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  1. Alirr OI, Rahni AAA
    J Digit Imaging, 2020 04;33(2):304-323.
    PMID: 31428898 DOI: 10.1007/s10278-019-00262-8
    Preoperative planning for liver surgical treatments is an essential planning tool that aids in reducing the risks of surgical resection. Based on the computed tomography (CT) images, the resection can be planned before the actual tumour resection surgery. The computer-aided system provides an overview of the spatial relationships of the liver organ and its internal structures, tumours, and vasculature. It also allows for an accurate calculation of the remaining liver volume after resection. The aim of this paper was to review the main stages of the computer-aided system that helps to evaluate the risk of resection during liver cancer surgical treatments. The computer-aided system assists with surgical planning by enabling physicians to get volumetric measurements and visualise the liver, tumours, and surrounding vasculature. In this paper, it is concluded that for accurate planning of tumour resections, the liver organ and its internal structures should be segmented to understand the clear spatial relationship between them, thus allowing for a safer resection. This paper presents the main proposed segmentation techniques for each stage in the computer-aided system, namely the liver organ, tumours, and vessels. From the reviewed methods, it has been found that instead of relying on a single specific technique, a combination of a group of techniques would give more accurate segmentation results. The extracted masks from the segmentation algorithms are fused together to give the surgeons the 3D visualisation tool to study the spatial relationships of the liver and to calculate the required resection planning parameters.
  2. Alirr OI, Rahni AAA
    J Appl Clin Med Phys, 2023 Mar 18.
    PMID: 36933239 DOI: 10.1002/acm2.13966
    PURPOSE: Liver hepatic vessels segmentation is a crucial step for the diagnosis process in patients with hepatic diseases. Segmentation of liver vessels helps to study the liver internal segmental anatomy that helps in the preoperative planning of surgical treatment.

    METHODS: Recently, the convolutional neural networks (CNN) have been proved to be efficient for the task of medical image segmentation. The paper proposes an automatic deep learning-based system for liver hepatic vessels segmentation of Computed Tomography (CT) datasets from different sources. The proposed work focuses on the combination of different steps; it starts by a preprocessing step to improve the vessels appearance within the liver region of interest in the CT scans. Coherence enhancing diffusion filtering (CED) and vesselness filtering methods are used to improve vessels contrast and intensity homogeneity. The proposed U-net based network architecture is implemented with modified residual block to include concatenation skip connection. The effect of enhancement using filtering step was studied. Also, the effect of data mismatch used in training and validation is studied.

    RESULTS: The proposed method is evaluated using many CT datasets. Dice similarity coefficient (DSC) is used to evaluate the method. The average DSC score achieved a score 79%.

    CONCLUSIONS: The proposed approach succeeded to segment liver vasculature from the liver envelope accurately, which makes it as potential tool for clinical preoperative planning.

  3. Alirr OI, Rahni AAA, Golkar E
    Int J Comput Assist Radiol Surg, 2018 Aug;13(8):1169-1176.
    PMID: 29860549 DOI: 10.1007/s11548-018-1801-z
    PURPOSE: Segmentation of liver tumours is an important part of the 3D visualisation of the liver anatomy for surgical planning. The spatial relationship between tumours and other structures inside the liver forms the basis of preoperative surgical risk assessment. However, the automatic segmentation of liver tumours from abdominal CT scans is riddled with challenges. Tumours located at the border of the liver impose a big challenge as the surrounding tissues could have similar intensities.

    METHODS: In this work, we introduce a fully automated liver tumour segmentation approach in contrast-enhanced CT datasets. The method is a multi-stage technique which starts with contrast enhancement of the tumours using anisotropic filtering, followed by adaptive thresholding to extract the initial mask of the tumours from an identified liver region of interest. Localised level set-based active contours are used to extend the mask to the tumour boundaries.

    RESULTS: The proposed method is validated on the IRCAD database with pathologies that offer highly variable and complex liver tumours. The results are compared quantitatively to the ground truth, which is delineated by experts. We achieved an average dice similarity coefficient of 75% over all patients with liver tumours in the database with overall absolute relative volume difference of 11%. This is comparable to other recent works, which include semiautomated methods, although they were validated on different datasets.

    CONCLUSIONS: The proposed approach aims to segment tumours inside the liver envelope automatically with a level of accuracy adequate for its use as a tool for surgical planning using abdominal CT images. The approach will be validated on larger datasets in the future.

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