A Hybrid Lung and Vessel Segmentation Algorithm for Computer Aided Detection of Pulmonary Embolism

Advances in multi-detector technology have made CT pulmonary angiography (CTPA) a popular radiological tool for pulmonary emboli (PE) detection. CTPA provide rich detail of lung anatomy and is a useful diagnostic aid in highlighting even very small PE. However analyzing hundreds of slices is laborious and time-consuming for the practicing radiologist which may also cause misdiagnosis due to the presence of various PE look-alike. Computer-aided diagnosis (CAD) can be a potential second reader in providing key diagnostic information. Since PE occurs only in vessel arteries, it is important to mark this region of interest (ROI) during CAD preprocessing. In this paper, we present a new lung and vessel segmentation algorithm for extracting contrast-enhanced vessel ROI in CTPA. Existing approaches to segmentation either provide only the larger lung area without highlighting the vessels or is computationally prohibitive. In this paper, we propose a hybrid lung and vessel segmentation which uses an initial lung ROI and determines the vessels through a series of refinement steps. We first identify a coarse vessel ROI by finding the "holes" from the lung ROI. We then use the initial ROI as seed-points for a region-growing process while carefully excluding regions which are not relevant. The vessel segmentation mask covers 99% of the 259 PE from a real-world set of 107 CTPA. Further, our algorithm increases the net sensitivity of a prototype CAD system by 5-9% across all PE categories in the training and validation data sets. The average run-time of algorithm was only 100 seconds on a standard workstation.