Spine and Individual Vertebrae Segmentation in Computed Tomography Images Using Geometric Flows and Shape Priors

The surgical treatment of injuries to the spine often requires the placement of pedicle screws. To prevent damage to nearby blood vessels and nerves, the individual vertebrae and their surrounding tissue must be precisely localized. To aid surgical planning in this context we present a clinically applicable geometric flow based method to segment the human spinal column from computed tomography (CT) scans. We first apply anisotropic diffusion and flux computation to mitigate the effects of region inhomogeneities and partial volume effects at vertebral boundaries in such data. The first pipeline of our segmentation approach uses a region-based geometric flow, requires only a single manually identified seed point to initiate, and runs efficiently on a multi-core central processing unit (CPU). A shape-prior formulation is employed in a separate second pipeline to segment individual vertebrae, using both region and boundary based terms to augment the initial segmentation. We validate our method on four different clinical databases, each of which has a distinct intensity distribution. Our approach obviates the need for manual segmentation, significantly reduces inter- and intra-observer differences, runs in times compatible with use in a clinical workflow, achieves Dice scores that are comparable to the state of the art, and yields precise vertebral surfaces that are well within the acceptable 2 mm mark for surgical interventions.