Automatic Detection of Mitral Regurgitant

Jet by k-means clustering

G.N.Balaji

T.S.Subashini

N.Chidambaram

Research Scholar,
Associate Professor,
Professor and Head,
Department of Computer Science,
Department of Computer Science,
Department of Cardiology,
Annamalai University,
Annamalai University,
Annamalai University
Email: balaji.gnb@gmail.com
Email: rtramsuba@gmail.com Email: drncm57@gmail.com

Abstract In this paper automatic segmentation and

tracking of mitral regurgitation jet in color Doppler
echocardiogram videos is proposed. Here the main
objective is to segment the jet area during Mitral
Regurgitation and track it for the convenience of
cardiologist. The severity of Mitral Regurgitation (MR)
is directly related to the jet area. The frames are
extracted from the echocardiogram video, which are
coarsely represented using 25 bins, and then coarse
representation uses the spatial information from a
Histogram based windowing process. The K-Means
clustering is used to segment the jet area.
Keywords: Mitral Regurgitation, pixel classification,
segmentation, Histogram, k-means.

I.

by using them with ultrasound Doppler [2].

Abnormalities in heart wall motion can be detected
and the volume of blood being pumped from the
heart with each beat can be measured using
Echocardiography. If the mitral valve does not close
properly when the heart pumps out the blood which
leads in regurgitation of blood back into the left
atrium in [3]. The color Doppler echocardiography
helps the cardiologist in finding out the accurate
severity of Mitral Regurgitation (MR) [4]. The Color
Doppler echocardiography plays an important role in
diagnosis of MR, surgery and replacement process
[5] [7]. The schematic diagram of Mitral
regurgitation is shown in Fig.1.

Introduction

Ultrasound based diagnostic imaging

technique called Echocardiogram identifies several
aspects of the heart leading to different cardiac
problems. Echocardiogram plays an important role in
cardiac disease diagnosis. Echocardiography used to
diagnose cardiovascular system using pulsed or
continuous wave Doppler ultrasound estimates the
blood velocity and cardiac tissue at any given peak
[1]. The size, shape, and movement of the heart's
valves and chambers and also the flow of blood
through the heart can be shown by the ultrasound
waves which bounce back or echo off the heart. This
allows the estimation of cardiac valve areas and
function, any abnormal communications between the
left and right side of the heart, any leaking of blood
through the valves (Valvular Regurgitation), and
calculation of the cardiac yield as well as the Ejection
fraction. Flow-related measurements can be enhanced

Fig.1 Schematic View of Mitral Regurgitation

Valvular Regurgitation (VR) can be estimated semi
quantitatively by jet area ratios. Quantitative
measurements of Valvular Regurgitation include the
computation of Regurgitant Volume (RV),
Regurgitant Fraction (RF), and the Effective

Regurgitant Orifice Area (EROA) [8]. The existing

techniques discover the severity and quantify the
regurgitation by means of PISA (Proximal Isovelocity
Surface Area) method. PISA measurement, also
called as flow convergence method which can be
used in Echocardiography to estimate the area of an
Input:
orifice through which the blood flows.

the frames is converted to video for the convenience

of cardiologist. The extracted mosaic pattern helps
the cardiologist to classify the severity of Mitral
Regurgitation (MR).
Echocardiogram Video
Convert video to frames

II.

Prior Work

The medical community can be enabled with

more accurate prediction of disease progression and
timelier planning of surgical interventions by a more
accurate classification of disease severity [9]. In
estimating valvular regurgitation the PISA of a
regurgitant color flow jet may be used. The
hemodynamic principle of flow through a small
circular orifice in a flat plate is the basis of PISA.
Just proximal to the orifice, there is flow
acceleration. On the orifice, the flow converges in
hemispherical equal velocity layers [10, 11]. Color
segmentation using K-means clustering with
histograms in HSV color space is proposed in [12].
To acquire better color representation the color
histogram bins and gray histogram bins should be
separated in [13, 14].
III.

ROI Selection

Color Based Segmentation Using K-means cluster

Extracting Mosaic Pattern by thresholding

Methodology

The Block diagram of the proposed system

is shown in Fig.1. The color doppler echocardiogram
image with Mitral Regurgitation is given as an input.
The input echocardiogram video is converted into
frames. The artifacts are labels and wedges present in
the boundaries of Echocardiogram image. Since the
artifact present in the images affects the feature
extraction the region of interest ie., the triangular
region containing the heart alone is selected and
cropped before extracting the features. Empirically
after analyzing a number of Echo images the
rectangular ROI is selected by cropping the image
using the [135 105 775 575] where (135,105)
represent the top left (x, y) coordinates of the ROI
triangle and 775 is the height and 575 is the width of
the rectangle. The image outside the region contains
artifacts which are not subjected to further
processing. Each frame is segmented using k-means
clustering and the mosaic pattern is extracted using
thresholding. The extracted mosaic pattern from all

Converting frames to Video

Fig. 1 Block diagram of proposed system

Fig.2 shows the region of interest to be removed ie.,
artifact removal and the jet area to be segmented.

ROI to remove artifact

Jet area to be segmented

Fig. 3 Sample Segmented Jet Areas

Fig. 2 ROI to be removed and Mosaic Pattern be

segmented
Color based Segmentation:
The red color in the color Doppler
echocardiogram denotes the blood flow towards the
transducer while the blue color denotes the blood
flow away from the transducer. In the case of color
doppler with mitral regurgitation disease a mosaic
pattern represents the regurgitated blood which is the
mitral regurgitant jet area to be segmented. K-means
clustering is used to segment jet area. K-means
clustering is an unsupervised classifier, which
classifies the features into K number of clusters,
where K is a positive integer. Clustering is done by
minimizing Euclidean distance between data and
corresponding cluster centroids.

Fig.4 segmented jet area superimposed on their

corresponding original frame

Table 1 Comparison of Jet area calculated by

cardiologist and automatically detected

Jet area
segmented
Manually by
K-means clustering algorithm
Cardiologist
1. Initialise K centroids.
JC
2. Compute the distance between each feature vector to the centroids.
(pixels)
3. Assign the feature vector to the centroid whose distance is minimum.
1
4670
5144
2
1302
1270
4. Re-estimate the centroids.
3
1271
5. Repeat the steps 2-4 until there is no change in centroids or for a fixed number of iterations. 1178
4
2324
2456
5
1302
1289
In order to remove the over segmentation a threshold
is applied. Since the pixel value of the jet area to be
segmented lies between 240 and 250 the threshold is
applied and the particular jet area is extracted.

Sample
Frame
No

Jet area
segmented
Automatically
JA
pixels
(
)

Differ
ence
|JA-Jc|
(pixels)

474
32
93
132
13

Table 1 shows the comparison of jet area calculated

by cardiologist and automatically segmented jet area
by proposed method. The proposed method almost
satisfies the clinical results since the difference
between the manually segmented and automatically
segmented area is low and acceptable.

IV.

Conclusion

The proposed method performs well in

detecting mitral regurgitation jet area. The color
based segmentation using K-means clustering is
evaluated with manually segmented area and the
result satisfies the clinical results. Further calculation
of regurgitant volume, effective orifice area etc.,
which determines the severity of mitral regurgitation
can be automated.
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