Purpose: To assess the feasibility of deep learning-based high resolution synthetic CT generation from MRI scans of the lower arm for orthopedic applications. Methods: A conditional Generative Adversarial Network was trained to synthesize CT images from multi-echo MR images. A training set of MRI and CT scans of 9 ex vivo lower arms was acquired and the CT images were registered to the MRI images. Three-fold cross-validation was applied to generate independent results for the entire dataset. The synthetic CT images were quantitatively evaluated with the mean absolute error metric, and Dice similarity and surface to surface distance on cortical bone segmentations. Results: The mean absolute error was 63.5 HU on the overall tissue volume and 144.2 HU on the cortical bone. The mean Dice similarity of the cortical bone segmentations was 0.86. The average surface to surface distance between bone on real and synthetic CT was 0.48 mm. Qualitatively, the synthetic CT images corresponded well with the real CT scans and partially maintained high resolution structures in the trabecular bone. The bone segmentations on synthetic CT images showed some false positives on tendons, but the general shape of the bone was accurately reconstructed. Conclusions: This study demonstrates that high quality synthetic CT can be generated from MRI scans of the lower arm. The good correspondence of the bone segmentations demonstrates that synthetic CT could be competitive with real CT in applications that depend on such segmentations, such as planning of orthopedic surgery and 3D printing.
Purpose To investigate the impact of image registration on deep learning-based synthetic CT (sCT) generation. Methods Paired MR images and CT scans of the pelvic region of radiotherapy patients were obtained and non-rigidly registered. After a manual verification of the registrations, the dataset was split into two groups containing either well-registered or poorly-registered MR-CT pairs. In three scenarios, a patch-based U-Net deep learning architecture was trained for sCT generation on (i) exclusively well-registered data, (ii) mixtures of well-registered and poorly-registered data or on (iii) poorly-registered data only. Furthermore, a failure case was designed by introducing a single misregistered subject in the training set of six well-registered subjects. Reconstruction quality was assessed using mean absolute error (MAE) in the entire body and specifically in bone and Dice similarity coefficient (DSC) evaluated cortical bone geometric fidelity. Results The model trained on well registered data had an average MAE of 27.6 ± 2.6HU on the entire body contour and 79.1 ± 16.1HU on the bone. The average cortical bone DSC was 0.89. When patients with registration errors were added to the training, MAE’s were higher and DSC lower with variations by up to 36HU for the average MAEbone. The failure mode demonstrated the potential far-reaching consequences of a single misregistered subject in the training set with variations by up to 38HU for MAEbone. Conclusion Poor registration quality of the training set had a negative impact on paired, deep learning-based sCT generation. Notably, as low as one poorly-registered MR-CT pair in the training phase was capable of drastically altering a model.
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