Computer-aided techniques for assessment of MRI-detected inflammation for early identification of inflammatory arthritis

Inflammatory arthritis comprises a group of diseases in which the immune system attacks the body’s own tissues. Two prevalent types of inflammatory arthritis are rheumatoid arthritis (RA) and spondyloarthritis (SpA). Clinical research points to the importance of early diagnosis, as treatment in early disease stages increases chances of better outcome and improved quality of life for patients. To this end, the diagnostic potential of imaging modalities sensitive to local inflammation, such as magnetic resonance imaging (MRI), is of great interest. The goal of this thesis was to develop computer-aided methods for assessment of MRI-detected inflammation with the aim of aiding early diagnosis of inflammatory arthritis. In particular, we focused on the tasks of comparative visualization, automatic quantification, and feature selection. The presented studies showcase the potential of comparative visualization and automatic quantification to overcome the limitations of visual scoring and lay out a fertile ground for future improvements. Additionally, the understanding of the diagnostic role of individual inflammatory features in prediction of RA development is further advanced. Collectively, these findings can help facilitate the use of MRI for early diagnosis of inflammatory arthritis and potentially increase chances of better outcome and quality of life for patients.This research was supported by the Dutch Technology Foundation STW, under grant number 13329. STW (currently TTW) is part of the Netherlands Organization for Scientific Research (NWO), which is partly funded by the Dutch Ministry of Economic Affairs.LUMC / Geneeskunde Repositoriu

In vivo morphometric and mechanical characterization of trabecular bone from high resolution magnetic resonance imaging

La osteoporosis es una enfermedad ósea que se manifiesta con una menor densidad ósea y el deterioro de la arquitectura del hueso esponjoso. Ambos factores aumentan la fragilidad ósea y el riesgo de sufrir fracturas óseas, especialmente en mujeres, donde existe una alta prevalencia. El diagnóstico actual de la osteoporosis se basa en la cuantificación de la densidad mineral ósea (DMO) mediante la técnica de absorciometría dual de rayos X (DXA). Sin embargo, la DMO no puede considerarse de manera aislada para la evaluación del riesgo de fractura o los efectos terapéuticos. Existen otros factores, tales como la disposición microestructural de las trabéculas y sus características que es necesario tener en cuenta para determinar la calidad del hueso y evaluar de manera más directa el riesgo de fractura. Los avances técnicos de las modalidades de imagen médica, como la tomografía computarizada multidetector (MDCT), la tomografía computarizada periférica cuantitativa (HR-pQCT) y la resonancia magnética (RM) han permitido la adquisición in vivo con resoluciones espaciales elevadas. La estructura del hueso trabecular puede observarse con un buen detalle empleando estas técnicas. En particular, el uso de los equipos de RM de 3 Teslas (T) ha permitido la adquisición con resoluciones espaciales muy altas. Además, el buen contraste entre hueso y médula que proporcionan las imágenes de RM, así como la utilización de radiaciones no ionizantes sitúan a la RM como una técnica muy adecuada para la caracterización in vivo de hueso trabecular en la enfermedad de la osteoporosis. En la presente tesis se proponen nuevos desarrollos metodológicos para la caracterización morfométrica y mecánica del hueso trabecular en tres dimensiones (3D) y se aplican a adquisiciones de RM de 3T con alta resolución espacial. El análisis morfométrico está compuesto por diferentes algoritmos diseñados para cuantificar la morfología, la complejidad, la topología y los parámetros de anisotropía del tejido trabecular. En cuanto a la caracterización mecánica, se desarrollaron nuevos métodos que permiten la simulación automatizada de la estructura del hueso trabecular en condiciones de compresión y el cálculo del módulo de elasticidad. La metodología desarrollada se ha aplicado a una población de sujetos sanos con el fin de obtener los valores de normalidad del hueso esponjoso. Los algoritmos se han aplicado también a una población de pacientes con osteoporosis con el fin de cuantificar las variaciones de los parámetros en la enfermedad y evaluar las diferencias con los resultados obtenidos en un grupo de sujetos sanos con edad similar.Los desarrollos metodológicos propuestos y las aplicaciones clínicas proporcionan resultados satisfactorios, presentando los parámetros una alta sensibilidad a variaciones de la estructura trabecular principalmente influenciadas por el sexo y el estado de enfermedad. Por otra parte, los métodos presentan elevada reproducibilidad y precisión en la cuantificación de los valores morfométricos y mecánicos. Estos resultados refuerzan el uso de los parámetros presentados como posibles biomarcadores de imagen en la enfermedad de la osteoporosis.Alberich Bayarri, Á. (2010). In vivo morphometric and mechanical characterization of trabecular bone from high resolution magnetic resonance imaging [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/8981Palanci

The feasibility of using feature-flow and label transfer system to segment medical images with deformed anatomy in orthopedic surgery

In computer-aided surgical systems, to obtain high fidelity three-dimensional models, we require accurate segmentation of medical images. State-of-art medical image segmentation methods have been used successfully in particular applications, but they have not been demonstrated to work well over a wide range of deformities. For this purpose, I studied and evaluated medical image segmentation using the feature-flow based Label Transfer System described by Liu and colleagues. This system has produced promising results in parsing images of natural scenes. Its ability to deal with variations in shapes of objects is desirable. In this paper, we altered this system and assessed its feasibility of automatic segmentation. Experiments showed that this system achieved better recognition rates than those in natural-scene parsing applications, but the high recognition rates were not consistent across different images. Although this system is not considered clinically practical, we may improve it and incorporate it with other medical segmentation tools

Benchmarking Encoder-Decoder Architectures for Biplanar X-ray to 3D Shape Reconstruction

Various deep learning models have been proposed for 3D bone shape reconstruction from two orthogonal (biplanar) X-ray images. However, it is unclear how these models compare against each other since they are evaluated on different anatomy, cohort and (often privately held) datasets. Moreover, the impact of the commonly optimized image-based segmentation metrics such as dice score on the estimation of clinical parameters relevant in 2D-3D bone shape reconstruction is not well known. To move closer toward clinical translation, we propose a benchmarking framework that evaluates tasks relevant to real-world clinical scenarios, including reconstruction of fractured bones, bones with implants, robustness to population shift, and error in estimating clinical parameters. Our open-source platform provides reference implementations of 8 models (many of whose implementations were not publicly available), APIs to easily collect and preprocess 6 public datasets, and the implementation of automatic clinical parameter and landmark extraction methods. We present an extensive evaluation of 8 2D-3D models on equal footing using 6 public datasets comprising images for four different anatomies. Our results show that attention-based methods that capture global spatial relationships tend to perform better across all anatomies and datasets; performance on clinically relevant subgroups may be overestimated without disaggregated reporting; ribs are substantially more difficult to reconstruct compared to femur, hip and spine; and the dice score improvement does not always bring a corresponding improvement in the automatic estimation of clinically relevant parameters.Comment: accepted to NeurIPS 202

Comparing Features of Three-Dimensional Object Models Using Registration Based on Surface Curvature Signatures

This dissertation presents a technique for comparing local shape properties for similar three-dimensional objects represented by meshes. Our novel shape representation, the curvature map, describes shape as a function of surface curvature in the region around a point. A multi-pass approach is applied to the curvature map to detect features at different scales. The feature detection step does not require user input or parameter tuning. We use features ordered by strength, the similarity of pairs of features, and pruning based on geometric consistency to efficiently determine key corresponding locations on the objects. For genus zero objects, the corresponding locations are used to generate a consistent spherical parameterization that defines the point-to-point correspondence used for the final shape comparison

4DCT analysis of in-vivo carpal kinematics during FEM

A consensus, detailed understanding of carpal kinematics remains elusive. 4-dimensional CT (4DCT) is a validated modality capable of accurately studying in-vivokinematic motion. The objective of this work is to quantify normal, in-vivo kinematic motion of the carpus through a flexion-extension arc of motion using 4DCT. Ten healthy, un-injured volunteers underwent a 4DCT scanning protocol through a complete arc of flexion-extension motion. Kinematic changes in motion were quantified using helical axis motion data for each carpal bone. Helical axes were compared between bones and statistical analysis performed using repeated-measures ANOVA to identify difference in kinematic motion between bones (p\u3c0.05). The carpus can be divided into four main kinematic blocks: the distal carpal block, the proximal carpal block and individual scaphoid and trapezial blocks. This work supports an additional segmentation of the trapezium from the distal carpal row, which suggests some modulation between the scaphoid and distal carpal row

Automatic image analysis of C-arm Computed Tomography images for ankle joint surgeries

Open reduction and internal fixation is a standard procedure in ankle surgery for treating a fractured fibula. Since fibula fractures are often accompanied by an injury of the syndesmosis complex, it is essential to restore the correct relative pose of the fibula relative to the adjoining tibia for the ligaments to heal. Otherwise, the patient might experience instability of the ankle leading to arthritis and ankle pain and ultimately revision surgery. Incorrect positioning referred to as malreduction of the fibula is assumed to be one of the major causes of unsuccessful ankle surgery. 3D C-arm imaging is the current standard procedure for revealing malreduction of fractures in the operating room. However, intra-operative visual inspection of the reduction result is complicated due to high inter-individual variation of the ankle anatomy and rather based on the subjective experience of the surgeon. A contralateral side comparison with the patient’s uninjured ankle is recommended but has not been integrated into clinical routine due to the high level of radiation exposure it incurs. This thesis presents the first approach towards a computer-assisted intra-operative contralateral side comparison of the ankle joint. The focus of this thesis was the design, development and validation of a software-based prototype for a fully automatic intra-operative assistance system for orthopedic surgeons. The implementation does not require an additional 3D C-arm scan of the uninjured ankle, thus reducing time consumption and cumulative radiation dose. A 3D statistical shape model (SSM) is used to reconstruct a 3D surface model from three 2D fluoroscopic projections representing the uninjured ankle. To this end, a 3D SSM segmentation is performed on the 3D image of the injured ankle to gain prior knowledge of the ankle. A 3D convolutional neural network (CNN) based initialization method was developed and its outcome was incorporated into the SSM adaption step. Segmentation quality was shown to be improved in terms of accuracy and robustness compared to the pure intensity-based SSM. This allows us to overcome the limitations of the previously proposed methods, namely inaccuracy due to metal artifacts and the lack of device-to-patient orientation of the C-arm. A 2D-CNN is employed to extract semantic knowledge from all fluoroscopic projection images. This step of the pipeline both creates features for the subsequent reconstruction and also helps to pre-initialize the 3D-SSM without user interaction. A 2D-3D multi-bone reconstruction method has been developed which uses distance maps of the 2D features for fast and accurate correspondence optimization and SSM adaption. This is the central and most crucial component of the workflow. This is the first time that a bone reconstruction method has been applied to the complex ankle joint and the first reconstruction method using CNN based segmentations as features. The reconstructed 3D-SSM of the uninjured ankle can be back-projected and visualized in a workflow-oriented manner to procure clear visualization of the region of interest, which is essential for the evaluation of the reduction result. The surgeon can thus directly compare an overlay of the contralateral ankle with the injured ankle. The developed methods were evaluated individually using data sets acquired during a cadaver study and representative clinical data acquired during fibular reduction. A hierarchical evaluation was designed to assess the inaccuracies of the system on different levels and to identify major sources of error. The overall evaluation performed on eleven challenging clinical datasets acquired for manual contralateral side comparison showed that the system is capable of accurately reconstructing 3D surface models of the uninjured ankle solely using three projection images. A mean Hausdorff distance of 1.72 mm was measured when comparing the reconstruction result to the ground truth segmentation and almost achieved the high required clinical accuracy of 1-2 mm. The overall error of the pipeline was mainly attributed to inaccuracies in the 2D-CNN segmentation. The consistency of these results requires further validation on a larger dataset. The workflow proposed in this thesis establishes the first approach to enable automatic computer-assisted contralateral side comparison in ankle surgery. The feasibility of the proposed approach was proven on a limited amount of clinical cases and has already yielded good results. The next important step is to alleviate the identified bottlenecks in the approach by providing more training data in order to further improve the accuracy. In conclusion, the new approach presented gives the chance to guide the surgeon during the reduction process, improve the surgical outcome while avoiding additional radiation exposure and reduce the number of revision surgeries in the long term

Semi-Automatic Segmentation of Normal Female Pelvic Floor Structures from Magnetic Resonance Images

Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are important health issues affecting millions of American women. Investigation of the cause of SUI and POP requires a better understand of the anatomy of female pelvic floor. In addition, pre-surgical planning and individualized treatment plans require development of patient-specific three-dimensional or virtual reality models. The biggest challenge in building those models is to segment pelvic floor structures from magnetic resonance images because of their complex shapes, which make manual segmentation labor-intensive and inaccurate. In this dissertation, a quick and reliable semi-automatic segmentation method based on a shape model is proposed. The model is built on statistical analysis of the shapes of structures in a training set. A local feature map of the target image is obtained by applying a filtering pipeline, including contrast enhancement, noise reduction, smoothing, and edge extraction. With the shape model and feature map, automatic segmentation is performed by matching the model to the border of the structure using an optimization technique called evolution strategy. Segmentation performance is evaluated by calculating a similarity coefficient between semi-automatic and manual segmentation results. Taguchi analysis is performed to investigate the significance of segmentation parameters and provide tuning trends for better performance. The proposed method was successfully tested on both two-dimensional and three-dimensional image segmentation using the levator ani and obturator muscles as examples. Although the method is designed for segmentation of female pelvic floor structures, it can also be applied to other structures or organs without large shape variatio