Automated 3-dimensional segmentation of pelvic lymph nodes in magnetic resonance images.

PURPOSE: Computer aided diagnosis (CAD) of lymph node metastases may help reduce reading time and improve interpretation of the large amount of image data in a 3-D pelvic MRI exam. The purpose of this study was to develop an algorithm for automated segmentation of pelvic lymph nodes from a single seed point, as part of a CAD system for the classification of normal vs metastatic lymph nodes, and to evaluate its performance compared to other algorithms. METHODS: The authors' database consisted of pelvic MR images of 146 consecutive patients, acquired between January 2008 and April 2010. Each dataset included four different MR sequences, acquired after infusion of a lymph node specific contrast medium based on ultrasmall superparamagnetic particles of iron oxide. All data sets were analyzed by two expert readers who, reading in consensus, annotated and manually segmented the lymph nodes. The authors compared four segmentation algorithms: confidence connected region growing (CCRG), extended CCRG (ECC), graph cut segmentation (GCS), and a segmentation method based on a parametric shape and appearance model (PSAM). The methods were ranked based on spatial overlap with the manual segmentations, and based on diagnostic accuracy in a CAD system, with the experts' annotations as reference standard. RESULTS: A total of 2347 manually annotated lymph nodes were included in the analysis, of which 566 contained a metastasis. The mean spatial overlap (Dice similarity coefficient) was: 0.35 (CCRG), 0.57 (ECC), 0.44 (GCS), and 0.46 (PSAM). When combined with the classification system, the area under the ROC curve was: 0.805 (CCRG), 0.890 (ECC), 0.807 (GCS), 0.891 (PSAM), and 0.935 (manual segmentation). CONCLUSIONS: We identified two segmentation methods, ECC and PSAM, that achieve a high diagnostic accuracy when used in conjunction with a CAD system for classification of normal vs metastatic lymph nodes. The manual segmentations still achieve the highest diagnostic accuracy.

Simulation of nodules and diffuse infiltrates in chest radiographs using CT templates.

A method is proposed to simulate nodules and diffuse infiltrates in chest radiographs. This allows creation of large annotated databases for training of both radiologists and computer aided diagnosis systems. Realistic nodules and diffuse infiltrates were generated from three-dimensional templates segmented from CT data. These templates are rescaled, rotated, projected and superimposed on a radiograph. This method was compared, in an observer study, to a previously published method that simulates pulmonary nodules as perfectly spherical objects. Results show that it is hard for human observers to distinguish real and simulated nodules when using templates (AUC-values do not significantly differ from .5, p > .05 for all observers). The method that produced spherical nodules performed slightly worse (AUC of one observer differs significantly from .5, p = .011). Simulation of diffuse infiltrates is challenging but also feasible (AUC = 0.67 for one observer).