Development and evaluation of a manual segmentation protocol for deep grey matter in multiple sclerosis: Towards accelerated semi-automated references.

BACKGROUND: Deep grey matter (dGM) structures, particularly the thalamus, are clinically relevant in multiple sclerosis (MS). However, segmentation of dGM in MS is challenging; labeled MS-specific reference sets are needed for objective evaluation and training of new methods. OBJECTIVES: This study aimed to (i) create a standardized protocol for manual delineations of dGM; (ii) evaluate the reliability of the protocol with multiple raters; and (iii) evaluate the accuracy of a fast-semi-automated segmentation approach (FASTSURF). METHODS: A standardized manual segmentation protocol for caudate nucleus, putamen, and thalamus was created, and applied by three raters on multi-center 3D T1-weighted MRI scans of 23 MS patients and 12 controls. Intra- and inter-rater agreement was assessed through intra-class correlation coefficient (ICC); spatial overlap through Jaccard Index (JI) and generalized conformity index (CIgen). From sparse delineations, FASTSURF reconstructed full segmentations; accuracy was assessed both volumetrically and spatially. RESULTS: All structures showed excellent agreement on expert manual outlines: intra-rater JI > 0.83; inter-rater ICC ≥ 0.76 and CIgen ≥ 0.74. FASTSURF reproduced manual references excellently, with ICC ≥ 0.97 and JI ≥ 0.92. CONCLUSIONS: The manual dGM segmentation protocol showed excellent reproducibility within and between raters. Moreover, combined with FASTSURF a reliable reference set of dGM segmentations can be produced with lower workload.

FAst Segmentation Through SURface Fairing (FASTSURF): A novel semi-automatic hippocampus segmentation method.

OBJECTIVE: The objective is to present a proof-of-concept of a semi-automatic method to reduce hippocampus segmentation time on magnetic resonance images (MRI). MATERIALS AND METHODS: FAst Segmentation Through SURface Fairing (FASTSURF) is based on a surface fairing technique which reconstructs the hippocampus from sparse delineations. To validate FASTSURF, simulations were performed in which sparse delineations extracted from full manual segmentations served as input. On three different datasets with different diagnostic groups, FASTSURF hippocampi were compared to the original segmentations using Jaccard overlap indices and percentage volume differences (PVD). In one data set for which back-to-back scans were available, unbiased estimates of overlap and PVD were obtained. Using longitudinal scans, we compared hippocampal atrophy rates measured by manual, FASTSURF and two automatic segmentations (FreeSurfer and FSL-FIRST). RESULTS: With only seven input contours, FASTSURF yielded mean Jaccard indices ranging from 72(±4.3)% to 83(±2.6)% and PVDs ranging from 0.02(±2.40)% to 3.2(±3.40)% across the three datasets. Slightly poorer results were obtained for the unbiased analysis, but the performance was still considerably better than both tested automatic methods with only five contours. CONCLUSIONS: FASTSURF segmentations have high accuracy and require only a fraction of the delineation effort of fully manual segmentation. Atrophy rate quantification based on completely manual segmentation is well reproduced by FASTSURF. Therefore, FASTSURF is a promising tool to be implemented in clinical workflow, provided a future prospective validation confirms our findings.

Regional analysis of volumes and reproducibilities of automatic and manual hippocampal segmentations.

PURPOSE: Precise and reproducible hippocampus outlining is important to quantify hippocampal atrophy caused by neurodegenerative diseases and to spare the hippocampus in whole brain radiation therapy when performing prophylactic cranial irradiation or treating brain metastases. This study aimed to quantify systematic differences between methods by comparing regional volume and outline reproducibility of manual, FSL-FIRST and FreeSurfer hippocampus segmentations. MATERIALS AND METHODS: This study used a dataset from ADNI (Alzheimer's Disease Neuroimaging Initiative), including 20 healthy controls, 40 patients with mild cognitive impairment (MCI), and 20 patients with Alzheimer's disease (AD). For each subject back-to-back (BTB) T1-weighted 3D MPRAGE images were acquired at time-point baseline (BL) and 12 months later (M12). Hippocampi segmentations of all methods were converted into triangulated meshes, regional volumes were extracted and regional Jaccard indices were computed between the hippocampi meshes of paired BTB scans to evaluate reproducibility. Regional volumes and Jaccard indices were modelled as a function of group (G), method (M), hemisphere (H), time-point (T), region (R) and interactions. RESULTS: For the volume data the model selection procedure yielded the following significant main effects G, M, H, T and R and interaction effects G-R and M-R. The same model was found for the BTB scans. For all methods volumes reduces with the severity of disease. Significant fixed effects for the regional Jaccard index data were M, R and the interaction M-R. For all methods the middle region was most reproducible, independent of diagnostic group. FSL-FIRST was most and FreeSurfer least reproducible. DISCUSSION/CONCLUSION: A novel method to perform detailed analysis of subtle differences in hippocampus segmentation is proposed. The method showed that hippocampal segmentation reproducibility was best for FSL-FIRST and worst for Freesurfer. We also found systematic regional differences in hippocampal segmentation between different methods reinforcing the need of adopting harmonized protocols.