Fully automated method for lung emphysema

quantification for Multidetector CT images

Irene Mayorga-Ruiz1,David García-Juan1, Ángel Alberich-Bayarri1,2, Fabio

García-Castro1, Luis Martí-Bonmatí1,2

1 QUIBIM S.L., Valencia, Spain

2 La Fe Health Research Institute,Valencia, Spain

• Introduction

• Purpose

• Materials and Methods

• Results

• Conclusions

Outline

Introduction

Lung emphysema is defined as an abnormal and persistent increment of the distal

aerial spaces to the terminal bronchiole, it could be accompanied with lung

parenchyma walls destruction and without fibrosis.

Purpose

Lung emphysema is considered with chronic bronchitis part of the Pulmonary Obstructive

Chronic Diseases (COPD).

Change of the paradigm between the qualitative and the quantitative information of

the disease.

Development of zero-click automatic algorithm able to segment, quantify and

characterized lung emphysema areas, lung parenchyma, blood vessels and lung

parenchyma densities.

Materials and Methods

Image Modality: 39 standard MDCT scans

- 22 male and 17 female

Acquisition Characteristics

- Voltage:120 kVp

- Current: 250 mA

- Slice thickness ≤ 2mm

- Pixel Size ≤ 1mm

Materials and Methods

Materials and Methods

Lung Emphysema Quantification

Fixed thresholding (-950 HU)

Adaptive thresholding (QUIBIM Patent)

Materials and Methods

• Quantification

1. Percentage:

Ratio between the total number of voxels of the ROI and the total number of the mask [%]

2. Volume Quantification:

Product between the number of voxels of the ROI and the dimensions of a slice [ml]

Results

Mean

VolumeMale Female

Right Lung 3209,78 ml 2515,07 ml

Left Lung 2979,18 ml 2136,17 ml

Total 6188,96 ml 5187,50 ml

• Algorithm execution takes 30-45 min on average depending study size

• Right lung volume is 8,7% and 9,5% greater than left lung volume for male

and female respectively

• Lung emphysema quantification by adaptive thresholding is 50% smaller on

average than lung emphysema quantification by fixed Thresholding

-10

0

10

20

30

40

50

60

0 5 10 15 20 25 30 35 40 45

TotalPercentage[%]

Pa entID

EmphysemaQuan fica onMethodsCompara ve

FixedThresholding

Adap veThresholding

Results

• 29 patients were diagnosed of

emphysema caused by external

agents. Emphysema was mainly

detected in the lung apex.

• 2 patients present alfa-1-antitripsine

deficient being the emphysema

detected mainly on lungs base.

• 8 patients were unspecific due to

percentage of emphysema below 5 %.

Lunginfo@quibim.com

http://www.quibim.com

Emphysema

Emphysema

QUIBIM PATENTED Adaptive Low Density Thresholding*

Legend

TA Patient Sex

Birthdate

Patient ID

Study Date

Modality CT

M

Imaging Center Patient Name

Study Description

26/09/2013

Left Lung

1233

1368

44.85 754

Whole Lung

Right Lung

903140 3609

1019

83455.07

0.490.39

17.32

15.11 20.30 99

9.69 1542

Upper Third

Middle Third

Lower Third

VolumesLeft Lung Right Lung

Whole Lung

Upper Third

Middle Third

Lower Third

VesselsAutomatic Vessel Segmentation

*Patent 201.331.295. Segmentation method by adaptive thresholding for the obtention of air reference values slice-by-slice in CT imaging studies.

Total Emphysema Percentage: Total Lung Volume:17.88 % 6749 mL

Emphysema

Percentage(%)

Volume (mL)Percentage

(%)Volume (mL)

4

132

338

474

6

267

459

732

VesselVolume (mL)

Volume (mL) Volume (mL)Vessel

Volume (mL)

12

33

45

12

36

51

Healthy Percentage < 5%

Data from this quantification report should be considered as the results of research with an evidence level 2 (Centre for Evidence-based Medicine) in phase of clinical approval.

QUIBIM S.L. - Quantitative Imaging Biomarkers in Medicine. Avenida Fernando Abril Martorell 106, Torre A, Biopolo La Fe, Valencia (SPAIN)

Conclusions

• Relation between the smoker status and the presence of emphysema

exists

• Adaptive thresholding is able to perform a better characterization of

emphysema due to image-threshold specificity

• Lung emphysema etiology could be inferred due to emphysema

quantification by lung thirds.

Automated lung emphysema quantification can be used for the diagnosis

and follow up of COPD.

Luis Martí Bonmatí – MD, PhD. GIBI PI and QUIBIMFounder

Ángel Alberich-Bayarri – PhD. GIBI Director andQUIBIMCEO

QUIBIM StaffFabio García Castro - M.ScRafa Hernández Navarro - B.ScDavid García - M.ScEncarna Sánchez - M.ScKatherineWilisch Ramírez - M.ScIrene Mayorga Ruiz - M.ScBelén Fos Guarinos - Internship StudentAna Jiménez Pastor - Internship Student

GIBI230 StaffEnrique Ruiz Martínez –M.ScAmadeoTen Esteve –M.ScAna Penadés - Adm.AlfredoTorregrosa - Internship StudentCarlos Moya - Internship Student

Team

Chief Scientific Officer Chief Technology Officer Back-End Development of Imaging Biomarkers Chief Marketing Officer

Coordinator and CEO Support

MS Biomedical Engineering

Imaging Study Coordinator

Chief FinancialOfficer

Image AnalysisScientist Artificial Intelligence Artificial Intelligence

Imaging Biomarker Developer

Imaging Biomarker Developer