title: Reliability of Using Retinal Vascular Fractal Dimension as a Biomarker in the Diabetic Retinopathy Detection.
abstract: The retinal fractal dimension (FD) is a measure of vasculature branching pattern complexity. FD has been considered as a potential biomarker for the detection of several diseases like diabetes and hypertension. However, conflicting findings were found in the reported literature regarding the association between this biomarker and diseases. In this paper, we examine the stability of the FD measurement with respect to (1) different vessel annotations obtained from human observers, (2) automatic segmentation methods, (3) various regions of interest, (4) accuracy of vessel segmentation methods, and (5) different imaging modalities. Our results demonstrate that the relative errors for the measurement of FD are significant and FD varies considerably according to the image quality, modality, and the technique used for measuring it. Automated and semiautomated methods for the measurement of FD are not stable enough, which makes FD a deceptive biomarker in quantitative clinical applications.
authors.affiliation: Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.
authors.forename: Fan
authors.identifier: 0000-0002-2382-1341
authors.initials: F
authors.lastname: Huang
authors.affiliation: Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.
authors.forename: Behdad
authors.identifier: 0000-0003-4443-1614
authors.initials: B
authors.lastname: Dashtbozorg
authors.affiliation: Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.
authors.forename: Jiong
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Bekkers
authors.affiliation: Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.
authors.forename: Samaneh
authors.initials: S
authors.lastname: Abbasi-Sureshjani
authors.affiliation: University Eye Clinic Maastricht, Maastricht, Netherlands.
authors.forename: Tos T J M
authors.identifier: 0000-0002-8101-939X
authors.initials: TT
authors.lastname: Berendschot
authors.affiliation: Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands; Department of Biomedical and Information Engineering, Northeastern University, Shenyang, China.
authors.forename: Bart M
authors.identifier: 0000-0003-3442-3207
authors.initials: BM
authors.lastname: Ter Haar Romeny