Magnetic resonance imaging (MRI) of the breast is quickly becoming an important component of breast cancer screening in the United States. The American Cancer Society revised its MRI screening guidelines in 2007 to include women with a 20 to 25 percent increased lifetime risk, including family history of breast and ovarian cancers or a history of prior treatment for Hodgkin's disease. MRI has become a tool for breast cancer screening because of its advantages over mammography and ultrasound. First, breast MRI is more sensitive than x-ray mammography and ultrasound and thus may be used to detect lesions that would otherwise remain undetected. Second, MRI has been shown to be advantageous in screening women with dense breast tissue, which is common in younger patients. Third, and likely most importantly, the dynamic contrast enhanced (DCE) component of DCEMRI provides information about vascularity of a lesion that is more difficult to obtain using x-ray mammography or ultrasound.
Triple negative (TN) breast cancer has recently gained much attention in the field of breast cancer research. TN breast cancer is a molecular subtype that lacks expression of the estrogen receptor, progesterone receptor, and the HER2 receptor. Because of its lack of receptor expression, targeted therapies are ineffective, and chemotherapy is currently the only treatment available. TN breast cancer is also particularly aggressive and accounts for 12% to 26% of all breast cancers, most often occurring in young patients and African-American patients. The research community has become interested in TN breast cancer because of its particularly aggressive clinical course and lack of targeted therapies. Studies examining the pathological phenotype have revealed a heterogeneous group of breast cancers that often present as interval cancers, presenting in the months in between annual breast cancers screenings. This clearly suggests the need for greater exploration into the detection methods and biological understanding of TN breast cancers. Studies have shown that x-ray mammography is less effective in TN breast cancer screening than DCE-MRI due to the greater sensitivity of DCE-MRI in detecting TN and basal-like breast cancer phenotypes. A similar pattern of enhancement, described as rim enhancement, was observed in both subtypes. Although, qualitative radiologic descriptors have been developed for small pilot studies in TN breast cancer cases, the Inventors are unaware of any quantitative classification of the TN subtype.
The present invention is embodied in a method and apparatus for classifying possibly malignant lesions from sets of DCE-MRI images. The method includes receiving a set of MRI slice images obtained at respectively different times, where each slice image includes voxels representative of at least one lesion. The images are processed to determine the boundaries of the lesions and the voxels within the identified boundaries in corresponding regions of the images from each time period are processed to extract kinetic texture features. The kinetic texture features are used to drive a classification process wherein each lesion is identified as as malignant or benign. The malignant lesions are further classified to separate TN lesions from non-TN lesions.
While the embodiments of the subject invention described below concern the detection of breast tumors, it is contemplated that they may be applied generally to detecting and classifying possibly malignant lesions in other parts of the body based on DCE-MRI data. In addition, the invention may be applied to detect and classify non-malignant regions of interest (ROI) in a body.
Due to the clinical nature of TN tumors, however, accurate and consistent identification of these specific tumors is desirable, and a computer-aided diagnosis (CAD) system that could detect the TN radiologic phenotype would assist clinicians in therapeutic decision-making, monitoring therapy response, and increasing our understanding of this aggressive breast cancer subtype.
Breast DCE-MRI is performed by first injecting gadolinium diethylenetriamine-pentaacid (Gd-DTPA) into the patient's bloodstream and concurrently acquiring MRI images of the breast. Since malignant lesions tend to grow leaky blood vessels in abundance, the contrast agent is taken up by tumors preferentially and subsequently leaks out of tumors rapidly. This provides the use of DCE-MRI with an advantage over the use of other modalities to detect the tumors and contributes to the high sensitivity rates reported for breast DCE-MRI.
Both benign and malignant neoplastic tissue, however, frequently have contrast enhancement patterns that differ from normal breast tissue, and these abnormalities are highlighted in the time-dependent MRIs. As such, it may be difficult for radiologists to differentiate between benign and malignant lesions simply by observing the contrast enhanced lesion on the post-contrast MRI. For this reason, clinicians have explored various methods of observing and measuring the manner in which a lesion takes up the contrast dye. It was found, for example, that data in the temporal MRIs could be plotted as single data points on a time series curve that is reflective of the lesion type. It has been shown that malignant lesions have a characteristic curve, showing rapid uptake of contrast (steep positive initial slope) and rapid washout (subsequent negative slope). Benign lesions, on the other hand, have slow contrast uptake (small positive initial slope) and then plateau or do not reach peak intensity during the time series. This description of the DCE-MRI data is now considered convention in radiologic interpretation of breast DCE-MRI.
Despite making rapid strides in the interpretation of breast DCE-MRI in the past decade, the optimal accuracy in diagnosis using breast DCE-MRI has not been achieved, and only highly experienced radiologists are able to accurately interpret breast MRIs. Furthermore, inter-observer variability for radiologic interpretation tends to be high. Numerous studies in the field of breast MRI have shown efficacy and improved diagnosis rates using CAD, but breast MRI CAD has yet to achieve the accuracy of that seen in CAD for x-ray mammography. There is a growing need in the field to provide multimodal data interpretation methods that will be able to consistently and accurately detect, diagnose and differentiate breast tumors in general and specifically benign and malignant tumors.
Described below is a comprehensive CAD system for the discrimination of (a) benign from malignant breast lesions, and (b) triple negative from non-triple negative breast lesions. The example embodiments concern a similar understanding of the typical lesion enhancement patterns to create an Expectation Maximization-driven Active Contour scheme to automatically extract the lesion contour. Quantitative features are then automatically obtained for each lesion.
Although features, such as morphology and texture are considered, the example embodiment uses a DCE-MRI feature called kinetic texture, which characterizes spatio-temporal changes in lesion texture. A classifier, for example, a support vector machine may be used to quantitatively classify the breast lesions in the dataset. Graph embedding or other nonlinear dimensionality reduction techniques may then be used to reduce data dimensionality and aid in visualization of the relationships between different breast lesion classes. The example CAD system employs three components: (1) Lesion detection and segmentation combining the time-series signal intensity data with an Expectation Maximization-driven Active Contour scheme; (2) Feature extraction using over 500 different features for the identification of the most discriminatory features of the tumor types; and (3) Breast lesion classification performed in a hierarchical manner, first distinguishing malignant from benign lesions and then, within the group of malignant lesions, identifying those of the aggressive triple-negative molecular phenotype.
An example system suitable for use with the subject invention is shown in
In the example embodiment, the memory 114 has sufficient space to hold all of the sets of images used by the algorithm described below with reference to
In the example method, described below, a total of 41 (24 malignant, 17 benign) breast DCE-MRI studies were used as the training and testing dataset. Immunohistochemistry was performed on the 24 malignant lesions to measure estrogen receptor, progesterone receptor, and HER2 receptor status. Of these, 13 were determined to be TN cases and 11 non-TN. Sagittal T1 weighted, spoiled gradient echo sequences with fat suppression consisting of one series pre-contrast Injection of Gd-DTPA and three to five series post-contrast injection were acquired (Matrix 384×384 512×512, or 896×896, slice thickness 3 cm). Temporal resolution between post-contrast acquisitions was in the range of 45-90 seconds. For each study, all of the sets of images were stored in the memory 114 by the processor 112. The data for these studies may be entered into the memory 114 through an input/output (I/O) port of the processor 112 (not shown) or through a wired or wireless network connection (not shown) to the processor 112.
In the example embodiment, the 41 studies are used in a testing mode to determine which image features are suitable for discriminating between malignant and non-malignant lesions and, within the identified malignant images to distinguish between TN and non-TN lesions. The sample studies and other sample studies may be used to determine ranges of parameter values that can be used to classify lesions as possibly malignant with known probabilities. The system shown in
With reference to
Next, at step 214, the obtained data is stored in the memory 114. At step 216, the system waits for an amount of time, for example, 45 to 90 seconds. At step 218 the algorithm determines if the last set of slices has been obtained. If not, control transfers to step 214 to obtain another set of post-contrast MRI images. If, at step 218, the last set of MRI data has been obtained, control transfers to step 220.
At step 220, using the study data—or data from a particular individual when operating in the diagnosis assistance mode—for each set of images, a radiologist selects a lesion slice most representative of each lesion. This selection may be made from set of image slices taken at any time. It is contemplated, however, that the selection may be made from a time after the contrast agent has been taken-up by the lesion. In the example embodiment, the analysis described below is performed only for that slice of the lesion volume. That is to say, for the particular study, only the identified slice in the set of slices taken at each time is considered. It is contemplated, however that multiple slices may be used, with each slice being compared to corresponding slices in succeeding and/or preceding time frames.
At step 222, the selected slices are processed, according to the example method, to automatically define the contours of the lesions in the selected slice for each time period. This example process, as shown in
In step 310, the radiologist-selected slice at each time point pre- and post-contrast is compiled into a three-dimensional matrix. A signal enhancement curve is then generated for each voxel based on the signal intensity values at each time point. The coefficients of a third order polynomial are then obtained from fitting the time series curve of each individual voxel. The image scene is defined as C=(C, ft), where C is a spatial grid of voxels cεC and ft is the associated signal intensity at time tε{0, 1, 2, . . . , T−1}. The time-signal Intensity vector (f0(c), f1(c), f2 (c), . . . , fT-1(c)) for every voxel c in the MRI image is fitted to a third order polynomial, in a least-squares sense, which is described by equation (1).
f1(c)=a3ct3+a2ct2+a1ct+a0c (1)
The Expectation Maximization (EM) algorithm groups the voxels based on a time-series coefficient matrix, [ac=(a3c, a2c, a1c, a0c), ∀cεC]. Based on Bayes' theorem, the EM algorithm aims to compute the posterior probability Pck of each voxel c belonging to k ε{1, 2, . . . , K}, given the priori pck, where pck is the priori probability that voxel c belongs to class k, and K is the number of Gaussian mixtures. In the example embodiment, K is 4, the dimension of the row vector ac. The algorithm is run iteratively, comprising two steps: the Expectation step (E-step) and the Maximization step (M-step). The E-step calculates the posterior probability Pck based on the current parameters of Gaussian mixture model while the M-step recalculates or updates the model parameters, Σk={μk, σk, βk} where μk and σk are the mean and covariance of each Gaussian component, respectively, and the βk values are mixture coefficients in the Gaussian mixture model. After a pre-defined number of iterations, voxel c is assigned to one of K classes, depending on which has the highest posterior probability Pck.
The EM results obtained in step 310 of
where φ is the level set function,
is the time derivative of φ, α is a real constant, q(C)=1/(1+|∇C|) and ∇(·) represents the 2D gradient. For a given image C, K class likelihood scenes Lk=(C, Ik) are constructed where Ik(c) assigns each voxel c εC the probability Pck of belonging to a class k determined from the EM result. Lk is maximized to obtain a binarized scene LkB=(C,lkB) where lkB(c)ε{0,1} and lkB(c)=1 if Pck(c) is the highest probability assigned to c. The appropriate scene LkB representing the ROI class is manually selected and is used to initialize the active contour. The initialization of the contour is defined as circles centered at centroids of the objects detected in LkB via connected component labeling. The contour is then evolved until the difference between the contours of the current iteration to the next is below an empirically determined threshold.
It is desirable to have the boundaries of the ROIs well defined in order to obtain a true measure of the texture of the ROI. If, for example, the boundary of the ROI were not well defined and included voxels that were not a part of the ROI, these extra voxels would affect the texture determination. The example method described above, however, provides well-defined boundaries and tend to exclude voxels surrounding the ROI.
Referring to
Eleven non-steerable gradient features are obtained using Sobel, Kirsch and standard derivative operations. Gabor gradient operators comprising the steerable class of gradient features are also defined for every cεC where c=(x, y), These features, hu(c) are described by equation (3).
where ω is the frequency of a sinusoidal plane wave along the X-axis, and Ψx and Ψy are the space constraints of the Gaussian envelope along the X and Y directions respectively. Filter orientation, θ, is affected by the coordinate transformations: x′=z(x cos θ+y sin θ) and y′=z(−x sin θ+y cos θ), where z is the scaling factor. Gabor gradient features were calculated at 6 scales
8 orientations
and 4 window sizes (sε{3, 5, 8, 15}).
Four first order statistical features (mean, median, standard deviation, and range) for 3 different window sizes are calculated for the gray values of pixels within the sliding window neighborhood Ns,sε{3, 5, 8}.
Thirteen Haralick features are also included in the extracted features. To calculate the second order statistical (Haralick) feature scenes, a G×G co-occurrence matrix Od,c,s is computed, associated with Ns(ci), where G is the maximum grayscale intensity in C. The value at any location [e1, e2] in Od,c,s, where e1, e2 ε{1, 2, . . . , M}, represents the frequency with which two distinct voxels ci, cjεNs(c) where i, j ε{1, 2, . . . , |C|} with associated image intensities f(c1)=g1, f(cj)=g2 are separated by distance d. A total of 13 Haralick features including contrast energy, contrast inverse moment, contrast average, contrast variance, contrast entropy, intensity average, intensity variance, intensity entropy, entropy, energy, correlation, and 2 information measures are extracted at every voxel ceC, based on Od,c,s, for sε{3, 5, 7}, d=1 and G ε{64, 128, 256}.
The feature set includes the extracted features described above as well as kinetic features calculated from the extracted features. The kinetic features are generated from the extracted features in step 226. Each of the kinetic features models the behavior of a voxel across all of the sample times in the set of corresponding slices. Although calculation of kinetic features is described above with respect to a ROI, it is understood that kinetic features may also be calculated for one or more non-ROI areas, by using extracted features representing the non-ROI areas. For example, kinetic features of non-ROI areas may be used to characterize and/or quantify breast parenchyma.
Kinetic signal intensity features are computed in step 226, as the coefficients [a3, a2, a1, a0] of a third order polynomial obtained from fitting a curve in a least-squares sense to the signal intensity contrast enhancement curves. Hence, for each c in Co, C1, C2, . . . , CT-1, a third order curve is fitted using equation to (4):
f(t)=a3t3+a2t2+a1t+a0 (4)
Where tε{0, 1, 2, . . . , T−1} and cεC. Note that ft(c) represents the signal intensity at each spatial location, cεC, across the pre- and post-contrast MRI scenes.
To calculate the kinetic textural features, a first order statistical descriptor which could be at least one of the textural feature's mean, mode, median, variance, or standard deviation value, pu, is plotted over time such that a kinetic texture curve is created, which is analogous to the one created for signal intensity. A third order polynomial is fitted to this curve to characterize its shape, defining four associated coefficients as shown in equation (5):
pu(t)=ru,3t3+ru,2t2+ru,1t+ru,0. (5)
[ru,3, ru,2, ru,1, ru,0] is the feature vector, describing the kinetic texture feature, for each texture feature, u, as a function of time. The Pre-contrast Textural Features are defined as the mean texture values for each feature described above before contrast injection (t=0).
A summary of the extracted features is shown in Table 1.
The features listed above are used in the testing mode of the system in which the 41 known cases are used to train and test the example system. As described below, the morphological features may not be needed when the system is operated in diagnostic assistance mode. Indeed, it is contemplated that a suitable classifier can be constructed using only the kinetic texture features.
After the kinetic features have been calculated in step 226, the next step in the process is to classify the features at step 228. In the example system, support vector machine (SVM) methods are applied to evaluate the ability of each feature class (morphology, texture, kinetic texture and kinetic signal intensity) to classify each ROI as benign or malignant. It is contemplated, however, that other classification methods may be used, such as neural networks, Hidden Markov Models and Frequent Itemset Mining. An example Support Vector Machine algorithm is described in a publication by C. Cortes and V. Vapnik entitled “Support Vector Networks,” Machine Learning, vol 20 no. 2 Springer Netherlands 273-297 (1995). An example Hidden Markov Model system is described in a publication by S. Wong, A. B. Gardner, A. M. Krieger, B. Litt, “A Stochastic Framework for Evaluating Seizure Prediction Algorithms Using Hidden Markov Models,” J. Neurophysiology 97(3): 2525-2532 (2007). An example Frequent Itemset Mining system is described in a publication by A. B. Gardner, A. M. Krieger, G. Vachtsevanos, B. Litt, entitled “One Class Novelty Detection for Seizure Analysis from Intracranial EEG,” J. Machine Learning Research 7 1025-1044, (2006). Although a binary classifier is described, it is understood that the classifier may include a multi-class classifier. Accordingly, the kinetic features may be classified into at least two classes.
The example classifier contains two stages: (a) training and (b) testing. The features corresponding to each of the feature classes are used as inputs to the classifier individually and In combination. From the training data, a hyper-plane is created in the eigen-space that optimally separates the data into benign and malignant ROI classes.
Given a set of labeled training data from two distinct classes, the example SVM classifier project the data into a high dimensional space constructed by a kernel function, Ψ, operating on the training data. Testing data are then classified according to where they fall in relation to the hyper-plane when operated on by the same kernel function Ψ. The objects of each class that lie closest to this hyper-plane are the “support vectors.” The general form of the SVM classifier is given by equation (6):
where x is the input training data, xr, Tε{1, 2, . . . , Ns} denotes the support vectors, yε{−1, 1} as the training labels, Ψ(·,·) is a positive, definite, symmetric kernel function, b is a bias obtained from the training set to maximize the distance between the support vectors, and ξ is a model parameter chosen to maximize the objective function shown in equation (7):
The kernel function, Ψ(·,·), defines the nature of the decision hyper-plane. The example SVM uses a common kernel called the radial basis function (RBF). The parameters p and b are found through empirical training and testing of the classifier.
After classifying the data in step 228 using the example SVM classifier, it may be desirable to reduce the dimensionality of the data in step 230 using a nonlinear dimensionality reduction technique such as graph embedding (GE) or locally linear embedding (LLE). GE is described in an article by S. Yan et al. entitled “Graph Embedding: A General Framework for Dimensionality Reduction,” Proc. 2005 Internal Conference on Computer Vision and Pattern Recognition. LLE is described in a publication by L. K. Saul et al. entitled “An Introduction to Locally Linear Embedding” which is available at http://www.cs.toronto.edu/˜roweis/IIe/papers/IIeintro.pdf.
After dimensional reduction in step 230, the last step in the process is to display the result in step 232 using the display device of the display/keyboard 116, shown in
The efficacy of the feature set is then evaluated based on the ability of the feature set to correctly classify each ROI, using the remaining ROIs in the dataset as the training set. Accuracy is defined as (tp+tn)/(tp+tn+fp+fn), where tp is the number of true positives, to is the number of true negatives, fp is the number of false positives, and fn is the number of false negatives.
In the example embodiment, after the system has been run to identify malignant ROIs, the data for the malignant ROIs is separated from the non-malignant ROIs and the classifier algorithm is run again on that data to separate TN lesions from non-TN malignant lesions.
Table 2 shows the ability of the example system to distinguish benign ROIs from malignant ROIs and Table 3 shows the ability of the example system to distinguish TN lesions from non-TN lesions. These tables quantify the accuracy (Acc.), sensitivity (Sens.) and specificity (Spec.) of the example method using respectively different feature sets to distinguish benign and malignant ROIs, in Table 2, and TN and non-TN lesions, in Table 3.
From these results, it is apparent that there is an advantage to using the kinetic first order textural features and kinetic second order statistical features to detect malignant ROIs and, in particular, TN lesions.
Although the invention is illustrated and described herein with reference to specific embodiments, the invention is not intended to be limited to the details shown. Rather, various modifications may be made in the details within the scope and range of equivalents of the claims and without departing from the invention.
The present application claims the benefit of priority of PCT International Application No. PCT/US2009/034505 filed Feb. 19, 2009 which claims the benefit from U.S. provisional application no. 61/029,697 the contents of which are incorporated herein by reference.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/US2009/034505 | 2/19/2009 | WO | 00 | 10/19/2010 |
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WO2009/105530 | 8/27/2009 | WO | A |
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