Development of Virtual Mammography from Breast MRI to Aid Breast Cancer

Detection and Diagnosis

ABSTRACT
Breast cancer has been recorded as the disease that causes the highest death among all cancers. According to
Cancer Prevention and Control (CDC), breast cancer causes 120.4 deathdeaths per 100,000 women [1].
Mammography, breast X-ray, has been shown to provide effective aid for breast cancer diagnosis, and in turns
to reduce the death rate of breast cancer. DHowever, due to the fact that acquiring mammography involves ionize
radiation, which is not appropriate for female at young age or pregnant, sometimes breast MRI is an alternative.
HoweverBut, due to the sensitivity and specificity issues, breast MRI may not express the information accurate enough,
which may increases the challenge for diagnosis.
The purpose of this paper is to use imaging processing techniques to develop a new set of image to mimic
mammography, which is named virtual mammography, out of breast MRI. The resulting images could provide additional
information than mammography and breast MRI; thus, to aid the breast cancer prognosis and detection.
Varieties of imaging processing techniques have been evaluated to create the virtual mammography, and finally
the sum of parabolic transformation method has found to yield the most optimal result among all the methods.
Keywords: breast MRI, Mammography.

1. MOTIVATION/PURPOSEINTRODUCTION
Breast cancer has been observed as the most common cancer among all in female groupfor women. In 2004,
519,000 people women died from breast cancer worldwide[2]. In 2007, amounts of 178,480 new breast cancer cases and
40,460 deaths caused by breast cancer had been estimated in the United States. Such death rate accounted for 7% of
deaths caused from cancers and 2% of deaths among all causes. Further, in 2008, the new cases of breast cancer had
risen to 207,090 and the estimated deaths had come to 39,840[3]. Many countries have strived to find more effective
cure and treatment to reduce the fatality and to prevent the occurrence. Mammography has been proved to effectively
help increase the survival rate during breast cancer growing process and treatment; thus, having mammography exam at
least once in every two years is recommended by US Preventive Service Task Force for female age fifty above, and
National Cancer Institute suggests the same frequency of examination for age forty above[4].
Although mammography has been dominant in helping prognosissupporting diagnosis and detection, it still has
some drawbacks under some circumstances. During the mammography exam, the breasts were are compressed by two
parallel plates in order to obtain more accurate images of lesions for physician's reading. This compression may cause
discomfort feels during the exams. Also, mammography has 10% to 30% of false-negative rate, which may extremely
mislead to the wrong diagnosis and staging[4]. It happens more often that the cancer is hidden behind other dense tissue
in the breast, which makes it more difficult to detect in mammography. Also, one form of cancer, lobular cancer, has a
growth pattern that produce shadows on the mammography, which are indistinguishable from normal breast tissue, also
bringing difficulty for physicians to detect[4]. Besides, female aged under forty or subjects having breast implantation
are not suggested to undergo mammography exam because of physiological risks due to the ionized radiation of Xray[4].
Under above limitations and restrictions of mammography, other imaging techniques are needed to provide
additional and critical information for detection and prognosis. Attribute to Breast MRI's high sensitivity, it has become
an aid to provide additional information especially for early or pre-staged cancer, such as Ductal Carcinoma in-situ
(DCIS) or the recurrence of breast cancer[4]. However, Breast MRI's high sensitivity also accompanies with its low
specificity, which leads to high false-positive rate in comparison to mammography, and in turns add burden and anxiety
to the subjects.
This work presentse following develops an algorithm to create a new set of images from breast MRI, which
mimics the mammography, named virtual mammography.

2. DATA
Two gray-level female chest regions MRI datasets were obtained. Patient 1 sizes 512x512 pixels and 32 slices
in volume. Patient 2 sizes 512x512 pixels and 120 slices in volume. Both image datasets fully present the internal chest
chamber and a pair of breast lobes.

3. METHODS
3.1 Pre-Processing
In order to focus on the breast regions, minimize unnecessary noise effect and minimize redundant
computation, truncation of the chest chamber and air portion outside the breast boundary was first performed. After
truncation, region growing from outside the breast boundary was performed to eliminate all thethe entire air portion. The
resulting images are shown in Figure 1, from which varieties of imaging techniques were attempted to create virtual
mammography.

(a)
(b)
Figure 1: (a) Truncated and region grew slice 18 from Patient 1 and (b) Truncated and region grew slice 71 from Patient 2.

3.2 Create High-Pass Filtered Image

In order to make the non-fat tissue boundary and structure more obvious in the final results, we postulate to use
a High Pass Filter to filter the image first.
The following procedures were applied to create the high pass filtered image:
1. Design a low pass filter for breast region image.
2. Create a filtered image by using this low pass filter.
3. Use the filtered image subtract the unfiltered image.
(a)

(b)
Figure 2: (a) Differenced image with Gaussian filter: size=75, STD =75 and (b) Differenced image with Gaussian filter: size=101,
STD =75.

Due to the fact that very sharp intensity difference along the breast boundary, we want to use other method to
create a better high pass filtered image.
A modified Gaussian Filter kernel was applied. This approach modified the Gaussian filter using average sum
of weights techniques. The steps are described following:
1. Manually create a Gaussian filter window.

2. Instead of directly applying to the breast region image, superimpose the center of filter window onto each
pixel one after one. While superimpose the window, correct the corresponding window value to zero if a zero value is
read in the mask, and keep others unchanged. This step is called modification/correction of the filter.
3. After the modification, divide the whole window by its sum, known as scaling.
4. Perform the element-by-element multiplication to each corresponding pixel with respect to the scaled
window; then, add sum of the resulting matrix to the corresponding center pixel of breast region image so that the center
pixel value is emphasized (most weighted) while the surrounding pixel values remain unchanged.
5. Repeat steps 2 to 4 for each pixel as we trace in the breast region image, a new blurring image results.
6. Use this blurred image to subtract breast region image to obtain a new difference image.
The new high pass filtered images are shown in figure 3.
(a)
(b)

Figure 3: (a) Differenced image with modified Gaussian filter:

size=75, STD =75 and (b) Differenced image with modified Gaussian filter: size=101, STD =75

After create the high pass filtered image, summation of transformation is applied, which is illustrated in the
following sections.

3.3 Linearization transformation and Summation of original and differenced breast image
A linear transformation method was developed and to be applied on the MR image to create virtual
mammography. Again, truncation and region growing were applied to obtain the breast-only area with zero-value
background. In this approach, each pixel value in the Patient 2 was linearly transformed to a new value that becomes the
virtual X-ray pixel value.
First, for all slices, average pixel values for fat and non-fat tissue were calculated. Average values for both fat
and non-fat were calculated from different slices, new average values for fat and non-fat were calculated among these
average to obtain two final average: 714.7 for fat and 315.9 for non-fat in patient 2 case. These two values are used to
calculate the linear transformation equation. The idea and guideline to find this linear equation is to make the non-fataverage (315.9) to a new maximum value, e.g. 41 while make the fat-average (714.7) to a new minimum, e.g. -1000. At
the same time, the zero value pixels have to be transformed to -1000 as well. With above conditions, two 1st order linear
equation can be found; one has positive slope and one with negative (Figure 4) With the same manner, a combination of
two first order linear equations were developed for patient 1 (Figure 4).
Figure 4: Linear transformation equations for original image of Patient 1 (left) and

Patient 2 (right)

With similar method, two linear transformation equations for the differenced images were also developed
(Figure 5).
F
i
g
u
r
e
5
:

Linear transformation equations for differenced image of Patient 1 (left) and Patient 2 (right)

After the transformation on each slice, we summed all image along Z direction to obtain a final image.

3.4 Parabolic transformation and Summation on original and differenced breast images
The previous result indicates that we might be on the right track to our goal, so we continually modified the
transformation equation to 2nd order parabolic equation. With previous calculated fat-average (714.7) and non-fataverage (315.9), and the restrictions that non-fat-average to be transformed to a new value of 41; while zero and fataverage to be transformed to -1000, a 2nd order parabolic equation (Figure 6) was calculated to optimize the image
result.
1000
X: 91
Y: 88

-1000

-2000

-3000

-4000

-5000

-6000

-7000

-8000

-9000

50

100

150

200

250

300

350

400

450

500

Figure 6: Parabolic transformation equation for original images of Patient 1 (left) and Patient 2 (right)

After transformation, summation of whole volume along Z direction was executed to obtain a new projection
image.
Further approach with differenced image: a new volume of differenced images were obtained by subtracting the
original images from the Gaussian blurred images, and calculated average values for fat and non-fat region: fat average
is 982.2; non-fat average is 707.26. Likewise, a 2nd order parabolic equation was developed (Figure 7).

Figure 7: Parabolic transformation equation for differenced images of Patient 1 (left) and Patient 2 (right)

200
X: 190
Y: 41.63

-200

-400

-600

-800

-1000

50

100

150

200

250

300

350

400

450

500

Then, the sum of transformation method was applied to these images to obtain a new projection image.

3.5 Brief summary of the algorithm

For a brief summary of all the methods implemented, a flow chart (Figure 8) is provided below for clarity.

Figure 8: Flow chart of the tentative processing algorithm

The whole process begins with the truncation of the uninterested regions, repeat region growing from outside
and inside the breast boundary, Gaussian blur of each slice image, calculate the average intensities for fat and non-fat

tissues, develop the parabolic transformation curve, apply the transformation curve in each slice and finally the
summation.

4. RESULTS
The following figure shows the original image transformed by combined linear equations from slice 15 to 105
of Patient 2.

Figure 9: Sum of transformed images of original Patient 2 image by linear transformation

The following figure shows the differenced image transformed by combined linear equations from slice 15 to
105 of Patient 2.

Figure 10: Sum of transformed images of differenced Patient 2 image by linear transformation

The following figure shows the original image transformed by a second order parabolic equation from slice 15
to 105 of Patient 2.

Figure 11: Sum of transformed images of original Patient 2 image by single parabolic transformation

The following figure shows the differenced image transformed by a second order parabolic equation from slice
15 to 105 of Patient 2.

Figure 12: Sum of transformed images of differenced Patient 2 image by single parabolic transformation

Figure 13: Sum of transformed images of original Patient 1 image by linear transformation

Figure 14: Sum of transformed images of differenced Patient 1 image by linear transformation

Figure 15: Sum of transformed images from original Patient 1 image by linear transformation.

Figure 16: Sum of transformed images from differenced Patient 1 image by single parabolic transformation.

5. DISCUSSION
As shown in the results, the proposed algorithm, summation of transformation, re-evaluates the breast MRI in a
different perspective, which preserves and reveals the tiny and trivial non-fat tissue structures.
After showing the image result obtained by single parabolic transformation, figure 15, to the radiologists, it
seems that figure 15 provides better information to show the detailed non-fat tissue structure.
Before we have come to the summation of transformation method, many combination of morphological
processing with high pass filtering techniques were attempted to preserve the tiny thin non-fat structure; however, the
resulting images did not come out as our desire because the morphological processing techniques either introduced too

much fat tissue and undesired region or it cuts the tiny non-fat tissue into small fragments. Also, as we went through the
transformation projection techniques, we used interpolation to expand the image volume because we suppose
interpolation could remove the bright bold boundary in some images; however, it did not work well. As a result, we
decided to keep our algorithm without using any interpolated image.
Even though the radiologists shows positive attitude to the image result (Figure 14), they expect to see the nonfat tissue appear to be more obvious while fat-tissue to be more darker. Also, radiologists do not want to see the bright
boundary and the blurry area within and in the lower portion of the breast (close to the chest chamber). Therefore, further
work and modification of algorithms and re-development of the transformation curve are urgently demanded.
The transformation curves play a very important role in converting from breast MRI to virtual mammography,
which determines the visibility, brightness and the contrast in the final image. As to further improve the resulting images,
closely investigation and re-develop of the transformation curve with more appropriate parameters become necessary.

6. CONCLUSION
Two breast MRI datasets of different resolutions were obtained for developing a virtual mammography
algorithm. The developed algorithm, summation of transformation by parabolic curves, seems to be a better approach
because the result preserves and reveals the tiny non-fat tissue in the breast region. The result, figure 15, after examined
by the radiologists, turns out to have a good clinical value during breast cancer diagnosis.

REFERENCES
[1]
[2]
[3]
[4]
[5]

[6]

CDC - Cancer Among Women. http://www.cdc.gov/cancer/dcpc/data/women.htm

World Health Organization|Cancer.
American Cancer Society. "Cancer Facts & Figures - 2008"
Nagwa Dongola., "Mammography in Breast Cancer" http://emedicine.medscape.com/article/346529-print (2009)
Chen W, Giger ML, Li H, Bick U, Newstead: Volumetric texture analysis of breast lesions on contrast-enhanced
magnetic resonance images. Magnetic Resonance in Medicine, 58: 562-571, 2007.
Gibbs, P., and Turnbull, L.W., Textural analysis of contrast-enhanced MR images of the breast Magnetic
Resonance in Medicine 50:92-98 (2003).