Semiautomated 3D liver segmentation using computed tomography and magnetic resonance imaging

Le foie est un organe vital ayant une capacité de régénération exceptionnelle et un rôle crucial dans le fonctionnement de l’organisme. L’évaluation du volume du foie est un outil important pouvant être utilisé comme marqueur biologique de sévérité de maladies hépatiques. La volumétrie du foie est indiquée avant les hépatectomies majeures, l’embolisation de la veine porte et la transplantation. La méthode la plus répandue sur la base d'examens de tomodensitométrie (TDM) et d'imagerie par résonance magnétique (IRM) consiste à délimiter le contour du foie sur plusieurs coupes consécutives, un processus appelé la «segmentation». Nous présentons la conception et la stratégie de validation pour une méthode de segmentation semi-automatisée développée à notre institution. Notre méthode représente une approche basée sur un modèle utilisant l’interpolation variationnelle de forme ainsi que l’optimisation de maillages de Laplace. La méthode a été conçue afin d’être compatible avec la TDM ainsi que l' IRM. Nous avons évalué la répétabilité, la fiabilité ainsi que l’efficacité de notre méthode semi-automatisée de segmentation avec deux études transversales conçues rétrospectivement. Les résultats de nos études de validation suggèrent que la méthode de segmentation confère une fiabilité et répétabilité comparables à la segmentation manuelle. De plus, cette méthode diminue de façon significative le temps d’interaction, la rendant ainsi adaptée à la pratique clinique courante. D’autres études pourraient incorporer la volumétrie afin de déterminer des marqueurs biologiques de maladie hépatique basés sur le volume tels que la présence de stéatose, de fer, ou encore la mesure de fibrose par unité de volume.The liver is a vital abdominal organ known for its remarkable regenerative capacity and fundamental role in organism viability. Assessment of liver volume is an important tool which physicians use as a biomarker of disease severity. Liver volumetry is clinically indicated prior to major hepatectomy, portal vein embolization and transplantation. The most popular method to determine liver volume from computed tomography (CT) and magnetic resonance imaging (MRI) examinations involves contouring the liver on consecutive imaging slices, a process called “segmentation”. Segmentation can be performed either manually or in an automated fashion. We present the design concept and validation strategy for an innovative semiautomated liver segmentation method developed at our institution. Our method represents a model-based approach using variational shape interpolation and Laplacian mesh optimization techniques. It is independent of training data, requires limited user interactions and is robust to a variety of pathological cases. Further, it was designed for compatibility with both CT and MRI examinations. We evaluated the repeatability, agreement and efficiency of our semiautomated method in two retrospective cross-sectional studies. The results of our validation studies suggest that semiautomated liver segmentation can provide strong agreement and repeatability when compared to manual segmentation. Further, segmentation automation significantly shortens interaction time, thus making it suitable for daily clinical practice. Future studies may incorporate liver volumetry to determine volume-averaged biomarkers of liver disease, such as such as fat, iron or fibrosis measurements per unit volume. Segmental volumetry could also be assessed based on subsegmentation of vascular anatomy

Morphological and multi-level geometrical descriptor analysis in CT and MRI volumes for automatic pancreas segmentation

Automatic pancreas segmentation in 3D radiological scans is a critical, yet challenging task. As a prerequisite for computer-aided diagnosis (CADx) systems, accurate pancreas segmentation could generate both quantitative and qualitative information towards establishing the severity of a condition, and thus provide additional guidance for therapy planning. Since the pancreas is an organ of high inter-patient anatomical variability, previous segmentation approaches report lower quantitative accuracy scores in comparison to abdominal organs such as the liver or kidneys. This paper presents a novel approach for automatic pancreas segmentation in magnetic resonance imaging (MRI) and computer tomography (CT) scans. This method exploits 3D segmentation that, when coupled with geometrical and morphological characteristics of abdominal tissue, classifies distinct contours in tight pixel-range proximity as “pancreas” or “non-pancreas”. There are three main stages to this approach: (1) identify a major pancreas region and apply contrast enhancement to differentiate between pancreatic and surrounding tissue; (2) perform 3D segmentation via continuous max-flow and min-cuts approach, structured forest edge detection, and a training dataset of annotated pancreata; (3) eliminate non-pancreatic contours from resultant segmentation via morphological operations on area, structure and connectivity between distinct contours. The proposed method is evaluated on a dataset containing 82 CT image volumes, achieving mean Dice Similarity coefficient (DSC) of 79.3 ± 4.4%. Two MRI datasets containing 216 and 132 image volumes are evaluated, achieving mean DSC 79.6 ± 5.7% and 81.6 ± 5.1% respectively. This approach is statistically stable, reflected by lower metrics in standard deviation in comparison to state-of-the-art approaches

AUTOMATIC LIVER SEGMENTATION FROM CT SCANS USING INTENSITY ANALYSIS AND LEVEL-SET ACTIVE CONTOURS

Liver segmentation from CT scans is still a challenging task due to the liver characteristics in terms of shape and intensity variability. In this work, we propose an automatic segmentation method of the liver from CT data sets. The framework consists of three main steps: liver shape model localization, liver intensity range estimation and localized active contouring. We proposed an adaptive multiple thresholding technique to estimate the range of the liver intensities. First, multiple thresholding is used to extract the dense tissue from the whole CT scan. A localization step is then used to find the approximate location of the liver in the CT scan, to localize a constructed mean liver shape model. A liver intensity-range estimation step is then applied within the localized shape model ROI. The localized shape model and the estimated liver intensity range are used to build the initial mask. A level set based active contour algorithm is used to deform the initial mask to the liver boundaries in the CT scan. The proposed method was evaluated on two public data sets: SLIVER07 and 3D-IRCAD. The experiments showed that the proposed method is able to segment to liver in all CT scans in the two data sets accurately

A comparative evaluation for liver segmentation from spir images and a novel level set method using signed pressure force function

Thesis (Doctoral)--Izmir Institute of Technology, Electronics and Communication Engineering, Izmir, 2013Includes bibliographical references (leaves: 118-135)Text in English; Abstract: Turkish and Englishxv, 145 leavesDeveloping a robust method for liver segmentation from magnetic resonance images is a challenging task due to similar intensity values between adjacent organs, geometrically complex liver structure and injection of contrast media, which causes all tissues to have different gray level values. Several artifacts of pulsation and motion, and partial volume effects also increase difficulties for automatic liver segmentation from magnetic resonance images. In this thesis, we present an overview about liver segmentation methods in magnetic resonance images and show comparative results of seven different liver segmentation approaches chosen from deterministic (K-means based), probabilistic (Gaussian model based), supervised neural network (multilayer perceptron based) and deformable model based (level set) segmentation methods. The results of qualitative and quantitative analysis using sensitivity, specificity and accuracy metrics show that the multilayer perceptron based approach and a level set based approach which uses a distance regularization term and signed pressure force function are reasonable methods for liver segmentation from spectral pre-saturation inversion recovery images. However, the multilayer perceptron based segmentation method requires a higher computational cost. The distance regularization term based automatic level set method is very sensitive to chosen variance of Gaussian function. Our proposed level set based method that uses a novel signed pressure force function, which can control the direction and velocity of the evolving active contour, is faster and solves several problems of other applied methods such as sensitivity to initial contour or variance parameter of the Gaussian kernel in edge stopping functions without using any regularization term

Automatic Pancreas Segmentation and 3D Reconstruction for Morphological Feature Extraction in Medical Image Analysis

The development of highly accurate, quantitative automatic medical image segmentation techniques, in comparison to manual techniques, remains a constant challenge for medical image analysis. In particular, segmenting the pancreas from an abdominal scan presents additional difficulties: this particular organ has very high anatomical variability, and a full inspection is problematic due to the location of the pancreas behind the stomach. Therefore, accurate, automatic pancreas segmentation can consequently yield quantitative morphological measures such as volume and curvature, supporting biomedical research to establish the severity and progression of a condition, such as type 2 diabetes mellitus. Furthermore, it can also guide subject stratification after diagnosis or before clinical trials, and help shed additional light on detecting early signs of pancreatic cancer. This PhD thesis delivers a novel approach for automatic, accurate quantitative pancreas segmentation in mostly but not exclusively Magnetic Resonance Imaging (MRI), by harnessing the advantages of machine learning and classical image processing in computer vision. The proposed approach is evaluated on two MRI datasets containing 216 and 132 image volumes, achieving a mean Dice similarity coefficient (DSC) of 84:1 4:6% and 85:7 2:3% respectively. In order to demonstrate the universality of the approach, a dataset containing 82 Computer Tomography (CT) image volumes is also evaluated and achieves mean DSC of 83:1 5:3%. The proposed approach delivers a contribution to computer science (computer vision) in medical image analysis, reporting better quantitative pancreas segmentation results in comparison to other state-of-the-art techniques, and also captures detailed pancreas boundaries as verified by two independent experts in radiology and radiography. The contributions’ impact can support the usage of computational methods in biomedical research with a clinical translation; for example, the pancreas volume provides a prognostic biomarker about the severity of type 2 diabetes mellitus. Furthermore, a generalisation of the proposed segmentation approach successfully extends to other anatomical structures, including the kidneys, liver and iliopsoas muscles using different MRI sequences. Thus, the proposed approach can incorporate into the development of a computational tool to support radiological interpretations of MRI scans obtained using different sequences by providing a “second opinion”, help reduce possible misdiagnosis, and consequently, provide enhanced guidance towards targeted treatment planning

Interactive Segmentation of 3D Medical Images with Implicit Surfaces

To cope with a variety of clinical applications, research in medical image processing has led to a large spectrum of segmentation techniques that extract anatomical structures from volumetric data acquired with 3D imaging modalities. Despite continuing advances in mathematical models for automatic segmentation, many medical practitioners still rely on 2D manual delineation, due to the lack of intuitive semi-automatic tools in 3D. In this thesis, we propose a methodology and associated numerical schemes enabling the development of 3D image segmentation tools that are reliable, fast and interactive. These properties are key factors for clinical acceptance. Our approach derives from the framework of variational methods: segmentation is obtained by solving an optimization problem that translates the expected properties of target objects in mathematical terms. Such variational methods involve three essential components that constitute our main research axes: an objective criterion, a shape representation and an optional set of constraints. As objective criterion, we propose a unified formulation that extends existing homogeneity measures in order to model the spatial variations of statistical properties that are frequently encountered in medical images, without compromising efficiency. Within this formulation, we explore several shape representations based on implicit surfaces with the objective to cover a broad range of typical anatomical structures. Firstly, to model tubular shapes in vascular imaging, we introduce convolution surfaces in the variational context of image segmentation. Secondly, compact shapes such as lesions are described with a new representation that generalizes Radial Basis Functions with non-Euclidean distances, which enables the design of basis functions that naturally align with salient image features. Finally, we estimate geometric non-rigid deformations of prior templates to recover structures that have a predictable shape such as whole organs. Interactivity is ensured by restricting admissible solutions with additional constraints. Translating user input into constraints on the sign of the implicit representation at prescribed points in the image leads us to consider inequality-constrained optimization

Liver Segmentation and its Application to Hepatic Interventions

The thesis addresses the development of an intuitive and accurate liver segmentation approach, its integration into software prototypes for the planning of liver interventions, and research on liver regeneration. The developed liver segmentation approach is based on a combination of the live wire paradigm and shape-based interpolation. Extended with two correction modes and integrated into a user-friendly workflow, the method has been applied to more than 5000 data sets. The combination of the liver segmentation with image analysis of hepatic vessels and tumors allows for the computation of anatomical and functional remnant liver volumes. In several projects with clinical partners world-wide, the benefit of the computer-assisted planning was shown. New insights about the postoperative liver function and regeneration could be gained, and most recent investigations into the analysis of MRI data provide the option to further improve hepatic intervention planning

Validierung einer neuen Software für halbautomatische Volumetrie – ist diese besser als manuelle Messungen?

This study compared a manual program for liver volumetry with a semiautomated software. The hypothesis was that the software would be faster, more accurate and less dependent on the evaluator’s experience. Materials and Methods: Ten patients undergoing hemihepatectomy were included into this IRB approved study after written informed consent. All patients underwent a preoperative abdominal CTScan, which was used for whole liver volumetry and volume prediction for the liver part to be resected. Two different softwares were used: 1) manual method: borders of the liver had to be defined per slice by the user; 2) semiautomated software: automatic identification of liver volume with manual assistance for definition of Couinaud-segments. Measurements were done by six observers with different experience levels. Water displacement volumetry immediately after partial liver resection served as gold standard. The resected part was examined with a CT-scan after displacement volumetry. Results: Volumetry of the resected liver scan showed excellent correlations to water displacement volumetry (manual: ρ=0.997; semiautomated software: ρ=0.995). Difference between the predicted volume and the real volume was significantly smaller with the semiautomated software than with the manual method (33 % vs. 57 %, p=0.002). The semiautomated software was almost four times faster for volumetry of the whole liver. Conclusion: Both methods for liver volumetry give an estimated liver volume close to the real one. The tested semiautomated software is faster, more accurate in predicting the volume of the resected liver part, gives more reproducible results and is less dependent on the user’s experience.Ziel dieser Studie war es, eine manuelle Methode zur Lebervolumetrie mit einer halbautomatischen Software zu vergleichen. Die zu prüfende Hypothese war eine Überlegenheit der halbautomatischen Software hinsichtlich Schnelligkeit, Genauigkeit und Unabhängigkeit von der Erfahrung des Auswerters. Material und Methoden: Die Studie wurde von der Ethikkommission geprüft und es lagen Einverständniserklärungen aller Patienten vor. In die Studie wurden zehn Patienten eingeschlossen, die eine Hemihepatektomie erhielten. Es wurde präoperativ ein CT-Scan angefertigt, der sowohl für die Volumetrie der gesamten Leber als auch zur Bestimmung des Resektatvolumens verwendet wurde. Für die Volumetrie wurden zwei verschiedene Programme genutzt: 1) eine manuelle Methode, wobei die Lebergrenzen in jeder Schicht vom Auswerter definiert werden mussten 2) eine halbautomatische Software mit automatischer Erkennung des Lebervolumens und manueller Definition der Lebersegmente nach Coinaud. Die Messungen wurden von sechs Auswertern mit unterschiedlicher Erfahrung vorgenommen. Als Goldstandard diente eine Verdrängungsvolumetrie des Leberresektats, die direkt nach der Resektion im Operationssaal durchgeführt wurde. Anschließend wurde zusätzlich ein CT-Scan des Resektats angefertigt. Ergebnisse: Die Ergebnisse des postoperativen CT-Scans korrelierten hochgradig mit den Ergebnissen der Verdrängungsvolumetrie (manuell: ρ=0.997; halbautomatische Software: ρ=0.995). Mit der halbautomatischen Software fielen die Unterschiede zwischen dem vorhergesagten und dem tatsächlichen Volumen signifikant kleiner aus (33 % vs. 57 %, p=0.002). Zudem lieferte die halbautomatische Software die Volumina der Gesamtleber 3.9mal schneller. Schlussfolgerung: Beide Methoden erlauben eine sehr gute Abschätzung des Lebervolumens. Die getestete halbautomatische Software kann das Lebervolumen jedoch schneller und das Resektatvolumen genauer vorhersagen und ist zusätzlich unabhängiger von der Erfahrung des Auswerters

IMAGE PROCESSING, SEGMENTATION AND MACHINE LEARNING MODELS TO CLASSIFY AND DELINEATE TUMOR VOLUMES TO SUPPORT MEDICAL DECISION

Techniques for processing and analysing images and medical data have become the main’s translational applications and researches in clinical and pre-clinical environments. The advantages of these techniques are the improvement of diagnosis accuracy and the assessment of treatment response by means of quantitative biomarkers in an efficient way. In the era of the personalized medicine, an early and efficacy prediction of therapy response in patients is still a critical issue. In radiation therapy planning, Magnetic Resonance Imaging (MRI) provides high quality detailed images and excellent soft-tissue contrast, while Computerized Tomography (CT) images provides attenuation maps and very good hard-tissue contrast. In this context, Positron Emission Tomography (PET) is a non-invasive imaging technique which has the advantage, over morphological imaging techniques, of providing functional information about the patient’s disease. In the last few years, several criteria to assess therapy response in oncological patients have been proposed, ranging from anatomical to functional assessments. Changes in tumour size are not necessarily correlated with changes in tumour viability and outcome. In addition, morphological changes resulting from therapy occur slower than functional changes. Inclusion of PET images in radiotherapy protocols is desirable because it is predictive of treatment response and provides crucial information to accurately target the oncological lesion and to escalate the radiation dose without increasing normal tissue injury. For this reason, PET may be used for improving the Planning Treatment Volume (PTV). Nevertheless, due to the nature of PET images (low spatial resolution, high noise and weak boundary), metabolic image processing is a critical task. The aim of this Ph.D thesis is to develope smart methodologies applied to the medical imaging field to analyse different kind of problematic related to medical images and data analysis, working closely to radiologist physicians. Various issues in clinical environment have been addressed and a certain amount of improvements has been produced in various fields, such as organs and tissues segmentation and classification to delineate tumors volume using meshing learning techniques to support medical decision. In particular, the following topics have been object of this study: • Technique for Crohn’s Disease Classification using Kernel Support Vector Machine Based; • Automatic Multi-Seed Detection For MR Breast Image Segmentation; • Tissue Classification in PET Oncological Studies; • KSVM-Based System for the Definition, Validation and Identification of the Incisinal Hernia Reccurence Risk Factors; • A smart and operator independent system to delineate tumours in Positron Emission Tomography scans; 3 • Active Contour Algorithm with Discriminant Analysis for Delineating Tumors in Positron Emission Tomography; • K-Nearest Neighbor driving Active Contours to Delineate Biological Tumor Volumes; • Tissue Classification to Support Local Active Delineation of Brain Tumors; • A fully automatic system of Positron Emission Tomography Study segmentation. This work has been developed in collaboration with the medical staff and colleagues at the: • Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi (DIBIMED), University of Palermo • Cannizzaro Hospital of Catania • Istituto di Bioimmagini e Fisiologia Molecolare (IBFM) Centro Nazionale delle Ricerche (CNR) of Cefalù • School of Electrical and Computer Engineering at Georgia Institute of Technology The proposed contributions have produced scientific publications in indexed computer science and medical journals and conferences. They are very useful in terms of PET and MRI image segmentation and may be used daily as a Medical Decision Support Systems to enhance the current methodology performed by healthcare operators in radiotherapy treatments. The future developments of this research concern the integration of data acquired by image analysis with the managing and processing of big data coming from a wide kind of heterogeneous sources

Automated Characterisation and Classification of Liver Lesions From CT Scans

Cancer is a general term for a wide range of diseases that can affect any part of the body due to the rapid creation of abnormal cells that grow outside their normal boundaries. Liver cancer is one of the common diseases that cause the death of more than 600,000 each year. Early detection is important to diagnose and reduce the incidence of death. Examination of liver lesions is performed with various medical imaging modalities such as Ultrasound (US), Computer tomography (CT), and Magnetic resonance imaging (MRI). The improvements in medical imaging and image processing techniques have significantly enhanced the interpretation of medical images. Computer-Aided Diagnosis (CAD) systems based on these techniques play a vital role in the early detection of liver disease and hence reduce liver cancer death rate. Moreover, CAD systems can help physician, as a second opinion, in characterising lesions and making the diagnostic decision. Thus, CAD systems have become an important research area. Particularly, these systems can provide diagnostic assistance to doctors to improve overall diagnostic accuracy. The traditional methods to characterise liver lesions and differentiate normal liver tissues from abnormal ones are largely dependent on the radiologists experience. Thus, CAD systems based on the image processing and artificial intelligence techniques gained a lot of attention, since they could provide constructive diagnosis suggestions to clinicians for decision making. The liver lesions are characterised through two ways: (1) Using a content-based image retrieval (CBIR) approach to assist the radiologist in liver lesions characterisation. (2) Calculating the high-level features that describe/ characterise the liver lesion in a way that is interpreted by humans, particularly Radiologists/Clinicians, based on the hand-crafted/engineered computational features (low-level features) and learning process. However, the research gap is related to the high-level understanding and interpretation of the medical image contents from the low-level pixel analysis, based on mathematical processing and artificial intelligence methods. In our work, the research gap is bridged if a relation of image contents to medical meaning in analogy to radiologist understanding is established. This thesis explores an automated system for the classification and characterisation of liver lesions in CT scans. Firstly, the liver is segmented automatically by using anatomic medical knowledge, histogram-based adaptive threshold and morphological operations. The lesions and vessels are then extracted from the segmented liver by applying AFCM and Gaussian mixture model through a region growing process respectively. Secondly, the proposed framework categorises the high-level features into two groups; the first group is the high-level features that are extracted from the image contents such as (Lesion location, Lesion focality, Calcified, Scar, ...); the second group is the high-level features that are inferred from the low-level features through machine learning process to characterise the lesion such as (Lesion density, Lesion rim, Lesion composition, Lesion shape,...). The novel Multiple ROIs selection approach is proposed, in which regions are derived from generating abnormality level map based on intensity difference and the proximity distance for each voxel with respect to the normal liver tissue. Then, the association between low-level, high-level features and the appropriate ROI are derived by assigning the ability of each ROI to represents a set of lesion characteristics. Finally, a novel feature vector is built, based on high-level features, and fed into SVM for lesion classification. In contrast with most existing research, which uses low-level features only, the use of high-level features and characterisation helps in interpreting and explaining the diagnostic decision. The methods are evaluated on a dataset containing 174 CT scans. The experimental results demonstrated that the efficacy of the proposed framework in the successful characterisation and classification of the liver lesions in CT scans. The achieved average accuracy was 95:56% for liver lesion characterisation. While the lesion’s classification accuracy was 97:1% for the entire dataset. The proposed framework is developed to provide a more robust and efficient lesion characterisation framework through comprehensions of the low-level features to generate semantic features. The use of high-level features (characterisation) helps in better interpretation of CT liver images. In addition, the difference-of-features using multiple ROIs were developed for robust capturing of lesion characteristics in a reliable way. This is in contrast to the current research trend of extracting the features from the lesion only and not paying much attention to the relation between lesion and surrounding area. The design of the liver lesion characterisation framework is based on the prior knowledge of the medical background to get a better and clear understanding of the liver lesion characteristics in medical CT images