Automatic segmentation of puborectalis muscle on three-dimensional transperineal ultrasound

Objectives: The introduction of 3D analysis of the puborectalis muscle, for diagnostic purposes, into daily practice is hindered by the need for appropriate training of the observers. Automatic 3D segmentation of the puborectalis muscle in 3D transperineal ultrasound may aid to its adaption in clinical practice.

Method: A manual 3D segmentation protocol was developed to segment the puborectalis muscle. The data of 20 women, in their first trimester of pregnancy, was used to validate the reproducibility of this protocol. For automatic segmentation, active appearance models of the puborectalis muscle were developed. Those models were trained using manual segmentation data of 50 women. The performance of both manual and automatic segmentation was analyzed by measuring the overlap and distance between the segmentations. Also, the interclass correlation coefficients and their 95% confidence intervals were determined for mean echogenicity and volume of the puborectalis muscle.

Results: The ICC values of mean echogenicity (0.968-0.991) and volume (0.626-0.910) are good to very good for both automatic and manual segmentation. The results of overlap and distance for manual segmentation are as expected, showing only few pixels (2–3) mismatch on average and a reasonable overlap. Based on overlap and distance 5 mismatches in automatic segmentation were detected, resulting in an automatic segmentation a success rate of 90%.

Conclusions: In conclusion, this study presents a reliable manual and automatic 3D segmentation of the puborectalis muscle. This will facilitate future investigation of the puborectalis muscle. It also allows for reliable measurements of clinically potentially valuable parameters like mean echogenicity.