Biomedical image segmentation (BIS) task is challenging due to the variations in organ types, position, shape, size, scale, orientation, and image contrast. Conventional methods lack accurate and automated designs. Artificial intelligence (AI)-based UNet has recently dominated BIS. This is the first review of its kind that microscopically addressed UNet types by complexity, stratification of UNet by its components, addressing UNet in vascular vs. non-vascular framework, the key to segmentation challenge vs. UNet-based architecture, and finally interfacing the three facets of AI, the pruning, the explainable AI (XAI), and the AI-bias. PRISMA was used to select 267 UNet-based studies. Five classes were identified and labeled as conventional UNet, superior UNet, attention-channel UNet, hybrid UNet, and ensemble UNet. We discovered 81 variations of UNet by considering six kinds of components, namely encoder, decoder, skip connection, bridge network, loss function, and their combination. Vascular vs. non-vascular UNet architecture was compared. AP(ai)Bias 2.0-UNet was identified in these UNet classes based on (i) attributes of UNet architecture and its performance, (ii) explainable AI (XAI), and, (iii) pruning (compression). Five bias methods such as (i) ranking, (ii) radial, (iii) regional area, (iv) PROBAST, and (v) ROBINS-I were applied and compared using a Venn diagram. Vascular and non-vascular UNet systems dominated with sUNet classes with attention. Most of the studies suffered from a low interest in XAI and pruning strategies. None of the UNet models qualified to be bias-free. There is a need to move from paper-to-practice paradigms for clinical evaluation and settings. 

UNet Deep Learning Architecture for Segmentation of Vascular and Non-Vascular Images: A Microscopic Look at UNet Components Buffered With Pruning, Explainable Artificial Intelligence, and Bias

Acute aortic syndrome (AAS) is a term used to describe a constellation of life-threatening aortic diseases that have similar presentation, but appear to have distinct demographic, clinical, pathological and survival characteristics Many believe that the three major entities that comprise AAS: aortic dissection (AD), intramural hematoma (IMH) and penetrating aortic ulcer (PAU), make up a spectrum of aortic disease in which one entity may evolve into or coexist with another Much of the confusion in accurately classifying an AAS is that they present with similar symptoms: typically acute onset of severe chest or back pain, and may have similar radiographic features, since the disease entities all involve injury or disruption of the medial layer of the aortic wall The accurate diagnosis of an AAS is often made at operation This manuscript will attempt to clarify the similarities and differences between AD, IMH and PAU of the ascending aorta and describe the challenges in distinguishing them from one another

Acute aortic syndrome

Abstract Aims Aortopathies are a series of disorders requiring multiple indicators to assess risk. Time-averaged wall shear stress (TAWSS) is currently considered as the primary indicator of aortopathies progression, which can only be calculated by Computational Fluid Dynamics (CFD). However, CFD's complexity and high computational cost, greatly limit its application. The study aimed to construct a deep learning platform which could accurately estimate TAWSS in ascending aorta. Methods and results A total of 154 patients who had thoracic computed tomography angiography were included and randomly divided into two parts: training set (90%, n = 139) and testing set (10%, n = 15). TAWSS were calculated via CFD. The artificial intelligence (AI)-based model was trained and assessed using the dice coefficient (DC), normalized mean absolute error (NMAE), and root mean square error (RMSE). Our AI platform brought into correspondence with the manual segmentation (DC = 0.86) and the CFD findings (NMAE, 7.8773% ± 4.7144%; RMSE, 0.0098 ± 0.0097), while saving 12000-fold computational cost. Conclusion The high-efficiency and robust AI platform can automatically estimate value and distribution of TAWSS in ascending aorta, which may be suitable for clinical applications and provide potential ideas for CFD-based problem solving.

/pdf/an-artificial-intelligence-based-platform-for-automatically-22k4p0wo.pdf

An artificial intelligence-based platform for automatically estimating time-averaged wall shear stress in the ascending aorta

Abstract Background Guidelines recommend that aortic dimension measurements in aortic dissection should include the aortic wall. This study aimed to evaluate two-dimensional (2D)- and three-dimensional (3D)-based deep learning approaches for extraction of outer aortic surface in computed tomography angiography (CTA) scans of Stanford type B aortic dissection (TBAD) patients and assess the speed of different whole aorta (WA) segmentation approaches. Methods A total of 240 patients diagnosed with TBAD between January 2007 and December 2019 were retrospectively reviewed for this study; 206 CTA scans from 206 patients with acute, subacute, or chronic TBAD acquired with various scanners in multiple different hospital units were included. Ground truth (GT) WAs for 80 scans were segmented by a radiologist using an open-source software. The remaining 126 GT WAs were generated via semi-automatic segmentation process in which an ensemble of 3D convolutional neural networks (CNNs) aided the radiologist. Using 136 scans for training, 30 for validation, and 40 for testing, 2D and 3D CNNs were trained to automatically segment WA. Main evaluation metrics for outer surface extraction and segmentation accuracy were normalized surface Dice (NSD) and Dice coefficient score (DCS), respectively. Results 2D CNN outperformed 3D CNN in NSD score (0.92 versus 0.90, p = 0.009), and both CNNs had equal DCS (0.96 versus 0.96, p = 0.110). Manual and semi-automatic segmentation times of one CTA scan were approximately 1 and 0.5 h, respectively. Conclusions Both CNNs segmented WA with high DCS, but based on NSD, better accuracy may be required before clinical application. CNN-based semi-automatic segmentation methods can expedite the generation of GTs. Relevance statement Deep learning can speeds up the creation of ground truth segmentations. CNNs can extract the outer aortic surface in patients with type B aortic dissection. Key points • 2D and 3D convolutional neural networks (CNNs) can extract the outer aortic surface accurately. • Equal Dice coefficient score (0.96) was reached with 2D and 3D CNNs. • Deep learning can expedite the creation of ground truth segmentations. Graphical Abstract 

/pdf/deep-learning-aided-extraction-of-outer-aortic-surface-from-2x7bmul1.pdf

Deep learning-aided extraction of outer aortic surface from CT angiography scans of patients with Stanford type B aortic dissection

Recent clinical studies have suggested that introducing 3D patient-specific aortic root models into the pre-operative assessment procedure of transcatheter aortic valve replacement (TAVR) would reduce the incident rate of peri-operative complications. Tradition manual segmentation is labor-intensive and low-efficient, which cannot meet the clinical demands of processing large data volumes. Recent developments in machine learning provided a viable way for accurate and efficient medical image segmentation for 3D patient-specific models automatically. This study quantitively evaluated the auto segmentation quality and efficiency of the four popular segmentation-dedicated three-dimensional (3D) convolutional neural network (CNN) architectures, including 3D UNet, VNet, 3D Res-UNet and SegResNet. All the CNNs were implemented in PyTorch platform, and low-dose CTA image sets of 98 anonymized patients were retrospectively selected from the database for training and testing of the CNNs. The results showed that despite all four 3D CNNs having similar recall, Dice similarity coefficient (DSC), and Jaccard index on the segmentation of the aortic root, the Hausdorff distance (HD) of the segmentation results from 3D Res-UNet is 8.56 ± 2.28, which is only 9.8% higher than that of VNet, but 25.5% and 86.4% lower than that of 3D UNet and SegResNet, respectively. In addition, 3D Res-UNet and VNet also performed better in the 3D deviation location of interest analysis focusing on the aortic valve and the bottom of the aortic root. Although 3D Res-UNet and VNet are evenly matched in the aspect of classical segmentation quality evaluation metrics and 3D deviation location of interest analysis, 3D Res-UNet is the most efficient CNN architecture with an average segmentation time of 0.10 ± 0.04 s, which is 91.2%, 95.3% and 64.3% faster than 3D UNet, VNet and SegResNet, respectively. The results from this study suggested that 3D Res-UNet is a suitable candidate for accurate and fast automatic aortic root segmentation for pre-operative assessment of TAVR.

/pdf/a-benchmark-study-of-convolutional-neural-networks-in-fully-35pggtyh.pdf

A benchmark study of convolutional neural networks in fully automatic segmentation of aortic root

To develop and validate a deep learning–based algorithm for segmenting and quantifying the physiological and diseased aorta in computed tomography angiographies. CTA exams of the aorta of 191 patients (68.1 ± 14 years, 128 male), performed between 2015 and 2018, were retrospectively identified from our imaging archive and manually segmented by two investigators. A 3D U-Net model was trained on the data, which was divided into a training, a validation, and a test group at a ratio of 7:1:2. Cases in the test group (n = 41) were evaluated to compare manual and automatic segmentations. Dice similarity coefficient (DSC), mean surface distance (MSD), and Hausdorff surface distance (HSD) were extracted. Maximum diameter, effective diameter, and area were quantified and compared between both segmentations at eight anatomical landmarks, and at the maximum area of an aneurysms if present (n = 14). Statistics included error calculation, intraclass correlation coefficient, and Bland-Altman analysis. A DSC of 0.95 [0.94; 0.95] and an MSD of 0.76 [0.06; 0.99] indicated close agreement between segmentations. HSD was 8.00 [4.47; 10.00]. The largest absolute errors were found in the ascending aorta with 0.8 ± 1.5 mm for maximum diameter and at the coeliac trunk with − 30.0 ± 81.6 mm2 for area. Results for absolute errors in aneurysms were − 0.5 ± 2.3 mm for maximum diameter, 0.3 ± 1.6 mm for effective diameter, and 64.9 ± 114.9 mm2 for area. ICC showed excellent agreement (> 0.9; p < 0.05) between quantitative measurements. Automated segmentation of the aorta on CTA data using a deep learning algorithm is feasible and allows for accurate quantification of the aortic lumen even if the vascular architecture is altered by disease. • A deep learning–based algorithm can automatically segment the aorta, mostly within acceptable margins of error, even if the vascular architecture is altered by disease. • Quantifications performed in the segmentations were mostly within clinically acceptable limits, even in pathologically altered segments of the aorta.

Automated segmentation and quantification of the healthy and diseased aorta in CT angiographies using a dedicated deep learning approach

Das Bauchaortenaneurysma (BAA) als eine fokale Erweiterung aller Wandschichten der Aorta abdominalis ist ein komplexes und lebensbedrohliches Krankheitsbild – Albert Einstein und Charles de Gaulle sind an einer Ruptur verblutet. Eine endovaskulare Aortenreparatur (EVAR) oder offen-chirurgische Therapie haben das Ziel, das Rupturrisiko niedrig zu halten bzw. zu eliminieren und die Lebenserwartung des Patienten zu verbessern. The abdominal aortic aneurysm is a complex, potentially life-threatening disease with high mortality rates up to 50%. Prominent examples of tragic courses include the death of Albert Einstein and Charles de Gaulle who died from rupture. Recently, several trials have been conducted in order to compare the relative benefits and disadvantages of modern diagnostic methods and endovascular aneurysm repair to those of traditional open surgery. This review attempts to deal with the puzzle of modern radiological imaging and treatment strategies of abdominal aortic aneurysms.

Bauchaortenaneurysma – Diagnostik und interventionell-radiologische Therapie

Das Bauchaortenaneurysma (BAA) als eine fokale Erweiterung aller Wandschichten der Aorta abdominalis ist ein komplexes und lebensbedrohliches Krankheitsbild – Albert Einstein und Charles de Gaulle sind an einer Ruptur verblutet. Eine endovaskulare Aortenreparatur (EVAR) oder offen-chirurgische Therapie haben das Ziel, das Rupturrisiko niedrig zu halten bzw. zu eliminieren und die Lebenserwartung des Patienten zu verbessern.

The “buddy balloon technique” facilitates retrograde ipsilateral access to postdilate an iliac side branch after endovascular aneurysm repair

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Automated segmentation and quantification of the healthy and diseased aorta in CT angiographies using a dedicated deep learning approach

Bauchaortenaneurysma – Diagnostik und interventionell-radiologische Therapie

Bauchaortenaneurysma – Diagnostik und interventionell-radiologische Therapie

The “buddy balloon technique” facilitates retrograde ipsilateral access to postdilate an iliac side branch after endovascular aneurysm repair