Segmentation and boundary detection of fetal kidney images in second and

third trimesters using Kernel-Based Fuzzy Clustering

S.Meenakshi 1, Dr.M.Suganthi2
Assistant Professor/ECE, Mahendra College of Engineering, Salem-636106

meenakshisece@gmail.com

Professor/ECE, Mahendra College of Engineering, Salem-636106

Abstract: Organ segmentation is an important step in fetal images for early prediction of
congenital abnormalities and to estimate delivery date. Many applications of 2D medical
imaging mainly face problems with speckle noise and object contours. Frequent scanning of fetal
leads to clinical disturbances to the fetal growth and the quantitative interpretation of ultrasonic
images also a difficult task compared to other image modalities. To determine renal diseases and
to estimate delivery date accurate kidney segmentation is required. Segmentation of Kidney
images has been done by several imaging modalities such as CT, MRI, and US. Modalities using
CT and MR are however challenging and tend to increase computational complexity. Apart from
imaging modalities, several morphological operators are also available for segmentation of
images from their background which includes edge detection, seed growing and region growing,
watershed segmentation etc. The conventional morphological methods supervised and
unsupervised methods are also available for segmentation. One such unsupervised method is the
clustering approach which groups the available subclasses into classes of similar patterns. A
cluster-based segmentation approach is utilized to segment the US fetal kidney images in this
paper to detect the shape and contour of fetal kidney images. These parameters are used to
decide the congenital disorders and prediction of gestation periods. The proposed technique has
been compared with FCM and probabilistic models and is found to exhibit superior performance
with respect to computation time and accuracy.
Keywords: Organ Segmentation, prediction of delivery rate, clustering, texture analysis.

1. INTRODUCTION
Segmentation plays a key role in medical imaging and abnormality detection techniques.
Appropriate imaging techniques such as computer tomography (CT), Magnetic Resonance
Imaging (MRI), Ultrasound (US) plays a major role in projecting and early detection of many
abnormalities, prediction of delivery time etc., in combination with a set of powerful image
segmentation and classification methods [2] [12]. Ultrasound imaging is cost effective and hence
US images are predominant in obstetrics and gynecology. Recent studies indicate that up to 4 per
1000 pregnancies are identified in congenital disorders with obstructive uropathies contributing
to 24% of prenatal detection of congenital abnormalities. In pregnancy, second and third
trimesters play a key role in the detection and monitoring of fetal and parental health status [14].
The second trimester ranges from the 13 th week to 27th week where several scans related to heart,
lungs, kidney, and brain are made to assess and ensure the healthy development of organs of the
fetus. A second-trimester fetal image is shown in Figure 1.

Figure 1 (a) 15th week 3D Fetal US Image (b). 29th week 3D Fetal US Image

The screening done in the second trimesters are basically for detection of abnormalities in
fetus, growth rate and delivery rate assessment, gender determination, evaluation of amniotic
fluid etc. The third trimester defines the time period from the 28 th week to the time of delivery.
The present work concentrates on the analysis of fetal kidney images for the detection of
gestational age and congenital abnormalities.

Figure 2 Analysis of death rate during the neonatal phase [WHO,2000 – 2015 adaptation]
 Figure 2 depicts the stake of death rate due to congenital disorders amongst other causes
of death. Congenital abnormalities are the cause of nearly three lakh death rates of babies within
4 weeks of birth every year [1] [4] and hence careful and systematic analysis techniques to
effectively detect abnormalities at an early stage. If left uncared, the congenital disorder may
affect the entire lifespan of the individual. Common congenital disorders include heart
dysfunction, Down’s syndrome and neural tube defects. The size and length of the kidney play a
crucial role and they directly influence the neonatal outcome related to renal pelvis and adrenals
for abnormality detection.

Fetal kidney can be visualized only from 9th week and completely seen in 12 th week
through trans-abdominal and transvaginal sonography [4] [5] [6]. Using appropriate
segmentation methods, several abnormalities could be detected at this early stage to avoid future
fatal complications. Some of the abnormalities that may be detected include bilateral renal
agenesis, infantile polycystic kidney disease, multicyclic dysplastic kidney disease, hydrophrosis
[5] etc. The first abnormality can be detected in the second trimester characterized by an absence
of bladder and absence of fetal kidneys in the scanned image. In the next case, the polycystic
disease is prevalent at a rate of 1:50000 cases characterized by enlarged kidneys. The third
disease is characterized by cystic tubules with cysts determining the size of the fetal kidneys. In
most cases, only one kidney becomes abnormal. Hydrophrosis is yet another abnormality caused
due to increased levels of maternal hormone circulations. Most of the detection is done using
antenatal US images available from early second trimesters. Assessment of the presence of fetal
kidneys, their position, and location, size, the volume of amniotic fluid helps in determining
anomalies like hydronephrosis, cystic kidney, dysplastic kidney and absence of kidneys.

Fetal abnormality identification is a vast area of research in biomedical and

bioinformatics. From the researchers' views and based on the research articles a survey is done to
enhance the proposed research work. Literature work provides much information regarding fetal
issues and the factors affecting the fetus growth. Different algorithms are implemented in various
cases and by comparing all those researches work a conclusion made in the proposed model.

The major problem in the detection features faced by the doctor is Speckle noise
introduced in the ultrasound image due to ultrasound echoes. It is a complex phenomenon and
degrades the quality of the image. Hence reduction of speckle noise is very much necessary to
detect the fine details of an image. The reduction of speckle noise with different kinds of filter
for various kinds of images has been described in [3]. It is observed that Median filter provides
best suited for kidney images Wan Mahani Hafizah et al., applied various spatial domain filtering
techniques for the enhancement of ultrasound kidney images. It has been concluded that Median
filter is best suited for enhancing kidney images. However, it lacks preserving edges in the
images. [4]
 Fetal Kidney image segmentation plays an important role for diagnosis and treatment of
kidney diseases as well as prediction of gestational age using medical image technologies. Due
to difficulties in the detection of object boundaries accurate detection of fetal kidney is become a
challenging task. Literature [1]] [2] depicts the issues handling in the different kinds of focal and
diffused liver disorders using ultrasound image. The research work uses active contour
segmentation for isolation of affected portion in the liver. Using various region-based
segmentation author extracted the details and the details are validated by the ten-fold cross-
validation strategy.

Shape based kidney segmentation method by considering the kidney in black and white
region and back ground separately [13]. Shape prior model is applied to smooth the boundary of
a kidney image. The estimated values were compared with the edge-based level set model. It
needs an alignment model to find the initial data set due to diversity in patient kidney shapes. A
texture and shape priors-based method for segmenting the fetal kidney images has been
described in [31]. It uses Gabor filters to extract the texture features and the similarities in the
texture features has been measured only in and out of the contour region. The segmentation
based on parametric shape model are also proposed both for natural as well as Ultrasound (US)
images.
An Active Shape Model (ASM) based on Covariance Matrix Adaptation Evolution
Strategy (CMA-ES) genetic algorithm for pediatric 2D ultrasound kidney images have been
proposed in [16]. A semi-automatic segmentation method by utilizing the Gradient Vector Force
(GVF) to determine the boundaries of fetal kidney image has been proposed by Arpana M. Kop
et al., [18]. The method is applied for left as well as right kidneys. To perform classification this
method also needs texture, edge curvature and shape of the object.

Image classification using the support vector-based system along with the feedback, this
fusion, and filtering approach for biomedical images is described in [9] [19] [20]. Since support
vector machine is one of the best classification approach used in the image processing this article
uses this algorithm into fusion and also in the filtering process. Literature [10] [22] depicts the
Principal component analysis (PCA) based image classification in the hyperspectral images. The
research work evaluates the way of reducing the large information content into reduced
information content. In general, PCA is used to reduce the large dimensionality data into small
reduced information content. These articles used this method into hyperspectral images.

Classification of ulcer images [5] caused due to diabetic food and researcher uses two-
stage support vector machine-based classification for obtaining the affected portion in the ulcer
images have been investigated. Determination of seed growth based on the image segmentation
from an image set of plants is described in [6]. This classification also used SVM for the
classification to identify the defected plants from set images which is taken continuously, based
on the comparison this binary classifier produces a positive value for the unaffected portion and a
zero value for the affected portion.

Another finding from the article [12] describes a constant false alarm rate detector using
the support vector machine for detecting the differences in the background images. This method
produces better results based on the classification and the current operational environment. The
results in the article provide the homogeneous backgrounds and the non-homogeneous
environments.
Wavelet-based classification for hyperspectral images using morphological profiles and
support vector machine is described in [14] [23]. The noise is removed in the preprocessing of
spectral images and the synchronizing updating is performed to update the reconstruction of
images. The author compares all the results over different hyperspectral images and calculated
the efficiency between them. [15] [27] [29] Uses the same SVM model in the hyperspectral
image classification instead of using morphological profiles and discrete space model.
A multimodal biometric recognition system using K-support vector machine has been
proposed in [30]. In the finger knuckle and finger vein images, a fusion algorithm is proposed
using firefly optimization. Features are extracted and optimized using the firefly and fused using
the k-SVM which is a combination of SVM classifier and K- Neural network. Experimental
results are used to analyze the false acceptance and rejection ratio and accuracy of the system is
obtained in the research work.
Findings from Literature [19] [20] depicts the two-stage cascade SVMs for the
identification of good object proposal. The problems in the high object recall and the
computational cost is the two factors which are mainly considered in this literature work. The
proposed model in the article used cascade SVMs for linear filtering process and linear
classification process. In the discussion, the results are compared to obtain the state of art of
performance of the entire system. Article [22] describes the classification of tissue based on
support vector machine for diagnosing the breast tissue features. Various parts of tissue are
classified in the article for increasing the characterization methodologies in classification. Two
methods are used in SVM for with and without data binning and pruning. Classification of
cervical cancers [23] is discussed for MR Images using texture analysis and Support Vector
Machines. Brix pharmacokinetic model [24] [27] [29] is derived in the work for dynamic
contrast-enhanced MRI. Leave –one-out-cross model [25] [26] is used for the validation of
classification models and random permutation tests are performed for identifying discriminates
between the normal and affected persons. Form the above survey work support vector machine is
a basic classification tool in image classification which is used in many applications . But in case
of the medical image the use of support vector machine is less and in particular, for the field of
fetal abnormalities identification SVM is not used. Few articles describe the use of SVM [28]
[33] in ultrasound but the information and results will vary widely in case of fetal images.
Finally, support vector machine classifier is used in the proposed model for identifying the
abnormities.
 The quality of Ultrasound image is majorily depends on speckle noise, shadows and
signal dropout needs a proper processing method at each stage. Alison Nobel et al., described
that most gestational age parameters were determined from 2D scan. Most of the segmentation
methods requires texture analysis and the segmentation method lacked in the prediction of
boundary of the required parameter [30 refer].

2.PROPOSED WORK

An efficient method for early detection of congenital abnormalities by analyzing fetal

kidney images could be done by incorporating an precise segmentation algorithm and analysis of
the texture through the features to classify them based on the object classes. The present work
combines the clustering and texture analysis method to effectively segment the second and third
trimester US images. A simple scheme of proposed research flow is given in Figure 3.

Image Textural
Acquisition Preprocessing Segmentation feature
extraction

Figure 3 Simple scheme of Segmentation of Images.

From the figure 3, it is seen that the input image acquired from Ultrasound or Sonograph
[31] is preprocessed as they may susceptible to noise from the imaging device. Most of the noise
associated in medical images are multiplicative in nature a suitable filter mask may be used to
filter out the noise components. It is to be noted that speckle noise is multiplicative and usage of
conventional filters like median filters, Gaussian filters may help to remove the noise but will not
aid in preserving the edges. Hence a specialized filter has to be applied to the input US image
which reduces speckle as well as preserves the edges. In general, a speckle noise model is
represented as

s ( x , y )=I ( x , y )∗δ ( x , y ) +∂( x , y) (1)

Where s ( x , y ) denotes the speckle noise, I ( x , y ) , the input image, δ and ∂

the multiplicative and additive components of speckle noise respectively. In the proposed work,
the combined effects of mean and median filters are used as a hybrid MM filter to remove the
speckle noise as well as to retain the edges. The working of the Hybrid Mean Median(HMM)
filter is quite simple as it replaces the mid pixel in the given mask with the maximum value of
mean and median of the neighborhood. Mathematically it is represented as
 )( )
k + (
I (x, y) I (x , y)
+1)
HMM =max ⁡[
1
(
∑ I (x , y) ,
K m=1
2
2
2
]

(2)

The above process is illustrated in figure 4 as shown below.

Mean Filter
De-noised
Noisy Input HMM Image
Image

Median Filter

Figure 4 Illustration of proposed preprocessing using HMM filter

After preprocessing the image is segmented and features extracted which are used to
provide the reconstructed image. In case of the proposed fetal kidney segmentation, the position,
size, and length of kidneys are taken as the key attributes for abnormality detection.

Segmentation in the proposed work is done by exploiting the clustering features inside a
fetal kidney image giving rise to Fuzzy C – means clustering algorithm. Given an image under
study, the objective function of Fuzzy C means is defined as

m n
2
I m ( x , y )=∑ ∑ pi , kl‖x k −c i‖ (3)
1 1

Where m is the fuzzy weighting index, p denotes the partition matrix and c i
denotes the cluster center, k denotes the iteration steps. The basic principle underlying FCM is
that it partitions the input vector set x into fuzzy subsets with p denoting the membership
function. However, FCM is very effective provided that the input data set is simple and spherical
in nature. The squared error term in (3) aims to minimize the objective function I m ( x , y ) . In
order to overcome the drawback of FCM, a biased FCM is derived by taking data points close to
the centroids of similar patterns while discarding data points far away from the centroid. The far
data points are characterized by a low value of membership function. The Equation (1) can be
remodified as

m n n
2 δ 2
I mb ( x , y ) =∑ ∑ pi ,k ‖x k −c i‖ + ∑ pi , k l‖ xk −c i‖
l
(4)
1 1 C 1

In (4) δ denotes the controlling parameter of the neighbor window function C and the
term ‖x k −ci‖ denotes the Euclidean distance. In this proposed work, a Kernel-based FCM
 2
‖x k −c i‖
(KFCM)is utilized which replaces the Euclidean distance with the distance . Given a
2

1−e σ
set of feature vector set S={S 1 , S2 , S 3 , S4 … S p }∈ R n , the objective function can be arrived as

x
c
(¿¿ i)
∅( ¿¿ k )−∅ ¿
¿
¿
¿2
¿ (5)
p i, k l ¿
n

∑¿
1
m
I mK ( x , y )=∑ ¿
1

Utilizing the replacement term for Euclidean distance mentioned above, (5) can be
rewritten as

m n
I mK ( x , y )=∑ ∑ pi , k l (1−K ( x k , ci ) ) (6)
Start1 1

Further the update equation for the membership term pi ,k is derived as

Initialize data set and
descriptors S 1
1 l−1
1−K (x k , ci )
Choose
pi ,k =Kernel 1
function 1
∑ 1−K ( x , c ) l−1

k i

(7)

The update of cCompute

i
Kernel
is given as matrix and
distance between cluster
centroids using kernel l
distance
c i=
∑ pi ,k K ( x k , ci ) x k
l
Compute target ∑ p i ,k K (x k , c i )
(8)J=i+1 function using (6)

No
Yes
s Is Output M_func &
met? terminate iteration

End
 Figure 5 Flow process of proposed Kernel-based FCM (KFCM) for fetal
segmentation

The pseudo code of the KFCM for the proposed implementation is given below along
with the flowchart depicted in figure 5.

Input: Input Descriptor set S={S 1 , S2 , S 3 , S4 … S p }∈ R n

Output: Extracted stream Ci ={C p , C pq , … … C p+q +r … }∈ P
Procedure
Generate candidate patterns P∈ P1 ∩ P2 ∩ P3 ∩ … ..∩ Pn
Assign seed = { }
Initialize number of cluster, k.
Apply Cnd Ptrn=P p ∩ Pn
for t = 1 to r where Pt ∈ P(x, y)
{
for all pixels (i, j) ∈ P p
 for i=0 to Pt −1
do
for j=i+1 to Pt
do
update pi ,k according to (5)
update c i as per (6)
end if
end for
Return Cnd Ptrn
Compute Con f measure =maxk , i| pi , k l− pi , k l−1|
Repeat the update steps until e(t) ⩭ 0 .
Group the clusters into Ci ={C p , C pq , … … C p+q +r … }∈ P
}
end if
end
end procedure

3.RESULTS AND DISCUSSION

The proposed model is tested in MATLAB 14.1 in the operating system of Windows 7
Intel i5 processor with the fetal dataset of 200 images. Dataset consists of various 200 images of
fetal with normal features and the test data set consists of images with abnormalities. The
abnormalities are observed by comparing the physical structure and time duration for the growth.
For example, if the fetus has to be in the stage of developing brain, eyes, and hands in the first
trimester but in case of abnormalities, the growth ratio is will be in a reduced manner so by
observing the normal fetus images these abnormalities can be identified.
 Figure 6 (a) Noisy Fetal image (b)De-noised Fetal Image (3x3 mask)
Figure 6 shows the noisy input fetal US image and its de-noised image using 3 x 3 HMM
filter to remove the speckle noise. The edge-preserving metrics of the proposed HMM filter has
been compared against Mean, Median, Wiener, and Geometric Filter as listed in table 1.

Table 1 Evaluation of edge-preserving parameters

Filter MSE PSNR SSIM FoM

Mean 138.44 28.41 0.804 0.654
Median 124.22 29.55 0.844 0.847
Wiener 108.41 30.14 0.876 0.855
Geometric 95.55 29.48 0.849 0.745
HMM 61.44 34.25 0.921 0.901

From the above table it could be seen that the proposed HMM provides optimal edge
preserving values where MSE indicates the Mean Squared Error, PSNR denotes the Peak Signal
to Noise Ratio (dB), SSIM representing Structural Similarity Index and FoM reflecting Figure of
Merit. Following pre-processing, the KFCM algorithm is applied to the fetal US image to
segment the region of interest (ROI). Figure 6 depicts the complete segmentation process using
the proposed KFCM algorithm.

Figure 7 a. Input Image b. ROI detection c. rough segmented kidney d. finely tuned output

From the above figure, it is seen that the first image 7a depicts the input fetal image
which is detected in 7b. The blue curve indicates the ROI extraction using proposed KFCM
while the pink region denotes manual ROI descriptor based extraction. 7c denotes the rough
segmented crude image while 7d denotes the fine-tuned segmented output after KFCM
converges between 0 and 1. 7c denotes the crude segmentation with no well-defined boundary. A
texture based boundary detection operator provides the fine-tuned segmented output. Following
this segmented output, the features are extracted from the segmented and boundary detected
output. The common features are listed below.
1
MN ∑
Mean= X (i, j)

(9)

X ( i , j )−mean
¿
¿
¿ (10)
1
Skewness=
MN
∑¿

X ( i , j )−mean
¿
¿
¿ (11)
1
Kurtosis=
MN
∑¿

max ⁡prob=∑ max ⁡( P ( i, j )) (12)

mean
(¿ ¿ x∗mean y )
( i∗ j )∗P ( i, j )− (13)
δx δ y
Correlation=∑ ¿

P(i , j )
homogenity=∑ (14)
1+|i− j|

i−meanx
¿
¿ (15)
∑squares ¿ ∑ ¿
The feature metrics for a healthy fetal condition are specified as a length ranging from 8 –
12cm, mean of 1.08 – 1.336, skewness value of 2.822 – 7.708, Kurtosis of 11.06 – 71.152,
homogeneity values ranging from 0.933 to 0.969, a correlation factor of 0.971 – 0.987, sum of
squares placed at 0.828-10.756.Based on the normal feature metrics defined in table 2, the
abnormality is detected. The comprehensive list of features extracted along with their numerical
values is presented in table 2.
 Figure 8 a. IMG_001 (540x480) b. IMG_166 (540x480) c. IMG_200 (540x480)

These values have been computed and presented for a sample specimen of 10 images. The
images have been labeled from 001 to 200 and a set of three images have been depicted in figure
8.

Table 2 Extracted feature values from fetal images (Second Trimester)

Image IMG_ IMG IMG IMG_ IMG_ IMG_ IMG_ IMG_ IMG IMG_
sample/Metri 001 _ _ 094 102 143 168 179 _ 200
c 075 084 188
Mean 1.10 1.14 1.13 1.14 1.06 1.00 1.47 1.28 1.14 1.21
Kurtosis 11.99 14.55 44.01 51.87 10.88 9.98 74.55 64.54 50.87 58.44
Skewness 2.94 3.41 5.66 5.47 1.98 1.64 7.41 4.44 5.14 6.98

Sum_Squares 0.94 2.44 3.54 4.98 0.74 0.68 11.14 6.54 7.10 8.88

Homogeneity 0.94 0.95 0.95 0.94 0.97 0.97 0.92 0.94 0.94 0.94

Correlation 0.97 0.98 0.97 0.98 0.95 0.95 0.99 0.97 0.97 0.97

Length 8 8.1 9.4 9.7 7.4 7.6 11.4 8.2 8.4 8.5

The observed values for fetal image feature vector set for the third trimester are tabulated
in table 3.
 Table 3 Extracted feature values from fetal images (Third Trimester)

Image sample/Metric IMG IMG IMG_ IMG IMG_ IMG_ IMG_ IMG_ IMG_ IMG
_ _ 074 _ 108 166 179 184 189 _
004 064 099 200
Mean 1.11 1.13 1.12 1.13 1.01 1.02 1.48 1.31 1.04 1.28
Kurtosis 11.45 14.58 44.09 51.80 10.78 9.88 74.67 64.32 50.77 58.34
Skewness 2.66 3.38 5.60 5.49 1.92 1.54 7.47 4.24 5.04 6.88

Sum_Squares 0.94 2.34 3.57 4.90 0.73 0.78 11.18 6.14 7.09 8.68

Homogeneity 0.94 0.95 0.95 0.92 0.96 0.89 0.94 0.92 0.92 0.93

Correlation 0.97 0.98 0.97 0.92 0.90 0.85 0.99 0.96 0.96 0.96

Length 8.2 8.4 9.44 9.38 7.1 7.2 11.4 8.25 8.44 8.85

Moreover, the disorder could be detected based on renal volume analysis and correlation factor.
The classification could be categorized into three segments namely premature, mature and full-
term based on renal volume. The standard and observed values have been depicted in table 4.

Table 4 Extracted feature values from fetal images

State of Renal Volume Standard Specime Observe Remarks

Fetus (mm3) deviation n d
Premature 5.6 +/-1.3 IMG_075 5.5 Normal
IMG_102 5.9 Abnorma
l
Mature 9.3 +/-1 IMG_075 8.8 Normal
IMG_102 10.4 Abnorma
l
Full term 10.2 +/-1.6 IMG_075 9.8 Normal
IMG_102 12.1 Abnorma
l

It could be seen from table 5 that the proposed KFCM is able to compute the maximum
number of optimal cluster numbers which accounts for the increased accuracy reported and
depicted in figure 8. The accuracy computation between the three techniques is depicted in figure
8.
 Table 5 Computation of best cluster – comparative analysis

Sample Image FCM PFCM KFCM

IMG_001 0.77 0.71 0.76
IMG_054 0.74 0.80 0.80
IMG_074 0.64 0.74 0.70
IMG_088 0.81 0.84 0.81
IMG_110 0.79 0.71 0.78
IMG_130 0.78 0.75 0.81
IMG_141 0.70 0.88 0.88
IMG_164 0.71 0.71 0.77
IMG_188 0.84 0.75 0.80
IMG_200 0.74 0.76 0.76

It could be further seen that the proposed KFCM exhibits a reduced computation exhibiting
23secs compared to 34secs reported for PFCM and 41secs reported for FCM.

Figure 8 Performance comparison of segmentation accuracy

 1. CONCLUSION

The proposed paper has investigated 200 ultrasound fetal images with the problem
formulation to segment and detect congenital disorders by analyzing kidney images as well to
predict the gestation period. The segmentation has been done using a derivative of the well
known fuzzy C means clustering by replacing the Euclidean distance with a kernel function
which helps to better approximate complex and non-spherical models. The performance analysis
of the proposed method has been compared with FCM and probabilistic FCM models and is
found to exhibit superior performance over the other two in terms of computation time and
precision expressed as accuracy. The experimentation has been done for two cases namely
second and third trimesters with the observed values compared against standard coefficient
metrics to determine abnormality. Regression functions have been utilized as predictors by
establishing the relationship between the gestation period and kidney dimension.

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Conflict of Interest

S.Meenakshi has no conflict of interest with Co-Author M.Suganthi. No conflict of Interest

between Two Authors.

Ethical Approval
This article does not contain any studies with human participants or animals performed by any
of the authors.

Informed Consent
As this article does not involve Human participants so, no such informed consent.