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VASIM: an automated tool for the quantification of carotid atherosclerosis by computed tomography angiography

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Abstract

The diagnostic imaging techniques currently used to evaluate the arterial atherosclerosis hinge on the manual marking and calculation of the stenosis degree. However, the manual assessment is highly dependent on the operator and characterized by low replicability. The study aimed to develop a fully-automated tool for the segmentation and analysis of atherosclerosis in the extracranial carotid arteries. The dataset consisted of 59 randomly-chosen individuals who had undergone head-and-neck computed tomography angiography (CTA), at the Tampere University Hospital, Tampere, Finland. The analysis algorithm was mainly based on the detection of carotid arteries, delineation of the vascular wall, and extraction of the atherosclerotic plaque. To improve the vascular detection rate, the model-based and volume-wide analytical approaches were deployed. A new fully-automated vascular imaging (VASIM) software tool was developed. For stenosis over 50%, the success rate was 83% for the detection and segmentation. Specificity and sensitivity of the algorithm were 25% and 83%, respectively. The overall accuracy was 71%. The VASIM tool is the first published approach for the fully-automated analysis of atherosclerosis in extracranial carotid arteries. The tool provides new outputs, which may help with the quantitative and qualitative, clinical evaluation of the atherosclerosis burden and evolution. The findings from this study provide a basis for the further development of automated atherosclerosis diagnosis and plaque analysis with CTA.

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Abbreviations

CCA:

Common carotid artery

CT:

Computed tomography

CTA:

Computed tomography angiography

CVAs:

Cerebrovascular accidents

CVDs:

Cardiovascular diseases

ECA:

External carotid artery

HU:

Hounsfield unit

ICA:

Internal carotid artery

MRI:

Magnetic resonance imaging

NASCET:

North American Symptomatic Carotid Endarterectomy Trial

SD:

Standard deviation

TAYS:

Tampere University Hospital

VASIM:

Vascular imaging

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Acknowledgements

The authors would like to thank Raija Paalavuo RN, Anna-Kaisa Parkkila MD, and Ullamari Hakulinen Lic.Sc., Med. Phys. for their help with patient recruitment and management.

Funding

FLCS was supported by the CIMO Foundation (Centre for International Mobility; KM-12-8107), Tampere University Hospital, and an iBioMEP doctoral scholarship. MP was supported by the Finnish Cultural Foundation (Central Fund, Grant No. 160735) and by the Academy of Finland (decision number 307967). The project was also partly supported by the Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital (Grant No. R07210/ 9K115).

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Authors and Affiliations

  1. BioMediTech, Faculty of Medicine and Health Technology, Tampere University, SM312, Korkeakoulunkatu 3, 33720, Tampere, Finland

    Florentino Luciano Caetano dos Santos, Hannu Eskola & Michelangelo Paci

  2. Department of Applied Physics, Faculty of Science, Fukuoka University, Fukuoka, Japan

    Mitsugu Terada

  3. Division of Vascular Surgery, Department of Surgery, Tampere University Hospital and Medical School, Tampere, Finland

    Juha Salenius

  4. Department of Radiology, Medical Imaging Center, Tampere University Hospital, Tampere, Finland

    Florentino Luciano Caetano dos Santos, Marcin Kolasa & Hannu Eskola

  5. BioMediTech, Faculty of Medicine and Health Technology, Tampere University, P.O. Box 692, Tampere, 33014, Finland

    Florentino Luciano Caetano dos Santos

Authors
  1. Florentino Luciano Caetano dos Santos
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  2. Marcin Kolasa
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  3. Mitsugu Terada
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  4. Juha Salenius
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  5. Hannu Eskola
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  6. Michelangelo Paci
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Contributions

All authors declare they have contributed to this article. FLCS was responsible for defining the study objectives and design, data collection, development of the image processing and segmentation algorithms, analysis of the data, and statistical analysis. MK was responsible for data collection from the patients files information and stenosis manual calculation. FLCS wrote the manuscript and the co-authors MK, MT, JS, HE, and MP reviewed, commented, and improved the text.

Corresponding author

Correspondence to Florentino Luciano Caetano dos Santos.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This research was approved by the Ethics Committee of the Pirkanmaa Hospital District (decision number R07210).

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Informed consent was obtained from all individual participants included in the study.

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Caetano dos Santos, F., Kolasa, M., Terada, M. et al. VASIM: an automated tool for the quantification of carotid atherosclerosis by computed tomography angiography. Int J Cardiovasc Imaging 35, 1149–1159 (2019). https://doi.org/10.1007/s10554-019-01549-1

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  • DOI: https://doi.org/10.1007/s10554-019-01549-1

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