False Positive Volume Fraction Research Articles

Quantification of body-torso-wide tissue composition on low-dose CT images via automatic anatomy recognition.

Quantification of body composition plays an important role in many clinical and research applications. Radiologic imaging techniques such as Dual-energy X-ray absorptiometry (DXA), magnetic resonance imaging (MRI), and computed tomography (CT) imaging make accurate quantification of the body composition possible. However, most current imaging-based methods need human interaction to quantify multiple tissues. When dealing with whole-body images of many subjects, interactive methods become impractical. This paper presents an automated, efficient, accurate, and practical body composition quantification method for low-dose CT images. Our method, named automatic anatomy recognition body composition analysis (AAR-BCA), aims to quantify four tissue components in body torso (BT) - subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), bone tissue, and muscle tissue - from CT images of given whole-body positron emission tomography/computed tomography (PET/CT) acquisitions. AAR-BCA consists of three key steps - modeling BT with its ensemble of key objects from a population of patient images, recognition or localization of these objects in a given patient image I, and delineation and quantification of the four tissue components in I guided by the recognized objects. In the first step, from a given set of patient images and the associated delineated objects, a fuzzy anatomy model of the key object ensemble, including anatomic organs, tissue regions, and tissue interfaces, is built where the objects are organized in a hierarchical order. The second step involves recognizing, or finding roughly the location of, each object in any given whole-body image I of a patient following the object hierarchy and guided by the built model. The third step makes use of this fuzzy localization information of the objects and the intensity distributions of the four tissue components, already learned and encoded in the model, to optimally delineate in a fuzzy manner and quantify these components. All parameters in our method are determined from training datasets. Thirty-eight low-dose CT images from different subjects are tested in a fivefold cross-validation strategy for evaluating AAR-BCA with a 23-15 train-test dataset division. For BT, over all objects, AAR-BCA achieves a false-positive volume fraction (FPVF) of 3.7% and false-negative volume fraction (FNVF) of 3.8%. Notably, SAT achieves both a FPVF and FNVF under 3%. For bone tissue, it achieves a FPVF and a FNVF both under 3.5%. For VAT tissue, the FNVF of 4.8% is higher than for other objects and so also for muscle (4.7%). The level of accuracy for the four tissue components in individual body subregions mostly remains at the same level as for BT. The processing time required per patient image is under a minute. Motivated by applications in cancer and systemic diseases, our goal in this paper was to seek a practical method for body composition quantification which is automated, accurate, and efficient, and works on BT in low-dose CT. The proposed AAR-BCA method toward this goal can quantify four tissue components including SAT, VAT, bone tissue, and muscle tissue in the body torso with under 5% overall error. All needed parameters can be automatically estimated from the training datasets.

A semi-automatic technique to quantify complex tuberculous lung lesions on 18F-fluorodeoxyglucose positron emission tomography/computerised tomography images

BackgroundThere is a growing interest in the use of 18F-FDG PET-CT to monitor tuberculosis (TB) treatment response. However, TB causes complex and widespread pathology, which is challenging to segment and quantify in a reproducible manner.To address this, we developed a technique to standardise uptake (Z-score), segment and quantify tuberculous lung lesions on PET and CT concurrently, in order to track changes over time. We used open source tools and created a MATLAB script. The technique was optimised on a training set of five pulmonary tuberculosis (PTB) cases after standard TB therapy and 15 control patients with lesion-free lungs.ResultsWe compared the proposed method to a fixed threshold (SUV > 1) and manual segmentation by two readers and piloted the technique successfully on scans of five control patients and five PTB cases (four cured and one failed treatment case), at diagnosis and after 1 and 6 months of treatment. There was a better correlation between the Z-score-based segmentation and manual segmentation than SUV > 1 and manual segmentation in terms of overall spatial overlap (measured in Dice similarity coefficient) and specificity (1 minus false positive volume fraction). However, SUV > 1 segmentation appeared more sensitive. Both the Z-score and SUV > 1 showed very low variability when measuring change over time. In addition, total glycolytic activity, calculated using segmentation by Z-score and lesion-to-background ratio, correlated well with traditional total glycolytic activity calculations. The technique quantified various PET and CT parameters, including the total glycolytic activity index, metabolic lesion volume, lesion volumes at different CT densities and combined PET and CT parameters. The quantified metrics showed a marked decrease in the cured cases, with changes already apparent at month one, but remained largely unchanged in the failed treatment case.ConclusionsOur technique is promising to segment and quantify the lung scans of pulmonary tuberculosis patients in a semi-automatic manner, appropriate for measuring treatment response. Further validation is required in larger cohorts.

Improved graph-cut segmentation for ultrasound liver cyst image

An optimal contour segmentation for ultrasonic liver cyst image is presented through combining graph-based method with particle swarm optimization (PSO) in this paper. After automatic selecting the region of interest (ROI) for ultrasonic liver cyst image, our method developed firstly a kind of multiple classes merging scheme by jointing the graph-based segmented result with the intensity of original ultrasound image. Then the evaluation function in the PSO was modified to optimize the parameter. Finally, the liver cysts were segmented according to the optimized parameter. In the experiment, we tested the influence of weight value on the improved method. And five indicators, which included Hausdorff distance (HD), mean absolute distance (MD), true positive volume fraction (TPVF), false-negative volume fraction (FNVF) and false-positive volume fraction (FPVF), were estimated to verify the improved method. Experimental results have validated that the improved method may extract successfully and accurately the contour of liver cyst.

Fast segmentation of kidney components using random forests and ferns.

This paper studies the feasibility of developing a fast and accurate automatic kidney component segmentation method. The proposed method segments the kidney into four components: renal cortex, renal column, renal medulla, and renal pelvis. In this article, we have proposed a highly efficient approach which strategically combines random forests and random ferns methods to segment the kidney into four components: renal cortex, renal column, renal medulla, and renal pelvis. The proposed method is designed following a coarse-to-fine strategy. The initial segmentation applies random forests and random ferns with a variety of features, and combines their results to obtain a coarse renal cortex region. Then the fine segmentation of four kidney components is achieved using the weighted forests-ferns approach with the well-designed potential energy features which are calculated based on the initial segmentation result. The proposed method was validated on a dataset with 37 contrast-enhanced CT images. Evaluation indices including Dice similarity coefficient (DSC), true positive volume fraction (TPVF), and false positive volume fraction (FPVF) are used to assess the segmentation accuracy. The proposed method was implemented and tested on a 64-bit system computer (Intel Core i7-3770 CPU, 3.4 GHz and 8 GB RAM). The experimental results demonstrated the high accuracy and efficiency for segmenting the kidney components: the mean Dice similarity coefficients were 89.85%, 80.60%, 86.63%, and 77.75% for renal cortex, column, medulla, and pelvis, respectively, for right and left kidneys. The computational time of segmenting the whole kidney into four components was about 3 s. The experimental results showed the feasibility and efficacy of the proposed automatic kidney component segmentation method. The proposed method applied an efficient weighted strategy to combine random forests and ferns, making full use of the advantages of both methods. The novel potential energy features help random forests effectively segment the kidney components and the background. The high accuracy and efficiency of our method make it practicable in clinical applications.

Three-dimensional continuous max flow optimization-based serous retinal detachment segmentation in SD-OCT for central serous chorioretinopathy.

Assessment of serous retinal detachment plays an important role in the diagnosis of central serous chorioretinopathy (CSC). In this paper, we propose an automatic, three-dimensional segmentation method to detect both neurosensory retinal detachment (NRD) and pigment epithelial detachment (PED) in spectral domain optical coherence tomography (SD-OCT) images. The proposed method involves constructing a probability map from training samples using random forest classification. The probability map is constructed from a linear combination of structural texture, intensity, and layer thickness information. Then, a continuous max flow optimization algorithm is applied to the probability map to segment the retinal detachment-associated fluid regions. Experimental results from 37 retinal SD-OCT volumes from cases of CSC demonstrate the proposed method can achieve a true positive volume fraction (TPVF), false positive volume fraction (FPVF), positive predicative value (PPV), and dice similarity coefficient (DSC) of 92.1%, 0.53%, 94.7%, and 93.3%, respectively, for NRD segmentation and 92.5%, 0.14%, 80.9%, and 84.6%, respectively, for PED segmentation. The proposed method can be an automatic tool to evaluate serous retinal detachment and has the potential to improve the clinical evaluation of CSC.

Dual-stage deep learning framework for pigment epithelium detachment segmentation in polypoidal choroidal vasculopathy.

Worldwide, polypoidal choroidal vasculopathy (PCV) is a common vision-threatening exudative maculopathy, and pigment epithelium detachment (PED) is an important clinical characteristic. Thus, precise and efficient PED segmentation is necessary for PCV clinical diagnosis and treatment. We propose a dual-stage learning framework via deep neural networks (DNN) for automated PED segmentation in PCV patients to avoid issues associated with manual PED segmentation (subjectivity, manual segmentation errors, and high time consumption).The optical coherence tomography scans of fifty patients were quantitatively evaluated with different algorithms and clinicians. Dual-stage DNN outperformed existing PED segmentation methods for all segmentation accuracy parameters, including true positive volume fraction (85.74 ± 8.69%), dice similarity coefficient (85.69 ± 8.08%), positive predictive value (86.02 ± 8.99%) and false positive volume fraction (0.38 ± 0.18%). Dual-stage DNN achieves accurate PED quantitative information, works with multiple types of PEDs and agrees well with manual delineation, suggesting that it is a potential automated assistant for PCV management.

Automatic Subretinal Fluid Segmentation of Retinal SD-OCT Images With Neurosensory Retinal Detachment Guided by Enface Fundus Imaging.

Accurate segmentation of neurosensory retinal detachment (NRD) associated subretinal fluid in spectral domain optical coherence tomography (SD-OCT) is vital for the assessment of central serous chorioretinopathy (CSC). A novel two-stage segmentation algorithm was proposed, guided by Enface fundus imaging. In the first stage, Enface fundus image was segmented using thickness map prior to detecting the fluid-associated abnormalities with diffuse boundaries. In the second stage, the locations of the abnormalities were used to restrict the spatial extent of the fluid region, and a fuzzy level set method with a spatial smoothness constraint was applied to subretinal fluid segmentation in the SD-OCT scans. Experimental results from 31 retinal SD-OCT volumes with CSC demonstrate that our method can achieve a true positive volume fraction (TPVF), false positive volume fraction (FPVF), and positive predicative value (PPV) of 94.3%, 0.97%, and 93.6%, respectively, for NRD regions. Our approach can also discriminate NRD-associated subretinal fluid from subretinal pigment epithelium fluid associated with pigment epithelial detachment with a TPVF, FPVF, and PPV of 93.8%, 0.40%, and 90.5%, respectively. We report a fully automatic method for the segmentation of subretinal fluid. Our method shows the potential to improve clinical therapy for CSC.

Interactive iterative relative fuzzy connectedness lung segmentation on thoracic 4D dynamic MR images.

Lung delineation via dynamic 4D thoracic magnetic resonance imaging (MRI) is necessary for quantitative image analysis for studying pediatric respiratory diseases such as thoracic insufficiency syndrome (TIS). This task is very challenging because of the often-extreme malformations of the thorax in TIS, lack of signal from bone and connective tissues resulting in inadequate image quality, abnormal thoracic dynamics, and the inability of the patients to cooperate with the protocol needed to get good quality images. We propose an interactive fuzzy connectedness approach as a potential practical solution to this difficult problem. Manual segmentation is too labor intensive especially due to the 4D nature of the data and can lead to low repeatability of the segmentation results. Registration-based approaches are somewhat inefficient and may produce inaccurate results due to accumulated registration errors and inadequate boundary information. The proposed approach works in a manner resembling the Iterative Livewire tool but uses iterative relative fuzzy connectedness (IRFC) as the delineation engine. Seeds needed by IRFC are set manually and are propagated from slice-to-slice, decreasing the needed human labor, and then a fuzzy connectedness map is automatically calculated almost instantaneously. If the segmentation is acceptable, the user selects "next" slice. Otherwise, the seeds are refined and the process continues. Although human interaction is needed, an advantage of the method is the high level of efficient user-control on the process and non-necessity to refine the results. Dynamic MRI sequences from 5 pediatric TIS patients involving 39 3D spatial volumes are used to evaluate the proposed approach. The method is compared to two other IRFC strategies with a higher level of automation. The proposed method yields an overall true positive and false positive volume fraction of 0.91 and 0.03, respectively, and Hausdorff boundary distance of 2 mm.

A Framework for Classification and Segmentation of Branch Retinal Artery Occlusion in SD-OCT.

Branch retinal artery occlusion (BRAO) is an ocular emergency, which could lead to blindness. Quantitative analysis of the BRAO region in the retina is necessary for the assessment of the severity of retinal ischemia. In this paper, a fully automatic framework was proposed to segment BRAO regions based on 3D spectral-domain optical coherence tomography (SD-OCT) images. To the best of our knowledge, this is the first automatic 3D BRAO segmentation framework. First, the input 3D image is automatically classified into BRAO of acute phase and BRAO of chronic phase or normal retina using an AdaBoost classifier based on combining local structural, intensity, textural features with our new feature distribution analyzing strategy. Then, BRAO regions of acute phase and chronic phase are segmented separately. A thickness model is built to segment BRAO in the chronic phase. While for segmenting BRAO in the acute phase, a two-step segmentation strategy is performed: rough initialization and refine segmentation. The proposed method was tested on SD-OCT images of 35 patients (12 BRAO acute phase, 11 BRAO chronic phase, and 12 normal eyes) using the leave-one-out strategy. The classification accuracy for BRAO acute phase, BRAO chronic phase, and normal retina were 100%, 90.9%, and 91.7%, respectively. The overall true positive volume fraction (TPVF) and false positive volume fraction (FPVF) for the acute phase were 91.1% and 5.5% and for the chronic phase were 92.7% and 8.4%, respectively.

3D Curvelet-Based Segmentation and Quantification of Drusen in Optical Coherence Tomography Images

Spectral-Domain Optical Coherence Tomography (SD-OCT) is a widely used interferometric diagnostic technique in ophthalmology that provides novel in vivo information of depth-resolved inner and outer retinal structures. This imaging modality can assist clinicians in monitoring the progression of Age-related Macular Degeneration (AMD) by providing high-resolution visualization of drusen. Quantitative tools for assessing drusen volume that are indicative of AMD progression may lead to appropriate metrics for selecting treatment protocols. To address this need, a fully automated algorithm was developed to segment drusen area and volume from SD-OCT images. The proposed algorithm consists of three parts: (1) preprocessing, which includes creating binary mask and removing possible highly reflective posterior hyaloid that is used in accurate detection of inner segment/outer segment (IS/OS) junction layer and Bruch’s membrane (BM) retinal layers; (2) coarse segmentation, in which 3D curvelet transform and graph theory are employed to get the possible candidate drusenoid regions; (3) fine segmentation, in which morphological operators are used to remove falsely extracted elongated structures and get the refined segmentation results. The proposed method was evaluated in 20 publically available volumetric scans acquired by using Bioptigen spectral-domain ophthalmic imaging system. The average true positive and false positive volume fractions (TPVF and FPVF) for the segmentation of drusenoid regions were found to be 89.15% ± 3.76 and 0.17% ± .18%, respectively.

A computerized volumetric segmentation method applicable to multi-centre MRI data to support computer-aided breast tissue analysis, density assessment and lesion localization

Density assessment and lesion localization in breast MRI require accurate segmentation of breast tissues. A fast, computerized algorithm for volumetric breast segmentation, suitable for multi-centre data, has been developed, employing 3D bias-corrected fuzzy c-means clustering and morphological operations. The full breast extent is determined on T1-weighted images without prior information concerning breast anatomy. Left and right breasts are identified separately using automatic detection of the midsternum. Statistical analysis of breast volumes from eighty-two women scanned in a UK multi-centre study of MRI screening shows that the segmentation algorithm performs well when compared with manually corrected segmentation, with high relative overlap (RO), high true-positive volume fraction (TPVF) and low false-positive volume fraction (FPVF), and has an overall performance of RO 0.94 ± 0.05, TPVF 0.97 ± 0.03 and FPVF 0.04 ± 0.06, respectively (training: 0.93 ± 0.05, 0.97 ± 0.03 and 0.04 ± 0.06; test: 0.94 ± 0.05, 0.98 ± 0.02 and 0.05 ± 0.07).

Automatic thoracic anatomy segmentation on CT images using hierarchical fuzzy models and registration.

In an attempt to overcome several hurdles that exist in organ segmentation approaches, the authors previously described a general automatic anatomy recognition (AAR) methodology for segmenting all major organs in multiple body regions body-wide [J. K. Udupa et al., "Body-wide hierarchical fuzzy modeling, recognition, and delineation of anatomy in medical images," Med. Image Anal. 18(5), 752-771 (2014)]. That approach utilized fuzzy modeling strategies, a hierarchical organization of organs, and divided the segmentation task into a recognition step to localize organs which was then followed by a delineation step to demarcate the boundary of organs. It achieved speed and accuracy without employing image/object registration which is commonly utilized in many reported methods, particularly atlas-based. In this paper, our aim is to study how registration may influence performance of the AAR approach. By tightly coupling the recognition and delineation steps, by performing registration in the hierarchical order of the organs, and through several object-specific refinements, the authors demonstrate that improved accuracy for recognition and delineation can be achieved by judicial use of image/object registration. The presented approach consists of three processes: model building, hierarchical recognition, and delineation. Labeled binary images for each organ are registered and aligned into a 3D fuzzy set representing the fuzzy shape model for the organ. The hierarchical relation and mean location relation between different organs are captured in the model. The gray intensity distributions of the corresponding regions of the organ in the original image are also recorded in the model. Following the hierarchical structure and location relation, the fuzzy shape model of different organs is registered to the given target image to achieve object recognition. A fuzzy connectedness delineation method is then employed to obtain the final segmentation result of organs with seed points provided by recognition. The authors assess the performance of this method for both nonsparse (compact blob-like) and sparse (thin tubular) objects in the thorax. The results of eight thoracic organs on 30 real images are presented. Overall, the delineation accuracy in terms of mean false positive and false negative volume fractions is 0.34% and 4.02%, respectively, for nonsparse objects, and 0.16% and 12.6%, respectively, for sparse objects. The two object groups achieve mean boundary distance relative to ground truth of 1.31 and 2.28 mm, respectively. The hierarchical structure and location relation integrated into the model provide the initial pose for registration and make the recognition process efficient and robust. The 3D fuzzy model combined with hierarchical affine registration ensures that accurate recognition can be obtained for both nonsparse and sparse organs. Tailoring the registration process for each organ by specialized similarity criteria and updating the organ intensity properties based on refined recognition improve the overall segmentation process.

An automated framework for 3D serous pigment epithelium detachment segmentation in SD-OCT images.

Pigment epithelium detachment (PED) is an important clinical manifestation of multiple chorioretinal diseases, which can cause loss of central vision. In this paper, an automated framework is proposed to segment serous PED in SD-OCT images. The proposed framework consists of four main steps: first, a multi-scale graph search method is applied to segment abnormal retinal layers; second, an effective AdaBoost method is applied to refine the initial segmented regions based on 62 extracted features; third, a shape-constrained graph cut method is applied to segment serous PED, in which the foreground and background seeds are obtained automatically; finally, an adaptive structure elements based morphology method is applied to remove false positive segmented regions. The proposed framework was tested on 25 SD-OCT volumes from 25 patients diagnosed with serous PED. The average true positive volume fraction (TPVF), false positive volume fraction (FPVF), dice similarity coefficient (DSC) and positive predictive value (PPV) are 90.08%, 0.22%, 91.20% and 92.62%, respectively. The proposed framework can provide clinicians with accurate quantitative information, including shape, size and position of the PED region, which can assist clinical diagnosis and treatment.

3D Fast Automatic Segmentation of Kidney Based on Modified AAM and Random Forest.

In this paper, a fully automatic method is proposed to segment the kidney into multiple components: renal cortex, renal column, renal medulla and renal pelvis, in clinical 3D CT abdominal images. The proposed fast automatic segmentation method of kidney consists of two main parts: localization of renal cortex and segmentation of kidney components. In the localization of renal cortex phase, a method which fully combines 3D Generalized Hough Transform (GHT) and 3D Active Appearance Models (AAM) is applied to localize the renal cortex. In the segmentation of kidney components phase, a modified Random Forests (RF) method is proposed to segment the kidney into four components based on the result from localization phase. During the implementation, a multithreading technology is applied to speed up the segmentation process. The proposed method was evaluated on a clinical abdomen CT data set, including 37 contrast-enhanced volume data using leave-one-out strategy. The overall true-positive volume fraction and false-positive volume fraction were 93.15%, 0.37% for renal cortex segmentation; 83.09%, 0.97% for renal column segmentation; 81.92%, 0.55% for renal medulla segmentation; and 80.28%, 0.30% for renal pelvis segmentation, respectively. The average computational time of segmenting kidney into four components took 20 seconds.

Automated 3-D retinal layer segmentation of macular optical coherence tomography images with serous pigment epithelial detachments.

Automated retinal layer segmentation of optical coherence tomography (OCT) images has been successful for normal eyes but becomes challenging for eyes with retinal diseases if the retinal morphology experiences critical changes. We propose a method to automatically segment the retinal layers in 3-D OCT data with serous retinal pigment epithelial detachments (PED), which is a prominent feature of many chorioretinal disease processes. The proposed framework consists of the following steps: fast denoising and B-scan alignment, multi-resolution graph search based surface detection, PED region detection and surface correction above the PED region. The proposed technique was evaluated on a dataset with OCT images from 20 subjects diagnosed with PED. The experimental results showed the following. 1) The overall mean unsigned border positioning error for layer segmentation is 7.87±3.36 μm , and is comparable to the mean inter-observer variability ( 7.81±2.56 μm). 2) The true positive volume fraction (TPVF), false positive volume fraction (FPVF) and positive predicative value (PPV) for PED volume segmentation are 87.1%, 0.37%, and 81.2%, respectively. 3) The average running time is 220 s for OCT data of 512 × 64 × 480 voxels.

Body-wide hierarchical fuzzy modeling, recognition, and delineation of anatomy in medical images.

To make Quantitative Radiology (QR) a reality in radiological practice, computerized body-wide Automatic Anatomy Recognition (AAR) becomes essential. With the goal of building a general AAR system that is not tied to any specific organ system, body region, or image modality, this paper presents an AAR methodology for localizing and delineating all major organs in different body regions based on fuzzy modeling ideas and a tight integration of fuzzy models with an Iterative Relative Fuzzy Connectedness (IRFC) delineation algorithm. The methodology consists of five main steps: (a) gathering image data for both building models and testing the AAR algorithms from patient image sets existing in our health system; (b) formulating precise definitions of each body region and organ and delineating them following these definitions; (c) building hierarchical fuzzy anatomy models of organs for each body region; (d) recognizing and locating organs in given images by employing the hierarchical models; and (e) delineating the organs following the hierarchy. In Step (c), we explicitly encode object size and positional relationships into the hierarchy and subsequently exploit this information in object recognition in Step (d) and delineation in Step (e). Modality-independent and dependent aspects are carefully separated in model encoding. At the model building stage, a learning process is carried out for rehearsing an optimal threshold-based object recognition method. The recognition process in Step (d) starts from large, well-defined objects and proceeds down the hierarchy in a global to local manner. A fuzzy model-based version of the IRFC algorithm is created by naturally integrating the fuzzy model constraints into the delineation algorithm. The AAR system is tested on three body regions - thorax (on CT), abdomen (on CT and MRI), and neck (on MRI and CT) - involving a total of over 35 organs and 130 data sets (the total used for model building and testing). The training and testing data sets are divided into equal size in all cases except for the neck. Overall the AAR method achieves a mean accuracy of about 2 voxels in localizing non-sparse blob-like objects and most sparse tubular objects. The delineation accuracy in terms of mean false positive and negative volume fractions is 2% and 8%, respectively, for non-sparse objects, and 5% and 15%, respectively, for sparse objects. The two object groups achieve mean boundary distance relative to ground truth of 0.9 and 1.5 voxels, respectively. Some sparse objects - venous system (in the thorax on CT), inferior vena cava (in the abdomen on CT), and mandible and naso-pharynx (in neck on MRI, but not on CT) - pose challenges at all levels, leading to poor recognition and/or delineation results. The AAR method fares quite favorably when compared with methods from the recent literature for liver, kidneys, and spleen on CT images. We conclude that separation of modality-independent from dependent aspects, organization of objects in a hierarchy, encoding of object relationship information explicitly into the hierarchy, optimal threshold-based recognition learning, and fuzzy model-based IRFC are effective concepts which allowed us to demonstrate the feasibility of a general AAR system that works in different body regions on a variety of organs and on different modalities.

Computerized tongue image segmentation via the double geo-vector flow.

BackgroundVisual inspection for tongue analysis is a diagnostic method in traditional Chinese medicine (TCM). Owing to the variations in tongue features, such as color, texture, coating, and shape, it is difficult to precisely extract the tongue region in images. This study aims to quantitatively evaluate tongue diagnosis via automatic tongue segmentation.MethodsExperiments were conducted using a clinical image dataset provided by the Laboratory of Traditional Medical Syndromes, Shanghai University of TCM. First, a clinical tongue image was refined by a saliency window. Second, we initialized the tongue area as the upper binary part and lower level set matrix. Third, a double geo-vector flow (DGF) was proposed to detect the tongue edge and segment the tongue region in the image, such that the geodesic flow was evaluated in the lower part, and the geo-gradient vector flow was evaluated in the upper part.ResultsThe performance of the DGF was evaluated using 100 images. The DGF exhibited better results compared with other representative studies, with its true-positive volume fraction reaching 98.5%, its false-positive volume fraction being 1.51%, and its false-negative volume fraction being 1.42%. The errors between the proposed automatic segmentation results and manual contours were 0.29 and 1.43% in terms of the standard boundary error metrics of Hausdorff distance and mean distance, respectively.ConclusionsBy analyzing the time complexity of the DGF and evaluating its performance via standard boundary and area error metrics, we have shown both efficiency and effectiveness of the DGF for automatic tongue image segmentation.

A framework to measure myocardial extracellular volume fraction using dual‐phase low dose CT images

Myocardial extracellular volume fraction (ECVF) is a surrogate imaging biomarker of diffuse myocardial fibrosis, a hallmark of pathologic ventricular remodeling. Low dose cardiac CT is emerging as a promising modality to detect diffuse interstitial myocardial fibrosis due to its fast acquisition and low radiation; however, the insufficient contrast in the low dose CT images poses great challenge to measure ECVF from the image. To deal with this difficulty, the authors present a complete ECVF measurement framework including a point-guided myocardial modeling, a deformable model-based myocardium segmentation, nonrigid registration of pre- and post-CT, and ECVF calculation. The proposed method was evaluated on 20 patients by two observers. Compared to the manually delineated reference segmentations, the accuracy of our segmentation in terms of true positive volume fraction (TPVF), false positive volume fraction (FPVF), and average surface distance (ASD), were 92.18% ± 3.52%, 0.31% ± 0.10%, 0.69 ± 0.14 mm, respectively. The interobserver variability measured by concordance correlation coefficient regarding TPVF, FPVF, and ASD were 0.95, 0.90, 0.94, respectively, demonstrating excellent agreement. Bland-Altman method showed 95% limits of agreement between ECVF at CT and ECVF at MR. The proposed framework demonstrates its efficiency, accuracy, and noninvasiveness in ECVF measurement and dramatically advances the ECVF at cardiac CT toward its clinical use.

Automated computer quantification of breast cancer in small-animal models using PET-guided MR image co-segmentation

BackgroundCare providers use complementary information from multiple imaging modalities to identify and characterize metastatic tumors in early stages and perform surveillance for cancer recurrence. These tasks require volume quantification of tumor measurements using computed tomography (CT) or magnetic resonance imaging (MRI) and functional characterization through positron emission tomography (PET) imaging. In vivo volume quantification is conducted through image segmentation, which may require both anatomical and functional images available for precise tumor boundary delineation. Although integrating multiple image modalities into the segmentation process may improve the delineation accuracy and efficiency, due to variable visibility on image modalities, complex shape of metastatic lesions, and diverse visual features in functional and anatomical images, a precise and efficient segmentation of metastatic breast cancer remains a challenging goal even for advanced image segmentation methods. In response to these challenges, we present here a computer-assisted volume quantification method for PET/MRI dual modality images using PET-guided MRI co-segmentation. Our aims in this study were (1) to determine anatomical tumor volumes automatically from MRI accurately and efficiently, (2) to evaluate and compare the accuracy of the proposed method with different radiotracers (18F-Z HER2-Affibody and 18F-flourodeoxyglucose (18F-FDG)), and (3) to confirm the proposed method’s determinations from PET/MRI scans in comparison with PET/CT scans.MethodsAfter the Institutional Administrative Panel on Laboratory Animal Care approval was obtained, 30 female nude mice were used to construct a small-animal breast cancer model. All mice were injected with human breast cancer cells and HER2-overexpressing MDA-MB-231HER2-Luc cells intravenously. Eight of them were selected for imaging studies, and selected mice were imaged with MRI, CT, and 18F-FDG-PET at weeks 9 and 10 and then imaged with 18F-Z HER2-Affibody-PET 2 days after the scheduled structural imaging (MRI and CT). After CT and MR images were co-registered with corresponding PET images, all images were quantitatively analyzed by the proposed segmentation technique.Automatically determined anatomical tumor volumes were compared to radiologist-derived reference truths. Observer agreements were presented through Bland-Altman and linear regression analyses. Segmentation evaluations were conducted using true-positive (TP) and false-positive (FP) volume fractions of delineated tissue samples, as complied with the state-of-the-art evaluation techniques for image segmentation. Moreover, the PET images, obtained using different radiotracers, were examined and compared using the complex wavelet-based structural similarity index (CWSSI). (continued on the next page) (continued from the previous page)ResultsPET/MR dual modality imaging using the 18F-Z HER2-Affibody imaging agent provided diagnostic image quality in all mice with excellent tumor delineations by the proposed method. The 18F-FDG radiotracer did not show accurate identification of the tumor regions. Structural similarity index (CWSSI) between PET images using 18F-FDG and 18F-Z HER2-Affibody agents was found to be 0.7838. MR showed higher diagnostic image quality when compared to CT because of its better soft tissue contrast. Significant correlations regarding the anatomical tumor volumes were obtained between both PET-guided MRI co-segmentation and reference truth (R2=0.92, p<0.001 for PET/MR, and R2=0.84, p<0.001, for PET/CT). TP and FP volume fractions using the automated co-segmentation method in PET/MR and PET/CT were found to be (TP 97.3%, FP 9.8%) and (TP 92.3%, FP 17.2%), respectively.ConclusionsThe proposed PET-guided MR image co-segmentation algorithm provided an automated and efficient way of assessing anatomical tumor volumes and their spatial extent. We showed that although the 18F-Z HER2-Affibody radiotracer in PET imaging is often used for characterization of tumors rather than detection, sensitivity and specificity of the localized radiotracer in the tumor region were informative enough; therefore, roughly determined tumor regions from PET images guided the delineation process well in the anatomical image domain for extracting accurate tumor volume information. Furthermore, the use of 18F-FDG radiotracer was not as successful as the 18F-Z HER2-Affibody in guiding the delineation process due to false-positive uptake regions in the neighborhood of tumor regions; hence, the accuracy of the fully automated segmentation method changed dramatically. Last, we qualitatively showed that MRI yields superior identification of tumor boundaries when compared to conventional CT imaging.

Three-Dimensional Segmentation of Fluid-Associated Abnormalities in Retinal OCT: Probability Constrained Graph-Search-Graph-Cut

An automated method is reported for segmenting 3-D fluid-associated abnormalities in the retina, so-called symptomatic exudate-associated derangements (SEAD), from 3-D OCT retinal images of subjects suffering from exudative age-related macular degeneration. In the first stage of a two-stage approach, retinal layers are segmented, candidate SEAD regions identified, and the retinal OCT image is flattened using a candidate-SEAD aware approach. In the second stage, a probability constrained combined graph search-graph cut method refines the candidate SEADs by integrating the candidate volumes into the graph cut cost function as probability constraints. The proposed method was evaluated on 15 spectral domain OCT images from 15 subjects undergoing intravitreal anti-VEGF injection treatment. Leave-one-out evaluation resulted in a true positive volume fraction (TPVF), false positive volume fraction (FPVF) and relative volume difference ratio (RVDR) of 86.5%, 1.7%, and 12.8%, respectively. The new graph cut-graph search method significantly outperformed both the traditional graph cut and traditional graph search approaches (p < 0.01, p < 0.04) and has the potential to improve clinical management of patients with choroidal neovascularization due to exudative age-related macular degeneration.