Applicability Evaluation of Full-Reference Image Quality Assessment Methods for Computed Tomography Images.

Image quality assessments (IQA) are an important task for providing appropriate medical care. Full-reference IQA (FR-IQA) methods, such as peak signal-to-noise ratio (PSNR) and structural similarity (SSIM), are often used to evaluate imaging conditions, reconstruction conditions, and image processing algorithms, including noise reduction and super-resolution technology. However, these IQA methods may be inapplicable for medical images because they were designed for natural images. Therefore, this study aimed to investigate the correlation between objective assessment by some FR-IQA methods and human subjective assessment for computed tomography (CT) images. For evaluation, 210 distorted images were created from six original images using two types of degradation: noise and blur. We employed nine widely used FR-IQA methods for natural images: PSNR, SSIM, feature similarity (FSIM), information fidelity criterion (IFC), visual information fidelity (VIF), noise quality measure (NQM), visual signal-to-noise ratio (VSNR), multi-scale SSIM (MSSSIM), and information content-weighted SSIM (IWSSIM). Six observers performed subjective assessments using the double stimulus continuous quality scale (DSCQS) method. The performance of IQA methods was quantified using Pearson's linear correlation coefficient (PLCC), Spearman rank order correlation coefficient (SROCC), and root-mean-square error (RMSE). Nine FR-IQA methods developed for natural images were all strongly correlated with the subjective assessment (PLCC and SROCC > 0.8), indicating that these methods can apply to CT images. Particularly, VIF had the best values for all three items, PLCC, SROCC, and RMSE. These results suggest that VIF provides the most accurate alternative measure to subjective assessments for CT images.

[A case of abscess-associated hepatocellular carcinoma with massive lymphoid cell infiltration].

A 76-year-old Japanese man was admitted to our hospital with chills and fever. Computed tomography revealed a 10-cm cystic tumor with peripheral ring enhancement in the left lobe of the liver and several small low-density areas with early peripheral enhancement in both lobes. The large liver mass was diagnosed as a pyogenic abscess and treated with antibiotics. However, elevation of the tumor marker, PIVKA-II, raised the possibility of hepatocellular carcinoma. A fine-needle aspiration biopsy was performed, and malignant hepatic cells were identified. The patient underwent left hepatectomy. Histological analyses of the resected surgical specimen confirmed necrotic liver abscess and residual hepatocellular carcinoma with massive lymphoid cell infiltration. Immunohistochemical analyses revealed that the lymphoid cells were positive for CD3 and CD8. The PIVKA-II level returned to normal after surgery and the hepatic lesions disappeared within 10 months. These findings suggest that the liver abscess stimulated cancer immunity, resulting in the proliferation of cytotoxic T lymphocytes and, subsequently, tumor regression.

Risk factors for late recurrence and postrelapse survival in estrogen receptor (ER)-positive, human epidermal growth factor receptor (HER) 2-negative breast cancer after 5 years of endocrine therapy.

It is unclear which patients with ER-positive, HER2-negative breast cancer benefit from extended endocrine therapy beyond 5 years. Prognostic factors for late-recurring breast cancer postrelapse survival have been reported. We retrospectively analyzed data from 892 patients with ER-positive and HER2-negative invasive breast cancer who were disease-free after completing a 5-year adjuvant endocrine therapy. Patients were then classified as high-risk (positive lymph nodes, large tumor size, high tumor grade) or low-risk. High-risk patients were divided into extended endocrine therapy and stop groups. Comparisons were made using propensity score matching, and the benefits of extended endocrine therapy for high-risk patients and prognostic factors for postrelapse survival were assessed. The high- and low-risk groups comprised 444 and 448 patients, respectively. The 10-year distant disease-free survival (DDFS) rates were 96.3 % (95 % confidence interval [CI] 0.912-0.985) and 86.5 % (95 % CI 0.798-0911) in the extended and stop groups, respectively (P = 0.00382). Cox proportional hazards model revealed that extended endocrine therapy promoted greater reduction in distant metastasis risk than 5-year endocrine therapy in high-risk populations (hazard ratio [HR] 0.27; 95 % CI 0.11-0.68; P = 0.0054). Postrelapse survival was significantly different in patients with DDFS ≥7 years (HR 0.24; 95 % CI 0.072-0.81; P = 0.021) and those with better response to first-line treatment (HR 0.072; 95 % CI, 0.058-0.90; P = 0.041). Patients with risk factors for late recurrence should be considered for extended endocrine therapy. Longer DDFS and response to first-line treatment may be a prognostic factor for postrelapse survival after late recurrence.

Spatial resolution and noise in organic light-emitting diode displays for medical imaging applications.

We report on the resolution and noise characteristics of handheld and workstation organic light-emitting diode (OLED) displays in comparison with liquid crystal displays (LCDs). The results demonstrate advantages, in terms of sharpness, of handheld OLED displays with modulation transfer function (MTF) values exceeding 0.60 at the Nyquist frequencies. The OLED workstation included in this study exhibits significant signal contamination among adjacent pixels resulting in degraded resolution performance indicated by horizontal and vertical MTF values of 0.13 and 0.24 at the Nyquist frequency. On the other hand, its noise characteristics are superior to the LCD workstation tested. While the noise power spectral (NPS) values of the OLED workstation are 8.0×10(-6) mm2 at 1 mm(-1), the LCD workstation has NPS values of 2.6×10(-5) mm2. Although phone-size OLED displays have superior resolution and noise per pixel, the perceived resolution characteristics at appropriate viewing distances are inferior to tablet-size and workstation LCDs. In addition, our results show some degree of dependency of the resolution and noise on luminance level and viewing orientation. We also found a slightly degraded resolution and increased low-frequency noise at off-normal orientations in the handheld displays.

Investigation of physical image characteristics and phenomenon of edge enhancement by phase contrast using equipment typical for mammography.

A technique called phase contrast mammography (PCM) has only recently been applied in clinical examination. In this application, PCM images are acquired at a 1.75 x magnification using an x-ray tube for clinical use, and then reduced to the real size of the object by image processing. The images showed enhanced object edges; reportedly, this enhancement occurred because of the refraction of x rays through a cylindrical object. The authors measured the physical image characteristics of PCM to compare the image characteristics of PCM with those of conventional mammography. More specifically, they measured the object-edge-response characteristics and the noise characteristics in the spatial frequency domain. The results revealed that the edge-response characteristics of PCM outperformed those of conventional mammography. In addition, the characteristics changed with the object-placement conditions and the object shapes. The noise characteristics of PCM were better than those of conventional mammography. Subsequently, to verify why object edges were enhanced in PCM images, the authors simulated image profiles that would be obtained if the x rays were refracted and totally reflected by using not only a cylindrical substance but also a planar substance as the object. So, they confirmed that the object edges in PCM images were enhanced because x rays were refracted irrespective of the object shapes. Further, they found that the edge enhancements depended on the object shapes and positions. It was also proposed that the larger magnification than 1.75 in the commercialized system might be more suitable for PCM. Finally, the authors investigated phase-contrast effects to breast tissues by the simulation and demonstrated that PCM would be helpful in the diagnoses of mammography.

Overall noise characteristics of reduced images on liquid crystal display and advantages of independent subpixel driving technology.

PURPOSE: During soft-copy diagnoses, medical images with a large number of matrices often need to display reduced images on liquid crystal displays (LCDs) because of the spatial resolution limitation of LCDs. A new technology, known as independent subpixel driving (ISD), was recently applied to clinical uses aiming to improve the spatial resolution. The authors' study demonstrates the overall noise characteristics of images displayed on a LCD at various display magnifications, with and without ISD application. METHODS: Measurements of the overall noise power spectra (NPS) of x-ray images displayed on LCD were performed at varying display magnifications, with and without ISD. The NPS of displayed images in several display situations were also simulated based on hypothetical noise factors. RESULTS: The measured and simulated NPS showed that noise characteristics worsened when the display magnification was reduced, due to aliasing errors. The overall noise characteristics were attributed to luminance-value fluctuation converted from pixel values, image-interpolation effects, inherent noise, and blurring of the LCD. ISD improved the noise characteristics because it suppressed noise increments by aliasing errors. CONCLUSIONS: ISD affected the noise-characteristic advantages of reduced images displayed on LCDs, particularly at low frequencies.

Image quality characteristics of handheld display devices for medical imaging.

Handheld devices such as mobile phones and tablet computers have become widespread with thousands of available software applications. Recently, handhelds are being proposed as part of medical imaging solutions, especially in emergency medicine, where immediate consultation is required. However, handheld devices differ significantly from medical workstation displays in terms of display characteristics. Moreover, the characteristics vary significantly among device types. We investigate the image quality characteristics of various handheld devices with respect to luminance response, spatial resolution, spatial noise, and reflectance. We show that the luminance characteristics of the handheld displays are different from those of workstation displays complying with grayscale standard target response suggesting that luminance calibration might be needed. Our results also demonstrate that the spatial characteristics of handhelds can surpass those of medical workstation displays particularly for recent generation devices. While a 5 mega-pixel monochrome workstation display has horizontal and vertical modulation transfer factors of 0.52 and 0.47 at the Nyquist frequency, the handheld displays released after 2011 can have values higher than 0.63 at the respective Nyquist frequencies. The noise power spectra for workstation displays are higher than 1.2 × 10(-5) mm(2) at 1 mm(-1), while handheld displays have values lower than 3.7 × 10(-6) mm(2). Reflectance measurements on some of the handheld displays are consistent with measurements for workstation displays with, in some cases, low specular and diffuse reflectance coefficients. The variability of the characterization results among devices due to the different technological features indicates that image quality varies greatly among handheld display devices.