A pipeline of unsupervised image analysis methods for extraction of geometrical features from retinal fundus images has previously been developed. Features related to vessel caliber, tortuosity and bifurcations, have been identified as potential biomarkers for a variety of diseases, including diabetes and Alzheimer’s. The current computationally expensive pipeline takes 24 minutes to process a single image, which impedes implementation in a screening setting. In this work, we approximate the pipeline with a convolutional neural network (CNN) that enables processing of a single image in a few seconds. As an additional benefit, the trained CNN is sensitive to key structures in the retina and can be used as a pretrained network for related disease classification tasks. Our model is based on the ResNet-50 architecture and outputs four biomarkers that describe global properties of the vascular tree in retinal fundus images. Intraclass correlation coefficients between the predictions of the CNN and the results of the pipeline showed strong agreement (0.86 - 0.91) for three of four biomarkers and moderate agreement (0.42) for one biomarker. Class activation maps were created to illustrate the attention of the network. The maps show qualitatively that the activations of the network overlap with the biomarkers of interest, and that the network is able to distinguish venules from arterioles. Moreover, local high and low tortuous regions are clearly identified, confirming that a CNN is sensitive to key structures in the retina.
The retinal vasculature is the only part of the blood circulation system that can be observed non-invasively using fundus cameras. Changes in the dynamic properties of retinal blood vessels are associated with many systemic and vascular diseases, such as hypertension, coronary heart disease and diabetes. The assessment of the characteristics of the retinal vascular network provides important information for an early diagnosis and prognosis of many systemic and vascular diseases. The manual analysis of the retinal vessels and measurement of quantitative biomarkers in large-scale screening programs is a tedious task, time-consuming and costly. This paper describes a reliable, automated, and efficient retinal health information and notification system (acronym RHINO) which can extract a wealth of geometric biomarkers in large volumes of fundus images. The fully automated software presented in this paper includes vessel enhancement and segmentation, artery/vein classification, optic disc, fovea, and vessel junction detection, and bifurcation/crossing discrimination. Pipelining these tools allows the assessment of several quantitative vascular biomarkers: width, curvature, bifurcation geometry features and fractal dimension. The brain-inspired algorithms outperform most of the state-of-the-art techniques. Moreover, several annotation tools are implemented in RHINO for the manual labeling of arteries and veins, marking optic disc and fovea, and delineating vessel centerlines. The validation phase is ongoing and the software is currently being used for the analysis of retinal images from the Maastricht study (the Netherlands) which includes over 10,000 subjects (healthy and diabetic) with a broad spectrum of clinical measurements
The Arteriolar-to-Venular Ratio (AVR) is a popular dimensionless measure which allows the assessment of patients’ condition for the early diagnosis of different diseases, including hypertension and diabetic retinopathy. This paper presents two new approaches for AVR computation in retinal photographs which include a sequence of automated processing steps: vessel segmentation, caliber measurement, optic disc segmentation, artery/vein classification, region of interest delineation, and AVR calculation. Both approaches have been tested on the INSPIRE-AVR dataset, and compared with a ground-truth provided by two medical specialists. The obtained results demonstrate the reliability of the fully automatic approach which provides AVR ratios very similar to at least one of the observers. Furthermore, the semi-automatic approach, which includes the manual modification of the artery/vein classification if needed, allows to significantly reduce the error to a level below the human error.