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In this paper we present a system for segmenting medical images using statistical shape models (SSM's) which is landmark free, fully 3D, and accurate. To overcome the limitations associated with previous 3D landmark-based SSM's, our system creates a levelset-based SSM which uses the minimum distance from each voxel in the image to the object's surface to define a shape. Subsequently, an advanced statistical appearance model (SAM) is generated to model the object of interest. This SAM is based on a series of statistical texture features calculated from each image, modeled by a Gaussian Mixture Model. In order to segment the object of interest on a new image, a Bayesian classifier is first employed to pre-classify the image voxels as belonging to the foreground object of interest or the background. The result of the Bayesian classifier is then employed for optimally fitting the SSM so there is maximum agreement between the SAM and the SSM. The SAM is then able to adaptively learn the statistics of the textures of the foreground and background voxels on the new image. The fitting of the SSM, and the adaptive updating of the SAM is repeated until convergence. We have tested our system on 36 T2-w, 3.0 Tesla, in vivo, endorectal prostate images. The results showed that our system achieves a Dice similarity coefficient of .84±.04, with a median Dice value of .86, which is comparable (and in most cases superior) to other state of the art prostate segmentation systems. Further, unlike most other state of the art prostate segmentation schemes, our scheme is fully automated requiring no user intervention.

In magnetic resonance imaging (MRI), intensity inhomogeneity refers to an acquisition artifact which introduces a non-linear variation in the signal intensities within the image. Intensity inhomogeneity is known to significantly affect computerized analysis of MRI data (such as automated segmentation or classification procedures), hence requiring the application of bias field correction (BFC) algorithms to account for this artifact. Quantitative evaluation of BFC schemes is typically performed using generalized intensity-based measures (percent coefficient of variation, %CV ) or information-theoretic measures (entropy). While some investigators have previously empirically compared BFC schemes in the context of different domains (using changes in %CV and entropy to quantify improvements), no consensus has emerged as to the best BFC scheme for any given application. The motivation for this work is that the choice of a BFC scheme for a given application should be dictated by application-specific measures rather than ad hoc measures such as entropy and %CV. In this paper, we have attempted to address the problem of determining an optimal BFC algorithm in the context of a computer-aided diagnosis (CAD) scheme for prostate cancer (CaP) detection from T2-weighted (T2w) MRI. One goal of this work is to identify a BFC algorithm that will maximize the CaP classification accuracy (measured in terms of the area under the ROC curve or AUC). A secondary aim of our work is to determine whether measures such as %CV and entropy are correlated with a classifier-based objective measure (AUC). Determining the presence or absence of these correlations is important to understand whether domain independent BFC performance measures such as %CV , entropy should be used to identify the optimal BFC scheme for any given application. In order to answer these questions, we quantitatively compared 3 different popular BFC algorithms on a cohort of 10 clinical 3 Tesla prostate T2w MRI datasets (comprising 39 2D MRI slices): N3 , PABIC, and the method of Cohen et al. Results of BFC via each of the algorithms was evaluated in terms of %CV , entropy, as well as classifier AUC for CaP detection from T2w MRI. The CaP classifier was trained and evaluated on a per-pixel basis using annotations of CaP obtained via registration of T2w MRI and ex vivo whole-mount histology sections. Our results revealed that different BFC schemes resulted in a maximization of different performance measures, that is, the BFC scheme identified by minimization of %CV and entropy was not the one that maximized AUC as well. Moreover, existing BFC evaluation measures (%CV , entropy) did not correlate with AUC (application-based evaluation), but did correlate with each other, suggesting that domain-specific performance measures should be considered in making a decision regarding choice of appropriate BFC scheme. Our results also revealed that N3 provided the best correction of bias field artifacts in prostate MRI data, when the goal was to identify prostate cancer.

Currently, there is significant interest in developing methods for quantitative integration of multi-parametric (structural, functional) imaging data with the objective of building automated meta-classifiers to improve disease detection, diagnosis, and prognosis. Such techniques are required to address the differences in dimensionalities and scales of individual protocols, while deriving an integrated multi-parametric data representation which best captures all disease-pertinent information available. In this paper, we present a scheme called Enhanced Multi-Protocol Analysis via Intelligent Supervised Embedding (EMPrAvISE); a powerful, generalizable framework applicable to a variety of domains for multi-parametric data representation and fusion. Our scheme utilizes an ensemble of embeddings (via dimensionality reduction, DR); thereby exploiting the variance amongst multiple uncorrelated embeddings in a manner similar to ensemble classifier schemes (e.g. Bagging, Boosting). We apply this framework to the problem of prostate cancer (CaP) detection on 12 3 Tesla pre-operative in vivo multi-parametric (T2-weighted, Dynamic Contrast Enhanced, and Diffusion-weighted) magnetic resonance imaging (MRI) studies, in turn comprising a total of 39 2D planar MR images. We first align the different imaging protocols via automated image registration, followed by quantification of image attributes from individual protocols. Multiple embeddings are generated from the resultant high-dimensional feature space which are then combined intelligently to yield a single stable solution. Our scheme is employed in conjunction with graph embedding (for DR) and probabilistic boosting trees (PBTs) to detect CaP on multi-parametric MRI. Finally, a probabilistic pairwise Markov Random Field algorithm is used to apply spatial constraints to the result of the PBT classifier, yielding a per-voxel classification of CaP presence. Per-voxel evaluation of detection results against ground truth for CaP extent on MRI (obtained by spatially registering pre-operative MRI with available whole-mount histological specimens) reveals that EMPrAvISE yields a statistically significant improvement (AUC=0.77) over classifiers constructed from individual protocols (AUC=0.62, 0.62, 0.65, for T2w, DCE, DWI respectively) as well as one trained using multi-parametric feature concatenation (AUC=0.67).

With improved survival outcomes after pediatric liver transplantation (LT), health-related quality of life (HRQoL) is an important outcome metric. Understanding the elements contributing to HRQoL after LT in children would enable more targeted strategies towards optimizing best outcomes. This qualitative study aimed to explore health care providers (HCP) perceptions about HRQoL after pediatric LT. Thirteen experienced HCP participated in two focus group discussions. Data analysis via a thematic analysis approach revealed 4 major themes: “LT as a facilitator of better HRQoL,” “coping and adapting to LT,” “living with a transplanted liver,” and “the family context.” HCP identified elements that both enhance (improved physical health, peer relationship, and activities of daily living) and challenge (need for immunosuppression, transplant follow-up, and restrictions) the multidimensional domains of HRQoL. HCP perceived LT to be a stressful life-changing event for children and their families. Patients and their parents’ ability to cope and adjust positively to LT was perceived as a key contributor to better HRQoL. HCP perspective highlights the importance of promoting psychosocial support and a family-centered care delivery model towards the overarching goal of optimizing durable outcomes.