The past two decades have witnessed developments of new imaging techniques that provide three-dimensional images about the interior of the human body in a manner never before available. Ultrasound (US) imaging is an important cost-effective technique used routinely in the management of a number of diseases. However, two-dimensional viewing of three-dimensional anatomy, using conventional two-dimensional US, limits our ability to quantify and visualize the anatomy and guide therapy, because multiple two-dimensional images must be integrated mentally. This practice is inefficient, and may lead to variability and incorrect diagnoses. Investigators and companies have addressed these limitations by developing three-dimensional US techniques. Thus, in this paper, we review the various techniques that are in current use in three-dimensional US imaging systems, with a particular emphasis placed on the geometric accuracy of the generation of three-dimensional images. The principles involved in three-dimensional US imaging are then illustrated with a diagnostic and an interventional application: (i) three-dimensional carotid US imaging for quantification and monitoring of carotid atherosclerosis and (ii) three-dimensional US-guided prostate biopsy.

Thanka murals are important cultural heritages of Tibet, but many precious murals were damaged during history. Thanka mural restoration is very important for the protection of Tibetan cultural heritage. Partial convolution has great potential for Thanka mural restoration due to its outstanding performance for inpainting irregular holes. However, three challenges prevent the existing partial convolution-based methods from solving Thanka restoration problems: 1) the features of multi-scale objects in Thanka murals cannot be extracted correctly because of single-scale partial convolution; 2) the stroke-like Thanka inpainting mode cannot be effectively simulated and learned by existing rectangular or arbitrary masks; and 3) the original content of damaged Thanka murals cannot be restored. To resolve these problems, we propose a Thanka mural inpainting method based on multi-scale adaptive partial convolution and stroke-like masks. The proposed method consists of three parts: 1) a kernel-level multi-scale adaptive partial convolution (MAPConv) to accurately discriminate valid pixels from invalid pixels, and to extract the features of multi-scale objects; 2) a parameter-configurable stroke-like mask generation method to simulate and learn the stroke-like Thanka inpainting mode; and 3) a 2-phase learning framework based on MAPConv Unet and different loss functions to restore the original content of Thanka murals. Experiments on both simulated and real damages of Thanka murals demonstrated that our approach works well on a small dataset (N=2780), generates realistic mural content, and restores the damaged Thanka murals with high speed (600 ms for multiple holes in 512×512 images). The proposed end-to-end method can be applied to other small datasets-based inpainting tasks.

Measurement of total-plaque-area (TPA) is important for determining long term risk for stroke and monitoring carotid plaque progression. Since delineation of carotid plaques is required, a deep learning method can provide automatic plaque segmentations and TPA measurements; however, it requires large datasets and manual annotations for training with unknown performance on new datasets. A UNet++ ensemble algorithm was proposed to segment plaques from 2D carotid ultrasound images, trained on three small datasets (n = 33, 33, 34 subjects) and tested on 44 subjects from the SPARC dataset (n = 144, London, Canada). The ensemble was also trained on the entire SPARC dataset and tested with a different dataset (n = 497, Zhongnan Hospital, China). Algorithm and manual segmentations were compared using Dice-similarity-coefficient (DSC), and TPAs were compared using the difference (ΔTPA), Pearson correlation coefficient (r) and Bland-Altman analyses. Segmentation variability was determined using the intra-class correlation coefficient (ICC) and coefficient-of-variation (CoV). For 44 SPARC subjects, algorithm DSC was 83.3-85.7%, and algorithm TPAs were strongly correlated (r = 0.985-0.988; p <; 0.001) with manual results with marginal biases (0.73-6.75) mm$^2$ using the three training datasets. Algorithm ICC for TPAs (ICC = 0.996) was similar to intra- and inter-observer manual results (ICC = 0.977, 0.995). Algorithm CoV = 6.98% for plaque areas was smaller than the inter-observer manual CoV (7.54%). For the Zhongnan dataset, DSC was 88.6% algorithm and manual TPAs were strongly correlated (r = 0.972, p <; 0.001) with ΔTPA = -0.44±4.05 mm$^2$ and ICC = 0.985. The proposed algorithm trained on small datasets and segmented a different dataset without retraining with accuracy and precision that may be useful clinically and for research.

Vessel-wall-volume (VWV) is an important three-dimensional ultrasound (3DUS) metric used in the assessment of carotid plaque burden and monitoring changes in carotid atherosclerosis in response to medical treatment. To generate the VWV measurement, we proposed an approach that combined a voxel-based fully convolution network (Voxel-FCN) and a continuous max-flow module to automatically segment the carotid media-adventitia (MAB) and lumen-intima boundaries (LIB) from 3DUS images. Voxel-FCN includes an encoder consisting of a general 3D CNN and a 3D pyramid pooling module to extract spatial and contextual information, and a decoder using a concatenating module with an attention mechanism to fuse multi-level features extracted by the encoder. A continuous max-flow algorithm is used to improve the coarse segmentation provided by the Voxel-FCN. Using 1007 3DUS images, our approach yielded a Dice-similarity-coefficient (DSC) of 93.2±3.0% for the MAB in the common carotid artery (CCA), and 91.9±5.0% in the bifurcation by comparing algorithm and expert manual segmentations. We achieved a DSC of 89.5±6.7% and 89.3±6.8% for the LIB in the CCA and the bifurcation respectively. The mean errors between the algorithm- and manually-generated VWVs were 0.2±51.2 mm3 for the CCA and -4.0±98.2 mm3 for the bifurcation. The algorithm segmentation accuracy was comparable to intra-observer manual segmentation but our approach required less than 1s, which will not alter the clinical work-flow as 10s is required to image one side of the neck. Therefore, we believe that the proposed method could be used clinically for generating VWV to monitor progression and regression of carotid plaques.