Automatic analysis of diabetic peripheral neuropathy using multi-scale quantitative morphology of nerve fibres in corneal confocal microscopy imaging

Dabbah, Mohammad A.; Graham, Jim; Petropoulos, Ioannis N.; Tavakoli, Mitra; Malik, Rayaz A.

doi:10.1016/j.media.2011.05.016

Cited by 245 publications

(220 citation statements)

References 38 publications

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“…This technique is highly reproducible14, 15 and well‐tolerated 16. An automated and standardized image analysis method for quantification of corneal nerve morphology has also been developed 17, 18…”

Section: Introductionmentioning

confidence: 99%

Corneal confocal microscopy in chronic inflammatory demyelinating polyneuropathy

Stettner

Hinrichs

Guthoff

et al. 2015

Ann Clin Transl Neurol

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ObjectiveThere is an unmet need for better diagnostic tools to further delineate clinical subsets of heterogeneous chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN) to facilitate treatment decisions. Corneal confocal microscopy (CCM) is a noninvasive and reproducible nerve imaging technique. This study evaluates the potential of CCM as a diagnostic surrogate in CIDP and MMN.MethodsIn a cross‐sectional prospective approach, 182 patients and healthy controls were studied using CCM to quantify corneal nerve damage and immune cell infiltration.ResultsPatients with CIDP and MMN had a reduction in corneal nerve fiber (CNF) measures and an increase in corneal immune cell infiltrates. In CIDP, CNF parameters decreased with increasing duration of disease. The number of dendritic cells in proximity to CNFs was increased in patients with early disease and correlated with the degree of motor affection. A further reduction in CNF parameters and an increase in nondendritic cells were observed in patients with painful neuropathy. In CIDP patients with antineuronal antibodies the number of nondendritic cells was increased.InterpretationOur findings suggest that CNF loss may reflect severity of neuropathy and quantification of distinct cells around the CNF plexus may help in stratifying CIDP subtypes, clinical course, and disease activity. However, further longitudinal studies are required before CCM can be considered as a valid surrogate endpoint for patients with CIDP and MMN.

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Section: Introductionmentioning

confidence: 99%

Corneal confocal microscopy in chronic inflammatory demyelinating polyneuropathy

Stettner

Hinrichs

Guthoff

et al. 2015

Ann Clin Transl Neurol

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“…Only 2 of the 30 images were misclassified using the proposed algorithm. Dabbah et al [37] developed two techniques for nerve fiber detection. The first technique is based on a linear operator, which was devised originally for asbestos fibers.…”

Section: Related Workmentioning

confidence: 99%

“…An automatic analysis and classification system for detecting nerves in confocal microscopy corneal images based on a multiscale dual model detection algorithm is presented in [29]. Feature vectors are generated from this dual-model detection to be used in the classification stage, which is based on the Random Forest (RF) and Neural Networks (NN) to classify the pixels as nerve or non-nerve pixels.…”

Section: Related Workmentioning

confidence: 99%

“…The overall performance of the proposed system was compared theoretically with other established automatic nerve detection systems [55,29], due to the unavailability of the datasets used in these works. These systems are mainly based on using the single-scale and multi-scale dual-models to detect the nerve fibers.…”

Section: The Global Consistency Error Measures the Extent To Whichmentioning

confidence: 99%

“…A fully automatic and real-time system for tracing sub-basal nerves and extracting clinically meaningful parameters is required. Such a system would reliably and efficiently assess nerve pathology in diabetic patients and provide an objective means for diagnostic and staging purposes [28,29,30]. However, in order to build an efficient and robust system for segmenting the sub-basal nerves in corneal images, a number of issues need to be taken into account, including the visual contrast of the nerves, the discontinuities in some nerve images, and the inconsistent intensities of corneal sub-basal images, which can all play a significant role in decreasing segmentation performance.…”

Section: Introductionmentioning

confidence: 99%

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A fully automatic nerve segmentation and morphometric parameter quantification system for early diagnosis of diabetic neuropathy in corneal images

Al-Fahdawi

Qahwaji

Al-Waisy

et al. 2016

Computer Methods and Programs in Biomedicine

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Use of Corneal Confocal Microscopy to Detect Corneal Nerve Loss and Increased Dendritic Cells in Patients With Multiple Sclerosis

et al. 2017

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IMPORTANCE Multiple sclerosis (MS) is characterized by demyelination, axonal degeneration, and inflammation. Corneal confocal microscopy has been used to identify axonal degeneration in several peripheral neuropathies.OBJECTIVE To assess corneal subbasal nerve plexus morphologic features, corneal dendritic cell (DC) density, and peripapillary retinal nerve fiber layer (RNFL) thickness in patients with MS. DESIGN, SETTING, AND PARTICIPANTSThis single-center, cross-sectional comparative study was conducted at a tertiary referral university hospital between May 27, 2016, and January 30, 2017. Fifty-seven consecutive patients with relapsing-remitting MS and 30 healthy, age-matched control participants were enrolled in the study. Corneal subbasal nerve plexus measures and DC density were quantified in images acquired with the laser scanning in vivo corneal confocal microscope, and peripapillary RNFL thickness was measured with spectral-domain optical coherence tomography. MAIN OUTCOMES AND MEASURESCorneal nerve fiber density, nerve branch density, nerve fiber length, DC density, peripapillary RNFL thickness, and association with the severity of neurologic disability as assessed by the Kurtzke Expanded Disability Status Scale (score range, 0-10; higher scores indicate greater disability) and Multiple Sclerosis Severity Score (score range, 0.01-9.99; higher scores indicate greater severity). RESULTSOf the 57 participants with MS, 42 (74%) were female and the mean (SD) age was 35.4 (8.9) years; of the 30 healthy controls, 19 (63%) were female and the mean (SD) age was 34.8 (10.2) years. Corneal nerve fiber density (mean [SE] difference, −6.78 [2.14] fibers/mm 2 ; 95% CI, −11.04 to −2.52; P = .002), nerve branch density (mean [SE] difference, branches/mm 2 ; 95% CI, −28.77 to −7.10; P = .001), nerve fiber length (mean [SE] difference, −3.03 [0.89] mm/mm 2 ; 95% CI, −4.81 to −1.25; P = .001), and the mean peripapillary RNFL thickness (mean [SE] difference, −17.06 [3.14] μm; 95% CI, −23.29 to −10.82; P < .001) were reduced in patients with MS compared with healthy controls. The DC density was increased (median [interquartile range], 27.7 [12.4-66.8] vs 17.3 [0-28.2] cells/mm 2 ; P = .03), independent of a patient's history of optic neuritis. Nerve fiber density and RNFL thickness showed inverse associations with the Expanded Disability Status Scale (ρ = −0.295; P = .03 for nerve fiber density and ρ = −0.374; P = .004 for RNFL thickness) and the Multiple Sclerosis Severity Score (R = −0.354; P = .007 for nerve fiber density and R = −0.283; P = .03 for RNFL thickness), whereas other study measures did not.CONCLUSIONS AND RELEVANCE These data suggest that corneal confocal microscopy demonstrates axonal loss and increased DC density in patients with MS. Additional longitudinal studies are needed to confirm the use of corneal confocal microscopy as an imaging biomarker in patients with MS.

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Automatic analysis of diabetic peripheral neuropathy using multi-scale quantitative morphology of nerve fibres in corneal confocal microscopy imaging

Cited by 245 publications

References 38 publications

Corneal confocal microscopy in chronic inflammatory demyelinating polyneuropathy

Corneal confocal microscopy in chronic inflammatory demyelinating polyneuropathy

A fully automatic nerve segmentation and morphometric parameter quantification system for early diagnosis of diabetic neuropathy in corneal images

Use of Corneal Confocal Microscopy to Detect Corneal Nerve Loss and Increased Dendritic Cells in Patients With Multiple Sclerosis

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