title: Co-registration of pre-operative CT with ex vivo surgically excised ground glass nodules to define spatial extent of invasive adenocarcinoma on in vivo imaging: a proof-of-concept study.
abstract: OBJECTIVE
  To develop an approach for radiology-pathology fusion of ex vivo histology of surgically excised pulmonary nodules with pre-operative CT, to radiologically map spatial extent of the invasive adenocarcinomatous component of the nodule.
  
  
  METHODS
  Six subjects (age: 75 ± 11 years) with pre-operative CT and surgically excised ground-glass nodules (size: 22.5 ± 5.1 mm) with a significant invasive adenocarcinomatous component (>5 mm) were included. The pathologist outlined disease extent on digitized histology specimens; two radiologists and a pulmonary critical care physician delineated the entire nodule on CT (in-plane resolution: <0.8 mm, inter-slice distance: 1-5 mm). We introduced a novel reconstruction approach to localize histology slices in 3D relative to each other while using CT scan as spatial constraint. This enabled the spatial mapping of the extent of tumour invasion from histology onto CT.
  
  
  RESULTS
  Good overlap of the 3D reconstructed histology and the nodule outlined on CT was observed (65.9 ± 5.2%). Reduction in 3D misalignment of corresponding anatomical landmarks on histology and CT was observed (1.97 ± 0.42 mm). Moreover, the CT attenuation (HU) distributions were different when comparing invasive and in situ regions.
  
  
  CONCLUSIONS
  This proof-of-concept study suggests that our fusion method can enable the spatial mapping of the invasive adenocarcinomatous component from 2D histology slices onto in vivo CT.
  
  
  CONCLUSIONS
  • 3D reconstructions are generated from 2D histology specimens of ground glass nodules. • The reconstruction methodology used pre-operative in vivo CT as 3D spatial constraint. • The methodology maps adenocarcinoma extent from digitized histology onto in vivo CT. • The methodology potentially facilitates the discovery of CT signature of invasive adenocarcinoma.
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA. mirabela.rusu@gmail.com.|GE Global Research, Niskayuna, NY, 12309, USA. mirabela.rusu@gmail.com.
authors.forename: Mirabela
authors.identifier: http://orcid.org/0000-0002-0372-0367
authors.initials: M
authors.lastname: Rusu
authors.affiliation: UT Southwestern Medical Center, Dallas, TX, USA.|University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Prabhakar
authors.initials: P
authors.lastname: Rajiah
authors.affiliation: University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Gilkeson
authors.affiliation: University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Yang
authors.affiliation: University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Donatelli
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Rajat
authors.initials: R
authors.lastname: Thawani
authors.affiliation: University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA.|Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Jacono
authors.affiliation: University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Linden
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA. anant.madabhushi@case.edu.
authors.forename: Anant
authors.initials: A
authors.lastname: Madabhushi
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging*; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging; D000075082:Proof of Concept Study; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Computed tomography; Computer-assisted image processing; Lung adenocarcinoma; Multimodal imaging; Pathology