Assessment of the reliability of the determination of carotid artery lumen sizes by quantitative image processing of magnetic resonance angiograms and images.

In order to use MR imaging to assess progression or regression of atherosclerosis, one must have an idea of the reproducibility of the imaging and image processing techniques. The ability of dark-blood MRI and semiautomated image processing to reproducibility measure the inner boundary of the carotid arteries was evaluated and compared with results obtained using bright-blood MRA. MRI and MRA images were obtained for two normal and two diseased volunteers six times each over a short period of time (6 months). The carotid bifurcation was used to align slices from different imaging sessions. The area for each vessel (right and left common, internal and external carotid artery) was determined for the six imaging sessions. The standard deviations of each lumen area normalized to the average area were computed for each vessel segment for each volunteer. For the common, internal, and external carotids, the averaged normalized standard deviations for MRI were 8, 12, and 17% and for MRA were 6, 8, and 13%. Lumen sizes obtained by MRI and MRA were found to be not statistically different. Eccentric plaques not seen on MRA were visualized by MRI. In conclusion, dark-blood MRI with semiautomated image processing yields reliable lumen areas that are in agreement with those obtained by MRA.

Unobtrusively tracking eye gaze direction and pupil diameter of mammographers.

RATIONALE AND OBJECTIVES: The visual process that radiologists use for diagnosis is incompletely understood. This study developed techniques to unobtrusively track direction and pupil diameter of radiologists reading a wide variety of films. We evaluated the eye gaze patterns of mammographic experts to gain knowledge that might improve the rate of early detection of breast cancer. METHODS: A video camera with a near-infrared light filter is pointed at the mammographic expert who is reading mammograms. The video images are analyzed in real time on a personal computer to detect eye gaze direction and pupil diameter. Two separate trials were used: 1) to demonstrate the system's speed and ability to work with mammograms (a brief test with one mammographer was used) and 2) four mammographic experts evaluated 14 mammograms. RESULTS: In the first trial, the system successfully tracked the eye gaze of a mammographer who quickly recognized the patient case, with the pupil diameter briefly increasing 40%, and then the gaze direction dwelling in an area of microcalcifications. In the second trial, 66% of the false-positive results for films with masses were associated with long eye gaze dwells, whereas 33% of the prolonged dwells for films with microcalcifications were associated with true-positive diagnoses. CONCLUSIONS: This near-infrared light system successfully tracked the eye gaze direction and pupil diameter of mammographic experts evaluating films. The association of long eye gaze dwells with diagnostic accuracy varied with the type of object being viewed. In films with masses, false-positive diagnoses were associated with long dwells. In films with microcalcifications, true-positive diagnoses were associated with long dwells.

Noninvasive quantitative evaluation of atherosclerosis using MRI and image analysis.

A new medical image analysis system to quantify atherosclerosis in the lower abdominal aorta using magnetic resonance imaging is described. This medical image analysis and display system permits the quantification of the three-dimensional (3D) properties of the vessel wall and lumen cross-sectional area and volumes. Preliminary results of employing this medical image analysis capability on magnetic resonance images demonstrated a twofold increase in wall volume per unit vessel length, corresponding to intimal thickening, before luminal narrowing was detected. This work demonstrated the feasibility and usefulness of quantitatively evaluating the 3D properties of the vessel lumen and wall by using a combination of magnetic resonance imaging and image analysis. The demonstration that intimal wall thickening is observed in images before observable occlusion of the lumen can be expected to provide an important early indicator of the future development of atherosclerosis. Such capability will permit detailed and quantitative studies to assess the effectiveness of therapies, such as drug, exercise, and dietary regimens.

Quantitative monitoring of capsular contraction around smooth and textured implants.

The purpose of this study was to assess the efficacy of textured silicone implants in reducing the incidence of capsular contracture. Each of 10 female New Zealand, albino rabbits received 2 saline-filled implants, 1 on either side of the lateral chest wall. The surface of 1 implant was smooth silicone, whereas the other implant's surface was textured silicone. Magnetic resonance imaging (MRI) scans of the implants were performed at 0, 9, 17, 26, 34, and 40 weeks after implantation. Data from the MRI scans were used to calculate the effective surface area of implants at each analysis interval. This technique provided a noninvasive method of monitoring implant contraction as a function of time. Eight rabbits completed the study. Four of 8 smooth implants developed contractures, whereas none of the textured implants developed contracture. For the 4 smooth implants that developed contractures, MRI scans calculated 72 +/- 12% contraction at 17 weeks, but the Baker palpation test detected only mild firmness. From 17 to 40 weeks, the mean percentage of contraction for these implants changed minimally, but their mean Baker score increased from mild to severe (II to IV). Quantitative data from MRI scans were much more predictive of final implant contraction than palpation (Baker test), applanation tonometry, or indentation tonometry. The latter two tests only detected the final stages of severe implant contraction.

Applications of hierarchical image segmentation techniques: aorta segmentation.

The segmentation of objects from complex images is difficult due to indistinct boundaries between objects and similarity of objects. We have used a hierarchical segmentation approach to accurately distinguish between objects and identify the corresponding boundaries. This approach has been used successfully to extract the aorta from transverse magnetic resonance (MR) images of the abdomen. The procedure to segment the abdominal aorta involves three progressive steps: aorta detection, aorta extraction, and estimation of the aorta wall boundary. Comparison of hierarchical segmentation techniques with single-step segmentation methods (e.g., region-growing, edge-detection) shows that hierarchical segmentation yields more reliable results.

Breast lesion discrimination using statistical analysis and shape measures on magnetic resonance imagery.

Magnetic resonance images of intact human breast tissue are evaluated using statistical measures and shape analysis. In this paper, the Mahalanobis distance measurement and a related F-statistical value demonstrate that breast lesions are statistically separable from normal breast tissue. The minimum set of parameters to provide first order statistical separability between fibroadenomas, cysts, and carcinomas are T1-weighted, T2-weighted, and Dixon opposed pulse sequences. Tumor shape is quantified by development of a compactness measure and a spatial frequency analysis of the lesion boundary. Malignant lesions are shown to be separable from benign lesions based on quantitative shape measures.

Image analysis and quantification of atherosclerosis using MRI.

This paper describes an image processing, pattern recognition, and computer graphics system for the noninvasive identification and evaluation of atherosclerosis using multidimensional Magnetic Resonance Imaging (MRI). Particular emphasis has been placed on the problem of developing a pattern recognition system for noninvasively identifying the different plaque classes involved in atherosclerosis using minimal a priori information. This pattern recognition technique involves an extension of the ISODATA clustering algorithm to include an information theoretic criterion (Consistent Akaike Information Criterion) to provide a measure of the fit of the cluster composition at a particular iteration to the actual data. A rapid 3-D display system is also described for the simultaneous display of multiple data classes resulting from the tissue identification process. This work demonstrates the feasibility of developing a "high information content" display which will aid in the diagnosis and analysis of the atherosclerotic disease process. Such capability will permit detailed and quantitative studies to assess the effectiveness of therapies, such as drug, exercise, and dietary regimens.

Identification and boundary extraction of blobs in complex imagery.

Automated identification and boundary extraction of blobs in "real world" imagery is a difficult task because the boundaries are so irregular that there is often insufficient a priori information describing these boundaries and traditional methods fail. This paper has proposed a progressive segmentation approach and a boundary estimation method to identify the blobs and to yield an accurate description of its boundary. The multiresolution image processing technique is incorporated into the whole work. This work has been applied to the problem of identifying and extracting the boundaries of major vessels (e.g., the aorta) in Magnetic Resonance (MR) imagery and the results are satisfactory. A Laplacian of Gaussian (LOG) operator is utilized as a spot detector to locate the approximate position of the blob of interest. A subimage centered on this approximate position is extracted to eliminate unwanted portions of the image and facilitate further processing. A histogram pyramid is created for the subimage histogram for automated determination of the threshold in the noisy histogram. A shrink-expand operation is then employed to reduced noise and undesired structures in the subimage. The rough and irregular boundary of the blob of interest obtained by thresholding is reparameterized into polar coordinates to create a Fourier descriptor representation of the boundary. Then, the discrete Fourier transform is applied to the reparameterized 1-D discrete curve to permit appropriate smoothing, as required, in frequency space. Finally, the boundary estimation is completed by taking the inverse Fourier transform to reconstruct the boundary of interest.

High-resolution 1H NMR spectral signature from human atheroma.

Coronary artery disease due to atherosclerosis takes the lives of approximately 550,000 Americans each year--an enormous toll. Put in economic terms, the cost to the United States alone has been estimated to exceed 60 billion dollars annually. We have found that well-resolved proton (1H) NMR spectra can be obtained from human atheroma (fatty plaque), despite its macroscopic solid appearance. The fraction of the total spectral intensity corresponding to the sharp 1H NMR signals is temperature dependent and approaches unity at body temperature (37 degrees C). Studies of the total lipids extracted from atheroma and cholesteryl esters were conducted to identify the chemical and physical origin of the spectral signature. The samples were characterized through assignment of their chemical shifts and by measurement of their T1 and T2 relaxation times as a function of magnetic field strength. The results suggest that the relatively sharp 1H NMR signals from human atheroma (excluding water) are due to a mixture of cholesteryl esters, whose liquid-crystalline to isotropic fluid phase transition is near body temperature. Preliminary applications to NMR imaging of human atheroma are reported, which demonstrate early fatty plaque formation within the wall of the aorta. These findings offer a basis for noninvasive imaging by NMR to monitor early and potentially reversible stages of human atherogenesis.

Identification and 3-D quantification of atherosclerosis using magnetic resonance imaging.

Cardiovascular disease due to atherosclerosis is a leading cause of death in the United States as well as other developed countries. This paper describes the development of image processing, pattern recognition, and graphical display techniques to non-invasively quantify the atherosclerotic disease process using magnetic resonance imaging (MRI). We have demonstrated the ability to identify the soft tissue classes of (1) normal, smooth muscle wall, (2) fatty plaque, (3) complex, fibrous plaque, and (4) calcified plaque. The objective of this work has been to combine functional information, such as plaque tissue type, with structural information, represented by 3-D display of vessel structure, into a single composite display. The results of this work provide a "high information content" display which will aid in the diagnosis and analysis of the atherosclerotic disease process, and permit detailed and quantitative studies to assess the effectiveness of therapies (e.g. changes in diet, exercise and drug administration).

High-resolution proton NMR spectra of human arterial plaque.

Well-resolved proton (1H) NMR spectra of solid human arterial plaque can be acquired. Studies have been carried out of human fatty plaque obtained postmortem (ex vivo), the total lipids extracted from human atheroma, and a model mixture of cholesteryl esters whose lipid composition resembles that of human atheroma. In each case, well-resolved 1H NMR spectra were obtained at body temperature (37 degrees C), with little or no underlying broad signal. Such sharp 1H NMR spectra are typical of isotropic fluids, whereas solid and liquid-crystalline materials give rise to much broader spectral lines. The results suggest the sharp 1H NMR spectra of human atheromatous lesions at body temperature are due largely to the presence of intracellular and extracellular droplets of cholesteryl esters in the isotropic liquid phase. These findings provide a necessary basis for use of 1H NMR techniques to image quantitatively the lipid constituents of human atheroma in vivo, and to study their chemical and physical properties.