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. 2012 Feb;22(2):302-9.
doi: 10.1007/s00330-011-2278-0. Epub 2011 Oct 8.

A method for the automatic quantification of the completeness of pulmonary fissures: evaluation in a database of subjects with severe emphysema

Eva M van Rikxoort  1 , Jonathan G Goldin, Maya Galperin-Aizenberg, Fereidoun Abtin, Hyun J Kim, Peiyun Lu, Bram van Ginneken, Greg Shaw, Matthew S Brown
Affiliations

A method for the automatic quantification of the completeness of pulmonary fissures: evaluation in a database of subjects with severe emphysema

Eva M van Rikxoort et al. Eur Radiol. 2012 Feb.

Abstract

Objectives: To propose and evaluate a technique for automatic quantification of fissural completeness from chest computed tomography (CT) in a database of subjects with severe emphysema.

Methods: Ninety-six CT studies of patients with severe emphysema were included. The lungs, fissures and lobes were automatically segmented. The completeness of the fissures was calculated as the percentage of the lobar border defined by a fissure. The completeness score of the automatic method was compared with a visual consensus read by three radiologists using boxplots, rank sum tests and ROC analysis.

Results: The consensus read found 49% (47/96), 15% (14/96) and 67% (64/96) of the right major, right minor and left major fissures to be complete. For all fissures visually assessed as being complete the automatic method resulted in significantly higher completeness scores (mean 92.78%) than for those assessed as being partial or absent (mean 77.16%; all p values <0.001). The areas under the curves for the automatic fissural completeness were 0.88, 0.91 and 0.83 for the right major, right minor and left major fissures respectively.

Conclusions: An automatic method is able to quantify fissural completeness in a cohort of subjects with severe emphysema consistent with a visual consensus read of three radiologists.

Key points: • Lobar fissures are important for assessing the extent and distribution of lung disease • Modern CT allows automatic lobar segmentation and assessment of the fissures • This segmentation can also assess the completeness of the fissures. • Such assessment is important for decisions about novel therapies (eg for emphysema).

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Figures

Fig. 1
Fig. 1
Illustration of the calculation of the percentage of the fissure’s completeness. The left frame shows an original coronal slice of a right lung. In the second frame the automatically found (incomplete) fissure is shown, followed by the automatically determined lobar border in the third frame. The last frame shows the colour-coded lobar boundary that is the output of the system. Voxels in yellow indicate fissure voxels, voxels in red indicate a lobar boundary without a fissure. The percentage complete is now simply calculated as the number of yellow voxels divided by the total number of voxels on the lobar boundary. Note that this image is a 2D slice, but the calculation of fissural completeness is performed in 3D
Fig. 2
Fig. 2
a: Descriptive statistics for the 96 CT studies used in this paper for the automatic method. b: Descriptive statistics for the 96 CT studies used in this paper for the visual consensus read
Fig. 3
Fig. 3
Sets of 4 coronal slices from 4 different CT studies and the corresponding output of the automatic fissural completeness quantification method. Voxels in yellow indicate fissure voxels, voxels in red indicate a lobar boundary without a fissure. a Example of a CT study for which all lobar fissures are complete. In (b) an example of an incomplete right minor fissure is shown. c and d Examples of incomplete major fissure(s)
Fig. 4
Fig. 4
a: Box-plots showing the quantitative fissural completeness score for each visually scored category for the right major fissure. b: Box-plots showing the quantitative fissural completeness score for each visually scored category for the right minor fissure. c: Box-plots showing the quantitative fissural completeness score for each visually scored category for the left major fissure
Fig. 5
Fig. 5
a: ROC curves comparing the automatic continuous completeness score with those of the individual readers and the consensus read for the right major fissure. b: ROC curves comparing the automatic continuous completeness score with the individual readers and the consensus read for the right minor fissure. c: ROC curves comparing the automatic continuous completeness score with those of the individual readers and the consensus read for the left major fissure
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