Pulmonary Computed Tomography Images Research Articles

Deep learning to predict respiratory lung-tissue displacement from multi-phase pulmonary computed tomography images

Lung surgery, particularly lung puncture, is challenging because respiration motion significantly displaces lung tissues (e.g., blood vessels, trachea), including targeted lesions. To improve the success of lung surgery, it is essential to determine how lung tissues move during respiration. Early work used simple mathematical models (e.g., linear models) to predict lung-tissue displacement. However, the quality and quantity of pulmonary computed tomography (CT) images used to build such models were limited, preventing their universal application. Moreover, such mathematical models are too simple to describe how lung tissues are displaced during respiration. In this work, we analyzed the relationship between body-surface and lung-tissue displacement in a large number of multi-phase pulmonary CT images to create a model predicting lung-tissue displacement. First, a systematic method based on unsupervised learning approaches was designed to calculate the displacement of the body surface and lung tissues. Second, a deep neural network model was developed to predict lung-tissue displacement, using the body-surface displacement observed in CT imaging data as input. Multi-phase pulmonary CT images from 199 patients were collected to train and test our model. The validation experiment demonstrated that the prediction accuracy based on our deep learning model reached 79.8%, which outperformed traditional machine learning approaches like the linear model (79.2%), linear support vector regression model (79.2%), and support vector regression model with radial basis function (67.2%). These results demonstrated that our method could predict lung-tissue displacement based on body-surface displacement during respiration, potentially improving the success of lung puncture procedures.

Attention U-net for automated pulmonary fissure integrity analysis in lung computed tomography images

Computed Tomography (CT) imaging is routinely used for imaging of the lungs. Deep learning can effectively automate complex and laborious tasks in medical imaging. In this work, a deep learning technique is utilized to assess lobar fissure completeness (also known as fissure integrity) from pulmonary CT images. The human lungs are divided into five separate lobes, divided by the lobar fissures. Fissure integrity assessment is important to endobronchial valve treatment screening. Fissure integrity is known to be a biomarker of collateral ventilation between lobes impacting the efficacy of valves designed to block airflow to diseased lung regions. Fissure integrity is also likely to impact lobar sliding which has recently been shown to affect lung biomechanics. Further widescale study of fissure integrity’s impact on disease susceptibility and progression requires rapid, reproducible, and noninvasive fissure integrity assessment. In this paper we describe IntegrityNet, an attention U-Net based automatic fissure integrity analysis tool. IntegrityNet is able to predict fissure integrity with an accuracy of 95.8%, 96.1%, and 89.8% for left oblique, right oblique, and right horizontal fissures, compared to manual analysis on a dataset of 82 subjects. We also show that our method is robust to COPD severity and reproducible across subject scans acquired at different time points.

Multi-Granularity Dilated Transformer for Lung Nodule Classification via Local Focus Scheme

Intelligent lung nodules classification is a meaningful and challenging research topic for early precaution of lung cancers, which aims to diagnose the malignancy of candidate nodules from the pulmonary computed tomography images. Nowadays, deep learning methods have made significant achievements in the medical field and promoted developments of lung nodules classification. Nevertheless, mainstream CNNs-based networks typically excel in learning coarse-grained local feature representations via stacked local-aware and weight-shared convolutions, and cannot practically model the long-range context interaction and the spatial dependencies. To tackle the above difficulties, we innovatively propose an effective Multi-Granularity Dilated Transformer to learn the long-range context relations, and explore fine-grained local details via the proposed Local Focus Scheme. Specifically, we delicately design a novel Deformable Dilated Transformer to incorporate diverse contextual information with self-attention for learning long-range global spatial dependencies. Moreover, numerous investigations indicate that local details are extremely crucial to classify indistinguishable lung nodules. Thus, we propose the Local Focus Scheme to focus on the more discriminative local features by modeling channel-wise grouped topology. Consequently, the Multi-Granularity Dilated Transformer is constructed by leveraging the Local Focus Scheme to guide the Deformable Dilated Transformer for learning fine-grained local cues. Experimental results on the mainstream benchmark LIDC-IDRI demonstrate the superiority of our model compared with the state-of-the-art methods.

Clinical and Pulmonary CT Characteristics of Patients Infected With the SARS-CoV-2 Omicron Variant Compared With Those of Patients Infected With the Alpha Viral Strain.

BackgroundOmicron has become the dominant variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) globally. We aimed to compare the clinical and pulmonary computed tomography (CT) characteristics of the patients infected with SARS-CoV-2 Omicron with those of patients infected with the Alpha viral strain.MethodsClinical profiles and pulmonary CT images of 420 patients diagnosed with coronavirus disease-2019 (COVID-19) at Ningbo First Hospital between January 2020 and April 2022 were collected. Demographic characteristics, symptoms, and imaging manifestations of patients infected with the SARS-CoV-2 Omicron variant were compared with those of patients infected with the Alpha strain.ResultsA total of 38 patients were diagnosed to be infected with the Alpha strain of SARS-CoV-2, whereas 382 patients were thought to be infected with the Omicron variant. Compared with patients infected with the Alpha strain, those infected with the Omicron variant were younger, and a higher proportion of men were infected (P < 0.001). Notably, 93 (24.3%) of the patients infected with Omicron were asymptomatic, whereas only two (5.3%) of the patients infected with the Alpha strain were asymptomatic. Fever (65.8%), cough (63.2%), shortness of breath (21.1%), and diarrhea (21.1%) were more common in patients infected with the SARS-CoV-2 Alpha strain, while runny nose (24.1%), sore throat (31.9%), body aches (13.6%), and headache (12.3%) were more common in patients with the Omicron variant. Compared with 33 (86.84%) of 38 patients infected with the Alpha strain, who had viral pneumonia on pulmonary CT images, only 5 (1.3%) of 382 patients infected with the Omicron variant had mild foci. In addition, the distribution of opacities in the five patients was unilateral and centrilobular, whereas most patients infected with the Alpha strain had bilateral involvement and multiple lesions in the peripheral zones of the lung.ConclusionThe SARS-CoV-2 Alpha strain mainly affects the lungs, while Omicron is confined to the upper respiratory tract in patients with COVID-19.

PLOSL: Population learning followed by one shot learning pulmonary image registration using tissue volume preserving and vesselness constraints.

This paper presents the Population Learning followed by One Shot Learning (PLOSL) pulmonary image registration method. PLOSL is a fast unsupervised learning-based framework for 3D-CT pulmonary image registration algorithm based on combining population learning (PL) and one-shot learning (OSL). The PLOSL image registration has the advantages of the PL and OSL approaches while reducing their respective drawbacks. The advantages of PLOSL include improved performance over PL, substantially reducing OSL training time and reducing the likelihood of OSL getting stuck in local minima. PLOSL pulmonary image registration uses tissue volume preserving and vesselness constraints for registration of inspiration-to-expiration and expiration-to-inspiration pulmonary CT images. A coarse-to-fine convolution encoder-decoder CNN architecture is used to register large and small shape features. During training, the sum of squared tissue volume difference (SSTVD) compensates for intensity differences between inspiration and expiration computed tomography (CT) images and the sum of squared vesselness measure difference (SSVMD) helps match the lung vessel tree. Results show that the PLOSL (SSTVD+SSVMD) algorithm achieved subvoxel landmark error while preserving pulmonary topology on the SPIROMICS data set, the public DIR-LAB COPDGene and 4DCT data sets.

An ensemble learning method based on ordinal regression for COVID-19 diagnosis from chest CT

Coronavirus disease 2019 (COVID-19) has brought huge losses to the world, and it remains a great threat to public health. X-ray computed tomography (CT) plays a central role in the management of COVID-19. Traditional diagnosis with pulmonary CT images is time-consuming and error-prone, which could not meet the need for precise and rapid COVID-19 screening. Nowadays, deep learning (DL) has been successfully applied to CT image analysis, which assists radiologists in workflow scheduling and treatment planning for patients with COVID-19. Traditional methods use cross-entropy as the loss function with a Softmax classifier following a fully-connected layer. Most DL-based classification methods target intraclass relationships in a certain class (early, progressive, severe, or dissipative phases), ignoring the natural order of different phases of the disease progression, i.e., from an early stage and progress to a late stage. To learn both intraclass and interclass relationships among different stages and improve the accuracy of classification, this paper proposes an ensemble learning method based on ordinal regression, which leverages the ordinal information on COVID-19 phases. The proposed method uses multi-binary, neuron stick-breaking (NSB), and soft labels (SL) techniques, and ensembles the ordinal outputs through a median selection. To evaluate our method, we collected 172 confirmed cases. In a 2-fold cross-validation experiment, the accuracy is increased by 22% compared with traditional methods when we use modified ResNet-18 as the backbone. And precision, recall, and F1-score are also improved. The experimental results show that our proposed method achieves a better classification performance than the traditional methods, which helps establish guidelines for the classification of COVID-19 chest CT images.

Computed Tomography Image under Convolutional Neural Network Deep Learning Algorithm in Pulmonary Nodule Detection and Lung Function Examination.

The objective of this study was to perform segmentation and extraction of CT images of pulmonary nodules based on convolutional neural networks (CNNs). The Mask-RCNN algorithm model is a typical end-to-end image segmentation model, which uses the R-FCN structure for nodule detection. The effect of applying the two algorithm models to the computed tomography (CT) diagnosis of pulmonary nodules was analyzed, and different indexes of pulmonary nodule CT images in lung function examination after algorithm optimization were compared. A total of 56 patients diagnosed with pulmonary nodules by surgery or puncture were taken as the research objects. Based on the Mask-RCNN algorithm, a model for CT image segmentation processing of pulmonary nodules was proposed. Subsequently, the 3D Faster-RCNN model was used to label the nodules in the pulmonary nodules. The experimental results showed that the trained Mask-RCNN algorithm model can effectively complete the segmentation task of lung CT images, but there was a little jitter at the boundary. The speed of R-FCN algorithm for nodular detection was 0.172 seconds/picture, and the accuracy was 88.9%. CT scans were performed on the 56 patients based on a deep learning algorithm. The results showed that 30 cases of malignant pulmonary nodules were confirmed, and the diagnostic accuracy was 93.75%. There were 22 benign lesions, the diagnostic accuracy was 91.67%, and the overall diagnostic accuracy was 92.85%. This study effectively improved the diagnostic efficiency of CT images of pulmonary nodules, and the accuracy of CT images in the diagnosis of pulmonary nodules was analyzed and evaluated. It provided theoretical support for the follow-up diagnosis of pulmonary nodules and the treatment of lung cancer. It also significantly improved the diagnostic effect and detection efficiency of pulmonary nodules.

New Approaches in the Classification and Prognosis of Sign Clusters on Pulmonary CT Images in Patients With Multidrug-Resistant Tuberculosis.

Background: To date, radiographic sign clusters of multidrug-resistant pulmonary tuberculosis (MDR-TB) patients have not been reported. We conducted a study to investigate the classification and prognosis of sign clusters in pulmonary Computed Tomography (CT) images from patients with MDR-TB for the first time by using principal component analysis (PCA).Methods: The clinical data and pulmonary CT findings of 108 patients with MDR-TB in the Liupanshui Third Hospital were collected (from January 2018 to December 2020). PCA was used to analyze the sign clusters on pulmonary CT, and receiver operating characteristic (ROC) analysis was used to analyze the predictive value of the treatment outcome of MDR-TB patients.Results: Six cluster signs of MDR-TB were determined by PCA: nodules, infiltration, consolidation, cavities, destroyed lung and non-active lesions. Nine months after treatment, the area under the ROC curve (AUC) of MDR-TB patients with a cavity sign cluster was 0.818 (95% CI: 0.733–0.886), and the positive predictive value (PPV) and negative predictive value (NPV) of the treatment outcome were 79.6% (95% CI: 65.7–89.8%) and 72.9% (95% CI: 59.7–83.6%), respectively.Conclusion: PCA plays an important role in the classification of sign groups on pulmonary CT images of MDR-TB patients, and the sign clusters obtained from PCA are of great significance in predicting the treatment outcome.

An accurate neural network algorithm to diagnose Covid-19 from CT images

Background: A new coronavirus appeared in late December 2019 in Wuhan, China. He was named Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). This virus is responsible for Covid-19, the name given to the disease associated with it. It spreads worldwide, infecting more than a million people and killing more than 70 miles. The rapid and accurate diagnosis of suspected Covid-19 cases plays a crucial role in medical treatment and timely quarantine. Materials and Methods: In order to counter the Covid-19 pandemic, we have developed a method for the automatic detection of Covid -19, from 2D computed tomography (CT) chest images. It is a supervised software system based on the ANN (Artificial Neural Network) algorithm. Pulmonary CT images were collected from multiple international datasets, with a total of 395 images: 70% were used for training and 30% were used for testing. For each patient, the lungs were segmented using simple thresholding. Then, the segmented lungs were fed into a neural network to predict the probability of SARS-CoV-2 infectious. Results: The internal validation achieved a total accuracy of 97.5% with a specificity of 96.6 % and a 100 % sensitivity. Conclusion: These results demonstrate the proof-ofprinciple for using artificial intelligence to extract radiological features for timely and accurate Covid-19 diagnosis.

Spatiotemporal Free-Form Registration Method Assisted by a Minimum Spanning Tree During Discontinuous Transformations.

The sliding motion along the boundaries of discontinuous regions has been actively studied in B-spline free-form deformation framework. This study focusses on the sliding motion for a velocity field-based 3D+t registration. The discontinuity of the tangent direction guides the deformation of the object region, and a separate control of two regions provides a better registration accuracy. The sliding motion under the velocity field-based transformation is conducted under the [Formula: see text]-Rényi entropy estimator using a minimum spanning tree (MST) topology. Moreover, a new topology changing method of the MST is proposed. The topology change is performed as follows: inserting random noise, constructing the MST, and removing random noise while preserving a local connection consistency of the MST. This random noise process (RNP) prevents the [Formula: see text]-Rényi entropy-based registration from degrading in sliding motion, because the RNP creates a small disturbance around special locations. Experiments were performed using two publicly available datasets: the DIR-Lab dataset, which consists of 4D pulmonary computed tomography (CT) images, and a benchmarking framework dataset for cardiac 3D ultrasound. For the 4D pulmonary CT images, RNP produced a significantly improved result for the original MST with sliding motion (p<0.05). For the cardiac 3D ultrasound dataset, only a discontinuity-based registration indicated activity of the RNP. In contrast, the single MST without sliding motion did not show any improvement. These experiments proved the effectiveness of the RNP for sliding motion.

Tracheal development after left pulmonary artery reimplantation: an individual study

Pulmonary artery sling (PA sling) often presents as a life-threatening condition requiring urgent surgical correction. We reported 32 cases of PA sling in children who were followed up postoperatively in the past 6 years. All patients with PA slings who were admitted to the hospital from January 2012 to December 2017 and underwent surgery were retrospectively analyzed. The mean age of the 32 patients at repair was 16.97 months (range, 15 days to 128 months). Six patients required ventilator assistance for respiratory failure. All children underwent left pulmonary artery (LPA) reimplantation (n = 32), and 3 patients needed reimplantation slide tracheoplasty (n = 3) due to ventilation weaning failure. Four patients died, 27 patients survived until discharge, and 18 patients were followed up. Pulmonary computed tomography imaging and echocardiography were performed in 18 patients who were followed up. After LPA reimplantation, the tracheal carina area was significantly enlarged compared to that preoperation (p = 0.0002). In this follow-up cohort study, 75% of the patients who underwent LPA reimplantation survived until discharge. The survivors had subsequently well-developed pulmonary arteries and tracheas.

A Deep Learning System to Screen Novel Coronavirus Disease 2019 Pneumonia

The real-time reverse transcription-polymerase chain reaction (RT-PCR) detection of viral RNA from sputum or nasopharyngeal swab had a relatively low positive rate in the early stage of coronavirus disease 2019 (COVID-19). Meanwhile, the manifestations of COVID-19 as seen through computed tomography (CT) imaging show individual characteristics that differ from those of other types of viral pneumonia such as influenza-A viral pneumonia (IAVP). This study aimed to establish an early screening model to distinguish COVID-19 from IAVP and healthy cases through pulmonary CT images using deep learning techniques. A total of 618 CT samples were collected: 219 samples from 110 patients with COVID-19 (mean age 50 years; 63 (57.3%) male patients); 224 samples from 224 patients with IAVP (mean age 61 years; 156 (69.6%) male patients); and 175 samples from 175 healthy cases (mean age 39 years; 97 (55.4%) male patients). All CT samples were contributed from three COVID-19-designated hospitals in Zhejiang Province, China. First, the candidate infection regions were segmented out from the pulmonary CT image set using a 3D deep learning model. These separated images were then categorized into the COVID-19, IAVP, and irrelevant to infection (ITI) groups, together with the corresponding confidence scores, using a location-attention classification model. Finally, the infection type and overall confidence score for each CT case were calculated using the Noisy-OR Bayesian function. The experimental result of the benchmark dataset showed that the overall accuracy rate was 86.7% in terms of all the CT cases taken together. The deep learning models established in this study were effective for the early screening of COVID-19 patients and were demonstrated to be a promising supplementary diagnostic method for frontline clinical doctors.

Diagnosis and treatment strategy of coronavirus disease 2019 with cardiovascular disease in elderly patients.

Diagnosis and treatment strategy of coronavirus disease 2019 with cardiovascular disease in elderly patients.

Automatic lung segmentation method in computed tomography scans

Lung segmentation in Computed Tomography (CT) images is one of the important steps in Computer Aided Diagnosis (CADx) systems. This paper has proposed a completely automatic algorithm for recognition and segmentation of lungs in 3D pulmonary X-ray CT images. The advantage of this method is separation of attached nodules to the lung wall which are removed in ordinary lung segmentation methods. This method is based on thresholding algorithm that identifies attached nodules with some morphological operations. This method applied to 20 lung CT images has shown that eventually the lungs were correctly segmented. The advantage of using a simple thresholding algorithm is high speed, e.g. the time of the lung segmentation for 300 images is less than 10 seconds.

Classification of Pulmonary CT Images by Using Hybrid 3D-Deep Convolutional Neural Network Architecture

Lung cancer is the most common cause of cancer-related deaths worldwide. Hence, the survival rate of patients can be increased by early diagnosis. Recently, machine learning methods on Computed Tomography (CT) images have been used in the diagnosis of lung cancer to accelerate the diagnosis process and assist physicians. However, in conventional machine learning techniques, using handcrafted feature extraction methods on CT images are complicated processes. Hence, deep learning as an effective area of machine learning methods by using automatic feature extraction methods could minimize the process of feature extraction. In this study, two Convolutional Neural Network (CNN)-based models were proposed as deep learning methods to diagnose lung cancer on lung CT images. To investigate the performance of the two proposed models (Straight 3D-CNN with conventional softmax and hybrid 3D-CNN with Radial Basis Function (RBF)-based SVM), the altered models of two-well known CNN architectures (3D-AlexNet and 3D-GoogleNet) were considered. Experimental results showed that the performance of the two proposed models surpassed 3D-AlexNet and 3D-GoogleNet. Furthermore, the proposed hybrid 3D-CNN with SVM achieved more satisfying results (91.81%, 88.53% and 91.91% for accuracy rate, sensitivity and precision respectively) compared to straight 3D-CNN with softmax in the diagnosis of lung cancer.

Vesselness-Based Deformable Registration Algorithms Can Reduce Landmark Errors in the Registration of Pulmonary Computed Tomography Images Before and After Radiation Therapy

Vesselness-Based Deformable Registration Algorithms Can Reduce Landmark Errors in the Registration of Pulmonary Computed Tomography Images Before and After Radiation Therapy

Imaging Features of Pulmonary CT in Type 2 Diabetic Patients with Multidrug-Resistant Tuberculosis.

BackgroundUntil now, radiographic manifestations of multidrug-resistant pulmonary tuberculosis (MDR- TB) in patients with diabetes mellitus (DM) have not been reported. We conducted a study to investigate the imaging features of pulmonary computed tomography (CT) for type 2 diabetic (T2DM) patients with MDR-TB.MethodsThe clinical data and pulmonary CT findings of 39 type 2 diabetic patients with MDR-TB, 46 type 2 diabetic patients with drug-susceptible tuberculosis (DS-TB), and 72 pure drug-susceptible TB cases (without T2DM and MDR) treated at Dalian Tuberculosis Hospital from 2012 to 2015 were collected, and the clinical features and imaging differences of the three groups were compared.ResultsThe clinical characteristics of the three groups of patients were not significantly different except with respect to age and previous treatment history. However, on imaging, the patients with MDR-TB showed consolidation in and above the pulmonary segments was significantly more extensive than that seen in the DS-TB group with or without T2DM.ConclusionConsolidation in or above multiple pulmonary segments with multiple mouth-eaten cavities and bronchial damage on pulmonary CT images in type 2 diabetic patients with tuberculosis suggests the possibility of multi-drug resistance.

Adhesion Pulmonary Nodules Detection Based on Dot-Filter and Extracting Centerline Algorithm

A suspected pulmonary nodule detection method was proposed based on dot-filter and extracting centerline algorithm. In this paper, we focus on the distinguishing adhesion pulmonary nodules attached to vessels in two-dimensional (2D) lung computed tomography (CT) images. Firstly, the dot-filter based on Hessian matrix was constructed to enhance the circular area of the pulmonary CT images, which enhanced the circular suspected pulmonary nodule and suppresses the line-like areas. Secondly, to detect the nondistinguishable attached pulmonary nodules by the dot-filter, an algorithm based on extracting centerline was developed to enhance the circle area formed by the end or head of the vessels including the intersection of the lines. 20 sets of CT images were used in the experiments. In addition, 20 true/false nodules extracted were used to test the function of classifier. The experimental results show that the method based on dot-filter and extracting centerline algorithm can detect the attached pulmonary nodules accurately, which is a basis for further studies on the pulmonary nodule detection and diagnose.

Computer‐aided detection and quantification of cavitary tuberculosis from CT scans

To present a computer-aided detection tool for identifying, quantifying, and evaluating tuberculosis (TB) cavities in the infected lungs from computed tomography (CT) scans. The authors' proposed method is based on a novel shape-based automated detection algorithm on CT scans followed by a fuzzy connectedness (FC) delineation procedure. In order to assess interaction between cavities and airways, the authors first roughly identified air-filled structures (airway, cavities, esophagus, etc.) by thresholding over Hounsfield unit of CT image. Then, airway and cavity structure detection was conducted within the support vector machine classification algorithm. Once airway and cavities were detected automatically, the authors extracted airway tree using a hybrid multiscale approach based on novel affinity relations within the FC framework and segmented cavities using intensity-based FC algorithm. At final step, the authors refined airway structures within the local regions of FC with finer control. Cavity segmentation results were compared to the reference truths provided by expert radiologists and cavity formation was tracked longitudinally from serial CT scans through shape and volume information automatically determined through the authors' proposed system. Morphological evolution of the cavitary TB were analyzed accordingly with this process. Finally, the authors computed the minimum distance between cavity surface and nearby airway structures by using the linear time distance transform algorithm to explore potential role of airways in cavity formation and morphological evolution. The proposed methodology was qualitatively and quantitatively evaluated on pulmonary CT images of rabbits experimentally infected with TB, and multiple markers such as cavity volume, cavity surface area, minimum distance from cavity surface to the nearest bronchial-tree, and longitudinal change of these markers (namely, morphological evolution of cavities) were determined precisely. While accuracy of the authors' cavity detection algorithm was 94.61%, airway detection part of the proposed methodology showed even higher performance by 99.8%. Dice similarity coefficients for cavitary segmentation experiments were found to be approximately 99.0% with respect to the reference truths provided by two expert radiologists (blinded to their evaluations). Moreover, the authors noted that volume derived from the authors' segmentation method was highly correlated with those provided by the expert radiologists (R(2) = 0.99757 and R(2) = 0.99496, p < 0.001, with respect to the observer 1 and observer 2) with an interobserver agreement of 98%. The authors quantitatively confirmed that cavity formation was positioned by the nearby bronchial-tree after exploring the respective spatial positions based on the minimum distance measurement. In terms of efficiency, the core algorithms take less than 2 min on a linux machine with 3.47 GHz CPU and 24 GB memory. The authors presented a fully automatic method for cavitary TB detection, quantification, and evaluation. The performance of every step of the algorithm was qualitatively and quantitatively assessed. With the proposed method, airways and cavities were automatically detected and subsequently delineated in high accuracy with heightened efficiency. Furthermore, not only morphological information of cavities were obtained through the authors' proposed framework, but their spatial relation to airways, and longitudinal analysis was also provided to get further insight on cavity formation in tuberculosis disease. To the authors' best of knowledge, this is the first study in computerized analysis of cavitary tuberculosis from CT scans.

Topomorphologic Separation of Fused Isointensity Objects via Multiscale Opening: Separating Arteries and Veins in 3-D Pulmonary CT

A novel multiscale topomorphologic approach for opening of two isointensity objects fused at different locations and scales is presented and applied to separating arterial and venous trees in 3-D pulmonary multidetector X-ray computed tomography (CT) images. Initialized with seeds, the two isointensity objects (arteries and veins) grow iteratively while maintaining their spatial exclusiveness and eventually form two mutually disjoint objects at convergence. The method is intended to solve the following two fundamental challenges: how to find local size of morphological operators and how to trace continuity of locally separated regions. These challenges are met by combining fuzzy distance transform (FDT), a morphologic feature with a topologic fuzzy connectivity, and a new morphological reconstruction step to iteratively open finer and finer details starting at large scales and progressing toward smaller scales. The method employs efficient user intervention at locations where local morphological separability assumption does not hold due to imaging ambiguities or any other reason. The approach has been validated on mathematically generated tubular objects and applied to clinical pulmonary noncontrast CT data for separating arteries and veins. The tradeoff between accuracy and the required user intervention for the method has been quantitatively examined by comparing with manual outlining. The experimental study, based on a blind seed selection strategy, has demonstrated that above 95% accuracy may be achieved using 25-40 seeds for each of arteries and veins. Our method is very promising for semiautomated separation of arteries and veins in pulmonary CT images even when there is no object-specific intensity variation at conjoining locations.