Registration of Pathological Images

Anomaly detection for the individual analysis of brain PET images

Purpose: In clinical practice, positron emission tomography (PET) images are mostly analyzed visually, but the sensitivity and specificity of this approach greatly depend on the observer's experience. Quantitative analysis of PET images would alleviate this problem by helping define an objective limit between normal and pathological findings. We present an anomaly detection framework for the individual analysis of PET images. Approach: We created subject-specific abnormality maps that summarize the pathology's topographical distribution in the brain by comparing the subject's PET image to a model of healthy PET appearance that is specific to the subject under investigation. This model was generated from demographically and morphologically matched PET scans from a control dataset. Results: We generated abnormality maps for healthy controls, patients at different stages of Alzheimer's disease and with different frontotemporal dementia syndromes. We showed that no anomalies were detected for the healthy controls and that the anomalies detected from the patients with dementia coincided with the regions where abnormal uptake was expected. We also validated the proposed framework using the abnormality maps as inputs of a classifier and obtained higher classification accuracies than when using the PET images themselves as inputs. Conclusions: The proposed method was able to automatically locate and characterize the areas characteristic of dementia from PET images. The abnormality maps are expected to (i) help clinicians in their diagnosis by highlighting, in a data-driven fashion, the pathological areas, and (ii) improve the interpretability of subsequent analyses, such as computer-aided diagnosis or spatiotemporal modeling.

Cortical Thickness Estimation in Individuals With Cerebral Small Vessel Disease, Focal Atrophy, and Chronic Stroke Lesions

BACKGROUND

Regional changes to cortical thickness in individuals with neurodegenerative and cerebrovascular diseases (CVD) can be estimated using specialized neuroimaging software. However, the presence of cerebral small vessel disease, focal atrophy, and cortico-subcortical stroke lesions, pose significant challenges that increase the likelihood of misclassification errors and segmentation failures.

PURPOSE

The main goal of this study was to examine a correction procedure developed for enhancing FreeSurfer's (FS's) cortical thickness estimation tool, particularly when applied to the most challenging MRI obtained from participants with chronic stroke and CVD, with varying degrees of neurovascular lesions and brain atrophy.

METHODS

In 155 CVD participants enrolled in the Ontario Neurodegenerative Disease Research Initiative (ONDRI), FS outputs were compared between a fully automated, unmodified procedure and a corrected procedure that accounted for potential sources of error due to atrophy and neurovascular lesions. Quality control (QC) measures were obtained from both procedures. Association between cortical thickness and global cognitive status as assessed by the Montreal Cognitive Assessment (MoCA) score was also investigated from both procedures.

RESULTS

Corrected procedures increased "Acceptable" QC ratings from 18 to 76% for the cortical ribbon and from 38 to 92% for tissue segmentation. Corrected procedures reduced "Fail" ratings from 11 to 0% for the cortical ribbon and 62 to 8% for tissue segmentation. FS-based segmentation of T1-weighted white matter hypointensities were significantly greater in the corrected procedure (5.8 mL vs. 15.9 mL, p < 0.001). The unmodified procedure yielded no significant associations with global cognitive status, whereas the corrected procedure yielded positive associations between MoCA total score and clusters of cortical thickness in the left superior parietal (p = 0.018) and left insula (p = 0.04) regions. Further analyses with the corrected cortical thickness results and MoCA subscores showed a positive association between left superior parietal cortical thickness and Attention (p < 0.001).

CONCLUSION

These findings suggest that correction procedures which account for brain atrophy and neurovascular lesions can significantly improve FS's segmentation results and reduce failure rates, thus maximizing power by preventing the loss of our important study participants. Future work will examine relationships between cortical thickness, cerebral small vessel disease, and cognitive dysfunction due to neurodegenerative disease in the ONDRI study.

A Deep Network for Joint Registration and Reconstruction of Images with Pathologies

Registration of images with pathologies is challenging due to tissue appearance changes and missing correspondences caused by the pathologies. Moreover, mass effects as observed for brain tumors may displace tissue, creating larger deformations over time than what is observed in a healthy brain. Deep learning models have successfully been applied to image registration to offer dramatic speed up and to use surrogate information (e.g., segmentations) during training. However, existing approaches focus on learning registration models using images from healthy patients. They are therefore not designed for the registration of images with strong pathologies for example in the context of brain tumors, and traumatic brain injuries. In this work, we explore a deep learning approach to register images with brain tumors to an atlas. Our model learns an appearance mapping from images with tumors to the atlas, while simultaneously predicting the transformation to atlas space. Using separate decoders, the network disentangles the tumor mass effect from the reconstruction of quasi-normal images. Results on both synthetic and real brain tumor scans show that our approach outperforms cost function masking for registration to the atlas and that reconstructed quasi-normal images can be used for better longitudinal registrations.

Patient-Specific Registration of Pre-operative and Post-recurrence Brain Tumor MRI Scans

Registering brain magnetic resonance imaging (MRI) scans containing pathologies is challenging primarily due to large deformations caused by the pathologies, leading to missing correspondences between scans. However, the registration task is important and directly related to personalized medicine, as registering between baseline pre-operative and post-recurrence scans may allow the evaluation of tumor infiltration and recurrence. While many registration methods exist, most of them do not specifically account for pathologies. Here, we propose a framework for the registration of longitudinal image-pairs of individual patients diagnosed with glioblastoma. Specifically, we present a combined image registration/reconstruction approach, which makes use of a patient-specific principal component analysis (PCA) model of image appearance to register baseline pre-operative and post-recurrence brain tumor scans. Our approach uses the post-recurrence scan to construct a patient-specific model, which then guides the registration of the pre-operative scan. Quantitative and qualitative evaluations of our framework on 10 patient image-pairs indicate that it provides excellent registration performance without requiring (1) any human intervention or (2) prior knowledge of tumor location, growth or appearance.

Brain extraction from normal and pathological images: A joint PCA/Image-Reconstruction approach

Brain extraction from 3D medical images is a common pre-processing step. A variety of approaches exist, but they are frequently only designed to perform brain extraction from images without strong pathologies. Extracting the brain from images exhibiting strong pathologies, for example, the presence of a brain tumor or of a traumatic brain injury (TBI), is challenging. In such cases, tissue appearance may substantially deviate from normal tissue appearance and hence violates algorithmic assumptions for standard approaches to brain extraction; consequently, the brain may not be correctly extracted. This paper proposes a brain extraction approach which can explicitly account for pathologies by jointly modeling normal tissue appearance and pathologies. Specifically, our model uses a three-part image decomposition: (1) normal tissue appearance is captured by principal component analysis (PCA), (2) pathologies are captured via a total variation term, and (3) the skull and surrounding tissue is captured by a sparsity term. Due to its convexity, the resulting decomposition model allows for efficient optimization. Decomposition and image registration steps are alternated to allow statistical modeling of normal tissue appearance in a fixed atlas coordinate system. As a beneficial side effect, the decomposition model allows for the identification of potentially pathological areas and the reconstruction of a quasi-normal image in atlas space. We demonstrate the effectiveness of our approach on four datasets: the publicly available IBSR and LPBA40 datasets which show normal image appearance, the BRATS dataset containing images with brain tumors, and a dataset containing clinical TBI images. We compare the performance with other popular brain extraction models: ROBEX, BEaST, MASS, BET, BSE and a recently proposed deep learning approach. Our model performs better than these competing approaches on all four datasets. Specifically, our model achieves the best median (97.11) and mean (96.88) Dice scores over all datasets. The two best performing competitors, ROBEX and MASS, achieve scores of 96.23/95.62 and 96.67/94.25 respectively. Hence, our approach is an effective method for high quality brain extraction for a wide variety of images.

Multimodal MR Synthesis via Modality-Invariant Latent Representation

We propose a multi-input multi-output fully convolutional neural network model for MRI synthesis. The model is robust to missing data, as it benefits from, but does not require, additional input modalities. The model is trained end-to-end, and learns to embed all input modalities into a shared modality-invariant latent space. These latent representations are then combined into a single fused representation, which is transformed into the target output modality with a learnt decoder. We avoid the need for curriculum learning by exploiting the fact that the various input modalities are highly correlated. We also show that by incorporating information from segmentation masks the model can both decrease its error and generate data with synthetic lesions. We evaluate our model on the ISLES and BRATS data sets and demonstrate statistically significant improvements over state-of-the-art methods for single input tasks. This improvement increases further when multiple input modalities are used, demonstrating the benefits of learning a common latent space, again resulting in a statistically significant improvement over the current best method. Finally, we demonstrate our approach on non skull-stripped brain images, producing a statistically significant improvement over the previous best method. Code is made publicly available at https://github.com/agis85/multimodal_brain_synthesis.

EFFICIENT REGISTRATION OF PATHOLOGICAL IMAGES: A JOINT PCA/IMAGE-RECONSTRUCTION APPROACH

Registration involving one or more images containing pathologies is challenging, as standard image similarity measures and spatial transforms cannot account for common changes due to pathologies. Low-rank/Sparse (LRS) decomposition removes pathologies prior to registration; however, LRS is memory-demanding and slow, which limits its use on larger data sets. Additionally, LRS blurs normal tissue regions, which may degrade registration performance. This paper proposes an efficient alternative to LRS: (1) normal tissue appearance is captured by principal component analysis (PCA) and (2) blurring is avoided by an integrated model for pathology removal and image reconstruction. Results on synthetic and BRATS 2015 data demonstrate its utility.