Toward physiologically motivated registration of diagnostic CT and PET/CT of lung volumes.

PURPOSE Current clinical practice for lung cancer diagnosis and staging requires the acquisition of a diagnostic computed tomography (CT) as well as positron emission tomography (PET)/CT volumes from a hybrid scanner, where the CT is used for attenuation correction (AC-CT). The PET and AC-CT images are implicitly aligned, however, image registration between the diagnostic CT and PET volumes is needed to relate the anatomical correspondences. This is an important but difficult task due to the absence of a direct or functional relationship between the intensities. Alternatively, here we propose the diagnostic CT can be aligned with the PET image through an indirect registration process that uses the AC-CT. The resultant deformation field can then be used to align the PET image to the diagnostic CT. The registration of the diagnostic CT to AC-CT registration still presents two major challenges: (a) it is a multimodal registration problem since the diagnostic CT is acquired after the injection of a contrast agent, and (b) the type and amplitude of the deformations require a registration process that includes physically motivated properties to achieve an accurate and physiologically plausible alignment. METHODS The authors propose a new framework based on fluid registration including three physiologically motivated properties: (i) sliding motion of the lungs against the pleura; (ii) preservation of rigid structures; (iii) preservation of topology. The sliding motion is modeled using direction dependent regularization that decouples the tangential and the normal components of the external force term. The rigid shape of the bones is preserved using a spatially varying filter for the deformations. Finally, the topology is maintained using the concept of log-unbiased deformations. To solve the multimodal problem, the authors use local cross correlation (LCC) as the similarity measure. RESULTS The proposed framework is first evaluated on CT lung image pairs representing several phases of the respiratory cycle. The authors show that their proposed framework has a superior performance compared to the classic fluid registration, both in quantitative and qualitative terms. The authors then evaluate the framework using ten real patient scans, where the authors also demonstrate how their physiologically motivated registration framework can be successfully applied to the task of fusing diagnostic CT with the PET/CT image volumes. CONCLUSIONS The proposed registration framework has better results for the fusion of diagnostic CT with PET images in comparison to the classic fluid registration framework.