title: Lumen segmentation and stenosis quantification of atherosclerotic carotid arteries in CTA utilizing a centerline intensity prior.
abstract: OBJECTIVE
  The degree of stenosis is an important biomarker in assessing the severity of cardiovascular disease. The purpose of our work is to develop and evaluate a semiautomatic method for carotid lumen segmentation and subsequent carotid artery stenosis quantification in CTA images.
  
  
  METHODS
  The authors present a semiautomatic stenosis detection and quantification method following lumen segmentation. The lumen of the carotid arteries is segmented in three steps. First, centerlines of the internal and external carotid arteries are extracted with an iterative minimum cost path approach in which the costs are based on a measure of medialness and intensity similarity to lumen. Second, the lumen boundary is delineated using a level set procedure which is steered by gradient information, regional intensity information, and spatial information. Special effort is made in adding terms based on local centerline intensity prior so as to exclude all possible plaque tissues from the segmentation. Third, side branches in the segmented lumen are removed by applying a shape constraint to the envelope of the maximum inscribed spheres of the segmentation. From the segmented lumen, the authors detect and quantify the cross-sectional area-based and cross-sectional diameter-based stenosis degrees according to the North American Symptomatic Carotid En-darterectomy Trial criterion.
  
  
  RESULTS
  The method is trained and tested on a publicly available database from the cls2009 challenge. For the segmentation, the authors obtain a Dice similarity coefficient of 90.2% and a mean absolute surface distance of 0.34 mm. For the stenosis quantification, the authors obtain an average error of 15.7% for cross-sectional diameter-based stenosis and 19.2% for cross-sectional area-based stenosis quantification.
  
  
  CONCLUSIONS
  With these results, the method ranks second in terms of carotid lumen segmentation accuracy, and first in terms of carotid artery stenosis quantification.
authors: Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. tanghui.seu@gmail.com
authors: Hui
authors: H
authors: Tang
authors: Theo
authors: T
authors: van Walsum
authors: Reinhard
authors: R
authors: Hameeteman
authors: Rahil
authors: R
authors: Shahzad
authors: Lucas J
authors: LJ
authors: van Vliet
authors: Wiro J
authors: WJ
authors: Niessen
mesh_terms: D000792:Angiography / Q000379:methods*; D050197:Atherosclerosis / Q000000981:diagnostic imaging*; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D007091:Image Processing, Computer-Assisted / Q000379:methods*