Fusion and Analysis of Multidimensional Medical Image Data

Analýza medicínských obrazů je předmětem základního výzkumu již řadu let. Za tu dobu bylo v této oblasti publikováno mnoho výzkumných prací zabývajících se dílčími částmi jako je rekonstrukce obrazů, restaurace, segmentace, klasifikace, registrace (lícování) a fúze. Kromě obecného úvodu, pojednává tato disertační práce o dvou medicínsky orientovaných tématech, jež byla formulována ve spolupráci s Philips Netherland BV, divizí Philips Healthcare. První téma je zaměřeno na oblast zpracování obrazů subtrakční angiografie dolních končetin člověka získaných pomocí výpočetní X-Ray tomografie (CT). Subtrakční angiografie je obvykle využívaná při podezření na periferní cévní onemocnění (PAOD) nebo při akutním poškození dolních končetin jako jsou fraktury apod. Současné komerční metody nejsou dostatečně spolehlivé už v předzpracování, jako je například odstranění pacientského stolu, pokrývky, dlahy, apod. Spolehlivost a přesnost identifikace cév v subtrahovaných datech vedoucích v blízkosti kostí je v důsledku Partial Volume artefaktu rovněž nízká. Automatické odstranění kalcifikací nebo detekce malých cév doplňujících nezbytnou informaci o náhradním zásobení dolních končetin krví v případě přerušení hlavních zásobujících cév v současné době rovněž nesplňují kritéria pro plně automatické zpracování. Proto hlavním cílem týkající se tohoto tématu bylo vyvinout automatický systém, který by mohl současné nedostatky v CTSA vyšetření odstranit. Druhé téma je orientováno na identifikaci patologických změn na páteři člověka v CT obrazech se zaměřením na osteolytické a osteoblastické léze u jednotlivých obratlů. Tyto změny obvykle nastávají v důsledků postižení metastazujícím procesem rakovinového onemocnění. Pro detekci patologických změn je pak potřeba identifikace a segmentace jednotlivých obratlů. Přesnost analýzy jednotlivých lézí však závisí rovněž na správné identifikaci těla a zadních segmentů u jednotlivých obratlů a na segmentaci trabekulárního centra obratlů, tj. odstranění kortikální kosti. Během léčby mohou být pacienti skenováni vícekrát, obvykle s několika-mesíčním odstupem. Hodnocení případného vývoje již detekovaných patologických změn pak logicky vychází ze správné detekce patologií v jednotlivých obratlech korespondujících si v jednotlivých akvizicích. Jelikož jsou příslušné obratle v jednotlivých akvizicích obvykle na různé pozici, jejich fúze, vedoucí k analýze časového vývoje detekovaných patologií, je komplikovaná. Požadovaným výsledkem v tomto tématu je vytvoření komplexního systému pro detekci patologických změn v páteři, především osteoblastických a osteolytických lézí. Takový systém tedy musí umožnovat jak segmentaci jednotlivých obratlů, jejich automatické rozdělení na hlavní části a odstranění kortikální kosti, tak také detekci patologických změn a jejich hodnocení. Ačkoliv je tato disertační práce v obou výše zmíněných tématech primárně zaměřena na experimentální část zpracování medicínských obrazů, zabývá se všemi nezbytnými kroky, jako je předzpracování, registrace, dodatečné zpracování a hodnocení výsledků, vedoucími k možné aplikovatelnosti obou systému v klinické praxi. Jelikož oba systémy byly řešeny v rámci týmové spolupráce jako celek, u obou témat jsou pro některé konkrétní kroky uvedeny odkazy na doktorskou práci Miloše Malínského.Analysis of medical images has been subject of basic research for many years. Many research papers have been published in the field related to image analysis and focused on partial aspects such as reconstruction, restoration, segmentation and classification, registration (spatial alignment) and fusion. Besides the introduction of related general concepts used in medical image processing, this thesis deals with two specific medical problems formulated in cooperation with Philips Netherland BV, Philips Healthcare division. The first topic is focused on subtraction angiography in patients’ lower legs utilizing image data from X-Ray computed tomography (CT). CT subtraction angiography (CTSA) is typically used for indication of the Peripheral Artery Occlusive Disease (PAOD) and for examination of acute injuries of lower legs such as acute fractures, etc. Current methods in clinical praxis are not sufficient regarding the pre-processing such as masking of patient desk, cover, splint, etc. The subtraction of blood vessels adjacent to neighboring bones in lower legs is of low accuracy due to the Partial Volume artifact. Masking of calcifications and detection of tiny blood vessels complementing necessary information about the alternative blood supply in lower legs in case of obstruction in main arteries is also not reliable for fully automated process presently. Therefore, the main aim regarding this topic was to develop an automated framework that could overcome current shortcomings in CTSA examination. The second topic is oriented on the identification and evaluation of pathologic changes in human spine, focusing on osteolytic and osteoblastic lesions in individual vertebrae in CT images. Such changes occur typically as a consequence of metastasizing process of cancerous disease. For the detection of pathologic changes, an identification and segmentation of individual vertebrae is necessary. Moreover, the analysis of individual lesions in vertebrae depends also on correct identification of vertebral body and posterior segments of each vertebra, and on segmentation of their trabecular centers. Patients are typically examined more than once during their therapy. Then, the evaluation of possible tumorous progression is based on accurate detection of pathologies in individual vertebrae in the base-line and corresponding follow-up images. Since the corresponding vertebrae are in mutually different positions in the follow-up images, their fusion leading to the analysis of the lesion progression is complicated. The main aim regarding this topic is to develop a complex framework for detection of pathologic lesions on spine, with the main focus on osteoblastic and osteolystic lesions. Such system has to provide not only reliable segmentation of individual vertebrae and detection of their main regions but also the masking of their cortical bone, detection of their pathologic changes and their evaluation. Although this dissertation thesis is primarily oriented at the experimental part of medical image processing considering both the above mentioned topics, it deals with all necessary processing steps, i.e. preprocessing, image registration, post-processing and evaluation of results, leading to the future use of both frameworks in clinical practice. Since both frameworks were developed in a team, there are some chapters referring to the dissertation thesis of Milos Malinsky.

Advanced Algorithms for 3D Medical Image Data Fusion in Specific Medical Problems

Fúze obrazu je dnes jednou z nejběžnějších avšak stále velmi diskutovanou oblastí v lékařském zobrazování a hraje důležitou roli ve všech oblastech lékařské péče jako je diagnóza, léčba a chirurgie. V této dizertační práci jsou představeny tři projekty, které jsou velmi úzce spojeny s oblastí fúze medicínských dat. První projekt pojednává o 3D CT subtrakční angiografii dolních končetin. V práci je využito kombinace kontrastních a nekontrastních dat pro získání kompletního cévního stromu. Druhý projekt se zabývá fúzí DTI a T1 váhovaných MRI dat mozku. Cílem tohoto projektu je zkombinovat stukturální a funkční informace, které umožňují zlepšit znalosti konektivity v mozkové tkáni. Třetí projekt se zabývá metastázemi v CT časových datech páteře. Tento projekt je zaměřen na studium vývoje metastáz uvnitř obratlů ve fúzované časové řadě snímků. Tato dizertační práce představuje novou metodologii pro klasifikaci těchto metastáz. Všechny projekty zmíněné v této dizertační práci byly řešeny v rámci pracovní skupiny zabývající se analýzou lékařských dat, kterou vedl pan Prof. Jiří Jan. Tato dizertační práce obsahuje registrační část prvního a klasifikační část třetího projektu. Druhý projekt je představen kompletně. Další část prvního a třetího projektu, obsahující specifické předzpracování dat, jsou obsaženy v disertační práci mého kolegy Ing. Romana Petera.Image fusion is one of today´s most common and still challenging tasks in medical imaging and it plays crucial role in all areas of medical care such as diagnosis, treatment and surgery. Three projects crucially dependent on image fusion are introduced in this thesis. The first project deals with the 3D CT subtraction angiography of lower limbs. It combines pre-contrast and contrast enhanced data to extract the blood vessel tree. The second project fuses the DTI and T1-weighted MRI brain data. The aim of this project is to combine the brain structural and functional information that purvey improved knowledge about intrinsic brain connectivity. The third project deals with the time series of CT spine data where the metastases occur. In this project the progression of metastases within the vertebrae is studied based on fusion of the successive elements of the image series. This thesis introduces new methodology of classifying metastatic tissue. All the projects mentioned in this thesis have been solved by the medical image analysis group led by Prof. Jiří Jan. This dissertation concerns primarily the registration part of the first project and the classification part of the third project. The second project is described completely. The other parts of the first and third project, including the specific preprocessing of the data, are introduced in detail in the dissertation thesis of my colleague Roman Peter, M.Sc.

Segmentation of neuroanatomy in magnetic resonance images

Segmentation in neurological Magnetic Resonance Imaging (MRI) is necessary for volume measurement, feature extraction and for the three-dimensional display of neuroanatomy. This thesis proposes several automated and semi-automated methods which offer considerable advantages over manual methods because of their lack of subjectivity, their data reduction capabilities, and the time savings they give. Work has concentrated on the use of dual echo multi-slice spin-echo data sets in order to take advantage of the intrinsically multi-parametric nature of MRI. Such data is widely acquired clinically and segmentation therefore does not require additional scans. The literature has been reviewed. Factors affecting image non-uniformity for a modem 1.5 Tesla imager have been investigated. These investigations demonstrate that a robust, fast, automatic three-dimensional non-uniformity correction may be applied to data as a pre-processing step. The merit of using an anisotropic smoothing method for noisy data has been demonstrated. Several approaches to neurological MRI segmentation have been developed. Edge-based processing is used to identify the skin (the major outer contour) and the eyes. Edge-focusing, two threshold based techniques and a fast radial CSF identification approach are proposed to identify the intracranial region contour in each slice of the data set. Once isolated, the intracranial region is further processed to identify CSF, and, depending upon the MRI pulse sequence used, the brain itself may be sub-divided into grey matter and white matter using semiautomatic contrast enhancement and clustering methods. The segmentation of Multiple Sclerosis (MS) plaques has also been considered. The utility of the stack, a data driven multi-resolution approach to segmentation, has been investigated, and several improvements to the method suggested. The factors affecting the intrinsic accuracy of neurological volume measurement in MRI have been studied and their magnitudes determined for spin-echo imaging. Geometric distortion - both object dependent and object independent - has been considered, as well as slice warp, slice profile, slice position and the partial volume effect. Finally, the accuracy of the approaches to segmentation developed in this thesis have been evaluated. Intracranial volume measurements are within 5% of expert observers' measurements, white matter volumes within 10%, and CSF volumes consistently lower than the expert observers' measurements due to the observers' inability to take the partial volume effect into account

High-Resolution Quantitative Cone-Beam Computed Tomography: Systems, Modeling, and Analysis for Improved Musculoskeletal Imaging

This dissertation applies accurate models of imaging physics, new high-resolution imaging hardware, and novel image analysis techniques to benefit quantitative applications of x-ray CT in in vivo assessment of bone health. We pursue three Aims: 1. Characterization of macroscopic joint space morphology, 2. Estimation of bone mineral density (BMD), and 3. Visualization of bone microstructure. This work contributes to the development of extremity cone-beam CT (CBCT), a compact system for musculoskeletal (MSK) imaging. Joint space morphology is characterized by a model which draws an analogy between the bones of a joint and the plates of a capacitor. Virtual electric field lines connecting the two surfaces of the joint are computed as a surrogate measure of joint space width, creating a rich, non-degenerate, adaptive map of the joint space. We showed that by using such maps, a classifier can outperform radiologist measurements at identifying osteoarthritic patients in a set of CBCT scans. Quantitative BMD accuracy is achieved by combining a polyenergetic model-based iterative reconstruction (MBIR) method with fast Monte Carlo (MC) scatter estimation. On a benchtop system emulating extremity CBCT, we validated BMD accuracy and reproducibility via a series of phantom studies involving inserts of known mineral concentrations and a cadaver specimen. High-resolution imaging is achieved using a complementary metal-oxide semiconductor (CMOS)-based x-ray detector featuring small pixel size and low readout noise. A cascaded systems model was used to performed task-based optimization to determine optimal detector scintillator thickness in nominal extremity CBCT imaging conditions. We validated the performance of a prototype scanner incorporating our optimization result. Strong correlation was found between bone microstructure metrics obtained from the prototype scanner and µCT gold standard for trabecular bone samples from a cadaver ulna. Additionally, we devised a multiresolution reconstruction scheme allowing fast MBIR to be applied to large, high-resolution projection data. To model the full scanned volume in the reconstruction forward model, regions outside a finely sampled region-of-interest (ROI) are downsampled, reducing runtime and cutting memory requirements while maintaining image quality in the ROI

Advancements and Breakthroughs in Ultrasound Imaging

Ultrasonic imaging is a powerful diagnostic tool available to medical practitioners, engineers and researchers today. Due to the relative safety, and the non-invasive nature, ultrasonic imaging has become one of the most rapidly advancing technologies. These rapid advances are directly related to the parallel advancements in electronics, computing, and transducer technology together with sophisticated signal processing techniques. This book focuses on state of the art developments in ultrasonic imaging applications and underlying technologies presented by leading practitioners and researchers from many parts of the world

U-Net and its variants for medical image segmentation: theory and applications

U-net is an image segmentation technique developed primarily for medical image analysis that can precisely segment images using a scarce amount of training data. These traits provide U-net with a very high utility within the medical imaging community and have resulted in extensive adoption of U-net as the primary tool for segmentation tasks in medical imaging. The success of U-net is evident in its widespread use in all major image modalities from CT scans and MRI to X-rays and microscopy. Furthermore, while U-net is largely a segmentation tool, there have been instances of the use of U-net in other applications. As the potential of U-net is still increasing, in this review we look at the various developments that have been made in the U-net architecture and provide observations on recent trends. We examine the various innovations that have been made in deep learning and discuss how these tools facilitate U-net. Furthermore, we look at image modalities and application areas where U-net has been applied.Comment: 42 pages, in IEEE Acces

Automated Strategies in Multimodal and Multidimensional Ultrasound Image-based Diagnosis

Medical ultrasonography is an effective technique in traditional anatomical and functional diagnosis. However, it requires the visual examination by experienced clinicians, which is a laborious, time consuming and highly subjective procedure. Computer-aided diagnosis (CADx) have been extensively used in clinical practice to support the interpretation of images; nevertheless, current ultrasound CADx still entails a substantial user-dependency and are unable to extract image data for prediction modelling. The aim of this thesis is to propose a set of fully automated strategies to overcome the limitations of ultrasound CADx. These strategies are addressed to multiple modalities (B-Mode, Contrast-Enhanced Ultrasound-CEUS, Power Doppler-PDUS and Acoustic Angiography-AA) and dimensions (2-D and 3-D imaging). The enabling techniques presented in this work are designed, developed and quantitively validated to efficiently improve the overall patients’ diagnosis. This work is subdivided in 2 macro-sections: in the first part, two fully automated algorithms for the reliable quantification of 2-D B-Mode ultrasound skeletal muscle architecture and morphology are proposed. In the second part, two fully automated algorithms for the objective assessment and characterization of tumors’ vasculature in 3-D CEUS and PDUS thyroid tumors and preclinical AA cancer growth are presented. In the first part, the MUSA (Muscle UltraSound Analysis) algorithm is designed to measure the muscle thickness, the fascicles length and the pennation angle; the TRAMA (TRAnsversal Muscle Analysis) algorithm is proposed to extract and analyze the Visible Cross-Sectional Area (VCSA). MUSA and TRAMA algorithms have been validated on two datasets of 200 images; automatic measurements have been compared with expert operators’ manual measurements. A preliminary statistical analysis was performed to prove the ability of texture analysis on automatic VCSA in the distinction between healthy and pathological muscles. In the second part, quantitative assessment on tumor vasculature is proposed in two automated algorithms for the objective characterization of 3-D CEUS/Power Doppler thyroid nodules and the evolution study of fibrosarcoma invasion in preclinical 3-D AA imaging. Vasculature analysis relies on the quantification of architecture and vessels tortuosity. Vascular features obtained from CEUS and PDUS images of 20 thyroid nodules (10 benign, 10 malignant) have been used in a multivariate statistical analysis supported by histopathological results. Vasculature parametric maps of implanted fibrosarcoma are extracted from 8 rats investigated with 3-D AA along four time points (TPs), in control and tumors areas; results have been compared with manual previous findings in a longitudinal tumor growth study. Performance of MUSA and TRAMA algorithms results in 100% segmentation success rate. Absolute difference between manual and automatic measurements is below 2% for the muscle thickness and 4% for the VCSA (values between 5-10% are acceptable in clinical practice), suggesting that automatic and manual measurements can be used interchangeably. The texture features extraction on the automatic VCSAs reveals that texture descriptors can distinguish healthy from pathological muscles with a 100% success rate for all the four muscles. Vascular features extracted of 20 thyroid nodules in 3-D CEUS and PDUS volumes can be used to distinguish benign from malignant tumors with 100% success rate for both ultrasound techniques. Malignant tumors present higher values of architecture and tortuosity descriptors; 3-D CEUS and PDUS imaging present the same accuracy in the differentiation between benign and malignant nodules. Vascular parametric maps extracted from the 8 rats along the 4 TPs in 3-D AA imaging show that parameters extracted from the control area are statistically different compared to the ones within the tumor volume. Tumor angiogenetic vessels present a smaller diameter and higher tortuosity. Tumor evolution is characterized by the significant vascular trees growth and a constant value of vessel diameter along the four TPs, confirming the previous findings. In conclusion, the proposed automated strategies are highly performant in segmentation, features extraction, muscle disease detection and tumor vascular characterization. These techniques can be extended in the investigation of other organs, diseases and embedded in ultrasound CADx, providing a user-independent reliable diagnosis

Computer aided diagnosis of cerebrovascular disease based on DSA image

In recent years, the incidence of cerebrovascular diseases in China has shown a significant upward trend, and it has become a common disease threatening people's lives. Digital Subtraction Angiography (DSA) is the gold standard for the diagnosis of clinical cerebrovascular disease, and it is the most direct method to check the brain lesion. At present, there are the following two problems in the clinical research of DSA images: DSA is a real-time image with numerous frames, containing much useless information in frames; thus, human interpretation and annotation are time-consuming and labor-intensive. The blood vessel structure in DSA images is so complicated that high practical skills are required for clinicians. In the computer-aided diagnosis of DSA sequence images, there is currently a lack of automatic and effective computer-aided diagnosis algorithms for cerebrovascular diseases. Based on the above issues, the main work of this paper is as follows: 1.A multi-target detection algorithm based on Faster-RCNN is designed and applied to the analysis of brain DSA images. The algorithm divides DSA images into arterial phase, capillary phase, pre-venous phase and sinus phase by identifying the main blood vessel structure in each frame. And on this basis, we analyze the time relationship between the time phases. 2.On the basis of DSA phase detection, a key frame location algorithm based on single blood vessel structure detection is designed for moyamoya disease. First, the target detection model is applied to locate the internal carotid artery and the Willis circle. Then, five frames of images are extracted from the arterial period as keyframes. Finally, the nidus' ROI is determined according to the position of the internal carotid artery. 3.A diagnostic method for cerebral arteriovenous malformation (AVM) is designed, which combines temporal features and radiomics features. First, on the basis of DSA time phase detection, we propose a deep learning network to extract vascular time features from the DSA video; then, the time feature is combined with the radiomics features of the static keyframe to establish an AVM diagnosis model. While assisting diagnosis, this method does not require any human intervention, and reduces the workload of clinicians. The diagnostic model that combines time features and radiomics features is applied to the study of AVM staging. The experimental results prove that the classification model trained by fusion features has better diagnostic performance than the model trained by either time features or radiomics features. Based on the above three parts, this paper establishes a cerebrovascular disease analysis framework based on radiomics method and deep learning. We introduce corresponding solutions for DSA automatic image reading, rapid diagnosis of moyamoya disease, and precise diagnosis of AVM. The method proposed in this paper has practical significance for assisting the diagnosis of cerebrovascular disease and reducing the burden of medical staff.Digital Subtraction Angiography(DSA), Radiomics analysis, Arteriovenous malformations, Moyamoya, Faster-RCNN, Temporal features, Fusion feature

U-net and its variants for medical image segmentation: A review of theory and applications

U-net is an image segmentation technique developed primarily for image segmentation tasks. These traits provide U-net with a high utility within the medical imaging community and have resulted in extensive adoption of U-net as the primary tool for segmentation tasks in medical imaging. The success of U-net is evident in its widespread use in nearly all major image modalities, from CT scans and MRI to Xrays and microscopy. Furthermore, while U-net is largely a segmentation tool, there have been instances of the use of U-net in other applications. Given that U-net’s potential is still increasing, this narrative literature review examines the numerous developments and breakthroughs in the U-net architecture and provides observations on recent trends. We also discuss the many innovations that have advanced in deep learning and discuss how these tools facilitate U-net. In addition, we review the different image modalities and application areas that have been enhanced by U-net