A framework for quantification and visualization of segmentation accuracy and variability in 3D lateral ventricle ultrasound images of preterm neonates.

PURPOSE Intraventricular hemorrhage (IVH) is a major cause of brain injury in preterm neonates. Three dimensional ultrasound (US) imaging systems have been developed to visualize 3D anatomical structure of preterm neonatal intracranial ventricular system with IVH and ventricular dilation. To allow quantitative analysis, the ventricle system is required to be segmented accurately and efficiently from 3D US images. Although semiautomatic segmentation algorithms have been developed, local segmentation accuracy and variability associated with these algorithms should be evaluated statistically before they can be applied in clinical settings. This work proposes a statistical framework to quantify the local accuracy and variability and performs statistical tests to identify locations where the semiautomatically segmented surfaces are significantly different from manually segmented surfaces. METHODS Three dimensional lateral ventricle US images of preterm neonates were each segmented six times manually and using a semiautomated segmentation algorithm. The local difference between manually and algorithmically segmented surfaces as well as the segmentation variability for each method was computed and superimposed on the ventricular surface of each subject. To summarize the segmentation performance for a whole group of subjects, the subject-specific local difference and standard deviation maps were registered onto a 3D template ventricular surface using a nonrigid registration algorithm. Pointwise, intersubject average accuracy and pooled variability for the whole group of subjects can be computed and visualized on the template surface, providing a summary of performance of the segmentation algorithm for the whole group of ventricles with highly variable geometry. In addition to pointwise statistical analysis performed on the template surface, statistical conclusion regarding the accuracy of the segmentation algorithm was made for subregions and the whole ventricle with the spatial correlation of pointwise accuracy taken into account. RESULTS Ten 3D US images were involved in this study. Pointwise local difference, ΔS, its absolute value |ΔS| as well as the standard deviations of the manual and algorithm segmentations were computed and superimposed on the each ventricle surface. Regions with lower segmentation accuracy and higher segmentation variability can be identified from these maps, and the localized information was applied to improve the accuracy of the algorithm. Intersubject average ΔS and |ΔS| as well as pooled standard deviations was computed on the template surface. Intersubject average ΔS and |ΔS| indicated that the algorithm underestimated regions in the neighborhood of the tips of anterior, inferior, and posterior horns. Intersubject pooled standard deviations indicated that manual segmentation had a higher segmentation variability than algorithm segmentation over the whole ventricle. Statistical analysis on the template surface showed that there was significant difference between algorithm and manual methods for segmenting the right lateral ventricle but not for the left lateral ventricle. CONCLUSIONS A framework was proposed for evaluating, visualizing, and summarizing the local accuracy and variability of a segmentation algorithm. This framework can be used for improving the accuracy of segmentation algorithms, as well as providing useful feedback to improve the manual segmentation performance. More importantly, this framework can be applied for longitudinal monitoring of local ventricular changes of neonates with IVH.