Incidence of lung nodules has surged due to improved lung cancer screening programs. Although localized microwave ablation (MWA) has been shown to be a minimally invasive safe, effective, cost and time efficient treatment for non-surgical candidates, it remains an underutilized curative modality for early-stage lung cancer patients, due in part to professed superiority of radiation for local tumor control, or prevention of local tumor progression (LTP). Identification of lesions that may be more amenable to effective MWA treatment may lead to improved outcomes. To aid physicians in optimizing patient selection, we developed a machine learning model to predict LTP after MWA treatment. Our model utilizes specialized 3D three-channel data: pre-ablation CT data (channel 1), post-ablation CT data depicting the resulting ablation zone (channel 2) and overlapping data of the tumor and ablation zone (channel 3). By spatially registering pre- and post-ablation CTs, we establish a clear spatial relationship between the tumor and ablation zone. Our neural network, trained on 55 MWA-treated lung-cancer patients, achieved a C-statistic (AUC) of 0.849 compared to 0.78 of prior approaches in 5-fold cross-validation. Notably, this performance was achieved without incorporating tabular features such as cancer type or ablation margin, highlighting strengths of the specialized 3D three-channels images. Combined with our past work, where we demonstrated the potential for accurate prediction of ablation zone boundaries during procedure planning, our research presents promising preliminary results for assisting physicians in predicting LTP following localized MWA treatment. The ability to identify good responders to MWA may provide a tool for patient selection, enhance patient outcome, and expand the utilization of this safe, effective treatment option.
The use of percutaneous and bronchoscopic microwave ablation to treat both primary and secondary lung tumors has been growing recently. These ablation systems are typically accompanied by an ablation planning system to optimize the treatment outcome by ensuring adequate margin in the expected ablation zone during the planning phase. The planning system utilizes pre-operative CT scan to identify the tumor and recommend microwave probe position. Radiomics is a process of converting medical images into higher-dimensional data and subsequent mining of data to reveal underlying pathophysiology for enhancing clinical decision support making. Radiomics analysis have shown promises in capturing distinct tumor characteristics and predicting prognosis of the tumor. Here, we present a new method to predict microwave ablation zones by supplementing a bioheat transfer model of microwave tissue ablation with microwave sensitive radiomics features. We hypothesize that supplementing traditional bioheat transfer modeling with microwave sensitive radiomics features will generate a more accurate and personalized ablation prediction that will lead to better treatment outcome. Inputs to the bioheat transfer modeling approach include the geometry of the target tumor, physical characteristics of the tissue, and dimensions of the microwave ablation applicator. The radiomics algorithm extracts characteristics of the targeted tumor’s size and shape, as well as texture characteristics, from pre-operative CT images. We employed cascaded segmentation based on RetinaNet and U-Net to obtain a tumor’s size and shape. Then, a segmented tumor is employed for texture analysis through a set of regression convolutional neural networks. These tumor characteristics are employed as radiomics features for more accurate dose prediction and margin for microwave ablation treatment. We present the preliminary results of a study using images from clinical lung tumor cases to predict ablation treatment outcome, with patient-specific tissue biophysical properties based on radiomics features.
Segmentation of pulmonary blood vessels from three-dimensional (3D) multi-detector CT (MDCT) images is
important for pulmonary applications. This work presents a method for extracting the vascular trees of the
pulmonary arteries and veins, applicable to both contrast-enhanced and unenhanced 3D MDCT image data.
The method finds 2D elliptical cross-sections and evaluates agreement of these cross-sections in consecutive
slices to find likely cross-sections. It next employs morphological multiscale analysis to separate vessels from
adjoining airway walls. The method then tracks the center of the likely cross-sections to connect them to the
pulmonary vessels in the mediastinum and forms connected vascular trees spanning both lungs. A ground-truth
study indicates that the method was able to detect on the order of 98% of the vessel branches having diameter
≥ 3.0 mm. The extracted vascular trees can be utilized for the guidance of safe bronchoscopic biopsy.
Accurate definition of the aorta and pulmonary artery from three-dimensional (3D) multi-detector CT (MDCT)
images is important for pulmonary applications. This work presents robust methods for defining the aorta and
pulmonary artery in the central chest. The methods work on both contrast enhanced and no-contrast 3D MDCT
image data. The automatic methods use a common approach employing model fitting and selection and adaptive
refinement. During the occasional event that more precise vascular extraction is desired or the method fails, we
also have an alternate semi-automatic fail-safe method. The semi-automatic method extracts the vasculature
by extending the medial axes into a user-guided direction. A ground-truth study over a series of 40 human 3D
MDCT images demonstrates the efficacy, accuracy, robustness, and efficiency of the methods.
Accurate definition of the central-chest vasculature from three-dimensional (3D) multi-detector CT (MDCT) images is important for pulmonary applications. For instance, the aorta and pulmonary artery help in automatic definition of the Mountain lymph-node stations for lung-cancer staging. This work presents a system for defining
major vascular structures in the central chest. The system provides automatic methods for extracting the aorta and pulmonary artery and semi-automatic methods for extracting the other major central chest arteries/veins, such as the superior vena cava and azygos vein. Automatic aorta and pulmonary artery extraction are performed
by model fitting and selection. The system also extracts certain vascular structure information to validate outputs. A semi-automatic method extracts vasculature by finding the medial axes between provided important sites. Results of the system are applied to lymph-node station definition and guidance of bronchoscopic biopsy.
KEYWORDS: 3D modeling, Computed tomography, 3D image processing, Model-based design, Data modeling, Image segmentation, Biopsy, Optimization (mathematics), Arteries, Lymphatic system
Bronchoscopic biopsy of the central-chest lymph nodes is vital in the staging of lung cancer. Three-dimensional
multi-detector CT (MDCT) images provide vivid anatomical detail for planning bronchoscopy. Unfortunately,
many lymph nodes are situated close to the aorta, and an inadvertent needle biopsy could puncture the aorta,
causing serious harm. As an eventual aid for more complete planning of lymph-node biopsy, it is important to
define the aorta. This paper proposes a method for extracting the aorta from a 3D MDCT chest image. The
method has two main phases: (1) Off-line Model Construction, which provides a set of training cases for fitting
new images, and (2) On-Line Aorta Construction, which is used for new incoming 3D MDCT images. Off-Line
Model Construction is done once using several representative human MDCT images and consists of the following
steps: construct a likelihood image, select control points of the medial axis of the aortic arch, and recompute
the control points to obtain a constant-interval medial-axis model. On-Line Aorta Construction consists of the
following operations: construct a likelihood image, perform global fitting of the precomputed models to the
current case's likelihood image to find the best fitting model, perform local fitting to adjust the medial axis
to local data variations, and employ a region recovery method to arrive at the complete constructed 3D aorta.
The region recovery method consists of two steps: model-based and region-growing steps. This region growing
method can recover regions outside the model coverage and non-circular tube structures. In our experiments,
we used three models and achieved satisfactory results on twelve of thirteen test cases.
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