Applying computer-aided detection (CAD) generated quantitative image markers has demonstrated significant advantages than using subjectively qualitative assessment in supporting translational clinical research. However, although many advanced CAD schemes have been developed, due to heterogeneity of medical images, achieving high scientific rigor of “black-box” type CAD schemes trained using small datasets remains a big challenge. In order to support and facilitate research effort and progress of physician researchers using quantitative imaging markers, we investigated and tested an interactive approach by developing CAD schemes with interactive functions and visual-aid tools. Thus, unlike fully automated CAD schemes, our interactive CAD tools allow users to visually inspect image segmentation results and provide instruction to correct segmentation errors if needed. Based on users’ instruction, CAD scheme automatically correct segmentation errors, recompute image features and generate machine learning-based prediction scores. We have installed three interactive CAD tools in clinical imaging reading facilities to date, which support and facilitate oncologists to acquire image markers to predict progression-free survival of ovarian cancer patients undergoing angiogenesis chemotherapies, and neurologists to compute image markers and prediction scores to assess prognosis of patients diagnosed with aneurysmal subarachnoid hemorrhage and acute ischemic stroke. Using these ICAD tools, clinical researchers have conducted several translational clinical studies by analyzing several diverse study cohorts, which have resulted in publishing seven peer-reviewed papers in clinical journals in the last three years. Additionally, feedbacks from physician researchers also indicate their increased confidence in using new quantitative image markers and help medical imaging researchers further improve or optimize interactive CAD tools.
Aneurysmal subarachnoid hemorrhage (aSAH) is a form of hemorrhagic stroke that affects middle-aged individuals and associated with significant morbidity and/or mortality especially those presenting with higher clinical and radiologic grades at the time of admission. Previous studies suggested that blood extravasated after aneurysmal rupture was a potentially clinical prognosis factor. But all such studies used qualitative scales to predict prognosis. The purpose of this study is to develop and test a new interactive computer-aided detection (CAD) tool to detect, segment and quantify brain hemorrhage and ventricular cerebrospinal fluid on non-contrasted brain CT images. First, CAD segments brain skull using a multilayer region growing algorithm with adaptively adjusted thresholds. Second, CAD assigns pixels inside the segmented brain region into one of three classes namely, normal brain tissue, blood and fluid. Third, to avoid “black-box” approach and increase accuracy in quantification of these two image markers using CT images with large noise variation in different cases, a graphic User Interface (GUI) was implemented and allows users to visually examine segmentation results. If a user likes to correct any errors (i.e., deleting clinically irrelevant blood or fluid regions, or fill in the holes inside the relevant blood or fluid regions), he/she can manually define the region and select a corresponding correction function. CAD will automatically perform correction and update the computed data. The new CAD tool is now being used in clinical and research settings to estimate various quantitatively radiological parameters/markers to determine radiological severity of aSAH at presentation and correlate the estimations with various homeostatic/metabolic derangements and predict clinical outcome.
The ability to study the biochemical composition of the brain is becoming important to better understand
neurodegenerative and neurodevelopmental disorders. Magnetic Resonance Spectroscopy (MRS) can non-invasively
provide quantification of brain metabolites in localized regions. The reliability of MRS is limited in part due to partial
volume artifacts. This results from the relatively large voxels that are required to acquire sufficient signal-to-noise ratios
for the studies. Partial volume artifacts result when a MRS voxel contains a mixture of tissue types. Concentrations of
metabolites vary from tissue to tissue. When a voxel contains a heterogeneous tissue composition, the spectroscopic
signal acquired from this voxel will consist of the signal from different tissues making reliable measurements difficult.
We have developed a novel tool for the estimation of partial volume tissue composition within MRS voxels thus
allowing for the correction of partial volume artifacts. In addition, the tool can localize MR spectra to anatomical regions
of interest. The tool uses tissue classification information acquired as part of a structural MR scan for the same subject.
The tissue classification information is co-registered with the spectroscopic data. The user can quantify the partial
volume composition of each voxel and use this information as covariates for metabolite concentrations.
KEYWORDS: Functional magnetic resonance imaging, Image registration, Statistical analysis, Image processing, Brain, Computer simulations, Monte Carlo methods, Neuroimaging, Magnetic resonance imaging, Signal attenuation
During functional magnetic resonance imaging (fMRI) brain examinations, the signal extraction from a large number of images is used to evaluate changes in blood oxygenation levels by applying statistical methodology. Image registration is essential as it assists in providing accurate fractional positioning accomplished by using interpolation between sequentially acquired fMRI images. Unfortunately, current subvoxel registration methods found in standard software may produce significant bias in the variance estimator when interpolating with fractional, spatial voxel shifts. It was found that interpolation schemes, as currently applied during the registration of functional brain images, could introduce statistical bias, but there is a possible correction scheme. This bias was shown to result from the "weighted-averaging" process employed by conventional implementation of interpolation schemes. The most severe consequence of inaccurate variance estimators is the undesirable violation of the fundamental 'stationary' assumption required for many statistical methods and Gaussian random field analysis. Thus, this bias violates assumptions of the general linear model (GLM) and/or t-tests commonly used in fMRI studies. Using simulated data as well as actual human data in this, it was demonstrated that this artifact can significantly alter the magnitude and location of the resulting activation patterns/results. Further, the work detailed here introduces a bias correction scheme and evaluates the improved accuracy of its sample variance calculation and influence on fMRI results through comparison with traditional fMRI image registered data.
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