Simultaneous extraction of carotid artery intima-media interfaces in ultrasound images: assessment of wall thickness temporal variation during the cardiac cycle

Objectives   The aim of this work is to present and evaluate a novel segmentation method for localizing the contours of the intima-media complex in the carotid artery wall through longitudinal ultrasound B-mode imaging. The method is used to investigate the association between atherosclerosis risk factors and the cyclic variation of the intima-media thickness during the heart beat.Methods   The framework introduced is based on two main features. The first is a simultaneous extraction of both the lumen-intima and the media-adventitia interfaces, using the combination of an original shape-adapted filter bank and a specific dynamic programming scheme. The second is an innovative spatial transformation that eases the extraction of skewed and curved contours, and exploits the result from the previous image as a priori information, when processing the current image. The intima-media thickness is automatically derived from the estimated contours for each time step during the cardiac cycle. Our method was evaluated in vivo on 57 healthy volunteers and 25 patients at high cardiovascular risk. Reference contours were generated for each subject by averaging the tracings performed by three experienced observers.Results   Segmentation errors were $$29 \pm 27\,\upmu \hbox {m}$$29±27μm for the lumen-intima interface, $$42 \pm 38\,\upmu \hbox {m}$$42±38μm for the media-adventitia interface, and $$22 \pm 16\,\upmu \hbox {m}$$22±16μm for the intima-media thickness. This uncertainty was similar to inter- and intra-observer variability. Furthermore, the amplitude of the temporal variation in thickness of the intima-media layers during the cardiac cycle was significantly higher in at-risk patients compared to healthy volunteers $$(79 \pm 36$$(79±36 vs. $$64 \pm 26\,\upmu \hbox {m},\, p=0.032)$$64±26μm,p=0.032).Conclusion   The method proposed may provide a relevant diagnostic aid for atherosclerosis screening in clinical studies.

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