DRAMMS: deformable registration via attribute matching and mutual-saliency weighting

Phase II study of tivozanib, an oral VEGFR inhibitor, in patients with recurrent glioblastoma

Targeting tumor angiogenesis is a potential therapeutic strategy for glioblastoma because of its high vascularization. Tivozanib is an oral pan-VEGF receptor tyrosine kinase inhibitor that hits a central pathway in glioblastoma angiogenesis. We conducted a phase II study to test the effectiveness of tivozanib in patients with recurrent glioblastoma. Ten adult patients were enrolled and treated with tivozanib 1.5 mg daily, 3 weeks on/1 week off in 28-day cycles. Brain MRI and blood biomarkers of angiogenesis were performed at baseline, within 24-72 h of treatment initiation, and monthly thereafter. Dynamic contrast enhanced MRI, dynamic susceptibility contrast MRI, and vessel architecture imaging were used to assess vascular effects. Resting state MRI was used to assess brain connectivity. Best RANO criteria responses were: 1 complete response, 1 partial response, 4 stable diseases, and 4 progressive disease (PD). Two patients were taken off study for toxicity and 8 patients were taken off study for PD. Median progression-free survival was 2.3 months and median overall survival was 8.1 months. Baseline abnormal tumor vascular permeability, blood flow, tissue oxygenation and plasma sVEGFR2 significantly decreased and plasma PlGF and VEGF increased after treatment, suggesting an anti-angiogenic effect of tivozanib. However, there were no clear structural changes in vasculature as vessel caliber and enhancing tumor volume did not significantly change. Despite functional changes in tumor vasculature, tivozanib had limited anti-tumor activity, highlighting the limitations of anti-VEGF monotherapy. Future studies in glioblastoma should leverage the anti-vascular activity of agents targeting VEGF to enhance the activity of other therapies.

Morphological covariance in anatomical MRI scans can identify discrete neural pathways in the brain and their disturbances in persons with neuropsychiatric disorders

We hypothesize that coordinated functional activity within discrete neural circuits induces morphological organization and plasticity within those circuits. Identifying regions of morphological covariation that are independent of morphological covariation in other regions therefore may therefore allow us to identify discrete neural systems within the brain. Comparing the magnitude of these variations in individuals who have psychiatric disorders with the magnitude of variations in healthy controls may allow us to identify aberrant neural pathways in psychiatric illnesses. We measured surface morphological features by applying nonlinear, high-dimensional warping algorithms to manually defined brain regions. We transferred those measures onto the surface of a unit sphere via conformal mapping and then used spherical wavelets and their scaling coefficients to simplify the data structure representing these surface morphological features of each brain region. We used principal component analysis (PCA) to calculate covariation in these morphological measures, as represented by their scaling coefficients, across several brain regions. We then assessed whether brain subregions that covaried in morphology, as identified by large eigenvalues in the PCA, identified specific neural pathways of the brain. To do so, we spatially registered the subnuclei for each eigenvector into the coordinate space of a Diffusion Tensor Imaging dataset; we used these subnuclei as seed regions to track and compare fiber pathways with known fiber pathways identified in neuroanatomical atlases. We applied these procedures to anatomical MRI data in a cohort of 82 healthy participants (42 children, 18 males, age 10.5 ± 2.43 years; 40 adults, 22 males, age 32.42 ± 10.7 years) and 107 participants with Tourette's Syndrome (TS) (71 children, 59 males, age 11.19 ± 2.2 years; 36 adults, 21 males, age 37.34 ± 10.9 years). We evaluated the construct validity of the identified covariation in morphology using DTI data from a different set of 20 healthy adults (10 males, mean age 29.7 ± 7.7 years). The PCA identified portions of structures that covaried across the brain, the eigenvalues measuring the magnitude of the covariation in morphology along the respective eigenvectors. Our results showed that the eigenvectors, and the DTI fibers tracked from their associated brain regions, corresponded with known neural pathways in the brain. In addition, the eigenvectors that captured morphological covariation across regions, and the principal components along those eigenvectors, identified neural pathways with aberrant morphological features associated with TS. These findings suggest that covariations in brain morphology can identify aberrant neural pathways in specific neuropsychiatric disorders.

PDM-ENLOR for segmentation of mouse brain gene expression images

Statistical shape models, such as Active Shape Models (ASMs), suffer from their inability to represent a large range of variations of a complex shape and to account for the large errors in detection of (point) landmarks. We propose a method, PDM-ENLOR (Point Distribution Model-based ENsemble of LOcal Regressors), that overcomes these limitations by locating each landmark individually using an ensemble of local regression models and appearance cues from selected landmarks. We first detect a set of reference landmarks which were selected based on their saliency during training. For each landmark, an ensemble of regressors is built. From the locations of the detected reference landmarks, each regressor infers a candidate location for that landmark using local geometric constraints, encoded by a point distribution model (PDM). The final location of that point is determined as a weighted linear combination, whose coefficients are learned from the training data, of candidates proposed by its ensemble's component regressors. We use multiple subsets of reference landmarks as explanatory variables for the component regressors to provide varying degrees of locality for the models in each ensemble. This helps our ensemble model to capture a larger range of shape variations as compared to a single PDM. We demonstrate the advantages of our method on the challenging problem of segmenting gene expression images of mouse brain. The overall mean and standard deviation of the Dice coefficient overlap over all 14 anatomical regions and all 100 test images were (88.1 ± 9.5)%.

Deformable registration for quantifying longitudinal tumor changes during neoadjuvant chemotherapy

PURPOSE

To evaluate DRAMMS, an attribute-based deformable registration algorithm, compared to other intensity-based algorithms, for longitudinal breast MRI registration, and to show its applicability in quantifying tumor changes over the course of neoadjuvant chemotherapy.

METHODS

Breast magnetic resonance images from 14 women undergoing neoadjuvant chemotherapy were analyzed. The accuracy of DRAMMS versus five intensity-based deformable registration methods was evaluated based on 2,380 landmarks independently annotated by two experts, for the entire image volume, different image subregions, and patient subgroups. The registration method with the smallest landmark error was used to quantify tumor changes, by calculating the Jacobian determinant maps of the registration deformation.

RESULTS

DRAMMS had the smallest landmark errors (6.05 ± 4.86 mm), followed by the intensity-based methods CC-FFD (8.07 ± 3.86 mm), NMI-FFD (8.21 ± 3.81 mm), SSD-FFD (9.46 ± 4.55 mm), Demons (10.76 ± 6.01 mm), and Diffeomorphic Demons (10.82 ± 6.11 mm). Results show that registration accuracy also depends on tumor versus normal tissue regions and different patient subgroups.

CONCLUSIONS

The DRAMMS deformable registration method, driven by attribute-matching and mutual-saliency, can register longitudinal breast magnetic resonance images with a higher accuracy than several intensity-matching methods included in this article. As such, it could be valuable for more accurately quantifying heterogeneous tumor changes as a marker of response to treatment.

Anatomical brain images alone can accurately diagnose chronic neuropsychiatric illnesses

Objective

Diagnoses using imaging-based measures alone offer the hope of improving the accuracy of clinical diagnosis, thereby reducing the costs associated with incorrect treatments. Previous attempts to use brain imaging for diagnosis, however, have had only limited success in diagnosing patients who are independent of the samples used to derive the diagnostic algorithms. We aimed to develop a classification algorithm that can accurately diagnose chronic, well-characterized neuropsychiatric illness in single individuals, given the availability of sufficiently precise delineations of brain regions across several neural systems in anatomical MR images of the brain.

Methods

We have developed an automated method to diagnose individuals as having one of various neuropsychiatric illnesses using only anatomical MRI scans. The method employs a semi-supervised learning algorithm that discovers natural groupings of brains based on the spatial patterns of variation in the morphology of the cerebral cortex and other brain regions. We used split-half and leave-one-out cross-validation analyses in large MRI datasets to assess the reproducibility and diagnostic accuracy of those groupings.

Results

In MRI datasets from persons with Attention-Deficit/Hyperactivity Disorder, Schizophrenia, Tourette Syndrome, Bipolar Disorder, or persons at high or low familial risk for Major Depressive Disorder, our method discriminated with high specificity and nearly perfect sensitivity the brains of persons who had one specific neuropsychiatric disorder from the brains of healthy participants and the brains of persons who had a different neuropsychiatric disorder.

Conclusions

Although the classification algorithm presupposes the availability of precisely delineated brain regions, our findings suggest that patterns of morphological variation across brain surfaces, extracted from MRI scans alone, can successfully diagnose the presence of chronic neuropsychiatric disorders. Extensions of these methods are likely to provide biomarkers that will aid in identifying biological subtypes of those disorders, predicting disease course, and individualizing treatments for a wide range of neuropsychiatric illnesses.

Deformable medical image registration: setting the state of the art with discrete methods

This review introduces a novel deformable image registration paradigm that exploits Markov random field formulation and powerful discrete optimization algorithms. We express deformable registration as a minimal cost graph problem, where nodes correspond to the deformation grid, a node's connectivity corresponds to regularization constraints, and labels correspond to 3D deformations. To cope with both iconic and geometric (landmark-based) registration, we introduce two graphical models, one for each subproblem. The two graphs share interconnected variables, leading to a modular, powerful, and flexible formulation that can account for arbitrary image-matching criteria, various local deformation models, and regularization constraints. To cope with the corresponding optimization problem, we adopt two optimization strategies: a computationally efficient one and a tight relaxation alternative. Promising results demonstrate the potential of this approach. Discrete methods are an important new trend in medical image registration, as they provide several improvements over the more traditional continuous methods. This is illustrated with several key examples where the presented framework outperforms existing general-purpose registration methods in terms of both performance and computational complexity. Our methods become of particular interest in applications where computation time is a critical issue, as in intraoperative imaging, or where the huge variation in data demands complex and application-specific matching criteria, as in large-scale multimodal population studies. The proposed registration framework, along with a graphical interface and corresponding publications, is available for download for research purposes (for Windows and Linux platforms) from http://www.mrf-registration.net.

Similarity-based appearance-prior for fitting a subdivision mesh in gene expression images

Automated segmentation of multi-part anatomical objects in images is a challenging task. In this paper, we propose a similarity-based appearance-prior to fit a compartmental geometric atlas of the mouse brain in gene expression images. A subdivision mesh which is used to model the geometry is deformed using a Markov random field (MRF) framework. The proposed appearance-prior is computed as a function of the similarity between local patches at corresponding atlas locations from two images. In addition, we introduce a similarity-saliency score to select the mesh points that are relevant for the computation of the proposed prior. Our method significantly improves the accuracy of the atlas fitting, especially in the regions that are influenced by the selected similarity-salient points, and outperforms the previous subdivision mesh fitting methods for gene expression images.

DRAMMS: Deformable registration via attribute matching and mutual-saliency weighting

A general-purpose deformable registration algorithm referred to as "DRAMMS" is presented in this paper. DRAMMS bridges the gap between the traditional voxel-wise methods and landmark/feature-based methods with primarily two contributions. First, DRAMMS renders each voxel relatively distinctively identifiable by a rich set of attributes, therefore largely reducing matching ambiguities. In particular, a set of multi-scale and multi-orientation Gabor attributes are extracted and the optimal components are selected, so that they form a highly distinctive morphological signature reflecting the anatomical and geometric context around each voxel. Moreover, the way in which the optimal Gabor attributes are constructed is independent of the underlying image modalities or contents, which renders DRAMMS generally applicable to diverse registration tasks. A second contribution of DRAMMS is that it modulates the registration by assigning higher weights to those voxels having higher ability to establish unique (hence reliable) correspondences across images, therefore reducing the negative impact of those regions that are less capable of finding correspondences (such as outlier regions). A continuously-valued weighting function named "mutual-saliency" is developed to reflect the matching uniqueness between a pair of voxels implied by the tentative transformation. As a result, voxels do not contribute equally as in most voxel-wise methods, nor in isolation as in landmark/feature-based methods. Instead, they contribute according to the continuously-valued mutual-saliency map, which dynamically evolves during the registration process. Experiments in simulated images, inter-subject images, single-/multi-modality images, from brain, heart, and prostate have demonstrated the general applicability and the accuracy of DRAMMS.

3D Non-rigid Registration Using Surface and Local Salient Features for Transrectal Ultrasound Image-guided Prostate Biopsy

We present a 3D non-rigid registration algorithm for the potential use in combining PET/CT and transrectal ultrasound (TRUS) images for targeted prostate biopsy. Our registration is a hybrid approach that simultaneously optimizes the similarities from point-based registration and volume matching methods. The 3D registration is obtained by minimizing the distances of corresponding points at the surface and within the prostate and by maximizing the overlap ratio of the bladder neck on both images. The hybrid approach not only capture deformation at the prostate surface and internal landmarks but also the deformation at the bladder neck regions. The registration uses a soft assignment and deterministic annealing process. The correspondences are iteratively established in a fuzzy-to-deterministic approach. B-splines are used to generate a smooth non-rigid spatial transformation. In this study, we tested our registration with pre- and post-biopsy TRUS images of the same patients. Registration accuracy is evaluated using manual defined anatomic landmarks, i.e. calcification. The root-mean-squared (RMS) of the difference image between the reference and floating images was decreased by 62.6±9.1% after registration. The mean target registration error (TRE) was 0.88±0.16 mm, i.e. less than 3 voxels with a voxel size of 0.38×0.38×0.38 mm3 for all five patients. The experimental results demonstrate the robustness and accuracy of the 3D non-rigid registration algorithm.

Simultaneous geometric--iconic registration

In this paper, we introduce a novel approach to bridge the gap between the landmark-based and the iconic-based voxel-wise registration methods. The registration problem is formulated with the use of Markov Random Field theory resulting in a discrete objective function consisting of thee parts. The first part of the energy accounts for the iconic-based volumetric registration problem while the second one for establishing geometrically meaningful correspondences by optimizing over a set of automatically generated mutually salient candidate pairs of points. The last part of the energy penalizes locally the difference between the dense deformation field due to the iconic-based registration and the implied displacements due to the obtained correspondences. Promising results in real MR brain data demonstrate the potentials of our approach.

GRAM: A framework for geodesic registration on anatomical manifolds

Medical image registration is a challenging problem, especially when there is large anatomical variation in the anatomies. Geodesic registration methods have been proposed to solve the large deformation registration problem. However, analytically defined geodesic paths may not coincide with biologically plausible paths of registration, since the manifold of diffeomorphisms is immensely broader than the manifold spanned by diffeomorphisms between real anatomies. In this paper, we propose a novel framework for large deformation registration using the learned manifold of anatomical variation in the data. In this framework, a large deformation between two images is decomposed into a series of small deformations along the shortest path on an empirical manifold that represents anatomical variation. Using a manifold learning technique, the major variation of the data can be visualized by a low-dimensional embedding, and the optimal group template is chosen as the geodesic mean on the manifold. We demonstrate the advantages of the proposed framework over direct registration with both simulated and real databases of brain images.

Sampling the spatial patterns of cancer: optimized biopsy procedures for estimating prostate cancer volume and Gleason Score

Prostate biopsy is the current gold-standard procedure for prostate cancer diagnosis. Existing prostate biopsy procedures have been mostly focusing on detecting cancer presence. However, they often ignore the potential use of biopsy to estimate cancer volume (CV) and Gleason Score (GS, a cancer grade descriptor), the two surrogate markers for cancer aggressiveness and the two crucial factors for treatment planning. To fill up this vacancy, this paper assumes and demonstrates that, by optimally sampling the spatial patterns of cancer, biopsy procedures can be specifically designed for estimating CV and GS. Our approach combines image analysis and machine learning tools in an atlas-based population study that consists of three steps. First, the spatial distributions of cancer in a patient population are learned, by constructing statistical atlases from histological images of prostate specimens with known cancer ground truths. Then, the optimal biopsy locations are determined in a feature selection formulation, so that biopsy outcomes (either cancer presence or absence) at those locations could be used to differentiate, at the best rate, between the existing specimens having different (high vs. low) CV/GS values. Finally, the optimized biopsy locations are utilized to estimate whether a new-coming prostate cancer patient has high or low CV/GS values, based on a binary classification formulation. The estimation accuracy and the generalization ability are evaluated by the classification rates and the associated receiver-operating-characteristic (ROC) curves in cross validations. The optimized biopsy procedures are also designed to be robust to the almost inevitable needle displacement errors in clinical practice, and are found to be robust to variations in the optimization parameters as well as the training populations.

Nonrigid Registration of Brain Tumor Resection MR Images Based on Joint Saliency Map and Keypoint Clustering

This paper proposes a novel global-to-local nonrigid brain MR image registration to compensate for the brain shift and the unmatchable outliers caused by the tumor resection. The mutual information between the corresponding salient structures, which are enhanced by the joint saliency map (JSM), is maximized to achieve a global rigid registration of the two images. Being detected and clustered at the paired contiguous matching areas in the globally registered images, the paired pools of DoG keypoints in combination with the JSM provide a useful cluster-to-cluster correspondence to guide the local control-point correspondence detection and the outlier keypoint rejection. Lastly, a quasi-inverse consistent deformation is smoothly approximated to locally register brain images through the mapping the clustered control points by compact support radial basis functions. The 2D implementation of the method can model the brain shift in brain tumor resection MR images, though the theory holds for the 3D case.