Incorporating Patient-Specific Variability in the Simulation of Realistic Whole-Body $^{18}{hbox{F-FDG}}$ Distributions for Oncology Applications

The purpose of the work described in this paper was the development of a framework for the creation of a realistic positron emission tomography (PET) simulated database incorporating patient-specific variability. The ground truth used was therefore based on clinical PET/computed tomography (CT) data of oncology patients. In the first step, the NURBS-based cardiac-torso phantom was adapted to the patient's CT acquisitions to reproduce their specific anatomy while the corresponding PET acquisitions were used to derive the activity distribution of each organ of interest. Secondly, realistic tumor shapes with homogeneous or heterogeneous activity distributions were modeled based on segmentation of the PET tumor volume and incorporated in the patient-specific models obtained at the first step. Lastly, patient-specific respiratory motion was also modeled. The derived patient-specific models were subsequently combined with the PET SORTEO Monte Carlo simulation tool for the simulation of the whole-body PET acquisition process. The accuracy of the simulated datasets was assessed in comparison to the original clinical patient images. In addition, a couple of applications for such simulated images were also demonstrated. Future work will focus on the creation of a comprehensive database of simulated raw data and reconstructed whole-body images, facilitating the rigorous evaluation of image-processing algorithms in PET for oncology applications.      

Real-time volume rendering visualization of dual-modality PET/CT images with interactive fuzzy thresholding segmentation.

Three-dimensional (3-D) visualization has become an essential part for imaging applications, including image-guided surgery, radiotherapy planning, and computer-aided diagnosis. In the visualization of dual-modality positron emission tomography and computed tomography (PET/CT), 3-D volume rendering is often limited to rendering of a single image volume and by high computational demand. Furthermore, incorporation of segmentation in volume rendering is usually restricted to visualizing the presegmented volumes of interest. In this paper, we investigated the integration of interactive segmentation into real-time volume rendering of dual-modality PET/CT images. We present and validate a fuzzy thresholding segmentation technique based on fuzzy cluster analysis, which allows interactive and real-time optimization of the segmentation results. This technique is then incorporated into a real-time multi-volume rendering of PET/CT images. Our method allows a real-time fusion and interchangeability of segmentation volume with PET or CT volumes, as well as the usual fusion of PET/CT volumes. Volume manipulations such as window level adjustments and lookup table can be applied to individual volumes, which are then fused together in real time as adjustments are made. We demonstrate the benefit of our method in integrating segmentation with volume rendering in its application to PET/CT images. Responsive frame rates are achieved by utilizing a texture-based volume rendering algorithm and the rapid transfer capability of the high-memory bandwidth available in low-cost graphic hardware.     

Exact and approximate rebinning algorithms for 3-D PET data

This paper presents two new rebinning algorithms for the reconstruction of three-dimensional (3-D) positron emission tomography (PET) data. A rebinning algorithm is one that first sorts the 3-D data into an ordinary two-dimensional (2-D) data set containing one sinogram for each transaxial slice to be reconstructed; the 3-D image is then recovered by applying to each slice a 2-D reconstruction method such as filtered-backprojection. This approach allows a significant speedup of 3-D reconstruction, which is particularly useful for applications involving dynamic acquisitions or whole-body imaging. The first new algorithm is obtained by discretizing an exact analytical inversion formula. The second algorithm, called the Fourier rebinning algorithm (FORE), is approximate but allows an efficient implementation based on taking 2-D Fourier transforms of the data. This second algorithm was implemented and applied to data acquired with the new generation of PET systems and also to simulated data for a scanner with an 18° axial aperture. The reconstructed images were compared to those obtained with the 3-D reprojection algorithm (3DRP) which is the standard “exact” 3-D filtered-backprojection method. Results demonstrate that FORE provides a reliable alternative to 3DRP, while at the same time achieving an order of magnitude reduction in processing time     

Super-resolution in PET imaging

This paper demonstrates a super-resolution method for improving the resolution in clinical positron emission tomography (PET) scanners. Super-resolution images were obtained by combining four data sets with spatial shifts between consecutive acquisitions and applying an iterative algorithm. Super-resolution attenuation corrected PET scans of a phantom were obtained using the two-dimensional and three-dimensional (3-D) acquisition modes of a clinical PET/computed tomography (CT) scanner (Discovery LS, GEMS). In a patient study, following a standard 18F-FDG PET/CT scan, a super-resolution scan around one small lesion was performed using axial shifts without increasing the patient radiation exposure. In the phantom study, smaller features (3 mm) could be resolved axially with the super-resolution method than without (6 mm). The super-resolution images had better resolution than the original images and provided higher contrast ratios in coronal images and in 3-D acquisition transaxial images. The coronal super-resolution images had superior resolution and contrast ratios compared to images reconstructed by merely interleaving the data to the proper axial location. In the patient study, super-resolution reconstructions displayed a more localized 18F-FDG uptake. A new approach for improving the resolution of PET images using a super-resolution method has been developed and experimentally confirmed, employing a clinical scanner. The improvement in axial resolution requires no changes in hardware.     

Improved regional activity quantitation in nuclear medicine using a new approach to correct for tissue partial volume and spillover effects

We have developed a new method of compensating for effects of partial volume and spillover in dual-modality imaging. The approach requires segmentation of just a few tissue types within a small volume-of-interest (VOI) surrounding a lesion; the algorithm estimates simultaneously, from projection data, the activity concentration within each segmented tissue inside the VOI. Measured emission projections were fitted to the sum of resolution-blurred projections of each such tissue, scaled by its unknown activity concentration, plus a global background contribution obtained by reprojection through the reconstructed image volume outside the VOI. The method was evaluated using multiple-pinhole μSPECT data simulated for the MOBY mouse phantom containing two spherical lung tumors and one liver tumor, as well as using multiple-bead phantom data acquired on μSPECT and μCT scanners. Each VOI in the simulation study was 4.8 mm (12 voxels) cubed and, depending on location, contained up to four tissues (tumor, liver, heart, lung) with different values of relative (99m)Tc concentration. All tumor activity estimates achieved bias after ～ 15 ordered-subsets expectation maximization (OSEM) iterations (×10 subsets) , with better than 8% precision ( ≤ 25% greater than the Cramer-Rao lower bound). The projection-based fitting approach also outperformed three standardized uptake value (SUV)-like metrics, one of which was corrected for count spillover. In the bead phantom experiment, the mean ± standard deviation of the bias of VOI estimates of bead concentration were 0.9±9.5%, comparable to those of a perturbation geometric transfer matrix (pGTM) approach (-5.4±8.6%); however, VOI estimates were more stable with increasing iteration number than pGTM estimates, even in the presence of substantial axial misalignment between μCT and μSPECT image volumes.     

Multifeature landmark-free active appearance models: application to prostate MRI segmentation

Active shape models (ASMs) and active appearance models (AAMs) are popular approaches for medical image segmentation that use shape information to drive the segmentation process. Both approaches rely on image derived landmarks (specified either manually or automatically) to define the object's shape, which require accurate triangulation and alignment. An alternative approach to modeling shape is the levelset representation, defined as a set of signed distances to the object's surface. In addition, using multiple image derived attributes (IDAs) such as gradient information has previously shown to offer improved segmentation results when applied to ASMs, yet little work has been done exploring IDAs in the context of AAMs. In this work, we present a novel AAM methodology that utilizes the levelset implementation to overcome the issues relating to specifying landmarks, and locates the object of interest in a new image using a registration based scheme. Additionally, the framework allows for incorporation of multiple IDAs. Our multifeature landmark-free AAM (MFLAAM) utilizes an efficient, intuitive, and accurate algorithm for identifying those IDAs that will offer the most accurate segmentations. In this paper, we evaluate our MFLAAM scheme for the problem of prostate segmentation from T2-w MRI volumes. On a cohort of 108 studies, the levelset MFLAAM yielded a mean Dice accuracy of 88% ± 5%, and a mean surface error of 1.5 mm ±.8 mm with a segmentation time of 150/s per volume. In comparison, a state of the art AAM yielded mean Dice and surface error values of 86% ± 9% and 1.6 mm ± 1.0 mm, respectively. The differences with respect to our levelset-based MFLAAM model are statistically significant . In addition, our results were in most cases superior to several recent state of the art prostate MRI segmentation methods.     

Segmentation of rodent whole-body dynamic PET images: an unsupervised method based on voxel dynamics

Positron emission tomography (PET) is a useful tool for pharmacokinetics studies in rodents during the preclinical phase of drug and tracer development. However, rodent organs are small as compared to the scanner's intrinsic resolution and are affected by physiological movements. We present a new method for the segmentation of rodent whole-body PET images that takes these two difficulties into account by estimating the pharmacokinetics far from organ borders. The segmentation method proved efficient on whole-body numerical rat phantom simulations, including 3-14 organs, together with physiological movements (heart beating, breathing, and bladder filling). The method was resistant to spillover and physiological movements, while other methods failed to obtain a correct segmentation. The radioactivity concentrations calculated with this method also showed an excellent correlation with the manual delineation of organs in a large set of preclinical images. In addition, it was faster, detected more organs, and extracted organs' mean time activity curves with a better confidence on the measure than manual delineation.     

MR Image Segmentation Using a Power Transformation Approach

This study proposes a segmentation method for brain MR images using a distribution transformation approach. The method extends traditional Gaussian mixtures expectation-maximization segmentation to a power transformed version of mixed intensity distributions, which includes Gaussian mixtures as a special case. As MR intensities tend to exhibit non-Gaussianity due to partial volume effects, the proposed method is designed to fit non-Gaussian tissue intensity distributions. One advantage of the method is that it is intuitively appealing and computationally simple. To avoid performance degradation caused by intensity inhomogeneity, different methods for correcting bias fields were applied prior to image segmentation, and their correction effects on the segmentation results were examined in the empirical study. The partitions of brain tissues (i.e., gray and white matter) resulting from the method were validated and evaluated against manual segmentation results based on 38 real T1-weighted image volumes from the internet brain segmentation repository, and 18 simulated image volumes from BrainWeb. The Jaccard and Dice similarity indexes were computed to evaluate the performance of the proposed approach relative to the expert segmentations. Empirical results suggested that the proposed segmentation method yielded higher similarity measures for both gray matter and white matter as compared with those based on the traditional segmentation using the Gaussian mixtures approach.      

Trimmed-likelihood estimation for focal lesions and tissue segmentation in multisequence MRI for multiple sclerosis

We present a new automatic method for segmentation of multiple sclerosis (MS) lesions in magnetic resonance images. The method performs tissue classification using a model of intensities of the normal appearing brain tissues. In order to estimate the model, a trimmed likelihood estimator is initialized with a hierarchical random approach in order to be robust to MS lesions and other outliers present in real images. The algorithm is first evaluated with simulated images to assess the importance of the robust estimator in presence of outliers. The method is then validated using clinical data in which MS lesions were delineated manually by several experts. Our method obtains an average Dice similarity coefficient (DSC) of 0.65, which is close to the average DSC obtained by raters (0.66).     

Learning-Based Vertebra Detection and Iterative Normalized-Cut Segmentation for Spinal MRI

Automatic extraction of vertebra regions from a spinal magnetic resonance (MR) image is normally required as the first step to an intelligent spinal MR image diagnosis system. In this work, we develop a fully automatic vertebra detection and segmentation system, which consists of three stages; namely, AdaBoost-based vertebra detection, detection refinement via robust curve fitting, and vertebra segmentation by an iterative normalized cut algorithm. In order to produce an efficient and effective vertebra detector, a statistical learning approach based on an improved AdaBoost algorithm is proposed. A robust estimation procedure is applied on the detected vertebra locations to fit a spine curve, thus refining the above vertebra detection results. This refinement process involves removing the false detections and recovering the miss-detected vertebrae. Finally, an iterative normalized-cut segmentation algorithm is proposed to segment the precise vertebra regions from the detected vertebra locations. In our implementation, the proposed AdaBoost-based detector is trained from 22 spinal MR volume images. The experimental results show that the proposed vertebra detection and segmentation system can achieve nearly 98% vertebra detection rate and 96% segmentation accuracy on a variety of testing spinal MR images. Our experiments also show the vertebra detection and segmentation accuracies by using the proposed algorithm are superior to those of the previous representative methods. The proposed vertebra detection and segmentation system is proved to be robust and accurate so that it can be used for advanced research and application on spinal MR images.     

A multiscale random field model for Bayesian image segmentation

Many approaches to Bayesian image segmentation have used maximum a posteriori (MAP) estimation in conjunction with Markov random fields (MRF). Although this approach performs well, it has a number of disadvantages. In particular, exact MAP estimates cannot be computed, approximate MAP estimates are computationally expensive to compute, and unsupervised parameter estimation of the MRF is difficult. The authors propose a new approach to Bayesian image segmentation that directly addresses these problems. The new method replaces the MRF model with a novel multiscale random field (MSRF) and replaces the MAP estimator with a sequential MAP (SMAP) estimator derived from a novel estimation criteria. Together, the proposed estimator and model result in a segmentation algorithm that is not iterative and can be computed in time proportional to MN where M is the number of classes and N is the number of pixels. The also develop a computationally efficient method for unsupervised estimation of model parameters. Simulations on synthetic images indicate that the new algorithm performs better and requires much less computation than MAP estimation using simulated annealing. The algorithm is also found to improve classification accuracy when applied to the segmentation of multispectral remotely sensed images with ground truth data.     

Multiresolution texture segmentation with application to diagnostic ultrasound images

A multiresolution texture segmentation (MTS) approach to image segmentation that addresses the issues of texture characterization, image resolution, and time to complete the segmentation is presented. The approach generalizes the conventional simulated annealing method to a multiresolution framework and minimizes an energy function that is dependent on the resolution of the size of the texture blocks in an image. A rigorous experimental procedure is also proposed to demonstrate the advantages of the proposed MTS approach on the accuracy of the segmentation, the efficiency of the algorithm, and the use of varying features at different resolution. Semireal images, created by sampling a series of diagnostic ultrasound images of an ovary in vitro, were tested to produce statistical measures on the performance of the approach. The ultrasound images themselves were then segmented to determine if the approach can achieve accurate results for the intended ultrasound application. Experimental results suggest that the MTS approach converges faster and produces better segmentation results than the single-level approach.     

Segmentation of cancellous bone from high-resolution computed tomography images: influence on trabecular bone measurements

The quantification of cancellous bone network from computed tomography (CT) images requires a segmentation step which is crucial and difficult because of the partial volume effect in CT images. In this paper, we present and evaluate a new approach for segmenting cancellous bone network from high-resolution CT (HRCT) slices. The idea is first to detect a skeleton from the crest lines of the structure and then to thicken it to extract the whole bone structure by satisfying local neighborhood constraints. The segmentation requires the adjustment of relative and not absolute parameters like most methods. We quantified the influence of these parameters on architectural measurements. Results were first validated by using a physical phantom and then examined on a series of 12 HRCT images of human lumbar vertebra of different ages. We demonstrated that the choice of segmentation parameters yielded important variability on architectural measurements (up to 20%), but less variability than a more commonly used approach. This stresses the importance of settle on the segmentation parameters for once, which is possible with the proposed method.     

Image change detection using paradoxical theory for patient follow-up quantitation and therapy assessment

In clinical oncology, positron emission tomography (PET) imaging can be used to assess therapeutic response by quantifying the evolution of semi-quantitative values such as standardized uptake value, early during treatment or after treatment. Current guidelines do not include metabolically active tumor volume (MATV) measurements and derived parameters such as total lesion glycolysis (TLG) to characterize the response to the treatment. To achieve automatic MATV variation estimation during treatment, we propose an approach based on the change detection principle using the recent paradoxical theory, which models imprecision, uncertainty, and conflict between sources. It was applied here simultaneously to pre- and post-treatment PET scans. The proposed method was applied to both simulated and clinical datasets, and its performance was compared to adaptive thresholding applied separately on pre- and post-treatment PET scans. On simulated datasets, the adaptive threshold was associated with significantly higher classification errors than the developed approach. On clinical datasets, the proposed method led to results more consistent with the known partial responder status of these patients. The method requires accurate rigid registration of both scans which can be obtained only in specific body regions and does not explicitly model uptake heterogeneity. In further investigations, the change detection of intra-MATV tracer uptake heterogeneity will be developed by incorporating textural features into the proposed approach.     

PET/CT图像分割及其发展现状

随着精准医疗技术的快速进步,PET/CT图像中病灶区域分割已在医疗计划制定中显现出重要作用.PET/CT将PET（功能代谢显像）和CT（解剖结构显像）两种先进的影像技术有机地结合在一起,是影像诊断学的一个重要进展.结合当前分割方法,本文详细介绍了PET/CT成像原理以及PET/CT图像的特点,对分割方法进行分类,深入分析各种方法的现状及其在肿瘤学中的应用.最后,进一步阐述了PET/CT图像分割技术的核心问题和发展趋势.     

Segmentation of VOI from multidimensional dynamic PET images by integrating spatial and temporal features.

Segmentation of multidimensional dynamic positron emission tomography (PET) images into volumes of interest (VOIs) exhibiting similar temporal behavior and spatial features is a challenging task due to inherently poor signal-to-noise ratio and spatial resolution. In this study, we propose VOI segmentation of dynamic PET images by utilizing both the three-dimensional (3-D) spatial and temporal domain information in a hybrid technique that integrates two independent segmentation techniques of cluster analysis and region growing. The proposed technique starts with a cluster analysis that partitions the image based on temporal similarities. The resulting temporal partitions, together with the 3-D spatial information are utilized in the region growing segmentation. The technique was evaluated with dynamic 2-[18F] fluoro-2-deoxy-D-glucose PET simulations and clinical studies of the human brain and compared with the k-means and fuzzy c-means cluster analysis segmentation methods. The quantitative evaluation with simulated images demonstrated that the proposed technique can segment the dynamic PET images into VOIs of different kinetic structures and outperforms the cluster analysis approaches with notable improvements in the smoothness of the segmented VOIs with fewer disconnected or spurious segmentation clusters. In clinical studies, the hybrid technique was only superior to the other techniques in segmenting the white matter. In the gray matter segmentation, the other technique tended to perform slightly better than the hybrid technique, but the differences did not reach significance. The hybrid technique generally formed smoother VOIs with better separation of the background. Overall, the proposed technique demonstrated potential usefulness in the diagnosis and evaluation of dynamic PET neurological imaging studies.     

Segmentation of thin structures in volumetric medical images.

We present a new segmentation method for extracting thin structures embedded in three-dimensional medical images based on modern variational principles. We demonstrate the importance of the edge alignment and homogeneity terms in the segmentation of blood vessels and vascular trees. For that goal, the Chan-Vese minimal variance method is combined with the boundary alignment, and the geodesic active surface models. An efficient numerical scheme is proposed. In order to simultaneously detect a number of different objects in the image, a hierarchal approach is applied.     

Lung motion correction on respiratory gated 3-D PET/CT images

Motion is a source of degradation in positron emission tomography (PET)/computed tomography (CT) images. As the PET images represent the sum of information over the whole respiratory cycle, attenuation correction with the help of CT images may lead to false staging or quantification of the radioactive uptake especially in the case of small tumors. We present an approach avoiding these difficulties by respiratory-gating the PET data and correcting it for motion with optical flow algorithms. The resulting dataset contains all the PET information and minimal motion and, thus, allows more accurate attenuation correction and quantification.     

Robust white matter lesion segmentation in FLAIR MRI

This paper discusses a white matter lesion (WML) segmentation scheme for fluid attenuation inversion recovery (FLAIR) MRI. The method computes the volume of lesions with subvoxel precision by accounting for the partial volume averaging (PVA) artifact. As WMLs are related to stroke and carotid disease, accurate volume measurements are most important. Manual volume computation is laborious, subjective, time consuming, and error prone. Automated methods are a nice alternative since they quantify WML volumes in an objective, efficient, and reliable manner. PVA is initially modeled with a localized edge strength measure since PVA resides in the boundaries between tissues. This map is computed in 3-D and is transformed to a global representation to increase robustness to noise. Significant edges correspond to PVA voxels, which are used to find the PVA fraction α (amount of each tissue present in mixture voxels). Results on simulated and real FLAIR images show high WML segmentation performance compared to ground truth (98.9% and 83% overlap, respectively), which outperforms other methods. Lesion load studies are included that automatically analyze WML volumes for each brain hemisphere separately. This technique does not require any distributional assumptions/parameters or training samples and is applied on a single MR modality, which is a major advantage compared to the traditional methods.     

Segmentation and measurement of the cortex from 3-D MR images using coupled-surfaces propagation

The cortex is the outermost thin layer of gray matter in the brain; geometric measurement of the cortex helps in understanding brain anatomy and function. In the quantitative analysis of the cortex from MR images, extracting the structure and obtaining a representation for various measurements are key steps. While manual segmentation is tedious and labor intensive, automatic reliable efficient segmentation and measurement of the cortex remain challenging problems, due to its convoluted nature. Here we present a new approach of coupled-surfaces propagation, using level set methods to address such problems. Our method is motivated by the nearly constant thickness of the cortical mantle and takes this tight coupling as an important constraint. By evolving two embedded surfaces simultaneously, each driven by its own image-derived information while maintaining the coupling, a final representation of the cortical bounding surfaces and an automatic segmentation of the cortex are achieved. Characteristics of the cortex, such as cortical surface area, surface curvature, and cortical thickness, are then evaluated. The level set implementation of surface propagation offers the advantage of easy initialization, computational efficiency, and the ability to capture deep sulcal folds. Results and validation from various experiments on both simulated and real three-dimensional (3-D) MR images are provided.