Background: Retinal blood vessel segmentation has an important guiding significance for the analysis and diagnosis of cardiovascular diseases such as hypertension and diabetes. But the traditional manual method of retinal blood vessel segmentation is not only time-consuming and laborious but also cannot guarantee the accuracy and efficiency of diagnosis. Therefore, it is especially significant to create a computer-aided method of automatic and accurate retinal vessel segmentation. Methods: In order to extract the blood vessels' contours of different diameters to realize fine segmentation of retinal vessels, we propose a Bidirectional Symmetric Cascade Network (BSCN) where each layer is supervised by vessel contour labels of specific diameter scale instead of using one general ground truth to train different network layers. In addition, to increase the multi-scale feature representation of retinal blood vessels, we propose the Dense Dilated Convolution Module (DDCM), which extracts retinal vessel features of different diameters by adjusting the dilation rate in the dilated convolution branches and generates two blood vessel contour prediction results by two directions respectively. All dense dilated convolution module outputs are fused to obtain the final vessel segmentation results. Results: We experimented the three datasets of DRIVE, STARE, HRF and CHASE_DB1, and the proposed method reaches accuracy of 0.9846/0.9872/0.9856/0.9889 and AUC of 0.9874/0.9941/0.9882/0.9874 on DRIVE, STARE, HRF and CHASE_DB1.
Conclusions:The experimental results show that compared with the state-of-art methods, the proposed method has strong robustness, it not only avoids the adverse interference of the lesion background but also detects the tiny blood vessels at the intersection accurately.A new study published in the British "Lancet Global Health" predicts that if the treatment of eye diseases is not improved by better funding, the number of blind people worldwide will increase to 115 million by 2050, 2.2 times more than the current 36 million [1]. In fact, Retinal vessel disease in the fundus is one of the vital causes of blindness and many can be prevented in advance by fundus