Integration of 3D scale-based pseudo-enhancement correction and partial volume image segmentation for improving electronic colon cleansing in CT colonograpy.

Orally administered tagging agents are usually used in CT colonography (CTC) to differentiate residual bowel content from native colonic structures. However, the high-density contrast agents tend to introduce pseudo-enhancement (PE) effect on neighboring soft tissues and elevate their observed CT attenuation value toward that of the tagged materials (TMs), which may result in an excessive electronic colon cleansing (ECC) since the pseudo-enhanced soft tissues are incorrectly identified as TMs. To address this issue, we integrated a 3D scale-based PE correction into our previous ECC pipeline based on the maximum a posteriori expectation-maximization partial volume (PV) segmentation. The newly proposed ECC scheme takes into account both the PE and PV effects that commonly appear in CTC images. We evaluated the new scheme on 40 patient CTC scans, both qualitatively through display of segmentation results, and quantitatively through radiologists' blind scoring (human observer) and computer-aided detection (CAD) of colon polyps (computer observer). Performance of the presented algorithm has shown consistent improvements over our previous ECC pipeline, especially for the detection of small polyps submerged in the contrast agents. The CAD results of polyp detection showed that 4 more submerged polyps were detected for our new ECC scheme over the previous one.