Increasing computer-aided detection specificity by projection features for CT colonography

A Survey on Machine Learning and Deep Learning-based Computer-Aided Methods for Detection of Polyps in CT Colonography

BACKGROUND

Colon cancer generally begins as a neoplastic growth of tissue, called polyps, originating from the inner lining of the colon wall. Most colon polyps are considered harmless but over the time, they can evolve into colon cancer, which, when diagnosed in later stages, is often fatal. Hence, time is of the essence in the early detection of polyps and the prevention of colon cancer.

METHODS

To aid this endeavor, many computer-aided methods have been developed, which use a wide array of techniques to detect, localize and segment polyps from CT Colonography images. In this paper, a comprehensive state-of-the-art method is proposed and categorize this work broadly using the available classification techniques using Machine Learning and Deep Learning.

CONCLUSION

The performance of each of the proposed approach is analyzed with existing methods and also how they can be used to tackle the timely and accurate detection of colon polyps.

High-Performance CAD-CTC Scheme Using Shape Index, Multiscale Enhancement Filters, and Radiomic Features

OBJECTIVE

Computer-aided detection (CAD) systems for computed tomography colonography (CTC) can automatically detect colorectal polyps. The main problem of currently developed CAD-CTC systems is the numerous false positives (FPs) caused by the existence of complicated colon structures (e.g., haustral fold, residual fecal material, inflation tube, and ileocecal valve). This study proposes a CAD-CTC scheme using shape index, multiscale enhancement filters, and radiomic features to address the FP issue.

METHODS

Shape index and multiscale enhancement filter calculated in the Gaussian smoothed geodesic distance field are combined to generate the polyp candidates. A total of 440 well-defined radiomic features collected from previous radiomic studies and 200 newly developed radiomic features are used to construct a supervised classification model to reduce the numerous FPs.

RESULTS

The proposed CAD-CTC scheme was evaluated on 152 oral contrast-enhanced CT datasets from 76 patients with 103 polyps ≥5 mm. The detection results were 98.1% and 95.3% by-polyp sensitivity and per-scan sensitivity, respectively, with the same FP rate of 1.3 FPs per dataset for polyps ≥5 mm.

CONCLUSION

Experimental results indicate that the proposed CAD-CTC scheme can achieve high sensitivity while maintaining a low FP rate.

SIGNIFICANCE

The proposed CAD-CTC scheme would be a beneficial tool in clinical colon examination.

An adaptive paradigm for computer-aided detection of colonic polyps

Most previous efforts in developing computer-aided detection (CADe) of colonic polyps apply similar measures or parameters to detect polyps regardless of their locations under an implicit assumption that all the polyps reside in a similar local environment, e.g. on a relatively flat colon wall. In reality, this implicit assumption is frequently invalid, because the haustral folds can have a very different local environment from that of the relatively flat colon wall. We conjecture that this assumption may be a major cause of missing the detection of polyps, especially small polyps (<10 mm linear size) located on the haustral folds. In this paper, we take the concept of adaptiveness and present an adaptive paradigm for CADe of colonic polyps. Firstly, we decompose the complicated colon structure into two simplified sub-structures, each of which has similar properties, of (1) relatively flat colon wall and (2) ridge-shaped haustral folds. Then we develop local environment descriptions to adaptively reflect each of these two simplified sub-structures. To show the impact of the adaptiveness of the local environment descriptions upon the polyp detection task, we focus on the local geometrical measures of the volume data for both the detection of initial polyp candidates (IPCs) and the reduction of false positives (FPs) in the IPC pool. The experimental outcome using the local geometrical measures is very impressive such that not only the previously-missed small polyps on the folds are detected, but also the previously miss-removed small polyps on the folds during FP reduction are retained. It is expected that this adaptive paradigm will have a great impact on detecting the small polyps, measuring their volumes and volume changes over time, and optimizing their management plan.

ROC operating point selection for classification of imbalanced data with application to computer-aided polyp detection in CT colonography

PURPOSE

Computer-aided detection and diagnosis (CAD) of colonic polyps always faces the challenge of classifying imbalanced data. In this paper, three new operating point selection strategies based on receiver operating characteristic curve are proposed to address the problem.

METHODS

Classification on imbalanced data performs inferiorly because of a major reason that the best differentiation threshold shifts due to the degree of data imbalance. To address this decision threshold shifting issue, three operating point selection strategies, i.e., shortest distance, harmonic mean and anti-harmonic mean, are proposed and their performances are investigated.

RESULTS

Experiments were conducted on a class-imbalanced database, which contains 64 polyps in 786 polyp candidates. Support vector machine (SVM) and random forests (RFs) were employed as basic classifiers. Two imbalanced data correcting techniques, i.e., cost-sensitive learning and training data down sampling, were applied to SVM and RFs, and their performances were compared with the proposed strategies. Comparing to the original thresholding method, i.e., 0.488 sensitivity and 0.986 specificity for RFs and 0.526 sensitivity and 0.977 specificity for SVM, our strategies achieved more balanced results, which are around 0.89 sensitivity and 0.92 specificity for RFs and 0.88 sensitivity and 0.90 specificity for SVM. Meanwhile, their performance remained at the same level regardless of whether other correcting methods are used.

CONCLUSIONS

Based on the above experiments, the gain of our proposed strategies is noticeable: the sensitivity improved from 0.5 to around 0.88 for RFs and 0.89 for SVM while remaining a relatively high level of specificity, i.e., 0.92 for RFs and 0.90 for SVM. The performance of our proposed strategies was adaptive and robust with different levels of imbalanced data. This indicates a feasible solution to the shifting problem for favorable sensitivity and specificity in CAD of polyps from imbalanced data.

Max-AUC feature selection in computer-aided detection of polyps in CT colonography

We propose a feature selection method based on a sequential forward floating selection (SFFS) procedure to improve the performance of a classifier in computerized detection of polyps in CT colonography (CTC). The feature selection method is coupled with a nonlinear support vector machine (SVM) classifier. Unlike the conventional linear method based on Wilks' lambda, the proposed method selected the most relevant features that would maximize the area under the receiver operating characteristic curve (AUC), which directly maximizes classification performance, evaluated based on AUC value, in the computer-aided detection (CADe) scheme. We presented two variants of the proposed method with different stopping criteria used in the SFFS procedure. The first variant searched all feature combinations allowed in the SFFS procedure and selected the subsets that maximize the AUC values. The second variant performed a statistical test at each step during the SFFS procedure, and it was terminated if the increase in the AUC value was not statistically significant. The advantage of the second variant is its lower computational cost. To test the performance of the proposed method, we compared it against the popular stepwise feature selection method based on Wilks' lambda for a colonic-polyp database (25 polyps and 2624 nonpolyps). We extracted 75 morphologic, gray-level-based, and texture features from the segmented lesion candidate regions. The two variants of the proposed feature selection method chose 29 and 7 features, respectively. Two SVM classifiers trained with these selected features yielded a 96% by-polyp sensitivity at false-positive (FP) rates of 4.1 and 6.5 per patient, respectively. Experiments showed a significant improvement in the performance of the classifier with the proposed feature selection method over that with the popular stepwise feature selection based on Wilks' lambda that yielded 18.0 FPs per patient at the same sensitivity level.

Machine Learning in Computer-aided Diagnosis of the Thorax and Colon in CT: A Survey

Computer-aided detection (CADe) and diagnosis (CAD) has been a rapidly growing, active area of research in medical imaging. Machine leaning (ML) plays an essential role in CAD, because objects such as lesions and organs may not be represented accurately by a simple equation; thus, medical pattern recognition essentially require "learning from examples." One of the most popular uses of ML is the classification of objects such as lesion candidates into certain classes (e.g., abnormal or normal, and lesions or non-lesions) based on input features (e.g., contrast and area) obtained from segmented lesion candidates. The task of ML is to determine "optimal" boundaries for separating classes in the multidimensional feature space which is formed by the input features. ML algorithms for classification include linear discriminant analysis (LDA), quadratic discriminant analysis (QDA), multilayer perceptrons, and support vector machines (SVM). Recently, pixel/voxel-based ML (PML) emerged in medical image processing/analysis, which uses pixel/voxel values in images directly, instead of features calculated from segmented lesions, as input information; thus, feature calculation or segmentation is not required. In this paper, ML techniques used in CAD schemes for detection and diagnosis of lung nodules in thoracic CT and for detection of polyps in CT colonography (CTC) are surveyed and reviewed.

A review of computer-aided diagnosis in thoracic and colonic imaging

Medical imaging has been indispensable in medicine since the discovery of x-rays. Medical imaging offers useful information on patients' medical conditions and on the causes of their symptoms and diseases. As imaging technologies advance, a large number of medical images are produced which physicians/radiologists must interpret. Thus, computer aids are demanded and become indispensable in physicians' decision making based on medical images. Consequently, computer-aided detection and diagnosis (CAD) has been investigated and has been an active research area in medical imaging. CAD is defined as detection and/or diagnosis made by a radiologist/physician who takes into account the computer output as a "second opinion". In CAD research, detection and diagnosis of lung and colorectal cancer in thoracic and colonic imaging constitute major areas, because lung and colorectal cancers are the leading and second leading causes, respectively, of cancer deaths in the U.S. and also in other countries. In this review, CAD of the thorax and colon, including CAD for detection and diagnosis of lung nodules in thoracic CT, and that for detection of polyps in CT colonography, are reviewed.

Haustral fold segmentation with curvature-guided level set evolution

Human colon has complex structures mostly because of the haustral folds. The folds are thin flat protrusions on the colon wall, which complicate the shape analysis for computer-aided detection (CAD) of colonic polyps. Fold segmentation may help reduce the structural complexity, and the folds can serve as an anatomic reference for computed tomographic colonography (CTC). Therefore, in this study, based on a model of the haustral fold boundaries, we developed a level-set approach to automatically segment the fold surfaces. To evaluate the developed fold segmentation algorithm, we first established the ground truth of haustral fold boundaries by experts' drawing on 15 patient CTC datasets without severe under/over colon distention from two medical centers. The segmentation algorithm successfully detected 92.7% of the folds in the ground truth. In addition to the sensitivity measure, we further developed a merit of segmented-area ratio (SAR), i.e., the ratio between the area of the intersection and union of the expert-drawn folds and the area of the automatically segmented folds, to measure the segmentation accuracy. The segmentation algorithm reached an average value of SAR = 86.2%, showing a good match with the ground truth on the fold surfaces. We believe the automatically segmented fold surfaces have the potential to benefit many postprocedures in CTC, such as CAD, taenia coli extraction, supine-prone registration, etc.

Strategies for improved interpretation of computer-aided detections for CT colonography utilizing distributed human intelligence

Computer-aided detection (CAD) systems have been shown to improve the diagnostic performance of CT colonography (CTC) in the detection of premalignant colorectal polyps. Despite the improvement, the overall system is not optimal. CAD annotations on true lesions are incorrectly dismissed, and false positives are misinterpreted as true polyps. Here, we conduct an observer performance study utilizing distributed human intelligence in the form of anonymous knowledge workers (KWs) to investigate human performance in classifying polyp candidates under different presentation strategies. We evaluated 600 polyp candidates from 50 patients, each case having at least one polyp ≥6 mm, from a large database of CTC studies. Each polyp candidate was labeled independently as a true or false polyp by 20 KWs and an expert radiologist. We asked each labeler to determine whether the candidate was a true polyp after looking at a single 3D-rendered image of the candidate and after watching a video fly-around of the candidate. We found that distributed human intelligence improved significantly when presented with the additional information in the video fly-around. We noted that performance degraded with increasing interpretation time and increasing difficulty, but distributed human intelligence performed better than our CAD classifier for "easy" and "moderate" polyp candidates. Further, we observed numerous parallels between the expert radiologist and the KWs. Both showed similar improvement in classification moving from single-image to video interpretation. Additionally, difficulty estimates obtained from the KWs using an expectation maximization algorithm correlated well with the difficulty rating assigned by the expert radiologist. Our results suggest that distributed human intelligence is a powerful tool that will aid in the development of CAD for CTC.

Matching 3-D prone and supine CT colonography scans using graphs

In this paper, we propose a new registration method for prone and supine computed tomographic colonography scans using graph matching. We formulate 3-D colon registration as a graph matching problem and propose a new graph matching algorithm based on mean field theory. In the proposed algorithm, we solve the matching problem in an iterative way. In each step, we use mean field theory to find the matched pair of nodes with highest probability. During iterative optimization, one-to-one matching constraints are added to the system in a step-by-step approach. Prominent matching pairs found in previous iterations are used to guide subsequent mean field calculations. The proposed method was found to have the best performance with smallest standard deviation compared with two other baseline algorithms called the normalized distance along the colon centerline (NDACC) ( p = 0.17) with manual colon centerline correction and spectral matching ( p < 1e-5). A major advantage of the proposed method is that it is fully automatic and does not require defining a colon centerline for registration. For the latter NDACC method, user interaction is almost always needed for identifying the colon centerlines.

Seeing is believing: video classification for computed tomographic colonography using multiple-instance learning

In this paper, we present development and testing results for a novel colonic polyp classification method for use as part of a computed tomographic colonography (CTC) computer-aided detection (CAD) system. Inspired by the interpretative methodology of radiologists using 3-D fly-through mode in CTC reading, we have developed an algorithm which utilizes sequences of images (referred to here as videos) for classification of CAD marks. For each CAD mark, we created a video composed of a series of intraluminal, volume-rendered images visualizing the detection from multiple viewpoints. We then framed the video classification question as a multiple-instance learning (MIL) problem. Since a positive (negative) bag may contain negative (positive) instances, which in our case depends on the viewing angles and camera distance to the target, we developed a novel MIL paradigm to accommodate this class of problems. We solved the new MIL problem by maximizing a L2-norm soft margin using semidefinite programming, which can optimize relevant parameters automatically. We tested our method by analyzing a CTC data set obtained from 50 patients from three medical centers. Our proposed method showed significantly better performance compared with several traditional MIL methods.

Pixel-based machine learning in medical imaging

Machine learning (ML) plays an important role in the medical imaging field, including medical image analysis and computer-aided diagnosis, because objects such as lesions and organs may not be represented accurately by a simple equation; thus, medical pattern recognition essentially require “learning from examples.” One of the most popular uses of ML is classification of objects such as lesions into certain classes (e.g., abnormal or normal, or lesions or nonlesions) based on input features (e.g., contrast and circularity) obtained from segmented object candidates. Recently, pixel/voxel-based ML (PML) emerged in medical image processing/analysis, which use pixel/voxel values in images directly instead of features calculated from segmented objects as input information; thus, feature calculation or segmentation is not required. Because the PML can avoid errors caused by inaccurate feature calculation and segmentation which often occur for subtle or complex objects, the performance of the PML can potentially be higher for such objects than that of common classifiers (i.e., feature-based MLs). In this paper, PMLs are surveyed to make clear (a) classes of PMLs, (b) similarities and differences within (among) different PMLs and those between PMLs and feature-based MLs, (c) advantages and limitations of PMLs, and (d) their applications in medical imaging.

Improved curvature estimation for computer-aided detection of colonic polyps in CT colonography

RATIONALE AND OBJECTIVES

Current schemes for computer-aided detection (CAD) of colon polyps usually use kernel methods to perform curvature-based shape analysis. However, kernel methods may deliver spurious curvature estimations if the kernel contains two surfaces, because of the vanished gradient magnitudes. The aim of this study was to use the Knutsson mapping method to deal with the difficulty of providing better curvature estimations and to assess the impact of improved curvature estimation on the performance of CAD schemes.

MATERIALS AND METHODS

The new method was compared to two widely used kernel methods in terms of the performance of two stages of CAD: initial detection and true-positive and false-positive classification. The evaluation was conducted on a database of 130 computed tomographic scans from 67 patients. In these patient scans, there were 104 clinically significant polyps and masses >5 mm.

RESULTS

In the initial detection stage, the detection sensitivity of the three methods was comparable. In the classification stage, at a 90% sensitivity level on the basis of the input of this step, the new technique yielded 3.15 false-positive results per scan, demonstrating reductions in false-positive findings of 30.2% (P < .01) and 27.9% (P < .01) compared to the two kernel methods.

CONCLUSIONS

The new method can benefit CAD schemes with reduced false-positive rates, without sacrificing detection sensitivity.

Massive-training support vector regression and Gaussian process for false-positive reduction in computer-aided detection of polyps in CT colonography

PURPOSE

A massive-training artificial neural network (MTANN) has been developed for the reduction of false positives (FPs) in computer-aided detection (CADe) of polyps in CT colonography (CTC). A major limitation of the MTANN is the long training time. To address this issue, the authors investigated the feasibility of two state-of-the-art regression models, namely, support vector regression (SVR) and Gaussian process regression (GPR) models, in the massive-training framework and developed massive-training SVR (MTSVR) and massive-training GPR (MTGPR) for the reduction of FPs in CADe of polyps.

METHODS

The authors applied SVR and GPR as volume-processing techniques in the distinction of polyps from FP detections in a CTC CADe scheme. Unlike artificial neural networks (ANNs), both SVR and GPR are memory-based methods that store a part of or the entire training data for testing. Therefore, their training is generally fast and they are able to improve the efficiency of the massive-training methodology. Rooted in a maximum margin property, SVR offers excellent generalization ability and robustness to outliers. On the other hand, GPR approaches nonlinear regression from a Bayesian perspective, which produces both the optimal estimated function and the covariance associated with the estimation. Therefore, both SVR and GPR, as the state-of-the-art nonlinear regression models, are able to offer a performance comparable or potentially superior to that of ANN, with highly efficient training. Both MTSVR and MTGPR were trained directly with voxel values from CTC images. A 3D scoring method based on a 3D Gaussian weighting function was applied to the outputs of MTSVR and MTGPR for distinction between polyps and nonpolyps. To test the performance of the proposed models, the authors compared them to the original MTANN in the distinction between actual polyps and various types of FPs in terms of training time reduction and FP reduction performance. The authors' CTC database consisted of 240 CTC data sets obtained from 120 patients in the supine and prone positions. The training set consisted of 27 patients, 10 of which had 10 polyps. The authors selected 10 nonpolyps (i.e., FP sources) from the training set. These ten polyps and ten nonpolyps were used for training the proposed models. The testing set consisted of 93 patients, including 19 polyps in 7 patients and 86 negative patients with 474 FPs produced by an original CADe scheme.

RESULTS

With the MTSVR, the training time was reduced by a factor of 190, while a FP reduction performance [by-polyp sensitivity of 94.7% (18/19) with 2.5 (230/93) FPs/patient] comparable to that of the original MTANN [the same sensitivity with 2.6 (244/93) FPs/patient] was achieved. The classification performance in terms of the area under the receiver-operating-characteristic curve value of the MTGPR (0.82) was statistically significantly higher than that of the original MTANN (0.77), with a two-sided p-value of 0.03. The MTGPR yielded a 94.7% (18/19) by-polyp sensitivity at a FP rate of 2.5 (235/93) per patient and reduced the training time by a factor of 1.3.

CONCLUSIONS

Both MTSVR and MTGPR improve the efficiency of the training in the massive-training framework while maintaining a comparable performance.

Supine and prone colon registration using quasi-conformal mapping

In virtual colonoscopy, CT scans are typically acquired with the patient in both supine (facing up) and prone (facing down) positions. The registration of these two scans is desirable so that the user can clarify situations or confirm polyp findings at a location in one scan with the same location in the other, thereby improving polyp detection rates and reducing false positives. However, this supine-prone registration is challenging because of the substantial distortions in the colon shape due to the patient's change in position. We present an efficient algorithm and framework for performing this registration through the use of conformal geometry to guarantee that the registration is a diffeomorphism (a one-to-one and onto mapping). The taeniae coli and colon flexures are automatically extracted for each supine and prone surface, employing the colon geometry. The two colon surfaces are then divided into several segments using the flexures, and each segment is cut along a taenia coli and conformally flattened to the rectangular domain using holomorphic differentials. The mean curvature is color encoded as texture images, from which feature points are automatically detected using graph cut segmentation, mathematic morphological operations, and principal component analysis. Corresponding feature points are found between supine and prone and are used to adjust the conformal flattening to be quasi-conformal, such that the features become aligned. We present multiple methods of visualizing our results, including 2D flattened rendering, corresponding 3D endoluminal views, and rendering of distortion measurements. We demonstrate the efficiency and efficacy of our registration method by illustrating matched views on both the 2D flattened colon images and in the 3D volume rendered colon endoluminal view. We analytically evaluate the correctness of the results by measuring the distance between features on the registered colons.

Virtual colonoscopy vs optical colonoscopy

IMPORTANCE OF THE FIELD: The high prevalence of colon carcinoma combined with the low compliance of currently recommended screening guidelines explains the continued high mortality rate of colon cancer. Utilizing a strategy of virtual colonoscopy (VC) in asymptomatic patients over 50, with optical colonoscopy (OC) follow-up for removal of detected adenomatous polyps may result in lowering the colon cancer death rate. However, the screening potential of VC has not yet been widely recognized. Debates and doubts of its potential benefits have been frequently seen in the literature since VC was first reported in 1994. AREAS COVERED IN THIS REVIEW: This article reviews the currently available screening options and discuss their advantages and drawbacks. TAKE HOME MESSAGE: VC has many advantages over the existing screening options and its several drawbacks can be mitigated so that it would become a valuable screening modality. A strategy that utilizes VC for population-based screening over the age of 50 and OC for screening high-risk individuals and those with positive VC findings would result in a significantly reduced rate of colon cancer deaths.