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

A Novel Fully Automated CAD System for Left Ventricle Volume Estimation

© 2018 IEEE. Left ventricular (LV) volumes, and emptying and filling function remain important indices in conditions such as heart failure. These parameters are derived from the volume curve contained by the inner border of the LV of the heart, throughout the emptying and filling phases of the cardiac cycle, and the peak emptying and filling rates. The gold standard uses the Simpson rule to estimate volume from stacks of short axis images acquired using cine MRI. In this study, a deep learning, automated supervised approach to estimate ventricular volumes is introduced. Unlike prior methods that required hand-crafted image features to segment the inner contour, the proposed approach uses an automatically selected region of interest (ROI), and intelligently determines the optimum features directly from the ROI information. These derived features are then inputted into a deep learning regression model, with the estimated volume as the output results

Left ventricle segmentation and quantification using deep learning

Cardiac MRI is a widely used noninvasive tool that can provide us with an evaluation of cardiac anatomy and function. It can also be used for heart diagnosis. Heart diagnosis through the estimation of physiological heart parameters requires careful segmentation of the left ventricle (LV) from the images of cardiac MRI. Therefore we aim at building a new deep learning method for the automated delineation and quantification of the LV from cine cardiac MRI. Our goal is to reach lower errors for the calculated heart parameters than the previous works by introducing a new deep learning cardiac segmentation method. Our pipeline starts with an accurate LV localization by finding LV cavity center point using a fully convolutional neural network (FCN) model called FCN1. Then, from all heart sections, we extract a region of interest (ROI) that encompasses the LV. A segmentation for the LV cavity and myocardium is performed from the extracted ROIs using FCN called FCN2. The FCN2 model is associated with multiple bottleneck layers and uses less memory footprint than traditional models such as U-net. Furthermore, we introduced a novel loss function called radial loss that works on minimizing the distance between the ground truth LV contours and the predicted contours. After myocardial segmentation, we estimate the functional and mass parameters of the LV. We used the Automated Cardiac Diagnosis Challenge (ACDC-2017) dataset to validate our pipeline, which provided better segmentation, accurate calculation of heart parameters, and produced fewer errors compared to other approaches applied on the same dataset. Additionally, our segmentation approach showed that it can generalize well across different datasets by validating its performance on a locally collected cardiac dataset. To sum up, we propose a novel deep learning framework that we can translate it into a clinical tool for cardiac diagnosis

3D Kidney Segmentation from Abdominal Images Using Spatial-Appearance Models

Kidney segmentation is an essential step in developing any noninvasive computer-assisted diagnostic system for renal function assessment. This paper introduces an automated framework for 3D kidney segmentation from dynamic computed tomography (CT) images that integrates discriminative features from the current and prior CT appearances into a random forest classification approach. To account for CT images’ inhomogeneities, we employ discriminate features that are extracted from a higher-order spatial model and an adaptive shape model in addition to the first-order CT appearance. To model the interactions between CT data voxels, we employed a higher-order spatial model, which adds the triple and quad clique families to the traditional pairwise clique family. The kidney shape prior model is built using a set of training CT data and is updated during segmentation using not only region labels but also voxels’ appearances in neighboring spatial voxel locations. Our framework performance has been evaluated on in vivo dynamic CT data collected from 20 subjects and comprises multiple 3D scans acquired before and after contrast medium administration. Quantitative evaluation between manually and automatically segmented kidney contours using Dice similarity, percentage volume differences, and 95th-percentile bidirectional Hausdorff distances confirms the high accuracy of our approach

Predicting the Level of Respiratory Support in COVID-19 Patients Using Machine Learning

In this paper, a machine learning-based system for the prediction of the required level of respiratory support in COVID-19 patients is proposed. The level of respiratory support is divided into three classes: class 0 which refers to minimal support, class 1 which refers to non-invasive support, and class 2 which refers to invasive support. A two-stage classification system is built. First, the classification between class 0 and others is performed. Then, the classification between class 1 and class 2 is performed. The system is built using a dataset collected retrospectively from 3491 patients admitted to tertiary care hospitals at the University of Louisville Medical Center. The use of the feature selection method based on analysis of variance is demonstrated in the paper. Furthermore, a dimensionality reduction method called principal component analysis is used. XGBoost classifier achieves the best classification accuracy (84%) in the first stage. It also achieved optimal performance in the second stage, with a classification accuracy of 83%

A Novel Deep Learning Approach for Left Ventricle Automatic Segmentation in Cardiac Cine MR

© 2019 IEEE. Cardiac magnetic resonance imaging provides a way for heart\u27s functional analysis. Through segmentation of the left ventricle from cardiac cine images, physiological parameters can be obtained. However, manual segmentation of the left ventricle requires significant time and effort. Therefore, automated segmentation of the left ventricle is the desired and practical alternative. This paper introduces a novel framework for the automated segmentation of the epi- and endo-cardial walls of the left ventricle, directly from the cardiac images using a fully convolutional neural network similar to the U-net. There is an acute class imbalance in cardiac images because left ventricle tissues comprise a very small proportion of the images. This imbalance negatively affects the learning process of the network by making it biased toward the majority class. To overcome the class imbalance problem, we propose a novel loss function into our framework, instead of the traditional binary cross entropy loss that causes learning bias in the model. Our new loss maximizes the overall accuracy while penalizing the learning bias caused by binary cross entropy. Our method obtained promising segmentation accuracies for the epi- and endo-cardial walls (Dice 0.94 and 0.96, respectively) compared with the traditional loss (Dice 0.89 and 0.87, respectively

Automatic segmentation and functional assessment of the left ventricle using u-net fully convolutional network

© 2019 IEEE. A new method for the automatic segmentation and quantitative assessment of the left ventricle (LV) is proposed in this paper. The method is composed of two steps. First, a fully convolutional U-net is used for the segmentation of the epi- A nd endo-cardial boundaries of the LV from cine MR images. This step incorporates a novel loss function that accounts for the class imbalance problem caused by the binary cross entropy (BCE) loss function. Our novel loss function maximizes the segmentation accuracy and penalizes the effect of the class-imbalance caused by BCE. In the second step, the ventricular volume curves are constructed from which LV function parameter is estimated (i.e., ejection fraction). Our method demonstrated a statistical significance in the segmentation of the epi- A nd endo-cardial boundaries (Dice score of 0.94 and 0.96, respectively) compared with the BCE loss (Dice score of 0.89 and 0.86, respectively). Furthermore, a high positive correlation of 0.97 between the estimated ejection fraction and the gold standard was obtained

A deep learning-based approach for automatic segmentation and quantification of the left ventricle from cardiac cine MR images

© 2020 Elsevier Ltd Cardiac MRI has been widely used for noninvasive assessment of cardiac anatomy and function as well as heart diagnosis. The estimation of physiological heart parameters for heart diagnosis essentially require accurate segmentation of the Left ventricle (LV) from cardiac MRI. Therefore, we propose a novel deep learning approach for the automated segmentation and quantification of the LV from cardiac cine MR images. We aim to achieve lower errors for the estimated heart parameters compared to the previous studies by proposing a novel deep learning segmentation method. Our framework starts by an accurate localization of the LV blood pool center-point using a fully convolutional neural network (FCN) architecture called FCN1. Then, a region of interest (ROI) that contains the LV is extracted from all heart sections. The extracted ROIs are used for the segmentation of LV cavity and myocardium via a novel FCN architecture called FCN2. The FCN2 network has several bottleneck layers and uses less memory footprint than conventional architectures such as U-net. Furthermore, a new loss function called radial loss that minimizes the distance between the predicted and true contours of the LV is introduced into our model. Following myocardial segmentation, functional and mass parameters of the LV are estimated. Automated Cardiac Diagnosis Challenge (ACDC-2017) dataset was used to validate our framework, which gave better segmentation, accurate estimation of cardiac parameters, and produced less error compared to other methods applied on the same dataset. Furthermore, we showed that our segmentation approach generalizes well across different datasets by testing its performance on a locally acquired dataset. To sum up, we propose a deep learning approach that can be translated into a clinical tool for heart diagnosis

A pyramidal deep learning pipeline for kidney whole-slide histology images classification

Renal cell carcinoma is the most common type of kidney cancer. There are several subtypes of renal cell carcinoma with distinct clinicopathologic features. Among the subtypes, clear cell renal cell carcinoma is the most common and tends to portend poor prognosis. In contrast, clear cell papillary renal cell carcinoma has an excellent prognosis. These two subtypes are primarily classified based on the histopathologic features. However, a subset of cases can a have a significant degree of histopathologic overlap. In cases with ambiguous histologic features, the correct diagnosis is dependent on the pathologist's experience and usage of immunohistochemistry. We propose a new method to address this diagnostic task based on a deep learning pipeline for automated classification. The model can detect tumor and non-tumoral portions of kidney and classify the tumor as either clear cell renal cell carcinoma or clear cell papillary renal cell carcinoma. Our framework consists of three convolutional neural networks and the whole slide images of kidney which were divided into patches of three different sizes for input into the networks. Our approach can provide patchwise and pixelwise classification. The kidney histology images consist of 64 whole slide images. Our framework results in an image map that classifies the slide image on the pixel-level. Furthermore, we applied generalized Gauss-Markov random field smoothing to maintain consistency in the map. Our approach classified the four classes accurately and surpassed other state-of-the-art methods, such as ResNet (pixel accuracy: 0.89 Resnet18, 0.92 proposed). We conclude that deep learning has the potential to augment the pathologist's capabilities by providing automated classification for histopathological images

Computer-Aided Diagnostic System for Early Detection of Acute Renal Transplant Rejection Using Diffusion-Weighted MRI

© 1964-2012 IEEE. Objective: Early diagnosis of acute renal transplant rejection (ARTR) is critical for accurate treatment. Although the current gold standard, diagnostic technique is renal biopsy, it is not preferred due to its invasiveness, long recovery time (1-2 weeks), and potential for complications, e.g., bleeding and/or infection. Methods: This paper presents a computer-aided diagnostic (CAD) system for early ARTR detection using (3D + b-value) diffusion-weighted (DW) magnetic resonance imaging (MRI) data. The CAD process starts from kidney tissue segmentation with an evolving geometric (level-set-based) deformable model. The evolution is guided by a voxel-wise stochastic speed function, which follows from a joint kidney-background Markov-Gibbs random field model accounting for an adaptive kidney shape prior and on-going kidney-background visual appearances. A B-spline-based three-dimensional data alignment is employed to handle local deviations due to breathing and heart beating. Then, empirical cumulative distribution functions of apparent diffusion coefficients of the segmented DW-MRI at different b-values are collected as discriminatory transplant status features. Finally, a deep-learning-based classifier with stacked nonnegative constrained autoencoders is employed to distinguish between rejected and nonrejected renal transplants. Results: In our initial \u27leave-one-subject-out\u27 experiment on 100 subjects, 97.0% of the subjects were correctly classified. The subsequent four-fold and ten-fold cross-validations gave the average accuracy of 96.0% and 94.0%, respectively. Conclusion: These results demonstrate the promise of this new CAD system to reliably diagnose renal transplant rejection. Significance: The technology presented here can significantly impact the quality of care of renal transplant patients since it has the potential to replace the gold standard in kidney diagnosis, biopsy