No Arabic abstract
Noninvasive MR-guided focused ultrasound (MRgFUS) treatments are promising alternatives to the surgical removal of malignant tumors. A significant challenge is assessing the viability of treated tissue during and immediately after MRgFUS procedures. Current clinical assessment uses the nonperfused volume (NPV) biomarker immediately after treatment from contrast-enhanced MRI. The NPV has variable accuracy, and the use of contrast agent prevents continuing MRgFUS treatment if tumor coverage is inadequate. This work presents a novel, noncontrast, learned multiparametric MR biomarker that can be used during treatment for intratreatment assessment, validated in a VX2 rabbit tumor model. A deep convolutional neural network was trained on noncontrast multiparametric MR images using the NPV biomarker from follow-up MR imaging (3-5 days after MRgFUS treatment) as the accurate label of nonviable tissue. A novel volume-conserving registration algorithm yielded a voxel-wise correlation between treatment and follow-up NPV, providing a rigorous validation of the biomarker. The learned noncontrast multiparametric MR biomarker predicted the follow-up NPV with an average DICE coefficient of 0.71, substantially outperforming the current clinical standard (DICE coefficient = 0.53). Noncontrast multiparametric MR imaging integrated with a deep convolutional neural network provides a more accurate prediction of MRgFUS treatment outcome than current contrast-based techniques.
Data-driven automatic approaches have demonstrated their great potential in resolving various clinical diagnostic dilemmas in neuro-oncology, especially with the help of standard anatomic and advanced molecular MR images. However, data quantity and quality remain a key determinant of, and a significant limit on, the potential of such applications. In our previous work, we explored synthesis of anatomic and molecular MR image network (SAMR) in patients with post-treatment malignant glioms. Now, we extend it and propose Confidence Guided SAMR (CG-SAMR) that synthesizes data from lesion information to multi-modal anatomic sequences, including T1-weighted (T1w), gadolinium enhanced T1w (Gd-T1w), T2-weighted (T2w), and fluid-attenuated inversion recovery (FLAIR), and the molecular amide proton transfer-weighted (APTw) sequence. We introduce a module which guides the synthesis based on confidence measure about the intermediate results. Furthermore, we extend the proposed architecture for unsupervised synthesis so that unpaired data can be used for training the network. Extensive experiments on real clinical data demonstrate that the proposed model can perform better than the state-of-theart synthesis methods.
Advances in imaging and early cancer detection have increased interest in magnetic resonance (MR) guided focused ultrasound (MRgFUS) technologies for cancer treatment. MRgFUS ablation treatments could reduce surgical risks, preserve organ tissue/function, and improve patient quality of life. However, surgical resection and histological analysis remain the gold standard to assess cancer treatment response. For non-invasive ablation therapies such as MRgFUS, the treatment response must be determined through MR imaging biomarkers. However, current MR biomarkers are inconclusive and have not been rigorously evaluated against histology via accurate registration. Existing registration methods rely on anatomical features to directly register in vivo MR and histology. For MRgFUS applications in anatomies such as liver, kidney, or breast, anatomical features independent from treatment features are often insufficient to perform direct registration. We present a novel MR to histology registration workflow that utilizes intermediate imaging and does not rely on these independent features. The presented workflow yields an overall registration accuracy of 1.00 +/- 0.13 mm. The developed registration pipeline is used to evaluate a common MRgFUS treatment assessment biomarker against histology. Evaluating MR biomarkers against histology using this registration pipeline will facilitate validating novel MRgFUS biomarkers to improve treatment assessment without surgical intervention.
Thermal ablation is a minimally invasive procedure for treat-ing small or unresectable tumors. Although CT is widely used for guiding ablation procedures, the contrast of tumors against surrounding normal tissues in CT images is often poor, aggravating the difficulty in accurate thermal ablation. In this paper, we propose a fast MR-CT image registration method to overlay a pre-procedural MR (pMR) image onto an intra-procedural CT (iCT) image for guiding the thermal ablation of liver tumors. By first using a Cycle-GAN model with mutual information constraint to generate synthesized CT (sCT) image from the cor-responding pMR, pre-procedural MR-CT image registration is carried out through traditional mono-modality CT-CT image registration. At the intra-procedural stage, a partial-convolution-based network is first used to inpaint the probe and its artifacts in the iCT image. Then, an unsupervised registration network is used to efficiently align the pre-procedural CT (pCT) with the inpainted iCT (inpCT) image. The final transformation from pMR to iCT is obtained by combining the two estimated transformations,i.e., (1) from the pMR image space to the pCT image space (through sCT) and (2) from the pCT image space to the iCT image space (through inpCT). Experimental results confirm that the proposed method achieves high registration accuracy with a very fast computational speed.
Medical instrument detection is essential for computer-assisted interventions since it would facilitate the surgeons to find the instrument efficiently with a better interpretation, which leads to a better outcome. This article reviews medical instrument detection methods in the ultrasound-guided intervention. First, we present a comprehensive review of instrument detection methodologies, which include traditional non-data-driven methods and data-driven methods. The non-data-driven methods were extensively studied prior to the era of machine learning, i.e. data-driven approaches. We discuss the main clinical applications of medical instrument detection in ultrasound, including anesthesia, biopsy, prostate brachytherapy, and cardiac catheterization, which were validated on clinical datasets. Finally, we selected several principal publications to summarize the key issues and potential research directions for the computer-assisted intervention community.
Arterial spin labeling (ASL) magnetic resonance imaging (MRI) is a powerful imaging technology that can measure cerebral blood flow (CBF) quantitatively. However, since only a small portion of blood is labeled compared to the whole tissue volume, conventional ASL suffers from low signal-to-noise ratio (SNR), poor spatial resolution, and long acquisition time. In this paper, we proposed a super-resolution method based on a multi-scale generative adversarial network (GAN) through unsupervised training. The network only needs the low-resolution (LR) ASL image itself for training and the T1-weighted image as the anatomical prior. No training pairs or pre-training are needed. A low-pass filter guided item was added as an additional loss to suppress the noise interference from the LR ASL image. After the network was trained, the super-resolution (SR) image was generated by supplying the upsampled LR ASL image and corresponding T1-weighted image to the generator of the last layer. Performance of the proposed method was evaluated by comparing the peak signal-to-noise ratio (PSNR) and structural similarity index (SSIM) using normal-resolution (NR) ASL image (5.5 min acquisition) and high-resolution (HR) ASL image (44 min acquisition) as the ground truth. Compared to the nearest, linear, and spline interpolation methods, the proposed method recovers more detailed structure information, reduces the image noise visually, and achieves the highest PSNR and SSIM when using HR ASL image as the ground-truth.