Development of an algorithm to automatically compress a CT image to visually lossless threshold.

BACKGROUND: To develop an algorithm to predict the visually lossless thresholds (VLTs) of CT images solely using the original images by exploiting the image features and DICOM header information for JPEG2000 compression and to evaluate the algorithm in comparison with pre-existing image fidelity metrics. METHODS: Five radiologists independently determined the VLT for 206 body CT images for JPEG2000 compression using QUEST procedure. The images were divided into training (n = 103) and testing (n = 103) sets. Using the training set, a multiple linear regression (MLR) model was constructed regarding the image features and DICOM header information as independent variables and regarding the VLTs determined with median value of the radiologists' responses (VLTrad) as dependent variable, after determining an optimal subset of independent variables by backward stepwise selection in a cross-validation scheme. The performance was evaluated on the testing set by measuring absolute differences and intra-class correlation (ICC) coefficient between the VLTrad and the VLTs predicted by the model (VLTmodel). The performance of the model was also compared two metrics, peak signal-to-noise ratio (PSNR) and high-dynamic range visual difference predictor (HDRVDP). The time for computing VLTs between MLR model, PSNR, and HDRVDP were compared using the repeated ANOVA with a post-hoc analysis. P < 0.05 was considered to indicate a statistically significant difference. RESULTS: The means of absolute differences with the VLTrad were 0.58 (95% CI, 0.48, 0.67), 0.73 (0.61, 0.85), and 0.68 (0.58, 0.79), for the MLR model, PSNR, and HDRVDP, respectively, showing significant difference between them (p < 0.01). The ICC coefficients of MLR model, PSNR, and HDRVDP were 0.88 (95% CI, 0.81, 0.95), 0.85 (0.79, 0.91), and 0.84 (0.77, 0.91). The computing times for calculating VLT per image were 1.5 ± 0.1 s, 3.9 ± 0.3 s, and 68.2 ± 1.4 s, for MLR metric, PSNR, and HDRVDP, respectively. CONCLUSIONS: The proposed MLR model directly predicting the VLT of a given CT image showed competitive performance to those of image fidelity metrics with less computational expenses. The model would be promising to be used for adaptive compression of CT images.

Evaluation of the robustness of the preprocessing technique improving reversible compressibility of CT images: tested on various CT examinations.

PURPOSE: To modify the preprocessing technique, which was previously proposed, improving compressibility of computed tomography (CT) images to cover the diversity of three dimensional configurations of different body parts and to evaluate the robustness of the technique in terms of segmentation correctness and increase in reversible compression ratio (CR) for various CT examinations. METHODS: This study had institutional review board approval with waiver of informed patient consent. A preprocessing technique was previously proposed to improve the compressibility of CT images by replacing pixel values outside the body region with a constant value resulting in maximizing data redundancy. Since the technique was developed aiming at only chest CT images, the authors modified the segmentation method to cover the diversity of three dimensional configurations of different body parts. The modified version was evaluated as follows. In randomly selected 368 CT examinations (352,787 images), each image was preprocessed by using the modified preprocessing technique. Radiologists visually confirmed whether the segmented region covers the body region or not. The images with and without the preprocessing were reversibly compressed using Joint Photographic Experts Group (JPEG), JPEG2000 two-dimensional (2D), and JPEG2000 three-dimensional (3D) compressions. The percentage increase in CR per examination (CRI) was measured. RESULTS: The rate of correct segmentation was 100.0% (95% CI: 99.9%, 100.0%) for all the examinations. The median of CRI were 26.1% (95% CI: 24.9%, 27.1%), 40.2% (38.5%, 41.1%), and 34.5% (32.7%, 36.2%) in JPEG, JPEG2000 2D, and JPEG2000 3D, respectively. CONCLUSIONS: In various CT examinations, the modified preprocessing technique can increase in the CR by 25% or more without concerning about degradation of diagnostic information.

The prevalence and characteristics of coronary atherosclerosis in asymptomatic subjects classified as low risk based on traditional risk stratification algorithm: assessment with coronary CT angiography.

OBJECTIVE: To evaluate the prevalence and characteristics of coronary atherosclerosis in asymptomatic subjects classified as low risk by National Cholesterol Education Program (NCEP) guideline using coronary CT angiography (CCTA). DESIGN: An observational study. SETTING: A single tertiary referral centre. PATIENTS: 2133 (49.2%) subjects, who were classified as low risk by the NCEP guideline, of 4339 consecutive middle-aged asymptomatic subjects who underwent CCTA with 64-slice scanners as part of a general health evaluation. MAIN OUTCOME MEASURES: The incidence of atherosclerosis plaques, significant stenosis. RESULTS: In the subjects at low risk, 11.4% (243 of 2133) of subjects had atherosclerosis plaques, 1.3% (28 of 2133) of subjects had significant stenosis, and 0.8% (18 of 2133) of subjects had significant stenosis caused by non-calcified plaque (NCP). Especially, 75.0% (21 of 28) of subjects with significant stenosis and 94.4% (17 of 18) of subjects with significant stenosis caused by NCP were young adults. Mid-term follow-up (29.3 ± 14.9 months) revealed four subjects with cardiac events: three subjects with unstable angina requiring hospital stay and one subject with percutaneous coronary intervention. CONCLUSIONS: Although an asymptomatic population classified as low risk by the NCEP guideline has been regarded as a minimal risk group, the prevalence of atherosclerosis plaques and significant stenosis were not negligible. However, considering very low event rate for those patients, CCTA should not be performed in low-risk asymptomatic subjects, although CCTA might have the potential for identification of high-risk groups in the selected subjects regarded as a minimal-risk group by NCEP guideline.

Asymptomatic subjects with zero coronary calcium score: coronary CT angiographic features of plaques in event-prone patients.

The aims of this study were: (a) to assess clinical predictors and coronary computed tomography angiography (CCTA) characteristics of noncalcified coronary plaques (NCP) in subjects who had cardiac events despite a zero coronary artery calcium score (CACS), and (b) to describe computed tomography (CT) plaque characteristics in subjects with cardiac events. A total of 7,961 subjects with zero CACS were evaluated; 6,531 subjects underwent CCTA as part of a health check-up. Those who had zero CACS were included in our mid-term follow-up study. Cardiac events included cardiac death, acute coronary syndrome or revascularization with stable angina. More than one NCP was identified in 441 subjects with zero CACS, including 48 subjects with obstructive coronary artery disease (CAD) caused by NCPs. Age, male gender, hypertension, diabetes and low density lipoprotein were independent predictors of obstructive CAD. Among subjects with obstructive CAD, young adults were classified into low (79.2 %) or moderate (72.9 %) risk groups by the National Centers for Environmental Prediction III guidelines. Approximately 0.2 % of subjects had cardiac events during our follow-up period. All patients with cardiac events had NCPs with significantly lower mean CT numbers, higher remodeling indexes and worse degree of stenosis. In asymptomatic subjects with zero CACS, NCP was associated with cardiac events. CCTA might be useful for risk stratification among select populations with CAD and zero CACS who have certain plaque characteristics associated with cardiac events.

Use of image features in predicting visually lossless thresholds of JPEG2000 compressed body CT images: initial trial.

PURPOSE: To test the image features that may be useful in predicting the visually lossless thresholds (VLTs) of body computed tomographic (CT) images for Joint Photographic Experts Group 2000 (JPEG2000) compression. MATERIALS AND METHODS: The institutional review board approved this study, with a waiver of informed patient consent. One hundred body CT studies obtained in different patients by using five scanning protocols were obtained, and 100 images, each of which was selected from each of the 100 studies, were collected. Five radiologists independently determined the VLT of each image for JPEG2000 compression by using the QUEST algorithm. The 100 images were randomly divided into two data sets-the training set (50 images) and the testing set (50 images)-and the division was repeated 200 times. For each of the 200 divisions, a multiple linear regression model was constructed on a training set and tested on a testing set regarding each of five image features-standard deviation of image intensity, image entropy, relative percentage of low-frequency (LF) energy, variation in high-frequency (HF) energy, and visual complexity-as independent variables and considering the VLTs determined with the median value of the radiologists' responses as a dependent variable. The root mean square residual and intraclass correlation coefficient (ICC) for the 200 divisions between the VLTs predicted by the models and those determined by radiologists were compared between the models by using repeated-measures analysis of variance with post-hoc comparisons. RESULTS: Mean root-mean-square residuals for multiple linear regression models constructed with variation in HF energy (1.20 ± 0.10 [standard deviation]) and visual complexity (1.09 ± 0.07) were significantly lower than those for standard deviation of image intensity (1.65 ± 0.13), image entropy (1.63 ± 0.14), and relative percentage of LF energy (1.58 ± 0.12) (P < .01). ICCs for variation in HF energy (0.64 ± 0.05) and visual complexity (0.71 ± 0.04) were significantly higher than those for standard deviation of image intensity (0.04 ± 0.02), image entropy (0.05 ± 0.02), and relative percentage of LF energy (0.20 ± 0.04) (P < .01). CONCLUSION: Among the five tested image features, variation in HF energy and visual complexity were the most promising in predicting the VLTs of body CT images for JPEG2000 compression.

Relationship between amount of cigarette smoking and coronary atherosclerosis on coronary CTA in asymptomatic individuals.

Current smoking is a powerful independent predictor of coronary atherosclerosis in asymptomatic individuals. Many researchers have suggested a cigarette dose-response relationship between smoking and subclinical coronary atherosclerosis. Our study purposes were (a) to investigate the prevalence and plaque characteristics of coronary atherosclerosis in asymptomatic smokers and (b) to assess the cigarette dose-response relationship between smoking and subclinical coronary atherosclerosis using coronary CT angiography (CTA). We consecutively enrolled 7,104 self-referred asymptomatic subjects who underwent coronary CTA as part of a general health evaluation. Current smokers (n = 1,784) were categorized according to total pack years (TPY) with four grades (A, 0.1-10; B, 10-20; C, 20-30; D, >30), smoking duration (SD, years) with four grades (A, 0.1-10; B, 10-20; C, 20-30; D, >30), and number of cigarettes per day (CPD) with four grades (A, 1-20; B, 10-20; C, 20-40; D, >40). After adjusting for other cardiovascular risk factors, adjusted odds ratios for current smokers versus never-smokers as a control group were estimated for the presence of plaques, significant stenosis, and non-calcified plaques (NCP). Current smokers had a statistically significant higher prevalence of any plaque, significant stenosis, NCP, and coronary artery calcium score >100 than never-smokers. According to each categorization of TPY, SD, and CPD, the subclinical coronary atherosclerosis risk increased as grades increased in asymptomatic current smokers relative to never-smokers after adjusting for variable clinical and chemical risk factors. Our study suggests a cigarette dose-response relationship between current smoking and coronary atherosclerosis in asymptomatic individuals.

JPEG2000 compression of CT images used for measuring coronary artery calcification score: assessment of optimal compression threshold.

OBJECTIVE: The purpose of our study was to assess the acceptable compression threshold for JPEG2000 compression of CT images used for measuring coronary artery calcification scores (CACS) in terms of variability. MATERIALS AND METHODS: In a retrospective review, 80 patients who had undergone CT for determination of the CACS were compiled in four subsets (20 scans each) according to CACS: 0, subset A; > 0 to ≥ 100, subset B; > 100 to ≤ 400, subset C; and > 400, subset D. Each scan was compressed using eight compression ratios (CRs). We measured the CACS on all 720 CT scans (80 original and 640 compressed scans). For each compressed scan, the variability in CACS was evaluated by comparing with the CACS of the corresponding original CT scan. RESULTS: For each subset and each CR, we determined whether the upper limit of the one-sided 95% CI of the variability in CACS exceeded 5%. The variability in CACS tended to increase as the CR increased and tended to decrease in the order of increasing CACSs at each CR (i.e., subset B > subset C > subset D). With 5% as the limit of variability, acceptable compression CRs were between 20:1 and 25:1 for subset B; between 40:1 and 60:1 for subset C; and > 100:1 for subset D. CONCLUSION: A level of 20:1 could be a potentially acceptable threshold for JPEG2000 compression of CT images used for measuring CACS, with 5% of the variability in CACS as the acceptable limit of variability.

Predicting the fidelity of JPEG2000 compressed CT images using DICOM header information.

PURPOSE: To propose multiple logistic regression (MLR) and artificial neural network (ANN) models constructed using digital imaging and communications in medicine (DICOM) header information in predicting the fidelity of Joint Photographic Experts Group (JPEG) 2000 compressed abdomen computed tomography (CT) images. METHODS: Our institutional review board approved this study and waived informed patient consent. Using a JPEG2000 algorithm, 360 abdomen CT images were compressed reversibly (n = 48, as negative control) or irreversibly (n = 312) to one of different compression ratios (CRs) ranging from 4:1 to 10:1. Five radiologists independently determined whether the original and compressed images were distinguishable or indistinguishable. The 312 irreversibly compressed images were divided randomly into training (n = 156) and testing (n = 156) sets. The MLR and ANN models were constructed regarding the DICOM header information as independent variables and the pooled radiologists' responses as dependent variable. As independent variables, we selected the CR (DICOM tag number: 0028, 2112), effective tube current-time product (0018, 9332), section thickness (0018, 0050), and field of view (0018, 0090) among the DICOM tags. Using the training set, an optimal subset of independent variables was determined by backward stepwise selection in a four-fold cross-validation scheme. The MLR and ANN models were constructed with the determined independent variables using the training set. The models were then evaluated on the testing set by using receiver-operating-characteristic (ROC) analysis regarding the radiologists' pooled responses as the reference standard and by measuring Spearman rank correlation between the model prediction and the number of radiologists who rated the two images as distinguishable. RESULTS: The CR and section thickness were determined as the optimal independent variables. The areas under the ROC curve for the MLR and ANN predictions were 0.91 (95% CI; 0.86, 0.95) and 0.92 (0.87, 0.96), respectively. The correlation coefficients of the MLR and ANN predictions with the number of radiologists who responded as distinguishable were 0.76 (0.69, 0.82, p < 0.001) and 0.78 (0.71, 0.83, p < 0.001), respectively. CONCLUSIONS: The MLR and ANN models constructed using the DICOM header information offer promise in predicting the fidelity of JPEG2000 compressed abdomen CT images.

Introduction of heat map to fidelity assessment of compressed CT images.

PURPOSE: This study aimed to introduce heat map, a graphical data presentation method widely used in gene expression experiments, to the presentation and interpretation of image fidelity assessment data of compressed computed tomography (CT) images. METHODS: The authors used actual assessment data that consisted of five radiologists' responses to 720 computed tomography images compressed using both Joint Photographic Experts Group 2000 (JPEG2000) 2D and JPEG2000 3D compressions. They additionally created data of two artificial radiologists, which were generated by partly modifying the data from two human radiologists. RESULTS: For each compression, the entire data set, including the variations among radiologists and among images, could be compacted into a small color-coded grid matrix of the heat map. A difference heat map depicted the advantage of 3D compression over 2D compression. Dendrograms showing hierarchical agglomerative clustering results were added to the heat maps to illustrate the similarities in the data patterns among radiologists and among images. The dendrograms were used to identify two artificial radiologists as outliers, whose data were created by partly modifying the responses of two human radiologists. CONCLUSIONS: The heat map can illustrate a quick visual extract of the overall data as well as the entirety of large complex data in a compact space while visualizing the variations among observers and among images. The heat map with the dendrograms can be used to identify outliers or to classify observers and images based on the degree of similarity in the response patterns.

Comparison of three image comparison methods for the visual assessment of the image fidelity of compressed computed tomography images.

PURPOSE: This study aimed to comparatively evaluate three different image comparison methods: alternate display without an intervening blank image (AWOB), alternate display with an intervening blank image (AWB), and side-by-side display (SSD), in terms of the perceptual sensitivity to image differences between Joint Photographic Experts Group 2000 (JPEG2000) compressed body CT images and their originals. METHODS: A total of 50 body CT images obtained with five different scan protocols (5-mm-thick abdomen, 0.67-mm-thick abdomen, 5-mm-thick lung, 0.67-mm-thick lung, and 5-mm-thick low-dose lung) were compressed to one of five compression ratios (reversible, 6:1, 8:1, 10:1, and 15:1) using JPEG2000 algorithm. The fidelity of the compressed images was visually assessed on a four-grade scale independently by five radiologists using each of the three image comparison methods of AWOB, AWB, and SSD. The fidelity grading results for the 40 irreversibly compressed images were compared between the three image comparison methods using the Friedman tests with post hoc Tukey tests. The number of image pairs with no perceptible difference was compared using the exact tests for paired proportions. The time required for the fidelity assessment for all of the 50 compressed images was also compared using the Friedman tests with post hoc Tukey tests. RESULTS: For the 40 irreversibly compressed images, the fidelity grade was significantly lower for AWOB than for AWB or SSD (p < 0.01 for all readers); however, there was no significant difference between AWB and SSD (p-value range, 0.06-0.92). The percentage of image pairs with no perceptible difference tended to be smaller for AWOB than for AWB (p < 0.01 for all readers) or SSD (p < 0.01 for readers 1-3, p = 0.04 for reader 4, and p = 0.23 for reader 5). However, there was no significant difference between AWB and SSD (p-value range, 0.12- >0.99). For all of the 50 compressed images, the fidelity grading time significantly increased in the order of AWOB, SSD, and AWB. CONCLUSIONS: In assessing the image fidelity of JPEG2000 compressed body CT images, AWOB yields lower fidelity grade and requires less fidelity grading time than AWB or SSD, indicating that AWOB is most sensitive to image differences among of them.

JPEG2000 2D and 3D reversible compressions of thin-section chest CT images: improving compressibility by increasing data redundancy outside the body region.

PURPOSE: To propose a preprocessing technique that increases the compressibility in reversible compressions of thin-section chest computed tomographic (CT) images and to measure the increase in compression ratio (CR) in Joint Photographic Experts Group (JPEG) 2000 two-dimensional (2D) and three-dimensional (3D) compressions. MATERIALS AND METHODS: This study had institutional review board approval, with waiver of informed patient consent. A preprocessing technique that automatically segments pixels outside the body region and replaces their values with a constant value to maximize data redundancy was developed. One hundred CT studies (50 standard-radiation dose and 50 low-radiation dose studies) were preprocessed by using the technique and then reversibly compressed by using the JPEG2000 2D and 3D compression methods. The CRs (defined as the original data size divided by the compressed data size) with and those without use of the preprocessing technique were compared by using paired t tests. The percentage increase in the CR was measured. RESULTS: The CR increased significantly (without vs with preprocessing) in JPEG2000 2D (mean CR, 2.40 vs 3.80) and 3D (mean CR, 2.61 vs 3.99) compressions for the standard-dose studies and in JPEG2000 2D (mean CR, 2.38 vs 3.36) and 3D (mean CR, 2.54 vs 3.55) compressions for the low-dose studies (P < .001 for all). The mean percentage increases in CR with preprocessing were 58.2% (95% confidence interval [CI]: 53.1%, 63.4%) and 52.4% (95% CI: 47.5%, 57.2%) in JPEG2000 2D and 3D compressions, respectively, for the standard-dose studies and 41.1% (95% CI: 38.8%, 43.4%) and 39.4% (95% CI: 37.4%, 41.7%) in JPEG2000 2D and 3D compressions, respectively, for the low-dose studies. CONCLUSION: The described preprocessing technique considerably increases CRs for reversible compressions of thin-section chest CT studies.

Does the amount of tagged stool and fluid significantly affect the radiation exposure in low-dose CT colonography performed with an automatic exposure control?

OBJECTIVE: To determine whether the amount of tagged stool and fluid significantly affects the radiation exposure in low-dose screening CT colonography performed with an automatic tube-current modulation technique. METHODS: The study included 311 patients. The tagging agent was barium (n = 271) or iodine (n = 40). Correlation was measured between mean volume CT dose index (CTDI (vol)) and the estimated x-ray attenuation of the tagged stool and fluid (ATT). Multiple linear regression analyses were performed to determine the effect of ATT on CTDI (vol ) and the effect of ATT on image noise while adjusting for other variables including abdominal circumference. RESULTS: CTDI (vol) varied from 0.88 to 2.54 mGy. There was no significant correlation between CTDI (vol) and ATT (p = 0.61). ATT did not significantly affect CTDI (vol) (p = 0.93), while abdominal circumference was the only factor significantly affecting CTDI (vol) (p < 0.001). Image noise ranged from 59.5 to 64.1 HU. The p value for the regression model explaining the noise was 0.38. CONCLUSION: The amount of stool and fluid tagging does not significantly affect radiation exposure.

Advantage in image fidelity and additional computing time of JPEG2000 3D in comparison to JPEG2000 in compressing abdomen CT image datasets of different section thicknesses.

PURPOSE: This study aimed to assess the advantage of the Joint Photographic Experts Group 2000 (JPEG2000) 3D (part 2) over JPEG2000 in compressing abdomen computed tomography (CT) image data sets of different section thicknesses (STs). METHODS: Twenty CT scans were reconstructed with six STs (0.67, 1, 2, 3, 4, and 5 mm) and were then compressed to seven compression ratios (CRs) (reversible, 6:1, 8:1, 10:1, 12:1, 14:1, and 16:1) using JPEG2000 and JPEG2000 3D algorithms. Computing (encoding and decoding) times were measured. The image fidelity of the compressed images was quantitatively measured with two computerized image fidelity metrics, peak signal-to-noise ratio (PSNR) and multiscale structural similarity (MS-SSIM). For 120 selected case-relevant images (20 patients x one image per patient x 6 STs), five radiologists independently compared original and compressed images and assessed the fidelity of the compressed images on a four-grade scale. Wilcoxon signed-rank tests and Friedman tests with post hoc Dunn tests were used for the comparisons between the two compressions and among the six STs, respectively RESULTS: For each combination of the ST and irreversible CR, JPEG2000 3D showed higher image fidelity than JPEG2000 in terms of PSNR (p < 0.0001), MS-SSIM (p < 0.0001), and five radiologists' grading (p-values ranged from <0.0001 to 0.003). At each CR, the advantage of JPEG2000 3D in image fidelity, measured as the differences in the two computerized image fidelity metrics (PSNR and MS-SSIM), significantly increased as the ST increased from 0.67 to 2 mm, and then slowly decreased as the ST increased from 2 to 5 mm. Similar trends were observed in visual analyses of 120 selected images by five radiologists. At each CR, the 3D-to-2D encoding-time ratio significantly decreased (p < 0.001) as the ST increased from 0.67 to 2 mm, and then slowly increased (p < 0.001) as the ST increased from 2 to 5 mm. The 3D-to-2D decoding-time ratio at each CR did not show a notable biphasic trend across the ST. CONCLUSIONS: In compressing abdomen CT image data sets of different STs, the advantage of JPEG2000 3D over JPEG2000 increases as the ST increases from 0.67 to 2 mm, and then slowly decreases as the ST increases from 2 to 5 mm. The practical advantage of JPEG2000 3D is limited for a submillimeter ST due to its greater computing time with only a marginal improvement in image fidelity.

Reproducibility in the assessment of noncalcified coronary plaque with 256-slice multi-detector CT and automated plaque analysis software.

We aimed to assess intra- and inter-observer reproducibility in evaluating volume and characteristics of non-calcified coronary plaques (NCPs) using a 256-slice multi-detector computed tomography (MDCT) angiography and dedicated automated plaque analysis software in asymptomatic individuals. Forty-two NCPs from 39 patients with a vessel diameter >2 mm were evaluated using a 256-slice MDCT with dedicated automated plaque analysis software. Two independent observers analyzed the characteristics of NCPs, including plaque volume (vol), mean CT number of the NCPs in Hounsfield units (HU(mean)), and remodeling index (RI). One of the observers repeated the evaluation of all datasets after an interval of at least 4 weeks. Bland-Altman analysis and concordance correlation coefficients (CCCs) were used to determine intra- and inter-observer variability. For vol measurements, the 95% limits of agreement were -21.6 and 13.2 mm(3), and -24.6 and 20.3 mm(3) for intra- and inter-observer variability, respectively. For HU(mean) measurements, the 95% limits of agreement were -22.2 and 20.8 HU, and -21.1 and 21.0 HU for intra- and inter-observer variability, respectively. For RI measurements, the 95% limits of agreement were -0.38 and 0.39, and -0.51 and 0.36 for intra- and inter-observer variability, respectively. The CCCs was very high for all measurements, ranging from 0.90 to 0.98. Using 256-slice MDCT with dedicated automated plaque analysis software, intra- and inter-observer reproducibility were excellent in evaluating the volume and characteristics of NCP in asymptomatic individuals.

A comparison of three image fidelity metrics of different computational principles for JPEG2000 compressed abdomen CT images.

This study aimed to evaluate three image fidelity metrics of different computational principles--peak signal-to-noise ratio (PSNR), high-dynamic range visual difference predictor (HDR-VDP), and multiscale structural similarity (MS-SSIM)--in measuring the fidelity of JPEG2000 compressed abdomen computed tomography images from a viewpoint of visually lossless compression. Three hundred images with 0.67- or 5-mm section thickness were compressed to one of five compression ratios ranging from reversible compression to 15:1. The fidelity of each compressed image was measured by five radiologists' visual analyses (distinguishable or indistinguishable from the original) and the three metrics. The Spearman rank correlation coefficients of the PSNR, HDR-VDP, and MS-SSIM values with the number of readers responding as indistinguishable were 0.86, 0.94, and 0.86, respectively. Using the pooled readers' responses as the reference standard, the area under the receiver-operating-characteristic curve for the HDR-VDP (0.99) was significantly greater than that for the PSNR (0.95) (p < 0.001) and for the MS-SSIM (0.96) (p = 0.003), and there was no significant difference between the PSNR and MS-SSIM (p = 0.70). In measuring the image fidelity, the HDR-VDP outperforms the PSNR and MS-SSIM, and the MS-SSIM and PSNR are comparable.

Objective index of image fidelity for JPEG2000 compressed body CT images.

Compression ratio (CR) has been the de facto standard index of compression level for medical images. The aim of the study is to evaluate the CR, peak signal-to-noise ratio (PSNR), and a perceptual quality metric (high-dynamic range visual difference predictor HDR-VDP) as objective indices of image fidelity for Joint Photographic Experts Group (JPEG) 2000 compressed body computed tomography (CT) images, from the viewpoint of visually lossless compression approach. A total of 250 body CT images obtained with five different scan protocols (5-mm-thick abdomen, 0.67-mm-thick abdomen, 5-mm-thick lung, 0.67-mm-thick lung, and 5-mm-thick low-dose lung) were compressed to one of five CRs (reversible, 6:1, 8:1, 10:1, and 15:1). The PSNR and HDR-VDP values were calculated for the 250 pairs of the original and compressed images. By alternately displaying an original and its compressed image on the same monitor, five radiologists independently determined if the pair was distinguishable or indistinguishable. The kappa statistic for the interobserver agreement among the five radiologists' responses was 0.70. According to the radiologists' responses, the number of distinguishable image pairs tended to significantly differ among the five scan protocols at 6:1-10:1 compressions (Fisher-Freeman-Halton exact tests). Spearman's correlation coefficients between each of the CR, PSNR, and HDR-VDP and the number of radiologists who responded as distinguishable were 0.72, -0.77, and 0.85, respectively. Using the radiologists' pooled responses as the reference standards, the areas under the receiver-operating-characteristic curves for the CR, PSNR, and HDR-VDP were 0.87, 0.93, and 0.97, respectively, showing significant differences between the CR and PSNR (p = 0.04), or HDR-VDP (p < 0.001), and between the PSNR and HDR-VDP (p < 0.001). In conclusion, the CR is less suitable than the PSNR or HDR-VDP as an objective index of image fidelity for JPEG2000 compressed body CT images. The HDR-VDP is more promising than the PSNR as such an index.

Detection of the normal appendix with low-dose unenhanced CT: use of the sliding slab averaging technique.

PURPOSE: To determine the frequency of normal appendix visualization at low-dose (LD) unenhanced computed tomography (CT) performed with a 16- or 64-detector row scanner when images are reviewed by using the sliding slab averaging technique. MATERIALS AND METHODS: The institutional review board approved the study and waived the informed consent requirement. A total of 259 patients, 37 (14.3%) of whom had previously undergone appendectomy, underwent LD unenhanced CT (mean effective dose, 1.7 mSv) performed with a 16- or 64-detector row scanner to assess urinary colic. Three readers used the sliding slab averaging technique to retrospectively review the thin-section (0.67- or 2.00-mm section thickness) images and grade the appendix as absent, unsurely or partly visualized, or clearly and entirely visualized. Interobserver agreement was measured with weighted kappa statistics. McNemar tests were used to compare sensitivity between the readers. Logistic regression analysis was performed to assess the effects of body mass index, patient sex, and type of CT scanner on appendiceal visualization. RESULTS: The kappa statistics for each reader pair were as follows: 0.97 for agreement between readers 1 and 2, 0.93 for agreement between readers 2 and 3, and 0.92 for agreement between readers 1 and 3. Each reader clearly identified the entire appendix in 213 (96.0%), 209 (94.1%), and 205 (92.3%) of the 222 patients without a history of appendectomy. When unsurely or partly visualized appendices were included, the frequencies increased to 99.1% (n = 220), 98.7% (n = 219), and 97.3% (n = 216), respectively, for readers 1, 2, and 3. These frequencies rarely differed between the readers. (P values ranged from .021 to greater than .99.) The three readers consistently reported that the appendix was not visualized in the 37 patients who had undergone appendectomy. None of the tested variables significantly affected appendix visualization. CONCLUSION: Most normal appendices are visualized on thin-section LD unenhanced CT images reviewed with the sliding slab averaging technique.

JPEG2000 3D compression vs. 2D compression: an assessment of artifact amount and computing time in compressing thin-section abdomen CT images.

To assess the advantages of the Joint Photographic Experts Group (JPEG)2000 3D (part 2) over JPEG2000 in compressing thin-section abdomen CT data sets, 60 thin-section (0.67 mm) scans from 35 males and 25 females, ranging from 23 to 95 years of age (mean, 58 years), were compressed reversibly (as a negative control) and irreversibly to 4:1, 6:1, 8:1, 10:1, and 12:1 using JPEG2000 3D and JPEG2000 algorithms. Encoding and decoding times and peak signal-to-noise ratios (PSNRs) were measured. For 60 (one image per scan) representative sections containing abnormalities, three radiologists independently compared original and compressed images and graded compression artifacts as 0 (none, indistinguishable), 1 (barely perceptible), 2 (subtle), or 3 (significant). According to pooled radiologists' responses, the range of visually lossless threshold (VLT, the highest compression ratio at which a compressed image is indistinguishable from its original) was determined as one of <4:1, 4:1-6:1, 6:1-8:1, 8:1-10:1, 10:1-12:1, and >12:1. Wilcoxon signed rank tests and exact tests for paired proportions were used for the comparisons between the two compressions. At each irreversible compression ratio, compared to JPEG2000, JPEG2000 3D required two- or threefold greater computing times (p < 0.001) and introduced less artifacts in terms of PSNR (p <0.001) and the grade (p < 0.02 at 6:1 or higher) and the presence of perceived artifacts (p <0.008, at 6:1 for all readers and at 8:1 for two readers). According to PSNR and readers' responses, 6:1 and 8:1 JPEG2000 3D compressions showed more artifacts than 4:1 and 6:1 JPEG2000 compressions, respectively, and 10:1 and 12:1 JPEG2000 3D compressions showed similar artifacts to those of 8:1 and 10:1 JPEG2000 compressions, respectively. The determined VLT range was higher for JPEG2000 3D than for JPEG2000 (p < 0.001): the 3D compression showed the VLT ranges of 4:1-6:1, 6:1-8:1, and 8:1-10:1 for 24 (40%), 30 (50%), and 6 (10%) of the 60 original images, respectively, while the 2D compression showed the VLT ranges of <4:1, 4:1-6:1, and 6:1-8:1 for 1 (1.7%), 40 (66.7%), and 19 (31.6%) images, respectively. Compared to JPEG2000, JPEG2000 3D increased the VLT range in 23 of the 60 original images by one (n=22) or two ranges (n=1), while the remaining 37 images had the same VLT range between the two compressions. In conclusion, compared to JPEG2000 compression, JPEG2000 3D compression yields less artifacts in compressing thin-section abdomen CT images but requires significantly greater computing times. For the tested data set compressed to the range from 4:1 to 12:1, JPEG2000 3D could increase compression level reasonably (by 2 or less in terms of compression ratio) compared to JPEG2000 for the same amount of artifacts.

Regional variance of visually lossless threshold in compressed chest CT images: lung versus mediastinum and chest wall.

OBJECTIVE: To estimate the visually lossless threshold (VLT) for the Joint Photographic Experts Group (JPEG) 2000 compression of chest CT images and to demonstrate the variance of the VLT between the lung and mediastinum/chest wall. SUBJECTS AND METHODS: Eighty images were compressed reversibly (as negative control) and irreversibly to 5:1, 10:1, 15:1 and 20:1. Five radiologists determined if the compressed images were distinguishable from their originals in the lung and mediastinum/chest wall. Exact tests for paired proportions were used to compare the readers' responses between the reversible and irreversible compressions and between the lung and mediastinum/chest wall. RESULTS: At reversible, 5:1, 10:1, 15:1, and 20:1 compressions, 0%, 0%, 3-49% (p<.004, for three readers), 69-99% (p<.001, for all readers), and 100% of the 80 image pairs were distinguishable in the lung, respectively; and 0%, 0%, 74-100% (p<.001, for all readers), 100%, and 100% were distinguishable in the mediastinum/chest wall, respectively. The image pairs were less frequently distinguishable in the lung than in the mediastinum/chest wall at 10:1 (p<.001, for all readers) and 15:1 (p<.001, for two readers). In 321 image comparisons, the image pairs were indistinguishable in the lung but distinguishable in the mediastinum/chest wall, whereas there was no instance of the opposite. CONCLUSION: For JPEG2000 compression of chest CT images, the VLT is between 5:1 and 10:1. The lung is more tolerant to the compression than the mediastinum/chest wall.

Regional difference in compression artifacts in low-dose chest CT images: effects of mathematical and perceptual factors.

OBJECTIVE: The objective of our study was to investigate the difference of perceptible artifacts between the lungs and the chest wall and mediastinum in Joint Photographic Experts Group (JPEG) 2000-compressed low-dose chest CT images and to show that a perceptual image quality metric-the High-Dynamic Range Visual Difference Predictor (HDR-VDP)-can reproduce this regional difference. MATERIALS AND METHODS: Twenty images were compressed reversibly and irreversibly to 6:1-30:1. To analyze the two regions separately (lungs; and chest wall and mediastinum), the compressed pixels outside each tested region were replaced with the original pixels. By comparing the compressed and original images, three radiologists independently rated the compression artifacts as grade 0, none, indistinguishable; 1, barely perceptible; 2, subtle; or 3, significant. At each compression level, the two regions were compared for the readers' responses, peak signal-to-noise ratio (PSNR), and HDR-VDP results. Wilcoxon's signed rank tests and exact tests for paired proportions were used with a p value threshold of 0.05. RESULTS: Artifacts were rated as lower grades in the lungs than in the chest wall and mediastinum, showing statistical significances at 10:1-20:1 for reader 1, 8:1-15:1 for reader 2, and 8:1-20:1 for reader 3. Grade 0 was more frequent in the lungs, showing statistical significances at 10:1 for reader 1 and at 8:1-10:1 for readers 2 and 3. The results of PSNR indicated greater artifacts in the lungs (p < 0.001), whereas HDR-VDP results indicated fewer artifacts in the lungs (p < 0.001). CONCLUSION: Although compression artifacts are mathematically greater in the lungs than in the chest wall and mediastinum, radiologists' artifact perceptions are the opposite, which can be successfully reproduced by HDR-VDP.