Purpose: Radiologists exhibit wide inter-reader variability in diagnostic performance. This work aimed to compare different feature sets to predict if a radiologist could detect a specific liver metastasis in contrast-enhanced computed tomography (CT) images and to evaluate possible improvements in individualizing models to specific radiologists.Approach: Abdominal CT images from 102 patients, including 124 liver metastases in 51 patients were reconstructed at five different kernels/doses using projection domain noise insertion to yield 510 image sets. Ten abdominal radiologists marked suspected metastases in all image sets. Potentially salient features predicting metastasis detection were identified in three ways: (i) logistic regression based on human annotations (semantic), (ii) random forests based on radiologic features (radiomic), and (iii) inductive derivation using convolutional neural networks (CNN). For all three approaches, generalized models were trained using metastases that were detected by at least two radiologists. Conversely, individualized models were trained using each radiologist’s markings to predict reader-specific metastases detection.Results: In fivefold cross-validation, both individualized and generalized CNN models achieved higher area under the receiver operating characteristic curves (AUCs) than semantic and radiomic models in predicting reader-specific metastases detection ability (p < 0.001). The individualized CNN with an AUC of mean (SD) 0.85(0.04) outperformed the generalized one [AUC = 0.78 ( 0.06 ) , p = 0.004]. The individualized semantic [AUC = 0.70 ( 0.05 ) ] and radiomic models [AUC = 0.68 ( 0.06 ) ] outperformed the respective generalized versions [semantic AUC = 0.66 ( 0.03 ) , p = 0.009; radiomic AUC = 0.64 ( 0.06 ) , p = 0.03].Conclusions: Individualized models slightly outperformed generalized models for all three feature sets. Inductive CNNs were better at predicting metastases detection than semantic or radiomic features. Generalized models have implementation advantages when individualized data are unavailable.
Automated lung parenchymal classification usually relies on supervised learning of expert chosen regions representative of the visually differentiable HRCT patterns specific to different pathologies (eg. emphysema, ground glass, honey combing, reticular and normal). Considering the elusiveness of a single most discriminating similarity measure, a plurality of weak learners can be combined to improve the machine learnability. Though a number of quantitative combination strategies exist, their efficacy is data and domain dependent. In this paper, we investigate multiple (N=12) quantitative consensus approaches to combine the clusters obtained with multiple (n=33) probability density-based similarity measures. Our study shows that hypergraph based meta-clustering and probabilistic clustering provides optimal expert-metric agreement.
Geometric analysis of the left atrium and pulmonary veins is important for studying reverse structural remodeling
following cardiac ablation therapy. It has been shown that the left atrium decreases in volume and the pulmonary
vein ostia decrease in diameter following ablation therapy. Most analysis techniques, however, require laborious
manual tracing of image cross-sections. Pulmonary vein diameters are typically measured at the junction between
the left atrium and pulmonary veins, called the pulmonary vein ostia, with manually drawn lines on volume
renderings or on image cross-sections. In this work, we describe a technique for making semi-automatic measurements
of the left atrium and pulmonary vein ostial diameters from high resolution CT scans and multi-phase
datasets. The left atrium and pulmonary veins are segmented from a CT volume using a 3D volume approach
and cut planes are interactively positioned to separate the pulmonary veins from the body of the left atrium.
The cut plane is also used to compute the pulmonary vein ostial diameter. Validation experiments are presented
which demonstrate the ability to repeatedly measure left atrial volume and pulmonary vein diameters from high
resolution CT scans, as well as the feasibility of this approach for analyzing dynamic, multi-phase datasets. In
the high resolution CT scans the left atrial volume measurements show high repeatability with approximately
4% intra-rater repeatability and 8% inter-rater repeatability. Intra- and inter-rater repeatability for pulmonary
vein diameter measurements range from approximately 2 to 4 mm. For the multi-phase CT datasets, differences
in left atrial volumes between a standard slice-by-slice approach and the proposed 3D volume approach are small,
with percent differences on the order of 3% to 6%.
Denoising is a critical preconditioning step for quantitative analysis of medical images. Despite promises for more
consistent diagnosis, denoising techniques are seldom explored in clinical settings. While this may be attributed
to the esoteric nature of the parameter sensitve algorithms, lack of quantitative measures on their ecacy to
enhance the clinical decision making is a primary cause of physician apathy. This paper addresses this issue
by exploring the eect of denoising on the integrity of supervised lung parenchymal clusters. Multiple Volumes
of Interests (VOIs) were selected across multiple high resolution CT scans to represent samples of dierent
patterns (normal, emphysema, ground glass, honey combing and reticular). The VOIs were labeled through
consensus of four radiologists. The original datasets were ltered by multiple denoising techniques (median
ltering, anisotropic diusion, bilateral ltering and non-local means) and the corresponding ltered VOIs were
extracted. Plurality of cluster indices based on multiple histogram-based pair-wise similarity measures were used
to assess the quality of supervised clusters in the original and ltered space. The resultant rank orders were
analyzed using the Borda criteria to nd the denoising-similarity measure combination that has the best cluster
quality. Our exhaustive analyis reveals (a) for a number of similarity measures, the cluster quality is inferior
in the ltered space; and (b) for measures that benet from denoising, a simple median ltering outperforms
non-local means and bilateral ltering. Our study suggests the need to judiciously choose, if required, a denoising
technique that does not deteriorate the integrity of supervised clusters.
Clinicians confirm the efficacy of dynamic multidisciplinary interactions in diagnosing Lung disease/wellness from
CT scans. However, routine clinical practice cannot readily accomodate such interactions. Current schemes for
automating lung tissue classification are based on a single elusive disease differentiating metric; this undermines
their reliability in routine diagnosis. We propose a computational workflow that uses a collection (#: 15) of
probability density functions (pdf)-based similarity metrics to automatically cluster pattern-specific (#patterns:
5) volumes of interest (#VOI: 976) extracted from the lung CT scans of 14 patients. The resultant clusters are
refined for intra-partition compactness and subsequently aggregated into a super cluster using a cluster ensemble
technique. The super clusters were validated against the consensus agreement of four clinical experts. The
aggregations correlated strongly with expert consensus. By effectively mimicking the expertise of physicians, the
proposed workflow could make automation of lung tissue classification a clinical reality.
Radiologists are adept at recognizing the appearance of lung parenchymal abnormalities in CT scans. However,
the inconsistent differential diagnosis, due to subjective aggregation, mandates supervised classification. Towards
optimizing Emphysema classification, we introduce a physician-in-the-loop feedback approach in order to minimize
uncertainty in the selected training samples. Using multi-view inductive learning with the training samples,
an ensemble of Support Vector Machine (SVM) models, each based on a specific pair-wise dissimilarity metric,
was constructed in less than six seconds. In the active relearning phase, the ensemble-expert label conflicts were
resolved by an expert. This just-in-time feedback with unoptimized SVMs yielded 15% increase in classification
accuracy and 25% reduction in the number of support vectors. The generality of relearning was assessed in the
optimized parameter space of six different classifiers across seven dissimilarity metrics. The resultant average
accuracy improved to 21%. The co-operative feedback method proposed here could enhance both diagnostic and
staging throughput efficiency in chest radiology practice.
The goal of Lung Tissue Resource Consortium (LTRC) is to improve the management of diffuse lung diseases through a
better understanding of the biology of Chronic Obstructive Pulmonary Disease (COPD) and fibrotic interstitial lung
disease (ILD) including Idiopathic Pulmonary Fibrosis (IPF). Participants are subjected to a battery of tests including
tissue biopsies, physiologic testing, clinical history reporting, and CT scanning of the chest. The LTRC is a repository
from which investigators can request tissue specimens and test results as well as semi-quantitative radiology reports,
pathology reports, and automated quantitative image analysis results from the CT scan data performed by the LTRC core
laboratories. The LTRC Radiology Core Laboratory (RCL), in conjunction with the Biomedical Imaging Resource
(BIR), has developed novel processing methods for comprehensive characterization of pulmonary processes on
volumetric high-resolution CT scans to quantify how these diseases manifest in radiographic images. Specifically, the
RCL has implemented a semi-automated method for segmenting the anatomical regions of the lungs and airways. In
these anatomic regions, automated quantification of pathologic features of disease including emphysema volumes and
tissue classification are performed using both threshold techniques and advanced texture measures to determine the
extent and location of emphysema, ground glass opacities, "honeycombing" (HC) and "irregular linear" or "reticular"
pulmonary infiltrates and normal lung. Wall thickness measurements of the trachea, and its branches to the 3rd and
limited 4th order are also computed. The methods for processing, segmentation and quantification are described. The
results are reviewed and verified by an expert radiologist following processing and stored in the public LTRC database
for use by pulmonary researchers. To date, over 1200 CT scans have been processed by the RCL and the LTRC project
is on target for recruitment of the 2200 patients with 1800 CT scans in the repository for the 5-year effort. Ongoing
analysis of the results in the LTRC database by the LTRC participating institutions and outside investigators are
underway to look at the clinical and physiological significance of the imaging features of these diseases and correlate
these findings with quality of life and other important prognostic indicators of severity. In the future, the quantitative
measures of disease may have greater utility by showing correlation with prognosis, disease severity and other
physiological parameters. These imaging features may provide non-invasive alternative endpoints or surrogate markers
to alleviate the need for tissue biopsy or provide an accurate means to monitor rate of disease progression or response to
therapy.
Idiopathic pulmonary fibrosis (IPF, also known as Idiopathic Usual Interstitial Pneumontis, pathologically) is a progressive diffuse lung disease which has a median survival rate of less than four years with a prevalence of 15-20/100,000 in the United States. Global function changes are measured by pulmonary function tests and the diagnosis and extent of pulmonary structural changes are typically assessed by acquiring two-dimensional high resolution CT (HRCT) images. The acquisition and analysis of volumetric high resolution Multi-Detector CT (MDCT) images with nearly isotropic pixels offers the potential to measure both lung function and structure. This paper presents a new approach to three dimensional lung image analysis and classification of normal and abnormal structures in lungs with IPF.
Chronic obstructive pulmonary diseases (COPD) are debilitating conditions of the lung and are the fourth leading cause of death in the United States. Early diagnosis is critical for timely intervention and effective treatment. The ability to quantify particular imaging features of specific pathology and accurately assess progression or response to treatment with current imaging tools is relatively poor. The goal of this project was to develop automated segmentation techniques that would be clinically useful as computer assisted diagnostic tools for COPD. The lungs were segmented using an optimized segmentation threshold and the trachea was segmented using a fixed threshold characteristic of air. The segmented images were smoothed by a morphological close operation using spherical elements of different sizes. The results were compared to other segmentation approaches using an optimized threshold to segment the trachea. Comparison of the segmentation results from 10 datasets showed that the method of trachea segmentation using a fixed air threshold followed by morphological closing with spherical element of size 23x23x5 yielded the best results. Inclusion of greater number of pulmonary vessels in the lung volume is important for the development of computer assisted diagnostic tools because the physiological changes of COPD can result in quantifiable anatomic changes in pulmonary vessels. Using a fixed threshold to segment the trachea removed airways from the lungs to a better extent as compared to using an optimized threshold. Preliminary measurements gathered from patient’s CT scans suggest that segmented images can be used for accurate analysis of total lung volume and volumes of regional lung parenchyma. Additionally, reproducible segmentation allows for quantification of specific pathologic features, such as lower intensity pixels, which are characteristic of abnormal air spaces in diseases like emphysema.
Osteoporosis affects an estimated 44 million Americans. This condition results from bone loss, but the measured change in bone mass does not fully account for the marked decrease in whole-bone structural integrity seen in osteoporosis. In order to study structural changes in bone mineral distribution due to normal ageing and osteoporosis, we have developed a method for progressive analysis of whole-bone mechanical integrity from helical CT images. The system provides rapid semi-automated alignment of femur and vertebrae volume images into standard anatomic reference planes, and calculates bone mineral density in any selected 3D sections of bone. Mineral density measures are obtained using both full-width-half-max contours and threshold-derived masks, and are obtained for cortical bone and trabecular bone separately. Biomechanical properties of the bone cross-section are also assessed, including the 2-D bending moment of the cortical bone region and the integrated flexural rigidity of the cortical region or whole-bone region in arbitrary planes. This method facilitates progressive refinement of the analysis protocol by separating the labor-intensive alignment and landmark selection process from the analysis process. As the analysis protocol evolves to include new measures, previously analyzed images can be automatically reanalyzed, using the image regions originally specified. Initial results show inverse correlation of indices of biomechanical bone strength with age, greater loss of bone strength in the lumbar spine than in the femoral neck, and more trabecular than cortical bone loss at both sites.
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