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Characterization of changes in blood vessel width and tortuosity in retinopathy of prematurity using image analysis
Conor Heneghan1, John Flynn, Michael O'Keefe
1Department of Electronic and Electrical Engineering, University College Dublin, Belfield, Dublin 4, Ireland. conor.heneghan@ucd.ie
Insights
This study introduces a novel method for analyzing retinal blood vessels to detect retinopathy of prematurity (ROP). The technique accurately measures vessel width and tortuosity, aiding in early disease identification.
Area of Science:
- Ophthalmology
- Medical Imaging
- Biomedical Engineering
Background:
- Retinal diseases often manifest as changes in retinal vasculature.
- Retinopathy of prematurity (ROP) and its associated "plus disease" involve increased vascular dilation and tortuosity.
Purpose of the Study:
- To present a general technique for segmenting and characterizing vascular structures in retinal images.
- To evaluate the effectiveness of this technique in identifying ROP and its progression.
Main Methods:
- A multi-step image processing pipeline involving morphological preprocessing, second derivative filtering, and thresholding to segment retinal vessels.
- Skeletonization of segmented vessels to identify bifurcations and crossing points.
- Calculation of vessel width and tortuosity from the segmented vascular network.
Main Results:
- The developed technique reliably measures vessel width and tortuosity in test images.
- Statistically significant differences in average vessel width (96.8 µm vs. 86.4 µm) and tortuosity (1.125 vs. 1.097) were observed between treated and non-treated ROP subjects.
- Subjects progressing to threshold ROP showed a significant average increase in vessel width (9.6 µm).
- A retrospective screening paradigm based on width and tortuosity achieved 82% sensitivity and 75% specificity.
Conclusions:
- The presented image analysis technique provides reliable measurements of retinal vessel width and tortuosity.
- These vascular parameters are significant indicators for detecting and monitoring retinopathy of prematurity.
- The method shows promise as a screening tool for ROP, although further refinement is needed to address confounding factors.
Abstract:
Many retinal diseases are characterised by changes to retinal vessels. For example, a common condition associated with retinopathy of prematurity (ROP) is so-called plus disease, characterised by increased vascular dilation and tortuosity. This paper presents a general technique for segmenting out vascular structures in retinal images, and characterising the segmented blood vessels. The segmentation technique consists of several steps. Morphological preprocessing is used to emphasise linear structures such as vessels. A second derivative operator is used to further emphasise thin vascular structures, and is followed by a final morphological filtering stage. Thresholding of this image is used to provide a segmented vascular mask. Skeletonisation of this mask allows identification of points in the image where vessels cross (bifurcations and crossing points) and allows the width and tortuosity of vessel segments to be calculated. The accuracy of the segmentation stage is quite dependent on the parameters used, particularly at the thresholding stage. However, reliable measurements of vessel width and tortuosity were shown using test images. Using these tools, a set of images drawn from 23 subjects being screened for the presence of threshold ROP disease is considered. Of these subjects, 11 subsequently required treatment for ROP, 9 had no evidence of ROP, and 3 had spontaneously regressed ROP. The average vessel width and tortuosity for the treated subjects was 96.8 microm and 1.125. The corresponding figures for the non-treated cohort were 86.4 microm and 1.097. These differences were statistically significant at the 99% and 95% significance level, respectively. Subjects who progressed to threshold disease during the course of screening showed an average increase in vessel width of 9.6 microm and in tortuosity of +0.008. Only the change in width was statistically significant. Applying a simple retrospective screening paradigm based solely on vessel width and tortuosity yields a screening test with a sensitivity and specificity of 82% and 75%. Factors confounding a more accurate test include poor image quality, inaccuracies in vessel segmentation, inaccuracies in measurement of vessel width and tortuosity, and limitations inherent in screening based solely on examination of the posterior pole.