Registration of three-dimensional magnetic resonance and radionuclide skeletal images.

PURPOSE: To apply postprocessing techniques to register three-dimensional TI-201 bone SPECT datasets with MRI. This may provide more accurate anatomic-functional correlation when localizing active tumors. MATERIALS AND METHODS: Three-dimensional datasets were constructed from previously acquired MRIs using routine imaging protocols. Registration software was used to coregister the TI-201 SPECT studies and the MRIs in three dimensions. RESULTS: Adequate TI-201 uptake in muscles and soft tissues along with relatively low accumulation in tendons and joint spaces provided adequate landmarks for visually aligning SPECT and MRI datasets. MR abnormalities were more extensive because of surrounding reactive tissue, and more focal TI-201 uptake could be demonstrated within the region of MR signal abnormality, allowing the focal metabolically active tissue to be distinguished from adjacent edema. CONCLUSIONS: Image registration of SPECT and anatomic imaging (CT or MRI) is used routinely to evaluate functional abnormalities within the brain. This technique has now been applied to the combination of TI-201 SPECT and MR data for evaluating bone lesions and may provide additional anatomic information for localizing functional abnormalities. This may be valuable for defining targets for biopsy, planning surgical treatment, and using minimally invasive therapies.     

Registration of two-dimensional cardiac images to preprocedural three-dimensional images for interventional applications

PURPOSE: To evaluate the accuracy and efficiency of rigid-body registration of two-dimensional fast cine and real-time cardiac images to high-resolution and SNR three-dimensional preprocedural reference volumes for application during MRI-guided interventional procedures. MATERIALS AND METHODS: Mutual information (MI) and correlation ratio (CR) similarity measures were evaluated. The dependence of registration accuracy and efficiency on different resolution and SNR parameters, and also on cardiac-phase differences was evaluated in a porcine model. Two-dimensional images were initially misoriented at distances (d) of 2-10 mm, and rotations of +/-5 degrees about all axes. Registration error and computation time were evaluated, and performance was also assessed visually. RESULTS: The maximum registration error using MI (<2.7 mm and <3.6 degrees ) occurred for d = 10 mm, misrotation of +/-5 degrees , and relative SNR = 1. The computation time was 15 seconds for MI and 10 seconds for CR. CONCLUSION: Registration accuracy was not highly dependent on the relative timing, within the cycle, between the two-dimensional and three-dimensional images. Registration using CR was faster than that using MI, although accuracy was marginally higher with MI. J.     

Registration of three-dimensional MR and PET images of the human brain without markers

Axial and sagittal magnetic resonance (MR) sections and contiguous sections of axial positron emission tomographic (PET) images obtained with fludeoxyglucose F-18 were used to evaluate a new method of registering three-dimensional images of the brain. The users specified the interhemispheric fissure plane in three dimensions for both the MR and PET data sets by specifying its endpoints within several axial sections. A transformation matrix aligning the interhemispheric fissure plane in MR and PET space was calculated and used to create one resectioned PET image on the resectioned PET image, and the user specified the remaining translations and rotation by moving the overlaid outline of the MR image. MR and PET data sets in four subjects were registered. The three-dimensional error on average was less than 3.8 mm and never exceeded 7.5 mm. Less than 1 hour per patient was required for registration. The method is accurate unless the interhemispheric fissure deviates significantly from a planar configuration. It does not need thin or contiguous MR sections and provides an estimate of the total registration error for every case.     

Real-time bronchoscope three-dimensional motion estimation using multiple sensor-driven alignment of CT images and electromagnetic measurements

Bronchoscope three-dimensional motion estimation plays a key role in developing bronchoscopic navigation systems. Currently external tracking devices, particularly electromagnetic trackers with electromagnetic sensors, are increasingly introduced to navigate surgical tools in pre-clinical images. An unavoidable problem, which is to align the electromagnetic tracker to pre-clinical images, must be solved before navigation. This paper proposes a multiple sensor-driven registration method to establish this alignment without using any anatomical fiducials. Although current fiducially free registration methods work well, they limit to the initialization of optimization and manipulating the bronchoscope along the bronchial centerlines, which could be failed easily during clinical interventions. To address these limitations, we utilize measurements of multiple electromagnetic sensors to calculate bronchoscope geometric center positions that are usually closer to the bronchial centerlines than the sensor itself measured positions. We validated our method on a bronchial phantom. The experimental results demonstrate that our idea of using multiple sensors to determine bronchoscope geometric center positions for fiducial-free registration was very effective. Compared to currently available methods in bronchoscope three-dimensional motion estimation, our method reduced fiducial alignment error from at least 6.79 to 4.68–5.26 mm and significantly improved motion estimation or tracking accuracy from at least 5.42 to 3.78–4.53 mm.     

Acetabular fractures: three-dimensional computer tomographic imaging and interactive surgical planning

Three-dimensional imaging can provide a valuable perceptual link between conventional radiographs and axial computed tomographic scans in the evaluation of complex acetabular fractures. With the 3D83 computer program, three-dimensional images can be generated to correlate with standard radiographic views. Unique images can also be created that offer perspectives unobtainable by conventional radiography. More sophisticated interactive techniques allow computer simulation of surgical approaches.     

How to quantify infarct size on delayed-enhancement MR images: a comparison between visual and quantitative approach

PURPOSE: Our aim was to evaluate the reliability of visual quantification of infarct extent on delayed enhanced magnetic resonance images. MATERIALS AND METHODS: Eighty patients with previous myocardial infarction underwent cine and contrast-enhanced cardiac magnetic resonance imaging. The gadolinium-enhanced images were evaluated using a segmental model with two different methods: a visual score on a 5-point scale (0 no hyperenhancement, 4 hyperenhancement>76% of myocardial wall) and a quantitative analysis based on the manual tracing of infarct contours with automatic threshold analysis. Each segment was also assigned a wall-motion score ranging from 0 (normokinesia) to 4 (dyskinesia). Statistical evaluation was performed. RESULTS: Out of 1,280 segments, 322 (25.1%) showed wall-motion abnormalities with enhancement in 327 (25.5%) evaluated with visual score and in 414 (32.3%) quantitatively. Among segments with normal or mild hypokinesia, 89.2% had a delayed-enhancement scoreor=3. Mean time required for the visual and quantitative approach was 7+/-3 and 18+/-9 min, respectively. There was strong agreement between the visual and quantitative method (k=0.92; p<0.01). CONCLUSIONS: Visual analysis of delayed enhancement is a timesaving approach that is sufficient to assess the transmural extent of infarction. Moreover, it has high correlation with wall-motion abnormalities.     

Registration of emission and transmission whole-body scintillation-camera images.

In this work, a method for registration of whole-body (WB) scintillation-camera images is presented. The primary motive for the development is to perform activity quantification using the conjugate view method on an image basis. Accurate image registration is required for sequential anterior and posterior scans, for serial emission images for analysis of the biokinetics, and for transmission and emission images for a pixel-based attenuation correction. METHODS: Registration is performed by maximization of the mutual information. The spatial transformation has been tailored for the registration of WB images and is composed of global and local transformations, including rigid, projective, and curved transformations. A coarse registration is first performed using cross-correlation and direct pixel scaling. Optimization is then performed in a sequence, beginning with the 2 legs independently, followed by the upper body and head. Evaluation is performed for clinical images of an (131)I-labeled monoclonal antibody and for Monte Carlo-simulated images. An anthropomorphic WB computer phantom, which has been especially modified to match the patient position during WB scanning, is used for the simulations. RESULTS: For simulated images, registration errors are within 1 pixel (<3.6 mm) for a sufficient image count level. Separate evaluation of the influence of noise shows that the errors increase below a total image count of approximately 10(5) (signal-to-noise ratio, approximately 4). For clinical evaluations, the deviations between point markers are 9 +/- 5 mm. CONCLUSION: An automatic registration method for WB images has been developed, which is applicable to emission-emission and transmission-emission registration. This method has been applied in more than 50 clinical studies and has shown to be robust and reliable.     

Example-based assisting approach for pulmonary nodule classification in three-dimensional thoracic computed tomography images

Rationale and Objectives. An example-based assisting approach that supports decision making in classifying pulmonary nodules in 3-dimensional (3D) thoracic computed tomography images has been developed.

Materials and Methods. The example-based assisting approach retrieves and displays nodules that exhibit morphologic and internal profiles consistent to the nodule in question. It uses a 3D computed tomography image database containing 143 pulmonary nodules for which diagnosis is known. The central module makes possible analysis of the query nodule image and extraction of the features of interest: shape, surrounding structure, and internal structure of the nodules. The principal axes and the compactness characterize the nodule shape. The surrounding and internal structures are represented by the distribution pattern of computed tomography density value and 3D curvature indexes. The nodule representation is then used for computing a similarity measure such as a correlation coefficient and a malignant likelihood of the query nodule. The malignant likelihood is estimated by the difference between the representation patterns of the query case and the retrieved lesions. The Mahalanobis distance was adopted as the difference measure. The approach performance was assessed through leave-one-out method by the false-positive rate.

Results. Given a query nodule image, the proposed method retrieved benign and malignant images similar to the query case and provided its malignant likelihood. The number of cases that obtained enough number of the retrieved cases for estimating the malignant likelihood was 107 cases (malignant, 70; benign, 37) in our database. Sensitivity was 91.4% (64 of 70 malignant nodules), specificity was 51.4% (19 of 37 benign nodules), and accuracy values were 77.6% (83 of 107 nodules).

Conclusion. Preliminary assessment of this approach showed that an example-based assisting approach is an effective tool for making the diagnostic decision in the classification of pulmonary nodules using the nodule image database.     

Geometric alignment and chromatic calibration of serial radiographic images

OBJECTIVE: To develop software for automated registration and intensity calibration of serial dental radiographs for the analysis of longitudinal changes in bone density. METHODS: Serial dental radiographs were acquired using a positioning device designed to minimize projection divergence. Each radiograph included an image of a standardized aluminium wedge. The radiographs were scanned on a flatbed scanner (AGFA Duo Scan) with a spatial resolution of 300 dpi, and pixel intensity coded in 16-bit grey scale. The intensity was calibrated using serial images of selected areas with defined thickness of the aluminium wedge. A robust B-splines multiresolution registration algorithm was implemented to overcome the acquisition misalignment. Radiographs, taken before and after periodontal therapy, were subtracted to assess bone density evolution. RESULTS: The intensity calibration decreased the maximum intensity variations between serial radiographs from 30+/-17% to 1+/-1% (mean+/-standard deviation), and improved the visual comparison between the radiographs. The registration stage allowed correcting the misalignment of the radiographs on the scanner screen and superimposing the radiography contents. The observed residual motion was about 0.02+/-0.01 mm. CONCLUSION: Very user-friendly software was developed. The manipulator needs to scan the radiographs only one time. The software performs all subsequent processing steps.     

Segmentation of tumors in magnetic resonance brain images using an interactive multiscale watershed algorithm

RATIONALE AND OBJECTIVE: This article presents the evaluation of an interactive multiscale watershed segmentation algorithm for segmenting tumors in magnetic resonance brain images of patients scheduled for neuronavigational procedures. MATERIALS AND METHODS: The watershed method is compared with manual delineation with respect to accuracy, repeatability, and efficiency. RESULTS: In the 20 patients included in this study, the measured volume of the tumors ranged from 2.7 to 81.9 cm(3). A comparison of the tumor volumes measured with watershed segmentation to the volumes measured with manual delineation shows that the two methods are interchangeable according to the Bland and Altman criterion, and thus equally accurate. The repeatability of the watershed method and the manual method are compared by looking at the similarity of the segmented volumes. The similarity for intraobserver and interobserver variability for watershed segmentation is 96.4% and 95.3%, respectively, compared with 93.5% and 90.0% for manual outlining, from which it may be concluded that the watershed method is more repeatable. Moreover, the watershed algorithm is on average three times faster than manual outlining. CONCLUSION: The watershed method has an accuracy comparable to that of manual delineation and outperforms manual outlining on the criteria of repeatability and efficiency.     

The brain: integrated three-dimensional display of MR and PET images

Three patients with intractable epilepsy, two with brain tumors, and one with encephalitis were imaged with magnetic resonance (MR) and positron emission tomography (PET). MR data were used to construct a three-dimensional (3D) computer model of the brain surface depicting the precentral (movement), postcentral (sensation), left inferior frontal (speech), and left superior temporal (hearing) gyri. PET-derived measurements of average surface metabolism were encoded as colors and mapped onto the 3D model by means of a retrospective technique for registering the two scans. The integrated 3D model depicted the location of PET-detected metabolic abnormalities with respect to the gyral anatomy visualized with MR. In each case, the predicted relationships were confirmed intraoperatively by means of inspection of the brain and electroencephalography. Multimodality 3D displays are likely to be particularly valuable for interpreting PET studies of epileptic patients and others with normal MR anatomy.     

Registration of three-dimensional MR and CT studies of the cervical spine

A three-dimensional image registration technique for CT and MR studies of the cervical spine was evaluated for feasibility and efficacy. Registration by means of external fiducial markers was slightly more accurate than registration by anatomic landmarks. The interrelationships between bony (eg, neural foramina) and soft tissue structures (eg, nerve roots) in the cervical spine were more conspicuous on registered images than on conventional displays. Registration of CT and MR images may be used to examine more precisely the relationships between bony and soft tissue structures of the cervical spine.     

Quality of brain perfusion single-photon emission tomography images: multicentre evaluation using an anatomically accurate three-dimensional phantom

The aim of the study was to evaluate the quality of routine brain perfusion single-photon emission tomography (SPET) images in Finnish nuclear medicine laboratories. Twelve laboratories participated in the study. A three-dimensional high resolution brain phantom (Data Spectrum’s 3D Hoffman Brain Phantom) was filled with a well-mixed solution of technetium-99m (110 MBq), water and detergent. Acquisition, reconstruction and printing were performed according to the clinical routine in each centre. Three nuclear medicine specialists blindly evaluated all image sets. The results were ranked from 1 to 5 (poor quality–high quality). Also a SPET performance phantom (Nuclear Associates’ PET/SPECT Performance Phantom PS 101) was filled with the same radioactivity concentration as the brain phantom. The parameters for the acquisition, the reconstruction and the printing were exactly the same as with the brain phantom. The number of detected ”hot” (from 0 to 8) and ”cold” lesions (from 0 to 7) was visually evaluated from hard copies. Resolution and contrast were quantified from digital images. Average score for brain phantom images was 2.7±0.8 (range 1.5–4.5). The average diameter of the ”hot” cylinders detected was 16 mm (range 9.2–20.0 mm) and that of the ”cold” cylinders detected, 11 mm (5.9–14.3 mm) according to visual evaluation. Quantification of digital images showed that the hard copy was one reason for low-quality images. The quality of the hard copies was good only in four laboratories and was amazingly low in the others when comparing it with the actual structure of the brain phantom. The described quantification method is suitable for optimizing resolution and contrast detectability of hard copies. This study revealed the urgent need for external quality assurance of clinical brain perfusion SPET images. Received 2 February and in revised form 31 May 1998     

Adult ankle fractures: comparison of plain films and interactive two- and three-dimensional CT scans

Thirteen patients with 15 ankle fractures potentially requiring surgical reduction according to plain film criteria were studied with transaxial CT, from which static and animated interactive two-dimensional (2-D) images and animated volumetric three-dimensional (3-D) images were generated. CT criteria believed to parallel well-accepted plain film criteria for triage of ankle fractures were developed and applied. The tibiofibular, talofibular, and tibiotalar articulations were characterized and, where possible (nine cases), compared with the (presumably normal) contralateral ankle. Talocrural angle measurements were made on interactive coronal measurements and compared with standard plain film measurements. Fracture fragment displacement, rotation, and impaction were noted. Posterior tibial lip disruption was quantified. Information derived from the 2-D/3-D CT study led to cancellation of proposed surgery in three of the distal fibular fractures and in two distal tibial fractures. There was far less variation than anticipated between the talocrural angles of the injured and normal ankles, and both injured and normal ankles deviated significantly from the accepted standard of 84 degrees. Displacement at the level of the fibular fracture was a poor predictor of more distal disruption. Two-dimensional CT was found to provide anatomic detail and information superior to either plain film or 3-D CT; 3-D CT was preferred by the surgeons for final surgical planning and for integration of the 2-D data. CT altered management in five of the 13 patients studied, supporting our belief that 2-D/3-D CT can be of significant value in assessing ankle fractures.     

Registration, segmentation, and visualization of multimodal brain images.

This paper gives an overview of the studies performed at our institute over the last decade on the processing and visualization of brain images, in the context of international developments in the field. The focus is on multimodal image registration and multimodal visualization, while segmentation is touched upon as a preprocessing step for visualization. The state-of-the-art in these areas is discussed and suggestions for future research are given.