Early Detection of Rheumatoid Arthritis using extremity MRI

109 Pages·2015·9.12 MB·English

DELFT UNIVERSITY OF TECHNOLOGY
Early Detection of Rheumatoid Arthritis using extremity MRI:
Quantification of Bone Marrow Edema in the Carpal bones
THESIS
submitted in partial fulfilment of the
requirements for the degree of

MASTER OF SCIENCE
in
BIOMEDICAL ENGINEERING

March 20, 2015

Edgar Alphonse Hendrik Roex
4253450

Faculteit Werktuigbouwkunde, Maritieme Techniek
& Technische Materiaalwetenschappen
Delft University of Technology
[email protected]
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EXAMINATION COMMITTEE MEMBERS:

Prof. Dr. Ir. B.P.F. Lelieveldt a,b Chair, Supervisor
Dr. B. C. Stoel b Daily Supervisor
Dr. Ir. Bart L. Kaptein c External Member
Prof. Dr. M. Loog a External Member

a Delft University of Technology, Faculty of Electrical Engineering, Mathematics & Computer Science, Delft, The Netherlands
b Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
c Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands

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Abstract — Visual scoring of magnetic resonance images for the
early detection of rheumatoid arthritis is prone to human subjectivity and
lacks sensitivity. In a bid to develop an objective and quantitative alternative
using digital image processing, this thesis proposes automatic segmentation
of the carpal bones, followed by the quantification of bone marrow edema,
which is an important inflammatory imaging biomarker. Segmentation of the
carpal bones is achieved using multi atlas-based segmentation. Compared to
manual segmentations of the training data, an average Dice overlap of 0.85
was achieved. By examining contrast-enhanced MR images of the wrist,
edematous bone is classified from normal bone marrow using knowledge
based fuzzy clustering. Validation of the quantitative score against the
existing RA MRI Scoring (RAMRIS) system showed a significant positive
correlation. Segmentation error was seen to be a confounding factor, limiting
the specificity of the BME measure. To increase agreement and maximise
the available information, it is recommended that data from a
complementary imaging plane is included.

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Acknowledgements
First and foremost, I would like to thank Boudewijn for the opportunity of completing my
MSc thesis at LKEB and overseeing the project. Berend, I have been very fortunate to have
you as my supervisor. Your availability, guidance and well-placed critique have undoubted-
ly lifted the quality of my work. I am grateful for the many lessons in good research practice
you have given me along the way.
Evgeni, cheers for all your input and our many in-depth discussions. Working together
on the early RA project made it all the more productive and importantly, enjoyable. I would
like to thank Denis for all the technical assistance, and the registration gurus, Marius and
Floris, for their expertise and of course everyone else at LKEB that offered me their time.
My thanks go to Annette, Lukas, Wouter, and Hanna from rheumatology and Monique
from radiology for their collaboration and clinical expertise. I would also like to
acknowledge all the patients and volunteers than underwent an MRI scan, and those who
scored the data.
I thank all my friends and fellow students, especially the more than 20 different
housemates I got to live with; you guys made my time as a (nomadic) student in Delft un-
forgettable.
Lastly, to my family and loved ones, near and far, thank you for your encouragement
and support.

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Abbreviations and acronyms
ABS Atlas-Based Segmentation
BME Bone Marrow Edema
CR Conventional Radiography
CT Computed Tomography
DCE-MRI Dynamic Contrast Enhanced MRI
EULAR European League Against Rheumatism
FOV Field of View
(N)MI (Normalised) Mutual Information
MCP Metacarpophalangeal (joints)
MRI Magnetic Resonance Imaging
OMERACT Outcome Measures in Rheumatoid Arthritis Clinical Trials
RA Rheumatoid Arthritis
RAMRIS Rheumatoid Arthritis MRI Scoring system
ROI Region of Interest
US Ultrasonography

Glossary

Articular Of or relating to a joint or joints
Arthralgia Joint pain
Edema Swelling caused by accumulation of fluid
Osteitis Inflammation of bony tissue
Prognosis A prediction of the probable course and outcome of a disease
Registration The process of matching or aligning of one image to another
Segmentation The process of subdividing an image into its constituent objects or regions
of interest
Synovitis Inflammation of the synovium
Synovium A soft-tissue membrane that lines the joint capsule of synovial joints
Voxel A volume element, the 3D analogy of a ‘pixel’

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