title: Automated Detection of Malarial Retinopathy in Digital Fundus Images for Improved Diagnosis in Malawian Children with Clinically Defined Cerebral Malaria.
abstract: Cerebral malaria (CM), a complication of malaria infection, is the cause of the majority of malaria-associated deaths in African children. The standard clinical case definition for CM misclassifies ~25% of patients, but when malarial retinopathy (MR) is added to the clinical case definition, the specificity improves from 61% to 95%. Ocular fundoscopy requires expensive equipment and technical expertise not often available in malaria endemic settings, so we developed an automated software system to analyze retinal color images for MR lesions: retinal whitening, vessel discoloration, and white-centered hemorrhages. The individual lesion detection algorithms were combined using a partial least square classifier to determine the presence or absence of MR. We used a retrospective retinal image dataset of 86 pediatric patients with clinically defined CM (70 with MR and 16 without) to evaluate the algorithm performance. Our goal was to reduce the false positive rate of CM diagnosis, and so the algorithms were tuned at high specificity. This yielded sensitivity/specificity of 95%/100% for the detection of MR overall, and 65%/94% for retinal whitening, 62%/100% for vessel discoloration, and 73%/96% for hemorrhages. This automated system for detecting MR using retinal color images has the potential to improve the accuracy of CM diagnosis.
authors.affiliation: VisionQuest Biomedical LLC, Albuquerque, NM, United States.
authors.forename: Vinayak
authors.initials: V
authors.lastname: Joshi
authors.affiliation: VisionQuest Biomedical LLC, Albuquerque, NM, United States.
authors.forename: Carla
authors.initials: C
authors.lastname: Agurto
authors.affiliation: VisionQuest Biomedical LLC, Albuquerque, NM, United States.
authors.forename: Simon
authors.initials: S
authors.lastname: Barriga
authors.affiliation: VisionQuest Biomedical LLC, Albuquerque, NM, United States.
authors.forename: Sheila
authors.initials: S
authors.lastname: Nemeth
authors.affiliation: VisionQuest Biomedical LLC, Albuquerque, NM, United States.
authors.forename: Peter
authors.initials: P
authors.lastname: Soliz
authors.affiliation: Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom.|Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.|Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: MacCormick
authors.affiliation: Kilimanjaro Centre for Community Ophthalmology, University Cape Town Groot Schuur Hospital, Cape Town, South Africa.
authors.forename: Susan
authors.initials: S
authors.lastname: Lewallen
authors.affiliation: Department of Osteopathic Medical Specialties, College of Osteopathic Medical Specialties, Michigan State University, East Lansing, MI, United States.|Blantyre Malaria Project, Blantyre, Malawi.
authors.forename: Terrie E
authors.initials: TE
authors.lastname: Taylor
authors.affiliation: Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Harding
mesh_terms: D000465:Algorithms; D002648:Child; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016779:Malaria, Cerebral / Q000150:complications* / Q000469:parasitology; D008297:Male; D009887:Ophthalmoscopy; D012372:ROC Curve; D012160:Retina / Q000000981:diagnostic imaging / Q000469:parasitology / Q000502:physiology; D012164:Retinal Diseases / Q000150:complications* / Q000175:diagnosis* / Q000469:parasitology; D012166:Retinal Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology; D012171:Retinal Vessels / Q000000981:diagnostic imaging / Q000473:pathology