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Wang L, Fatemi M, Alizad A. Artificial intelligence techniques in liver cancer. Front Oncol 2024; 14:1415859. [PMID: 39290245 PMCID: PMC11405163 DOI: 10.3389/fonc.2024.1415859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/15/2024] [Indexed: 09/19/2024] Open
Abstract
Hepatocellular Carcinoma (HCC), the most common primary liver cancer, is a significant contributor to worldwide cancer-related deaths. Various medical imaging techniques, including computed tomography, magnetic resonance imaging, and ultrasound, play a crucial role in accurately evaluating HCC and formulating effective treatment plans. Artificial Intelligence (AI) technologies have demonstrated potential in supporting physicians by providing more accurate and consistent medical diagnoses. Recent advancements have led to the development of AI-based multi-modal prediction systems. These systems integrate medical imaging with other modalities, such as electronic health record reports and clinical parameters, to enhance the accuracy of predicting biological characteristics and prognosis, including those associated with HCC. These multi-modal prediction systems pave the way for predicting the response to transarterial chemoembolization and microvascular invasion treatments and can assist clinicians in identifying the optimal patients with HCC who could benefit from interventional therapy. This paper provides an overview of the latest AI-based medical imaging models developed for diagnosing and predicting HCC. It also explores the challenges and potential future directions related to the clinical application of AI techniques.
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Affiliation(s)
- Lulu Wang
- Department of Engineering, School of Technology, Reykjavık University, Reykjavík, Iceland
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Azra Alizad
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
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Chierici A, Lareyre F, Salucki B, Iannelli A, Delingette H, Raffort J. Vascular liver segmentation: a narrative review on methods and new insights brought by artificial intelligence. J Int Med Res 2024; 52:3000605241263170. [PMID: 39291427 PMCID: PMC11418557 DOI: 10.1177/03000605241263170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/28/2024] [Indexed: 09/19/2024] Open
Abstract
Liver vessel segmentation from routinely performed medical imaging is a useful tool for diagnosis, treatment planning and delivery, and prognosis evaluation for many diseases, particularly liver cancer. A precise representation of liver anatomy is crucial to define the extent of the disease and, when suitable, the consequent resective or ablative procedure, in order to guarantee a radical treatment without sacrificing an excessive volume of healthy liver. Once mainly performed manually, with notable cost in terms of time and human energies, vessel segmentation is currently realized through the application of artificial intelligence (AI), which has gained increased interest and development of the field. Many different AI-driven models adopted for this aim have been described and can be grouped into different categories: thresholding methods, edge- and region-based methods, model-based methods, and machine learning models. The latter includes neural network and deep learning models that now represent the principal algorithms exploited for vessel segmentation. The present narrative review describes how liver vessel segmentation can be realized through AI models, with a summary of model results in terms of accuracy, and an overview on the future progress of this topic.
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Affiliation(s)
- Andrea Chierici
- Department of Digestive Surgery, Hospital of Antibes Juan-les-Pins, Antibes, France
- Department of Digestive Surgery, University Hospital of Nice, Nice, France
- Université Côte d'Azur, Inria, Epione Team, Sophia Antipolis, France
| | - Fabien Lareyre
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, Antibes, France
- Université Côte d'Azur, Inserm U1065, C3M, Nice, France
| | - Benjamin Salucki
- Department of Digestive Surgery, Hospital of Antibes Juan-les-Pins, Antibes, France
| | - Antonio Iannelli
- Université Côte d'Azur, Inserm U1065, Team 8 “Hepatic complications of obesity and alcohol”, Nice, France
- ADIPOCIBLE Study Group, Université Côte d'Azur, Nice, France
| | - Hervé Delingette
- Université Côte d'Azur, Inria, Epione Team, Sophia Antipolis, France
| | - Juliette Raffort
- Université Côte d'Azur, Inserm U1065, C3M, Nice, France
- Clinical Chemistry Laboratory, University Hospital of Nice, Nice, France
- 3IA Institute, Université Côte d'Azur, Nice, France
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3
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Gross M, Huber S, Arora S, Ze'evi T, Haider SP, Kucukkaya AS, Iseke S, Kuhn TN, Gebauer B, Michallek F, Dewey M, Vilgrain V, Sartoris R, Ronot M, Jaffe A, Strazzabosco M, Chapiro J, Onofrey JA. Automated MRI liver segmentation for anatomical segmentation, liver volumetry, and the extraction of radiomics. Eur Radiol 2024; 34:5056-5065. [PMID: 38217704 PMCID: PMC11245591 DOI: 10.1007/s00330-023-10495-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/20/2023] [Accepted: 10/29/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES To develop and evaluate a deep convolutional neural network (DCNN) for automated liver segmentation, volumetry, and radiomic feature extraction on contrast-enhanced portal venous phase magnetic resonance imaging (MRI). MATERIALS AND METHODS This retrospective study included hepatocellular carcinoma patients from an institutional database with portal venous MRI. After manual segmentation, the data was randomly split into independent training, validation, and internal testing sets. From a collaborating institution, de-identified scans were used for external testing. The public LiverHccSeg dataset was used for further external validation. A 3D DCNN was trained to automatically segment the liver. Segmentation accuracy was quantified by the Dice similarity coefficient (DSC) with respect to manual segmentation. A Mann-Whitney U test was used to compare the internal and external test sets. Agreement of volumetry and radiomic features was assessed using the intraclass correlation coefficient (ICC). RESULTS In total, 470 patients met the inclusion criteria (63.9±8.2 years; 376 males) and 20 patients were used for external validation (41±12 years; 13 males). DSC segmentation accuracy of the DCNN was similarly high between the internal (0.97±0.01) and external (0.96±0.03) test sets (p=0.28) and demonstrated robust segmentation performance on public testing (0.93±0.03). Agreement of liver volumetry was satisfactory in the internal (ICC, 0.99), external (ICC, 0.97), and public (ICC, 0.85) test sets. Radiomic features demonstrated excellent agreement in the internal (mean ICC, 0.98±0.04), external (mean ICC, 0.94±0.10), and public (mean ICC, 0.91±0.09) datasets. CONCLUSION Automated liver segmentation yields robust and generalizable segmentation performance on MRI data and can be used for volumetry and radiomic feature extraction. CLINICAL RELEVANCE STATEMENT Liver volumetry, anatomic localization, and extraction of quantitative imaging biomarkers require accurate segmentation, but manual segmentation is time-consuming. A deep convolutional neural network demonstrates fast and accurate segmentation performance on T1-weighted portal venous MRI. KEY POINTS • This deep convolutional neural network yields robust and generalizable liver segmentation performance on internal, external, and public testing data. • Automated liver volumetry demonstrated excellent agreement with manual volumetry. • Automated liver segmentations can be used for robust and reproducible radiomic feature extraction.
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Affiliation(s)
- Moritz Gross
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Sandeep Arora
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Tal Ze'evi
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Stefan P Haider
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Otorhinolaryngology, University Hospital of Ludwig Maximilians Universität München, Munich, Germany
| | - Ahmet S Kucukkaya
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Iseke
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Tom Niklas Kuhn
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Diagnostic and Interventional Radiology, University Duesseldorf, Duesseldorf, Germany
| | - Bernhard Gebauer
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Michallek
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marc Dewey
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Valérie Vilgrain
- Université Paris Cité, Île-de-France, Paris, France
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Department of Radiology, Île-de-France, Clichy, France
| | - Riccardo Sartoris
- Université Paris Cité, Île-de-France, Paris, France
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Department of Radiology, Île-de-France, Clichy, France
| | - Maxime Ronot
- Université Paris Cité, Île-de-France, Paris, France
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Department of Radiology, Île-de-France, Clichy, France
| | - Ariel Jaffe
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Mario Strazzabosco
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - John A Onofrey
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA.
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Zecevic M, Hasenstab KA, Wang K, Dhyani M, Cunha GM. Signal Intensity Trajectories Clustering for Liver Vasculature Segmentation and Labeling (LiVaS) on Contrast-Enhanced MR Images: A Feasibility Pilot Study. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:873-883. [PMID: 38319438 PMCID: PMC11031533 DOI: 10.1007/s10278-024-00970-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/03/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024]
Abstract
This study aims to develop a semiautomated pipeline and user interface (LiVaS) for rapid segmentation and labeling of MRI liver vasculature and evaluate its time efficiency and accuracy against manual reference standard. Retrospective feasibility pilot study. Liver MR images from different scanners from 36 patients were included, and 4/36 patients were randomly selected for manual segmentation as referenced standard. The liver was segmented in each contrast phase and masks registered to the pre-contrast segmentation. Voxel-wise signal trajectories were clustered using the k-means algorithm. Voxel clusters that best segment the liver vessels were selected and labeled by three independent radiologists and a research scientist using LiVaS. Segmentation times were compared using a paired-sample t-test on log-transformed data. The agreement was analyzed qualitatively and quantitatively using DSC for hepatic and portal vein segmentations. The mean segmentation time among four readers was significantly shorter than manual (3.6 ± 1.4 vs. 70.0 ± 29.2 min; p < 0.001), even when using a higher number of clusters to enhance accuracy. The DSC for portal and hepatic veins reached up to 0.69 and 0.70, respectively. LiVaS segmentations were overall of good quality, with variations in performance related to the presence/severity of liver disease, acquisition timing, and image quality. Our semi-automated pipeline was robust to different MRI vendors in producing segmentation and labeling of liver vasculature in agreement with expert manual annotations, with significantly higher time efficiency. LiVaS could facilitate the creation of large, annotated datasets for training and validation of neural networks for automated MRI liver vascularity segmentation. HIGHLIGHTS: Key Finding: In this pilot feasibility study, our semiautomated pipeline for segmentation of liver vascularity (LiVaS) on MR images produced segmentations with simultaneous labeling of portal and hepatic veins in good agreement with the manual reference standard but at significantly shorter times (mean LiVaS 3.6 ± 1.4 vs. mean manual 70.0 ± 29.2 min; p < 0.001). Importance: LiVaS was robust in producing liver MRI vascular segmentations across images from different scanners in agreement with expert manual annotations, with significant ly higher time efficiency, and therefore potential scalability.
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Affiliation(s)
- Mladen Zecevic
- Department of Radiology, University of Washington, 1705 NE Pacific St, BB308, Seattle, WA, 98195, USA
| | - Kyle A Hasenstab
- Department of Mathematics and Statistics, San Diego State University, San Diego, CA, USA
| | - Kang Wang
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Manish Dhyani
- Department of Radiology, University of Washington, 1705 NE Pacific St, BB308, Seattle, WA, 98195, USA
| | - Guilherme Moura Cunha
- Department of Radiology, University of Washington, 1705 NE Pacific St, BB308, Seattle, WA, 98195, USA.
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Mervak BM, Fried JG, Wasnik AP. A Review of the Clinical Applications of Artificial Intelligence in Abdominal Imaging. Diagnostics (Basel) 2023; 13:2889. [PMID: 37761253 PMCID: PMC10529018 DOI: 10.3390/diagnostics13182889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/23/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Artificial intelligence (AI) has been a topic of substantial interest for radiologists in recent years. Although many of the first clinical applications were in the neuro, cardiothoracic, and breast imaging subspecialties, the number of investigated and real-world applications of body imaging has been increasing, with more than 30 FDA-approved algorithms now available for applications in the abdomen and pelvis. In this manuscript, we explore some of the fundamentals of artificial intelligence and machine learning, review major functions that AI algorithms may perform, introduce current and potential future applications of AI in abdominal imaging, provide a basic understanding of the pathways by which AI algorithms can receive FDA approval, and explore some of the challenges with the implementation of AI in clinical practice.
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Affiliation(s)
| | | | - Ashish P. Wasnik
- Department of Radiology, University of Michigan—Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA; (B.M.M.); (J.G.F.)
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Zbinden L, Catucci D, Suter Y, Berzigotti A, Ebner L, Christe A, Obmann VC, Sznitman R, Huber AT. Convolutional neural network for automated segmentation of the liver and its vessels on non-contrast T1 vibe Dixon acquisitions. Sci Rep 2022; 12:22059. [PMID: 36543852 PMCID: PMC9772168 DOI: 10.1038/s41598-022-26328-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
We evaluated the effectiveness of automated segmentation of the liver and its vessels with a convolutional neural network on non-contrast T1 vibe Dixon acquisitions. A dataset of non-contrast T1 vibe Dixon liver magnetic resonance images was labelled slice-by-slice for the outer liver border, portal, and hepatic veins by an expert. A 3D U-Net convolutional neural network was trained with different combinations of Dixon in-phase, opposed-phase, water, and fat reconstructions. The neural network trained with the single-modal in-phase reconstructions achieved a high performance for liver parenchyma (Dice 0.936 ± 0.02), portal veins (0.634 ± 0.09), and hepatic veins (0.532 ± 0.12) segmentation. No benefit of using multi-modal input was observed (p = 1.0 for all experiments), combining in-phase, opposed-phase, fat, and water reconstruction. Accuracy for differentiation between portal and hepatic veins was 99% for portal veins and 97% for hepatic veins in the central region and slightly lower in the peripheral region (91% for portal veins, 80% for hepatic veins). In conclusion, deep learning-based automated segmentation of the liver and its vessels on non-contrast T1 vibe Dixon was highly effective. The single-modal in-phase input achieved the best performance in segmentation and differentiation between portal and hepatic veins.
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Affiliation(s)
- Lukas Zbinden
- ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Damiano Catucci
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Yannick Suter
- ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | - Annalisa Berzigotti
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Verena Carola Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Raphael Sznitman
- ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | - Adrian Thomas Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland.
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Ultrasound-based navigation for open liver surgery using active liver tracking. Int J Comput Assist Radiol Surg 2022; 17:1765-1773. [PMID: 35622201 DOI: 10.1007/s11548-022-02659-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/25/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Despite extensive preoperative imaging, intraoperative localization of liver lesions after systemic treatment can be challenging. Therefore, an image-guided navigation setup is explored that links preoperative diagnostic scans and 3D models to intraoperative ultrasound (US), enabling overlay of detailed diagnostic images on intraoperative US. Aim of this study is to assess the workflow and accuracy of such a navigation system which compensates for liver motion. METHODS Electromagnetic (EM) tracking was used for organ tracking and movement of the transducer. After laparotomy, a sensor was attached to the liver surface while the EM-tracked US transducer enabled image acquisition and landmark digitization. Landmarks surrounding the lesion were selected during patient-specific preoperative 3D planning and identified for registration during surgery. Endpoints were accuracy and additional times of the investigative steps. Accuracy was computed at the center of the target lesion. RESULTS In total, 22 navigated procedures were performed. Navigation provided useful visualization of preoperative 3D models and their overlay on US imaging. Landmark-based registration resulted in a mean fiducial registration error of 10.3 ± 4.3 mm, and a mean target registration error of 8.5 ± 4.2 mm. Navigation was available after an average of 12.7 min. CONCLUSION We developed a navigation method combining ultrasound with active liver tracking for organ motion compensation, with an accuracy below 10 mm. Fixation of the liver sensor near the target lesion compensates for local movement and contributes to improved reliability during navigation. This represents an important step forward in providing surgical navigation throughout the procedure. TRIAL REGISTRATION This study is registered in the Netherlands Trial Register (number NL7951).
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8
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Zhang J, Wu F, Chang W, Kong D. Techniques and Algorithms for Hepatic Vessel Skeletonization in Medical Images: A Survey. ENTROPY (BASEL, SWITZERLAND) 2022; 24:465. [PMID: 35455128 PMCID: PMC9031516 DOI: 10.3390/e24040465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 02/01/2023]
Abstract
Hepatic vessel skeletonization serves as an important means of hepatic vascular analysis and vessel segmentation. This paper presents a survey of techniques and algorithms for hepatic vessel skeletonization in medical images. We summarized the latest developments and classical approaches in this field. These methods are classified into five categories according to their methodological characteristics. The overview and brief assessment of each category are provided in the corresponding chapters, respectively. We provide a comprehensive summary among the cited publications, image modalities and datasets from various aspects, which hope to reveal the pros and cons of every method, summarize its achievements and discuss the challenges and future trends.
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Affiliation(s)
- Jianfeng Zhang
- School of Mathematical Sciences, Zhejiang University, Hangzhou 310027, China; (J.Z.); (W.C.)
- College of Mathematical Medicine, Zhejiang Normal University, Jinhua 321004, China
| | - Fa Wu
- Zhejiang Demetics Medical Technology Co., Ltd., Hangzhou 310012, China;
| | - Wanru Chang
- School of Mathematical Sciences, Zhejiang University, Hangzhou 310027, China; (J.Z.); (W.C.)
| | - Dexing Kong
- School of Mathematical Sciences, Zhejiang University, Hangzhou 310027, China; (J.Z.); (W.C.)
- College of Mathematical Medicine, Zhejiang Normal University, Jinhua 321004, China
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Guo Q, Song H, Fan J, Ai D, Gao Y, Yu X, Yang J. Portal Vein and Hepatic Vein Segmentation in Multi-Phase MR Images Using Flow-Guided Change Detection. IEEE TRANSACTIONS ON IMAGE PROCESSING : A PUBLICATION OF THE IEEE SIGNAL PROCESSING SOCIETY 2022; 31:2503-2517. [PMID: 35275817 DOI: 10.1109/tip.2022.3157136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Segmenting portal vein (PV) and hepatic vein (HV) from magnetic resonance imaging (MRI) scans is important for hepatic tumor surgery. Compared with single phase-based methods, multiple phases-based methods have better scalability in distinguishing HV and PV by exploiting multi-phase information. However, these methods just coarsely extract HV and PV from different phase images. In this paper, we propose a unified framework to automatically and robustly segment 3D HV and PV from multi-phase MR images, which considers both the change and appearance caused by the vascular flow event to improve segmentation performance. Firstly, inspired by change detection, flow-guided change detection (FGCD) is designed to detect the changed voxels related to hepatic venous flow by generating hepatic venous phase map and clustering the map. The FGCD uniformly deals with HV and PV clustering by the proposed shared clustering, thus making the appearance correlated with portal venous flow robustly delineate without increasing framework complexity. Then, to refine vascular segmentation results produced by both HV and PV clustering, interclass decision making (IDM) is proposed by combining the overlapping region discrimination and neighborhood direction consistency. Finally, our framework is evaluated on multi-phase clinical MR images of the public dataset (TCGA) and local hospital dataset. The quantitative and qualitative evaluations show that our framework outperforms the existing methods.
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Hill CE, Biasiolli L, Robson MD, Grau V, Pavlides M. Emerging artificial intelligence applications in liver magnetic resonance imaging. World J Gastroenterol 2021; 27:6825-6843. [PMID: 34790009 PMCID: PMC8567471 DOI: 10.3748/wjg.v27.i40.6825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/16/2021] [Accepted: 09/30/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic liver diseases (CLDs) are becoming increasingly more prevalent in modern society. The use of imaging techniques for early detection, such as magnetic resonance imaging (MRI), is crucial in reducing the impact of these diseases on healthcare systems. Artificial intelligence (AI) algorithms have been shown over the past decade to excel at image-based analysis tasks such as detection and segmentation. When applied to liver MRI, they have the potential to improve clinical decision making, and increase throughput by automating analyses. With Liver diseases becoming more prevalent in society, the need to implement these techniques to utilize liver MRI to its full potential, is paramount. In this review, we report on the current methods and applications of AI methods in liver MRI, with a focus on machine learning and deep learning methods. We assess four main themes of segmentation, classification, image synthesis and artefact detection, and their respective potential in liver MRI and the wider clinic. We provide a brief explanation of some of the algorithms used and explore the current challenges affecting the field. Though there are many hurdles to overcome in implementing AI methods in the clinic, we conclude that AI methods have the potential to positively aid healthcare professionals for years to come.
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Affiliation(s)
- Charles E Hill
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - Luca Biasiolli
- Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
| | | | - Vicente Grau
- Department of Engineering, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - Michael Pavlides
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
- Translational Gastroenterology Unit, University of Oxford, Oxford OX3 9DU, United Kingdom
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford OX3 9DU, United Kingdom
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11
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Lee S, Summers RM. Clinical Artificial Intelligence Applications in Radiology: Chest and Abdomen. Radiol Clin North Am 2021; 59:987-1002. [PMID: 34689882 DOI: 10.1016/j.rcl.2021.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Organ segmentation, chest radiograph classification, and lung and liver nodule detections are some of the popular artificial intelligence (AI) tasks in chest and abdominal radiology due to the wide availability of public datasets. AI algorithms have achieved performance comparable to humans in less time for several organ segmentation tasks, and some lesion detection and classification tasks. This article introduces the current published articles of AI applied to chest and abdominal radiology, including organ segmentation, lesion detection, classification, and predicting prognosis.
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Affiliation(s)
- Sungwon Lee
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Building 10, Room 1C224D, 10 Center Drive, Bethesda, MD 20892-1182, USA
| | - Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Building 10, Room 1C224D, 10 Center Drive, Bethesda, MD 20892-1182, USA.
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12
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Nazir A, Cheema MN, Sheng B, Li P, Kim J, Lee TY. Living Donor-Recipient Pair Matching for Liver Transplant via Ternary Tree Representation With Cascade Incremental Learning. IEEE Trans Biomed Eng 2021; 68:2540-2551. [PMID: 33417536 DOI: 10.1109/tbme.2021.3050310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Visual understanding of liver vessels anatomy between the living donor-recipient (LDR) pair can assist surgeons to optimize transplant planning by avoiding non-targeted arteries which can cause severe complications. We propose to visually analyze the anatomical variants of the liver vessels anatomy to maximize similarity for finding a suitable Living Donor-Recipient (LDR) pair. Liver vessels are segmented from computed tomography angiography (CTA) volumes by employing a cascade incremental learning (CIL) model. Our CIL architecture is able to find optimal solutions, which we use to update the model with liver vessel CTA images. A novel ternary tree based algorithm is proposed to map all the possible liver vessel variants into their respective tree topologies. The tree topologies of the recipient's and donor's liver vessels are then used for an appropriate matching. The proposed algorithm utilizes a set of defined vessel tree variants which are updated to maintain the maximum matching options by leveraging the accurate segmentation results of the vessels derived from the incremental learning ability of the CIL. We introduce a novel concept of in-order digital string based comparison to match the geometry of two anatomically varied trees. Experiments through visual illustrations and quantitative analysis demonstrated the effectiveness of our approach compared to state-of-the-art.
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Smit JN, Kuhlmann KFD, Thomson BR, Kok NFM, Fusaglia M, Ruers TJM. Technical note: Validation of 3D ultrasound for image registration during oncological liver surgery. Med Phys 2021; 48:5694-5701. [PMID: 34224161 DOI: 10.1002/mp.15080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/21/2021] [Accepted: 06/09/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Registration of pre- and intraoperative images is a crucial step of surgical liver navigation, where rigid registration of vessel centerlines is currently commonly used. When using 3D ultrasound (US), accuracy during navigation might be influenced by the size of the intraoperative US volume, yet the relationship between registration accuracy and US volume size is understudied. In this study, we specify an optimal 3D US volume size for registration using varying volumes of liver vasculature. While previous studies measured accuracy at registered fiducials, in this work, accuracy is determined at the target lesion which is clinically the most relevant structure. METHODS Three-dimensional US volumes were acquired in 14 patients after laparotomy and liver mobilization. Manual segmentation of vasculature and centerline extraction was performed. Intraoperative and preoperative vasculature centerlines were registered with coherent point drift, using different sub-volumes (sphere with radius r = 30, 40, …, 120 mm). Accuracy was measured by fiducial registration error (FRE) between vessel centerlines and target registration error (TRE) at the center of the target lesion. RESULTS The lowest FRE for vessel registration was reached with r = 50 mm (6.5 ± 2.5 mm), the highest with r = 120 mm (7.1 ± 2.1 mm). Clinical accuracy at the target lesion, resulted most accurate (TRE = 8.8 ± 5.0 mm) in sub-volumes with a radius of 50 mm. Smaller US sub-volumes resulted in lower average TREs when compared to larger US sub-volumes (Pearson's correlation coefficient R = 0.91, p < 0.001). CONCLUSION Our results indicate that there is a linear correlation between US volume size and registration accuracy at the tumor. Volumes with radii of 50 mm around the target lesion yield higher accuracy (p < 0.05) (Trial number IRBd18032, 11 September 2018).
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Affiliation(s)
- Jasper N Smit
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Koert F D Kuhlmann
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Bart R Thomson
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Niels F M Kok
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Matteo Fusaglia
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Theo J M Ruers
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Faculty of Science and Technology (TNW), Nanobiophysics group (NBP), University of Twente, NB Enschede, The Netherlands
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Ivashchenko OV, Kuhlmann KFD, van Veen R, Pouw B, Kok NFM, Hoetjes NJ, Smit JN, Klompenhouwer EG, Nijkamp J, Ruers TJM. CBCT-based navigation system for open liver surgery: Accurate guidance toward mobile and deformable targets with a semi-rigid organ approximation and electromagnetic tracking of the liver. Med Phys 2021; 48:2145-2159. [PMID: 33666243 PMCID: PMC8251891 DOI: 10.1002/mp.14825] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose The surgical navigation system that provides guidance throughout the surgery can facilitate safer and more radical liver resections, but such a system should also be able to handle organ motion. This work investigates the accuracy of intraoperative surgical guidance during open liver resection, with a semi‐rigid organ approximation and electromagnetic tracking of the target area. Methods The suggested navigation technique incorporates a preoperative 3D liver model based on diagnostic 4D MRI scan, intraoperative contrast‐enhanced CBCT imaging and electromagnetic (EM) tracking of the liver surface, as well as surgical instruments, by means of six degrees‐of‐freedom micro‐EM sensors. Results The system was evaluated during surgeries with 35 patients and resulted in an accurate and intuitive real‐time visualization of liver anatomy and tumor's location, confirmed by intraoperative checks on visible anatomical landmarks. Based on accuracy measurements verified by intraoperative CBCT, the system’s average accuracy was 4.0 ± 3.0 mm, while the total surgical delay due to navigation stayed below 20 min. Conclusions The electromagnetic navigation system for open liver surgery developed in this work allows for accurate localization of liver lesions and critical anatomical structures surrounding the resection area, even when the liver was manipulated. However, further clinically integrating the method requires shortening the guidance‐related surgical delay, which can be achieved by shifting to faster intraoperative imaging like ultrasound. Our approach is adaptable to navigation on other mobile and deformable organs, and therefore may benefit various clinical applications.
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Affiliation(s)
- Oleksandra V Ivashchenko
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Koert F D Kuhlmann
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Ruben van Veen
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Bas Pouw
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Niels F M Kok
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Nikie J Hoetjes
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Jasper N Smit
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Elisabeth G Klompenhouwer
- Department of Radiology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Jasper Nijkamp
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Theodoor J M Ruers
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Faculty of Science and Technology (TNW), University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
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Ivashchenko OV, Smit JN, Nijkamp J, Ter Beek LC, Rijkhorst EJ, Kok NFM, Ruers TJM, Kuhlmann KFD. Clinical Implementation of In-House Developed MR-Based Patient-Specific 3D Models of Liver Anatomy. Eur Surg Res 2021; 61:143-152. [PMID: 33508828 DOI: 10.1159/000513335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/20/2020] [Indexed: 11/19/2022]
Abstract
Knowledge of patient-specific liver anatomy is key to patient safety during major hepatobiliary surgery. Three-dimensional (3D) models of patient-specific liver anatomy based on diagnostic MRI images can provide essential vascular and biliary anatomical insight during surgery. However, a method for generating these is not yet publicly available. This paper describes how these 3D models of the liver can be generated using open source software, and then subsequently integrated into a sterile surgical environment. The most common image quality aspects that degrade the quality of the 3D models as well possible ways of eliminating these are also discussed. Per patient, a single diagnostic multiphase MRI scan with hepatospecific contrast agent was used for automated segmentation of liver contour, arterial, portal, and venous anatomy, and the biliary tree. Subsequently, lesions were delineated manually. The resulting interactive 3D model could be accessed during surgery on a sterile covered tablet. Up to now, such models have been used in 335 surgical procedures. Their use simplified the surgical treatment of patients with a high number of liver metastases and contributed to the localization of vanished lesions in cases of a radiological complete response to neoadjuvant treatment. They facilitated perioperative verification of the relationship of tumors and the surrounding vascular and biliary anatomy, and eased decision-making before and during surgery.
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Affiliation(s)
- Oleksandra V Ivashchenko
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands, .,Department of Radiology, Leiden University Medical Center, Medical Physics Group, Leiden, The Netherlands,
| | - Jasper N Smit
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Jasper Nijkamp
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Leon C Ter Beek
- Department of Medical Physics and Technology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Erik-Jan Rijkhorst
- Department of Medical Physics and Technology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Niels F M Kok
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Theo J M Ruers
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Faculty of Science and Technology (TNW), Nanobiophysics Group (NBP), University of Twente, Enschede, The Netherlands
| | - Koert F D Kuhlmann
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Liu M, Vanguri R, Mutasa S, Ha R, Liu YC, Button T, Jambawalikar S. Channel width optimized neural networks for liver and vessel segmentation in liver iron quantification. Comput Biol Med 2020; 122:103798. [PMID: 32658724 DOI: 10.1016/j.compbiomed.2020.103798] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION MRI T2* relaxometry protocols are often used for Liver Iron Quantification in patients with hemochromatosis. Several methods exist to semi-automatically segment parenchyma and exclude vessels for this calculation. PURPOSE To determine if inclusion of multiple echoes inputs to Convolutional Neural Networks (CNN) improves automated liver and vessel segmentation in MRI T2* relaxometry protocols and to determine if the resultant segmentations agree with manual segmentations for liver iron quantification analysis. METHODS Multi echo Gradient Recalled Echo (GRE) MRI sequence for T2* relaxometry was performed for 79 exams on 31 patients with hemochromatosis for iron quantification analysis. 275 axial liver slices were manually segmented as ground truth masks. A batch normalized U-Net with variable input width to incorporate multiple echoes is used for segmentation, using DICE as the accuracy metric. ANOVA is used to evaluate significance of channel width changes in segmentation accuracy. Linear regression is used to model the relationship of channel width on segmentation accuracy. Liver segmentations are applied to relaxometry data to calculate liver T2* yielding liver iron concentration(LIC) derived from literature based calibration curves. Manual and CNN based LIC values are compared with Pearson correlation. Bland altman plots are used to visualize differences between manual and CNN based LIC values. RESULTS Performance metrics are tested on 55 hold out slices. Linear regression indicates that there is a monotonic increase of DICE with increasing channel depth (p = 0.001) with a slope of 3.61e-3. ANOVA indicates a significant increase segmentation accuracy over single channel starting at 3 channels. Incorporation of all channels results in an average DICE of 0.86, an average increase of 0.07 over single channel. The calculated LIC from CNN segmented livers agrees well with manual segmentation (R = 0.998, slope = 0.914, p«0.001), with an average absolute difference 0.27 ± 0.99 mg Fe/g or 1.34 ± 4.3%. CONCLUSION More input echoes yields higher model accuracy until the noise floor. Echos beyond the first three echo times in GRE based T2* relaxometry do not contribute significant information for segmentation of liver for LIC calculation. Deep learning models with three channel width allow for generalization of model to protocols of more than three echoes, effectively a universal requirement for relaxometry. Deep learning segmentations achieve a good accuracy compared with manual segmentations with minimal preprocessing. Liver iron values calculated from hand segmented liver and Neural network segmented liver were not statistically different from each other.
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Affiliation(s)
- Michael Liu
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY, 10032, USA.
| | - Rami Vanguri
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Simukayi Mutasa
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY, 10032, USA
| | - Richard Ha
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY, 10032, USA
| | - Yu-Cheng Liu
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY, 10032, USA
| | - Terry Button
- Department of Radiology, Stony Brook University, Stony Brook, NY, USA
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY, 10032, USA
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