Segmentation of liver vasculature from contrast enhanced CT images using context-based voting

Evaluating the Impact of Liver Vasculature Model Complexity for Estimating Dose to Circulating Blood During Radiation Therapy

PURPOSE

To assess the impact of liver model complexity on the estimated radiation dose to circulating blood during radiation therapy.

METHODS AND MATERIALS

Six patients with hepatocellular carcinoma (HCC) were selected covering a range of clinical treatment volume (CTV) sizes and locations. Photon and proton treatment plans were generated for each patient. Planning computed tomography, CTV contours, and dose distributions were deformably registered to the reference livers provided by the International Commission on Radiological Protection report. Three vasculature models were considered: (1) main vascular tree (MVT), (2) coarse vascular tree (CVT) of 1045 vessels, and (3) detailed vascular tree (DVT) of 2041 vessels. Blood dose-volume histograms (bDVHMVT, bDVHCVT, and bDVHDVT) and the mean circulating blood dose (μb,MVT, μb,CVT, and μb,DVT) were estimated using Monte Carlo simulations for all 3 models. The effect of varying blood velocity (vb) in HCC tumors on dose estimation was also evaluated through increasing the tumor vb by 1.5, 2, and 4.2 times.

RESULTS

For the 3 lesions located in the left lobe, the estimated μb,MVT was lower than μb,DVT by an average ± standard deviation of (6 ± 4)% and (17 ± 7)% for photon and proton treatments, respectively. Smaller differences were found for lesions in the right lobe, where μb,MVT was on average (2 ± 1)% lower than μb,DVT for photon and (3 ± 1)% lower for proton treatments. More pronounced difference between μb,MVT and μb,DVT was seen in lesions with smaller CTV sizes. We also found that considering the elevated tumor vb led to a reduction of estimated dose to circulating blood, with a maximum reduction in the estimated μb of 39% and 8% for CTV of 603 and 249 mL, respectively.

CONCLUSION

Our study revealed that the impact of liver vasculature model complexity on the estimated dose to blood depended on lesion-specific characteristics. For lesions with larger CTV size on the right liver lobe treated with photons, modeling only major vessels could generate bDVHs that are dosimetrically comparable with bDVHs of more complex vascular models. Increased tumor vb resulted in a reduction of the estimated blood dose.

Mechanical properties of human hepatic tissues to develop liver-mimicking phantoms for medical applications

Using liver phantoms for mimicking human tissue in clinical training, disease diagnosis, and treatment planning is a common practice. The fabrication material of the liver phantom should exhibit mechanical properties similar to those of the real liver organ in the human body. This tissue-equivalent material is essential for qualitative and quantitative investigation of the liver mechanisms in producing nutrients, excretion of waste metabolites, and tissue deformity at mechanical stimulus. This paper reviews the mechanical properties of human hepatic tissues to develop liver-mimicking phantoms. These properties include viscosity, elasticity, acoustic impedance, sound speed, and attenuation. The advantages and disadvantages of the most common fabrication materials for developing liver tissue-mimicking phantoms are also highlighted. Such phantoms will give a better insight into the real tissue damage during the disease progression and preservation for transplantation. The liver tissue-mimicking phantom will raise the quality assurance of patient diagnostic and treatment precision and offer a definitive clinical trial data collection.

Hepatic vessels segmentation using deep learning and preprocessing enhancement

PURPOSE

Liver hepatic vessels segmentation is a crucial step for the diagnosis process in patients with hepatic diseases. Segmentation of liver vessels helps to study the liver internal segmental anatomy that helps in the preoperative planning of surgical treatment.

METHODS

Recently, the convolutional neural networks (CNN) have been proved to be efficient for the task of medical image segmentation. The paper proposes an automatic deep learning-based system for liver hepatic vessels segmentation of Computed Tomography (CT) datasets from different sources. The proposed work focuses on the combination of different steps; it starts by a preprocessing step to improve the vessels appearance within the liver region of interest in the CT scans. Coherence enhancing diffusion filtering (CED) and vesselness filtering methods are used to improve vessels contrast and intensity homogeneity. The proposed U-net based network architecture is implemented with modified residual block to include concatenation skip connection. The effect of enhancement using filtering step was studied. Also, the effect of data mismatch used in training and validation is studied.

RESULTS

The proposed method is evaluated using many CT datasets. Dice similarity coefficient (DSC) is used to evaluate the method. The average DSC score achieved a score 79%.

CONCLUSIONS

The proposed approach succeeded to segment liver vasculature from the liver envelope accurately, which makes it as potential tool for clinical preoperative planning.

Diagnosis of Clinically Significant Portal Hypertension Using CT- and MRI-based Vascular Model

Background Currently, the hepatic venous pressure gradient (HVPG) remains the reference standard for diagnosis of clinically significant portal hypertension (CSPH) but is limited by its invasiveness and availability. Purpose To investigate a vascular geometric model for noninvasive diagnosis of CSPH (HVPG ≥10 mm Hg) in patients with liver cirrhosis for both contrast-enhanced CT and MRI. Materials and Methods In this retrospective study, consecutive patients with liver cirrhosis who underwent HVPG measurement from August 2016 to April 2019 were included. Patients without hepatic diseases were included and marked as non-CSPH to balance the ratio of CSPH 1:1. A variety of vascular parameters were extracted from the portal vein, hepatic vein, aorta, and inferior vena cava and then entered into a vascular geometric model for identification of CSPH. Diagnostic performance was assessed with the area under the receiver operating characteristic curve (AUC). Results The model was developed and tested with retrospective data from 250 patients with liver cirrhosis and 273 patients without clinical evidence of hepatic disease at contrast-enhanced CT examination, including 213 patients with CSPH (mean age, 49 years ± 12 [SD]; 138 women) and 310 patients without CSPH (mean age, 50 years ± 9; 177 women). For external validation, an MRI data set with 224 patients with cirrhosis (mean age, 49 years ± 10; 158 women) and a CT data set with 106 patients with cirrhosis (mean age, 53 years ± 12; 71 women) were analyzed. Significant reductions in mean whole-vessel volumes were observed in the portal vein (ranging from 36.9 cm³ ± 16.0 to 29.6 cm³ ± 11.1; P < .05) and hepatic vein (ranging from 35.3 cm³ ± 21.5 to 22.4 cm³ ± 15.7; P < .05) when CSPH occurred. Similarly, the mean whole-vessel lengths were shorter in patients with CSPH (portal vein: 1.7 m ± 1.2 vs 3.0 m ± 2.4, P < .05; hepatic vein: 0.9 m ± 1.5 vs 1.8 m ± 1.5, P < .05) than in those without CSPH. The proposed vascular model performed well in the internal test set (mean AUC, 0.90 ± 0.02) and external test sets (mean AUCs, 0.84 ± 0.12 and 0.87 ± 0.11). Conclusion A contrast-enhanced CT- and MRI-based vascular model was proposed with good diagnostic consistency for hepatic venous pressure gradient measurement. ClinicalTrials.gov registration nos. NCT03138915 and NCT03766880 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Roldán-Alzate and Reeder in this issue.

HPM-Net: Hierarchical progressive multiscale network for liver vessel segmentation in CT images

BACKGROUND AND OBJECTIVE

The segmentation and visualization of liver vessels in 3D CT images are essential for computer-aided diagnosis and preoperative planning of liver diseases. Due to the irregular structure of liver vessels and image noise, accurate extraction of liver vessels is difficult. In particular, accurate segmentation of small vessels is always a challenge, as multiple single down-sampling usually results in a loss of information.

METHODS

In this paper, we propose a hierarchical progressive multiscale learning network (HPM-Net) framework for liver vessel segmentation. Firstly, the hierarchical progressive multiscale learning network combines internal and external progressive learning methods to learn semantic information about liver vessels at different scales by acquiring receptive fields of different sizes. Secondly, to better capture vessel features, we propose a dual-branch progressive 3D Unet, which uses a dual-branch progressive (DBP) down-sampling strategy to reduce the loss of detailed information in the process of network down-sampling. Finally, a deep supervision mechanism is introduced into the framework and backbone network to speed up the network convergence and achieve better training of the network.

RESULTS

We conducted experiments on the public dataset 3Dircadb for liver vessel segmentation. The average dice coefficient and sensitivity of the proposed method reached 75.18% and 78.84%, respectively, both higher than the original network.

CONCLUSION

Experimental results show that the proposed hierarchical progressive multiscale network can accurately segment the labeled liver vessels from the CT images.

Robust Deep 3D Blood Vessel Segmentation Using Structural Priors

Deep learning has enabled significant improvements in the accuracy of 3D blood vessel segmentation. Open challenges remain in scenarios where labeled 3D segmentation maps for training are severely limited, as is often the case in practice, and in ensuring robustness to noise. Inspired by the observation that 3D vessel structures project onto 2D image slices with informative and unique edge profiles, we propose a novel deep 3D vessel segmentation network guided by edge profiles. Our network architecture comprises a shared encoder and two decoders that learn segmentation maps and edge profiles jointly. 3D context is mined in both the segmentation and edge prediction branches by employing bidirectional convolutional long-short term memory (BCLSTM) modules. 3D features from the two branches are concatenated to facilitate learning of the segmentation map. As a key contribution, we introduce new regularization terms that: a) capture the local homogeneity of 3D blood vessel volumes in the presence of biomarkers; and b) ensure performance robustness to domain-specific noise by suppressing false positive responses. Experiments on benchmark datasets with ground truth labels reveal that the proposed approach outperforms state-of-the-art techniques on standard measures such as DICE overlap and mean Intersection-over-Union. The performance gains of our method are even more pronounced when training is limited. Furthermore, the computational cost of our network inference is among the lowest compared with state-of-the-art.

3D Graph-Connectivity Constrained Network for Hepatic Vessel Segmentation

Segmentation of hepatic vessels from 3D CT images is necessary for accurate diagnosis and preoper-ative planning for liver cancer. However, due to the low contrast and high noises of CT images, automatic hepatic vessel segmentation is a challenging task. Hepatic vessels are connected branches containing thick and thin blood vessels, showing an important structural characteristic or a prior: the connectivity of blood vessels. However, this is rarely applied in existing methods. In this paper, we segment hepatic vessels from 3D CT images by utilizing the connectivity prior. To this end, a graph neural network (GNN) used to describe the connectivity prior of hepatic vessels is integrated into a general convolutional neu-ral network (CNN). Specifically, a graph attention network (GAT) is first used to model the graphical connectivity information of hepatic vessels, which can be trained with the vascular connectivity graph constructed directly from the ground truths. Second, the GAT is integrated with a lightweight 3D U-Net by an efficient mechanism called the plug-in mode, in which the GAT is incorporated into the U-Net as a multi-task branch and is only used to supervise the training procedure of the U-Net with the connectivity prior. The GAT will not be used in the inference stage, and thus will not increase the hardware and time costs of the inference stage compared with the U-Net. Therefore, hepatic vessel segmentation can be well improved in an efficient mode. Extensive experiments on two public datasets show that the proposed method is superior to related works in accuracy and connectivity of hepatic vessel segmentation.

Survey on Liver Tumour Resection Planning System: Steps, Techniques, and Parameters

Preoperative planning for liver surgical treatments is an essential planning tool that aids in reducing the risks of surgical resection. Based on the computed tomography (CT) images, the resection can be planned before the actual tumour resection surgery. The computer-aided system provides an overview of the spatial relationships of the liver organ and its internal structures, tumours, and vasculature. It also allows for an accurate calculation of the remaining liver volume after resection. The aim of this paper was to review the main stages of the computer-aided system that helps to evaluate the risk of resection during liver cancer surgical treatments. The computer-aided system assists with surgical planning by enabling physicians to get volumetric measurements and visualise the liver, tumours, and surrounding vasculature. In this paper, it is concluded that for accurate planning of tumour resections, the liver organ and its internal structures should be segmented to understand the clear spatial relationship between them, thus allowing for a safer resection. This paper presents the main proposed segmentation techniques for each stage in the computer-aided system, namely the liver organ, tumours, and vessels. From the reviewed methods, it has been found that instead of relying on a single specific technique, a combination of a group of techniques would give more accurate segmentation results. The extracted masks from the segmentation algorithms are fused together to give the surgeons the 3D visualisation tool to study the spatial relationships of the liver and to calculate the required resection planning parameters.

Liver vessel segmentation based on inter-scale V-Net

Segmentation and visualization of liver vessel is a key task in preoperative planning and computer-aided diagnosis of liver diseases. Due to the irregular structure of liver vessel, accurate liver vessel segmentation is difficult. This paper proposes a method of liver vessel segmentation based on an improved V-Net network. Firstly, a dilated convolution is introduced into the network to make the network can still enlarge the receptive field without reducing down-sampling and save detailed spatial information. Secondly, a 3D deep supervision mechanism is introduced into the network to speed up the convergence of the network and help the network learn semantic features better. Finally, inter-scale dense connections are designed in the decoder of the network to prevent the loss of high-level semantic information during the decoding process and effectively integrate multi-scale feature information. The public datasets 3Dircadb were used to perform liver vessel segmentation experiments. The average dice and sensitivity of the proposed method reached 71.6 and 75.4%, respectively, which are higher than those of the original network. The experimental results show that the improved V-Net network can automatically and accurately segment labeled or even other unlabeled liver vessels from the CT images.

Computational Methods for Liver Vessel Segmentation in Medical Imaging: A Review

The segmentation of liver blood vessels is of major importance as it is essential for formulating diagnoses, planning and delivering treatments, as well as evaluating the results of clinical procedures. Different imaging techniques are available for application in clinical practice, so the segmentation methods should take into account the characteristics of the imaging technique. Based on the literature, this review paper presents the most advanced and effective methods of liver vessel segmentation, as well as their performance according to the metrics used. This paper includes results available for four imaging methods, namely: computed tomography (CT), computed tomography angiography (CTA), magnetic resonance (MR), and ultrasonography (USG). The publicly available datasets used in research are also presented. This paper may help researchers gain better insight into the available materials and methods, making it easier to develop new, more effective solutions, as well as to improve existing approaches. This article analyzes in detail various segmentation methods, which can be divided into three groups: active contours, tracking-based, and machine learning techniques. For each group of methods, their theoretical and practical characteristics are discussed, and the pros and cons are highlighted. The most advanced and promising approaches are also suggested. However, we conclude that liver vasculature segmentation is still an open problem, because of the various deficiencies and constraints researchers need to address and try to eliminate from the solutions used.

Combining deep learning with anatomical analysis for segmentation of the portal vein for liver SBRT planning

Automated segmentation of the portal vein (PV) for liver radiotherapy planning is a challenging task due to potentially low vasculature contrast, complex PV anatomy and image artifacts originated from fiducial markers and vasculature stents. In this paper, we propose a novel framework for automated segmentation of the PV from computed tomography (CT) images. We apply convolutional neural networks (CNNs) to learn the consistent appearance patterns of the PV using a training set of CT images with reference annotations and then enhance the PV in previously unseen CT images. Markov random fields (MRFs) were further used to smooth the results of the enhancement of the CNN enhancement and remove isolated mis-segmented regions. Finally, CNN-MRF-based enhancement was augmented with PV centerline detection that relied on PV anatomical properties such as tubularity and branch composition. The framework was validated on a clinical database with 72 CT images of patients scheduled for liver stereotactic body radiation therapy. The obtained accuracy of the segmentation was [Formula: see text] 0.83 and [Formula: see text] 1.08 mm in terms of the median Dice coefficient and mean symmetric surface distance, respectively, when segmentation is encompassed into the PV region of interest. The obtained results indicate that CNNs and anatomical analysis can be used for the accurate segmentation of the PV and potentially integrated into liver radiation therapy planning.

Liver vessel segmentation and identification based on oriented flux symmetry and graph cuts

BACKGROUND AND OBJECTIVE

Accurate segmentation of liver vessels from abdominal computer tomography angiography (CTA) volume is very important for liver-vessel analysis and living-related liver transplants. This paper presents a novel liver-vessel segmentation and identification method.

METHODS

Firstly, an anisotropic diffusion filter is used to smooth noise while preserving vessel boundaries. Then, based on the gradient symmetry and antisymmetry pattern of vessel structures, optimal oriented flux (OOF) and oriented flux antisymmetry (OFA) measures are respectively applied to detect liver vessels and their boundaries, and further to slenderize vessels. Next, according to vessel geometrical structure, a centerline extraction measure based on height ridge traversal and leaf node line-growing (LNLG) is proposed for the extraction of liver-vessel centerlines, and an intensity model based on fast marching is integrated into graph cuts (GCs) for effective segmentation of liver vessels. Finally, a distance voting mechanism is applied to separate the hepatic vein and portal vein.

RESULTS

The experiment results on abdominal CTA images show that the proposed method can effectively segment liver vessels, achieving an average accuracy, sensitivity, and specificity of 97.7%, 79.8%, and 98.6%, respectively, and has a good performance on thin-vessel extraction.

CONCLUSIONS

The proposed method does not require manual selection of the centerlines and vessel seeds, and can effectively segment liver vessels and identify hepatic vein and portal vein.

Hepatic vessel segmentation using variational level set combined with non-local robust statistics

Hepatic vessel segmentation is a challenging step in therapy guided by magnetic resonance imaging (MRI). This paper presents an improved variational level set method, which uses non-local robust statistics to suppress the influence of noise in MR images. The non-local robust statistics, which represent vascular features, are learned adaptively from seeds provided by users. K-means clustering in neighborhoods of seeds is utilized to exclude inappropriate seeds, which are obviously corrupted by noise. The neighborhoods of appropriate seeds are placed in an array to calculate the non-local robust statistics, and the variational level set formulation can be constructed. Bias correction is utilized in the level set formulation to reduce the influence of intensity inhomogeneity of MRI. Experiments were conducted over real MR images, and showed that the proposed method performed better on small hepatic vessel segmentation compared with other segmentation methods.

Segmentation of hepatic vessels from MRI images for planning of electroporation-based treatments in the liver

INTRODUCTION

Electroporation-based treatments rely on increasing the permeability of the cell membrane by high voltage electric pulses delivered to tissue via electrodes. To ensure that the whole tumor is covered by the sufficiently high electric field, accurate numerical models are built based on individual patient geometry. For the purpose of reconstruction of hepatic vessels from MRI images we searched for an optimal segmentation method that would meet the following initial criteria: identify major hepatic vessels, be robust and work with minimal user input.

MATERIALS AND METHODS

We tested the approaches based on vessel enhancement filtering, thresholding, and their combination in local thresholding. The methods were evaluated on a phantom and clinical data.

RESULTS

Results show that thresholding based on variance minimization provides less error than the one based on entropy maximization. Best results were achieved by performing local thresholding of the original de-biased image in the regions of interest which were determined through previous vessel-enhancement filtering. In evaluation on clinical cases the proposed method scored in average sensitivity of 93.68%, average symmetric surface distance of 0.89 mm and Hausdorff distance of 4.04 mm.

CONCLUSIONS

The proposed method to segment hepatic vessels from MRI images based on local thresholding meets all the initial criteria set at the beginning of the study and necessary to be used in treatment planning of electroporation-based treatments: it identifies the major vessels, provides results with consistent accuracy and works completely automatically. Whether the achieved accuracy is acceptable or not for treatment planning models remains to be verified through numerical modeling of effects of the segmentation error on the distribution of the electric field.

Electroporation-based treatment planning for deep-seated tumors based on automatic liver segmentation of MRI images

Electroporation is the phenomenon that occurs when a cell is exposed to a high electric field, which causes transient cell membrane permeabilization. A paramount electroporation-based application is electrochemotherapy, which is performed by delivering high-voltage electric pulses that enable the chemotherapeutic drug to more effectively destroy the tumor cells. Electrochemotherapy can be used for treating deep-seated metastases (e.g. in the liver, bone, brain, soft tissue) using variable-geometry long-needle electrodes. To treat deep-seated tumors, patient-specific treatment planning of the electroporation-based treatment is required. Treatment planning is based on generating a 3D model of the organ and target tissue subject to electroporation (i.e. tumor nodules). The generation of the 3D model is done by segmentation algorithms. We implemented and evaluated three automatic liver segmentation algorithms: region growing, adaptive threshold, and active contours (snakes). The algorithms were optimized using a seven-case dataset manually segmented by the radiologist as a training set, and finally validated using an additional four-case dataset that was previously not included in the optimization dataset. The presented results demonstrate that patient's medical images that were not included in the training set can be successfully segmented using our three algorithms. Besides electroporation-based treatments, these algorithms can be used in applications where automatic liver segmentation is required.

AUTOMATIC MULTI-SCALE SEGMENTATION OF INTRAHEPATIC VESSEL IN CT IMAGES FOR LIVER SURGERY PLANNING

The processing of blood vessels is an indispensable part in complicated surgeries of livers and hearts as the development of medical image technologies, which requires an automatic segmentation system over CT images of organs. However, the vascular pattern of livers in CT images suffers from low contrast to background so that the existing segmentation technologies are not able to extract the blood vessels completely. In the paper, we propose a new algorithm to extract the blood vessels of livers based on the adaptive multi-scale segmentation. First, we prove that the background histogram of normal scale blood vessels obeys the Gaussian distribution in CT images, and obtain the vascular distribution function from the vascular signal segmented from the background with a local optimal threshold. Second, Hessian matrix is employed to enhance the thin blood vessels before the extraction, and a complete and clear segmentation system for blood vessels is constructed by combining the major and thin blood vessels via filtering. Experimental results show the effectiveness of the proposed method, which is able to extract more complete blood vessels for 3D system, and assist the clinical liver surgeries efficiently.

Computer-aided focal liver lesion detection

PURPOSE

Our aim is to develop an automatic method which can detect diverse focal liver lesions (FLLs) in 3D CT volumes.

METHOD

A hybrid generative-discriminative framework is proposed. It first uses a generative model to describe non-lesion components and then identifies all candidate FLLs within a 3D liver volume by eliminating non-lesion components. It subsequently uses a discriminative approach to suppress false positives with the advantage of tumoroid, a novel measurement combining three shape features spherical symmetry, compactness and size.

RESULTS

This method was tested on 71 abdominal CT datasets (5,854 slices from 61 patients, with 261 FLLs covering six pathological types) and evaluated using the free-response receiver operating characteristic (FROC) curves. Overall, it achieved a true positive rate of 90 % with one false positive per liver. It degenerated gently with the decrease in lesion sizes to 30 ml. It achieved a true-positive rate of 36 % when tested on the lesions less than 4 ml. The average computing time of the lesion detection is 4 min and 28 s per CT volume on a PC with 2.67 GHz CPU and 4.0 GB RAM.

CONCLUSIONS

The proposed method is comparable to the radiologists' visual investigation in terms of efficiency. The tool has great potential to reduce radiologists' burden in going through thousands of images routinely.

How bioinformatics influences health informatics: usage of biomolecular sequences, expression profiles and automated microscopic image analyses for clinical needs and public health

ABSTRACT

The currently hyped expectation of personalized medicine is often associated with just achieving the information technology led integration of biomolecular sequencing, expression and histopathological bioimaging data with clinical records at the individual patients' level as if the significant biomedical conclusions would be its more or less mandatory result. It remains a sad fact that many, if not most biomolecular mechanisms that translate the human genomic information into phenotypes are not known and, thus, most of the molecular and cellular data cannot be interpreted in terms of biomedically relevant conclusions. Whereas the historical trend will certainly be into the general direction of personalized diagnostics and cures, the temperate view suggests that biomedical applications that rely either on the comparison of biomolecular sequences and/or on the already known biomolecular mechanisms have much greater chances to enter clinical practice soon. In addition to considering the general trends, we exemplarily review advances in the area of cancer biomarker discovery, in the clinically relevant characterization of patient-specific viral and bacterial pathogens (with emphasis on drug selection for influenza and enterohemorrhagic E. coli) as well as progress in the automated assessment of histopathological images. As molecular and cellular data analysis will become instrumental for achieving desirable clinical outcomes, the role of bioinformatics and computational biology approaches will dramatically grow.

AUTHOR SUMMARY

With DNA sequencing and computers becoming increasingly cheap and accessible to the layman, the idea of integrating biomolecular and clinical patient data seems to become a realistic, short-term option that will lead to patient-specific diagnostics and treatment design for many diseases such as cancer, metabolic disorders, inherited conditions, etc. These hyped expectations will fail since many, if not most biomolecular mechanisms that translate the human genomic information into phenotypes are not known yet and, thus, most of the molecular and cellular data collected will not lead to biomedically relevant conclusions. At the same time, less spectacular biomedical applications based on biomolecular sequence comparison and/or known biomolecular mechanisms have the potential to unfold enormous potential for healthcare and public health. Since the analysis of heterogeneous biomolecular data in context with clinical data will be increasingly critical, the role of bioinformatics and computational biology will grow correspondingly in this process.