Computerized scar detection on renal cortical scintigraphy images.

Objective: Renal cortical scintigraphy is a well-established functional imaging technique for visual analysis of radiopharmaceutical tracer distribution. However, the visual evaluation is subjective, causing interobserver variability, especially in a quantifiable number of scars. The purpose of this study was to develop new computerized methods in renal cortical scintigraphy image interpretation, particularly addressing activity distribution and cortex continuity (scars).

Methods: The proposed methods involve preprocessing stages of model-based automatic kidney segmentation using active-shape model and image normalization (transforming each kidney image into a standardized image vector). For our previous computer-aided diagnosis scheme, two new image-based features [localized activity drop and principal component analysis (PCA)] were defined. Their performance was evaluated and compared with our previous scheme by using free-response receiver operating characteristic that is in terms of sensitivity (true-positive fraction) and the mean number of false positives (FPs) per image.

Results: Clinical tests were conducted in 297 patients (231 normal and 66 abnormal). The PCA-based image feature presented the best scar detection performance, followed by the localized activity drop feature. Both schemes were found to be superior to our previous computer-aided diagnosis scheme. In the PCA-based scheme, for sensitivity of 0.90 (76/84), the mean number of FPs was measured as 4.52 (1343/297). For another setting with reduced sensitivity of 0.79 (66/84), the mean number of FPs improved to 1.21 (360/297). Finally, a decision fusion scheme using 'majority voting' was also proposed, the sensitivity and mean number of FPs of which were measured as 0.83 (70/84) and 1.90 (563/297), respectively.

Conclusion: The proposed methods have potential to provide effective second-reader information to nuclear medicine specialists in finding scar regions. Possible ways to improve the FP rate were also proposed.