Automated measurement of fetal myocardial performance index in ultrasound Doppler waveforms

Abstract

We introduce an automated method for myocardial performance index (MPI), also known as Tei index, which is one of the most substantial indicators in the early screening of heart defects. Since assessing fetal cardiac functions using MPI has become a routine and significant process, there have been explicit requirements to automate MPI measurements. Due to small heart sizes of fetuses, we focus on the automation of modified MPI (Mod-MPI) which uses a single Doppler gate. The proposed method detects four valve click signals in Doppler waveforms using four image features which are extracted by vertical projection of Doppler waveforms after several transformations. To evaluate performance, 88 of fetal examinations were collected from a commercial ultrasound machine, and two clinical experts measured the Mod-MPI both manually and automatically. Quantitative comparisons based on intra-class correlation coefficients (ICC) yield that intra-observer reproducibility is higher when performing the proposed method (ICC=0.951 and 0.932 for observer 1 and 2) comparing to those of manual measurements (ICC=0.868 and 0.857 for observer 1 and observer 2). Thus, our method (ICC=0.962) reveals superior inter-observer reproducibility than that of manual method (ICC=0.597). Although mean difference from observer 2 (−0.062) is over three times larger than that of observer 1 (−0.018) due to different experiences, both of mean differences are acceptable. In conclusion, the proposed MPI measurement method can improve intra- and inter-reproducibility while providing reliable results.