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Research ArticleNeurointervention

Transcranial MR Imaging–Guided Focused Ultrasound Interventions Using Deep Learning Synthesized CT

P. Su, S. Guo, S. Roys, F. Maier, H. Bhat, E.R. Melhem, D. Gandhi, R. Gullapalli and J. Zhuo
American Journal of Neuroradiology October 2020, 41 (10) 1841-1848; DOI: https://doi.org/10.3174/ajnr.A6758
P. Su
aFrom the Department of Diagnostic Radiology and Nuclear Medicine (P.S., S.G., S.R., E.R.M., D.G., R.G., J.Z.), University of Maryland School of Medicine, Baltimore, Maryland
bSiemens Medical Solutions USA (P.S., H.B.), Malvern, Pennsylvania
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S. Guo
aFrom the Department of Diagnostic Radiology and Nuclear Medicine (P.S., S.G., S.R., E.R.M., D.G., R.G., J.Z.), University of Maryland School of Medicine, Baltimore, Maryland
cCenter for Metabolic Imaging and Therapeutics (S.G., S.R., R.G., J.Z.), University of Maryland Medical Center, Baltimore, Maryland
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S. Roys
aFrom the Department of Diagnostic Radiology and Nuclear Medicine (P.S., S.G., S.R., E.R.M., D.G., R.G., J.Z.), University of Maryland School of Medicine, Baltimore, Maryland
cCenter for Metabolic Imaging and Therapeutics (S.G., S.R., R.G., J.Z.), University of Maryland Medical Center, Baltimore, Maryland
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F. Maier
dSiemens Healthcare GmbH (F.M.), Erlangen, Germany
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H. Bhat
bSiemens Medical Solutions USA (P.S., H.B.), Malvern, Pennsylvania
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E.R. Melhem
aFrom the Department of Diagnostic Radiology and Nuclear Medicine (P.S., S.G., S.R., E.R.M., D.G., R.G., J.Z.), University of Maryland School of Medicine, Baltimore, Maryland
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D. Gandhi
aFrom the Department of Diagnostic Radiology and Nuclear Medicine (P.S., S.G., S.R., E.R.M., D.G., R.G., J.Z.), University of Maryland School of Medicine, Baltimore, Maryland
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R. Gullapalli
aFrom the Department of Diagnostic Radiology and Nuclear Medicine (P.S., S.G., S.R., E.R.M., D.G., R.G., J.Z.), University of Maryland School of Medicine, Baltimore, Maryland
cCenter for Metabolic Imaging and Therapeutics (S.G., S.R., R.G., J.Z.), University of Maryland Medical Center, Baltimore, Maryland
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J. Zhuo
aFrom the Department of Diagnostic Radiology and Nuclear Medicine (P.S., S.G., S.R., E.R.M., D.G., R.G., J.Z.), University of Maryland School of Medicine, Baltimore, Maryland
cCenter for Metabolic Imaging and Therapeutics (S.G., S.R., R.G., J.Z.), University of Maryland Medical Center, Baltimore, Maryland
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  • FIG 1.
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    FIG 1.

    Schema of the employed deep learning architecture based on the widely used U-Net convolutional neural network consisting of encoding and decoding pathways. Dual-echo UTE images were used as the input for the network. Reference CT of the skull was segmented from the reference CT and was used as the predication target. The difference between output of the network, DL synthetic CT of the skull, and reference CT of the skull was minimized using MAE loss function. Drop-out regularization (rate = 0.5) was applied connecting the encoder and decoder. BN indicates batch normalization; ReLu, rectified linear unit; Conv, convolutional layer; Ref-CT, reference CT.

  • FIG 2.
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    FIG 2.

    Deep learning results from 1 representative testing subject (55 years of age, female). From top to bottom: UTE echo 1 and echo 2 images, reference CT, segmented reference CT of the skull, DL synthetic CT of the skull, and the absolute difference between the 2. For this subject, the Dice coefficient for skull masks between DL synthetic CT and the reference CT is 0.92, and the mean absolute difference is 96.27 HU.

  • FIG 3.
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    FIG 3.

    Voxelwise 2D histogram scatterplot between the reference skull CT intensity and the DL synthetic skull CT signal intensity in Hounsfield units within skull. The correlation coefficient is r = 0.80 (same testing subject as in Fig 2). Color bar represents the voxel count.

  • FIG 4.
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    FIG 4.

    A, Association of average CT Hounsfield unit values between the DL synthetic CT of the skull and the reference CT of the skull for all 40 testing subjects from cross-validation. Each dot represents 1 subject. B, The relationship between SDR values determined from the reference CT and DL synthetic CT from all 40 subjects. Each dot represents 1 subject.

  • FIG 5.
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    FIG 5.

    A and B, The calculated average skull thickness map from the reference CT and the DL synthetic CT images, respectively, from all 40 testing subjects. C, The differences between A and B with a maximum thickness difference of 0.2 mm (2% error) and the average error of 0.03 mm (0.3%). Note that regional maps are based on the entries of the 1024 ultrasound beams from the ExAblate system (InSightec). D and E, The calculated average SDR map based on the reference CT and DL synthetic CT images from all 40 subjects. F, The differences between D and E with a maximum SDR difference of 0.03 (4% error) and the average error of 1024 entries was <0.01 (1.3%).

  • FIG 6.
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    FIG 6.

    Comparison of calculated bone density and the simulated temperature rise. The first and second columns show the calculated bone density map using the reference CT and DL synthetic CT images on 8 representative testing cases, in which the red dots are the assigned focal targets. In the third and fourth columns, the simulated temperature elevations at the focal spots caused by a 16-second, 1000-W sonication are compared between reference CT and DL synthetic CT on a base brain temperature of 37°C. The simulated peak temperature rise values based on original and DL synthetic CT images for all 8 subjects are the following: case 1: 55.3°C and 54.2°C (6.0% error on temperature rise), case 2: 59.0°C and 58.9°C (0.5% error), case 3: 57.6°C and 55.9°C (8.2% error), case 4: 57.5°C and 59.1°C (7.8% error), case 5: 54.3°C and 54.6°C (0.6% error), case 6: 55.5°C and 56.0°C (0.9% error), case 7: 54.5°C and 55.1°C (1.1% error), case 8: 53.5°C and 54.5°C (1.9% error), respectively. These errors are well within the errors that one might expect from the simulation.

Tables

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  • Various metrics (mean ± standard deviation) showing the performance of the deep learning model from all 5 runs of the cross-validation processa

    Run 1Run 2Run 3Run 4Run 5Average
    Dice coefficient0.91 ± 0.030.92 ± 0.030.91 ± 0.030.91 ± 0.020.92 ± 0.030.91 ± 0.03
    Spatial correlation coefficient0.84 ± 0.050.77 ± 0.100.81 ± 0.070.78 ± 0.080.81 ± 0.080.80 ± 0.08
    MAE (HU)89.32 ± 12.29109.18 ± 23.4998.95 ± 13.75105.10 ± 17.62120.29 ± 26.91104.57 ± 21.33
    • ↵a Averaged metrics from all 40 testing datasets are also included.

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American Journal of Neuroradiology: 41 (10)
American Journal of Neuroradiology
Vol. 41, Issue 10
1 Oct 2020
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Cite this article
P. Su, S. Guo, S. Roys, F. Maier, H. Bhat, E.R. Melhem, D. Gandhi, R. Gullapalli, J. Zhuo
Transcranial MR Imaging–Guided Focused Ultrasound Interventions Using Deep Learning Synthesized CT
American Journal of Neuroradiology Oct 2020, 41 (10) 1841-1848; DOI: 10.3174/ajnr.A6758

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Transcranial MR Imaging–Guided Focused Ultrasound Interventions Using Deep Learning Synthesized CT
P. Su, S. Guo, S. Roys, F. Maier, H. Bhat, E.R. Melhem, D. Gandhi, R. Gullapalli, J. Zhuo
American Journal of Neuroradiology Oct 2020, 41 (10) 1841-1848; DOI: 10.3174/ajnr.A6758
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