Segmentation of ECG-gated Multi-detector Row CT Cardiac Images for Functional Analysis

Jin Sung Kim, Yonghum Na, Kyongtae T. Bae Electronic Radiology Laboratory, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110
ABSTRACT
Multi-row detector CT (MDCT) gated with ECG-tracing allows continuous image acquisition of the heart during a breath-hold with a high spatial and temporal resolution. Dynamic segmentation and display of CT images, especially short- and long-axis view, is important in functional analysis of cardiac morphology. The size of dynamic MDCT cardiac images, however, is typically very large involving several hundred CT images and thus a manual analysis of these images can be time-consuming and tedious. In this paper, an automatic scheme was proposed to segment and reorient the left ventricular images in MDCT. Two segmentation techniques, deformable model and region-growing methods, were developed and tested. The contour of the ventricular cavity was segmented iteratively from a set of initial coarse boundary points placed on a transaxial CT image and was propagated to adjacent CT images. Segmented transaxial diastolic cardiac phase MDCT images were reoriented along the long- and short-axis of the left ventricle. The axes were estimated by calculating the principal components of the ventricular boundary points and then confirmed or adjusted by an operator. The reorientation of the coordinates was applied to other transaxial MDCT image sets reconstructed at different cardiac phases. Estimated short-axes of the left ventricle were in a close agreement with the qualitative assessment by a radiologist. Preliminary results from our methods were promising, with a considerable reduction in analysis time and manual operations. Keywords: Segmentation, ECG-gated Multi-row Detector CT, Cardiac Image, deformable model, region-growing

1. INTRODUCTION
The recently available multi-detector row helical CT scanners, in combination of subsecond gantry rotation, partial reconstruction algorithm, and retrospective or prospective electrocardiographic (ECG) gating, provide a new opportunity for imaging the heart and coronary artery. 1 In a retrospective ECG-gating scan mode, while a continuous ECG tracing is recorded, the heart is imaged during a single breath-hold (30-40 sec) with approximately 250 msec temporal resolution per image. The resulting 3D helical scan data is time-stamped with the phase of cardiac cycle represented in ECG time points. From this data, transaxial dynamic images of the heart are reconstructed by incrementally shifting the phases of the cardiac cycle. Three-dimensional representation of the reconstructed CT images allows us to evaluate the heart in a multi-phase cine mode. For the analysis of cardiac morphology and function, dynamic segmentation and display of CT images are important. For example, ventricular segmentation is a prerequisite to compute ejection fraction and cardiac output. Display of dynamic images at the same coordinate frame will also facilitate visualization and analysis of dynamic changes in ventricular wall motion. Multi-section, multiphase short-axis cardiac images are most suitable to assess LV function without any assumptions about LV geometry, but the planning procedure for these images is time-consuming and requires substantial insight into cardiac anatomy.2-5 Repeated selections and adjustments from intermediate long-axis image views by an operator are often required to accurately determine the optimal orientation of the short-axis volume, which could be time-consuming and imprecise. Thus, we have developed an automatic method for segmenting left ventricle from MDCT cardiac images and for estimating long- and short-axis views for a cardiac functional analysis. The qualitative assessment of reoriented images was confirmed by a radiologist.

2. MATERIALS AND METHODS

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The Overall scheme of our method is shown in Figure 1. ECG-gated, MDCT helical scan data was obtained with a Somatom Volume Zoom (Siemens, Islin, NJ). The scan parameters were 4*1 mm (simultaneous acquisition of 4 slices with 1 mm collimation), 120 Kvp, 300 mA, 0.5 msec gantry rotation, and 3 mm/sec table feed. Non-ionic contrast medium was injected to enhance the cardiac chamber and coronary artery. The images were reconstructed with 1.25 mm slice thickness at 0.6 mm image increment. The number of the reconstructed images at each cardiac cycle was typically in a range of 175 to 225. The segmentation process was conducted in two different approaches: deformable model and region-growing methods. The deformable model method is based on a systematic tracking of the boundary of gray-level images, while the region-growing method is based on tracing the boundary of a threshold binary image. The implementation and performance of both methods were compared. From the segmented images, a 3D volume of the left ventricular cavity was generated. The long-axis of the 3D volume was estimated by means of a principal component analysis of the segmented boundary points. Then, the 3D data was reoriented along the long-axis. The image data, initially acquired at 16-bit grayscale resolution, were reduced 8-bits to improve computing power. The algorithms were implemented in a Matlab based development environment (The MathWorks, Inc, Natick, MA, USA) on a PC with Windows 2000 operating system. MDCT images Segmentation using Region-growing Segmentation using Deformable model

3D volume Principal Component Analysis (PCA) Reoriented CT images along the short-axis or long axis

Figure 1. Schematic diagram of overall method

2.1.

Region-growing method

Seed extraction step is crucial because improperly-placed seed points may produce a wrong segmentation. At first, an operator identified the left ventricular cavity region in the first slice (I0) of the CT image set and placed a seed point (S0) over the region. From the seed point, a circular region of interest defined by 20-pixel diameter was determined. A histogram was calculated from the pixel values within the region of interest. The distribution of pixel values in the histogram tended to be narrow, since the CT numbers within the enhanced ventricle were rather uniform. A gray-level threshold value was determined from the maximum and minimum pixel values containing 90 percent of the CT numbers representing contrast enhanced blood and the myocardial CT numbers whose range is typically constant at 30-60 HU. Using this threshold, a binary image was generated. The boundary of connected region defining the ventricular cavity was delineated using an 8-point connectivity starting from the seed point. After the segmentation of the boundary at this slice, the seed points for the next slice (I1) were determined by propagating the segmented boundary onto the next slice. If the pixels within the segmented boundary have CT numbers between the earlier-defined maximum and minimum pixel values, these pixels were extracted as a set of seed points. From these seed points, the region-growing process resumed at this slice. Since the slice thickness of the CT image set is small, adjacent CT slices share similar CT number profiles that would facilitate successful segmentation steps (Figure 2).

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In On

Object (On) segmented on previous slice (In)

Projection

Current slice (In+1)

Propagation

Thresholding & Seed selection

In+1 Sn+1 On+1

Region Growing

New object (On+1)

Figure 2. Boundary extraction and propagation steps in region-growing method

2.2.

Deformable model (snake model)

The snake algorithm was first introduced by Kass et al in 1987 as an alternative to rigid geometric modeling. 6 The snakes are energy minimizing splines that, under the constraints of an image, are pulled towards features such as edges or lines. Energy in this active contour model is represented by three energy terms: E int , E image , E ext . The total energy is therefore:

E snake =

( Eint + E image + E ext )ds

2 2

Eint represents the internal energy of the contour, typically containing terms of first and second derivatives.
E int = V s ( s ) + V ss ( s )
The contour for the snake model is represented by a vector, V ( s ) = ( x ( s ), y ( s )) parameterized by its arc length, s. The energy function, E snake , is defined as the sum of internal, external and image energy. E image is the image forces, and E ext is the external constraints. The values of and at a point determine the extent to which the contour is allowed to stretch or vend at that point. The first term minimizes the total length, while the second term requires the contour to be as smooth as possible. However, we can set = 0 , if the snake points are well sampled to prevent shrinking and clustering problem of snake points. In a gray-level Image I ( x, y ) , internal energy can be written as

)2

E image = G * I ( x, y )
where G is a Gaussian smoothing filter of standard deviation applied to the image in order to improve the images edge map, and also to perform some noise reduction.7 Therefore, as regions approach closer to an edge, the gradient term increases and results in stronger force. is a weighting parameter. From our previous test cases, we found that the best results were obtained using snake parameters ( , , , , threshold value and comparative error value) corresponding to (0, 1.5, 0.5, 1.5, 50HU and 0.01%), respectively. The initial points on the first slice were selected around the left ventricle boundary for the initial contouring with pre-assigned parameters. The converged snake contour propagated to adjacent slices as an initial contour since there

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were no significant changes in the shape of the left ventricle between adjacent slices in most cases. The snake instability resulted from the self-intersection of the snake contour. Every iteration performed the frame buffer method to check the self-intersection, and then the snake points were redistributed to equal distance, 3 pixels wide. For the automatic propagation process, snake was always iterated until error (RMS), which was the difference between initial point values and final boundary point values, became less than 0.01%.
n

2 = ( xi x f ) 2 , RMS =

i =1

i2

xi is initial point value, x f is final boundary point value and n is total number of points.
Start RMS calculation First CT slice Input parameters RMS < 0.01%

, , , , threshold value
Define initial points Snake algorithm (iteration) Extracted boundary points Propagation

Figure 3. Overview of the segmentation though snake algorithm.

2.3.

Principal Component Analysis

The principal component analysis (PCA) or Karhunen-Loeve transform is a mathematical way of determining that a linear transformation of sample points in n-dimensional space exhibits the properties of the sample most clearly along the coordinate axes.8-9 Along the new axes the sample variances are minimum and uncorrelated. In this study the sample points, the input of PCA, are the contour points of the left ventricle on the segmented CT slices. Every contour point on a slice is represented in a three-dimension coordinate system. The principal components are based on the eigenvectors of the covariance the correlation matrix. The variance-covariance matrix C x can be defined as:

where X represents three-dimensional volume data with its mean vector, M , and number of pixels, p . Each component Yi is denoted by

Yi = a1i X 1 + a 2i X 2 + a3i X 3

= ai X
T

Cx =

1 p ( X i M )( X i M )T p 1 i =1

End

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ai is the transpose of the normalized eigenvectors of the matrix C x . The whole transformation can be shown as

Y = AT X
where A is the matrix of eigenvectors and is related to the covariance matrix C y of Y by

C y = AC x AT
The C y matrix is a diagonal matrix whose elements are eigenvalues of C x

Cy = 0 0

2
0

0 , A = e2 = e2, x

e3

e3, x

e2, y e3, y

e2 , z e3, z

Eigenvectors (e1 , e2 , e3 ) of the covariance matrix of the set of images represent the principal components in threedimensional left ventricle volume.

long-axis

e1

e2
short-axis

A B
x

e3
(a) (b) (c)

z
long-axis

Transaxial images (T)

e2

y
e1 x

Rotated transaxial image (TR) by ( n ) Sagittal image (S) Rotated sagittal image (SR) by ( n )

e3
short-axis

Short-axis transaxial images (TS) (e)

(d)

Figure 4. (a) Ellipsoid with three eigenvectors represented in the original coordinate system. (b) Transaxial cardiac CT image with line A, i.e., the projection of the eigenvectors over the x-y plane. (c) Sagittally rotated cardiac CT image with line B, i.e., the projection of the eigenvectors over the y-z plane (d) Ellipsoid with three eigenvectors that correspond to the rotated coordinate system. (e) Overview of the reorientation procedure.

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e1

e1, x

e1, y

e1, z

2.4.

Reorientation

The processes involving the reorientation of the left ventricle along the long-axis are illustrated in Figure 4. An ellipsoid with three principal components (e1 , e2 , e3 ) that are calculated from the PCA is shown in Figure 4a. The principal components are projected over the original coordinate systems of the transaxial CT images to yield two projection lines: line A in the x-y plane and line B in the y-z plane (Figures 4b and 4c). An angle, , between line A and the x-axis is calculated from the equation below. The CT data set is rotated by - so that the x-axis and line A overlap. Then, an angle, , between line B and the y-axis, is calculated, and the CT data set is rotated by - for the y-axis aligned with line B. The image rotated in the sagittal plane is shown in Figure 4c. The final reoriented ellipsoid along the principal components is denoted in Figure 4d. From the long-axis principal component e1 (e1, x , e2 , y , e3, z ) , two angles between the long-axis of the heart and the x-axis of original coordinate system are calculated: 1 is tilted in the x-y plane and to the z-axis

1 = arctan

e1, y e1, x

, 1 = arctan

e1, z e1, x + e1, y

2 2

3. RESULTS and DISSCUSSION

3.1. Two segmentation techniques

Boundaries segmented by means of the region-growing method and the deformable model are shown in Figure 5 along with pre-segmented cardiac CT images in Figure 5a. The results from the both segmentation methods were in close agreement, although the boundary segmented from the region-growing method was in general smoother than that from the deformable model method. Both segmentation methods appeared to produce similar and consistent results. Although these results imply the robustness of these segmentation methods, the success of detecting correct boundary largely depends on how distinct the tissue contrast is between the enhanced ventricular cavity and myocardial regions. In most clinical cases, the tissue contrast is well defined because of fast contrast medium administration in CT angiographic applications. We have not systemically evaluated or manipulated the smoothness of the segmented boundary in this study. However, our limited analysis indicated that the smoothness of the segmented boundary could be readily modified by adjusting the intervals between snake points in the deformable model method or by applying a morphologic filtering in the region-growing method.

3.2.

Reorientation of the left ventricle

Reoriented, short-axis cardiac images are displayed in a 2D multiplanar representation (Figure 6a) and in a 3D volumerendering representation (Figure 6b). These images were in close agreement with those based on a manual rotation performed by a radiologist. In this example in Figure 6, the calculated x-y plane angles ( 1 ) and z-axis angle ( 1 ) were 30 and 55 . The processing time in the current implementation with MatLab software system was 15-20 minutes for the region-growing method and 30-45 minutes for the deformable model method. However, we have not yet investigated time-efficient methods to reduce the processing time. We believe that the processing time could be substantially decreased by applying commonly available efficient programming techniques. For example, the currently implemented bicubic interpolation scheme could be readily modified to improve its processing efficiency.

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4. CONCLUSIONS
In conclusion, we have implemented and tested automatic image segmentation and re-orientation methods for ECGgated, multi-detector row CT images. The contour of the ventricular cavity was segmented iteratively from a set of initial coarse boundary points placed on a transaxial CT image and was propagated to adjacent CT images. Segmented transaxial diastolic cardiac phase MDCT images were reoriented along the long- and short-axis of the left ventricle. The axes were estimated by calculating the principal components of the ventricular boundary points and then confirmed or adjusted by an operator. The reorientation of the coordinates was applied to other transaxial MDCT image sets reconstructed at different cardiac phases. Estimated short-axes of the left ventricle were in a close agreement with the qualitative assessment by a radiologist. Preliminary results from our methods were promising, with a considerable reduction in analysis time and manual operations.

(a)

(b)
(b)

(c)
Figure 5. Transaxial CT images and segmented boundaries: (a) pre-segmented, ECG-gated MDCT images, (b) boundaries segmented by the region-growing method, and (c) boundaries segmented by the deformable model method.

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(a)

(b)
Figure 6. Reoriented, short-axis view of MDCT images in (a) 2D multiplanar representation and (b) 3D volumerendering representation.

5. REFERENCES
1. Michael W. Bourne, Electrocardiographically gated multi-detector row CT of the heart: The new frontiers in coronary heart diseases, RSNA categorical course in diagnostic radiology: Thoracic imaging, Chest and Cardiac, 177-183, 2001 Haag UJ, Maier SE, Jakob M, et al. Left ventricular wall thickness measurements by magnetic resonance: a validation study, Int J Cardiac Imaging, 7, 31-41, 1991 Pattynama PMT, Lamb HJ, van der Velde EA, van der Wall EE, de Roos A, Left ventricular measurements with cine and spin-echo MR imaging: a study of reproducibility with variance component analysis, Radiology, 187, 261-268, 1993

2. 3.

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4.

Lamb HJ, Doornbos J, van der Velde EA, Kruit MC, Reiber JHC, de Roos A. Echo-planar MRI of the heart on a standard system: validation of measurement of left ventricular function and mass, J Comput Assist Tomogr, 20, 942-949, 1996 5. Boudewijn P. F. Lelieveldt, Rob J. van der Geest, Hildo J. Lamb, Hein W. M. Kayser, Johan H. C. Reiber, Automated observer-independent acquisition of cardiac short-axis MR images: a pilot study, Radiology, 221, 537542, 2001 6. M,Kass, A.Witkin and D.Terzopoulos. Snakes: Active Contour Models, International Journal of Computer Vision, 1(4):324-331, 1988. 7. C, Xu and J.L.Prince. Snakes, Shapes and Gradient Vector Flow: A New External Force for Snake. IEEE Proceedings on Computer Vision and Patten Recognition, 66-71, 1997 8. M. G. Partridge and R. A. Calvo. Fast dimensionality reduction and simple PCA. Intelligent Data Analysis, 2(3), 1998 9. R. A. Calvo, M. G. Partridge, and M. A. Jabri. A comparative study of principal component analysis techniques. In Proceeding of Ninth Australian Conference on Neural Networks, Brisbane, QLD, Feb. 1998. 10. Feiglin DH, George CR, Maclntyre WJ, ODonnel JK, Go RT, Pavlicek W, Meaney TF, Gated cardiac magnetic resonance structural imaging: optimization by electronic axial rotation, Radiology, 154, 129-132, 1985 11. Murphy DH, Gutierrez FR, Levitt RG, Glazer HS, Lee KT, Oblique views of the heart by magnetic resonance imaging, Radiology, 154, 225-226, 1985 12. Milan Sonka, J. Michael Fizpatrick, Handbook of Medical Imaging. vol 2, 71-120, 675-705, SPIE press, 2000

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