Purpose: Implanting stents to re-open stenotic lesions during percutaneous coronary interventions is considered a standard treatment for acute or chronic coronary syndrome. Intravascular ultrasound (IVUS) can be used to guide and assess the technical success of these interventions. Automatically segmenting stent struts in IVUS sequences improves workflow efficiency but is non-trivial due to a challenging image appearance entailing manifold ambiguities with other structures. Manual, ungated IVUS pullbacks constitute a challenge in this context. We propose a fully data-driven strategy to first longitudinally detect and subsequently segment stent struts in IVUS frames.
Approach: A cascaded deep learning approach is presented. It first trains an encoder model to classify frames as “stent,” “no stent,” or “no use.” A segmentation model then delineates stent struts on a pixel level only in frames with a stent label. The first stage of the cascade acts as a gateway to reduce the risk for false positives in the second stage, the segmentation, which is trained on a smaller and difficult-to-annotate dataset. Training of the classification and segmentation model was based on 49,888 and 1826 frames of 74 sequences from 35 patients, respectively.
Results: The longitudinal classification yielded Dice scores of 92.96%, 82.35%, and 94.03% for the classes stent, no stent, and no use, respectively. The segmentation achieved a Dice score of 65.1% on the stent ground truth (intra-observer performance: 75.5%) and 43.5% on all frames (including frames without stent, with guidewires, calcium, or without clinical use). The latter improved to 49.5% when gating the frames by the classification decision and further increased to 57.4% with a heuristic on the plausible stent strut area.
Conclusions: A data-driven strategy for segmenting stents in ungated, manual pullbacks was presented—the most common and practical scenario in the time-critical clinical workflow. We demonstrated a mitigated risk for ambiguities and false positive predictions.
Ischemic heart disease remains one of the leading causes of death worldwide. Percutaneous coronary interventions (PCIs) for implanting coronary stents are preferred for patients with acute myocardial infarction but may also be performed in patients with chronic coronary syndromes to improve symptoms and outcome. During the PCI, the assessment of stent apposition, evaluation of in-stent restenosis or guidance for complex stenting of bifurcation lesions may be improved by intravascular imaging such as intravascular ultrasound (IVUS). However, advanced interpretation of the image often requires expertise and training. To approach this issue, we introduce an automatic delineation of stent struts within the IVUS pullback. We propose a cascaded segmentation based on data-driven learning with a neural encoder-decoder architecture. The learning process uses 80 IVUS sequences from 28 patients which were acquired and partially annotated by the Department of Cardiology, University Heart and Vascular Center Hamburg, Germany. The annotations include 1108, 555 and 355 frames with delineated lumen, stent and calcium as well as 13696 and 10689 frame-wise stent and no-stent indications. The network was pre-trained on lumen segmentation and refined to first identify stent frames using an encoder network and subsequently segment the struts with a decoder. Quantitative evaluation using 3-fold cross-validation revealed 88.3% precision, 92.4% recall and 0.824 Dice for the encoder and 67.0%, 60.3% and 0.611 for the decoder. We conclude that the encoder successfully leverages the larger number of high-level annotations to reject non-stent frames avoiding unnecessary false positives for the decoder trained on much less, but fine-granular annotations.
Automatic delineation of relevant structures in intravascular imaging can support percutaneous coronary interventions (PCIs), especially when dealing with rather demanding cases. We found three major error types which occur regularly when segmenting lumen and wall of morphologically complex vessels with convolutional neural networks (CNNs). In order to reduce these three error types, we developed three IVUS-specific methods which are able to improve generalizability of state-of-the-art CNNs for IVUS segmentation tasks. These methods are based on three concepts: speckle statistics, artery shape priors via independent component analysis (ICA) and the concentricity condition of lumen and vessel wall. We found that all three methods outperform the baseline. Since all three concepts can be readily transferred to intravascular optical coherence tomography (IVOCT), we expect these findings can support the segmentation of corresponding images as well.
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