Segmentation of the placenta and its vascular tree in Doppler ultrasound for fetal surgery planning
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ORIGINAL ARTICLE
Segmentation of the placenta and its vascular tree in Doppler ultrasound for fetal surgery planning Enric Perera-Bel1 · Mario Ceresa1 · Jordina Torrents-Barrena1 · Narcís Masoller3,4,5 · Brenda Valenzuela-Alcaraz3,4,5 · Eduard Gratacós3,4,5 · Elisenda Eixarch3,4,5 · Miguel A. González Ballester1,2 Received: 20 January 2020 / Accepted: 2 September 2020 © CARS 2020
Abstract Purpose Twin-to-twin transfusion syndrome (TTTS) is a serious condition that occurs in about 10–15% of monochorionic twin pregnancies. In most instances, the blood flow is unevenly distributed throughout the placenta anastomoses leading to the death of both fetuses if no surgical procedure is performed. Fetoscopic laser coagulation is the optimal therapy to considerably improve co-twin prognosis by clogging the abnormal anastomoses. Notwithstanding progress in recent years, TTTS surgery is highly risky. Computer-assisted planning of the intervention can thus improve the outcome. Methods In this work, we implement a GPU-accelerated random walker (RW) algorithm to detect the placenta, both umbilical cord insertions and the placental vasculature from Doppler ultrasound (US). Placenta and background seeds are manually initialized in 10–20 slices (out of 245). Vessels are automatically initialized in the same slices by means of Otsu thresholding. The RW finds the boundaries of the placenta and reconstructs the vasculature. Results We evaluate our semiautomatic method in 5 monochorionic and 24 singleton pregnancies. Although satisfactory performance is achieved on placenta segmentation (Dice ≥ 84.0%), some vascular connections are still neglected due to the presence of US reverberation artifacts (Dice ≥ 56.9%). We also compared inter-user variability and obtained Dice coefficients of ≥ 76.8% and ≥ 97.42% for placenta and vasculature, respectively. After a 3-min manual initialization, our GPU approach speeds the computation 10.6 times compared to the CPU. Conclusions Our semiautomatic method provides a near real-time user experience and requires short training without compromising the segmentation accuracy. A powerful approach is thus presented to rapidly plan the fetoscope insertion point ahead of TTTS surgery. Keywords Fetal surgery · Doppler US · TTTS · Placenta and vessel detection · Random walker · GPU optimization
Introduction
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Enric Perera-Bel [email protected]
1
Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
2
ICREA, Barcelona, Spain
3
BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
4
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
5
Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
Fetal surgery has improved the prognosis of pregnancies with complications, and considerable progress has been evidenced in recent years. Approximately 70% of all twin pregnancies are monochorionic, i.e. the twins share the same placenta
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