Automated Microaneurysms Detection in Fundus

Images Using Image Segmentation

Syna Sreng, Noppadol Maneerat Kazuhiko Hamamoto

Faculty of Engineering School of Information and Telecommunication Engineering
King Mongkut’s Institute of Technology Ladkrabang Tokai University
Bangkok, Thailand Tokyo, Japan
srengsina@yahoo.com hama@keyaki.cc.u-tokai.ac.jp
kmnoppad@kmitl.ac.th

Abstract— Diabetic retinopathy is one of the complicated country, and most of them are living in Bangkok [3]. This
diseases which occurs in diabetic patients when the affects damage means that it is quite difficult to find the ophthalmologists in
the retina. The eyes vision can lead to be lost in case of late the provinces, especially in the rural area. Therefore, the
treatment. Microaneurysms are the earliest detectable automatic system for primary screening of DR is so useful in
abnormalities of diabetic retinopathy, so the automated detection
of the lesions is essential and useful task. This paper proposed a
this task to help the ophthalmologists.
simple method to detect microaneurysms based on its
characteristics in fundus images using some techniques in image
segmentation. First, we preprocessed to reduce image noise and
improve the contrast. Then we segmented them using Canny edges
detection and maximum entropy thresholding. The characteristics
of microaneurysms which appear as small red dots and circular
shape are the specific points to discriminate them from the other
lesions as well as the anatomical structures of the fundus image by
applying area and eccentricity methods. Finally, the
morphological operation was applied to mark out these symptoms.
The results were analysis by ophthalmologist in order to define
system accuracy and preciseness. According to results of
comparison, we found that the accuracy is 90 % and the average
processing time is 9.53 seconds per image.

Keywords— microaneurysms; diabetic retinopathy; fundus

image; Canny edges detection; maximum entropy thresholding;

I. INTRODUCTION Fig. 1. Microanuerysms in retinal image.

Diabetes is one of the well-known diseases in the world.
When it affects on the eye, we called Diabetic Retinopathy
(DR). The effected eyes vision can lead to blindness in case of
late treatment. MIcroaneurysms (MIs) are the first sign of DR,
so the early detection and timely treatment of the lesions can
save the patients’ visions. Therefore, timely examination at
least once every year should be done for all people with diabete.
According to [1], the report from Novo Nordisk Pharma
(Thailand) Ltd, there are about 382 million people worldwide
have some forms of diabetes. Among all of them, the estimated
3.2 million Thai adults have diabetes; 6.4 percent of the adult
population. This number will increase to 4.3 million by 2035.
The total amount around 6 million people are sufering by
diabete in Thailand based on the suvey in [2], and 30 percent of
them are affected by DR. With this amount, the number of eyes
need to be examined are at least about 12 million for each year.
However, the numbers of ophthalmologists are limited in
Thailand. There are approximately 1000 people in the whole
In clinical environment, the brightness and contrast of the
backround in fundus images still remaind the main obstracles
for DR lesions detection. Therefore, there have been many
researchers try to propose new ideas to detect the lesions. The
approaches for MIs detection presented in the literatures can be
roughly divided into different types such as mathematical
morphology [5-6] base analyzes on the characteristics of MIs
(size, pixel range, shape etc.). The average values of the HSV
color model were defined by the color of MIs in the images with
area and eccentricity methods were used in [7]. In [8], the
authors propose a method to detect MIs based on eigenvalue
analysis using the Hessian matrix. Supervised learning method
[9] train the algorithm with 21 images to classify MIs
candidates based on kernel density estimation. Support Vector
Machines[10] was applied to classify MIs candidates after
extracting the features using different morphological
operations. The same classification method was applied in [11]
after applying top hat transformation in features extraction step.

978-1-5090-5210-3/17/$31.00 ©2017 IEEE

and morphological operation to remove the blood vessels. In step. After that the inverse discrete 2D wavelet transforms and
[12], the proper threshold value was selected first, then the optic medians filter are applied to remove noise and improve the
disk area and blood vessels were eliminated by applying quality of the image.
morphological operation. Finally, the MIs candidates were
classified by support vector machine algorithm. ݂஻ ൌ ‫ܥ‬௙೛೎ೌ ሺ‫ܯܫ‬ሻ (1)
The above proposed methods seem complicated and take where ݂஻ image is resulted image from the conversion of ݂௣௖௔
time to proceed. So, this paper develops a simple method to image by using Inverse 2D wavelet transforms (I) and Medians
detect MIs based on its characteristics with four processing filter (M).
steps. First, preprocessing step is applied to reduce noise and
improve the contrast of the image. Then Canny edges detection Finally, the resulted images in preprocessing step are
is used to define the lesions containing on the retinal image. shown in Fig. 3.
Since these lesoins contain also the bright lesoins, maximum
entropy thresholding method is suitable to define these bright
lesoins for substracting from the result. After that, the areas of
MIs are selected based on the eccentricity and area methods.
Finally, the MIs symptoms are marked out by morphological
algorithm.
The rest of this paper is organized as follows: section II,
proposed method was deeply described. Section III, the
performance of result and discussion were demonstrated and
finally, section IV is conclusion.
II. METHODOLOGY
Four processing steps are proposed for MIs detection: A.
Prepocessing step, B. Microaneurysms extraction, C. Small
bright features filtering and finally D. Microaneurysms
detection. The block diagram of the processing steps is shown
in Fig. 2.

T
Pre- Microaneurysms
processing Extraction Fig. 3. Preprocessing step

B. Microaneurysms Extraction

Microaneurysms Small Bright Features
Detection Filtering
Fig. 2. Block diagram of microaneurysms detection
A. Preprocessing Step
The bad contrast, illumination and color inside the fundus
images are very complicated in the detection of MIs.
Preprocessing step is the first and important step to solve these
problems.
In this research, first the images were resized to 576 x 720
pixels in order to reduce the processing time. There are several
different color models in the literature and all color models have
their own advantages. Therefore, the testing process is the best
choice to find the best grayscale conversion method. Grayscale
conversion in the LAB color model was selected (݂௣௖௔ image).
Next the ݂௣௖௔ image is complemented to reverse the intensity
values for the desired lesions become easier in thresholding
Fig.4 shows the process for filtering out the small lesions
in the retinal image. First, Canny edges detection is applied to
݂஻ image. This transformation is used to track all features which
appear with edges inside ݂஻ image by using fudge factor ߙ௙
which assumes its value as 0.5.
݂஼௔௡௡௬ ൌ ܶ௙ಳ ሺߙ௙ ሻ (2)
where ݂஼௔௡௡௬ image is resulted image from the transformation
of ݂஻ image by using Canny edges detection with the fudge
factor ߙ௙ ൌ ͲǤͷ.
The appeared lesions can be defined as the closed curve
inside ݂஼௔௡௡௬ image so, then all holes are filled to mark them
out.
݂ு ൌ ݂݈݈݅݉݅ሺ݂஼௔௡௡௬ ǡ Ԣ݄‫݈݁݋‬Ԣሻ (3)
where ݂ு image is the resulted image of filling the holes in the
݂஼௔௡௡௬ image.
After marking out, all lesions can be filtered out by
subtracting the ݂஼௔௡௡௬ image from the ݂ு image.
 ݂௅ ൌ ݂ு െ  ݂஼௔௡௡௬ (4)
where ݂௅ image is the resulted image from subtracting the
݂஼௔௡௡௬ image from the ݂ு image.
MIs are defined as red dots with the round shape and a
diameter Ȝ < 125ȝm [13]. With this characteristic, we have to
consider both the area and shape of MIs. The area of MIs can
be found in the range of pixels from 7 to 15 in an image of 576
x 720 pixels. After that the group of pixels with the pixels’
range from 7 to 15 are defined by area method.
݂஺ ൌ ܴ௙ಽ ሺ‫ܽ݁ݎܣ‬ሻ (5)
where ݂஺ image is the resulted image from removing all group
of pixels which are out of range from 7 to 15 from ݂௅ image.
Finally, the shape of MIs can be found by eccentricity
method with the values from 0.8 to 1. The value of eccentricity
is range from 0 (line) to 1 (circle).
݂஺௟௟ ൌ ܴ௙ಲ ሺ……ሻ (6)
where ݂஺௟௟ image is the resulted image from removing all group
of pixels with the values of eccentricity are out of range from
0.8 to 1 from ݂஺ image.
The resulted image ݂஺௟௟ here contains all small lesions
which the shape and diameter are similar with MIs. Therefore,
the bright lesions in section C need to define to eliminate them
from the final result.
a. b.
c. d.
Fig. 4 Microaneurysms extraction
C. Small Bright Features Filtering
For bright features detection, we preprocess by selecting
green channel in RGB color model (݂௚ image) and apply
contrast-limited adaptive histogram equalization to improve the
contrast. After that, median filter is used to reduce noise.
݂஼ ൌ ‫ܥ‬௙೒ ሺ‫ܯܥ‬ሻ (7)
where ݂஼ image is resulted image from the conversion of ݂௚
image by using Contrast-limited adaptive histogram
equalization (C) and Medians filter (M).
To define both low and high levels of bright features
without affect to the background in retinal image, double
thresholds using maximum entropy thresholding [14] are
applied. The first step is used to define the high level of bright
features, and then the resulted image is used to eliminate
themselves out from ݂஼ image. Next, maximum entropy
thresholding is applied again to define the low level of bright
features.
݂௧௪௢ ൌ ‫ܧ‬௙೒ ሺʹ‫ܮ‬ሻ (8)
where ݂௧௪௢ image is obtained after elimination 2 Levels (2L) of
bright features from ݂஼ image.
Since the result contains also some noises from the
background , the big groups of pixels which are more then 3,000
pixels are removed out. They are considered as the background
of the retina.
݂௕௥௜௚௛௧ ൌ ܴ௙మಽ ሺ‫ܲܩܤ‬ሻ (9)
where ݂௕௥௜௚௛௧ image is the resulted image from removing all Big
Group of Pixels (BGP) from ݂ଶ௅ image.
Finally, small bright features is defined by appliying
AND-operator between the ݂஺௟௟ and ݂௕௥௜௚௛௧ images.
݂ௌି௕௥௜௚௛௧ ൌ ‫ܦܰܣ‬ሺ݂஺௟௟ ǡ ݂௕௥௜௚௛௧ ሻ (10)
The resulted images for small bright features filtering are
illustrated in Fig. 5.
Fig. 5 Small bright features filtering
D. Microaneurysms Detection
After small bright features are detected, we can eliminate
these features by subtracting them out from the result of
microaneurysms extraction as shown in equation (11).
݂ெூ௦ି௠௔௦௞ ൌ ݂௔௟௟ െ  ݂ௌି௕௥௜௚௛௧ (11)
where ݂ெூ௦ି௠௔௦௞ image is the resulted image from subtracting
the ݂ௌି௕௥௜௚௛௧ image from the ݂௔௟௟ image.
Finally, we overlaid the resulted ݂ெூ௦ି௠௔௦௞ image on the
original retinal image to mark out these lesions by using
morpological reconstruction.
݂ெூ௦ ൌ ܴ௙ಷೠ೙೏ೠೞ ሺ݂ெூ௦ି௠௔௦௞ ൯ (12)
where ݂ெூ௦ି௠௔௦௞ is the mask image, ݂ி௨௡ௗ௨௦ is the original
image, and ݂ெூ௦ image is the result of Mis detection.
Fig. 7 illustrates the result of microaneurysms detection.
Fig. 7. Blood vessels detection
III. RESULTS
579 fundus images from Bhumibol Adulyadej Hospital
and 89 images from online database (DIARETDB1) were used
in this paper. The image resolution varies from 1500 x 1152
pixels (DIARETDB1) to 3872 x 2592 pixels (local database) in
24 bit PNG and JPEG format. These images contain all lesions
related to DR (microaneurysms, hemorrhages, cotton-wool
spots, exudate, etc.) and healthy images.
In this paper, the performance evaluation has been done
over all the images by the verification of an ophthalmologist.
The ophthalmologist verifies the detection results for all test
image sets based on the values of sensitivity and specificity.
The accuracy is the overall correctness of the system and is
calculated as the sum of correct classifications divided by the
total number of classifications. The results from the
ophthalmologist shows that 90% of MIs detections were
successful. The average of processing time is 9.53 seconds per
image using a laptop with Intel Dual core CPU and Ram 2 GB.
IV. CONCLUSION
This paper proposed a simple method for automated MIs
detection in fundus images. It is a part of DR lesions detection
system which is very important to help the ophthalmologists for
primary DR screening. To develop this robust MIs descriptor,
four processing steps were proposed based on the
characteristics of MIs as mentioned in the above section. Given
a success rate of 90 % on MIs detection with the average
processing time 9.53 seconds per image, the proposed method
is acceptable for time consuming process. However, we needs
carefully examine the reason of failure in some cases in the
future work.
ACKNOWLEDGMENT
We would like to acknowledge Asian University Network
(AUN/SEED-Net) for financial support one of the authors (Mr.
Syna Sreng) for his study at King Mongkut’s Institute of
Technology Ladkrabang (KMITL), THAILAND.
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