Introduction:
Major calcifications are of great concern when performing percutaneous coronary intervention as they hinder stent deployment. Calcifications can lead to under-expansion and strut malapposition, with increased risk of thrombosis and in-stent restenosis. Therefore, accurate identification, visualization, and quantification of calcifications are important.
Objective:
In this study, we developed a 2-step deep learning approach to enable segmentation of major calcifications in a typical 500+ frame intravascular optical coherence tomography (IVOCT) images.
Methods:
The dataset consisted of a total of 12,551 IVOCT frames across 68 patients with 68 pullbacks. We applied a series of pre-processing steps including guidewire/shadow removal, lumen detection, pixel shifting, and Gaussian filtering. To detect the major calcifications in step 1, we implemented the 3D convolutional neural network consisting of 5 convolutional, 5 max-pooling, and 2 fully-connected layers. In step-2, SegNet deep learning model was used to segment calcified plaques. In both steps, classification errors were reduced using conditional random field.
Results:
Step-1 reliably identified major calcifications (sensitivity/specificity: 97.7%/87.7%). Semantic segmentation of calcifications following step-2 was typically visually quite good (Fig. 1) with (sensitivity/specificity: 86.2%/96.7%). Our method was superior to a single step approach and showed excellent reproducibility on repetitive IVOCT pullbacks, with very small differences of clinically relevant attributes (maximum angle, maximum thickness, and length) and the exact same IVOCT calcium scores for assessment of stent deployment.
Conclusions:
We developed the fully-automated method for identifying calcifications in IVOCT images based on a 2-step deep learning approach. Extensive analyses indicate that our method is very informative for both live-time treatment planning and research purposes.
Coronary Artery Segmentation from Intravascular Optical Coherence Tomography Using Deep Capsules