Fast and accurate segmentation of musculoskeletal ultrasound images is an on-going challenge. Two principal factors make this task difficult: firstly, the presence of speckle noise arising from the interference that accompanies all coherent imaging approaches; secondly, the sometimes subtle interaction between musculoskeletal components that leads to non-uniformity of the image intensity. Our work presents an investigation of the potential of Convolutional Neural Networks (CNNs) to address both of these problems. CNNs are an effective tool that has previously been used in image processing of several biomedical imaging modalities. However, there is little published material addressing the processing of musculoskeletal ultrasound images, particularly using a panoramic technique. In our work we explore the effectiveness of CNNs when trained to act as a pre-segmentation pixel classifier that determines whether a pixel is an edge or non-edge pixel. Our CNNs are trained using two different ground truth interpretations. The first one uses an automatic Canny edge detector to provide the ground truth image; in the second interpretation, the ground truth was obtained using the same image marked-up by an expert anatomist. In this initial study the CNNs have been trained using half of the prepared data from one image, using the other half for testing; validation was also carried out using three unseen ultrasound images. CNN performance was assessed using Mathew's Correlation Coefficient, Sensitivity, Specificity and Accuracy. The results show that CNN performance when using expert ground truth image is better than in the case of using Canny ground truth image. Our technique is promising and has the potential to speed-up the image processing pipeline using appropriately trained CNNs.

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Anomalous flexor digitorum superficialis muscles in the hand are an uncommon phenomenon, and therefore present challenges in diagnosis and management. We report a case of a 16-year-old girl presenting with a painful, slowly enlarging palmar swelling. The swelling was investigated with ultrasound and magnetic resonance imaging, and was found to be an anomalous muscle belly of the flexor digitorum superficialis muscle. After careful consideration, multidisciplinary discussion, and thorough imaging, the patient was treated successfully without surgical exploration or excision, in comparison to previously reported cases. The patient was pain free and had no concerns at 8-month follow-up, demonstrating the value of conservative management in these cases.

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