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Lesion Conspicuity and Efficiency of CT Colonography with Electronic Cleansing Based on a Three-Material Transition Model

Iwo W. O. Serlie1,2,3, Ayso H. de Vries 4, Lucas J. van Vliet3, Chung Y. Nio4, Roel Truyen1, Jaap Stoker4 and Franciscus M. Vos3,4

1 Present address: Clinical Science and Advanced Development, Healthcare Informatics, Philips Medical Systems Nederland, Veenpluis 4-6, 5684 PC, Best, The Netherlands.
2 Department of Biomedical Imaging, Technical University Eindhoven, Eindhoven, The Netherlands.
3 Quantitative Imaging Group, Department of Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands.
4 Department of Radiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.


Figure 1
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  		Fig. 1A —Interface for CT colonography evaluation in 57-year-old man (WRAMC 393). Supine (A) and prone (B) enhanced 3D display images from part 1, in which 3D cine loops (using unfolded cube display; ViewForum, Philips Healthcare) were examined. Note that views are linked.

 

Figure 2
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  		Fig. 1B —Interface for CT colonography evaluation in 57-year-old man (WRAMC 393). Supine (A) and prone (B) enhanced 3D display images from part 1, in which 3D cine loops (using unfolded cube display; ViewForum, Philips Healthcare) were examined. Note that views are linked.

 

Figure 3
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  		Fig. 1C —Interface for CT colonography evaluation in 57-year-old man (WRAMC 393). Axial CT images from part 2, in which original axial slices were examined to verify whether surface parts were obscured by tagged material while tracking colon's centerline.

 

Figure 4
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  		Fig. 1D —Interface for CT colonography evaluation in 57-year-old man (WRAMC 393). Axial CT images from part 2, in which original axial slices were examined to verify whether surface parts were obscured by tagged material while tracking colon's centerline.

 

Figure 5
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  		Fig. 2A —Walter Reed patient with fluid surface bordering on soft tissue. Image shows 3D display rendered without electronic cleansing.

 

Figure 6
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  		Fig. 2B —Walter Reed patient with fluid surface bordering on soft tissue. Image shows result as electronic cleansing is applied only to "pure" materials and two material transitions.

 

Figure 7
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  		Fig. 2C —Walter Reed patient with fluid surface bordering on soft tissue. Image shows result after applying electronic cleansing to three-material voxels as well (indicated by shaded band (arrow) in image B).

 

Figure 8
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  		Fig. 3A —Histograms of polyp conspicuity for both observers stratified by polyp size. Light gray indicates air and dark gray indicates tagged material. Histograms for observer 1, all data (A); observer 2, all data (B); observer 1, size < 10 mm (C); observer 2, size < 10 mm (D); observer 1, size ≥ 10 mm (E); and observer 2, size ≥ 10 mm (F).

 

Figure 9
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  		Fig. 3B —Histograms of polyp conspicuity for both observers stratified by polyp size. Light gray indicates air and dark gray indicates tagged material. Histograms for observer 1, all data (A); observer 2, all data (B); observer 1, size < 10 mm (C); observer 2, size < 10 mm (D); observer 1, size ≥ 10 mm (E); and observer 2, size ≥ 10 mm (F).

 

Figure 10
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  		Fig. 3C —Histograms of polyp conspicuity for both observers stratified by polyp size. Light gray indicates air and dark gray indicates tagged material. Histograms for observer 1, all data (A); observer 2, all data (B); observer 1, size < 10 mm (C); observer 2, size < 10 mm (D); observer 1, size ≥ 10 mm (E); and observer 2, size ≥ 10 mm (F).

 

Figure 11
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  		Fig. 3D —Histograms of polyp conspicuity for both observers stratified by polyp size. Light gray indicates air and dark gray indicates tagged material. Histograms for observer 1, all data (A); observer 2, all data (B); observer 1, size < 10 mm (C); observer 2, size < 10 mm (D); observer 1, size ≥ 10 mm (E); and observer 2, size ≥ 10 mm (F).

 

Figure 12
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  		Fig. 3E —Histograms of polyp conspicuity for both observers stratified by polyp size. Light gray indicates air and dark gray indicates tagged material. Histograms for observer 1, all data (A); observer 2, all data (B); observer 1, size < 10 mm (C); observer 2, size < 10 mm (D); observer 1, size ≥ 10 mm (E); and observer 2, size ≥ 10 mm (F).

 

Figure 13
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  		Fig. 3F —Histograms of polyp conspicuity for both observers stratified by polyp size. Light gray indicates air and dark gray indicates tagged material. Histograms for observer 1, all data (A); observer 2, all data (B); observer 1, size < 10 mm (C); observer 2, size < 10 mm (D); observer 1, size ≥ 10 mm (E); and observer 2, size ≥ 10 mm (F).

 

Figure 14
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  		Fig. 4A —Histograms of polyp conspicuity for both observers stratified by polyp environment (completely surrounded by air [white], fully submerged [dark gray], or partly submerged [light gray]). Histograms for observer 1, all data (A) and observer 2, all data (B).

 

Figure 15
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  		Fig. 4B —Histograms of polyp conspicuity for both observers stratified by polyp environment (completely surrounded by air [white], fully submerged [dark gray], or partly submerged [light gray]). Histograms for observer 1, all data (A) and observer 2, all data (B).

 

Figure 16
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  		Fig. 5 —Examples of polyps (arrows) with varying conspicuity before (first two columns and last column) and after (third column) electronic cleansing from 52-year-old man with rating of excellent conspicuity (top row), 58-year-old man with rating of good conspicuity (second row), 53-year-old woman with rating of average conspicuity (third row), 53-year-old woman with rating of questionable conspicuity (fourth row), 54-year-old woman with rating of inadequate conspicuity (bottom row). Rating of conspicuity was given by both observers to electronically cleansed data. Circles indicate approximate polyp location. Asterisks and calipers indicate orientation of volume.

 

Figure 17
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  		Fig. 6A —Visualization of the segmented colonic volume before and after electronic cleansing. Images from patient with highest processed volume fraction in both scans (WRAMC 9) show segment ed colonic volume before (A) and after (B) electronic cleansing (processed volume fraction: supine, 0.44 L / 0.98 L = 0.45; prone, 0.44 L / 1.33 L = 0.33).

 

Figure 18
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  		Fig. 6B —Visualization of the segmented colonic volume before and after electronic cleansing. Images from patient with highest processed volume fraction in both scans (WRAMC 9) show segment ed colonic volume before (A) and after (B) electronic cleansing (processed volume fraction: supine, 0.44 L / 0.98 L = 0.45; prone, 0.44 L / 1.33 L = 0.33).

 

Figure 19
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  		Fig. 6C —Visualization of the segmented colonic volume before and after electronic cleansing. Images from patient with lowest processed volume fraction in both scans (WRAMC 408) show segmented colonic volume before (C) and after (D) electronic cleansing (processed volume fraction: supine, 0.31 L / 2.33 L = 0.13; prone, 0.30 L / 2.33 L = 0.13).

 

Figure 20
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  		Fig. 6D —Visualization of the segmented colonic volume before and after electronic cleansing. Images from patient with lowest processed volume fraction in both scans (WRAMC 408) show segmented colonic volume before (C) and after (D) electronic cleansing (processed volume fraction: supine, 0.31 L / 2.33 L = 0.13; prone, 0.30 L / 2.33 L = 0.13).

 

Figure 21
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  		Fig. 7A —Histograms of observer effort and confidence level. Original data = light gray, electronically cleansed data = dark gray. Histograms of assessment effort of CT colonography inspection for observer 1 (A) and observer 2 (B) over all segments and patients.

 

Figure 22
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  		Fig. 7B —Histograms of observer effort and confidence level. Original data = light gray, electronically cleansed data = dark gray. Histograms of assessment effort of CT colonography inspection for observer 1 (A) and observer 2 (B) over all segments and patients.

 

Figure 23
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  		Fig. 7C —Histograms of observer effort and confidence level. Original data = light gray, electronically cleansed data = dark gray. Histograms of observer confidence in reading using original and electronically cleansed data for observer 1 (C) and observer 2 (D) over all patients.

 

Figure 24
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  		Fig. 7D —Histograms of observer effort and confidence level. Original data = light gray, electronically cleansed data = dark gray. Histograms of observer confidence in reading using original and electronically cleansed data for observer 1 (C) and observer 2 (D) over all patients.

 

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