Supine and prone colon registration using quasi-conformal mapping

Centerline-guided reinforcement learning model for pancreatic duct identifications

Purpose

Pancreatic ductal adenocarcinoma is forecast to become the second most significant cause of cancer mortality as the number of patients with cancer in the main duct of the pancreas grows, and measurement of the pancreatic duct diameter from medical images has been identified as relevant for its early diagnosis.

Approach

We propose an automated pancreatic duct centerline tracing method from computed tomography (CT) images that is based on deep reinforcement learning, which employs an artificial agent to interact with the environment and calculates rewards by combining the distances from the target and the centerline. A deep neural network is implemented to forecast step-wise values for each potential action. With the help of this mechanism, the agent can probe along the pancreatic duct centerline using the best possible navigational path. To enhance the tracing accuracy, we employ landmark-based registration, which enables the generation of a probability map of the pancreatic duct. Subsequently, we utilize a gradient-based method on the registered data to extract a probability map specifically indicating the centerline of the pancreatic duct.

Results

Three datasets with a total of 115 CT images were used to evaluate the proposed method. Using image hold-out from the first two datasets, the method performance was 2.0, 4.0, and 2.1 mm measured in terms of the mean detection error, Hausdorff distance (HD), and root mean squared error (RMSE), respectively. Using the first two datasets for training and the third one for testing, the method accuracy was 2.2, 4.9, and 2.6 mm measured in terms of the mean detection error, HD, and RMSE, respectively.

Conclusions

We present an algorithm for automated pancreatic duct centerline tracing using deep reinforcement learning. We observe that validation on an external dataset confirms the potential for practical utilization of the presented method.

A balance of clinical assessment and use of diagnostic imaging: A CT colonography comparative case report

Computer tomography colonography (CTC) is a non-invasive procedure which has replaced barium enema. CTC uses helical images of a cleansed and gas-distended colon for the diagnosis and treatment of colonic neoplasms. This case study compares 2 patients: one with positive pathology (patient A) and another as comparator (patient B) with a similar pathology to discuss and debate possible treatment pathways. Patient (A) CTC showed 2 polyps: 6 mm and 10 mm, which the colorectal surgeons thought only needed follow-up. Our comparator (patient B) displayed a similar pathology which measured 9 mm. In this case (patient B), there was mutual agreement with the surgeons for polypectomy but without haematology involvement which was atypical of the usual pathway. The surgeons did not see the 9 mm polyp at polypectomy which could be due to observer error or radiology reporter error. Given that conventional colonoscopy is more sensitive in detecting polyps; a repeat of both tests could confirm the presence of polyp, however, the surgeons gave patient (B) a virtual appointment and requested a repeat CTC in 12 months. In colorectal medicine there can be variations in the treatment of patients with polyps. While a repeat of both tests could confirm the presence of polyp in patient (B), the surgeons' decisions regarding the patient's treatment reflected a balance of confidence in clinical assessment and use of diagnostic imaging which can reduce unnecessary requests and use of diagnostic tests.

Automatic landmark detection and registration of brain cortical surfaces via quasi-conformal geometry and convolutional neural networks

In medical imaging, surface registration is extensively used for performing systematic comparisons between anatomical structures, with a prime example being the highly convoluted brain cortical surfaces. To obtain a meaningful registration, a common approach is to identify prominent features on the surfaces and establish a low-distortion mapping between them with the feature correspondence encoded as landmark constraints. Prior registration works have primarily focused on using manually labeled landmarks and solving highly nonlinear optimization problems, which are time-consuming and hence hinder practical applications. In this work, we propose a novel framework for the automatic landmark detection and registration of brain cortical surfaces using quasi-conformal geometry and convolutional neural networks. We first develop a landmark detection network (LD-Net) that allows for the automatic extraction of landmark curves given two prescribed starting and ending points based on the surface geometry. We then utilize the detected landmarks and quasi-conformal theory for achieving the surface registration. Specifically, we develop a coefficient prediction network (CP-Net) for predicting the Beltrami coefficients associated with the desired landmark-based registration and a mapping network called the disk Beltrami solver network (DBS-Net) for generating quasi-conformal mappings from the predicted Beltrami coefficients, with the bijectivity guaranteed by quasi-conformal theory. Experimental results are presented to demonstrate the effectiveness of our proposed framework. Altogether, our work paves a new way for surface-based morphometry and medical shape analysis.

3D Virtual Pancreatography

We present 3D virtual pancreatography (VP), a novel visualization procedure and application for non-invasive diagnosis and classification of pancreatic lesions, the precursors of pancreatic cancer. Currently, non-invasive screening of patients is performed through visual inspection of 2D axis-aligned CT images, though the relevant features are often not clearly visible nor automatically detected. VP is an end-to-end visual diagnosis system that includes: A machine learning based automatic segmentation of the pancreatic gland and the lesions, a semi-automatic approach to extract the primary pancreatic duct, a machine learning based automatic classification of lesions into four prominent types, and specialized 3D and 2D exploratory visualizations of the pancreas, lesions and surrounding anatomy. We combine volume rendering with pancreas- and lesion-centric visualizations and measurements for effective diagnosis. We designed VP through close collaboration and feedback from expert radiologists, and evaluated it on multiple real-world CT datasets with various pancreatic lesions and case studies examined by the expert radiologists.

Shape analysis via inconsistent surface registration

In this work, we develop a framework for shape analysis using inconsistent surface mapping. Traditional landmark-based geometric morphometr- ics methods suffer from the limited degrees of freedom, while most of the more advanced non-rigid surface mapping methods rely on a strong assumption of the global consistency of two surfaces. From a practical point of view, given two anatomical surfaces with prominent feature landmarks, it is more desirable to have a method that automatically detects the most relevant parts of the two surfaces and finds the optimal landmark-matching alignment between these parts, without assuming any global 1-1 correspondence between the two surfaces. Our method is capable of solving this problem using inconsistent surface registration based on quasi-conformal theory. It further enables us to quantify the dissimilarity of two shapes using quasi-conformal distortion and differences in mean and Gaussian curvatures, thereby providing a natural way for shape classification. Experiments on Platyrrhine molars demonstrate the effectiveness of our method and shed light on the interplay between function and shape in nature.

Modeling Complex Deformations of the Sigmoid Colon Between External Beam Radiation Therapy and Brachytherapy Images of Cervical Cancer

PURPOSE

In this study, we investigated registration methods for estimating the large interfractional sigmoid deformations that occur between external beam radiation therapy (EBRT) and brachytherapy (BT) for cervical cancer.

METHODS AND MATERIALS

Sixty-three patients were retrospectively analyzed. The sigmoid colon was delineated on 2 computed tomography images acquired during EBRT (without applicator) and BT (with applicator) for each patient. Five registration approaches were compared to propagate the contour of the sigmoid from BT to EBRT anatomies: rigid registration, commercial hybrid (ANAtomically CONstrained Deformation Algorithm), controlling ROI surface projection of RayStation, and the classical and constrained symmetrical thin-plate spline robust point matching (sTPS-RPM) methods. Deformation of the sigmoid due to insertion of the BT applicator was reported. Registration performance was compared by using the Dice similarity coefficient (DSC), distance to agreement, and Hausdorff distance. The 2 sTPS-RPM methods were compared by using surface triangle quality criteria between deformed surfaces. Using the deformable approaches, the BT dose of the sigmoid was deformed toward the EBRT anatomy. The displacement and discrepancy between the deformable methods to propagate the planned D1cm³ and D2cm³ of the sigmoid from BT to EBRT anatomies were reported for 55 patients.

RESULTS

Large and complex deformations of the sigmoid were observed for each patient. Rigid registration resulted in poor sigmoid alignment with a mean DSC of 0.26. Using the contour to drive the deformation, ANAtomically CONstrained Deformation Algorithm was able to slightly improve the alignment of the sigmoid with a mean DSC of 0.57. Using only the sigmoid surface as controlling ROI, the mean DSC was improved to 0.79. The classical and constrained sTPS-RPM methods provided mean DSCs of 0.95 and 0.96, respectively, with an average inverse consistency error <1 mm. The constrained sTPS-RPM provided more realistic deformations and better surface topology of the deformed sigmoids. The planned mean (range) D1cm³ and D2cm³ of the sigmoid were 13.4 Gy (1-24.1) and 12.2 Gy (1-21.5) on the BT anatomy, respectively. Using the constrained sTPS-RPM to deform the sigmoid from BT to EBRT anatomies, these hotspots had a mean (range) displacement of 27.1 mm (6.8-81).

CONCLUSIONS

Large deformations of the sigmoid were observed between the EBRT and BT anatomies, suggesting that the D1cm³ and D2cm³ of the sigmoid would unlikely to be at the same position throughout treatment. The proposed constrained sTPS-RPM seems to be the preferred approach to manage the large deformation due to BT applicator insertion. Such an approach could be used to map the EBRT dose to the BT anatomy for personalized BT planning optimization.

Temporal Views of Flattened Mitral Valve Geometries

The mitral valve, one of the four valves in the human heart, controls the bloodflow between the left atrium and ventricle and may suffer from various pathologies. Malfunctioning valves can be treated by reconstructive surgeries, which have to be carefully planned and evaluated. While current research focuses on the modeling and segmentation of the valve, we base our work on existing segmentations of patient-specific mitral valves, that are also time-resolved ( 3D+t) over the cardiac cycle. The interpretation of the data can be ambiguous, due to the complex surface of the valve and multiple time steps. We therefore propose a software prototype to analyze such 3D+t data, by extracting pathophysiological parameters and presenting them via dimensionally reduced visualizations. For this, we rely on an existing algorithm to unroll the convoluted valve surface towards a flattened 2D representation. In this paper, we show that the 3D+t data can be transferred to 3D or 2D representations in a way that allows the domain expert to faithfully grasp important aspects of the cardiac cycle. In this course, we not only consider common pathophysiological parameters, but also introduce new observations that are derived from landmarks within the segmentation model. Our analysis techniques were developed in collaboration with domain experts and a survey showed that the insights have the potential to support mitral valve diagnosis and the comparison of the pre- and post-operative condition of a patient.

Immersive Virtual Colonoscopy

Virtual colonoscopy (VC) is a non-invasive screening tool for colorectal polyps which employs volume visualization of a colon model reconstructed from a CT scan of the patient's abdomen. We present an immersive analytics system for VC which enhances and improves the traditional desktop VC through the use of VR technologies. Our system, using a head-mounted display (HMD), includes all of the standard VC features, such as the volume rendered endoluminal fly-through, measurement tool, bookmark modes, electronic biopsy, and slice views. The use of VR immersion, stereo, and wider field of view and field of regard has a positive effect on polyp search and analysis tasks in our immersive VC system, a volumetric-based immersive analytics application. Navigation includes enhanced automatic speed and direction controls, based on the user's head orientation, in conjunction with physical navigation for exploration of local proximity. In order to accommodate the resolution and frame rate requirements for HMDs, new rendering techniques have been developed, including mesh-assisted volume raycasting and a novel lighting paradigm. Feedback and further suggestions from expert radiologists show the promise of our system for immersive analysis for VC and encourage new avenues for exploring the use of VR in visualization systems for medical diagnosis.

LMap: Shape-Preserving Local Mappings for Biomedical Visualization

Visualization of medical organs and biological structures is a challenging task because of their complex geometry and the resultant occlusions. Global spherical and planar mapping techniques simplify the complex geometry and resolve the occlusions to aid in visualization. However, while resolving the occlusions these techniques do not preserve the geometric context, making them less suitable for mission-critical biomedical visualization tasks. In this paper, we present a shape-preserving local mapping technique for resolving occlusions locally while preserving the overall geometric context. More specifically, we present a novel visualization algorithm, LMap, for conformally parameterizing and deforming a selected local region-of-interest (ROI) on an arbitrary surface. The resultant shape-preserving local mappings help to visualize complex surfaces while preserving the overall geometric context. The algorithm is based on the robust and efficient extrinsic Ricci flow technique, and uses the dynamic Ricci flow algorithm to guarantee the existence of a local map for a selected ROI on an arbitrary surface. We show the effectiveness and efficacy of our method in three challenging use cases: (1) multimodal brain visualization, (2) optimal coverage of virtual colonoscopy centerline flythrough, and (3) molecular surface visualization.

Conformal mapping of carotid vessel wall and plaque thickness measured from 3D ultrasound images

Measurements of vessel-wall-plus-plaque thickness (VWT) from 3D carotid ultrasound have been shown to be sensitive to the effect of pharmaceutical interventions. Since the geometry of carotid arteries is highly subject-specific, quantitative comparison of the distributions of point-wise VWT measured for different patients or for the same patients at different ultrasound scanning sessions requires the development of a mapping strategy to adjust for the geometric variability of different carotid surface models. In this paper, we present an algorithm mapping each 3D carotid surface to a 2D carotid template with an emphasis on preserving the local geometry of the carotid surface by minimizing local angular distortion. The previously described arc-length scaling (AL) approach was applied to generate an initial 2D VWT map. Using results established in the quasi-conformal theory, a new map was computed to compensate for the angular distortion incurred in AL mapping. As the 2D carotid template lies on an L-shaped non-convex domain, one-to-one correspondence of the mapping operation was not guaranteed. To address this issue, an iterative Beltrami differential chopping and smoothing procedure was developed to enforce bijectivity. Evaluations performed in the 20 carotid surface models showed that the reduction in average angular distortion made by the proposed algorithm was highly significant (P = 2.06 × 10^-5). This study is the first study showing that a bijective conformal map to a non-convex domain can be obtained using the iterative Beltrami differential chopping and smoothing procedure. The improved consistency exhibited in the 2D VWT map generated by the proposed algorithm will allow for unbiased quantitative comparisons of VWT as well as local geometric and hemodynamic quantities in population studies.

Corresponding Supine and Prone Colon Visualization Using Eigenfunction Analysis and Fold Modeling

We present a method for registration and visualization of corresponding supine and prone virtual colonoscopy scans based on eigenfunction analysis and fold modeling. In virtual colonoscopy, CT scans are acquired with the patient in two positions, and their registration is desirable so that physicians can corroborate findings between scans. Our algorithm performs this registration efficiently through the use of Fiedler vector representation (the second eigenfunction of the Laplace-Beltrami operator). This representation is employed to first perform global registration of the two colon positions. The registration is then locally refined using the haustral folds, which are automatically segmented using the 3D level sets of the Fiedler vector. The use of Fiedler vectors and the segmented folds presents a precise way of visualizing corresponding regions across datasets and visual modalities. We present multiple methods of visualizing the results, including 2D flattened rendering and the corresponding 3D endoluminal views. The precise fold modeling is used to automatically find a suitable cut for the 2D flattening, which provides a less distorted visualization. Our approach is robust, and we demonstrate its efficiency and efficacy by showing matched views on both the 2D flattened colons and in the 3D endoluminal view. We analytically evaluate the results by measuring the distance between features on the registered colons, and we also assess our fold segmentation against 20 manually labeled datasets. We have compared our results analytically to previous methods, and have found our method to achieve superior results. We also prove the hot spots conjecture for modeling cylindrical topology using Fiedler vector representation, which allows our approach to be used for general cylindrical geometry modeling and feature extraction.

Haustral loop extraction for CT colonography using geodesics

Purpose

The human colon has complex geometric structures because of its haustral folds, which are thin flat protrusions on the colon wall. The haustral loop is the curve (approximately triangular in shape) that encircles the highly convex region of the haustral fold, and is regarded as the natural landmark of the colon, intersecting the longitude of the colon in the middle. Haustral loop extraction can assist in reducing the structural complexity of the colon, and the loops can also serve as anatomic markers for computed tomographic colonography (CTC). Moreover, haustral loop sectioning of the colon can help with the performance of precise prone–supine registration.

Methods

We propose an accurate approach of extracting haustral loops for CT virtual colonoscopy based on geodesics. First, the longitudinal geodesic (LG) connecting the start and end points is tracked by the geodesic method and the colon is cut along the LG. Second, key points are extracted from the LG, after which paired points that are used for seeking the potential haustral loops are calculated according to the key points. Next, for each paired point, the shortest distance (geodesic line) between the paired points twice is calculated, namely one on the original surface and the other on the cut surface. Then, the two geodesics are combined to form a potential haustral loop. Finally, erroneous and nonstandard potential loops are removed.

Results

To evaluate the haustral loop extraction algorithm, we first utilized the algorithm to extract the haustral loops. Then, we let the clinicians determine whether the haustral loops were correct and then identify the missing haustral loops. The extraction algorithm successfully detected 91.87% of all of the haustral loops with a very low false positive rate.

Conclusions

We believe that haustral loop extraction may benefit many post-procedures in CTC, such as supine–prone registration, computer-aided diagnosis, and taenia coli extraction.

Virtual colon flattening method based on colonic outer surface

Virtual colon flattening (VF) is a minimally invasive viewing mode used to detect colorectal polyps on the colonic inner surface in virtual colonoscopy. Compared with conventional colonoscopy, inspecting a flattened colonic inner surface is faster and results in fewer uninspected regions. Unfortunately, the deformation distortions of flattened colonic inner surface impede the performance of VF. Conventionally, the deformation distortions can be corrected by using the colonic inner surface. However, colonic curvatures and haustral folds make correcting deformation distortions using only the colonic inner surface difficult. Therefore, we propose a VF method that is based on the colonic outer surface. The proposed method includes two novel algorithms, namely, the colonic outer surface extraction algorithm and the colonic outer surface-based distortion correction algorithm. Sixty scans involving 77 annotated polyps were used for the validation. The flattened colons were independently inspected by three operators and then compared with three existing VF methods. The correct detection rates of the proposed method and the three existing methods were 79.6%, 67.1%, 71.9%, and 72.7%, respectively, and the false positives per scan were 0.16, 0.32, 0.21, and 0.26, respectively. The experimental results demonstrate that our proposed method has better performance than existing methods that are based on the colonic inner surface.

Feasibility of using the marginal blood vessels as reference landmarks for CT colonography

OBJECTIVE

The purpose of this study was to show the spatial relationship of the colonic marginal blood vessels and the teniae coli on CT colonography (CTC) and the use of the marginal blood vessels for supine-prone registration of polyps and for determination of proper connectivity of collapsed colonic segments.

MATERIALS AND METHODS

We manually labeled the marginal blood vessels on 15 CTC examinations. Colon segmentation, centerline extraction, teniae detection, and teniae identification were automatically performed. For assessment of their spatial relationships, the distances from the marginal blood vessels to the three teniae coli and to the colon were measured. Student t tests (paired, two-tailed) were performed to evaluate the differences among these distances. To evaluate the reliability of the marginal vessels as reference points for polyp correlation, we analyzed 20 polyps from 20 additional patients who underwent supine and prone CTC. The average difference of the circumferential polyp position on the supine and prone scans was computed. Student t tests (paired, two-tailed) were performed to evaluate the supine-prone differences of the distance. We performed a study on 10 CTC studies from 10 patients with collapsed colonic segments by manually tracing the marginal blood vessels near the collapsed regions to resolve the ambiguity of the colon path.

RESULTS

The average distances (± SD) from the marginal blood vessels to the tenia mesocolica, tenia omentalis, and tenia libera were 20.1 ± 3.1 mm (95% CI, 18.5-21.6 mm), 39.5 ± 4.8 mm (37.1-42.0 mm), and 36.9 ± 4.2 mm (34.8-39.1 mm), respectively. Pairwise comparison showed that these distances to the tenia libera and tenia omentalis were significantly different from the distance to the tenia mesocolica (p < 0.001). The average distance from the marginal blood vessels to the colon wall was 15.3 ± 2.0 mm (14.2-16.3 mm). For polyp localization, the average difference of the circumferential polyp position on the supine and prone scans was 9.6 ± 9.4 mm (5.5-13.7 mm) (p = 0.15) and expressed as a percentage of the colon circumference was 3.1% ± 2.0% (2.3-4.0%) (p = 0.83). We were able to trace the marginal blood vessels for 10 collapsed colonic segments and determine the paths of the colon in these regions.

CONCLUSION

The marginal blood vessels run parallel to the colon in proximity to the tenia mesocolica and enable accurate supine-prone registration of polyps and localization of the colon path in areas of collapse. Thus, the marginal blood vessels may be used as reference landmarks complementary to the colon centerline and teniae coli.

A Novel Colon Wall Flattening Model for Computed Tomographic Colonography: Method and Validation

Computed tomographic colonography (CTC) has been developed for screening of colon cancer. Flattening the three-dimensional (3D) colon wall into two-dimensional (2D) image is believed to (1) provide supplementary information to the endoscopic views and further (2) facilitate colon registration, taniae coli (TC) detection, and haustral fold segmentation. Though the previously-used conformal mapping-based flattening methods can preserve the angular geometry, they have the limitations in providing accurate information of the 3D inner colon wall due to the lack of undulating topography. In this paper, we present a novel colon-wall flattening method using a strategy of 2.5D approach. Coupling with the conformal flattening model, the presented new approach builds an elevation distance map to depict the neighborhood characteristics of the inner colon wall. We validated the new method via two CTC applications: TC detection and haustral fold segmentation. Experimental results demonstrated the effectiveness of our strategy for CTC studies.

Colon flattening using heat diffusion Riemannian metric

We propose a new colon flattening algorithm that is efficient, shape-preserving, and robust to topological noise. Unlike previous approaches, which require a mandatory topological denoising to remove fake handles, our algorithm directly flattens the colon surface without any denoising. In our method, we replace the original Euclidean metric of the colon surface with a heat diffusion metric that is insensitive to topological noise. Using this heat diffusion metric, we then solve a Laplacian equation followed by an integration step to compute the final flattening. We demonstrate that our method is shape-preserving and the shape of the polyps are well preserved. The flattened colon also provides an efficient way to enhance the navigation and inspection in virtual colonoscopy. We further show how the existing colon registration pipeline is made more robust by using our colon flattening. We have tested our method on several colon wall surfaces and the experimental results demonstrate the robustness and the efficiency of our method.

3D Reconstruction of virtual colon structures from colonoscopy images

This paper presents the first fully automated reconstruction technique of 3D virtual colon segments from individual colonoscopy images. It is the basis of new software applications that may offer great benefits for improving quality of care for colonoscopy patients. For example, a 3D map of the areas inspected and uninspected during colonoscopy can be shown on request of the endoscopist during the procedure. The endoscopist may revisit the suggested uninspected areas to reduce the chance of missing polyps that reside in these areas. The percentage of the colon surface seen by the endoscopist can be used as a coarse objective indicator of the quality of the procedure. The derived virtual colon models can be stored for post-procedure training of new endoscopists to teach navigation techniques that result in a higher level of procedure quality. Our technique does not require a prior CT scan of the colon or any global positioning device. Our experiments on endoscopy images of an Olympus synthetic colon model reveal encouraging results with small average reconstruction errors (4.1 mm for the fold depths and 12.1 mm for the fold circumferences).

CT colonography: external clinical validation of an algorithm for computer-assisted prone and supine registration

PURPOSE

To perform external validation of a computer-assisted registration algorithm for prone and supine computed tomographic (CT) colonography and to compare the results with those of an existing centerline method.

MATERIALS AND METHODS

All contributing centers had institutional review board approval; participants provided informed consent. A validation sample of CT colonographic examinations of 51 patients with 68 polyps (6-55 mm) was selected from a publicly available, HIPAA compliant, anonymized archive. No patients were excluded because of poor preparation or inadequate distension. Corresponding prone and supine polyp coordinates were recorded, and endoluminal surfaces were registered automatically by using a computer algorithm. Two observers independently scored three-dimensional endoluminal polyp registration success. Results were compared with those obtained by using the normalized distance along the colonic centerline (NDACC) method. Pairwise Wilcoxon signed rank tests were used to compare gross registration error and McNemar tests were used to compare polyp conspicuity.

RESULTS

Registration was possible in all 51 patients, and 136 paired polyp coordinates were generated (68 polyps) to test the algorithm. Overall mean three-dimensional polyp registration error (mean ± standard deviation, 19.9 mm ± 20.4) was significantly less than that for the NDACC method (mean, 27.4 mm ± 15.1; P = .001). Accuracy was unaffected by colonic segment (P = .76) or luminal collapse (P = .066). During endoluminal review by two observers (272 matching tasks, 68 polyps, prone to supine and supine to prone coordinates), 223 (82%) polyp matches were visible (120° field of view) compared with just 129 (47%) when the NDACC method was used (P < .001). By using multiplanar visualization, 48 (70%) polyps were visible after scrolling ± 15 mm in any multiplanar axis compared with 16 (24%) for NDACC (P < .001).

CONCLUSION

Computer-assisted registration is more accurate than the NDACC method for mapping the endoluminal surface and matching the location of polyps in corresponding prone and supine CT colonographic acquisitions.

Endoluminal surface registration for CT colonography using haustral fold matching

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Novel haustral fold matching algorithm.

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Achieves 96.1% mean accuracy over 1743 reference points in 17 CTC datasets.

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New initialisation to non-rigid intensity-based surface registration method.

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Full method shows 6.0 mm mean error.

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Use of initialisation shows significant improvement (p < 0.001).

Computed Tomographic (CT) colonography is a technique used for the detection of bowel cancer or potentially precancerous polyps. The procedure is performed routinely with the patient both prone and supine to differentiate fixed colonic pathology from mobile faecal residue. Matching corresponding locations is difficult and time consuming for radiologists due to colonic deformations that occur during patient repositioning.

We propose a novel method to establish correspondence between the two acquisitions automatically. The problem is first simplified by detecting haustral folds using a graph cut method applied to a curvature-based metric applied to a surface mesh generated from segmentation of the colonic lumen. A virtual camera is used to create a set of images that provide a metric for matching pairs of folds between the prone and supine acquisitions. Image patches are generated at the fold positions using depth map renderings of the endoluminal surface and optimised by performing a virtual camera registration over a restricted set of degrees of freedom. The intensity difference between image pairs, along with additional neighbourhood information to enforce geometric constraints over a 2D parameterisation of the 3D space, are used as unary and pair-wise costs respectively, and included in a Markov Random Field (MRF) model to estimate the maximum a posteriori fold labelling assignment.

The method achieved fold matching accuracy of 96.0% and 96.1% in patient cases with and without local colonic collapse. Moreover, it improved upon an existing surface-based registration algorithm by providing an initialisation. The set of landmark correspondences is used to non-rigidly transform a 2D source image derived from a conformal mapping process on the 3D endoluminal surface mesh. This achieves full surface correspondence between prone and supine views and can be further refined with an intensity based registration showing a statistically significant improvement (p < 0.001), and decreasing mean error from 11.9 mm to 6.0 mm measured at 1743 reference points from 17 CTC datasets.

An improved method of automatic colon segmentation for virtual colon unfolding

The technique of virtual colon unfolding (VU) is a non-invasive procedure to detect polyps on the colon inner wall. Compared with conventional virtual colonoscopy, VU is faster and results in fewer uninspected regions. However, the performance of VU is more vulnerable to the quality of colon segmentation. In this paper, an improved colon segmentation method is proposed to enhance the performance of VU. The improved method is with the use of a novel post-processing scheme, which is composed of two parts: attain more accurate centerlines with the help of scalar complementary geodesic distance field and compensate gap-like artifacts based on local morphological information. We validated the improved method on twenty colon cases via two widely used VU techniques, the ray-casting technique and the conformal-mapping technique. Experimental results indicated that with the use of the improved method, the rates of correct response via ray-casting and conformal-mapping techniques were respectively elevated by 14.9% and 13.1%, while the rates of false response were respectively reduced by 8.4% and 10.8%.

Haustral fold segmentation with curvature-guided level set evolution

Human colon has complex structures mostly because of the haustral folds. The folds are thin flat protrusions on the colon wall, which complicate the shape analysis for computer-aided detection (CAD) of colonic polyps. Fold segmentation may help reduce the structural complexity, and the folds can serve as an anatomic reference for computed tomographic colonography (CTC). Therefore, in this study, based on a model of the haustral fold boundaries, we developed a level-set approach to automatically segment the fold surfaces. To evaluate the developed fold segmentation algorithm, we first established the ground truth of haustral fold boundaries by experts' drawing on 15 patient CTC datasets without severe under/over colon distention from two medical centers. The segmentation algorithm successfully detected 92.7% of the folds in the ground truth. In addition to the sensitivity measure, we further developed a merit of segmented-area ratio (SAR), i.e., the ratio between the area of the intersection and union of the expert-drawn folds and the area of the automatically segmented folds, to measure the segmentation accuracy. The segmentation algorithm reached an average value of SAR = 86.2%, showing a good match with the ground truth on the fold surfaces. We believe the automatically segmented fold surfaces have the potential to benefit many postprocedures in CTC, such as CAD, taenia coli extraction, supine-prone registration, etc.

Predicting polyp location on optical colonoscopy from CT colonography by minimal-energy curve modeling of the colonoscope path

The ability to accurately locate a polyp found on computed tomographic colonography (CTC) at subsequent optical colonoscopy (OC) is an important task in colorectal cancer screening. We present a method to more accurately match polyp locations at CTC and OC. A colonoscope was modeled as a flexible tube with negligible stretch and minimal strain. The path of the colonoscope was estimated using a minimal-energy curve method. The energy function was defined and optimized by a subdivision scheme. The prediction of polyp locations at OC from CTC was converted to an optimization problem. The prediction performance was evaluated on 134 polyps by comparing the predicted with the true polyp locations at OC. The method can accurately predict polyp locations at OC to within ±0.5 colonoscope mark (5 cm) for more than 58% of polyps and to within ±1 colonoscope mark (10 cm) for more than 96% of polyps, significantly improving upon previously published methods. This method can be easily incorporated into routine OC practice and allow the colonoscopist to begin the examination by targeting locations of potential polyps found at CTC.

Matching 3-D prone and supine CT colonography scans using graphs

In this paper, we propose a new registration method for prone and supine computed tomographic colonography scans using graph matching. We formulate 3-D colon registration as a graph matching problem and propose a new graph matching algorithm based on mean field theory. In the proposed algorithm, we solve the matching problem in an iterative way. In each step, we use mean field theory to find the matched pair of nodes with highest probability. During iterative optimization, one-to-one matching constraints are added to the system in a step-by-step approach. Prominent matching pairs found in previous iterations are used to guide subsequent mean field calculations. The proposed method was found to have the best performance with smallest standard deviation compared with two other baseline algorithms called the normalized distance along the colon centerline (NDACC) ( p = 0.17) with manual colon centerline correction and spectral matching ( p < 1e-5). A major advantage of the proposed method is that it is fully automatic and does not require defining a colon centerline for registration. For the latter NDACC method, user interaction is almost always needed for identifying the colon centerlines.

Automated teniae coli detection and identification on computed tomographic colonography

PURPOSE

Computed tomographic colonography (CTC) is a minimally invasive technique for colonic polyps and cancer screening. Teniae coli are three bands of longitudinal smooth muscle on the colon surface. Teniae coli are important anatomically meaningful landmarks on human colon. In this paper, the authors propose an automatic teniae coli detection method for CT colonography.

METHODS

The original CTC slices are first segmented and reconstructed to a 3D colon surface. Then, the 3D colon surface is unfolded using a reversible projection technique. After that the unfolded colon is projected to a 2D height map. The teniae coli are detected using the height map and then reversely projected back to the 3D colon. Since teniae are located at the junctions where the haustral folds meet, the authors apply 2D Gabor filter banks to extract features of haustral folds. The maximum response of the filter banks is then selected as the feature image. The fold centers are then identified based on local maxima and thresholding on the feature image. Connecting the fold centers yields a path of the folds. Teniae coli are extracted as lines running between the fold paths. The authors used the spatial relationship between ileocecal valve (ICV) and teniae mesocolica (TM) to identify the TM, then the teniae omentalis (TO) and the teniae libera (TL) can be identified subsequently.

RESULTS

The authors tested the proposed method on 47 cases of 37 patients, 10 of the patients with both supine and prone CT scans. The proposed method yielded performance with an average normalized root mean square error (RMSE) ( ± standard deviation [95% confidence interval]) of 4.87% ( ± 2.93%, [4.05% 5.69%]).

CONCLUSIONS

The proposed fully-automated teniae coli detection and identification method is accurate and promising for future clinical applications.

Context preserving maps of tubular structures

When visualizing tubular 3D structures, external representations are often used for guidance and display, and such views in 2D can often contain occlusions. Virtual dissection methods have been proposed where the entire 3D structure can be mapped to the 2D plane, though these will lose context by straightening curved sections. We present a new method of creating maps of 3D tubular structures that yield a succinct view while preserving the overall geometric structure. Given a dominant view plane for the structure, its curve skeleton is first projected to a 2D skeleton. This 2D skeleton is adjusted to account for distortions in length, modified to remove intersections, and optimized to preserve the shape of the original 3D skeleton. Based on this shaped 2D skeleton, a boundary for the map of the object is obtained based on a slicing path through the structure and the radius around the skeleton. The sliced structure is conformally mapped to a rectangle and then deformed via harmonic mapping to match the boundary placement. This flattened map preserves the general geometric context of a 3D object in a 2D display, and rendering of this flattened map can be accomplished using volumetric ray casting. We have evaluated our method on real datasets of human colon models.

Registration of the endoluminal surfaces of the colon derived from prone and supine CT colonography

PURPOSE

Computed tomographic (CT) colonography is a relatively new technique for detecting bowel cancer or potentially precancerous polyps. CT scanning is combined with three-dimensional (3D) image reconstruction to produce a virtual endoluminal representation similar to optical colonoscopy. Because retained fluid and stool can mimic pathology, CT data are acquired with the bowel cleansed and insufflated with gas and patient in both prone and supine positions. Radiologists then match visually endoluminal locations between the two acquisitions in order to determine whether apparent pathology is real or not. This process is hindered by the fact that the colon, essentially a long tube, can undergo considerable deformation between acquisitions. The authors present a novel approach to automatically establish spatial correspondence between prone and supine endoluminal colonic surfaces after surface parameterization, even in the case of local colon collapse.

METHODS

The complexity of the registration task was reduced from a 3D to a 2D problem by mapping the surfaces extracted from prone and supine CT colonography onto a cylindrical parameterization. A nonrigid cylindrical registration was then performed to align the full colonic surfaces. The curvature information from the original 3D surfaces was used to determine correspondence. The method can also be applied to cases with regions of local colonic collapse by ignoring the collapsed regions during the registration.

RESULTS

Using a development set, suitable parameters were found to constrain the cylindrical registration method. Then, the same registration parameters were applied to a different set of 13 validation cases, consisting of 8 fully distended cases and 5 cases exhibiting multiple colonic collapses. All polyps present were well aligned, with a mean (+/- std. dev.) registration error of 5.7 (+/- 3.4) mm. An additional set of 1175 reference points on haustral folds spread over the full endoluminal colon surfaces resulted in an error of 7.7 (+/- 7.4) mm. Here, 82% of folds were aligned correctly after registration with a further 15% misregistered by just onefold.

CONCLUSIONS

The proposed method reduces the 3D registration task to a cylindrical registration representing the endoluminal surface of the colon. Our algorithm uses surface curvature information as a similarity measure to drive registration to compensate for the large colorectal deformations that occur between prone and supine data acquisitions. The method has the potential to both enhance polyp detection and decrease the radiologist's interpretation time.

Volumetric Colon Wall Unfolding Using Harmonic Differentials

Volumetric colon wall unfolding is a novel method for virtual colon analysis and visualization with valuable applications in virtual colonoscopy (VC) and computer-aided detection (CAD) systems. A volumetrically unfolded colon enables doctors to visualize the entire colon structure without occlusions due to haustral folds, and is critical for performing efficient and accurate texture analysis on the volumetric colon wall. Though conventional colon surface flattening has been employed for these uses, volumetric colon unfolding offers the advantages of providing the needed quantities of information with needed accuracy. This work presents an efficient and effective volumetric colon unfolding method based on harmonic differentials. The colon volumes are reconstructed from CT images and are represented as tetrahedral meshes. Three harmonic 1-forms, which are linearly independent everywhere, are computed on the tetrahedral mesh. Through integration of the harmonic 1-forms, the colon volume is mapped periodically to a canonical cuboid. The method presented is automatic, simple, and practical. Experimental results are reported to show the performance of the algorithm on real medical datasets. Though applied here specifically to the colon, the method is general and can be generalized for other volumes.