Computer-aided lymph node detection using pelvic magnetic resonance imaging

Pelvic Lymph Nodes (PLNs) segmentation and classification are fundamental tools in the medical image analysis of pelvic gynecological cancer such as endometrial and cervical cancer. Often used by the radiologist, PLN classification requires detailed knowledge of the morphological features of PLNs, derived from size, shape, contour and heterogeneous appearance. Accurate PLN segmentation is an essential step in PLN classification. In order to supply the best assessment of a nodal status, semi-automatic and automatic PLN segmentation and classification methods are highly desired as they can strongly capture the wide variability in morphological features and reduce classification errors due to the inter and intra-observer variability, while avoiding the time-consuming for manual delineation of PLN boundary. Nevertheless, semi-automatic segmentation methods require the clinician intervention to select the initial seed point. However, typical semi-automatic PLN segmentation methods might fail due to (1) the intensity inhomogeneity, noise and low contrast in medical images, and (2) the position of the starting point. Thus, the performance of these methods can be enhanced by using a preprocessing-based iterative segmentation approach. Currently, Magnetic Resonance Imaging (MRI) is the most common imaging modality used for staging endometrial and cervical cancer, evaluation of PLN involvement and selection of therapeutic strategy. PLN detection using classic features can be challenging due to the similarity between normal and abnormal PLNs structures. In pelvic cancer and metastatic PLN, Diffusion Weighted (DW)-MRI exhibits brighter areas indicating tumor and metastatic PLN. This paper combines anatomic T2-Weighted (T2-w) imaging with DW imaging. Specifically, we propose a computer-aided pelvic framework, which leverages (1) an ensemble preprocessing method to improve PLN segmentation, (2) the iterative correction of the position of the initial point by executing the segmentation algorithm several times in succession, (3) the fusion of structural and diffusion MRI and, (4) the extraction of morphological features of segmented PLNs (axial T2-w image) as well as intensity feature derived from the fused image for the final classification of PLNs as suspect or non-suspect. Research in the field of PLN detection is important as it can help doctors to better detect cervical and endometrial cancer and decide the appropriate treatment. To the best of our knowledge, this is the first work to segment and classify PLN. Our preprocessing-based iterative segmentation approach significantly (p<0.05) improved comparison segmentation methods, with a segmentation accuracy boosted from 61.37% for the conventional region-growing algorithm to 66.53% for the proposed method. Furthermore, we obtained an average accuracy of 78.50% for pelvic nodule classification.