Sushmita Datta1, Jay-Jiguang Zhu2, Roy F Riascos-Castaneda1, and Ponnada A Narayana1
1Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX, United States, 2Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, United States
Synopsis
Automated quantification of tumors and its components are important in
monitoring disease status in glioblastoma patients. We have proposed an automatic
segmentation procedure based on morphological grayscale reconstruction
techniques to classify and identify tumor sub-regions using multi-modal MRI. Purpose
Glioblastoma
is one of the most aggressive tumors affecting adults. Magnetic resonance
imaging (MRI) is widely used for diagnosis and monitoring disease status following
intervention including craniotomy, irradiation and various chemotherapies. The Macdonald
or Response Assessment in Neuro-Oncology (RANO) criteria based on tumor volume
estimations using MRI are routinely used to determine tumor response to
treatment. However, these methods are manual and prone to operator bias. They
also do not consider tumor heterogeneity. Automated estimations of volumes of
tumor sub-regions are necessary to follow disease status objectively. In this
study, we developed and implemented and automated technique using morphological
methodologies to identify and classify tumor sub-regions by integrating
information from multi-modal MRI.
Materials and Methods
Nine
subjects (5 males, 4 females) were included in the study. Average age was 52.43
(± 11.87) years ranging from 29 to 66 years. Three-dimensional
(1 mm3 isotropic voxel) T2-weighted (T2 images; TR/TE = 2500
ms/388.3 ms), fluid attenuated inversion recovery (FLAIR; TR/TE/TI = 4800
ms/323 ms/1650 ms), and T1-weighted (T1) pre- and post-contrast images (TR/TE =
8.1 ms/3.7 ms) were acquired. FLAIR, T1 pre-/post-contrast images were
co-aligned with T2 images using rigid body registration technique [1]. The T2
images were skull-stripped [2] which was then used to mask the FLAIR and T1
images. The images were further processed for intensity non-uniformities
correction and noise reduction [1]. Morphological
grayscale reconstruction (MGR) by geodesic dilation was applied to FLAIR and T2
images to obtain regional maxima [3, 5-6]. The original image was first
decomposed by the application of grayscale erosion with a three-dimensional
structuring element (sphere) to obtain a modified image with voxel intensities
lower than or equal to the intensities of corresponding voxel on original
image. An elementary geodesic dilation was applied to the modified image by
first dilating the image with the structuring element, followed by the
calculation of point-wise minimum with the modified image resulting in the
reconstructed image. The elementary geodesic dilation was applied iteratively until
no further change in the reconstructed image was observed. Subtraction of
reconstructed image from the original image resulted in regional maxima. The
procedure identified all regional maxima in the image and therefore the
application of it to FLAIR images results to tumor/vasogenic edema. But
application of this procedure toT2 images identifies both cerebrospinal fluid (CSF)
and tumor regions. Similarly, application of MGR by iterative application of
elementary geodesic erosion to FLAIR image results in the identification of regional
minima representing CSF [4, 5-6]. Therefore, tumor/vasogenic edema is extracted
by combining the results of MGR on FLAIR and T2 images. On the other hand,
application of MGR by geodesic dilation applied to T1 post-contrast images results
in the identification of regional maxima that include enhanced part of the
tumor and false classification representing vasculatures [2, 4-5]. The false
classifications are eliminated by masking the results with the ratio maps (T1
pre-contrast - T1 post-contrast)/ T1 pre-contrast images. Our technique
performed consistently well across all the patients. The raters who included a
neuroradiologist and a neurooncologist judged the performance of this technique
to be highly satisfactory in segmenting various sub-components of the tumor.
Results
Figure 1 shows the application of MGR to determine the
regional maxima on FLAIR and T2 images at different iteration levels. In this
example, the reconstructed image converged after 24 iterations. As can be
observed from this figure, regional maxima consist of tumor region only on
FLAIR, but include CSF on T2 image. Figure 2 shows an example of multi-channel
images and the extracted tumor on FLAIR and enhanced part of tumor on the T1
post-contrast images. The neuroradiologist and neurooncologist felt that the
automated program performed exceedingly well.
Discussion
We have developed, implemented, and validated an automated
technique for identifying tumor and its sub-components with minimal false
classification. This technique also appears to be very robust based on the
consistent results obtained across all the patients. We expect this technique
to play an important role in the management of glioblastoma patients.
Acknowledgements
No acknowledgement found.References
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