Cristina Caresio, Massimo Salvi, Filippo Molinari, Kristen M

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Fully Automated Muscle Ultrasound Analysis (MUSA): Robust and Accurate Muscle Thickness Measurement Cristina Caresio, Massimo Salvi, Filippo Molinari, Kristen M. Meiburger, Marco Alessandro Minetto Ultrasound in Medicine and Biology Volume 43, Issue 1, Pages 195-205 (January 2017) DOI: 10.1016/j.ultrasmedbio.2016.08.032 Copyright © 2016 World Federation for Ultrasound in Medicine & Biology Terms and Conditions

Fig. 1 Schematic representation of the MUSA algorithm. Ultrasound in Medicine and Biology 2017 43, 195-205DOI: (10.1016/j.ultrasmedbio.2016.08.032) Copyright © 2016 World Federation for Ultrasound in Medicine & Biology Terms and Conditions

Fig. 2 MUSA algorithm first steps. (a) Original image of a representative medial gastrocnemius muscle; (b) automatically cropped image; (c) vertical Sobel of image; (d) binary mask of the FODG filter; (d) FODG mask with inconsistent aponeurosis structures eliminated; (f) FODG mask with branch removal. In panels (e) and (f), the arrow indicates the effect of the branch removal on the binary FODG mask. APOSUP = superficial aponeurosis; APOINF = deep aponeurosis. Ultrasound in Medicine and Biology 2017 43, 195-205DOI: (10.1016/j.ultrasmedbio.2016.08.032) Copyright © 2016 World Federation for Ultrasound in Medicine & Biology Terms and Conditions

Fig. 3 Fascicle detection and heuristic. (a) Binary mask obtained with image equalization and Otsu thresholding; (b) cleaned fascicle mask; (c) Final fascicles mask overlaid on original image. The fascicles are portrayed in green, whereas the endpoints of the fascicles are in yellow; (d) sketch of the heuristic search. The fascicles are shown in green, the endpoints in yellow and three example ROIs are drawn in dotted rectangles. Ultrasound in Medicine and Biology 2017 43, 195-205DOI: (10.1016/j.ultrasmedbio.2016.08.032) Copyright © 2016 World Federation for Ultrasound in Medicine & Biology Terms and Conditions

Fig. 4 Final profile and correct aponeurosis determination. (a) Profile obtained at the end of the heuristic process. The white arrows indicates the presence of spikes; (b) spikes removal and final trace of profile on the binary mask of the of the FODG filter; (c) application of the DoG filter on the original image; (d) final interpolated profiles of the superficial and deep aponeuroses. APOSUP = superficial aponeurosis; APOINF = deep aponeurosis. Ultrasound in Medicine and Biology 2017 43, 195-205DOI: (10.1016/j.ultrasmedbio.2016.08.032) Copyright © 2016 World Federation for Ultrasound in Medicine & Biology Terms and Conditions

Fig. 5 Processing of tibialis anterior. (a) Example of tibialis anterior image; (b) binary mask of the of FODG filter for the tibialis anterior; (c) profiles of the deep aponeurosis and of the central aponeurosis which define the deep compartment; (d) profiles of superficial aponeurosis and of the central aponeurosis which define the superficial compartment; (e) final interpolated profiles of the superficial and deep aponeuroses for the tibialis anterior. APOSUP = superficial aponeurosis; APOINF = deep aponeurosis. Ultrasound in Medicine and Biology 2017 43, 195-205DOI: (10.1016/j.ultrasmedbio.2016.08.032) Copyright © 2016 World Federation for Ultrasound in Medicine & Biology Terms and Conditions

Fig. 6 Examples of automatic thickness measurement (left panels, a, c, e, g) and manual thickness measurement (performed by one of the three operators - right panels, b, d, f, h) in the four investigated muscles (a and b: rectus femoris, c and d: vastus lateralis, e and f tibialis anterior, g and h medial gastrocnemius). APOSUP = superficial aponeurosis; APOINF = deep aponeurosis. Ultrasound in Medicine and Biology 2017 43, 195-205DOI: (10.1016/j.ultrasmedbio.2016.08.032) Copyright © 2016 World Federation for Ultrasound in Medicine & Biology Terms and Conditions

Fig. 7 Bland-Altman plots showing the comparison between the mean of the three operators and the automatic measurements for all four muscles considered: (a) rectus femoris, (b) vastus lateralis, (c) tibialis anterior, (d) medial gastrocnemius. Ultrasound in Medicine and Biology 2017 43, 195-205DOI: (10.1016/j.ultrasmedbio.2016.08.032) Copyright © 2016 World Federation for Ultrasound in Medicine & Biology Terms and Conditions