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Optimal processing of computed tomography images using experimentally measured noise properties.

The spatial resolution and noise properties of a computed tomography (CT) image may be altered by two-dimensional linear filtering of the initial image. In this paper, we derive filters that minimize the noise variance subject to a constraint on the spatial resolution. The resulting filter functions can reduce the noise variance by 17% in comparison with conventional filters. The method for obtaining these filters requires knowledge of the noise and imaging properties of the system. We derive theoretical expressions for these properties and introduce experimental techniques for their measurement. The statistical characteristics are shown to be anisotropic, spatially variant, and object dependent. We discuss the implications of this result both for optimal filtering and for the general problem of CT image noise property measurement.

Humans↗

A method for attenuation and scatter correction of brain SPECT based on computed tomography images.

A method for attenuation and scatter correction of brain single photon emission computed tomography (SPECT) is described where computed tomography (CT) images of the brain are used for the calculation of attenuation maps. The method is evaluated for the substance 99mTc hexamethylpropylene amine oxime. A transmission dependent scatter correction is utilized and is based on ray sums calculated through the attenuation map. A method based on external markers is used to align the SPECT and CT image volumes. The markers need only to be present during the SPECT acquisition since the corresponding landmarks can be found without markers on the CT images. The mismatching has been investigated for five patients who have undergone both a CT examination and a SPECT examination with markers. Twelve individuals from the staff have pointed out the landmarks on the CT images, with an average standard deviation of 3.4 mm. Reconstructions with an attenuation map shifted the corresponding 95% confidence interval have been performed to obtain an estimation of the quantitative uncertainty caused by the mismatching, and quantitative errors of up to 6.3% have been measured. At present the method is probably most useful when groups of patients are studied.

Algorithms↗

Optimal noise control in and fast reconstruction of fan-beam computed tomography image.

We proposed a linear approach that exploits statistically complementary information inherent in the projection data of fan-beam computed tomography (CT) for achieving a bias-free image-variance reduction in fan-beam CT. This linear approach leads to the development of infinite classes of hybrid algorithms for image reconstruction in fan-beam CT. These hybrid algorithms are computationally more efficient and numerically less susceptible to data noise and to the effect of finite sampling than the conventional fan-beam filtered back-projection (FFBP) algorithm. We also developed infinite classes of generalized fan-beam filtered back-projection (GFFBP) algorithms, which include the conventional FFBP algorithm as a special member. We demonstrated theoretically and quantitatively that the hybrid and GFFBP algorithms are identical (or different) in the absence (or presence) of data noise and of the effect of finite sampling. More importantly, we identified the statistically optimal hybrid algorithm that may have potentially significant implication to image reconstruction in fan-beam CT. Extensive numerical results of computer-simulation studies validated our theoretical results.

Algorithms↗

Effect of temporal subtraction images on radiologists' detection of lung cancer on CT: results of the observer performance study with use of film computed tomography images.

RATIONALE AND OBJECTIVES: To evaluate the effect of temporal subtraction images on the radiologists' detection of early primary lung cancer in computed tomography (CT) scans. MATERIALS AND METHODS: Fourteen cases with primary lung cancer and 16 normal cases were used for this study from a database of low-dose CT images, which were obtained from a lung cancer screening program in Nagano, Japan. Images were obtained with a single-detector helical CT scanner using 10 mm collimation and 2:1 pitch. Each case had both previous and current CT scans. Temporal subtraction images were obtained by subtracting the warped previous images from the current images. Seven radiologists, including four attendings and three residents, provided their confidence levels for the presence or absence of lung cancers with use of film CT images without and with temporal subtraction images. Receiver operating characteristic analysis was used to compare their performance without and with temporal subtraction images. RESULTS: The mean Az values (area under the receiver operating characteristic curve) of seven observers without and with temporal subtraction images were 0.868 and 0.930, respectively. Diagnostic accuracy was significantly improved by using temporal subtraction images (P = .007). Temporal subtraction images were especially useful when a nodule was present near the pulmonary hilum, where radiologists tended to overlook it. CONCLUSION: The temporal subtraction technique can significantly improve the sensitivity and specificity for detection of lung cancer on CT scans.

Adult↗

Left ventricular boundary detection from spatio-temporal volumetric computed tomography images.

This paper presents a new automatic technique for left ventricle boundary detection from a set of three-dimensional (3D) computed tomography (CT) volumetric cardiac images. The goals of this paper are to incorporate the temporal information into LV boundary detection, to link the shape modeling and LV boundary detection together, and to provide a compact representation of recovered LV boundaries to cardiac imaging. The proposed technique introduces spatio-temporal boundary detection and iterative model-based boundary refinement to left ventricular boundary extraction. The proposed technique has been applied to two sets of four-dimensional (4D) computed tomography images. Experimental results are compared with the manually edited images.

Algorithms↗

Prognostic value of stress myocardial perfusion single photon emission computed tomography imaging in patients with left ventricular bundle branch block.

BACKGROUND: Left bundle branch block (LBBB) may occur with or without structural heart disease. In patients with coronary artery disease the presence of LBBB is associated with an increased risk of cardiovascular events. METHODS AND RESULTS: This study examined the outcome of 293 medically treated patients with LBBB and symptoms who were undergoing stress thallium-201 single photon emission computed tomography imaging. One hundred seventy-three men and 120 women with an age range of 67 +/- 9 years and a pretest probability of coronary artery disease of 77% +/- 28% were studied. During a mean follow-up of 33 months 58 hard cardiac events (death or nonfatal myocardial infarction) and 112 total events (hard events, coronary angioplasty, coronary bypass surgery, or cardiac transplantation) occurred. Univariate and multivariate Cox survival analysis with clinical, stress, hemodynamic, and single photon emission computed tomography variables identified the perfusion defect size (chi square = 27, p = 0.0001) and increased lung thallium uptake as the most important independent predictors of hard or total cardiac events. The hard event-free survival rate was 91% in patients with no or small defects (<15% of left ventricular myocardium) and 72% in patients with large defects (p = 0.0001, RR = 3.2, 95% CI 1.7 to 5.9). The total event-free survival rate was 81% in patients with small defects and 48% in patients with large defects (p = 0.0001, RR = 2.7, 95% CI 1.9 to 4.0). The total event rate was 54% in patients with large perfusion defects and increased lung uptake and 17% in patients with no or small abnormality and normal lung thallium uptake (p = 0.0001). CONCLUSION: Single photon emission computed tomography perfusion imaging is useful in predicting outcome in patients with LBBB and intermediate pretest probability of coronary artery disease. The size of perfusion abnormality and lung thallium uptake stratified patients into high and low risk groups with a threefold difference in hard and total cardiac events.

Aged↗

Comparison of image processing techniques (magnetic resonance imaging, computed tomography scan and ultrasound) for 3D modeling and analysis of the human bones.

Magnetic resonance imaging (MRI), computed tomography scanning (CT scan), and ultrasound imaging techniques (UI) were used for data acquisition to construct/develop a 3D solid model of the human tibia, femur, and skull. CT scan was found to be an acceptable technique for cadavers. CT scans are harmful to the human body in large doses, while MRIs and ultrasound are known to be safe. However, MRIs form a better tool in performing this image generation task for living beings because of its high resolution capacity when compared with images obtained using ultrasound techniques. High resolution poses to be a very important factor, as the consideration of various material properties of the bones was part of the emphasis of this research. MRIs have the capacity of displaying a distinct boundary between the muscles and the bone, in addition to the boundary between the cortical and the cancellous region within the bone. Ultrasound was found to be the cheapest technique and gave reasonably good results for just the outside boundaries of the bone. The models of the human bones were generated on a Computer Aided Design (CAD) system. The cross-sections obtained from (MRI, CT, or UI) were scanned into the computer. Image processing software was used to detect the boundaries of the bones. A C + + program was used to read the coordinates of the edges and construct a B-spline curve on the CAD system. The curves were converted to a B-rep solid using skinning. The solid models were meshed, constrained, and material properties were assigned to different regions of the models for Finite Element Analysis (FEM).

Anatomy, Cross-Sectional↗

Computed tomography image analyzer: 3D reconstruction and segmentation applying active contour models--'snakes'.

Many diagnostic and therapeutic procedures depend on medical images. In order to overcome imperfections of the obtained images, which are due to the acquisition process, and to extract new information from the available images, many techniques have been developed. In this study, a new method of image segmentation and 3D reconstruction based on active contour models ('snakes') was applied in analyzing computed tomography (CT) images in patients with acute head trauma. Using this method, lesion to brain (LBR) and ventricle to brain ratio (VBR) parameters, as well as 3D reconstruction of traumatic lesion, was obtained accurately. In our study group, 215 patients (mean age 42.4+/-23.5 years, 138/215 (64.2%) males) were included. Among them, 72 (33.5%) did not survive during hospitalisation in the Emergency Department. LBR correlated with the Glasgow Coma Score and the intrahospital outcome (r=-0.457 and r=0.515, respectively). Besides, non-survivors had greater LTB values (0.042+/-0.034) than survivors (0.005+/-0.011). However, VBR did not correlate with these clinical parameters. In addition, LBR was significantly higher in the patients with other pathologic CT findings. The proposed methodology, based on extracting maximum information from available CT scans, could be a basis for further medical decision making in patients with acute head trauma.

Adult↗

Noise and contrast detection in computed tomography images.

A discrete representation of the reconstruction process is used in an analysis of noise in computed tomography (CT) images. This model is consistent with the method of data collection in actual machines. An expression is derived which predicts the variance on the measured linear attenuation coefficient of a single pixel in an image. The dependence of the variance on various CT scanner design parameters such as pixel size, slice width, scan time, number of detectors, etc., is then described. The variation of noise with sampling area is theoretically explained. These predictions are in good agreement with a set of experimental measurements made on a range of CT scanners. The equivalent sampling aperture of the CT process is determined and the effect of the reconstruction filter on the variance of the linear attenuation coefficient is also noted, in particular, the choice and its consequences for reconstructed images and noise behaviour. The theory has been extended to include contrast detail behaviour, and these predictions compare favourably with experimental measurements. The theory predicts that image smoothing will have little effect on the contrast-detail detectability behaviour of reconstructed images.

Humans↗

The digital radiographic and computed tomography imaging of two types of explosive devices.

Two well-established medical imaging methods, digital radiography (DR) and computed tomography (CT), were employed to obtain images of two types of explosive devices, model rocket engines and shotgun shells. The images were evaluated from an airport security perspective. In terms of geometrical shape, the detection probability of the explosive devices appears to be higher with DR imaging, but in terms of the actual explosive compounds in the devices, CT appears to offer a higher detection probability. DR imaging offers a low detection probability for the explosive powder in the shotgun shells, but a rather significant detection probability for the explosive propellant in the model rocket engines.

Explosions↗

Craniofacial deformity in patients with uncorrected congenital muscular torticollis: an assessment from three-dimensional computed tomography imaging.

Congenital muscular torticollis is caused by idiopathic fibrosis of the sternocleidomastoid muscle that restricts movement and pulls the head toward the involved side. Deformation of the craniofacial skeleton will develop if the restriction is not released and result in aesthetic and functional problems. The purpose of this study was to use three-dimensional computed tomography imaging for qualitative and quantitative evaluation of the craniofacial deformity in a series of patients with uncorrected congenital muscular torticollis, and to assess age as a precipitating factor for severity of the deformity. A total of 14 patients from 1 month to 24 years of age were included. The skull images were rotated into standard orientation and reconfigured for evaluation of the cranium, endocranial base, and facial skeletal structures. The midlines of cranial base and facial bone, angle of midline deviation, width of each hemicranium and hemiface, and the orbital index were defined and measured. The results showed that the cranium and cranial base deformation took place as early as in infant stage, with the most prominent change occurring in the posterior cranial fossa. Facial bone asymmetry started to appear after 5 years of age, at which time the mandibular and occlusal abnormalities were observed. The deformity of the orbits and maxilla occurred at an older age, characterized by the deviation and decreased vertical height on the affected side. The severity of the observed deformities increased with age. The angle of midline deviation was 2.48 +/- 1.68 degrees in the cranial base and 3.26 +/- 3.28 degrees on the facial bone. Both of the midline deviations were significantly correlated with age. Compared with the contralateral side, the width of the ipsilateral posterior hemicranium was longer (54.36 +/- 6.72 mm versus 50.81 +/- 6.55 mm), and the width of the ipsilateral lower hemiface was shorter (35.30 +/- 7.27 mm versus 43.49 +/- 11.34 mm). Both differences were statistically significant. Measurement of the orbital index demonstrated a significantly flatter orbit on the ipsilateral side (89.48 +/- 0.11 versus 92.74 +/- 0.08). This study showed that the cranium and cranial base deformity occurred early in patients with uncorrected torticollis, while the facial bone deformity occurred in childhood stage. The cranial and facial deformity became more severe with age. Early release of the muscle restriction is advised to prevent craniofacial deformation.

Adolescent↗

The utility of megavoltage computed tomography images from a helical tomotherapy system for setup verification purposes.

PURPOSE: To evaluate the utility of relatively low-dose megavoltage computed tomography (MVCT) images from a clinical helical tomotherapy system for setup verification purposes. METHODS AND MATERIALS: Cross-sectional kilovolt computed tomography (kVCT) images were obtained for treatment planning purposes on a diagnostic third-generation CT scanner, followed by MVCT images from a helical tomotherapy system in 8 pet dogs with spontaneously occurring tumors. The kVCT and MVCT images were aligned for setup verification purposes, allowing repositioning before treatment delivery. RESULTS: Tumors are readily visualized on the MVCT images. At a dose of 2-3 cGy, the MVCT images are of sufficient quality for verification of treatment setup, but soft-tissue contrast is inferior to that with conventional kVCT. The MV and kVCT images were successfully aligned. When necessary, patients undergoing helical tomotherapy were repositioned before treatment. CONCLUSIONS: Megavoltage CT image quality is sufficient for tumor identification and three-dimensional setup verification in dogs with spontaneous tumors. The MVCT images can be aligned with the planning kVCT to ensure proper patient registration before treatment. Image alignment was successful in these canine patients, despite no skin markings defining patient positioning between the two scans. MVCT images facilitate setup verification, and their tomographic nature offers improvements over conventional portal imaging.

Animals↗

Preoperative simulation of vascular anatomy by three-dimensional computed tomography imaging in laparoscopic gastric cancer surgery.

BACKGROUND: Treatment of early gastric cancer may be an ideal application for laparoscopic surgery. But laparoscopic surgery has various limitations derived from the lack of tactile feedback and a two-dimensional display of the operative field. So, laparoscopic surgery is technically challenging and requires a more detailed understanding of local anatomy than conventional open surgery does. The purpose of this study was to evaluate the value of three-dimensional computed tomography imaging in the preoperative simulation of laparoscopic gastric cancer surgery. STUDY DESIGN: Multidetector-row helical CT was performed preoperatively in 49 patients who underwent laparoscopic gastric cancer surgery. Scanning was initiated approximately 20 seconds after an intravenous injection of 100 mL of contrast material at 5 mL/second. Three-dimensional CT images were reconstructed using the volume-rendering technique. RESULTS: 3D-CT imaging depicted the stomach, arterial, and venous anatomy and was able to identify important vascular variants. Preoperative information concerning the right gastric artery led us to the site of its branching and facilitated dissection of suprapyloric lymph nodes. The left gastric artery furnishing the aberrant left hepatic artery was successfully revealed and this information enabled us to avoid accidental hemorrhage and ischemic liver damage. Preoperative confirmation of the drainage routes of the left gastric vein was also useful in accomplishing secure lymphadenectomy. CONCLUSIONS: 3D-CT imaging provides a vascular "road map," which is critical for surgical guidance, and prevents the risks involved in surgery. Preoperative 3D-CT imaging may be an informative device to overcome the disadvantages of laparoscopic gastric cancer surgery.

Computer Simulation↗

Enhanced four-detector row computed tomography imaging of laryngeal and hypopharyngeal cancers.

PURPOSE: Four-detector row computed tomography (4D CT) enables imaging of the larynx and hypopharynx with high temporal resolution and rapid reformatting of coronal planes. The aim of our study was to assess the usefulness of postcontrast biphasic 4D CT in diagnosing tumor extent. METHODS: Forty-seven patients with laryngeal or hypopharyngeal cancer were investigated using 4D CT. Two radiologists retrospectively evaluated transverse and reformatted coronal images in both the early and late phases. RESULTS: Images in the late phase were superior to those in the early phase in the conspicuity of the depicted lesions. The coronal images facilitated assessment of the craniocaudal extension of tumors and obliteration of the paraglottic space. The maximal diameter of tumors tended to be larger on the coronal image than on the transverse image. CONCLUSIONS: Images in the late phase were more informative than images in the early phase to demonstrate tumor extension. Reformatted coronal imaging was useful in evaluating craniocaudal extension.

Adult↗

Sequential computed tomography images demonstrating characteristic changes in fibrous dysplasia.

Images of fibrous dysplasia (FD) on computed tomography (CT) or magnetic resonance imaging (MRI) vary depending on the relative proportions of the fibrous and osseous components. Based on analysis of the literature, Camilleri suggested that structural changes revealed by conventional radiography may be indicative of the progression of FD. Here we describe the case of a boy who presented at 12 years of age with monostotic FD located in the right maxilla. The lesion first appeared as a lamellar, "onion peel"-like structure on CT; then over the course of the next five years, the structure became what has been termed an "egg-shell lesion", before eventually assuming the form of a "ground-glass lesion".

Adult↗

Detection of hypervascular hepatocellular carcinoma by dynamic magnetic resonance imaging with double-echo chemical shift in-phase and opposed-phase gradient echo technique: comparison with dynamic helical computed tomography imaging with double arterial phase.

PURPOSE: The technique of double-echo chemical shift gradient echo magnetic resonance imaging (MRI) with the fast low-angle shot (double-echo FLASH) sequence provides in-phase and opposed-phase images in a single breath hold. The purpose of this study was to evaluate the efficacy of dynamic MRI with double-echo FLASH imaging for the detection of hypervascular hepatocellular carcinoma by comparing it with dynamic helical computed tomography (CT) imaging with double arterial phase. MATERIALS AND METHODS: Twenty-nine patients with 67 hypervascular hepatocellular carcinoma nodules who underwent both dynamic MRI with double-echo FLASH imaging (repetition time/echo time/flip angle: 160/3.6, 7.0/80 degrees ) and dynamic helical CT imaging with double arterial phase were enrolled in the study. For dynamic MRI, precontrast, arterial, portal venous, and equilibrium phase images were obtained before and approximately 19, 60, and 120 seconds, respectively, after intravenous injection of 0.1 mmol/kg of gadopentetate dimeglumine at a rate of 2 ml/s. For dynamic CT imaging, quadraphase images, including early arterial, late arterial, portal venous, and equilibrium phases, were obtained serially approximately 20, 30, 70, and 180 seconds, respectively, after intravenous administration of 2 ml/kg of 300 mgI/ml of nonionic contrast medium at a rate of 5 ml/s. Three masked observers independently interpreted images obtained with each technique in random order, separately and without patient identifiers. Sensitivity and positive predictive values as well as the area below the alternative-free response receiver operating characteristic curve (Az) for each imaging technique were calculated and compared statistically. RESULTS: Mean sensitivity and positive predictive values of MRI for hypervascular hepatocellular carcinoma were 48% and 94%, respectively, and those of CT imaging were 47% and 91%, respectively. In 11 (38%) of the 29 patients, at least one observer judged dynamic MRI to be superior, whereas in 5 patients (17%), dynamic CT was judged to be superior. There was no significant difference in the sensitivity and positive predictive values between these techniques (p > 0.05). There was no significant difference either in mean Az values between CT (0.55) and MRI (0.57) (p = 0.61). CONCLUSION: Dynamic MRI with double-echo FLASH imaging can detect hypervascular hepatocellular carcinoma as well as dynamic helical CT imaging with double arterial phase.

Adult↗

[Development of computer-aided diagnostic system for detection of lung nodules in three-dimensional computed tomography images].

We have developed an automated computerized method for the detection of lung nodules in three-dimensional (3D) computed tomography (CT) images obtained by helical CT. In this scheme, a lung segmentation technique for the determination of the nodule search area is performed based on a gray-level thresholding technique. To enhance lung nodules, we employed the 3D cross-correlation method by using a 3D Gaussian template with zero-surrounding as a model of lung nodule. False positives are then eliminated by using a rule-base with 53 features. For further reduction of false positives, we performed linear discriminant analysis using these 53 features. The average number of false positives was 6.7 per case at a percent sensitivity of 85.0%. This computerized scheme will be useful to radiologists by providing a "second opinion" in case of possible early lung cancer.

Diagnosis, Computer-Assisted↗

Accuracy and time efficiency for the detection of thoracic cage fractures: volume rendering compared with transverse computed tomography images.

OBJECTIVE: To compare the accuracy and time efficiency of volume rendering (VR) compared with transverse images of multidetector-row computed tomography data to identify thoracic cage fractures. METHODS: Computed tomography scans of 50 patients with acute blunt chest trauma were retrospectively analyzed by using VR and transverse images. The number, location, and type of rib and sternal fractures revealed by these viewing methods were compared, and the time needed for diagnosis was measured. RESULTS: Thirty of 50 patients had a total of 178 rib fractures. The mean sensitivity, specificity, and accuracy for their detection were similar for transverse (96%, 100%, and 99%) and VR (98%, 100%, and 100%) images. Three sternal fractures were correctly diagnosed with VR, and 1 was missed on transverse images by both readers. The time to read VR images (mean of 105 seconds) was significantly reduced compared with the time needed for transverse image reading (mean of 167 seconds; P < 0.001). CONCLUSION: Volume rendering of computed tomography data depicts thoracic cage fractures with a high accuracy similar to that of transverse images but is considerably faster.

Adolescent↗