title: Toward automatic regional analysis of pulmonary function using inspiration and expiration thoracic CT.
abstract: OBJECTIVE
  To analyze pulmonary function using a fully automatic technique which processes pairs of thoracic CT scans acquired at breath-hold inspiration and expiration, respectively. The following research objectives are identified to: (a) describe and systematically analyze the processing pipeline and its results; (b) verify that the quantitative, regional ventilation measurements acquired through CT are meaningful for pulmonary function analysis; (c) identify the most effective of the calculated measurements in predicting pulmonary function; and (d) demonstrate the potential of the system to deliver clinically important information not available through conventional spirometry.
  
  
  METHODS
  A pipeline of automatic segmentation and registration techniques is presented and demonstrated on a database of 216 subjects well distributed over the various stages of COPD (chronic obstructive pulmonary disorder). Lungs, fissures, airways, lobes, and vessels are automatically segmented in both scans and the expiration scan is registered with the inspiration scan using a fully automatic nonrigid registration algorithm. Segmentations and registrations are examined and scored by expert observers to analyze the accuracy of the automatic methods. Quantitative measures representing ventilation are computed at every image voxel and analyzed to provide information about pulmonary function, both globally and on a regional basis. These CT derived measurements are correlated with results from spirometry tests and used as features in a kNN classifier to assign COPD global initiative for obstructive lung disease (GOLD) stage.
  
  
  RESULTS
  The steps of anatomical segmentation (of lungs, lobes, and vessels) and registration in the workflow were shown to perform very well on an individual basis. All CT-derived measures were found to have good correlation with spirometry results, with several having correlation coefficients, r, in the range of 0.85-0.90. The best performing kNN classifier succeeded in classifying 67% of subjects into the correct COPD GOLD stage, with a further 29% assigned to a class neighboring the correct one.
  
  
  CONCLUSIONS
  Pulmonary function information can be obtained from thoracic CT scans using the automatic pipeline described in this work. This preliminary demonstration of the system already highlights a number of points of clinical importance such as the fact that an inspiration scan alone is not optimal for predicting pulmonary function. It also permits measurement of ventilation on a per lobe basis which reveals, for example, that the condition of the lower lobes contributes most to the pulmonary function of the subject. It is expected that this type of regional analysis will be instrumental in advancing the understanding of multiple pulmonary diseases in the future.
authors.affiliation: Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands. keelinm@ gmail.com
authors.forename: Keelin
authors.initials: K
authors.lastname: Murphy
authors.forename: Josien P W
authors.initials: JP
authors.lastname: Pluim
authors.forename: Eva M
authors.initials: EM
authors.lastname: van Rikxoort
authors.forename: Pim A
authors.initials: PA
authors.lastname: de Jong
authors.forename: Bartjan
authors.initials: B
authors.lastname: de Hoop
authors.forename: Hester A
authors.initials: HA
authors.lastname: Gietema
authors.forename: Onno
authors.initials: O
authors.lastname: Mets
authors.forename: Marleen
authors.initials: M
authors.lastname: de Bruijne
authors.forename: Pechin
authors.initials: P
authors.lastname: Lo
authors.forename: Mathias
authors.initials: M
authors.lastname: Prokop
authors.forename: Bram
authors.initials: B
authors.lastname: van Ginneken
mesh_terms: D000368:Aged; D001331:Automation; D045853:Exhalation; D005260:Female; D006801:Humans; D001239:Inhalation; D008173:Lung Diseases, Obstructive / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic / Q000379:methods*; D012129:Respiratory Function Tests / Q000379:methods*