# The Value of Fractal Analysis in Ultrasound Imaging: Exploring Intricate Patterns
## 3 Results
### Heart and Blood Vessels  
[PERSON] et al. [35] investigated the fractal correlation properties of R-R interval dynamics in asymptomatic relatives of patients with familial dilated cardiomyopathy (DCM). The authors utilized the short-term scaling component from detrended fluctuation analysis to measure heart rate variability (HRV) as a prognostic tool. The study compared 22 asymptomatic relatives with left ventricular enlargement (LVE), 24 DCM patients and 14 controls. The results showed that, while traditional HRV indices, such as the standard deviation of NN intervals (SDNN), were reduced only in DCM patients, the short-term scaling component index was significantly lower in both DCM patients and LVE relatives compared to controls. This suggests that fractal measures may be more sensitive in detecting early autonomic dysfunction in individuals at risk of DCM progression [35]. Looking at blood vessels, [PERSON] et al. [36] showed a new fractal analysis-based technique to quantitatively assess the irregularity of atherosclerotic plaque borders. This method is aimed at improving the prediction of plaque instability and correlating it with cardiovascular risk factors. The study involved 42 asymptomatic subjects with carotid stenosis. Carotid ultrasound evaluations were performed and blood samples were analyzed for lipid profiles, including HDL and triglycerides. Fractal dimension was used as a measure of the complexity and irregularity of the plaque surface and was computed usingthe box-counting via FraLac plugin. The fractal dimension was calculated for the main plaques (mFD) and globally across all plaques (gFD) for each patient [36]. The mean mFD was 1.136 \(\pm\) 0.039 and the mean gFD was 1.145 \(\pm\) 0.039. There was a significant inverse correlation between mFD and plasma HDL levels (r = \(-\)0.367, \(p\) = 0.02) and a positive correlation between mFD and the triglycerides-to-HDL ratio (r = 0.480, \(p\) = 0.002). Fractal dimension showed good reproducibility with high inter- and intra-observer agreement [36]. The study suggested fractal analysis as a feasible and reproducible method for quantifying plaque irregularity, which correlates with lipid profiles, indicating a potential marker for plaque instability [36]. Fractal analysis offers a quantitative and reproducible approach to evaluating plaque irregularity, which correlates with lipid profiles. This technique could aid in the identification of patients at higher risk of cardiovascular events due to plaque instability. In the realm of cardiovascular medicine, the accurate diagnosis of coronary artery stenosis is pivotal for the effective management of patients with ischemic heart disease. [PERSON] et al. [37] explored the diagnostic performance of intravascular ultrasound-based fractional flow reverse (IVUS-FFR) analysis utilizing a generative adversarial network (GAN) and bifurcation fractal law. The study was conducted with a retrospective design, including data from 87 patients with 108 vessels. The participants underwent both IVUS and invasive FFR measurements. The IVUS-FFR analysis was performed by analysts blinded to the invasive FFR values. The methodology involved segmentation of IVUS images using GAN (SegAN), followed by an IVUS-FFR calculation considering side branch flow through bifurcation fractal law [37]. The IVUS-FFR calculation, conducted in several steps, involved extracting the vessel's centerline and cross-sectional area, splitting the centerline into segments, detecting stenosis and solving the Navier-Stokes equations to determine pressure distribution [37]. The bifurcation fractal law, specifically the HK model, was used to account for side branch blood flow, enhancing the accuracy of the single-tube coronary artery model. The study highlighted the effectiveness of IVUS-FFR analysis using SegAN for IVUS image segmentation and the bifurcation fractal law for side branch blood flow consideration. This method not only aligns well with invasive FFR but also reduces computation time, making it a viable alternative to traditional methods [37].