Algorithmic assessment of cardiac viability using magnetic resonance imaging

MRI is a non-invasive imaging method which produces high resolution images of human tissues from inside the human body. Due to its outstanding ability, it is quickly becoming a major tool for medical and clinical studies, including high profile areas such as neurology, oncology, cardiology and etc. MRI technology developed relatively slowly compared to other methods such as x-ray. A decade ago, it took more than 5 minutes to construct an MR image. However more recently, with several significant inventions such as echo planar imaging and steady state free procession techniques, the acquisition time of MRI has significantly reduced. At present, it is possible to capture dozens of MR images in a second. Those techniques are generally called ultra-fast MRI. The fast MR acquisition techniques enable us to extend our studies to the moving tissues such as the myocardium. Using the ultra-fast MRI, multiple images can be acquired during a cardiac cycle allowing the construction of cardiac cinematographic MR images. Cardiac motion can therefore be revealed. Abnormal cardiac motion is often related to cardiac diseases such as ischaemic myocardium and myocardial infarction. With advanced MRI techniques, cardiac diseases can be more specifically defined. For example, the late contrast enhanced MRI highlights acute myocardial infarction. The first-pass perfusion MRI suggests the existence of ischaemic myocardium. At the present time the majority of the analysis of MR images can be performed either qualitatively or quantitatively. The qualitative assessment is an eye-ball assessment of the images on a MRI workstation, which is subjective and inaccurate. The quantitative assessment of MR image relies on the computer technologies of both hardware and software. In recent years, the demands for the quantitative assessment of MR images have increased sharply. Many so-called computer aided diagnosis systems were developed to process data either more accurately or more efficiently. In this study, we developed an algorithmic method to analyse the late contrast enhanced MR images, revealing the so-called hibernating myocardium. The algorithm is based on an efficient and robust image registration algorithm. Using the image registration algorithm, we are able to integrate the static late contrast enhanced MR image with its corresponding cardiac cinematography MR images, and so constructing cardiac CINE late enhanced MR images. Our algorithm was tested on 20 subjects. In each of the subject, the mean left ventricle diastolic volume and systolic volume was measured by planimetry from both the original CINE images and the constructed late enhanced CINE images. The results are: left ventricle diastolic volume (original / constructed) = 206 / 215 ml, p = 0.35. Left ventricle systolic volume (original / constructed) = 129 / 123 ml, p = 0.33. With our algorithm, the cardiac motion and the myocardial infarction can therefore be studied simultaneously to locate the hibernating myocardium which moves abnormally. The accurate location of the hibernating myocardium is important because it could turn into the irreversible myocardial infarction. On the other hand, with proper medical treatment or cardiac surgery, the hibernating myocardium could be revitalised. The experimental results show there are no significant differences between the artificial cine late contrast enhanced MR images and the original cinematography MR images in left ventricle diastolic volume, left ventricle systolic volume. The method therefore appears promising as an improved cardiac viability assessment tool. In addition, we extended the method to a semi-automatic cardiac contour definition algorithm, which has produced a satisfactory result in contour definition for cardiac cinematography MR images from 34 subjects including 20 healthy volunteers and 14 patients. Although it is a semi-automatic method, the diagnosis time could be significantly reduced compared to the manual method. The algorithm was preliminarily tested on 10 first-pass perfusion MR sequences and 10 aortic MR sequences. The experimental results were satisfactory. Although, minor manual correction is required on some occasions, we believe our method could be clinically useful for the study of cardiac cinematography MR images, first-pass perfusion MR images and aortic MR images

Automatic motion compensation of free breathing acquired myocardial perfusion data by using independent component analysis

Images acquired during free breathing using first-pass gadolinium-enhanced myocardial perfusion magnetic resonance imaging (MRI) exhibit a quasiperiodic motion pattern that needs to be compensated for if a further automatic analysis of the perfusion is to be executed. In this work, we present a method to compensate this movement by combining independent component analysis (ICA) and image registration: First, we use ICA and a time?frequency analysis to identify the motion and separate it from the intensity change induced by the contrast agent. Then, synthetic reference images are created by recombining all the independent components but the one related to the motion. Therefore, the resulting image series does not exhibit motion and its images have intensities similar to those of their original counterparts. Motion compensation is then achieved by using a multi-pass image registration procedure. We tested our method on 39 image series acquired from 13 patients, covering the basal, mid and apical areas of the left heart ventricle and consisting of 58 perfusion images each. We validated our method by comparing manually tracked intensity profiles of the myocardial sections to automatically generated ones before and after registration of 13 patient data sets (39 distinct slices). We compared linear, non-linear, and combined ICA based registration approaches and previously published motion compensation schemes. Considering run-time and accuracy, a two-step ICA based motion compensation scheme that first optimizes a translation and then for non-linear transformation performed best and achieves registration of the whole series in 32 ± 12 s on a recent workstation. The proposed scheme improves the Pearsons correlation coefficient between manually and automatically obtained time?intensity curves from .84 ± .19 before registration to .96 ± .06 after registratio

Analysis of contrast-enhanced medical images.

Early detection of human organ diseases is of great importance for the accurate diagnosis and institution of appropriate therapies. This can potentially prevent progression to end-stage disease by detecting precursors that evaluate organ functionality. In addition, it also assists the clinicians for therapy evaluation, tracking diseases progression, and surgery operations. Advances in functional and contrast-enhanced (CE) medical images enabled accurate noninvasive evaluation of organ functionality due to their ability to provide superior anatomical and functional information about the tissue-of-interest. The main objective of this dissertation is to develop a computer-aided diagnostic (CAD) system for analyzing complex data from CE magnetic resonance imaging (MRI). The developed CAD system has been tested in three case studies: (i) early detection of acute renal transplant rejection, (ii) evaluation of myocardial perfusion in patients with ischemic heart disease after heart attack; and (iii), early detection of prostate cancer. However, developing a noninvasive CAD system for the analysis of CE medical images is subject to multiple challenges, including, but are not limited to, image noise and inhomogeneity, nonlinear signal intensity changes of the images over the time course of data acquisition, appearances and shape changes (deformations) of the organ-of-interest during data acquisition, determination of the best features (indexes) that describe the perfusion of a contrast agent (CA) into the tissue. To address these challenges, this dissertation focuses on building new mathematical models and learning techniques that facilitate accurate analysis of CAs perfusion in living organs and include: (i) accurate mathematical models for the segmentation of the object-of-interest, which integrate object shape and appearance features in terms of pixel/voxel-wise image intensities and their spatial interactions; (ii) motion correction techniques that combine both global and local models, which exploit geometric features, rather than image intensities to avoid problems associated with nonlinear intensity variations of the CE images; (iii) fusion of multiple features using the genetic algorithm. The proposed techniques have been integrated into CAD systems that have been tested in, but not limited to, three clinical studies. First, a noninvasive CAD system is proposed for the early and accurate diagnosis of acute renal transplant rejection using dynamic contrast-enhanced MRI (DCE-MRI). Acute rejection–the immunological response of the human immune system to a foreign kidney–is the most sever cause of renal dysfunction among other diagnostic possibilities, including acute tubular necrosis and immune drug toxicity. In the U.S., approximately 17,736 renal transplants are performed annually, and given the limited number of donors, transplanted kidney salvage is an important medical concern. Thus far, biopsy remains the gold standard for the assessment of renal transplant dysfunction, but only as the last resort because of its invasive nature, high cost, and potential morbidity rates. The diagnostic results of the proposed CAD system, based on the analysis of 50 independent in-vivo cases were 96% with a 95% confidence interval. These results clearly demonstrate the promise of the proposed image-based diagnostic CAD system as a supplement to the current technologies, such as nuclear imaging and ultrasonography, to determine the type of kidney dysfunction. Second, a comprehensive CAD system is developed for the characterization of myocardial perfusion and clinical status in heart failure and novel myoregeneration therapy using cardiac first-pass MRI (FP-MRI). Heart failure is considered the most important cause of morbidity and mortality in cardiovascular disease, which affects approximately 6 million U.S. patients annually. Ischemic heart disease is considered the most common underlying cause of heart failure. Therefore, the detection of the heart failure in its earliest forms is essential to prevent its relentless progression to premature death. While current medical studies focus on detecting pathological tissue and assessing contractile function of the diseased heart, this dissertation address the key issue of the effects of the myoregeneration therapy on the associated blood nutrient supply. Quantitative and qualitative assessment in a cohort of 24 perfusion data sets demonstrated the ability of the proposed framework to reveal regional perfusion improvements with therapy, and transmural perfusion differences across the myocardial wall; thus, it can aid in follow-up on treatment for patients undergoing the myoregeneration therapy. Finally, an image-based CAD system for early detection of prostate cancer using DCE-MRI is introduced. Prostate cancer is the most frequently diagnosed malignancy among men and remains the second leading cause of cancer-related death in the USA with more than 238,000 new cases and a mortality rate of about 30,000 in 2013. Therefore, early diagnosis of prostate cancer can improve the effectiveness of treatment and increase the patient’s chance of survival. Currently, needle biopsy is the gold standard for the diagnosis of prostate cancer. However, it is an invasive procedure with high costs and potential morbidity rates. Additionally, it has a higher possibility of producing false positive diagnosis due to relatively small needle biopsy samples. Application of the proposed CAD yield promising results in a cohort of 30 patients that would, in the near future, represent a supplement of the current technologies to determine prostate cancer type. The developed techniques have been compared to the state-of-the-art methods and demonstrated higher accuracy as shown in this dissertation. The proposed models (higher-order spatial interaction models, shape models, motion correction models, and perfusion analysis models) can be used in many of today’s CAD applications for early detection of a variety of diseases and medical conditions, and are expected to notably amplify the accuracy of CAD decisions based on the automated analysis of CE images

Automatic Characterization of Myocardial Perfusion in Contrast Enhanced MRI

The use of contrast medium in cardiac MRI allows joining the high-resolution anatomical information provided by standard magnetic resonance with functional information obtained by means of the perfusion of contrast agent in myocardial tissues. The current approach to perfusion MRI characterization is the qualitative one, based on visual inspection of images. Moving to quantitative analysis requires extraction of numerical indices of myocardium perfusion by analysis of time/intensity curves related to the area of interest. The main problem in quantitative image sequence analysis is the heart movement, mainly due to patient respiration. We propose an automatic procedure based on image registration, segmentation of the myocardium, and extraction and analysis of time/intensity curves. The procedure requires a minimal user interaction, is robust with respect to the user input, and allows effective characterization of myocardial perfusion. The algorithm was tested on cardiac MR images acquired from voluntaries and in clinical routine

Medical imaging analysis with artificial neural networks

Given that neural networks have been widely reported in the research community of medical imaging, we provide a focused literature survey on recent neural network developments in computer-aided diagnosis, medical image segmentation and edge detection towards visual content analysis, and medical image registration for its pre-processing and post-processing, with the aims of increasing awareness of how neural networks can be applied to these areas and to provide a foundation for further research and practical development. Representative techniques and algorithms are explained in detail to provide inspiring examples illustrating: (i) how a known neural network with fixed structure and training procedure could be applied to resolve a medical imaging problem; (ii) how medical images could be analysed, processed, and characterised by neural networks; and (iii) how neural networks could be expanded further to resolve problems relevant to medical imaging. In the concluding section, a highlight of comparisons among many neural network applications is included to provide a global view on computational intelligence with neural networks in medical imaging

Data registration and fusion for cardiac applications

The registration and fusion of information from multiple cardiac image modalities such as magnetic resonance imaging (MRI), X-ray computed tomography (CT), positron emission tomography (PET) and single photon emission computed tomography (SPECT) has been of increasing interest to the medical community as tools for furthering physiological understanding and for diagnostic of ischemic heart diseases. Ischemic heart diseases and their consequence, myocardial infarct, are the leading cause of mortality in industrial countries. In cardiac image registration and data fusion, the combination of structural information from MR images and functional information from PET and SPECT is of special interest in the estimation of myocardial function and viability. Cardiac image registration is a more complex problem than brain image registration. The non-rigid motion of the heart and the thorax structures introduce additional difficulties in registration. In this thesis the goal was develop methods for cardiac data registration and fusion. A rigid registration method was developed to register cardiac MR and PET images. The method was based on the registration of the segmented thorax structures from MR and PET transmission images. The thorax structures were segmented from images using deformable models. A MR short axis registration with PET emission image was also derived. The rigid registration method was evaluated using simulated images and clinical MR and PET images from ten patients with multivessel coronary artery diseases. Also an elastic registration method was developed to register intra-patient cardiac MR and PET images and inter-patient head MR images. In the elastic registration method, a combination of mutual information, gradient information and smoothness of transformation was used to guide the deformation of one image towards another image. An approach for the creation of 3-D functional maps of the heart was also developed. An individualized anatomical heart model was extracted from the MR images. A rigid registration of anatomical MR images and PET metabolic images was carried out using surface based registration, and the registration of MR images with magnetocardiography (MCG) data using external markers. The method resulted in a 3-D anatomical and functional model of the heart that included structural information from the MRI and functional information from the PET and MCG. Different error sources in the registration method of the MR images and MCG data was also evaluated in this thesis. The results of the rigid MR-PET registration method were also used in the comparison of multimodality MR imaging methods to PET.reviewe