Deep learning strategy for accurate carotid intima-media thickness measurement: An ultrasound study on Japanese diabetic cohort

Motivation: The carotid intima-media thickness (cIMT) is an important biomarker for cardiovascular diseases and stroke monitoring. This study presents an intelligence-based, novel, robust, and clinically-strong strategy that uses a combination of deep-learning (DL) and machine-learning (ML) paradigms. Methodology: A two-stage DL-based system (a class of AtheroEdge (TM) systems) was proposed for cIMT measurements. Stage I consisted of a convolution layer-based encoder for feature extraction and a fully convolutional network-based decoder for image segmentation. This stage generated the raw inner lumen borders and raw outer interadventitial borders. To smooth these borders, the DL system used a cascaded stage II that consisted of ML-based regression. The final outputs were the far wall lumen-intima (LI) and media-adventitia (MA) borders which were used for cIMT measurements. There were two sets of gold standards during the DL design, therefore two sets of DL systems (DL1 and DL2) were derived. Results: A total of 396 B-mode ultrasound images of the right and left common carotid artery were used from 203 patients (Institutional Review Board approved, Toho University, Japan). For the test set, the cIMT error for the DL1 and DL2 systems with respect to the gold standard was 0.126 +/- 0.134 and 0.124 +/- 0.100 mm, respectively. The corresponding LI error for the DL1 and DL2 systems was 0.077 +/- 0.057 and 0.077 +/- 0.049 mm, respectively, while the corresponding MA error for DL1 and DL2 was 0.113 +/- 0.105 and 0.109 +/- 0.088 mm, respectively. The results showed up to 20% improvement in cIMT readings for the DL system compared to the sonographer's readings. Four statistical tests were conducted to evaluate reliability, stability, and statistical significance. Conclusion: The results showed that the performance of the DL-based approach was superior to the nonintelligence-based conventional methods that use spatial intensities alone. The DL system can be used for stroke risk assessment during routine or clinical trial modes.