title: Fractal analysis of nuclear medicine images for the diagnosis of pulmonary emphysema: interpretations, implications, and limitations.
abstract: OBJECTIVE
  The purpose of this study was to investigate, on images obtained in nuclear medicine examinations, the physical meanings and consequent implications of fractal analysis developed in a recent study that was reported to be effective in quantifying the heterogeneous distribution of carbon particle radioaerosol in the lungs.
  
  
  METHODS
  Fractal dimensions were computed for 108 sets of radionuclide imaging data from 28 patients according to the methods in a previous report, and were then correlated with the ratio of tissue areas segmented at two thresholds (15% and 35% of maximal radioactivity).
  
  
  RESULTS
  Fractal dimension was found to linearly correlate with the ratio natural logarithm of tissue areas segmented at two different threshold levels (n = 108, r = 0.999), with regression slope accurately predicted (error = 0.06%). Bland-Altman analysis showed that fractal dimensions ranging from 0.2 to 1.9 can be explained by this area ratio with disagreement of only 5.13% at two standard deviations; thus, fractal dimension seems to be an over-simplified parameter unrelated to spatial heterogeneity of radioaerosol distribution.
  
  
  CONCLUSIONS
  The analysis of this study suggested that the fractal dimension defined in a previous report was limited to the indication of the percentage area of low-radioactivity regions with respect to total tissue area in the image. Because the fractal dimension partially reflects, but is not specific to, a certain degree of focal spots of low radioactivity, we suggest using fractal analysis in clinical practice only with careful control and thorough understanding of the physical meanings.
authors.affiliation: Department of Electrical Engineering, National Taiwan University, Taipei.
authors.forename: H W
authors.initials: HW
authors.lastname: Chung
authors.forename: Y H
authors.initials: YH
authors.lastname: Huang
mesh_terms: D017709:Fractals; D006801:Humans; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D012189:Retrospective Studies