Abstract-Background: Blood vessel segmentation is a topic of high interest in medical image analysis since the analysis of vessels is crucial for diagnosis, treatment planning and execution, and evaluation of clinical outcomes in different fields, including laryngology, neurosurgery and ophthalmology. Automatic or semiautomatic vessel segmentation can support clinicians in performing these tasks. Different medical imaging techniques are currently used in clinical practice and an appropriate choice of the segmentation algorithm is mandatory to deal with the adopted imaging technique characteristics (e.g. resolution, noise and vessel contrast).Objective: This paper aims at reviewing the most recent and innovative blood vessel segmentation algorithms. Among the algorithms and approaches considered, we deeply investigated the most novel blood vessel segmentation including machine learning, deformable model, and tracking-based approaches.Method: This paper analyzes more than 100 articles focused on blood vessel segmentation methods. For each analyzed approach, summary tables are presented reporting imaging technique used, anatomical region and performance measures employed. Benefits and disadvantages of each method are highlighted.Discussion: Despite the constant progress and efforts addressed in the field, several issues still need to be overcome. A relevant limitation consists in the segmentation of pathological vessels. Unfortunately, not consistent research effort has been addressed to this issue yet. Research is needed since some of the main assumptions made for healthy vessels (such as linearity and circular cross-section) do not hold in pathological tissues, which on the other hand require new vessel model formulations. Moreover, image intensity drops, noise and low contrast still represent an important obstacle for the achievement of a high-quality enhancement. This is particularly true for optical imaging, where the image quality is usually lower in terms of noise and contrast with respect to magnetic resonance and computer tomography angiography. Conclusion:No single segmentation approach is suitable for all the different anatomical region or imaging modalities, thus the primary goal of this review was to provide an up to date source of information about the state of the art of the vessel segmentation algorithms so that the most suitable methods can be chosen according to the specific task.

Leukocyte-labeled scintigraphy, a noninvasive and reproducible technique, is a useful tool in the diagnosis and therapeutic strategy of IBD, and provides information on the presence, the intensity, and the extent of the disease, particularly in the terminal ileum. Leukocyte-labeled scintigraphy may not replace colonoscopy with biopsies for diagnosis confirmation. Its reliability seems higher than that of ultrasonography.

Three dimensional visualization of vascular structures can assist clinicians in preoperative planning, intraoperative guidance, and post-operative decision-making. The goal of this work is to provide an automatic, accurate and fast method for brain vessels segmentation in Contrast Enhanced Cone Beam Computed Tomography (CE-CBCT) dataset based on a residual Fully Convolutional Neural Network (FCNN). The proposed NN embeds in an encoder-decoder architecture residual elements which decreases the vanishing effect due to deep architecture while accelerating the convergence. Moreover, a two-stage training has been proposed as a countermeasure for the unbalanced nature of the dataset. The FCNN training was performed on 20 CE-CBCT volumes exploiting minibatch gradient descent andthe Adam optimizer. Binary crossentropy was used as loss function. Performance evaluation was conducted considering 5 datasets. A median value of Dice, Precision and Recall of 0.79, 0.8 and 0.69 were obtained with respect to manual annotations.

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Several neurosurgical procedures, such as Artero Venous Malformations (AVMs), aneurysm embolizations and StereoElectroEncephaloGraphy (SEEG) require accurate reconstruction of the cerebral vascular tree, as well as the classification of arteries and veins, in order to increase the safety of the intervention. Segmentation of arteries and veins from 4D CT perfusion scans has already been proposed in different studies. Nonetheless, such procedures require long acquisition protocols and the radiation dose given to the patient is not negligible. Hence, space is open to approaches attempting to recover the dynamic information from standard Contrast Enhanced Cone Beam Computed Tomography (CE-CBCT) scans. The algorithm proposed by our team is called ART 3.5 D. It is a novel algorithm based on the postprocessing of both the angiogram and the raw data of a standard Digital Subtraction Angiography from a CBCT (DSA-CBCT) allowing arteries and veins segmentation and labeling without requiring any additional radiation exposure for the patient and neither lowering the resolution. In addition, while in previous versions of the algorithm just the distinction of arteries and veins was considered, here the capillary phase simulation and identification is introduced, in order to increase further information useful for more precise vasculature segmentation.

Classification of arteries and veins in cerebral angiograms can increase the safety of neurosurgical procedures, such as StereoElectroEncephaloGraphy, and aid the diagnosis of vascular pathologies, as arterovenous malformations. We propose a new method for vessel classification using the contrast medium dynamics in standard Digital Subtraction Angiography (DSA). After 3D DSA and angiogram segmentation, contrast enhanced projections are processed to suppress soft tissue and bone structures attenuation effect and further enhance the contrast medium flow. For each voxel labelled as vessel, a Time Intensity Curve (TIC) is obtained as a linear combination of temporal basis functions whose weights are addressed by Simultaneous Algebraic Reconstruction Technique (SART 3.5D), expanded to include dynamics. Each TIC is classified by comparing the areas under the curve in the arterial and venous phases. Clustering is applied to optimize the classification thresholds. On a dataset of 60 patients, a median value of sensitivity (90%), specificity (91%), and accuracy (92%) were obtained with respect to manually annotated arterial and venous voxels up to branching order 4-5. Qualitative results are also presented about CM arrival time mapping and its distribution in arteries and veins respectively. In conclusion, this study shows a valuable impact, at no protocol extra-cost or invasiveness, concerning surgical planning related to the enhancement of arteries as major organs at risk. Also, it opens a new scope on the pathophysiology of cerebrovascular dynamics and its anatomical relationships.

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