Estimation of mitral valve hinge point coordinates -- deep neural net for echocardiogram segmentation

Cardiac image segmentation is a powerful tool in regard to diagnostics and treatment of cardiovascular diseases. Purely feature-based detection of anatomical structures like the mitral valve is a laborious task due to specifically required feature engineering and is especially challenging in echocardiograms, because of their inherently low contrast and blurry boundaries between some anatomical structures. With the publication of further annotated medical datasets and the increase in GPU processing power, deep learning-based methods in medical image segmentation became more feasible in the past years. We propose a fully automatic detection method for mitral valve hinge points, which uses a U-Net based deep neural net to segment cardiac chambers in echocardiograms in a first step, and subsequently extracts the mitral valve hinge points from the resulting segmentations in a second step. Results measured with this automatic detection method were compared to reference coordinate values, which with median absolute hinge point coordinate errors of 1.35 mm for the x- (15-85 percentile range: [0.3 mm; 3.15 mm]) and 0.75 mm for the y- coordinate (15-85 percentile range: [0.15 mm; 1.88 mm]).

Impact of PCA-based preprocessing and different CNN structures on deformable registration of sonograms

Central venous catheters (CVC) are commonly inserted into the large veins of the neck, e.g. the internal jugular vein (IJV). CVC insertion may cause serious complications like misplacement into an artery or perforation of cervical vessels. Placing a CVC under sonographic guidance is an appropriate method to reduce such adverse events, if anatomical landmarks like venous and arterial vessels can be detected reliably. This task shall be solved by registration of patient individual images vs. an anatomically labelled reference image. In this work, a linear, affine transformation is performed on cervical sonograms, followed by a non-linear transformation to achieve a more precise registration. Voxelmorph (VM), a learning-based library for deformable image registration using a convolutional neural network (CNN) with U-Net structure was used for non-linear transformation. The impact of principal component analysis (PCA)-based pre-denoising of patient individual images, as well as the impact of modified net structures with differing complexities on registration results were examined visually and quantitatively, the latter using metrics for deformation and image similarity. Using the PCA-approximated cervical sonograms resulted in decreased mean deformation lengths between 18% and 66% compared to their original image counterparts, depending on net structure. In addition, reducing the number of convolutional layers led to improved image similarity with PCA images, while worsening in original images. Despite a large reduction of network parameters, no overall decrease in registration quality was observed, leading to the conclusion that the original net structure is oversized for the task at hand.