Iterative framework for the joint segmentation and CT synthesis of MR images: application to MRI-only radiotherapy treatment planning.

To tackle the problem of magnetic resonance imaging (MRI)-only radiotherapy treatment planning (RTP), we propose a multi-atlas information propagation scheme that jointly segments organs and generates pseudo x-ray computed tomography (CT) data from structural MR images (T1-weighted and T2-weighted). As the performance of the method strongly depends on the quality of the atlas database composed of multiple sets of aligned MR, CT and segmented images, we also propose a robust way of registering atlas MR and CT images, which combines structure-guided registration, and CT and MR image synthesis. We first evaluated the proposed framework in terms of segmentation and CT synthesis accuracy on 15 subjects with prostate cancer. The segmentations obtained with the proposed method were compared using the Dice score coefficient (DSC) to the manual segmentations. Mean DSCs of 0.73, 0.90, 0.77 and 0.90 were obtained for the prostate, bladder, rectum and femur heads, respectively. The mean absolute error (MAE) and the mean error (ME) were computed between the reference CTs (non-rigidly aligned to the MRs) and the pseudo CTs generated with the proposed method. The MAE was on average [Formula: see text] HU and the ME [Formula: see text] HU. We then performed a dosimetric evaluation by re-calculating plans on the pseudo CTs and comparing them to the plans optimised on the reference CTs. We compared the cumulative dose volume histograms (DVH) obtained for the pseudo CTs to the DVH obtained for the reference CTs in the planning target volume (PTV) located in the prostate, and in the organs at risk at different DVH points. We obtained average differences of [Formula: see text] in the PTV for [Formula: see text], and between [Formula: see text] and 0.05% in the PTV, bladder, rectum and femur heads for D mean and [Formula: see text]. Overall, we demonstrate that the proposed framework is able to automatically generate accurate pseudo CT images and segmentations in the pelvic region, potentially bypassing the need for CT scan for accurate RTP

Deformable Image Registration in the Analysis of Multiple Sclerosis

In medical image analysis, image registration is the task of finding corresponding features in two or more images, and using them to solve for the transformation that best aligns the images. Knowing the alignment allows information, such as landmarks and functional metrics, to be easily transferred between images, and allows them to be analyzed together. This dissertation focuses on the development of deformable image registration techniques for the analysis of multiple sclerosis (MS), a neurodegenerative disease that damages the myelin sheath of nervous tissue. MS is known to affect the entire central nervous system (CNS), and can result in the loss of sensorimotor control, cognition, and vision. Hence, the four primary contributions of this dissertation are on the development and application of deformable image registration in the three areas of the CNS that are most currently studied for MS -- the spinal cord, the retina, and the brain. First, for spinal cord magnetic resonance imaging (MRI), an approach is presented that uses deformable registration to provide atlas priors for automatic topology-preserving segmentation of the spinal cord and cerebrospinal fluid. The method shows high accuracy and robustness when compared to manual raters, and allows spinal cord atrophy to be analyzed on large datasets without manual segmentations. Second, for spinal cord diffusion tensor imaging, a pipeline is presented that uses deformable registration to correct for susceptibility distortions in the images. The pipeline allows for accurate computation of spinal cord diffusion metrics, which are shown to be significantly correlated with clinical measures of sensorimotor function and disability levels. Third, for optical coherence tomography (OCT) of the retina, a deformable registration technique is presented that constrains the transformation to follow the OCT acquisition geometry. 3D voxel-based analysis using the algorithm found significant differences between healthy and MS cohorts in regions of the retina that is consistent with previous findings using 2D analysis. Lastly, for brain MRI, a multi-channel registration framework is presented that can use distance transforms and image synthesis to improve registration accuracy. Together, these techniques have enabled several types of analysis that were previously unavailable for the study of MS