Dynamic-Computed Tomography Angiography for Cerebral Vessel Templates and Segmentation
This work addresses segmentation challenges in medical imaging for neuroradiologists, but it is incremental as it applies existing deep learning methods to a new imaging modality.
The study tackled vessel segmentation in dynamic CTA for cerebrovascular disease diagnosis by developing and evaluating two techniques: atlas-based and deep learning segmentation, with deep learning outperforming atlas-based methods (e.g., average modified dice coefficient of 0.856 vs. 0.324 for arteries).
Background: Computed Tomography Angiography (CTA) is crucial for cerebrovascular disease diagnosis. Dynamic CTA is a type of imaging that captures temporal information about the We aim to develop and evaluate two segmentation techniques to segment vessels directly on CTA images: (1) creating and registering population-averaged vessel atlases and (2) using deep learning (DL). Methods: We retrieved 4D-CT of the head from our institutional research database, with bone and soft tissue subtracted from post-contrast images. An Advanced Normalization Tools pipeline was used to create angiographic atlases from 25 patients. Then, atlas-driven ROIs were identified by a CT attenuation threshold to generate segmentation of the arteries and veins using non-linear registration. To create DL vessel segmentations, arterial and venous structures were segmented using the MRA vessel segmentation tool, iCafe, in 29 patients. These were then used to train a DL model, with bone-in CT images as input. Multiple phase images in the 4D-CT were used to increase the training and validation dataset. Both segmentation approaches were evaluated on a test 4D-CT dataset of 11 patients which were also processed by iCafe and validated by a neuroradiologist. Specifically, branch-wise segmentation accuracy was quantified with 20 labels for arteries and one for veins. DL outperformed the atlas-based segmentation models for arteries (average modified dice coefficient (amDC) 0.856 vs. 0.324) and veins (amDC 0.743 vs. 0.495) overall. For ICAs, vertebral and basilar arteries, DL and atlas -based segmentation had an amDC of 0.913 and 0.402, respectively. The amDC for MCA-M1, PCA-P1, and ACA-A1 segments were 0.932 and 0.474, respectively. Conclusion: Angiographic CT templates are developed for the first time in literature. Using 4D-CTA enables the use of tools like iCafe, lessening the burden of manual annotation.