Image Analysis for Cystic Fibrosis: Computer-Assisted Airway Wall and Vessel Measurements from Low-Dose, Limited Scan Lung CT Images

Cystic fibrosis (CF) is a life-limiting genetic disease that affects approximately 30,000 Americans. When compared to those of normal children, airways of infants and young children with CF have thicker walls and are more dilated in high-resolution computed tomographic (CT) imaging. In this study, we develop computer-assisted methods for assessment of airway and vessel dimensions from axial, limited scan CT lung images acquired at low pediatric radiation doses. Two methods (threshold- and model-based) were developed to automatically measure airway and vessel sizes for pairs identified by a user. These methods were evaluated on chest CT images from 16 pediatric patients (eight infants and eight children) with different stages of mild CF related lung disease. Results of threshold-based, corrected with regression analysis, and model-based approaches correlated well with both electronic caliper measurements made by experienced observers and spirometric measurements of lung function. While the model-based approach results correlated slightly better with the human measurements than those of the threshold method, a hybrid method, combining these two methods, resulted in the best results

Multidetector row CT for imaging the paediatric tracheobronchial tree

The introduction of multidetector row computed tomography (MDCT) scanners has altered the approach to imaging the paediatric thorax. In an environment where the rapid acquisition of CT data allows general hospitals to image children instead of referring them to specialist paediatric centres, it is vital that general radiologists have access to protocols appropriate for paediatric applications. Thus a dramatic reduction in the delivered radiation dose is ensured with optimal contrast bolus delivery and timing, and inappropriate repetition of the scans is avoided. This article focuses on the main principles of volumetric CT imaging that apply generically to all MDCT scanners. We describe the reconstruction techniques for imaging the paediatric thorax and the low-dose protocols used in our institution on a 16-slice detector CT scanner. Examples of the commonest clinical applications are also given

Evaluating Small Airways Disease in Asthma and COPD using the Forced Oscillation Technique and Magnetic Resonance Imaging

Obstructive lung disease, including asthma and chronic obstructive pulmonary disease (COPD), is characterized by heterogeneous ventilation. Unfortunately, the underlying structure-function relationships and the relationships between measurements of heterogeneity and patient quality-of-life in obstructive lung disease are not well understood. Hyperpolarized noble gas MRI is used to visualize and quantify ventilation distribution and the forced oscillation technique (FOT) applies a multi-frequency pressure oscillation at the mouth to measure respiratory impedance to airflow (including resistance and reactance). My objective was to use FOT, ventilation MRI and computational airway tree modeling to better understand ventilation heterogeneity in asthma and COPD. FOT-measured respiratory system impedance was correlated with MRI ventilation heterogeneity and both were related to quality-of-life in asthma and COPD. FOT-measurements and model-predictions of reactance and small-airways resistance were correlated in asthma and COPD respectively. This study is the first to demonstrate the relationships between FOT-measured impedance, MRI ventilation heterogeneity, and patient quality-of-life

Pulmonary CT and MRI phenotypes that help explain chronic pulmonary obstruction disease pathophysiology and outcomes

Pulmonary x-ray computed tomographic (CT) and magnetic resonance imaging (MRI) research and development has been motivated, in part, by the quest to subphenotype common chronic lung diseases such as chronic obstructive pulmonary disease (COPD). For thoracic CT and MRI, the main COPD research tools, disease biomarkers are being validated that go beyond anatomy and structure to include pulmonary functional measurements such as regional ventilation, perfusion, and inflammation. In addition, there has also been a drive to improve spatial and contrast resolution while at the same time reducing or eliminating radiation exposure. Therefore, this review focuses on our evolving understanding of patient-relevant and clinically important COPD endpoints and how current and emerging MRI and CT tools and measurements may be exploited for their identification, quantification, and utilization. Since reviews of the imaging physics of pulmonary CT and MRI and reviews of other COPD imaging methods were previously published and well-summarized, we focus on the current clinical challenges in COPD and the potential of newly emerging MR and CT imaging measurements to address them. Here we summarize MRI and CT imaging methods and their clinical translation for generating reproducible and sensitive measurements of COPD related to pulmonary ventilation and perfusion as well as parenchyma morphology. The key clinical problems in COPD provide an important framework in which pulmonary imaging needs to rapidly move in order to address the staggering burden, costs, as well as the mortality and morbidity associated with COPD

3-D lung deformation and function from respiratory-gated 4-D x-ray CT images : application to radiation treatment planning.

Many lung diseases or injuries can cause biomechanical or material property changes that can alter lung function. While the mechanical changes associated with the change of the material properties originate at a regional level, they remain largely asymptomatic and are invisible to global measures of lung function until they have advanced significantly and have aggregated. In the realm of external beam radiation therapy of patients suffering from lung cancer, determination of patterns of pre- and post-treatment motion, and measures of regional and global lung elasticity and function are clinically relevant. In this dissertation, we demonstrate that 4-D CT derived ventilation images, including mechanical strain, provide an accurate and physiologically relevant assessment of regional pulmonary function which may be incorporated into the treatment planning process. Our contributions are as follows: (i) A new volumetric deformable image registration technique based on 3-D optical flow (MOFID) has been designed and implemented which permits the possibility of enforcing physical constraints on the numerical solutions for computing motion field from respiratory-gated 4-D CT thoracic images. The proposed optical flow framework is an accurate motion model for the thoracic CT registration problem. (ii) A large displacement landmark-base elastic registration method has been devised for thoracic CT volumetric image sets containing large deformations or changes, as encountered for example in registration of pre-treatment and post-treatment images or multi-modality registration. (iii) Based on deformation maps from MOFIO, a novel framework for regional quantification of mechanical strain as an index of lung functionality has been formulated for measurement of regional pulmonary function. (iv) In a cohort consisting of seven patients with non-small cell lung cancer, validation of physiologic accuracy of the 4-0 CT derived quantitative images including Jacobian metric of ventilation, Vjac, and principal strains, (V?1, V?2, V?3, has been performed through correlation of the derived measures with SPECT ventilation and perfusion scans. The statistical correlations with SPECT have shown that the maximum principal strain pulmonary function map derived from MOFIO, outperforms all previously established ventilation metrics from 40-CT. It is hypothesized that use of CT -derived ventilation images in the treatment planning process will help predict and prevent pulmonary toxicity due to radiation treatment. It is also hypothesized that measures of regional and global lung elasticity and function obtained during the course of treatment may be used to adapt radiation treatment. Having objective methods with which to assess pre-treatment global and regional lung function and biomechanical properties, the radiation treatment dose can potentially be escalated to improve tumor response and local control

Human Treelike Tubular Structure Segmentation: A Comprehensive Review and Future Perspectives

Various structures in human physiology follow a treelike morphology, which often expresses complexity at very fine scales. Examples of such structures are intrathoracic airways, retinal blood vessels, and hepatic blood vessels. Large collections of 2D and 3D images have been made available by medical imaging modalities such as magnetic resonance imaging (MRI), computed tomography (CT), Optical coherence tomography (OCT) and ultrasound in which the spatial arrangement can be observed. Segmentation of these structures in medical imaging is of great importance since the analysis of the structure provides insights into disease diagnosis, treatment planning, and prognosis. Manually labelling extensive data by radiologists is often time-consuming and error-prone. As a result, automated or semi-automated computational models have become a popular research field of medical imaging in the past two decades, and many have been developed to date. In this survey, we aim to provide a comprehensive review of currently publicly available datasets, segmentation algorithms, and evaluation metrics. In addition, current challenges and future research directions are discussed.Comment: 30 pages, 19 figures, submitted to CBM journa

SPECT/CT and pulmonary embolism

Acute pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/P) scintigraphy or pulmonary CT angiography (CTPA). In recent years both techniques have improved. Many nuclear medicine centres have adopted the single photon emission CT (SPECT) technique as opposed to the planar technique for diagnosing PE. SPECT has been shown to have fewer indeterminate results and a higher diagnostic value. The latest improvement is the combination of a low-dose CT scan with a V/P SPECT scan in a hybrid tomograph. In a study comparing CTPA, planar scintigraphy and SPECT alone, SPECT/CT had the best diagnostic accuracy for PE. In addition, recent developments in the CTPA technique have made it possible to image the pulmonary arteries of the lungs in one breath-hold. This development is based on the change from a single-detector to multidetector CT technology with an increase in volume coverage per rotation and faster rotation. Furthermore, the dual energy CT technique is a promising modality that can provide functional imaging in combination with anatomical information. Newer high-end CT scanners and SPECT systems are able to visualize smaller subsegmental emboli. However, consensus is lacking regarding the clinical impact and treatment. In the present review, SPECT and SPECT in combination with low-dose CT, CTPA and dual energy CT are discussed in the context of diagnosing PE

Experimental imaging of asthma progression and therapeutic response in mouse lung models

Asthma ist eine Erkrankung die das komplette Immunsystems involviert, ein System so komplex, dass es sich nur unzureichend in-vitro studieren lässt. Daher haben sich Mausmodelle als ein unverzichtbares Werkzeug in der präklinischen Asthmaforschung etabliert. Da es sich weiterhin bei Asthma um eine Erkrankung handelt, die durch eine schnelle Änderung der Symptome gekennzeichnet ist, wäre longitudinale vorzugsweise nicht-invasive Bildgebung, insbesondere bei der Entwicklung und Bewertung neuer Therapiekonzepte von großem Interesse. Nachteilig hingegen ist, dass die Darstellung der Mauslunge in der Praxis auf Grund der Größe des Organs und, im Falle einer in vivo Bildgebung, durch die Bewegung des Brustkorbes sich als äußerst schwierig herausstellt. Die Vielzahl der Luft-Gewebe-Grenzflächen erzeugt starke Streuung in der optischen Bildgebung, der große Hohlraum der Lunge verursacht Suszeptibilitätsartefakte bei der MRT und die Rippen erschweren eine Ultraschallbildgebung. Aus diesen Gründen besteht ein großer Bedarf an neuen Bildgebungsverfahren, um die durch Asthma verursachten anatomischen, funktionalen und molekularen Veränderungen darstellen zu können. Um die Schwierigkeiten in der Lungenbildgebung bei Mäusen zu umgehen, habe ich mich auf drei wesentliche Bildgebungsstrategien fokussiert: A) anatomische Bildgebung durch “inline free propagation phase contrast computed tomography”, B) direkte Messung der Lungenfunktion durch “low dose planar cinematic x-ray imaging” und C) funktionale Bildgebung mit Hilfe der „near infrared fluorescence imaging“ in Kombination mit Antikörpern, die mit einem Fluoreszenzfarbstoff markiert wurden, oder “smart probes”, die in Gegenwart von Entzündungen aktiviert werden. Durch die Anwendung von “phase contrast computed tomography” für die anatomische Bildgebung war ich in der Lage morphologische Veränderung des Lungengewebes zu quantifizieren, indem ich lokal das Verhältnis zwischen Weichgewebe und Luft, das Zusammenziehen der Luftwege sowie das Anschwellen der Bronchialwände im asthmatischen Lungengewebe ausgewertet habe. Diese Parameter erlaubten es zwischen Mäusen von Asthmamodellen unterschiedlicher Schweregrade, therapierten und gesunden Mäusen zu unterscheiden. Zusätzlich ermöglichte diese Technik die Darstellung intra-tracheal applizierter Bariumsulfat markierter Makrophagen im Lungengewebe. Dies stellt meines Wissens die erste Kombination einer funktionalisierten Kontrastierung und hochauflösender Lungenbildgebung mittels CT unter in vivo ähnlichen Bedingungen dar. Um diese Ergebnisse mit dem Grad der asthmabedingten Kurzatmigkeit zu korrelieren, habe ich eine einfache und verlässige Methode entwickelt die es, basierend auf 2D Röntgen-videos niedriger Röntgendosis (~6,5mGy) erlaubt, in narkotisierten Mäusen die Lungenfunktion zu bewerten. Mit Hilfe dieser neuen Methode gelang es mir charakteristische Unterschiede in der Lungenfunktion von asthmatischen, therapierten und gesunden Mäusen in vivo über die Zeit nachzuweisen, und diese Resultate mit den Ergebnissen von CT und Histologie zu korrelieren. Das Verfahren wird derzeit von mir für die Anwendung an frei beweglichen und nicht narkotisierten Mäusen weiterentwickelt. Dies sollte zu einer deutlichen Stressreduktion für die Maus bei der Untersuchung führen und somit, vor allem in Asthma, im Gegensatz zu etablierten Verfahren wie Plethysmographie, die Erhebung validerer Messdaten erlauben. Mit Hilfe von „near infrared fluorescence imaging“ konnten wir in vivo und longitudinal erfolgreich verschiedene durch Asthma ausgelöste molekulare Veränderungen in der Mauslunge verfolgen. Erstens erlaubte die Verwendung einer neuen Polyglyzerol Probe mit dendritischer Struktur (MN2012) die spezifisch an Selektine bindet, die Darstellung der durch Asthma verursachten Entzündung der Lunge. Im Zuge dessen konnten wir nachweisen, dass sich MN2012  zur Darstellung von Enzymkinetiken bei Entzündungsreaktionen durch eine schnellere Kinetik und höher Spezifität als kommerziell erhältliche Proben auszeichnet. Zweitens haben wir gezeigt, dass in Kombination mit einem Fluoreszenz markiertem Antikörper gegen SiglecF, einem Antigen das hauptsächlich auf Eosinophilen exprimiert ist, Eosinophilie in asthmatischen Mäusen verfolgt und der Effekt einer Dexamethason Behandlung  ebenso dargestellt werden kann. Drittens konnten wir den Verbleib inhalierter fluoreszierender Nanopartikel in der Lunge der Maus in vivo untersuchen und dabei nachweisen, dass diese hauptsächlich von endogenen Makrophagen im Lungengewebe aufgenommen werden. Alle diese Techniken wurden gegeneinander und mittels histologischer Analyse und Fluoreszenzmikroskopie korreliert und validiert.  Zusammenfassend bilden die in meiner Dissertation entwickelten Lungenbildgebungsstrategien für Asthmamausmodelle eine Bildgebungsplattform, um sowohl spezifische Effekte in asthmatischen Mäusen unterschiedlichen Schweregrades als auch die Auswirkungen neuer Therapien abzubilden und im Detail zu untersuchen