Accuracy of Dose-Saving Artificial-Intelligence-Based 3D Angiography (3DA) for Grading of Intracranial Artery Stenoses: Preliminary Findings.

BACKGROUND AND PURPOSE: Based on artificial intelligence (AI), 3D angiography (3DA) is a novel postprocessing algorithm for "DSA-like" 3D imaging of cerebral vasculature. Because 3DA requires neither mask runs nor digital subtraction as the current standard 3D-DSA does, it has the potential to cut the patient dose by 50%. The object was to evaluate 3DA's diagnostic value for visualization of intracranial artery stenoses (IAS) compared to 3D-DSA. MATERIALS AND METHODS: 3D-DSA datasets of IAS (nIAS = 10) were postprocessed using conventional and prototype software (Siemens Healthineers AG, Erlangen, Germany). Matching reconstructions were assessed by two experienced neuroradiologists in consensus reading, considering image quality (IQ), vessel diameters (VD1/2), vessel-geometry index (VGI = VD1/VD2), and specific qualitative/quantitative parameters of IAS (e.g., location, visual IAS grading [low-/medium-/high-grade] and intra-/poststenotic diameters [dintra-/poststenotic in mm]). Using the NASCET criteria, the percentual degree of luminal restriction was calculated. RESULTS: In total, 20 angiographic 3D volumes (n3DA = 10; n3D-DSA = 10) were successfully reconstructed with equivalent IQ. Assessment of the vessel geometry in 3DA datasets did not differ significantly from 3D-DSA (VD1: r = 0.994, p = 0.0001; VD2:r = 0.994, p = 0.0001; VGI: r = 0.899, p = 0.0001). Qualitative analysis of IAS location (3DA/3D-DSA:nICA/C4 = 1, nICA/C7 = 1, nMCA/M1 = 4, nVA/V4 = 2, nBA = 2) and the visual IAS grading (3DA/3D-DSA:nlow-grade = 3, nmedium-grade = 5, nhigh-grade = 2) revealed identical results for 3DA and 3D-DSA, respectively. Quantitative IAS assessment showed a strong correlation regarding intra-/poststenotic diameters (rdintrastenotic = 0.995, pdintrastenotic = 0.0001; rdpoststenotic = 0.995, pdpoststenotic = 0.0001) and the percentual degree of luminal restriction (rNASCET 3DA = 0.981; pNASCET 3DA = 0.0001). CONCLUSIONS: The AI-based 3DA is a resilient algorithm for the visualization of IAS and shows comparable results to 3D-DSA. Hence, 3DA is a promising new method that allows a considerable patient-dose reduction, and its clinical implementation would be highly desirable.

Robust learning-based x-ray image denoising-potential pitfalls, their analysis and solutions.

Purpose:Since guidance based on x-ray imaging is an integral part of interventional procedures, continuous efforts are taken towards reducing the exposure of patients and clinical staff to ionizing radiation. Even though a reduction in the x-ray dose may lower associated radiation risks, it is likely to impair the quality of the acquired images, potentially making it more difficult for physicians to carry out their procedures.Method:We present a robust learning-based denoising strategy involving model-based simulations of low-dose x-ray images during the training phase. The method also utilizes a data-driven normalization step-based on an x-ray imaging model-to stabilize the mixed signal-dependent noise associated with x-ray images. We thoroughly analyze the method's sensitivity to a mismatch in dose levels used for training and application. We also study the impact of differing noise models used when training for low and very low-dose x-ray images on the denoising results.Results:A quantitative and qualitative analysis based on acquired phantom and clinical data has shown that the proposed learning-based strategy is stable across different dose levels and yields excellent denoising results, if an accurate noise model is applied. We also found that there can be severe artifacts when the noise characteristics of the training images are significantly different from those in the actual images to be processed. This problem can be especially acute at very low dose levels. During a thorough analysis of our experimental results, we further discovered that viewing the results from the perspective of denoising via thresholding of sub-band coefficients can be very beneficial to get a better understanding of the proposed learning-based denoising strategy.Conclusion:The proposed learning-based denoising strategy provides scope for significant x-ray dose reduction without the loss of important image information if the characteristics of noise is accurately accounted for during the training phase.

Data-driven estimation of noise variance stabilization parameters for low-dose x-ray images.

PURPOSE: Denoising x-ray images corrupted by signal-dependent mixed noise is usually approached either by considering noise statistics directly or by using noise variance stabilization (NVS) techniques. An advantage of the latter is that the noise variance can be stabilized to a known constant throughout the image, facilitating the application of denoising algorithms designed for the removal of additive Gaussian noise. A well-performing NVS is the generalized Anscombe transform (GAT). To calculate the GAT, the system gain as well as the variance of electronic noise are required. Unfortunately, these parameters are difficult to predict from the x-ray tube settings in clinical practice, because the system gain observed at the detector depends on the beam hardening caused by the patient. MATERIALS AND METHODS: We propose a data-driven method for estimating the parameters required to carry out an NVS using the GAT. It utilizes the energy compaction property of the discrete cosine transform to obtain the NVS parameters using a robust regression approach relying on a linear Poisson-Gaussian model. The method has been experimentally validated with respect to beam hardening as well as denoising performance for different dose and scatter levels. RESULTS: Across a range of low-dose x-ray settings, the proposed robust regression approach has estimated both system gain and electronic noise level with an average error of only 4.2%. When used to perform a GAT followed by the denoising of low-dose x-ray images, performance gains of 5% for peak-signal-to-noise ratio and 4% for structural similarity index can be obtained. CONCLUSION: The parameters needed to calculate the GAT can be estimated efficiently and robustly using a data-driven approach. The improved parameter estimation method facilitates a more accurate GAT-based NVS and, hence, better denoising of low-dose x-ray images when algorithms designed for additive Gaussian noise are applied.

Evaluation of an Artificial Intelligence-Based 3D-Angiography for Visualization of Cerebral Vasculature.

PURPOSE: The three-dimensional digital subtraction angiography (3D DSA) technique is the current standard and is based on both mask and fill runs to enable the subtraction technique. Artificial intelligence (AI)-based 3D angiography (3DA) was developed to reduce radiation dosage because only one contrast-enhanced run of the C­arm system is required for reconstruction of DSA-like 3D volumes. The aim was the evaluation of this algorithm regarding its diagnostic information. METHODS: 3D DSA datasets without pathologic findings were reconstructed both with subtraction technique and with the AI-based algorithm. Corresponding reconstructions were evaluated by 2 neuroradiologists with respect to image quality (IQ), visualization of major segments of the circle of Willis (ICA = C4-C7; OphA; ACA = A1-A2, MCA = M1-M2; VA = V4; BA; AICA; SUCA; PCA = P1-P2), identifiability of perforators (lenticulostriate/thalamoperforating arteries) and vessel diameters (ICA = C4; MCA = M1; BA; PCA = P1). RESULTS: In total 15 datasets were successfully reconstructed as 3D DSA and 3DA with diagnostic image quality. All major segments of the circle of Willis and perforators were comparably visualized with 3DA. Quantitative analysis of vessel diameters in 3D DSA and 3DA datasets was equivalent and did not show relevant differences (rICA = 0.901, p = 0.001; rM1 = 0.951, p = 0.001; rBA = 0.906, p = 0.001; rP1 = 0.991, p = 0.001). CONCLUSIONS: The use of 3DA demonstrated reliable visualization of cerebral vasculature with respect to quantitative and qualitative parameters. Therefore, 3DA is a promising method that might help to reduce patient radiation.

Preliminary results of DSA denoising based on a weighted low-rank approach using an advanced neurovascular replication system.

PURPOSE: 2D digital subtraction angiography (DSA) has become an important technique for interventional neuroradiology tasks, such as detection and subsequent treatment of aneurysms. In order to provide high-quality DSA images, usually undiluted contrast agent and a high X-ray dose are used. The iodinated contrast agent puts a burden on the patients' kidneys while the use of high-dose X-rays expose both patients and medical staff to a considerable amount of radiation. Unfortunately, reducing either the X-ray dose or the contrast agent concentration usually results in a sacrifice of image quality. MATERIALS AND METHODS: To denoise a frame, the proposed spatiotemporal denoising method utilizes the low-rank nature of a spatially aligned temporal sequence where variation is introduced by the flow of contrast agent through a vessel tree of interest. That is, a constrained weighted rank-1 approximation of the stack comprising the frame to be denoised and its temporal neighbors is computed where the weights are used to prevent the contribution of non-similar pixels toward the low-rank approximation. The method has been evaluated using a vascular flow phantom emulating cranial arteries into which contrast agent can be manually injected (Vascular Simulations Replicator, Vascular Simulations, Stony Brook NY, USA). For the evaluation, image sequences acquired at different dose levels as well as different contrast agent concentrations have been used. RESULTS: Qualitative and quantitative analyses have shown that with the proposed approach, the dose and the concentration of the contrast agent could both be reduced by about 75%, while maintaining the required image quality. Most importantly, it has been observed that the DSA images obtained using the proposed method have the closest resemblance to typical DSA images, i.e., they preserve the typical image characteristics best. CONCLUSION: Using the proposed denoising approach, it is possible to improve the image quality of low-dose DSA images. This improvement could enable both a reduction in contrast agent and radiation dose when acquiring DSA images, thereby benefiting patients as well as clinicians. Since the resulting images are free from artifacts and as the inherent characteristics of the images are also preserved, the proposed method seems to be well suited for clinical images as well.

An analytical approach for the simulation of realistic low-dose fluoroscopic images.

PURPOSE: The quality of X-ray images plays an important role in computer-assisted interventions. Although learning-based denoising techniques have been shown to be successful in improving the image quality, they often rely on pairs of associated low- and high-dose X-ray images that are usually not possible to acquire at different dose levels in a clinical scenario. Moreover, since data variation is an important requirement for learning-based methods, the use of phantom data alone may not be sufficient. A possibility to address this issue is a realistic simulation of low-dose images from their related high-dose counterparts. METHOD: We introduce a novel noise simulation method based on an X-ray image formation model. The method makes use of the system parameters associated with low- and high-dose X-ray image acquisitions, such as system gain and electronic noise, to preserve the image noise characteristics of low-dose images. RESULTS: We have compared several corresponding regions of the associated real and simulated low-dose images-obtained from two different imaging systems-visually as well as statistically, using a two-sample Kolmogorov-Smirnov test at 5% significance. In addition to being visually similar, the hypothesis that the corresponding regions-from 80 pairs of real and simulated low-dose regions-belonging to the same distribution has been accepted in 81.43% of the cases. CONCLUSION: The results suggest that the simulated low-dose images obtained using the proposed method are almost indistinguishable from real low-dose images. Since extensive calibration procedures required in previous methods can be avoided using the proposed approach, it allows an easy adaptation to different X-ray imaging systems. This in turn leads to an increased diversity of the training data for potential learning-based methods.

A photon recycling approach to the denoising of ultra-low dose X-ray sequences.

PURPOSE: Clinical procedures that make use of fluoroscopy may expose patients as well as the clinical staff (throughout their career) to non-negligible doses of radiation. The potential consequences of such exposures fall under two categories, namely stochastic (mostly cancer) and deterministic risks (skin injury). According to the "as low as reasonably achievable" principle, the radiation dose can be lowered only if the necessary image quality can be maintained. METHODS: Our work improves upon the existing patch-based denoising algorithms by utilizing a more sophisticated noise model to exploit non-local self-similarity better and this in turn improves the performance of low-rank approximation. The novelty of the proposed approach lies in its properly designed and parameterized noise model and the elimination of initial estimates. This reduces the computational cost significantly. RESULTS: The algorithm has been evaluated on 500 clinical images (7 patients, 20 sequences, 3 clinical sites), taken at ultra-low dose levels, i.e. 50% of the standard low dose level, during electrophysiology procedures. An average improvement in the contrast-to-noise ratio (CNR) by a factor of around 3.5 has been found. This is associated with an image quality achieved at around 12 (square of 3.5) times the ultra-low dose level. Qualitative evaluation by X-ray image quality experts suggests that the method produces denoised images that comply with the required image quality criteria. CONCLUSION: The results are consistent with the number of patches used, and they demonstrate that it is possible to use motion estimation techniques and "recycle" photons from previous frames to improve the image quality of the current frame. Our results are comparable in terms of CNR to Video Block Matching 3D-a state-of-the-art denoising method. But qualitative analysis by experts confirms that the denoised ultra-low dose X-ray images obtained using our method are more realistic with respect to appearance.

Magnetic particle imaging in vascular medicine.

Magnetic particle imaging (MPI) is a new medical imaging technique that enables three-dimensional real-time imaging of a magnetic tracer material. Although it is not yet in clinical use, it is highly promising, especially for vascular and interventional imaging. The advantages of MPI are that no ionizing radiation is necessary, its high sensitivity enables the detection of very small amounts of the tracer material, and its high temporal resolution enables real-time imaging, which makes MPI suitable as an interventional imaging technique. As MPI is a tracer-based imaging technique, functional imaging is possible by attaching specific molecules to the tracer material. In the first part of this article, the basic principle of MPI will be explained and a short overview of the principles of the generation and spatial encoding of the tracer signal will be given. After this, the used tracer materials as well as their behavior in MPI will be introduced. A subsequent presentation of selected scanner topologies will show the current state of research and the limitations researchers are facing on the way from preclinical toward human-sized scanners. Furthermore, it will be briefly shown how to reconstruct an image from the tracer materials' signal. In the last part, a variety of possible future clinical applications will be presented with an emphasis on vascular imaging, such as the use of MPI during cardiovascular interventions by visualizing the instruments. Investigations will be discussed, which show the feasibility to quantify the degree of stenosis and diagnose strokes and traumatic brain injuries as well as cerebral or gastrointestinal bleeding with MPI. As MPI is not only suitable for vascular medicine but also offers a broad range of other possible applications, a selection of those will be briefly presented at the end of the article.

Non-Equispaced System Matrix Acquisition for Magnetic Particle Imaging Based on Lissajous Node Points.

Magnetic Particle Imaging (MPI) is an emerging technology in the field of (pre)clinical imaging. The acquisition of a particle signal is realized along specific sampling trajectories covering a defined field of view (FOV). In a system matrix (SM) based reconstruction procedure, the commonly used acquisition path in MPI is a Lissajous trajectory. Such a trajectory features an inhomogeneous coverage of the FOV, i.e. the center region is sampled less dense than the regions towards the edges of the FOV. Conventionally, the respective SM acquisition and the subsequent reconstruction do not reflect this inhomogeneous coverage. Instead, they are performed on an equispaced grid. The objective of this work is to introduce a sampling grid that inherently features the aforementioned inhomogeneity by using node points of Lissajous trajectories. Paired with a tailored polynomial interpolation of the reconstructed MPI signal, the entire image can be recovered. It is the first time that such a trajectory related non-equispaced grid is used for image reconstruction on simulated and measured MPI data and it is shown that the number of sampling positions can be reduced, while the spatial resolution remains constant.

Magnetic particle imaging: current developments and future directions.

Magnetic particle imaging (MPI) is a novel imaging method that was first proposed by Gleich and Weizenecker in 2005. Applying static and dynamic magnetic fields, MPI exploits the unique characteristics of superparamagnetic iron oxide nanoparticles (SPIONs). The SPIONs' response allows a three-dimensional visualization of their distribution in space with a superb contrast, a very high temporal and good spatial resolution. Essentially, it is the SPIONs' superparamagnetic characteristics, the fact that they are magnetically saturable, and the harmonic composition of the SPIONs' response that make MPI possible at all. As SPIONs are the essential element of MPI, the development of customized nanoparticles is pursued with the greatest effort by many groups. Their objective is the creation of a SPION or a conglomerate of particles that will feature a much higher MPI performance than nanoparticles currently available commercially. A particle's MPI performance and suitability is characterized by parameters such as the strength of its MPI signal, its biocompatibility, or its pharmacokinetics. Some of the most important adjuster bolts to tune them are the particles' iron core and hydrodynamic diameter, their anisotropy, the composition of the particles' suspension, and their coating. As a three-dimensional, real-time imaging modality that is free of ionizing radiation, MPI appears ideally suited for applications such as vascular imaging and interventions as well as cellular and targeted imaging. A number of different theories and technical approaches on the way to the actual implementation of the basic concept of MPI have been seen in the last few years. Research groups around the world are working on different scanner geometries, from closed bore systems to single-sided scanners, and use reconstruction methods that are either based on actual calibration measurements or on theoretical models. This review aims at giving an overview of current developments and future directions in MPI about a decade after its first appearance.

Axially elongated field-free point data acquisition in magnetic particle imaging.

The magnetic particle imaging (MPI) technology is a new imaging technique featuring an excellent possibility to detect iron oxide based nanoparticle accumulations in vivo. The excitation of the particles and in turn the signal generation in MPI are achieved by using oscillating magnetic fields. In order to realize a spatial encoding, a field-free point (FFP) is steered through the field of view (FOV). Such a positioning of the FFP can thereby be achieved by mechanical or electromagnetical movement. Conventionally, the data acquisition path is either a planar 2-D or a 3-D FFP trajectory. Assuming human applications, the size of the FOV sampled by such trajectories is strongly limited by heating of the body and by nerve stimulations. In this work, a new approach acquiring MPI data based on the axial elongation of a 2-D FFP trajectory is proposed. It is shown that such an elongation can be used as a data acquisition path to significantly increase the acquisition speed, with negligible loss of spatial resolution.

On the formulation of the image reconstruction problem in magnetic particle imaging.

In magnetic particle imaging (MPI), the spatial distribution of magnetic nanoparticles is determined by applying various static and dynamic magnetic fields. Due to the complex physical behavior of the nanoparticles, it is challenging to determine the MPI system matrix in practice. Since the first publication on MPI in 2005, different methods that rely on measurements or simulations for the determination of the MPI system matrix have been proposed. Some methods restrict the simulation to an idealized model to speed up data reconstruction by exploiting the structure of an idealized MPI system matrix. Recently, a method that processes the measurement data in x-space rather than frequency space has been proposed. In this work, we compare the different approaches for image reconstruction in MPI and show that the x-space and the frequency space reconstruction techniques are equivalent.