The Advanced Image Analysis Laboratory in the Radiology Department at Children’s Hospital Boston allows pediatric radiologists, nuclear medicine physicians, and referring clinicians to maximize utilization of the data obtained from computed tomography (CT), magnetic resonance imaging (MRI), ultrasounds for children, and nuclear medicine exams. The three-dimensional models, fused images, and other advanced post-processing methods improve patient care by aiding diagnosis, treatment planning, and surgical intervention. The images can also be used for patient-friendly explanations and answering research questions.
Modern CT and MRI scanners generate large amounts of data. Using this data, we are able to produce volumetric (three-dimensional) images of all parts of the body. In addition, we can analyze the images to derive clinically useful measurements and visualizations that can be used to plan surgical approaches and evaluate treatment response. Some of these visualizations allow clinicians to better visualize a patient's anatomy using only one or a few images and are important in diagnosis, treatment, and surgical planning. They convey critical information that supplements the review of hundreds of individual 2D slice images. Patients and their families can better understand the disease process and the treatment planned using these models.
At Children's, advanced post-processing has been used in:
- Brain and Spine Imaging - vascular disease, tumor volumes, surgical planning
- Head and Neck Imaging - craniofacial anomalies and dysmorphism
- Cardiovascular Imaging - surgical connections
- Thoracic Imaging - Dynamic airway studies
- Genetics - facial dysmorphisms
- Musculoskeletal Imaging - fractures & orthopedic hardware
- Abdominopelvic Imaging - pre and post transplant evaluation, tumor volume measurement
The following are examples of advanced image processing performed in the lab:
- 3D models
- Volumetric measurements
- Mulitimodality image fusion and overlays
- Perfusion imaging analysis
Pre- and post-treatment images in a patient with partial left coronal suture synostosis at 1 month of age. The image on the right shows normal appearance post suture release (one year post treatment).
Clarifying the diagnosis: Subtle fracture demonstrated best on the 3D model (right).
Abnormal vertebral bodies (segmentation anomalies) in a patient with scoliosis.
Dilated collecting systems and ureters (bilateral hydroureteronephrosis).
Tractography analysis from MRI DTI data.
FOR MORE INFORMATION AND RELEVANT PUBLICATIONS:
Guitton TG, Ring D. Three-Dimensional Computed Tomographic Imaging and Modeling in the Upper Extremity. Hand Clin 2010 26(3):447-53.
Prabhu SP, Newton A, Perez-Rosello J, Kleinman PK. 3D models rendered from Axial Head CT for Problem Solving in Cases of Suspected Child Abuse. Society of Pediatric Radiology, Boston. USA annual meeting 2010.
Santiago Medina, L. Three-dimensional CT Maximum Intensity Projections of the Calvaria: A New Approach for Diagnosis of Craniosynostosis and Fractures. AJNR Am J Neuroradiol 2000; 21(10):1951-54.
Nuclear medicine studies can be particularly useful when they are digitally combined (fused) with anatomical images generated by computed tomography (CT) or magnetic resonance imaging (MRI). Boston Children's Hospital is one of the few pediatric nuclear medicine programs nationwide that is routinely capable of electronically fusing nuclear medicine studies with images obtained from CT or MRI. Since 1996, we have routinely applied image fusion to single photon emission tomography (SPECT), position emission tomography (PET), bone scans, rest-stress myocardial perfusion scintigraphy, MRI, and CT.
These enhanced 3D images are helpful to improve our diagnostic ability. For example, a neurologist can see the exact location in the brain where a seizure originated or an oncologist can determine which parts of a tumor are growing the fastest. Our work has been published and has been the topic of several presentations at national and international meetings.
At Children's, image fusion is used in:
- Neurology - To determine the exact location in the brain where a seizure originates
- Neuro-Oncology - To determine if a brain tumor is metabolically active or not following treatment
- Oncology - To diagnose and determine the extent of a tumor, guide biopsy and radiation oncology treatment, and provide more specific assessment of the effect of therapy
The following are examples of fused images
Example of a nuclear medicine brain SPECT (color) fused to an MRI (black and white) showing the region of the brain responsible for epileptic seizures.
A brain tumor seen on MRI and fused to a brain PET (18F-FDG), reveals that only a portion of the tumor mass is still actively growing after chemotherapy and radiation therapy.
The bone PET (18F-sodium fluoride) shows an area of stress in the lower back due to intense physical activity. The PET/CT fusion provides exquisite anatomical localization of the bone injury.
SPECT/MRI Fusion: A 123I-MIBG SPECT in a young patient with neuroblastoma is fused with and MRI showing that the lesion seen on the SPECT is located in the spine.
FOR MORE INFORMATION AND RELEVANT PUBLICATIONS:
Habboush IH, Mitchell KD, Mulkern RV, Barnes PD, Treves ST. Registration and alignment of three-dimensional images: an interactive visual approach. Radiology 1996; 199(2):573-8.
Treves ST, Mitchell KD, Habboush IH. Three dimensional image alignment, registration and fusion. Q J Nucl Med 1998; 42(2):83-92.