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Vertebral labelling and segmentation are two fundamental tasks in an automated spine processing pipeline. Reliable and accurate processing of spine images is expected to benefit clinical decision support systems for diagnosis, surgery planning, and population-based analysis of spine and bone health. However, designing automated algorithms for spine processing is challenging predominantly due to considerable variations in anatomy and acquisition protocols and due to a severe shortage of publicly available data. Addressing these limitations, the Large Scale Vertebrae Segmentation Challenge (VerSe) was organised in conjunction with the International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) in 2019 and 2020, with a call for algorithms tackling the labelling and segmentation of vertebrae. Two datasets containing a total of 374 multi-detector CT scans from 355 patients were prepared and 4505 vertebrae have individually been annotated at voxel level by a human-machine hybrid algorithm (https://osf.io/nqjyw/, https://osf.io/t98fz/). A total of 25 algorithms were benchmarked on these datasets. In this work, we present the results of this evaluation and further investigate the performance variation at the vertebra level, scan level, and different fields of view. We also evaluate the generalisability of the approaches to an implicit domain shift in data by evaluating the top-performing algorithms of one challenge iteration on data from the other iteration. The principal takeaway from VerSe: the performance of an algorithm in labelling and segmenting a spine scan hinges on its ability to correctly identify vertebrae in cases of rare anatomical variations. The VerSe content and code can be accessed at: https://github.com/anjany/verse.
Gruppenweise Registrierung zur robusten Bewegungsfeldschätzung in artefaktbehafteten 4D-CT-Bilddaten
(2015)
Das Ziel der Strahlentherapie ist, eine möglichst hohe Dosis in den Tumor zu applizieren und zeitgleich die Strahlenexposition des Normalgewebes zu minimieren. Insbesondere bei thorakalen und abdominalen Tumoren treten aufgrund der Atmung während der Bestrahlung große, komplexe und patientenspezifisch unterschiedliche Bewegungen der Gewebe auf. Um den Einfluss dieser Bewegung auf die i.d.R. statisch geplante Dosisverteilung abzuschätzen, können unter Verwendung der nicht-linearen Bildregistrierung anhand von 3D-CT-Aufnahmen eines Atmungszyklus - also 4D-CT-Daten - zunächst die Bewegungsfelder für die strahlentherapeutisch relevanten Strukturen, beispielsweise für die Lunge, berechnet werden. Diese Informationen bilden die Grundlage für sogenannte 4D-Dosisberechnungs- oder Dosisakkumulationsverfahren. Deren Genauigkeit hängt aber wesentlich von der Genauigkeit der Bewegungsfeldschätzung ab.
Klassisch erfolgt die Berechnung der Bewegungsfelder mittels paarweiser Bildregistrierung, womit für die Berechnung des Bewegungsfeldes zwischen zwei Bildern im Allgemeinen eine sehr hohe Genauigkeit erreicht wird. Auch für CT-Bilder, die Bewegungsartefakte, wie beispielsweise doppelte oder unvollständige Strukturen, enthalten, wird unter Verwendung der paarweisen Bildregistrierung im Kontext der Registrierung eine exakte Abbildung der anatomischen Strukturen zwischen den beiden Bildern erreicht. Dabei erfolgt aber eine physiologisch unplausible Anpassung der Felder an die Artefakte. Bei Verwendung der paarweisen Bildregistrierung müssen weiterhin für einen Atemzyklus die Voxel-Trajektorien aus Bewegungsfeldern zwischen mehreren dreidimensionalen Bildern zusammengesetzt werden. Durch Bewegungsartefakte entsprechen diese Trajektorien dann teilweise keiner natürlichen Bewegung der anatomischen Strukturen. Diese Ungenauigkeit stellt in der klinischen Anwendung ein Problem dar; dies gilt umso mehr, wenn Bewegungsartefakte im Bereich eines Tumors vorliegen.
Im Gegensatz zu der paarweisen Registrierung kann mit der gruppenweisen Registrierung das Problem der durch Bewegungsartefakte hervorgerufenen ungenauen Abbildung der physiologischen Gegebenheiten dadurch reduziert werden, dass im Registrierungsprozess Bildinformationen aller Bilder, also in diesem Kontext der CT-Daten zu unterschiedlichen Atemphasen, gleichzeitig genutzt werden. Es kann bereits im Registrierungsprozess eine zeitliche Glattheit der Voxel-Trajektorien gefordert werden.
In dieser Arbeit wird eine Methode zur B-Spline-basierten zeitlich regularisierten gruppenweisen Registrierung entwickelt. Die Genauigkeit der entwickelten Methode wird für frei zugängliche klinische Datensätze landmarkenbasiert evaluiert. Dabei wird mit dem Target Registration Error (TRE) die durchschnittliche dreidimensionale euklidische Distanz zwischen den korrespondierenden Landmarken nach Transformation der Landmarken bezeichnet. Eine Genauigkeit in der Größenordnung von aktuellen paarweisen Registrierungen verdeutlicht die Qualität des vorgestellten Registrierungs-Algorithmus. Anschließend werden die Vorteile der gruppenweisen Registrierung durch Experimente an einem Lungenphantom und an manipulierten, artefaktbehafteten klinischen 4D-CT-Bilddaten demonstriert. Dabei werden unter Verwendung der gruppenweisen Registrierung im Vergleich zu der paarweisen Registrierung glattere Trajektorien berechnet, die der realen Bewegung der anatomischen Strukturen stärker entsprechen. Für die Patientendaten wird außerdem anhand von automatisch detektierten Landmarken der TRE ausgewertet. Der TRE verschlechterte sich für die paarweise Bildregistrierung unter Vorliegen von Bewegungsartefakten von durchschnittlich 1,30 mm auf 3,94 mm. Auch hier zeigte sich für die gruppenweise Registrierung die Robustheit gegenüber Bewegungsartefakten und der TRE verschlechterte sich nur geringfügig von 1,45 mm auf 1,71 mm.
Knee osteoarthritis (KOA) is a degenerative disease that leads to pain and loss of function. It is estimated to affect over 500 million humans world-wide and is one of the most common reasons for disability. KOA is usually diagnosed by radiologists or clinical experts by anamnesis, physical examination, and by assessing medical image data. The latter is typically acquired using X-Ray or magnetic resonance imaging. Since manual image reading is subjective, tedious and time-consuming, automated methods are required for a fast and objective decision support and for a better understanding of the pathogenesis of KOA.
This thesis sets a foundation towards automated computation of image-based KOA biomarkers for holistic assessment of the knee. This involves the assessment of multiple knee bones and soft tissues. An assessment of particular structures requires localization of these tissues. In order to automate a faithful localization of anatomical structures, deep learning-based methods are investigated and utilized. Additionally, convolutional neural networks (CNNs) are used for classification of medical image data, i.e., for a direct determination of the disease status and to detect anatomical structures and landmarks. The automatically computed anatomical volumes, locations, and other measurements are finally compared to values acquired by clinical experts and evaluated for clustering of KOA groups, classification of KOA severity, prediction of KOA progression, and prediction of total knee replacement.
In various experiments it is shown that CNN-based methods are suitable for accurate medical image segmentation, object detection, landmark detection, and direct classification of disease stages from the image data. Computed features related to the menisci are found to be most expressive in terms of clustering of KOA groups and
predicting of future disease states, thus allowing diagnosis of current KOA conditions and prediction of future conditions.
The conclusion of this thesis is that machine learning-based, fully automated processing of medical image data shows potential for diagnosis and prediction of KOA grades. Future studies could investigate additional features in order to achieve an assessment of the whole knee or validate the findings of this work in clinical
studies.
Convolutional neural networks (CNNs) are the state-of-the-art for automated assessment of knee osteoarthritis (KOA) from medical image data. However, these methods lack interpretability, mainly focus on image texture, and cannot completely grasp the analyzed anatomies’ shapes. In this study we assess the informative value of quantitative features derived from segmentations in order to assess their potential as an alternative or extension to CNN-based approaches regarding multiple aspects of KOA
A fully automated method is employed to segment six anatomical structures around the knee (femoral and tibial bones, femoral and tibial cartilages, and both menisci) in 46,996 MRI scans. Based on these segmentations, quantitative features are computed, i.e., measurements such as cartilage volume, meniscal extrusion and tibial coverage, as well as geometric features based on a statistical shape encoding of the anatomies. The feature quality is assessed by investigating their association to the Kellgren-Lawrence grade (KLG), joint space narrowing (JSN), incident KOA, and total knee replacement (TKR). Using gold standard labels from the Osteoarthritis Initiative database the balanced accuracy (BA), the area under the Receiver Operating Characteristic curve (AUC), and weighted kappa statistics are evaluated.
Features based on shape encodings of femur, tibia, and menisci plus the performed measurements showed most potential as KOA biomarkers. Differentiation between healthy and severely arthritic knees yielded BAs of up to 99%, 84% were achieved for diagnosis of early KOA. Substantial agreement with weighted kappa values of 0.73, 0.73, and 0.79 were achieved for classification of the grade of medial JSN, lateral JSN, and KLG, respectively. The AUC was 0.60 and 0.75 for prediction of incident KOA and TKR within 5 years, respectively.
Quantitative features from automated segmentations yield excellent results for KLG and JSN classification and show potential for incident KOA and TKR prediction. The validity of these features as KOA biomarkers should be further evaluated, especially as extensions of CNN-based approaches. To foster such developments we make all segmentations publicly available together with this publication.
Convolutional neural networks (CNNs) are the state-of-the-art for automated assessment of knee osteoarthritis (KOA) from medical image data. However, these methods lack interpretability, mainly focus on image texture, and cannot completely grasp the analyzed anatomies’ shapes. In this study we assess the informative value of quantitative features derived from segmentations in order to assess their potential as an alternative or extension to CNN-based approaches regarding multiple aspects of KOA.
Six anatomical structures around the knee (femoral and tibial bones, femoral and tibial cartilages, and both menisci) are segmented in 46,996 MRI scans. Based on these segmentations, quantitative features are computed, i.e., measurements such as cartilage volume, meniscal extrusion and tibial coverage, as well as geometric features based on a statistical shape encoding of the anatomies. The feature quality is assessed by investigating their association to the Kellgren-Lawrence grade (KLG), joint space narrowing (JSN), incident KOA, and total knee replacement (TKR). Using gold standard labels from the Osteoarthritis Initiative database the balanced accuracy (BA), the area under the Receiver Operating Characteristic curve (AUC), and weighted kappa statistics are evaluated.
Features based on shape encodings of femur, tibia, and menisci plus the performed measurements showed most potential as KOA biomarkers. Differentiation between non-arthritic and severely arthritic knees yielded BAs of up to 99%, 84% were achieved for diagnosis of early KOA. Weighted kappa values of 0.73, 0.72, and 0.78 were achieved for classification of the grade of medial JSN, lateral JSN, and KLG, respectively. The AUC was 0.61 and 0.76 for prediction of incident KOA and TKR within one year, respectively.
Quantitative features from automated segmentations provide novel biomarkers for KLG and JSN classification and show potential for incident KOA and TKR prediction. The validity of these features should be further evaluated, especially as extensions of CNN- based approaches. To foster such developments we make all segmentations publicly available together with this publication.
In der Strahlentherapie von Lungentumoren kann mittels Dosisakkumulation der Einfluss von Atembewegungen auf statisch geplante Dosisverteilungen abgeschätzt werden. Grundlage sind 4D-CT-Daten des Patienten, aus denen mittels nicht-linearer Bildregistrierung eine Sequenz von Bewegungsfeldern berechnet wird. Typischerweise werden Methoden der paarweisen Bildregistrierung eingesetzt, d.h. konsekutiv zwei Atemphasen aufeinander registriert. Hierbei erfolgt i.d.R. eine physiologisch nicht plausible Anpassung der Felder an CT-Bewegungsartefakte. Gruppenweise Registrierungsansätze berücksichtigen hingegen gleichzeitig sämtliche Bilddaten des 4D-CT-Scans und ermöglichen die Integration von zeitlichen Konsistenzbetrachtungen. In diesem Beitrag wird der potentielle Vorteil der gruppen- im Vergleich zur paarweisen Registrierung in artefaktbehafteten 4D-CT-Daten untersucht.
Precise voxel trajectory estimation in 4D CT images is a prerequisite for reliable dose accumulation during 4D treatment planning. 4D CT image data is, however, often affected by motion artifacts and applying standard pairwise registration to such data sets bears the risk of aligning anatomical structures to artifacts – with physiologically unrealistic trajectories being the consequence. In this work, the potential of a novel non-linear hybrid intensity- and feature-based groupwise registration method for robust motion field estimation in artifact-affected 4D CT image data is investigated. The overall registration performance is evaluated on the DIR-lab datasets; Its robustness if applied to artifact-affected data sets is analyzed using clinically acquired data sets with and without artifacts. The proposed registration approach achieves an accuracy comparable to the state-of-the-art (subvoxel accuracy), but smoother voxel trajectories compared to pairwise registration. Even more important: it maintained accuracy and trajectory smoothness in the presence of image artifacts – in contrast to standard pairwise registration, which yields higher landmark-based registration errors and a loss of trajectory smoothness when applied to artifact-affected data sets.
Abstract: Objective: To present a novel method for automated segmentation of knee menisci from MRIs. To evaluate quantitative meniscal biomarkers for osteoarthritis (OA) estimated thereof.
Method: A segmentation method employing convolutional neural networks in combination with statistical shape models was developed. Accuracy was evaluated on 88 manual segmentations. Meniscal volume, tibial coverage, and meniscal extrusion were computed and tested for differences between groups of OA, joint space narrowing (JSN), and WOMAC pain. Correlation between computed meniscal extrusion and MOAKS experts' readings was evaluated for 600 subjects. Suitability of biomarkers for predicting incident radiographic OA from baseline to 24 months was tested on a group of 552 patients (184 incident OA, 386 controls) by performing conditional logistic regression.
Results: Segmentation accuracy measured as Dice Similarity Coefficient was 83.8% for medial menisci (MM) and 88.9% for lateral menisci (LM) at baseline, and 83.1% and 88.3% at 12-month follow-up. Medial tibial coverage was significantly lower for arthritic cases compared to non-arthritic ones. Medial meniscal extrusion was significantly higher for arthritic knees. A moderate correlation between automatically computed medial meniscal extrusion and experts' readings was found (ρ=0.44). Mean medial meniscal extrusion was significantly greater for incident OA cases compared to controls (1.16±0.93 mm vs. 0.83±0.92 mm; p<0.05).
Conclusion: Especially for medial menisci an excellent segmentation accuracy was achieved. Our meniscal biomarkers were validated by comparison to experts' readings as well as analysis of differences w.r.t groups of OA, JSN, and WOMAC pain. It was confirmed that medial meniscal extrusion is a predictor for incident OA.
Abstract: Objective: To present a novel method for automated segmentation of knee menisci from MRIs. To evaluate quantitative meniscal biomarkers for osteoarthritis (OA) estimated thereof. Method: A segmentation method employing convolutional neural networks in combination with statistical shape models was developed. Accuracy was evaluated on 88 manual segmentations. Meniscal volume, tibial coverage, and meniscal extrusion were computed and tested for differences between groups of OA, joint space narrowing (JSN), and WOMAC pain. Correlation between computed meniscal extrusion and MOAKS experts' readings was evaluated for 600 subjects. Suitability of biomarkers for predicting incident radiographic OA from baseline to 24 months was tested on a group of 552 patients (184 incident OA, 386 controls) by performing conditional logistic regression. Results: Segmentation accuracy measured as Dice Similarity Coefficient was 83.8% for medial menisci (MM) and 88.9% for lateral menisci (LM) at baseline, and 83.1% and 88.3% at 12-month follow-up. Medial tibial coverage was significantly lower for arthritic cases compared to non-arthritic ones. Medial meniscal extrusion was significantly higher for arthritic knees. A moderate correlation between automatically computed medial meniscal extrusion and experts' readings was found (ρ=0.44). Mean medial meniscal extrusion was significantly greater for incident OA cases compared to controls (1.16±0.93 mm vs. 0.83±0.92 mm; p<0.05). Conclusion: Especially for medial menisci an excellent segmentation accuracy was achieved. Our meniscal biomarkers were validated by comparison to experts' readings as well as analysis of differences w.r.t groups of OA, JSN, and WOMAC pain. It was confirmed that medial meniscal extrusion is a predictor for incident OA.
Abstract: Objective: To present a novel method for automated segmentation of knee menisci from MRIs. To evaluate quantitative meniscal biomarkers for osteoarthritis (OA) estimated thereof. Method: A segmentation method employing convolutional neural networks in combination with statistical shape models was developed. Accuracy was evaluated on 88 manual segmentations. Meniscal volume, tibial coverage, and meniscal extrusion were computed and tested for differences between groups of OA, joint space narrowing (JSN), and WOMAC pain. Correlation between computed meniscal extrusion and MOAKS experts' readings was evaluated for 600 subjects. Suitability of biomarkers for predicting incident radiographic OA from baseline to 24 months was tested on a group of 552 patients (184 incident OA, 386 controls) by performing conditional logistic regression. Results: Segmentation accuracy measured as Dice Similarity Coefficient was 83.8% for medial menisci (MM) and 88.9% for lateral menisci (LM) at baseline, and 83.1% and 88.3% at 12-month follow-up. Medial tibial coverage was significantly lower for arthritic cases compared to non-arthritic ones. Medial meniscal extrusion was significantly higher for arthritic knees. A moderate correlation between automatically computed medial meniscal extrusion and experts' readings was found (ρ=0.44). Mean medial meniscal extrusion was significantly greater for incident OA cases compared to controls (1.16±0.93 mm vs. 0.83±0.92 mm; p<0.05). Conclusion: Especially for medial menisci an excellent segmentation accuracy was achieved. Our meniscal biomarkers were validated by comparison to experts' readings as well as analysis of differences w.r.t groups of OA, JSN, and WOMAC pain. It was confirmed that medial meniscal extrusion is a predictor for incident OA.