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Loizou C.P.,Intercollege | Murray V.,University of Lima | Murray V.,University of New Mexico | Pattichis M.S.,University of Lima | And 3 more authors.
International Journal of Biomedical Imaging | Year: 2014

The intima-media thickness (IMT) of the common carotid artery (CCA) is widely used as an early indicator of cardiovascular disease (CVD). Typically, the IMT grows with age and this is used as a sign of increased risk of CVD. Beyond thickness, there is also clinical interest in identifying how the composition and texture of the intima-media complex (IMC) changed and how these textural changes grow into atherosclerotic plaques that can cause stroke. Clearly though texture analysis of ultrasound images can be greatly affected by speckle noise, our goal here is to develop effective despeckle noise methods that can recover image texture associated with increased rates of atherosclerosis disease. In this study, we perform a comparative evaluation of several despeckle filtering methods, on 100 ultrasound images of the CCA, based on the extracted multiscale Amplitude-Modulation Frequency-Modulation (AM-FM) texture features and visual image quality assessment by two clinical experts. Texture features were extracted from the automatically segmented IMC for three different age groups. The despeckle filters hybrid median and the homogeneous mask area filter showed the best performance by improving the class separation between the three age groups and also yielded significantly improved image quality. © 2014 C. P. Loizou et al.


Sharma A.M.,University of Virginia | Gupta A.,New York Medical College | Kumar P.K.,National Institute of Technology Karnataka | Kumar P.K.,Global Biomedical Technologies Inc. | And 10 more authors.
Current Atherosclerosis Reports | Year: 2015

Cardiovascular diseases (including stroke and heart attack) are identified as the leading cause of death in today’s world. However, very little is understood about the arterial mechanics of plaque buildup, arterial fibrous cap rupture, and the role of abnormalities of the vasa vasorum. Recently, ultrasonic echogenicity characteristics and morphological characterization of carotid plaque types have been shown to have clinical utility in classification of stroke risks. Furthermore, this characterization supports aggressive and intensive medical therapy as well as procedures, including endarterectomy and stenting. This is the first state-of-the-art review to provide a comprehensive understanding of the field of ultrasonic vascular morphology tissue characterization. This paper presents fundamental and advanced ultrasonic tissue characterization and feature extraction methods for analyzing plaque. Additionally, the paper shows how the risk stratification is achieved using machine learning paradigms. More advanced methods need to be developed which can segment the carotid artery walls into multiple regions such as the bulb region and areas both proximal and distal to the bulb. Furthermore, multimodality imaging is needed for validation of such advanced methods for stroke and cardiovascular risk stratification. © 2015, Springer Science+Business Media New York.


PubMed | CorVasc Vascular Laboratory, University of Barcelona, National Institute of Technology Raipur, AtheroPointTM and 5 more.
Type: Journal Article | Journal: Journal of medical systems | Year: 2015

Quantitative assessment of calcified atherosclerotic volume within the coronary artery wall is vital for cardiac interventional procedures. The goal of this study is to automatically measure the calcium volume, given the borders of coronary vessel wall for all the frames of the intravascular ultrasound (IVUS) video. Three soft computing fuzzy classification techniques were adapted namely Fuzzy c-Means (FCM), K-means, and Hidden Markov Random Field (HMRF) for automated segmentation of calcium regions and volume computation. These methods were benchmarked against previously developed threshold-based method. IVUS image data sets (around 30,600 IVUS frames) from 15 patients were collected using 40 MHz IVUS catheter (Atlantis SR Pro, Boston Scientific, pullback speed of 0.5 mm/s). Calcium mean volume for FCM, K-means, HMRF and threshold-based method were 37.84 17.38 mm(3), 27.79 10.94 mm(3), 46.44 19.13 mm(3) and 35.92 16.44 mm(3) respectively. Cross-correlation, Jaccard Index and Dice Similarity were highest between FCM and threshold-based method: 0.99, 0.92 0.02 and 0.95 + 0.02 respectively. Students t-test, z-test and Wilcoxon-test are also performed to demonstrate consistency, reliability and accuracy of the results. Given the vessel wall region, the system reliably and automatically measures the calcium volume in IVUS videos. Further, we validated our system against a trained expert using scoring: K-means showed the best performance with an accuracy of 92.80%. Out procedure and protocol is along the line with method previously published clinically.


PubMed | zienda Ospedaliero Universitaria di Cagliari, CorVasc Vascular Laboratory, Global Biomedical Technologies Inc., Kalyani Government Engineering College and 2 more.
Type: Journal Article | Journal: Journal of medical systems | Year: 2016

Embedding of diagnostic and health care information requires secure encryption and watermarking. This research paper presents a comprehensive study for the behavior of some well established watermarking algorithms in frequency domain for the preservation of stroke-based diagnostic parameters. Two different sets of watermarking algorithms namely: two correlation-based (binary logo hiding) and two singular value decomposition (SVD)-based (gray logo hiding) watermarking algorithms are used for embedding ownership logo. The diagnostic parameters in atherosclerotic plaque ultrasound video are namely: (a) bulb identification and recognition which consists of identifying the bulb edge points in far and near carotid walls; (b) carotid bulb diameter; and (c) carotid lumen thickness all along the carotid artery. The tested data set consists of carotid atherosclerotic movies taken under IRB protocol from University of Indiana Hospital, USA-AtheroPoint (Roseville, CA, USA) joint pilot study. ROC (receiver operating characteristic) analysis was performed on the bulb detection process that showed an accuracy and sensitivity of 100 % each, respectively. The diagnostic preservation (DPsystem) for SVD-based approach was above 99 % with PSNR (Peak signal-to-noise ratio) above 41, ensuring the retention of diagnostic parameter devalorization as an effect of watermarking. Thus, the fully automated proposed system proved to be an efficient method for watermarking the atherosclerotic ultrasound video for stroke application.


Meiburger K.M.,Polytechnic University of Turin | Molinari F.,Polytechnic University of Turin | Acharya U.R.,Ngee Ann Polytechnic | Saba L.,A.O.U. di Cagliari | And 6 more authors.
Physics in Medicine and Biology | Year: 2011

Evaluation of the carotid artery wall is essential for the assessment of a patient's cardiovascular risk or for the diagnosis of cardiovascular pathologies. This paper presents a new, completely user-independent algorithm called carotid artery intima layer regional segmentation (CAILRS, a class of AtheroEdge™ systems), which automatically segments the intima layer of the far wall of the carotid ultrasound artery based on mean shift classification applied to the far wall. Further, the system extracts the lumen-intima and media-adventitia borders in the far wall of the carotid artery. Our new system is characterized and validated by comparing CAILRS borders with the manual tracings carried out by experts. The new technique is also benchmarked with a semi-automatic technique based on a first-order absolute moment edge operator (FOAM) and compared to our previous edge-based automated methods such as CALEX (Molinari et al 2010 J. Ultrasound Med. 29 399-418, 2010 IEEE Trans. Ultrason. Ferroelectr. Freq. Control 57 1112-24), CULEX (Delsanto et al 2007 IEEE Trans. Instrum. Meas. 56 1265-74, Molinari et al 2010 IEEE Trans. Ultrason. Ferroelectr. Freq. Control 57 1112-24), CALSFOAM (Molinari et al Int. Angiol. (at press)), and CAUDLES-EF (Molinari et al J. Digit. Imaging (at press)). Our multi-institutional database consisted of 300 longitudinal B-mode carotid images. In comparison to semi-automated FOAM, CAILRS showed the IMT bias of -0.035 0.186 mm while FOAM showed -0.016 0.258 mm. Our IMT was slightly underestimated with respect to the ground truth IMT, but showed uniform behavior over the entire database. CAILRS outperformed all the four previous automated methods. The system's figure of merit was 95.6%, which was lower than that of the semi-automated method (98%), but higher than that of the other automated techniques. © 2011 Institute of Physics and Engineering in Medicine.


Acharya U.R.,Ngee Ann Polytechnic | Faust O.,Ngee Ann Polytechnic | Sree S.V.,Global Biomedical Technologies Inc. | Molinari F.,Polytechnic University of Turin | And 5 more authors.
IEEE Transactions on Instrumentation and Measurement | Year: 2012

Computer-aided diagnosis (CAD) of carotid atherosclerosis into symptomatic or asymptomatic is useful in the analysis of cardiac health. This paper describes a patented CAD system called Atheromatic™ for symptomatic versus asymptomatic plaque classification in carotid ultrasound images. The system involves two steps: 1) feature extraction using a combination of discrete wavelet transform and averaging algorithms and 2) classification using a support vector machine (SVM) classifier for automated decision making. The CAD system was evaluated using a database consisting of 150 asymptomatic and 196 symptomatic plaque regions which were labeled using the ground truth based on the presence or absence of symptoms. Threefold cross-validation protocol was adapted for developing and testing the classifiers. We observed that the SVM classifier with a polynomial kernel of order 2 was to achieve a classification accuracy of 83.7%. © 2011 IEEE.


Molinari F.,Polytechnic University of Turin | Meiburger K.M.,Polytechnic University of Turin | Zeng G.,Mayo Medical School | Nicolaides A.,University of Cyprus | And 3 more authors.
Journal of Digital Imaging | Year: 2011

The evaluation of the carotid artery wall is essential for the diagnosis of cardiovascular pathologies or for the assessment of a patient's cardiovascular risk. This paper presents a completely user-independent algorithm, which automatically extracts the far double line (lumen- intima and media-adventitia) in the carotid artery using an Edge Flow technique based on directional probability maps using the attributes of intensity and texture. Specifically, the algorithm traces the boundaries between the lumen and intima layer (line one) and between the media and adventitia layer (line two). The Carotid Automated Ultrasound Double Line Extraction System based on Edge-Flow (CAUDLESEF) is characterized and validated by comparing the output of the algorithm with the manual tracing boundaries carried out by three experts. We also benchmark our new technique with the two other completely automatic techniques (CALEXia and CULEXsa) we previously published. Our multi-institutional database consisted of 300 longitudinal Bmode carotid images with normal and pathologic arteries. We compared our current new method with previous methods, and showed the mean and standard deviation for the three methods: CALEXia, CULEXsa, and CAUDLESEF as 0.134±0.088, 0.074±0.092, and 0.043±0.097 mm, respectively. Our IMT was slightly underestimated with respect to the ground truth IMT, but showed a uniform behavior over the entire database. Regarding the Figure of Merit (FoM), CALEXia and CULEXsa showed the values of 84.7% and 91.5%, respectively, while our new approach, CAUDLES-EF, performed the best at 94.8%, showing a good improvement compared to previous methods. © Society for Imaging Informatics in Medicine 2011.


Aristokleous N.,Cyprus University of Technology | Seimenis I.,Democritus University of Thrace | Georgiou G.C.,University of Cyprus | Papaharilaou Y.,IACM FORTH | And 3 more authors.
IEEE Journal of Biomedical and Health Informatics | Year: 2014

This paper aims at evaluating the changes that head rotation poses on morphological and flow characteristics of the carotid bifurcation (CB) and on the distribution of parameters that are regarded as important in atherosclerosis development, such as relative particle residence time (RRT), normalized oscillatory shear index (nOSI), and helicity (HL). Using a subject-specific approach, six healthy volunteers were MR-scanned in two head postures: supine neutral and prone with rightward head rotation. Cross-sectional flow velocity distribution was obtained using phase-contrast MRI at the common carotid artery (CCA). Our results indicate that peak systolic flow rate is reduced at the prone position in most cases for both CCAs. Morphological MR images are used to segment and construct the CB models. Numerical simulations are performed and areas exposed to high helicity or unfavorable hemodynamics are calculated. Head rotation affects the instantaneous spatial extent of high helicity regions. Posture-related observed differences in the distribution of nOSI and RRT suggest that inlet flow waveform tends to moderate geometry-induced changes in the qualitative and quantitative distribution of atherosclerosis-susceptible wall regions. Overall, presented results indicate that an individualized approach is required to fully assess the postural role in atherosclerosis development and in complications arising in stenotic and stented vessels. © 2013 IEEE.


Griffin M.B.,Vascular Screening and Diagnostic Center | Kyriacou E.,University of Cyprus | Pattichis C.,University of Cyprus | Bond D.,Vascular Screening and Diagnostic Center | And 9 more authors.
Journal of Vascular Surgery | Year: 2010

Objectives: The aim was to determine the diagnostic value of a juxtaluminal black (hypoechoic) area without a visible echogenic cap (JBA) in ultrasonic images of internal carotid artery plaques. Methods: Ultrasonic images of plaques from 324 patients with asymptomatic (n = 139) and symptomatic (n = 185) internal carotid 50% to 99% stenosis in relation to the bulb (European Carotid Surgery Trial) referred for duplex scanning were studied. The JBA in mm2 and the gray-scale median (GSM) were obtained after image normalization. Cut-off points for GSM and JBA (combined highest sensitivity with highest specificity) were determined from receiver operator characteristic (ROC) curves. Results: JBA ≥ 8 mm2 was associated with a high prevalence of symptomatic plaques in all grades of stenosis. In a multiple logistic regression model, increasing stenosis (mild, moderate, severe), GSM ≤ 15 and JBA ≥ 8 mm2 were independent predictors of the presence of hemispheric symptoms. This model could identify a high-risk group of 188 plaques that contained 142 (77%) of the 185 symptomatic plaques (odds ratio [OR], 6.7; 95% confidence interval [CI], 4.08-10.91), (P < .001), (sensitivity: 77%; specificity 66%; positive predictive value 75%; negative predictive value 68%). Conclusions: The results of this study indicate the diagnostic value and for the first time suggest a cut-off point of 8 mm2 for JBA. This cut-off point needs to be validated in other groups and then applied to prospective studies of asymptomatic patients. © 2010 Society for Vascular Surgery.


Zamboni P.,University of Ferrara | Morovic S.,University of Ferrara | Morovic S.,University of Zagreb | Menegatti E.,University of Ferrara | And 2 more authors.
International Angiology | Year: 2011

Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenoses or obstructions of the internal jugular and/or azygos veins with disturbed flow and formation of collateral venous channels. Studies using ultrasound in patients with multiple sclerosis (MS) have demonstrated a high prevalence of CCSVI (mean 70%; range 0-100%; N.=1496), whereas, in normal controls and patients without MS the prevalence was much lower (mean 10%; range 0-36%; N.=635). Ultrasound uses a combination of physiological measurements as well as anatomical imaging and has been used for the detection of CCSVI by different centers with variable results. A high prevalence ranging from 62% to 100% of obstructive lesions has been found by some teams in patients with MS compared with a lower prevalence of 0-25% in controls. However, absence of such lesions or a lower prevalence (16-52%) has been reported by others. This variability could be the result of differences in technique, training, experience or criteria used. The current lack of a methodology shared among experts is a confounding element in epidemiologic studies, and does not permit further Bayesan or other kind of analysis. In order to ensure a high reproducibility of Duplex scanning with comparable accuracy between centers, a detailed protocol with standard methodology and criteria is proposed. This is also necessary for training. It has been shown that inter-rater variability increases post-training (from k=0.47 to k=0.80), while within-rater reproducibility in trained operators was k=0.75. Finally, the consensus document proposes a reporting standard of Duplex measurements, and future research to answer areas of uncertainty.

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