Using structural equation modeling and intima-media complex texture features to assess cardiovascular disease risk in the common carotid artery

Abstract

The potential for stroke risk in humans due to clinical cardiovascular disease (CVD), which leads to the hardening of the artery walls (atherosclerosis), can be assessed by examining the common carotid artery (CCA) in ultrasound images. Specifically, this can be done by measuring the intima media thickness (IMT), which represents the thickness of the arteries wall, and by analyzing texture features (TFs) of the CCA's intima-media complex (IMC) of the artery wall. In this paper, a sample of 612 longitudinal-section ultrasound images of the left and the right CCA from 158 men and 148 women, out of which 42 demonstrated clinical CVD, is studied. All images are intensity normalized and despeckled, with the IMC segmented through an in-house system of semi-automated segmentation, where the IMT is measured, and 40 different TFs are extracted. Then, employing structural equation modeling (SEM), these TFs, which are put in 6 groups (constructs), are collectively tested on how they are related to CVD. The influence of the IMT is also studied through a moderation analysis, while gender and age of the sub-jects of the study are tested with regard to their control effect. The main conclusions of the study are as follows. The 6 TFs groups and the IMT fit the measurement model very well. Also, 6 hypothesized paths for the impact of each TFs group on CVD are tested in a structural model, with 5 of them, namely Statistical Features (SF), Spatial Gray Level Dependence Matrices (SGLDM), Gray Level Difference Statistics (GLDS), Statistical Feature Matrix (SFM) and Laws Texture Energy Measures (LTEM), impacting CVD in a moderate manner (p-values between 0.04 and 0.07). The IMT is shown to play a strong moderating role (p-values of Δχ2 < 0.01), enhancing the level of impact of the TFs on CVD. Gender and age have a strong controlling effect on CVD (p-values of < 0.01). The precision of the findings of this study is considerably improved compared to those previously reported, because of the very good model fit (e.g., normed fit index (NFI) = 0.94) for both measurement and structural models. However, due to the moderate nature of the impact, supplementary work is required for testing either additional combinations of TFs, as well as testing other samples through the proposed model, for further evaluation of the CVD risk on symptomatic subjects at risk of atherosclerosis.