Anatomical Image Information Research Articles

It is not appropriate to “deform” dose along with deformable image registration in adaptive radiotherapy

It is not appropriate to “deform” dose along with deformable image registration in adaptive radiotherapy

Development and evaluation of a dual-modality (MRI/SPECT) molecular imaging bioprobe

Specific bioprobes for single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI) have enormous potential for use in cancer imaging in near-future clinical settings. The authors describe the development of dual modality molecular imaging bioprobes, in the form of magnetic nanoparticles (NPs) conjugated to antibodies, for SPECT and MRI of mesothelin-expressing cancers. The bioprobes were developed by conjugating 111In labeled antimesothelin antibody mAbMB to superparamagnetic iron oxide NPs. Our experimental findings provide evidence that such bioprobes retain their magnetic properties as well as the ability to specifically localize in mesothelin-expressing tumors. It is anticipated that combining SPECT with MR will help obtain both functional and anatomical imaging information with high signal sensitivity and contrast, thereby providing a powerful diagnostic tool for early diagnosis and treatment planning of mesothelin-expressing cancers. From the Clinical EditorThis team of investigators presents a dual-modality functionalized contrast material that enables tumor visualization both via MRI and SPECT. Similar systems are likely to be utilized in future cancer research.

The future of hybrid imaging—part 3: PET/MR, small-animal imaging and beyond

Since the 1990s, hybrid imaging by means of software and hardware image fusion alike allows the intrinsic combination of functional and anatomical image information. This review summarises in three parts the state of the art of dual-technique imaging with a focus on clinical applications. We will attempt to highlight selected areas of potential improvement of combined imaging technologies and new applications. In this third part, we discuss briefly the origins of combined positron emission tomography (PET)/magnetic resonance imaging (MRI). Unlike PET/computed tomography (CT), PET/MRI started out from developments in small-animal imaging technology, and, therefore, we add a section on advances in dual- and multi-modality imaging technology for small animals. Finally, we highlight a number of important aspects beyond technology that should be addressed for a sustained future of hybrid imaging. In short, we predict that, within 10 years, we may see all existing multi-modality imaging systems in clinical routine, including PET/MRI. Despite the current lack of clinical evidence, integrated PET/MRI may become particularly important and clinically useful in improved therapy planning for neurodegenerative diseases and subsequent response assessment, as well as in complementary loco-regional oncology imaging. Although desirable, other combinations of imaging systems, such as single-photon emission computed tomography (SPECT)/MRI may be anticipated, but will first need to go through the process of viable clinical prototyping. In the interim, a combination of PET and ultrasound may become available. As exciting as these new possible triple-technique—imaging systems sound, we need to be aware that they have to be technologically feasible, applicable in clinical routine and cost-effective.

The future of hybrid imaging—part 2: PET/CT

Since the 1990s, hybrid imaging by means of software and hardware image fusion alike allows the intrinsic combination of functional and anatomical image information. This review summarises the state-of-the-art of dual-modality imaging with a focus on clinical applications. We highlight selected areas for potential improvement of combined imaging technologies and new applications. In the second part, we briefly review the background of dual-modality PET/CT imaging, discuss its main applications and attempt to predict technological and methodological improvements of combined PET/CT imaging. After a decade of clinical evaluation, PET/CT will continue to have a significant impact on patient management, mainly in the area of oncological diseases. By adopting more innovative acquisition schemes and data processing PET/CT will become a fast and dose-efficient imaging method and an integral part of state-of-the-art clinical patient management.

The future of hybrid imaging—part 1: hybrid imaging technologies and SPECT/CT

Since the 1990s, hybrid imaging by means of software and hardware image fusion alike allows the intrinsic combination of functional and anatomical image information. This review summarises in three parts the state-of-the-art of dual-technique imaging, with a focus on clinical applications. We will attempt to highlight selected areas of potential improvement of combined imaging technologies and new applications. In this first part, we briefly review the origins of hybrid imaging and comment on the status and future development of single photon emission tomography (SPECT)/computed tomography (CT). In short, we could predict that, within 10 years, we may see all existing dual-technique imaging systems, including SPECT/CT, in clinical routine use worldwide. SPECT/CT, in particular, may evolve into a whole-body imaging technique with supplementary use in dosimetry applications.

Assessment of pulmonary veins after atrio-pericardial anastomosis by cardiovascular magnetic resonance.

BackgroundThe atrio-pericardial anastomosis (APA) uses a pericardial pouch to create a large communication between the left atrium and the pulmonary venous contributaries in order to avoid direct suturing of the pulmonary veins during the repair of congenital cardiac malformations. Post-operative imaging is routinely performed by echocardiography but Cardiovascular Magnetic Resonance (CMR) offers excellent anatomical imaging and quantitative information about pulmonary blood flow. We sought to compare the diagnostic value of echocardiography and CMR for assessing pulmonary vein anatomy after the APA.MethodsThis retrospective study evaluated all consecutive patients between October 1998 and January 2010 after either a primary or secondary APA followed by post-repair CMR.ResultsOf 103 patients who had an APA, 31 patients had an analyzable CMR study. The average time to CMR was 24.6 ± 32.5 months post-repair. Echocardiographic findings were confirmed by CMR in 12 patients. There was incomplete imaging by echocardiography in 7 patients and underestimation of pulmonary vein restenosis in 12, when compared to CMR. In total, 19/31 patients (61%) from our cohort had significant stenosis following the APA as assessed by CMR. Our data suggest that at least 18% (19/103) of all patients had significant obstruction post-repair.ConclusionsEchocardiography incompletely imaged or underestimated the severity of obstruction in patients compared with CMR. Pulmonary vein stenosis remains a sizable complication after repair, even using the APA.

O-002 Acute stroke treatment: without time limitations

BackgroundMany new stroke trials are evaluating the utility of perfusion imaging for patient selection within certain time constraints. There is evidence that patients with a delayed (>12 h) clinical–diffusion mismatch...

Imaging Prostate Cancer: An Update on Positron Emission Tomography and Magnetic Resonance Imaging

Prostate cancer is a common cancer in men and continues to be a major health problem. Imaging plays an essential role in the clinical management of patients. An important goal for prostate cancer imaging is more accurate disease characterization through the synthesis of anatomic, functional, and molecular imaging information. Developments in imaging technologies, specifically magnetic resonance imaging (MRI) and positron emission tomography (PET)/computed tomography (CT), have improved the detection rate of prostate cancer. MRI has improved lesion detection and local staging. Furthermore, MRI allows functional assessment with techniques such as diffusion-weighted MRI, MR spectroscopy, and dynamic contrast-enhanced MRI. The most common PET radiotracer, (18)F-fluorodeoxyglucose, is not very useful in prostate cancer. However, in recent years other PET tracers have improved the accuracy of PET/CT imaging of prostate cancer. Among these, choline (labeled with (18)F or (11)C), (11)C-acetate, and (18)F-fluoride have demonstrated promising results, and other new radiopharmaceuticals are currently under evaluation in preclinical and clinical studies.

Using inverse electrocardiography to image myocardial infarction—reflecting on the 2007 PhysioNet/Computers in Cardiology Challenge

The goal of the 2007 PhysioNet/Computers in Cardiology Challenge was to try to establish how well it is possible to characterize the location and extent of old myocardial infarcts using electrocardiographic evidence supplemented by anatomical imaging information. A brief overview of the challenge and how different challengers approached the competition is provided, followed by detailed response of the first author to integrate electrophysiologic and anatomical data. The first author used the provided 120-electrode body-surface potential mapping data and magnetic resonance imaging heart and torso images to calculate epicardial potentials on customized ventricular geometries. A method was developed to define the location and extent of scar tissue based on the morphology of computed epicardial electrograms. Negative Q-wave deflection followed by R-wave on the left ventricular surface seemed to correspond with the location of the scar as determined by the gadolinium-enhanced magnetic resonance imaging gold standard in the supplied data sets. The method shows promising results as a noninvasive imaging tool to quantitatively characterize chronic infarcts and warrants further investigation on a larger patient data set.

TU‐C‐332‐04: Pilot Patient Studies Using a Dedicated Dual‐Modality SPECT‐CT System for Breast Imaging

Purpose: Acknowledging the limitations/discomfort of mammography has inspired the development of a dedicated SPECT‐CT system to detect breast cancer, monitor therapeutic responses, and improve patient comfort. This system provides semi‐quantitative 3D functional/anatomical imaging of a pendant, uncompressed breast. Fused images can potentially provide more valuable clinical information than independent systems alone. Method and Materials: The SPECT subsystem permits fully‐3D complex acquisition trajectories around the breast, avoiding physical hindrances, overcoming distortions due to inadequate sampling, and allowing lesion detection on the chest wall. The CT subsystem, restricted to circular rotation, uses a quasi‐monochromatic, cone‐beam x‐ray source, which allows for reduced radiation dose and increased contrast between similar soft tissue attenuation coefficients. With no breast compression and an open, common field‐of‐view geometry system, the patient lies prone on a customized patient bed while the hybrid device non‐invasively acquires 3D data underneath. A preliminary investigation on the clinical performance of the hybrid system was done by imaging women with biopsy confirmed breast cancer Results: SPECT patient images can clearly visualize the tracer uptake by the tumor and view into the chest wall. Physical system constraints limit chest wall visualization in the CT patient images and thus patient positioning is under modification. Eliminating overlapping tissues through 3D imaging, the CT images improve lesion isolation versus 2D imaging modalities. Complementary functional and anatomical image information helps localize suspicious areas for subsequent analysis. Conclusion: Implementation of the world's first dedicated SPECT‐CT system promises greatly improved visualization of the 3D breast volume. Complementary information from functional and anatomical imaging can guide lesion localization for subsequent analysis. Conflict of Interest: MPT is an inventor of this technology, and is named as an inventor on the patent for this technology applied for by Duke. If this technology becomes commercially successful, he and Duke could benefit financially.

Imaging Prostate Cancer: A Multidisciplinary Perspective

The major goal for prostate cancer imaging in the next decade is more accurate disease characterization through the synthesis of anatomic, functional, and molecular imaging information. No consensus exists regarding the use of imaging for evaluating primary prostate cancers. Ultrasonography is mainly used for biopsy guidance and brachytherapy seed placement. Endorectal magnetic resonance (MR) imaging is helpful for evaluating local tumor extent, and MR spectroscopic imaging can improve this evaluation while providing information about tumor aggressiveness. MR imaging with superparamagnetic nanoparticles has high sensitivity and specificity in depicting lymph node metastases, but guidelines have not yet been developed for its use, which remains restricted to the research setting. Computed tomography (CT) is reserved for the evaluation of advanced disease. The use of combined positron emission tomography/CT is limited in the assessment of primary disease but is gaining acceptance in prostate cancer treatment follow-up. Evidence-based guidelines for the use of imaging in assessing the risk of distant spread of prostate cancer are available. Radionuclide bone scanning and CT supplement clinical and biochemical evaluation (prostate-specific antigen [PSA], prostatic acid phosphate) for suspected metastasis to bones and lymph nodes. Guidelines for the use of bone scanning (in patients with PSA level > 10 ng/mL) and CT (in patients with PSA level > 20 ng/mL) have been published and are in clinical use. Nevertheless, changes in practice patterns have been slow. This review presents a multidisciplinary perspective on the optimal role of modern imaging in prostate cancer detection, staging, treatment planning, and follow-up.

Integrated structural and functional optical imaging combining spectral-domain optical coherence and multiphoton microscopy

An integrated microscope that combines different optical techniques for simultaneous imaging is demonstrated. The microscope enables spectral-domain optical coherence microscopy based on optical backscatter, and multiphoton microscopy for the detection of two-photon fluorescence and second harmonic generation signals. The unique configuration of this integrated microscope allows for the simultaneous acquisition of both anatomical (structural) and functional imaging information with particular emphasis for applications in the fields of tissue engineering and cell biology. In addition, the contemporary analysis of the spectroscopic features can enhance contrast by differentiating among different tissue components.

Magnetic source imaging and reactivity to rhythmical stimulation in tuberous sclerosis

The present study combined functional magnetoencephalography (MEG) and anatomical magnetic resonance imaging (MRI) information in three patients affected by tuberous sclerosis and partial epilepsy. MEG recordings were performed during both spontaneous and visual evoked activity. The former showed a large variety of complexes whose spatial and temporal distribution suggested different neuronal populations acting simultaneously in the same focal district. When these data were integrated with MRI images (magnetic source imaging, MSI) there was agreement in the definition of tubers and extension of the epileptogenic area. Furthermore, cortical reactivity to rhythmical stimulation was studied with trains of visual stimuli according to a recently proposed frequency responsiveness procedure (FRP). As compared to normal controls, a large 6 Hz activity was observed during the pause after a non-resonant stimulation. This altered resonance property may indicate a disturbed primary sensory processing notwithstanding a preserved associated processing. These results show that neuronal malfunctioning in tuberous sclerosis complex patients may not be restricted to the area of cortical tubers, but can also affect functionally correlated regions.

CT measurements of capillary permeability within nodal masses: a potential technique for assessing the activity of lymphoma.

Analysis of time-attenuation data has enabled CT to measure capillary permeability within the brain and kidney. As yet, such techniques have not been applied to nodal masses in patients with lymphoma. Tumour angiogenesis is known to produce capillaries that exhibit increased permeability and CT measurements of permeability could therefore potentially provide a marker of tumour viability. This study aims to determine the feasibility and limitations of CT measurement of capillary permeability within lymphoma nodal masses. Six patients with biopsy proven lymphoma have been studied. Time-attenuation curves from the aorta and nodal mass were generated from a single-location dynamic sequence of images acquired over 3 min following an intravenous bolus of iopamidol. A nuclear medicine data processing technique, Patlak analysis, was used to calculate capillary permeability and blood volume within the nodal mass. Renal blood vessel permeability was also determined in four patients. Median lymph node permeability to iopamidol was 88.5 microliters min-1 ml-1 (range 36.4-198.5 microliters min-1 ml-1). The correlation coefficient of the linear fit for the Patlak analysis ranged from 0.74 to 0.95 and was greater than 0.9 for regions of interest of 150 pixels or more (256 x 256 matrix). The values for renal permeability (442 microliters min-1 ml-1; range: 349-589 microliters min-1 ml-1) were comparable to those previously reported. Functional images of permeability were also obtained. The study has confirmed the feasibility of CT measurements of capillary permeability within nodal masses. The technique combines anatomical imaging and functional information within one examination and has potential application in monitoring the response of lymphoma to therapy.

医用画像からの運動器系軟部組織の抽出支援技術

An automatic segmentation method of locomotor organs and soft tissues, bones, muscular tissues and joint disc from medical images has been required in the field of plastic surgery and biomechanics. For this purpose, a region-growing method was used generally. In the general region-growing method, a core grows to add a homogeneous pixel judged from its features (edge, intensity and so on) based on image information. However, the bones and tissues in the medical images of the joint are not always extracted by a region-growing method based on only image information. A geometric model of the tissues should not be used for this purpose, because a number of locomotor organs exist and we cannot prepare models for all the tissues. Thus, we improve the conventional region-growing method by using not only image information but also anatomical features of the tissues. The bones and other tissues are extracted by the present method without geometric models. The shape of the core is determined from the core of the previous image because of spatial continuity of the tissues. Next, the core position is estimated roughly in the limitation area as follows: A template pattern of the core was obtained from the previous image, and the core position in the present image was determined by template-matching. The template-matching was performed in the limitation area that was determined by structural features of the bone and the tissues. As a result, estimated core position corresponds to the best matching position of the template pattern obtained from the previous image. When there is continuity of the tissue shape between the cross-section images, the pixel adjoining the core is judged to either add to the core or not by using following anatomical features: location of the tissue (range from the core), complexity of the shape (perimeter/area) and size (area). These anatomical features are described in fuzzy rules and the judgment was performed by the anatomical features and image information using fuzzy reasoning method. In the ideal case, manual digitization of the tissues was required only at the first of the cross-section images. In reality, the region segmented by the present method was not always suitable. If the segmented region was unsuitable, redigitization was required. Using the present method, intereosseous membrane was segmented from coronal MR images of forearms, and the movements of the articular disc were obtained from a temporal series of sagittal MR images. The segmented shapes by this method agreed with the shape segmented by a medical doctor. Three-dimensional shapes of the intereosseous membrane in supination and pronation were obtained from the segmented region. As a result, it was found that the present method would be a new method of measuring of joint detail motion for biomechanics.

Digital portal image registration by sequential anatomical matchpoint and image correlations for real‐time continuous field alignment verification

Detection of radiotherapy field misalignments with electronic portal imaging devices requires the precise initial registration of the digital portal image with a reference image indicating the prescribed field alignment. Moreover, for real-time continuous detection this registration must be performed rapidly--arguably within 250 ms. The quality of this registration is sensitive to the ability of the user to accurately identify corresponding anatomical landmarks in the image pair. To improve the accuracy of the registration and, ultimately, that of the field misalignment measurement, we have developed a sequential digital portal image registration method using both user-identified anatomical matchpoints and image information. A first pass generates registration parameters from user-provided matchpoint coordinates and explicitly accounts for the uncertainty in matchpoint identification. The second pass uses both the initial registration parameters and image information to further improve the registration quality by maximizing cross correlations between segments of the image pair. As this registration method does not use massive matrix/vector computations common to other algorithms, it is inherently faster and well-suited for real-time field placement error detection. On a platform representative of those controlling many commercial electronic portal imaging devices (486 CPU), this algorithm registers portal images in times of less than 6 ms per matchpoint with errors of less than 2% in magnification, 0.5 degree in in-plane rotation, and less than 1 pixel dimension in in-plane translation. As the algorithm assumes a rigid-body geometry, it is sensitive to out-of-plane rotations. A quantitative analysis of this algorithm is presented, indicates its accuracy, and describes its sensitivity to out-of-plane rotations.