Distal wall delineation using automated Dual Snake paradigm: A multi-center and multi-ethnic carotid ultrasound evaluation

We present here a novel and patented completely automated IMT measurement system that we developed for common carotid arterial ultrasound longitudinal images, called Carotid Measurement Using Dual Snakes (CMUDS) - a class of AtheroEdge™ system. CMUDS is a dual deformable parametric model (snake) system where the dual snakes evolve simultaneously and are forced to maintain a regularized distance to prevent collapsing or diverging. We benchmarked CMUDS against a conventional single snake (CMUSS). CMUDS is totally automatic while CMUSS is semi-automatic. For performance evaluation, two readers manually traced the lumen-intima (LI) and media-adventitia (MA) borders of our multi-institutional, multi-ethnic, and multi-scanner database of 655 longitudinal B-Mode ultrasound images. CMUDS and CMUSS correctly processed all 665 images. The average IMT biases were equal to 0.030±0.284 mm and -0.004±0.273 mm for CMUDS, and -0.011±0.329 mm and -0.045±0.317 mm for CMUSS. The Figure of Merit of the system was 96.0% and 99.6% for CMUDS and 98.5% and 94.4% for CMUSS. CMUDS improved accuracy (Wilcoxon, p<;0.02) and reproducibility (Fisher, p<;3 10^-2), proving that the novel CMUDS system is adaptable to large multi-centric studies, where a standard IMT measurement technique is required.