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Su X, Wang Y, Chu H, Jiang L, Yan Y, Qiao X, Yu J, Guo K, Zong Y, Wan M. Low-rank prior-based Fast-RPCA for clutter filtering and noise suppression in non-contrast ultrasound microvascular imaging. ULTRASONICS 2024; 142:107379. [PMID: 38981172 DOI: 10.1016/j.ultras.2024.107379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/21/2024] [Accepted: 06/07/2024] [Indexed: 07/11/2024]
Abstract
Accurate and real-time separation of blood signal from clutter and noise signals is a critical step in clinical non-contrast ultrasound microvascular imaging. Despite the widespread adoption of singular value decomposition (SVD) and robust principal component analysis (RPCA) for clutter filtering and noise suppression, the SVD's sensitivity to threshold selection, along with the RPCA's limitations in undersampling conditions and heavy computational burden often result in suboptimal performance in complex clinical applications. To address those challenges, this study presents a novel low-rank prior-based fast RPCA (LP-fRPCA) approach to enhance the adaptability and robustness of clutter filtering and noise suppression with reduced computational cost. A low-rank prior constraint is integrated into the non-convex RPCA model to achieve a robust and efficient approximation of clutter subspace, while an accelerated alternating projection iterative algorithm is developed to improve convergence speed and computational efficiency. The performance of the LP-fRPCA method was evaluated against SVD with a tissue/blood threshold (SVD1), SVD with both tissue/blood and blood/noise thresholds (SVD2), and the classical RPCA based on the alternating direction method of multipliers algorithm through phantom and in vivo non-contrast experiments on rabbit kidneys. In the slow flow phantom experiment of 0.2 mm/s, LP-fRPCA achieved an average increase in contrast ratio (CR) of 10.68 dB, 9.37 dB, and 8.66 dB compared to SVD1, SVD2, and RPCA, respectively. In the in vivo rabbit kidney experiment, the power Doppler results demonstrate that the LP-fRPCA method achieved a superior balance in the trade-off between insufficient clutter filtering and excessive suppression of blood flow. Additionally, LP-fRPCA significantly reduced the runtime of RPCA by up to 94-fold. Consequently, the LP-fRPCA method promises to be a potential tool for clinical non-contrast ultrasound microvascular imaging.
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Affiliation(s)
- Xiao Su
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Yueyuan Wang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Hanbing Chu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Liyuan Jiang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Yadi Yan
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Xiaoyang Qiao
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Jianjun Yu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Kaitai Guo
- School of Electronic Engineering, Xidian University, Xi'an, 710071, China
| | - Yujin Zong
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Mingxi Wan
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.
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Huang Y, Chen X, Badescu E, Kuenen M, Bonnefous O, Mischi M. Adaptive higher-order singular value decomposition clutter filter for ultrafast Doppler imaging of coronary flow under non-negligible tissue motion. ULTRASONICS 2024; 140:107307. [PMID: 38579486 DOI: 10.1016/j.ultras.2024.107307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/24/2024] [Accepted: 03/23/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND AND OBJECTIVE With the development of advanced clutter-filtering techniques by singular value decomposition (SVD) and leveraging favorable acquisition settings such as open-chest imaging by a linear high-frequency probe and plane waves, several studies have shown the feasibility of cardiac flow measurements during the entire cardiac cycle, ranging from coronary flow to myocardial perfusion. When applying these techniques in a routine clinical setting, using transthoracic ultrasound imaging, new challenges emerge. Firstly, a smaller aperture is needed that can fit between ribs. Consequently, diverging waves are employed instead of plane waves to achieve an adequate field of view. Secondly, to ensure imaging at a larger depth, the maximum pulse repetition frequency has to be reduced. Lastly, in comparison to the open-chest scenario, tissue motion induced by the heartbeat is significantly stronger. The latter complicates substantially the distinction between clutter and blood signals. METHODS This study investigates a strategy to overcome these challenges by diverging wave imaging with an optimal number of tilt angles, in combination with dedicated clutter-filtering techniques. In particular, a novel, adaptive, higher-order SVD (HOSVD) clutter filter, which utilizes spatial, temporal, and angular information of the received ultrasound signals, is proposed to enhance clutter and blood separation. RESULTS When non-negligible tissue motion is present, using fewer tilt angles not only reduces the decorrelation between the received waveforms but also allows for collecting more temporal samples at a given ensemble duration, contributing to improved Doppler performance. The addition of a third angular dimension enables the application of HOSVD, providing greater flexibility in selecting blood separation thresholds from a 3-D tensor. This differs from the conventional threshold selection method in a 2-D spatiotemporal space using SVD. Exhaustive threshold search has shown a significant improvement in Contrast and Contrast-to-Noise ratio for Power Doppler images filtered with HOSVD compared to the SVD-based clutter filter. CONCLUSION With the improved settings, the obtained Power Doppler images show the feasibility of measuring coronary flow under the influence of non-negligible tissue motion in both in vitro and ex vivo.
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Affiliation(s)
- Yizhou Huang
- Lab. of Biomedical Diagnostics, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Xufei Chen
- Lab. of Biomedical Diagnostics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | | | | | - Massimo Mischi
- Lab. of Biomedical Diagnostics, Eindhoven University of Technology, Eindhoven, The Netherlands
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Kiernan MJ, Al Mukaddim R, Mitchell CC, Maybock J, Wilbrand SM, Dempsey RJ, Varghese T. Lumen segmentation using a Mask R-CNN in carotid arteries with stenotic atherosclerotic plaque. ULTRASONICS 2024; 137:107193. [PMID: 37952384 PMCID: PMC10841729 DOI: 10.1016/j.ultras.2023.107193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/19/2023] [Accepted: 10/29/2023] [Indexed: 11/14/2023]
Abstract
In patients at high risk for ischemic stroke, clinical carotid ultrasound is often used to grade stenosis, determine plaque burden and assess stroke risk. Analysis currently requires a trained sonographer to manually identify vessel and plaque regions, which is time and labor intensive. We present a method for automatically determining bounding boxes and lumen segmentation using a Mask R-CNN network trained on sonographer assisted ground-truth carotid lumen segmentations. Automatic lumen segmentation also lays the groundwork for developing methods for accurate plaque segmentation, and wall thickness measurements in cases with no plaque. Different training schemes are used to identify the Mask R-CNN model with the highest accuracy. Utilizing a single-channel B-mode training input, our model produces a mean bounding box intersection over union (IoU) of 0.81 and a mean lumen segmentation IoU of 0.75. However, we encountered errors in prediction when the jugular vein is the most prominently visualized vessel in the B-mode image. This was due to the fact that our dataset has limited instances of B-mode images with both the jugular vein and carotid artery where the vein is dominantly visualized. Additional training datasets are anticipated to mitigate this issue.
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Affiliation(s)
- Maxwell J Kiernan
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health (UW-SMPH), United States.
| | - Rashid Al Mukaddim
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health (UW-SMPH), United States
| | | | - Jenna Maybock
- Department of Neurological Surgery, UW-SMPH. Madison, WI, United States
| | | | - Robert J Dempsey
- Department of Neurological Surgery, UW-SMPH. Madison, WI, United States
| | - Tomy Varghese
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health (UW-SMPH), United States.
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Jiang L, Chu H, Yu J, Su X, Liu J, Wu H, Wang F, Zong Y, Wan M. Clutter filtering of angular domain data for contrast-free ultrafast microvascular imaging. Phys Med Biol 2023; 69:015006. [PMID: 38041871 DOI: 10.1088/1361-6560/ad11a2] [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: 06/07/2023] [Accepted: 12/01/2023] [Indexed: 12/04/2023]
Abstract
Objective. Contrast-free microvascular imaging is clinically valuable for the assessment of physiological status and the early diagnosis of diseases. Effective clutter filtering is essential for microvascular visualization without contrast enhancement. Singular value decomposition (SVD)-based spatiotemporal filter has been widely used to suppress clutter. However, clinical real-time imaging relies on short ensembles (dozens of frames), which limits the implementation of SVD filtering due to the large error of eigen-correlated estimations and high dependence on optimal threshold when used in such ensembles.Approach. To address the above challenges of imaging in short ensembles, two optimized filters of angular domain data are proposed in this paper: grouped angle SVD (GA-SVD) and angular-coherence-based higher-order SVD (AC-HOSVD). GA-SVD applies SVD to the concatenation of all angular data to improve clutter rejection performance in short ensembles, while AC-HOSVD applies HOSVD to the angular data tensor and utilizes angular coherence in addition to spatial and temporal features for filtering. Feasible threshold selection strategies in each feature space are provided. The clutter rejection performance of the proposed filters and SVD was evaluated with Doppler phantom andin vivostudies at different cases. Moreover, the robustness of the filters was explored under wrong singular value threshold estimation, and their computational complexity was studied.Main results. Qualitative and quantitative results indicated that GA-SVD and AC-HOSVD can effectively improve clutter rejection performance in short ensembles, especially AC-HOSVD. Notably, the proposed methods using 20 frames had similar image quality to SVD using 100 frames.In vivostudies showed that compared to SVD, GA-SVD increased the signal-to-noise-ratio (SNR) by 6.03 dB on average, and AC-HOSVD increased the SNR by 8.93 dB on average. Furthermore, AC-HOSVD remained better power Doppler image quality under non-optimal thresholds, followed by GA-SVD.Significance. The proposed filters can greatly enhance contrast-free microvascular visualization in short ensembles and have potential for different clinical translations due to the performance differences.
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Affiliation(s)
- Liyuan Jiang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Hanbing Chu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Jianjun Yu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Xiao Su
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Jiacheng Liu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Haitao Wu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Feiqian Wang
- Ultrasound Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, People's Republic of China
| | - Yujin Zong
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Mingxi Wan
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
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Vienneau EP, Byram BC. A Coded Excitation Framework for High SNR Transcranial Ultrasound Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2023; 42:2886-2898. [PMID: 37079411 PMCID: PMC10691235 DOI: 10.1109/tmi.2023.3269022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Robust transcranial ultrasound imaging is difficult due to poor image quality. In particular, low signal-to-noise ratio (SNR) limits sensitivity to blood flow and has hindered clinical translation of transcranial functional ultrasound neuroimaging thus far. In this work, we present a coded excitation framework to increase SNR in transcranial ultrasound without negatively impacting frame rate or image quality. We applied this coded excitation framework in phantom imaging and showed SNR gains as large as 24.78 dB and signal-to-clutter ratio gains as high as 10.66 dB with a 65 bit code. We also analyzed how imaging sequence parameters can impact image quality and showed how coded excitation sequences can be designed to maximize image quality for a given application. In particular, we show that considering the number of active transmit elements and the transmit voltage is critical for coded excitation with long codes. Finally, we applied our coded excitation technique in transcranial imaging of ten adult subjects and showed an average SNR gain of 17.91 ± 0.96 dB without a significant increase in clutter using a 65 bit code. We also performed transcranial power Doppler imaging in three adult subjects and showed contrast and contrast-to-noise ratio improvements of 27.32 ± 8.08 dB and 7.25 ± 1.61 dB, respectively with a 65 bit code. These results show that transcranial functional ultrasound neuroimaging may be possible using coded excitation.
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Insana MF, Dai B, Babaei S, Abbey CK. Combining Spatial Registration With Clutter Filtering for Power-Doppler Imaging in Peripheral Perfusion Applications. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:3243-3254. [PMID: 36191097 PMCID: PMC9741924 DOI: 10.1109/tuffc.2022.3211469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Power-Doppler ultrasonic (PD-US) imaging is sensitive to echoes from blood cell motion in the microvasculature but generally nonspecific because of difficulties with filtering nonblood-echo sources. We are studying the potential for using PD-US imaging for routine assessments of peripheral blood perfusion without contrast media. The strategy developed is based on an experimentally verified computational model of tissue perfusion that simulates typical in vivo conditions. The model considers directed and diffuse blood perfusion states in a field of moving clutter and noise. A spatial registration method is applied to minimize tissue motion prior to clutter and noise filtering. The results show that in-plane clutter motion is effectively minimized. While out-of-plane motion remains a strong source of clutter-filter leakage, those registration errors are readily minimized by straightforward modification of scanning techniques and spatial averaging.
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Bruce M, DeWees D, Harmon JN, Cates L, Khaing ZZ, Hofstetter CP. Blood Flow Changes Associated with Spinal Cord Injury Assessed by Non-linear Doppler Contrast-Enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1410-1419. [PMID: 35523621 PMCID: PMC9704544 DOI: 10.1016/j.ultrasmedbio.2022.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 05/23/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) is clinically used to image the microcirculation at lower imaging frequencies (<2 MHz). Recently, plane-wave acquisitions and Doppler processing have revealed improved microbubble sensitivity, enabling CEUS use at higher frequencies (15 MHz) and the ability to image simultaneously blood flow in the micro- and macrocirculations. We used this approach to assess acute and chronic blood flow changes within contused spinal cord in a rodent spinal cord injury model. Immediately after spinal cord injury, we found significant differences in perfusion deficit between moderate and severe injuries (1.73 ± 0.1 mm2 vs. 3.2 ± 0.3 mm2, respectively), as well as a delay in microbubble arrival time in tissue adjacent to the injury site (0.97 ± 0.1 s vs. 1.54 ± 0.1 s, respectively). Acutely, morphological changes to central sulcal arteries were observed where vessels rostral to the contusion were displaced 4.8 ± 2.2° and 8.2 ± 3.1° anteriorly, and vessels caudal to the contusion 17.8 ± 3.9° and 24.2 ± 4.1° posteriorly, respectively, for moderate and severe injuries. Significant correlation of the acute perfusion deficit and arrival time were found with the chronic assessment of locomotive function and histological estimate of spared spinal cord tissue.
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Affiliation(s)
- Matthew Bruce
- Applied Physics Laboratory/Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington, USA.
| | - Dane DeWees
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Jennifer N Harmon
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Lindsay Cates
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Zin Z Khaing
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
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Cheng D, Wang J, Yokota T, Someya T. Spatiotemporal processing in photoplethysmography for skin microcirculatory perfusion imaging. BIOMEDICAL OPTICS EXPRESS 2022; 13:838-849. [PMID: 35284154 PMCID: PMC8884234 DOI: 10.1364/boe.442764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/16/2021] [Accepted: 10/27/2021] [Indexed: 05/09/2023]
Abstract
Technological advances in the real-time visualization of cutaneous microcirculation aim to realize benefits including high-resolution imaging, suppressed noise, and robust temporal coherence. Photoplethysmography (PPG), a noninvasive technique that measures single or multiple points of relative blood volume changes in blood vessels under the skin, shows potential as a signal candidate for visualizing blood vessels and tracking blood flow. However, challenges still remain, such as extracting/image reconstruction of the blood vessel/flow signal in a precise frequency window (<0.2 Hz) from a noisy image that is caused by the loss of spatial coherence of the light source in a turbid biological tissue. We attempted to overcome this challenge by adopting a combination of direct-contact-type, lens-less, conformable imagers and singular value decomposition (SVD) in this study. We focused on the numerical analysis of SVD for discriminating the tissue and vein blood flow in PPG for reconstructing blood fluidic images, followed by a complete demonstration of skin microcirculation blood tracking in the vessel visualization process when applying our lens-less, conformable, wearable imagers.
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Huang C, Song P, Trzasko JD, Gong P, Lok UW, Tang S, Manduca A, Chen S. Simultaneous Noise Suppression and Incoherent Artifact Reduction in Ultrafast Ultrasound Vascular Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:2075-2085. [PMID: 33513103 PMCID: PMC8154644 DOI: 10.1109/tuffc.2021.3055498] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Ultrasound vascular imaging based on ultrafast plane wave imaging and singular value decomposition (SVD) clutter filtering has demonstrated superior sensitivity in blood flow detection. However, ultrafast ultrasound vascular imaging is susceptible to electronic noise due to the weak penetration of unfocused waves, leading to a lower signal-to-noise ratio (SNR) at larger depths. In addition, incoherent clutter artifacts originating from strong and moving tissue scatterers that cannot be completely removed create a strong mask on top of the blood signal that obscures the vessels. Herein, a method that can simultaneously suppress the background noise and incoherent artifacts is proposed. The method divides the tilted plane or diverging waves into two subgroups. Coherent spatial compounding is performed within each subgroup, resulting in two compounded data sets. An SVD-based clutter filter is applied to each data set, followed by a correlation between the two data sets to produce a vascular image. Uncorrelated noise and incoherent artifacts can be effectively suppressed with the correlation process, while the coherent blood signal can be preserved. The method was evaluated in wire-target simulations and phantom, in which around 7-10-dB SNR improvement was shown. Consistent results were found in a flow channel phantom with improved SNR by the proposed method (39.9 ± 0.2 dB) against conventional power Doppler (29.1 ± 0.6 dB). Last, we demonstrated the effectiveness of the method combined with block-wise SVD clutter filtering in a human liver, breast tumor, and inflammatory bowel disease data sets. The improved blood flow visualization may facilitate more reliable small vessel imaging for a wide range of clinical applications, such as cancer and inflammatory diseases.
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Affiliation(s)
- Chengwu Huang
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Pengfei Song
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801
| | - Joshua D. Trzasko
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Ping Gong
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - U-Wai Lok
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Shanshan Tang
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Armando Manduca
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905 USA
| | - Shigao Chen
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
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