We need better clinical tools to improve monitoring of synovitis, synovial inflammation in the joints, in rheumatoid arthritis (RA) assessment. Given its economical, safe and fast characteristics, ultrasound (US) especially Doppler ultrasound is frequently used. However, manual scoring of synovitis in US images is subjective and prone to observer variations. In this study, we propose a new and robust method for automated synovium segmentation in the commonly affected joints, i.e. metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints, which would facilitate automation in quantitative RA assessment. The bone contour in the US image is firstly detected based on a modified dynamic programming method, incorporating angular information for detecting curved bone surface and using image fuzzification to identify missing bone structure. K-means clustering is then performed to initialize potential synovium areas by utilizing the identified bone contour as boundary reference. After excluding invalid candidate regions, the final segmented synovium is identified by reconnecting remaining candidate regions using level set evolution. 15 MCP and 15 MTP US images were analyzed in this study. For each image, segmentations by our proposed method as well as two sets of annotations performed by an experienced clinician at different time-points were acquired. Dice’s coefficient is 0.77±0.12 between the two sets of annotations. Similar Dice’s coefficients are achieved between automated segmentation and either the first set of annotations (0.76±0.12) or the second set of annotations (0.75±0.11), with no significant difference (P = 0.77). These results verify that the accuracy of segmentation by our proposed method and by clinician is comparable. Therefore, reliable synovium identification can be made by our proposed method.
Pak-Hei Yeung, York-Kiat Tan, and Shuoyu Xu, "Automated synovium segmentation in doppler ultrasound images for rheumatoid arthritis assessment," Proc. SPIE 10575, Medical Imaging 2018: Computer-Aided Diagnosis, 105750K (Presented at SPIE Medical Imaging: February 13, 2018; Published: 27 February 2018); https://doi.org/10.1117/12.2293310.
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