Computer aided detection of pulmonary embolism using multi-slice multi-axial segmentation

Abstract

Pulmonary Embolism (PE) is a respiratory disease caused by blood clots lodg+ed in the pulmonary arteries, blocking perfusion, limiting blood oxyg+enation, and inducing a higher load on the right ventricle. Pulmonary embolism is diagnosed using contrast enhanced Computed Tomography Pulmonary Angiography (CTPA), resulting in a 3D imag+e where the pulmonary arteries appear as bright structures, and emboli appear as filling defects, with these often being difficult to see, especially in the subsegmental case. In comparison to an expert panel, the averag+e radiologist has a sensitivity of between 77% and 94%. Computer Aided Detection (CAD) is regarded as a promising system to detect emboli, but current algorithms are hindered by a high false positive rate. In this paper, we propose a novel methodology for emboli detection. Instead of finding candidate points and characterizing them, we find emboli directly on the whole imag+e slice. Detections across different slices are merg+ed into a single detection volume that is post-processed to g+enerate emboli detections. The system was evaluated on a public PE database of 80 scans. On 20 test scans, our system obtained a per-embolus sensitivity of 68% at a regime of one false positive per scan, improving on state-of-the-art methods. We therefore conclude that our multi-slice emboli segmentation CAD for PE method is a valuable alternative to the standard methods of candidate point selection and classification.