Faculty Publications
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Item State-of-the-art review on automated lumen and adventitial border delineation and its measurements in carotid ultrasound(Elsevier Ireland Ltd, 2018) Kumar, P.K.; Araki, T.; Rajan, J.; Laird, J.R.; Nicolaïdes, A.; Suri, J.S.Background and objective: Accurate, reliable, efficient, and precise measurements of the lumen geometry of the common carotid artery (CCA) are important for (a) managing the progression/regression of atherosclerotic build-up and (b) the risk of stroke. The image-based degree of stenosis in the carotid artery and the plaque burden can be predicted using the automated carotid lumen diameter (LD)/inter-adventitial diameter (IAD) measurements from B-mode ultrasound images. The objective of this review is to present the state-of-the-art methods and systems for the measurement of LD/IAD in CCA based on automated or semi-automated strategies. Further, the performance of these systems is compared based on various metrics for its measurements. Methods: The automated algorithms proposed for the segmentation of carotid lumen are broadly classified into two different categories as: region-based and boundary-based. These techniques are discussed in detail specifying their pros and cons. Further, we discuss the challenges encountered in the segmentation process along with its quantitative assessment. Lastly, we present stenosis quantification and risk stratification strategies. Results: Even though, we have found more boundary-based approaches compared to region-based approaches in the literature, however, the region-based strategy yield more satisfactory performance. Novel risk stratification strategies are presented. On a patient database containing 203 patients, 9 patients are identified as high risk patients, whereas 27 patients are identified as medium risk patients. Conclusions: We have presented different techniques for the lumen segmentation of the common carotid artery from B-mode ultrasound images and measurement of lumen diameter and inter-adventitial diameter. We believe that the issue regarding boundary-based techniques can be compensated by taking regional statistics embedded with boundary-based information. © 2018 Elsevier B.V.Item Numerical analysis of the effect of turbulence transition on the hemodynamic parameters in human coronary arteries(AME Publishing Company info@amepc.org, 2016) Mahalingam, A.; Gawandalkar, U.U.; Kini, G.; Buradi, A.; Araki, T.; Ikeda, N.; Nicolaïdes, A.; Laird, J.R.; Saba, L.; Suri, J.S.Background: Local hemodynamics plays an important role in atherogenesis and the progression of coronary atherosclerosis disease (CAD). The primary biological effect due to blood turbulence is the change in wall shear stress (WSS) on the endothelial cell membrane, while the local oscillatory nature of the blood flow affects the physiological changes in the coronary artery. In coronary arteries, the blood flow Reynolds number ranges from few tens to several hundreds and hence it is generally assumed to be laminar while calculating the WSS calculations. However, the pulsatile blood flow through coronary arteries under stenotic condition could result in transition from laminar to turbulent flow condition. Methods: In the present work, the onset of turbulent transition during pulsatile flow through coronary arteries for varying degree of stenosis (i.e., 0%, 30%, 50% and 70%) is quantitatively analyzed by calculating the turbulent parameters distal to the stenosis. Also, the effect of turbulence transition on hemodynamic parameters such as WSS and oscillatory shear index (OSI) for varying degree of stenosis is quantified. The validated transitional shear stress transport (SST) k-? model used in the present investigation is the best suited Reynolds averaged Navier-Stokes turbulence model to capture the turbulent transition. The arterial wall is assumed to be rigid and the dynamic curvature effect due to myocardial contraction on the blood flow has been neglected. Results: Our observations shows that for stenosis 50% and above, the WSSavg, WSSmax and OSI calculated using turbulence model deviates from laminar by more than 10% and the flow disturbances seems to significantly increase only after 70% stenosis. Our model shows reliability and completely validated. Conclusions: Blood flow through stenosed coronary arteries seems to be turbulent in nature for area stenosis above 70% and the transition to turbulent flow begins from 50% stenosis. © Cardiovascular Diagnosis and Therapy. All rights reserved.Item Carotid inter-adventitial diameter is more strongly related to plaque score than lumen diameter: An automated tool for stroke analysis(John Wiley and Sons Inc. P.O.Box 18667 Newark NJ 07191-8667, 2016) Saba, L.; Araki, T.; Krishna Kumar, P.; Rajan, J.; Lavra, F.; Ikeda, N.; Sharma, A.M.; Shafique, S.; Nicolaïdes, A.; Laird, J.R.; Gupta, A.; Suri, J.S.Purpose: To compare the strength of correlation between automatically measured carotid lumen diameter (LD) and interadventitial diameter (IAD) with plaque score (PS). Methods: Retrospective study on a database of 404 common carotid artery B-mode sonographic images from 202 diabetic patients. LD and IAD were computed automatically using an advanced computerized edge detection method and compared with two distinct manual measurements. PS was computed by adding the maximal thickness in millimeters of plaques in segments taken from the internal carotid artery, bulb, and common carotid artery on both sides. Results: The coefficient of correlation was 0.19 (p < 0.007) between LD and PS, and 0.25 (p < 0.0006) between IAD and PS. After excluding 10 outliers, coefficient of correlation was 0.25 (p < 0.0001) between LD and PS, and 0.38 (p < 0.0001) between IAD and PS. The precision of merit of automated versus the two manual measurements was 96.6% and 97.2% for LD, and 97.7% and 98.1%, for IAD, respectively. Conclusions: Our automated measurement system gave satisfying results in comparison with manual measurements. Carotid IAD was more strongly correlated to PS than carotid LD in this population sample of Japanese diabetic patients. © 2016 Wiley Periodicals, Inc.Item Two Automated Techniques for Carotid Lumen Diameter Measurement: Regional versus Boundary Approaches(Springer New York LLC barbara.b.bertram@gsk.com, 2016) Araki, T.; Kumar, P.K.; Suri, H.S.; Ikeda, N.; Gupta, A.; Saba, L.; Rajan, J.; Lavra, F.; Sharma, A.M.; Shafique, S.; Nicolaïdes, A.; Laird, J.R.; Suri, J.S.The degree of stenosis in the carotid artery can be predicted using automated carotid lumen diameter (LD) measured from B-mode ultrasound images. Systolic velocity-based methods for measurement of LD are subjective. With the advancement of high resolution imaging, image-based methods have started to emerge. However, they require robust image analysis for accurate LD measurement. This paper presents two different algorithms for automated segmentation of the lumen borders in carotid ultrasound images. Both algorithms are modeled as a two stage process. Stage one consists of a global-based model using scale-space framework for the extraction of the region of interest. This stage is common to both algorithms. Stage two is modeled using a local-based strategy that extracts the lumen interfaces. At this stage, the algorithm-1 is modeled as a region-based strategy using a classification framework, whereas the algorithm-2 is modeled as a boundary-based approach that uses the level set framework. Two sets of databases (DB), Japan DB (JDB) (202 patients, 404 images) and Hong Kong DB (HKDB) (50 patients, 300 images) were used in this study. Two trained neuroradiologists performed manual LD tracings. The mean automated LD measured was 6.35 ± 0.95 mm for JDB and 6.20 ± 1.35 mm for HKDB. The precision-of-merit was: 97.4 % and 98.0 % w.r.t to two manual tracings for JDB and 99.7 % and 97.9 % w.r.t to two manual tracings for HKDB. Statistical tests such as ANOVA, Chi-Squared, T-test, and Mann-Whitney test were conducted to show the stability and reliability of the automated techniques. © 2016, Springer Science+Business Media New York.Item Wall shear stress and oscillatory shear index distribution in carotid artery with varying degree of stenosis: A hemodynamic study(World Scientific Publishing Co. Pte Ltd wspc@wspc.com.sg, 2017) Basavaraja, P.; Anish, S.; Gupta, A.; Saba, L.; Laird, J.R.; Nicolaïdes, A.; Mtui, E.E.; Baradaran, H.; Lavra, F.; Suri, J.S.A significant proportion of cerebral stroke is a consequence of the arterial stenotic plaque rupture causing local thrombosis or distal embolization. The formation and subsequent rupture of the plaque depends on wall shear stress (WSS) and oscillatory shear index (OSI). The purpose of the present study was to understand the effect of hemodynamics on the spatial and temporal variations of WSS and OSI using realistic models with varying degree of carotid artery stenosis (DOS). Multiple CT volumes were obtained from subjects in the carotid bifurcation zone and the 3D models were generated. A finite volume-based computational fluid dynamics (CFD) method was utilized to understand the hemodynamics in pulsatile flow conditions. It was observed that high stenosis models occupied a large value of normalized WSS in the internal carotid artery (ICA) whereas they had smaller values of normalized WSS in the common carotid artery (CCA). For clinical use, the authors recommend using the spatial average value of oscillatory shear rather than the maximum value for an accurate knowledge about the severity of stenosis. The resultant vorticity changes the direction of spin after the bifurcation zone. Additionally, we propose the use of limiting streamlines as a novel and convenient method to identify the disturbed flow regions that are prone to atherogenesis. © 2017 World Scientific Publishing Company.Item Accurate lumen diameter measurement in curved vessels in carotid ultrasound: an iterative scale-space and spatial transformation approach(Springer Verlag service@springer.de, 2017) Krishna Kumar, P.; Araki, T.; Rajan, J.; Saba, L.; Lavra, F.; Ikeda, N.; Sharma, A.M.; Shafique, S.; Nicolaïdes, A.; Laird, J.R.; Gupta, A.; Suri, J.S.Monitoring of cerebrovascular diseases via carotid ultrasound has started to become a routine. The measurement of image-based lumen diameter (LD) or inter-adventitial diameter (IAD) is a promising approach for quantification of the degree of stenosis. The manual measurements of LD/IAD are not reliable, subjective and slow. The curvature associated with the vessels along with non-uniformity in the plaque growth poses further challenges. This study uses a novel and generalized approach for automated LD and IAD measurement based on a combination of spatial transformation and scale-space. In this iterative procedure, the scale-space is first used to get the lumen axis which is then used with spatial image transformation paradigm to get a transformed image. The scale-space is then reapplied to retrieve the lumen region and boundary in the transformed framework. Then, inverse transformation is applied to display the results in original image framework. Two hundred and two patients’ left and right common carotid artery (404 carotid images) B-mode ultrasound images were retrospectively analyzed. The validation of our algorithm has done against the two manual expert tracings. The coefficient of correlation between the two manual tracings for LD was 0.98 (p < 0.0001) and 0.99 (p < 0.0001), respectively. The precision of merit between the manual expert tracings and the automated system was 97.7 and 98.7%, respectively. The experimental analysis demonstrated superior performance of the proposed method over conventional approaches. Several statistical tests demonstrated the stability and reliability of the automated system. © 2016, International Federation for Medical and Biological Engineering.