RadloGraphics Index terms: Imaging technology PERCEPTION ANb DISPLAY Magnetic resonance Imaging TECHNICAL Cumulative Index terms:

Magnetic resonance (MR) image processing

Application of image enhancement techniques to magnetic resonance imaging

Michael L. W ood,
M.D.t Ph.D.

Val M. Runge,

widely available, image enhancement techniques but their applications are not well defined. The authors encourage radiologists to become familiar with these techniques, to evaluate them, and to incorporate them into specific display protocols.

THIS EXHIBIT WAS DISPLAYED AT THE 73RD SCIENTIFIC ASSEMBLY AND ANNUAL MEETING OF THE RADIOLOGICAL SOCIETY OF NORTH AMERICA, NOVEMBER 29-DECEMBER 4, 1987, CHICAGO, ILLINOIS. IT

Image

Enhancement

WAS RECOMMENDED BY THE RADIATION PHYSICS AND MRI PANELS AND WAS ACCEPTED FOR PUBLICATION AFTER PEER REVIEW AND REVISION ON MARCH 1, 1988.

From Division

the

Medical

Physics

C) and the Department of Radiology (t), New England Medical Center and
Tufts University School of

Image enhancement, one of the simplest categories of image processing, attempts to make diagnostic detail more obvious. A wealth of techniques exist for reducing image noise, highlighting edges, or displaying digital images (1,2). It is difficult to judge the effectiveness of these techniques for three reasons (I) The outcome depends on the exact application One technique might perform well in astronomy on geophysics, but not in magnetic resonance imaging (MRI), on even for every protocol in MRI. (2) A different outcome might be desired for radiologists than for referring physicians less familiar with MRI. (3) Image enhancement does not attempt to suppress artifacts or make images more accurate-just easier to interpret. This subjective goal makes quantitative evaluation difficult. The purpose of this article is to demonstrate several techniques that enhance the appearance of MR images, beginning with the filtering of single images to reduce noise or accentuate edges. A second section deals with the sequences of images, a consideration that is especially pertinent to MRI. The 64 or 128 thin slices produced In three dimensional MRI can be reformatted into high resolution images in other orientations, and combining numerous images into surfaces can also be useful for display.

Medicine, Boston, Massachusetts. Address reprint requests

to M. L. Wood, Ph.D., Medical

Physics Division, New England Medical Center, Box 246, 750 Washington Street, Boston, MA 02111. Volume 8, Number 4
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Methods Image enhancement techniques were applied to MR images of the head, body and knee that exhibited diverse pathology. The images were acquired on a Siemens MAGNETOM1 1.0 tesla MRI system. The images were digital and 256 X 256 pixels in size. The gray scale was quantized into 12 bits, which allowed 4096 different pixel intensities. Both two dimensional (2D) and three dimensional (3D) Fourier imaging techniques were used. A 3D FLASH technique (3) was used to generate 64 or 128 contiguous thin slices. The MR images were transferred to a KONTRON MIPRON2 image processing workstation, and existing enhancement techniques were applied. The workstation used eight bits for each pixel, or 256 intensity levels. A software program compressed the 12 bit magnetic resonance images linearly to a maximum intensity of 255.

Filtering

of Single SMOOTHING

Images

Filtering is a mathematical operation in which the intensity of one pixel is combined with the intensity of neighboring pixels. This neighborhood is defined by a box that has at least three pixels on a side. After filtering modifies the pixel in the center of the box, the box is centered over a new pixel. Perhaps the simplest filter is the mean filter, which sums the intensity of pixels in the box and determines the mean. The outcome of the mean filter applied to Figure IA is shown in Figure lB. As might be expected, the averaging of neighboring pixels blurred the image while reducing the level of noise. The simplest noise reduction filters perform the same operation on every part of an image, while the more complicated filtens adapt according to regional information (4). The nonlinear mean filter is an example of an adaptive filter. In Figures I and 2 it caused less blurring than the mean or median filter. Unfortunately, the nonlinear mean filter was also less successful at noise reduction. A more useful adaptive filter is the sigma filter.

Siemens Kontron

Medical Systems Inc.. Iselin, NJ Instruments Inc., Everett, MA

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Noise reduction filters are demonstrated on this MR image of a patient with an acoustic neuroma (anrow). Sixty-four slices, each 2.2 mm thick, were acquired in 6 minutes from a 3D FLASH technique featuning a 400 tip angle, TR/TE=24/8 ms, and a 300 mm field of view. Three filters were applied to image (A) using a box containing three pixels on each side. The effects of filtering are most obvious in the details of the tongue and cerebellum. Image (B) is the result of a mean filter, which simply replaced the pixel in the center of each box with the average of the nine pixels in that box. The standard deviation of

noise in the background was reduced by half, but there was far too much blurring. A similar mean filter was used to produce image (C), except that the original intensity was returned to pixels in the filtered image that had changed intensity by more than i 5 levels out of 256. This nonlinear mean filter caused less blurring, but left noisy spikes in the image. For image (D), a median filter ordered the nine pixels in each 3 x 3 box according to intensity. The pixel in the middle of the box was replaced with the fifth most intense. In spite of the small box size, all of the filtered images were too blurred.

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.e same smoothing operations as in Figure 1 were applied to a coronal MR image through both legs. A neoplastic lesion is exhibited in the right tibia (arrow). Image (A) is one of 64 slices from 3D FLASH, with TR/TE=60/i 8 ms, 1.5 mm slice thickness and a 300 mm field of view. As in Figure i (A) is the unfiltered image and (B) to (D) arose after mean, nonlinear mean and median filtering, respectively. Again, these smoothing filters reduced the noise, but caused too much blurring.
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SIGMA

FILTER

The sigma filter (5) averages only those pixels within a box of predetermined size that do not deviate too much from the pixel that the box is centered on. It is well known that most noise in MRI is random and characterized statistically by a Gaussian distribution (6). Consequently, if a pixel differs in intensity by more than two standard deviations from the pixel in the center of the box, there is a 95.5% probability that the difference is not due to noise. The sigma filter with a threshold of two standard deviations would ignore such a pixel. A box size and a threshold must be specified for the sigma filter. Figure 3 provides an example showing how new pixels are computed by a sigma filter of size 3 and threshold 10. Greaten noise reduction is achieved by using a larger threshold or box, or performing multiple iterations. Figures 4 to 6 show that heavy smoothing reduces detail in images, however. Clearly, a tradeoff must be reached between noise reduction and preservation of detail.

SIGMA

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Figure 3 This example shows the intensity of nine neighboring pixels and the effect of a sigma filter on the pixel in the center. For this particular sigma filter, the box had three pixels to a side and the threshold was 10. For comparison, a mean filter would have averaged all nine pixels and assigned an intensity of 46 to the center pixel.

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4 A noisy MR image through the head of a patient with a thalamic glioma was chosen to illustrate properties of the sigma filter. Image (A) is a 1.5 mm thick slice from a 3D FLASH technique that took 6 minutes to acquire 64 slices, with TR/TE=40/i 2 ms and 128 phase encoding steps. The standard deviation of image intensity in a region of deep white matter was 7.3. A sigma filter employing a box with 1 1 pixels to a side was applied to image (A). The threshold for the filter was 5, i 0, or 15 for images (B), (C) and (D), respectively. Filtering lowered the standard deviation of image intensity in the white matter to 6.3, 4.5 and 3.0 in (B), (C) and (D), respectively. These measurements are helpful because differences between the images are subtle. Smoothing was noticeable in homogeneous regions, such as the deep white matter and the tumor. Boundaries between gray matter and white matter in the cortex became blurred in (D). Therefore, image (C) achieved the best compromise between noise reduction and preservation of detail.

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The image in Figure 4A was also used to demonstrate the effect of box size for the sigma filter. A large threshold, 15, was chosen for the filter that produced images (B) to (D) from image (A). The box size increased from 3 in (B) to 15 in (C), and was 9 in (D). The standard deviation of image intensity in the deep white matter became 4.7, 3.0 and 3.0 in (B), (C) and (D), respectively. The smallest box was relatively ineffective, but a large box and high threshold allowed too much smoothing to occur and caused blurring as in Figure 4D.

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Figure 6 Multiple iterations of the sigma filter are possible. Image (A) is the same unfiltered image as Figure 4A. The sigma filter was applied once for (B), twice for (C) and three times for (D). The box size was 1 i and the threshold was i 0 for the first iteration, and five for the other two. Each iteration produced more smoothing, which is particularly evident in the deep white matter. In fact, the standard deviation measured in the deep white matter of (B), (C) and (D) was 4.5, 2.7 and 1.5, respectively. After three iterations, boundaries between gray matten and white matter in the cortex became blurred. Image (D) expenienced too much loss of detail.

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EDGE ENHANCEMENT An effective technique for sharpening edges is to subtract a blurred image from the original. Edges can also be enhanced through gray-level rescaling, which alters the conversion of pixel intensity to shades of gray. Two images with low contrast lesions were chosen for demonstrating edge enhancement in Figures 7 and 8.

Figure 7 This transaxial MR image (TR/TE=3000/90) shows multiple pathology in the head, including bilateral subdurals, i ; a tumor near the pineal gland, 2; a Iacunar infarct, 3; and several punctate lesions in the frontal white matter 4. Images (B) and (C) are the results of subtracting a blurred image of (A) from (A). The blurred image was weighted to 2/3 of its original intensity before subtraction. The blurring filten operated within a 3 x 3 box for image (B) and an i i x 1 1 box for image (C). Note the enhance-

ment of fine detail, such as the punctate lesions in (B). Edges became thicker in image (C) which made boundaries between gray matter and white matter more distinct. Image (D) arose after a carefully chosen narrow range of intensity in image (A) was reassigned twice as many shades of gray, without changing the gray scale elsewhere. This particuIan rescaling improved the contrast between gray matter and white matter.

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8 The same edge enhancement operations as in Figure 7 were performed on a coronal image (TR/TE=800/i 7) showing a giant cell tumor in the right iliac bone (arrow). Subtraction of blurred images from (A) led to (B) and (C), which had more distinct boundaries. Moreover, gray level
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rescaling improved the delineation between the tumor and the surrounding muscle in image (D). Note, however, that the superolateral border of the right kidney became less clear. Thus, rescaling may improve certain regions, but degrade others.

Display

of Sequences REFORMATTING

of Images

A stack of digital MR images can be regarded as a three-dimensional grid. The grid can be sliced to yield images in any onientation. For example, a set of sagittal images can be reformatted into transaxial, coronal, or

oblique planes. This is an agreeable alternative to the direct acquisition of another set of images. Moreover, reformatted oblique slices need not arise from special techniques, which invariably lack advanced features such as the

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ability to compensate for motion on achieve the shortest TE. Even curved slices are possible. Three-dimensional MRI can generate cubic voxels, so reformatted images need not have

lower resolution than the originals. Reformatting allows greater use of the structural information contained in a set of images and, as Figures 9 and 10 attest, this can improve perception.

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Figure 9 An image of a patient with a cystic metastasis in the pons (arrow) was chosen to illustrate reformatting. In 1 i minutes, i 28 slices were acquired with TRTrE=40/8. The voxels were i mm cubes. The original images, of which (A) is representative, were oriented sagittally. Reformatted transaxial images, such as (B), improved

the visualization of the lesion. The coronal reformatted image (C), like the transaxial, was equal in quality to the original, because the voxels were cubic. Image (D) arose after the original sagittal images were formatted along a curved path that followed the brain stem and spinal cord.

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Figure 10 A set of high resolution MR images of a knee was acquired for further demonstration of reformatting. Image (A) is one of 128 slices that were acquired in 1 1 minutes from 3D FLASH, with TR/TE=40/8. The voxels were 8 mm cubes. This image shows a normal anterior cruciate ligament in the right knee (ar-

row). A transaxial reformatted image is shown in (B). The dark C is the lateral meniscus. Image (C) is one of the coronal reformatted images. The original images were reformatted along an oblique plane parallel to the anterior cruciate ligament to produce (D).

SURFACE DISPLAYS Computer programs exist for creating sunface reconstructions from a set of cross sectional images. When MR images possess excellent contrast and little noise, ray tracing algorithms have been found useful. Ray tracing defines a surface by searching along rays through a set of images for a pixel that exceeds a chosen threshold. Figure 1 1 compares a cross sectional image with three different surface displays. The thin slices that are possible in MRI allow for well-defined surfaces. Methods to create surfaces continue to improve, which offers strong prospects for the
future.

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F 1 Four alternative displays of image data of a patient with an occipital hemorrhage are illustrated. Using TR/TE=60/i 8 and 256 phase encoding steps, 64 slices were acquired in i 6 minutes with 3D FLASH. A single coronal slice is displayed in (A). This is the most common format. The exterior surface is presented from an oblique angle in (B). Closer regions were shaded more intensely by a process called depth encoding. Another type of surface is shown in (C). Only those tissues with intensity greater than a threshold were considered for this sunface. Compared to the exterior surface in (B), the hemorrhage is much better visualized. The superior sagittal sinus is also apparent. Image (D) reveals some internal structures imbedded inside the sunface. The ray tracing technique began i 0 steps inside the exterior sunface. The first sufficiently intense pixel was averaged with the next three to provide features common to both cross sections and sunfaces.

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Conclusions The digital format of MR images lends itself to a wealth of image enhancement techniques. Filtering can reduce noise, enhance contours, on alter the gray scale. Unfortunately, careless smoothing blurs images and nemoves detail. More sophisticated filters, such as the sigma filter, however, reduce image noise while preserving edges. Edges can be enhanced slightly by subtracting a blurred image from the original. Reformatting simply presents the same information in a set of images from a new perspective. This may seem redundant, but it can improve perception. Moreover, reformatted images need not be of poorer quality than the originals when the oniginals are thin slices. Surface displays help the viewer to recognize associations between the structures in various slices. This is particularly welcome when there are 128 slices to read. Image enhancement techniques are widely available now, but their applications are not well defined. It is to be hoped that nadiologists will gain familiarity with these techniques, evaluate them rigorously, and incorporate them into specific protocols. It is likely that each type of MR image will achieve the greatest benefit from slightly different filtering. The choice will probably depend upon personal preference. Whatever the choice, however, filters will need to be applied consistently and automatically to gain acceptance. Rememben that the windowing and centering operations that are now taken for granted, and which are often automated, were cumbersome tasks before the advent of digital imaging.

References
1. Wang DCC. Vagnucci AH. Li CC. Digital image enhancement: A survey. Comput Vision, Graphics. Imaging Processing 1983; 24:363-38 1. 2. Pratt WK. Digital image processing. New York; Wiley. 1978. 3. Frahm J. Haase A. Maffhaei D. Rapid three-dimensional MR imaging using the FLASH technique. J Comput Assist Tomogr 1986; 10:363-368. 4. Mastin GA. Adaptive filters for digital image noise smoothing: An evaluation. Comput Vision, Graphics, Image Processing 1985; 31:103-121. 5. Lee JS. Digital image smoothing and the sigma filter. Comput Vision, Graphics, Image Processing 1983; 24:255-269. 6. McVeigh ER. Henkelman RM, Bronskill MJ. Noise and filtration in magnetic resonance imaging. Med Phys 1985; 12(5):586-591.

gland

The help of Joanne Medical Center

in

Incerpi. Boston,

Martha Pacetti, MA was greatly

and Dean Kaufman, appreciated.

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