Innovate Mississippi

Point Innovation Magazine Winter 2013

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RESEARCH SPOTLIGHT Research at UMMC Revolutionizes the Treatment of Cirrhosis Jack Mazurak N ew software developed by a University of Mississippi Medical Center (UMMC) radiologist that detects liver disease on CT scan images could lead to earlier detection and treatment of cirrhosis in potentially millions of patients. Andrew Smith, M.D., Ph.D., UMMC assistant professor of radiology and director of radiology research, got the idea during a flight to a radiology conference. "We know that the liver gets nodular in cirrhosis, and this is most obvious at the surface," said Smith. "I thought if we can define the edge in an existing CT image of the liver, we can look for and measure nodularity. "I wanted something like the tool in Photoshop that can recognize and outline the edge of an object against a different background," he explained. "Once we learned to detect the liver surface, we developed tools to measure the amount of nodularity." The U.S. Centers for Disease Control and Prevention estimates that 27,000 to 30,000 people in the United States die annually from cirrhosis. While those are end-stage cases, earlier stages of cirrhosis may affect up to 3 million Americans, or one percent of the population. The most common causes of cirrhosis include alcoholism, fatty liver disease and hepatitis C infection. In many cases, the condition remains undetected until clinical symptoms appear. At that point, patients need more drastic and expensive treatment, sometimes including a transplant. Since early-stage cirrhosis is treatable, earlier detection could prevent many advanced cases. Scientists and physicians have long known that liver nodules, especially as they approach 1-2 millimeters in size, signal cirrhosis. But there was no way to accurately and reproducibly detect and measure the nodules on routine CT scan images, so patients currently need invasive liver biopsies to make the diagnosis. "A liver biopsy is the bronze standard for diagnosing cirrhosis right now," said Smith. "We call it bronze, not gold, because livers are heterogeneous and a biopsy is a tiny sample, so they don't always accurately show what's going on across the organ. "Detecting and measuring liver surface nodularity on CT scan images offers a much less invasive test, and allows us to screen for variances and liver cancer, common complications of cirrhosis," he continued. To write the software, Smith enlisted Ohio-based software development firm ImageIQ , a spinoff of the prestigious Cleveland Clinic. The team incorporated algorithms to detect the liver surface and measure nodularity. Smith and developers at ImageIQ have been fine-tuning the program since March, putting it through multiple revisions and preparing it for clinical trials. Using a plastic model of the liver, called a phantom, with areas of different-sized nodules, Smith and his team are tweaking the software to work effectively across different brands of CT scanners including General Electric Co., Siemens, Toshiba and Philips. Now, they are processing hundreds of scans to validate the program, comparing the results with biopsies taken from the same patients. 33

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