, MN, USA
| | - Kristine E Ensrud
- University of Minnesota, Minneapolis, MN, USA; Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, MN, USA
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Martin-Isla C, Campello VM, Izquierdo C, Raisi-Estabragh Z, Baeßler B, Petersen SE, Lekadir K. Image-Based Cardiac Diagnosis With Machine Learning: A Review. Front Cardiovasc Med 2020; 7:1. [PMID: 32039241 PMCID: PMC6992607 DOI: 10.3389/fcvm.2020.00001] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/06/2020] [Indexed: 01/28/2023] Open
Abstract
Cardiac imaging plays an important role in the diagnosis of cardiovascular disease (CVD). Until now, its role has been limited to visual and quantitative assessment of cardiac structure and function. However, with the advent of big data and machine learning, new opportunities are emerging to build artificial intelligence tools that will directly assist the clinician in the diagnosis of CVDs. This paper presents a thorough review of recent works in this field and provide the reader with a detailed presentation of the machine learning methods that can be further exploited to enable more automated, precise and early diagnosis of most CVDs.
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Affiliation(s)
- Carlos Martin-Isla
- Departament de Matemàtiques & Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Victor M Campello
- Departament de Matemàtiques & Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Cristian Izquierdo
- Departament de Matemàtiques & Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Zahra Raisi-Estabragh
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Bettina Baeßler
- Department of Diagnostic & Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Steffen E Petersen
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Karim Lekadir
- Departament de Matemàtiques & Informàtica, Universitat de Barcelona, Barcelona, Spain
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6
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A fully automated pipeline for mining abdominal aortic aneurysm using image segmentation. Sci Rep 2019; 9:13750. [PMID: 31551507 PMCID: PMC6760111 DOI: 10.1038/s41598-019-50251-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/19/2019] [Indexed: 11/24/2022] Open
Abstract
Imaging software have become critical tools in the diagnosis and the treatment of abdominal aortic aneurysms (AAA). The aim of this study was to develop a fully automated software system to enable a fast and robust detection of the vascular system and the AAA. The software was designed from a dataset of injected CT-scans images obtained from 40 patients with AAA. Pre-processing steps were performed to reduce the noise of the images using image filters. The border propagation based method was used to localize the aortic lumen. An online error detection was implemented to correct errors due to the propagation in anatomic structures with similar pixel value located close to the aorta. A morphological snake was used to segment 2D or 3D regions. The software allowed an automatic detection of the aortic lumen and the AAA characteristics including the presence of thrombus and calcifications. 2D and 3D reconstructions visualization were available to ease evaluation of both algorithm precision and AAA properties. By enabling a fast and automated detailed analysis of the anatomic characteristics of the AAA, this software could be useful in clinical practice and research and be applied in a large dataset of patients.
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Graffy PM, Liu J, O'Connor S, Summers RM, Pickhardt PJ. Automated segmentation and quantification of aortic calcification at abdominal CT: application of a deep learning-based algorithm to a longitudinal screening cohort. Abdom Radiol (NY) 2019; 44:2921-2928. [PMID: 30976827 DOI: 10.1007/s00261-019-02014-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate an automated aortic calcium segmentation and scoring tool at abdominal CT in an adult screening cohort. METHODS Using instance segmentation with convolutional neural networks (Mask R-CNN), a fully automated vascular calcification algorithm was applied to a data set of 9914 non-contrast CT scans from 9032 consecutive asymptomatic adults (mean age, 57.5 ± 7.8 years; 4467 M/5447F) undergoing colonography screening. Follow-up scans were performed in a subset of 866 individuals (mean interval, 5.4 years). Automated abdominal aortic calcium volume, mass, and Agatston score were assessed. In addition, comparison was made with a separate validated semi-automated approach in a subset of 812 cases. RESULTS Mean values were significantly higher in males for Agatston score (924.2 ± 2066.2 vs. 564.2 ± 1484.2, p < 0.001), aortic calcium mass (222.2 ± 526.0 mg vs. 144.5 ± 405.4 mg, p < 0.001) and volume (699.4 ± 1552.4 ml vs. 426.9 ± 1115.5 HU, p < 0.001). Overall age-specific Agatston scores increased an average of 10%/year for the entire cohort; males had a larger Agatston score increase between the ages of 40 to 60 than females (91.2% vs. 75.1%, p < 0.001) and had significantly higher mean Agatston scores between ages 50 and 80 (p < 0.001). For the 812-scan subset with both automated and semi-automated methods, median difference in Agatston score was 66.4 with an r2 agreement value of 0.84. Among the 866-patient cohort with longitudinal follow-up, the average Agatston score change was 524.1 ± 1317.5 (median 130.9), reflecting a mean increase of 25.5% (median 73.6%). CONCLUSION This robust, fully automated abdominal aortic calcification scoring tool allows for both individualized and population-based assessment. Such data could be automatically derived at non-contrast abdominal CT, regardless of the study indication, allowing for opportunistic assessment of cardiovascular risk.
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Affiliation(s)
- Peter M Graffy
- E3/311 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI, 53792-3252, USA
| | - Jiamin Liu
- Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Stacy O'Connor
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ronald M Summers
- Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Perry J Pickhardt
- E3/311 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI, 53792-3252, USA.
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Schousboe JT, Lewis JR, Kiel DP. Abdominal aortic calcification on dual-energy X-ray absorptiometry: Methods of assessment and clinical significance. Bone 2017; 104:91-100. [PMID: 28119178 DOI: 10.1016/j.bone.2017.01.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
Abdominal aortic calcification (AAC) can be accurately recognized on lateral spine images intended for vertebral fracture assessment, that are obtained with dual-energy X-ray absorptiometry (DXA). Greater amounts of AAC are common in the older population for whom DXA is routinely done, and have been consistently associated with incident atherosclerotic cardiovascular disease (ASCVD) events. AAC has also been associated with incident fractures in some prospective studies, but not in others. However, further research is needed to quantify the extent to which measurement of AAC improves prediction of ASCVD events and its impact on physician and patient ASCVD risk management. Additionally, research to develop better, more precise, automated, quantitative methods of AAC assessment on lateral spine densitometric images will hopefully lead to better prediction of clinical outcomes. In conclusion, although the prime indication for densitometric lateral spine imaging remains vertebral fracture assessment, AAC that is found incidentally on lateral spine images should be reported, so that patients and their health care providers are aware of its presence.
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Affiliation(s)
- John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc., Minneapolis, MN, USA; Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
| | - Joshua R Lewis
- University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia; Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Douglas P Kiel
- Institute for Aging Research, Hebrew Senior Life, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Oda H, Bhatia KK, Oda M, Kitasaka T, Iwano S, Homma H, Takabatake H, Mori M, Natori H, Schnabel JA, Mori K. Automated mediastinal lymph node detection from CT volumes based on intensity targeted radial structure tensor analysis. J Med Imaging (Bellingham) 2017; 4:044502. [PMID: 29152534 PMCID: PMC5683200 DOI: 10.1117/1.jmi.4.4.044502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 10/16/2017] [Indexed: 01/10/2023] Open
Abstract
This paper presents a local intensity structure analysis based on an intensity targeted radial structure tensor (ITRST) and the blob-like structure enhancement filter based on it (ITRST filter) for the mediastinal lymph node detection algorithm from chest computed tomography (CT) volumes. Although the filter based on radial structure tensor analysis (RST filter) based on conventional RST analysis can be utilized to detect lymph nodes, some lymph nodes adjacent to regions with extremely high or low intensities cannot be detected. Therefore, we propose the ITRST filter, which integrates the prior knowledge on detection target intensity range into the RST filter. Our lymph node detection algorithm consists of two steps: (1) obtaining candidate regions using the ITRST filter and (2) removing false positives (FPs) using the support vector machine classifier. We evaluated lymph node detection performance of the ITRST filter on 47 contrast-enhanced chest CT volumes and compared it with the RST and Hessian filters. The detection rate of the ITRST filter was 84.2% with 9.1 FPs/volume for lymph nodes whose short axis was at least 10 mm, which outperformed the RST and Hessian filters.
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Affiliation(s)
- Hirohisa Oda
- Nagoya University, Graduate School of Information Science, Furo-cho, Chikusa-ku, Nagoya, Japan
| | - Kanwal K. Bhatia
- King’s College London, Division of Imaging Sciences and Biomedical Engineering, St. Thomas’ Hospital, London, United Kingdom
| | - Masahiro Oda
- Nagoya University, Graduate School of Informatics, Furo-cho, Chikusa-ku, Nagoya, Japan
| | - Takayuki Kitasaka
- Aichi Institute of Technology, School of Information Science, Yakusa-cho, Toyota, Japan
| | - Shingo Iwano
- Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | | | | | - Masaki Mori
- Sapporo-Kosei General Hospital, Chuo-ku, Sapporo, Japan
| | | | - Julia A. Schnabel
- King’s College London, Division of Imaging Sciences and Biomedical Engineering, St. Thomas’ Hospital, London, United Kingdom
| | - Kensaku Mori
- Nagoya University, Graduate School of Informatics, Furo-cho, Chikusa-ku, Nagoya, Japan
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Alimohammadi M, Pichardo-Almarza C, Agu O, Díaz-Zuccarini V. Development of a Patient-Specific Multi-Scale Model to Understand Atherosclerosis and Calcification Locations: Comparison with In vivo Data in an Aortic Dissection. Front Physiol 2016; 7:238. [PMID: 27445834 PMCID: PMC4914588 DOI: 10.3389/fphys.2016.00238] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/03/2016] [Indexed: 01/11/2023] Open
Abstract
Vascular calcification results in stiffening of the aorta and is associated with hypertension and atherosclerosis. Atherogenesis is a complex, multifactorial, and systemic process; the result of a number of factors, each operating simultaneously at several spatial and temporal scales. The ability to predict sites of atherogenesis would be of great use to clinicians in order to improve diagnostic and treatment planning. In this paper, we present a mathematical model as a tool to understand why atherosclerotic plaque and calcifications occur in specific locations. This model is then used to analyze vascular calcification and atherosclerotic areas in an aortic dissection patient using a mechanistic, multi-scale modeling approach, coupling patient-specific, fluid-structure interaction simulations with a model of endothelial mechanotransduction. A number of hemodynamic factors based on state-of-the-art literature are used as inputs to the endothelial permeability model, in order to investigate plaque and calcification distributions, which are compared with clinical imaging data. A significantly improved correlation between elevated hydraulic conductivity or volume flux and the presence of calcification and plaques was achieved by using a shear index comprising both mean and oscillatory shear components (HOLMES) and a non-Newtonian viscosity model as inputs, as compared to widely used hemodynamic indicators. The proposed approach shows promise as a predictive tool. The improvements obtained using the combined biomechanical/biochemical modeling approach highlight the benefits of mechanistic modeling as a powerful tool to understand complex phenomena and provides insight into the relative importance of key hemodynamic parameters.
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Affiliation(s)
| | | | - Obiekezie Agu
- Vascular Unit, University College Hospital London, UK
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Abstract
OBJECTIVE Automated analysis of abdominal CT has advanced markedly over just the last few years. Fully automated assessment of organs, lymph nodes, adipose tissue, muscle, bowel, spine, and tumors are some examples where tremendous progress has been made. Computer-aided detection of lesions has also improved dramatically. CONCLUSION This article reviews the progress and provides insights into what is in store in the near future for automated analysis for abdominal CT, ultimately leading to fully automated interpretation.
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12
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Determining the influence of calcification on the failure properties of abdominal aortic aneurysm (AAA) tissue. J Mech Behav Biomed Mater 2015; 42:154-67. [DOI: 10.1016/j.jmbbm.2014.11.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/21/2014] [Accepted: 11/03/2014] [Indexed: 11/20/2022]
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Tarjoman M, Fatemizadeh E, Badie K. An implementation of a CBIR system based on SVM learning scheme. J Med Eng Technol 2013; 37:43-7. [PMID: 23276155 DOI: 10.3109/03091902.2012.742157] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Content-based image retrieval (CBIR) has been one of the most active areas of research. The retrieval principle of CBIR systems is based on visual features such as colour, texture and shape or the semantic meaning of the images. A CBIR system can be used to locate medical images in large databases. This paper presents a CBIR system for retrieving digital human brain magnetic resonance images (MRI) based on textural features and the support vector machine (SVM) learning method. This system can retrieve similar images from the database in two groups: normal and tumoural. This research uses the knowledge of the CBIR approach to the application of medical decision support and discrimination between the normal and abnormal medical images based on features. This study presents and compares the results of the proposed method with the CBIR systems used in recent works. The experimental results indicate that the proposed method is reliable and has high image retrieval efficiency compared with the previous works.
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Affiliation(s)
- Mana Tarjoman
- Department of Engineering, Abhar Branch, Islamic Azad University, Abhar, Iran.
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Isgum I, Prokop M, Niemeijer M, Viergever MA, van Ginneken B. Automatic coronary calcium scoring in low-dose chest computed tomography. IEEE TRANSACTIONS ON MEDICAL IMAGING 2012; 31:2322-34. [PMID: 22961297 DOI: 10.1109/tmi.2012.2216889] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The calcium burden as estimated from non-ECG-synchronized computed tomography (CT) exams acquired in screening of heavy smokers has been shown to be a strong predictor of cardiovascular events. We present a method for automatic coronary calcium scoring with low-dose, non-contrast-enhanced, non-ECG-synchronized chest CT. First, a probabilistic coronary calcium map was created using multi-atlas segmentation. This map assigned an a priori probability for the presence of coronary calcifications at every location in a scan. Subsequently, a statistical pattern recognition system was designed to identify coronary calcifications by texture, size, and spatial features; the spatial features were computed using the coronary calcium map. The detected calcifications were quantified in terms of volume and Agatston score. The best results were obtained by merging the results of three different supervised classification systems, namely direct classification with a nearest neighbor classifier, and two-stage classification with nearest neighbor and support vector machine classifiers.We used a total of 231 test scans containing 45,674 mm³ of coronary calcifications. The presented method detected on average 157/198 mm³ (sensitivity 79.2%) of coronary calcium volume with on average 4 mm false positive volume. Calcium scoring can be performed automatically in low-dose, non-contrast enhanced, non-ECG-synchronized chest CT in screening of heavy smokers to identify subjects who might benefit from preventive treatment.
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Affiliation(s)
- Ivana Isgum
- Image Sciences Institute, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
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15
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Komen N, Klitsie P, Hermans JJ, Niessen WJ, Kleinrensink GJ, Jeekel J, Lange JF. Calcium scoring in unenhanced and enhanced CT data of the aorta-iliacal arteries: impact of image acquisition, reconstruction, and analysis parameter settings. Acta Radiol 2011; 52:943-50. [PMID: 21969704 DOI: 10.1258/ar.2011.110189] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Several studies have been published on the matter of abdominal aortic and iliac calcifications and the association to clinical entities such as diabetes mellitus and renal failure. However, comparing of these studies is questionable since quantification methods for atherosclerosis differ. PURPOSE To evaluate the effect of image acquisition settings, reconstruction parameters, and analysis methods on calcium quantification in the abdominal aorta. MATERIAL AND METHODS Calcium scores were retrospectively determined on standardized abdominal CT scans of 15 patients. Two researchers obtained calcium scores with 10 different lower thresholds (LT) (130, 145, 160, 175, 200, 300, 400, 500, 600, 1000) in CT scans with and without contrast enhancement, with slice thicknesses (ST) varying between 2.0-5.0 mm for the non-contrast-enhanced series and between 1.0-5.0 mm for the contrast-enhanced series. In addition calcium scores obtained with two convolution kernels (B10f, B20f) were compared. Inter-observer variability was calculated. RESULTS Calcium scoring at higher STs is overestimated compared to smaller STs and this effect was more pronounced with increasing calcium loads. Concerning the convolution kernel, scores obtained with kernel B10f were overestimated compared to kernel B20f. Increase of LT resulted in a decrease of the calcium score and scoring in contrast-enhanced series resulted in higher scores compared to non-contrast-enhanced series. These effects are more apparent in patients with higher calcium loads. Calcium scoring reproducibility with the reference standard is limited for the aorta-iliac trajectory, whereas scoring with the remaining settings is reproducible. CONCLUSION Scores obtained with different settings cannot be compared. The inter-observer reproducibility was limited using the reference standard and practical difficulties were substantial. Scoring with higher LT, ST, and contrast enhancement is faster and has less practical difficulties.
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Affiliation(s)
- N Komen
- Department of Surgery, University Medical Center Rotterdam, Erasmus MC, Rotterdam, the Netherlands
- Department of Surgery, University Hospital Antwerp, Edegem, Belgium
| | - P Klitsie
- Department of Surgery, University Medical Center Rotterdam, Erasmus MC, Rotterdam, the Netherlands
| | - JJ Hermans
- Department of Radiology, University Medical Center Rotterdam, Erasmus MC, Rotterdam, the Netherlands
| | - WJ Niessen
- Department of Radiology, University Medical Center Rotterdam, Erasmus MC, Rotterdam, the Netherlands
| | - GJ Kleinrensink
- Department of Neurosciences and Anatomy, University Medical Center Rotterdam, Erasmus MC, Rotterdam, the Netherlands
| | - J Jeekel
- Department of Surgery, University Medical Center Rotterdam, Erasmus MC, Rotterdam, the Netherlands
| | - JF Lange
- Department of Surgery, University Medical Center Rotterdam, Erasmus MC, Rotterdam, the Netherlands
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Išgum I, Rutten A, Prokop M, Staring M, Klein S, Pluim JPW, Viergever MA, van Ginneken B. Automated aortic calcium scoring on low-dose chest computed tomography. Med Phys 2010; 37:714-23. [DOI: 10.1118/1.3284211] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Vukadinovic D, van Walsum T, Manniesing R, Rozie S, Hameeteman R, de Weert TT, van der Lugt A, Niessen WJ. Segmentation of the outer vessel wall of the common carotid artery in CTA. IEEE TRANSACTIONS ON MEDICAL IMAGING 2010; 29:65-76. [PMID: 19556191 DOI: 10.1109/tmi.2009.2025702] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A novel method is presented for carotid artery vessel wall segmentation in computed tomography angiography (CTA) data. First the carotid lumen is semi-automatically segmented using a level set approach initialized with three seed points. Subsequently, calcium regions located within the vessel wall are automatically detected and classified using multiple features in a GentleBoost framework. Calcium regions segmentation is used to improve localization of the outer vessel wall because it is an easier task than direct outer vessel wall segmentation. In a third step, pixels outside the lumen area are classified as vessel wall or background, using the same GentleBoost framework with a different set of image features. Finally, a 2-D ellipse shape deformable model is fitted to a cost image derived from both the calcium and vessel wall classifications. The method has been validated on a dataset of 60 CTA images. The experimental results show that the accuracy of the method is comparable to the interobserver variability.
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Affiliation(s)
- Danijela Vukadinovic
- Biomedical Imaging Group Rotterdam, Department of Radiology, Erasmus MC, 3015GE Rotterdam, The Netherlands.
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BOWDEN DJ, AITKEN SRI, WILKINSON IB, DIXON AK. Interobserver variability in the measurement of abdominal aortic calcification using unenhanced CT. Br J Radiol 2009; 82:69-72. [DOI: 10.1259/bjr/13585245] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Scherl H, Hornegger J, Prümmer M, Lell M. Semi-automatic level-set based segmentation and stenosis quantification of the internal carotid artery in 3D CTA data sets. Med Image Anal 2007; 11:21-34. [PMID: 17126064 DOI: 10.1016/j.media.2006.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Revised: 09/25/2006] [Accepted: 09/28/2006] [Indexed: 10/23/2022]
Abstract
We present a new level-set based method to segment and quantify stenosed internal carotid arteries (ICAs) in 3D contrast-enhanced computed tomography angiography (CTA). Within these data sets it is a difficult task to evaluate the degree of stenoses deterministically even for the experienced physician because the actual vessel lumen is hardly distinguishable from calcified plaque and there is no sharp border between lumen and arterial wall. According to our knowledge no commercially available software package allows the detection of the boundary between lumen and plaque components. Therefore in the clinical environment physicians have to perform the evaluation manually. This approach suffers from both intra- and inter-observer variability. The limitation of the manual approach requires the development of a semi-automatic method that is able to achieve deterministic segmentation results of the internal carotid artery via level-set techniques. With the new method different kinds of plaques were almost completely excluded from the segmented regions. For an objective evaluation we also studied the method's performance with four different phantom data sets for which the ground truth of the degree of stenosis was known a priori. Finally, we applied the method to 10 ICAs and compared the obtained segmentations with manual measurements of three physicians.
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Affiliation(s)
- Holger Scherl
- Institute of Pattern Recognition, Department of Computer Sciences, Friedrich-Alexander-Universität Erlangen-Nürnberg, Martensstrasse 3, D-91058 Erlangen, Germany.
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Baum S. Academic radiology the first six years in the new millenium. Acad Radiol 2005; 12:1487-90. [PMID: 16321736 DOI: 10.1016/j.acra.2005.09.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Revised: 09/16/2005] [Accepted: 09/19/2005] [Indexed: 11/20/2022]
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Gratama van Andel HAF, Meijering E, van der Lugt A, Vrooman HA, de Monyé C, Stokking R. Evaluation of an improved technique for automated center lumen line definition in cardiovascular image data. Eur Radiol 2005; 16:391-8. [PMID: 16170556 DOI: 10.1007/s00330-005-2854-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Revised: 06/15/2005] [Accepted: 06/28/2005] [Indexed: 10/25/2022]
Abstract
The aim of the study was to evaluate a new method for automated definition of a center lumen line in vessels in cardiovascular image data. This method, called VAMPIRE, is based on improved detection of vessel-like structures. A multiobserver evaluation study was conducted involving 40 tracings in clinical CTA data of carotid arteries to compare VAMPIRE with an established technique. This comparison showed that VAMPIRE yields considerably more successful tracings and improved handling of stenosis, calcifications, multiple vessels, and nearby bone structures. We conclude that VAMPIRE is highly suitable for automated definition of center lumen lines in vessels in cardiovascular image data.
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Affiliation(s)
- Hugo A F Gratama van Andel
- Department of Medical Informatics, Erasmus MC-University Medical Center Rotterdam, Dr. Molewaterplein 50, Room Ee 2167, 3015 GE, Rotterdam, The Netherlands
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Jayalath RW, Mangan SH, Golledge J. Aortic calcification. Eur J Vasc Endovasc Surg 2005; 30:476-88. [PMID: 15963738 DOI: 10.1016/j.ejvs.2005.04.030] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2005] [Accepted: 04/05/2005] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Vascular calcification is a complicating factor observed in advanced atherosclerosis. This review summarises the present knowledge regarding abdominal aortic calcification. DESIGN Literature review. METHODS A literature review was carried using MEDLINE and PUBMED with the search terms 'abdominal', 'aortic' and 'calcification'. Articles were assessed for data regarding mechanisms, measurement, risk factors and outcomes of aortic calcification. RESULTS Thirty relevant studies were identified. These demonstrated a positive correlation between abdominal aortic calcification and the following factors: older age, hypertension, and smoking. Further studies are required to critically assess other risk factors such as gender, diabetes mellitus and renal failure. Calcification of the abdominal aorta is associated with an increased risk of mortality, coronary heart disease and stroke. CONCLUSION Aortic calcification predicts an increased incidence of cardiovascular events, however, the reasons for this association requires further investigation. Accurate measurement of aortic calcification is likely to be increasingly used to determine the risk of cardiovascular events.
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Affiliation(s)
- R W Jayalath
- Vascular Biology Unit, Department of Surgery, School of Medicine, James Cook University, Townsville, Qld 4811, Australia
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Olabarriaga SD, Rouet JM, Fradkin M, Breeuwer M, Niessen WJ. Segmentation of thrombus in abdominal aortic aneurysms from CTA with nonparametric statistical grey level appearance modeling. IEEE TRANSACTIONS ON MEDICAL IMAGING 2005; 24:477-485. [PMID: 15822806 DOI: 10.1109/tmi.2004.843260] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This paper presents a new method for deformable model-based segmentation of lumen and thrombus in abdominal aortic aneurysms from computed tomography (CT) angiography (CTA) scans. First the lumen is segmented based on two positions indicated by the user, and subsequently the resulting surface is used to initialize the automated thrombus segmentation method. For the lumen, the image-derived deformation term is based on a simple grey level model (two thresholds). For the more complex problem of thrombus segmentation, a grey level modeling approach with a nonparametric pattern classification technique is used, namely k-nearest neighbors. The intensity profile sampled along the surface normal is used as classification feature. Manual segmentations are used for training the classifier: samples are collected inside, outside, and at the given boundary positions. The deformation is steered by the most likely class corresponding to the intensity profile at each vertex on the surface. A parameter optimization study is conducted, followed by experiments to assess the overall segmentation quality and the robustness of results against variation in user input. Results obtained in a study of 17 patients show that the agreement with respect to manual segmentations is comparable to previous values reported in the literature, with considerable less user interaction.
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Affiliation(s)
- Silvia D Olabarriaga
- University Medical Center Utrecht, Image Sciences Institute, Q.S. 459, Heidelberglaan 100, 3584CX Utrecht, The Netherlands.
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