Osteoporosis is a common bone disease that occurs when the creation of new bone does not keep up with the loss of old bone, resulting in increased fracture risk. Adults over the age of 50 are especially at risk and see their quality of life diminished because of limited mobility, which can lead to isolation and depression. We are developing a robust screening method capable of identifying individuals predisposed to hip fracture to address this clinical challenge. The method uses finite element analysis and relies on segmented computed tomography (CT) images of the hip. Presently, the segmentation of the proximal femur requires manual input, which is a tedious task, prone to human error, and severely limits the practicality of the method in a clinical context. Here we present a novel approach for segmenting the proximal femur that uses a deep convolutional neural network to produce accurate, automated, robust, and fast segmentations of the femur from CT scans. The network architecture is based on the renowned u-net, which consists of a downsampling path to extract increasingly complex features of the input patch and an upsampling path to convert the acquired low resolution image into a high resolution one. Skipped connections allow us to recover critical spatial information lost during downsampling. The model was trained on 30 manually segmented CT images and was evaluated on 200 ground truth manual segmentations. Our method delivers a mean Dice similarity coefficient (DSC) and 95th percentile Hausdorff distance (HD95) of 0.990 and 0.981 mm, respectively.
Lesions that appear hyperintense in both Fluid Attenuated Inversion Recovery (FLAIR) and T2-weighted magnetic resonance images (MRIs) of the human brain are common in the brains of the elderly population and may be caused by ischemia or demyelination. Lesions are biomarkers for various neurodegenerative diseases, making accurate quantification of them important for both disease diagnosis and progression. Automatic lesion detection using supervised learning requires manually annotated images, which can often be impractical to acquire. Unsupervised lesion detection, on the other hand, does not require any manual delineation; however, these methods can be challenging to construct due to the variability in lesion load, placement of lesions, and voxel intensities. Here we present a novel approach to address this problem using a convolutional autoencoder, which learns to segment brain lesions as well as the white matter, gray matter, and cerebrospinal fluid by reconstructing FLAIR images as conical combinations of softmax layer outputs generated from the corresponding T1, T2, and FLAIR images. Some of the advantages of this model are that it accurately learns to segment lesions regardless of lesion load, and it can be used to quickly and robustly segment new images that were not in the training set. Comparisons with state-of-the-art segmentation methods evaluated on ground truth manual labels indicate that the proposed method works well for generating accurate lesion segmentations without the need for manual annotations.
Enlarged ventricles are a marker of several brain diseases; however, they are also associated with normal aging. Better understanding of the distribution of ventricular sizes in a large population would be of great clinical value to robustly define imaging markers that distinguish health and disease. The AGES-Reykjavik study includes magnetic resonance imaging scans of 4811 individuals from an elderly Icelandic population. Automated brain segmentation algorithms are necessary to analyze such a large data set but state-of-the-art algorithms often require long processing times or depend on large manually annotated data sets when based on deep learning approaches. In an effort to increase robustness, decrease processing time, and avoid tedious manual delineations, we selected 60 subjects with a large range of ventricle sizes and generated training labels using an automated whole brain segmentation algorithm designed for brains with ventriculomegaly. Lesion labels were added to the training labels, which were subsequently used to train a patch-based three-dimensional U-net Convolutional Neural Network for very fast and robust labeling of the remaining subjects. Comparisons with ground truth manual labels demonstrate that the proposed method yields robust segmentation and labeling of the four main sub-compartments of the ventricular system.