Variability of bronchial measurements obtained by sequential CT using two computer-based methods.

This study aimed to evaluate the variability of lumen (LA) and wall area (WA) measurements obtained on two successive MDCT acquisitions using energy-driven contour estimation (EDCE) and full width at half maximum (FWHM) approaches. Both methods were applied to a database of segmental and subsegmental bronchi with LA > 4 mm(2) containing 42 bronchial segments of 10 successive slices that best matched on each acquisition. For both methods, the 95% confidence interval between repeated MDCT was between -1.59 and 1.5 mm(2) for LA, and -3.31 and 2.96 mm(2) for WA. The values of the coefficient of measurement variation (CV(10), i.e., percentage ratio of the standard deviation obtained from the 10 successive slices to their mean value) were strongly correlated between repeated MDCT data acquisitions (r > 0.72; p < 0.0001). Compared with FWHM, LA values obtained using EDCE were higher for LA < 15 mm(2), whereas WA values were lower for bronchi with WA < 13 mm(2); no systematic EDCE underestimation or overestimation was observed for thicker-walled bronchi. In conclusion, variability between CT examinations and assessment techniques may impair measurements. Therefore, new parameters such as CV(10) need to be investigated to study bronchial remodeling. Finally, EDCE and FWHM are not interchangeable in longitudinal studies.

Computed tomography-estimated specific gravity of noncontused brain areas as a marker of severity in human traumatic brain injury.

In this study, we assessed the relationship between brain estimated specific gravity (eSG) and clinical symptoms, therapeutic intensity level, and outcome in human traumatic brain injury (TBI). Brain weight, volume, and eSG of the noncontused hemispheric areas were measured from computed tomography (CT) DICOM images on the initial (5 +/- 6 h) CT of 120 patients with severe TBI. Control values were obtained from 40 healthy patients. The eSG of the noncontused hemispheric areas was significantly higher in TBI patients than in controls. eSG was higher in patients having a Marshall CT classification of 3 or 4 or a low initial Glasgow coma score. Two groups were defined according to the eSG of the noncontused hemispheric areas: less than (n = 83, 69%) or more than (n = 37, 31%) the threshold of normality (defined as 1.96 sd above normal = 1.0355 g/mL). The occurrence of mydriasis, use of osmotherapy at the scene of the accident, and therapeutic intensity level were higher in the increased eSG group. The outcome at intensive care unit discharge was worse in patients with an increased eSG although the difference was no longer significant at 1 yr. eSG determination by CT analysis might be relevant in the early management of TBI.

A non-rigid registration approach for quantifying myocardial contraction in tagged MRI using generalized information measures.

We address the problem of quantitatively assessing myocardial function from tagged MRI sequences. We develop a two-step method comprising (i) a motion estimation step using a novel variational non-rigid registration technique based on generalized information measures, and (ii) a measurement step, yielding local and segmental deformation parameters over the whole myocardium. Experiments on healthy and pathological data demonstrate that this method delivers, within a reasonable computation time and in a fully unsupervised way, reliable measurements for normal subjects and quantitative pathology-specific information. Beyond cardiac MRI, this work redefines the foundations of variational non-rigid registration for information-theoretic similarity criteria with potential interest in multimodal medical imaging.

Airflow modeling of steady inspiration in two realistic proximal airway trees reconstructed from human thoracic tomodensitometric images.

Detailed description of the flow field in human airways is highly important to better understand human breathing and provide a patient's customized diagnosis. An integrated numerical simulation platform is presently proposed in order to incorporate medical images into a numerical software to calculate flow field and to analyze it in terms of fluid dynamics. The platform was set up to compute steady inspiratory airflow in realistic human airways reconstructed from tomodensitometric medical images at resting breathing conditions. This morpho-functional simulation platform has been tested retrospectively with two CT-scanned patient airway morphological models: (i) a normal airway model (subject A) with no evidence of morphological alteration and (ii) a highly altered airway model (subject B) exhibiting a severe stenosis in the right main bronchus. First, various morphological aspects proper to each airway model are provided to show the performance and interest of the reconstruction method. Second, we describe the three-dimensional flow patterns associated to the global morphological features, which are mainly shared by the present realistic models and previous idealistic airway models. Finally, the flow characteristics associated to local morphological features specific to realistic airway models are discussed. The results demonstrate that the morpho-functional simulation platform is able to capture the main features of airway velocity patterns but also more specific airflow patterns which are related to customized patient morphological features such as laminar vortex formation. The present results suggest that the proposed airway functional imaging platform is adequate to provide most of functional information related to airflow and enable a patient to patient diagnosis.

Pulmonary airways: 3-D reconstruction from multislice CT and clinical investigation.

In the framework of computer-aided diagnosis, this paper proposes a novel functionality for the computerized tomography (CT)-based investigation of the pulmonary airways. It relies on an energy-based three-dimensional (3-D) reconstruction of the bronchial tree from multislice CT acquisitions, up to the sixth- to seventh-order subdivisions. Global and local analysis of the reconstructed airways is possible by means of specific visualization modalities, respectively, the CT bronchography and the virtual bronchoscopy. The originality of the 3-D reconstruction approach consists in combining axial and radial propagation potentials to control the growth of a subset of low-order airways extracted from the CT volume by means of a robust mathematical morphology operator-the selective marking and depth constrained (SMDC) connection cost. The proposed approach proved to be robust with respect to a large spectrum of airway pathologies, including even severe stenosis (bronchial lumen obstruction/collapse). Validated by expert radiologists, examples of airway 3-D reconstructions are presented and discussed for both normal and pathological cases. They highlight the interest in considering CT bronchography and virtual bronchoscopy as complementary tools for clinical diagnosis and follow-up of airway diseases.

Volumetric quantification of airway wall in CT via collision-free active surface model: application to asthma assessment.

Emerging idea in asthma phenotyping, incorporating local morphometric information on the airway wall thickness would be able to better account for the process of airway remodeling as indicator of pathology or therapeutic impact. It is thus important that such information be provided uniformly along the airway tree, not on a sparse (cross-section) sampling basis. The volumetric segmentation of the airway wall from CT data is the issue addressed in this paper by exploiting a patient-specific surface active model. An original aspect taken into account in the proposed deformable model is the management of auto-collisions for this complex morphology. The analysis of several solutions ended up with the design of a motion vector field specific to the patient geometry to guide the deformation. The segmentation result, presented as two embedded inner/outer surfaces of the wall, allows the quantification of the tissue thickness based on a locally-defined measure sensitive to even small surface irregularities. The method is validated with respect to several ground truth simulations of pulmonary CT data with different airway geometries and acquisition protocols showing accuracy within the CT resolution range. Results from an ongoing clinical study on moderate and severe asthma are presented and discussed.

Multi-feature statistical nonrigid registration using high-dimensional generalized information measures.

Nonrigid image registration methods based on the optimization of information-theoretic measures provide versatile solutions for robustly aligning mono-modal data with nonlinear variations and multi-modal data in radiology. Whereas mutual information and its variations arise as a first choice, generalized information measures offer relevant alternatives in specific clinical contexts, Their usual application setting is the alignement of image pairs by statistically matching scalar random variables (generally, greylevel distributions), handled via their probability densities. In this paper, we address the issue of estimating and optimizing generalized information measures over high-dimensional state spaces to derive multi-feature statistical nonrigid registration models. Specifically, we introduce novel consistent and asymptotically unbiaised kappa nearest neighbors estimators of alpha-informations, and study their variational optimization over finite and infinite dimensional smooth transform spaces. The resulting theoretical framework provides a well-posed and computationally efficient alternative to entropic graph techniques. Its performances are assessed on two cardiological applications: measuring myocardial deformations in tagged MRI, and compensating cardio-thoracic motions in perfusion MRI.

Spatio-temporal registration of cardiac perfusion MRI exams using high-dimensional mutual information.

Compensating for cardio-thoracic motion artifacts in contrast-enhanced cardiac perfusion MRI (p-MRI) sequences is a key issue for the quantitative assessment of myocardial iscæmia. The classical paradigm consists of registering each sequence frame on some reference using an intensity-based matching criterion. In this paper, we present a novel unsupervised method for the groupwise registration of cardiac p-MRI exams based on mutual information between high-dimensional feature distributions. Specifically, local contrast enhancement curves are used as a dense set of spatio-temporal features, and statistically matched to a target feature distribution derived from a registered reference template. Using consistent kth nearest neighbors entropy estimators further enables the variational optimization of the model over finite- and infinite-dimensional transform spaces. Experiments on simulated and natural datasets demonstrate its accuracy and relevance for the reliable assessment of regional perfusion.

Investigation of airways using MDCT for visual and quantitative assessment in COPD patients.

Multidetector computed tomography (MDCT) acquisition during a single breath hold using thin collimation provides high resolution volumetric data set permitting multiplanar and three dimensional reconstruction of the proximal airways. In chronic obstructive pulmonary disease (COPD) patients, this technique provides an accurate assessment of bronchial wall thickening, tracheobronchial deformation, outpouchings reflecting dilatation of the submucous glands, tracheobronchomalacia, and expiratory air trapping. New software developed to segment adequately the lumen and walls of the airways on MDCT scans allows quantitative assessment of the airway dimensions which has shown to be reliable in clinical practice. This technique can become important in longitudinal studies of the pathogenesis of COPD, and in the assessment of therapeutic interventions.

Diffuse parenchymal lung diseases: 3D automated detection in MDCT.

Characterization and quantification of diffuse parenchymal lung disease (DPLD) severity using MDCT, mainly in interstitial lung diseases and emphysema, is an important issue in clinical research for the evaluation of new therapies. This paper develops a 3D automated approach for detection and diagnosis of DPLDs (emphysema, fibrosis, honeycombing, ground glass). The proposed methodology combines multi-resolution image decomposition based on 3D morphological filtering, and graph-based classification for a full characterization of the parenchymal tissue. The very promising results obtained on a small patient database are good premises for a near implementation and validation of the proposed approach in clinical routine.

Assessment of airway remodeling in asthma: volumetric versus surface quantification approaches.

This paper develops a volumetric quantification approach of the airway wall in multi-detector computed tomography (MDCT), exploiting a 3D segmentation methodology based on patient-specific deformable mesh model. A comparative study carried out with respect to a reference 2D/3D surface quantification technique underlines the clinical interest of the proposed approach in assessing airway remodeling in asthmatics and in evaluating the efficiency of therapeutic protocols.

Opposed effects of hypertonic saline on contusions and noncontused brain tissue in patients with severe traumatic brain injury.

OBJECTIVE: The aim of this study was to quantify the effect of hypertonic saline solution on contused and noncontused brain tissue in patients with traumatic brain injury. We hypothesize that hypertonic saline would increase the volume of brain contusion while decreasing the volume of noncontused hemispheric areas. DESIGN: Prospective observational study. SETTING: Neurosciences critical care unit of a university hospital. PATIENTS: Fourteen traumatic brain injury patients with increased intracranial pressure. INTERVENTIONS: A computed tomography scan was performed before and after a 20-min infusion of 40 mL of 20% saline. MEASUREMENTS AND MAIN RESULTS: The volume, weight, and specific gravity of contused and noncontused hemispheric areas were assessed from computed tomography DICOM images by using a custom-designed software (BrainView). Physiologic variables and natremia were measured before and after infusion. Hypertonic saline significantly increased natremia from 143 +/- 5 to 146 +/- 5 mmol/L and decreased intracranial pressure from 23 +/- 3 to 17 +/- 5 mm Hg. The volume of the noncontused hemispheric areas decreased by 13 +/- 8 mL whereas the specific gravity increased by 0.029 +/- 0.027%. The volume of contused hemispheric tissue increased by 5 +/- 5 mL without any con-comitant change in density. There was a wide interindividual variability in the response of the noncontused hemispheric tissue with changes in specific gravity varying between -0.0124% and 0.0998%. CONCLUSIONS: Three days after traumatic brain injury, the blood- brain barrier remains semipermeable in noncontused areas but not in contusions. Further studies are needed to tailor the use of hypertonic saline in patients with traumatic brain injury according to the volume of contusions assessed on computed tomography.

CT hepatic venography: 3D vascular segmentation for preoperative evaluation.

Preventing complications during hepatic surgery in living-donor transplantation or in oncologic resections requires a careful preoperative analysis of the hepatic venous anatomy. Such an analysis relies on CT hepatic venography data, which enhances the vascular structure due to contrast medium injection. However, a 3D investigation of the enhanced vascular anatomy based on typical computer vision tools is ineffective because of the large amount of occlusive opacities to be removed. This paper proposes an automated 3D approach for the segmentation of the vascular structure in CT hepatic venography, providing the appropriate tools for such an investigation. The developed methodology relies on advanced topological and morphological operators applied in mono- and multiresolution filtering schemes. It allows to discriminate the opacified vessels from the bone structures and liver parenchyma regardless of noise presence or inter-patient variability in contrast medium dispersion. The proposed approach was demonstrated at different phases of hepatic perfusion and is currently under extensive validation in clinical routine.

Quantification of myocardial function using tagged MR and cine MR images.

Magnetic Resonance Imaging (MRI) is recognized as a relevant modality for dynamically imaging the heart anatomy and function, and achieving satisfying qualitative diagnosis. Reliable methods for quantitatively analyzing cardiac motion from MR images remain, however, to be elaborated. This paper presents a novel approach for measuring myocardial deformations from tagged MRI sequences. Based on efficient pixel-based statistical non-rigid registration, it allows for automatically extracting local/global deformation parameters at the pixel and myocardial segment scales. Its performances for assessing the myocardial function are illustrated both for the normal heart and for pathologies of the ischemic and dilated cardiomyopathic type.

New frontiers in CT imaging of airway disease.

Combining helical volumetric CT acquisition and thin-slice thickness during breath hold provides an accurate assessment of both focal and diffuse airway diseases. With multiple detector rows, compared with single-slice helical CT, multislice CT can cover a greater volume, during a simple breath hold, and with better longitudinal and in-plane spatial resolution and improved temporal resolution. The result in data set allows the generation of superior multiplanar and 3D images of the airways, including those obtained from techniques developed specifically for airway imaging, such as virtual bronchography and virtual bronchoscopy. Complementary CT evaluation at suspended or continuous full expiration is mandatory to detect air trapping that is a key finding for depicting an obstruction on the small airways. Indications for CT evaluation of the airways include: (a) detection of endobronchial lesions in patients with an unexplained hemoptysis; (b) evaluation of extent of tracheobronchial stenosis for planning treatment and follow-up; (c) detection of congenital airway anomalies revealed by hemoptysis or recurrent infection; (d) detection of postinfectious or postoperative airway fistula or dehiscence; and (e) diagnosis and assessment of extent of bronchiectasis and small airway disease. Improvement in image analysis technique and the use of spirometrically control of lung volume acquisition have made possible accurate and reproducible quantitative assessment of airway wall and lumen areas and lung density. This contributes to better insights in physiopathology of obstructive lung disease, particularly in chronic obstructive pulmonary disease and asthma.