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CT-Based Evaluation of the Shape of the Diaphragm Using 3D Slicer

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Abstract

The diaphragm is the main inspiratory muscle and separates the thorax and the abdomen. In COPD, the evaluation of the diaphragm shape is clinically important, especially in the case of hyperinflation. However, delineating the diaphragm remains a challenge as it cannot be seen entirely on CT scans. Therefore, the lungs, ribs, sternum, and lumbar vertebrae are used as surrogate landmarks to delineate the diaphragm. We herein describe a CT-based method for evaluating the shape of the diaphragm using 3D Slicer—a free software that allows delineation of the diaphragm landmarks—in ten COPD patients. Using the segmentation performed with 3D Slicer, the diaphragm shape was reconstructed with open-source Free Pascal Compiler. From this graduated model, the length of the muscle fibers, the radius of curvature, and the area of the diaphragm—the main determinants of its function—can be measured. Inter- and intra-user variabilities were evaluated with Bland and Altman plots and linear mixed models. Except for the coronal length (p = 0.049), there were not statistically significant inter- or intra-user differences (p values ranging from 0.326 to 0.910) suggesting that this method is reproducible and repeatable. In conclusion, 3D Slicer can be applied to CT scans for determining the shape of the diaphragm in COPD patients.

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Data Availability

All the data are available upon reasonable request to the corresponding author (Olivier Taton).

Abbreviations

COPD:

Chronic obstructive pulmonary disease

CT:

Computed tomography

DICOM:

Digital imaging and communications in medicine

FRC:

Functional residual capacity

PACS:

Picture archiving and communication system

References

  1. De Troyer A, Boriek AM. Mechanics of the respiratory muscle. Compr Physiol. 2011;1:1273–1300.

    Article  PubMed  Google Scholar 

  2. Similowski T, Yan S, Gauthier AP, Macklem PT, Bellemare F. Contractile properties of the human diaphragm during chronic hyperinflation. N Engl J Med. 1991;325:917–923.

    Article  CAS  PubMed  Google Scholar 

  3. Fessler HE, Permutt S. Lung volume reduction surgery and airflow limitation. Am J Respir Crit Care Med. 1998;157:715–722.

    Article  CAS  PubMed  Google Scholar 

  4. Pazokifard B, Sowmya A, Moses D. Automatic 3D modelling of human diaphragm from lung MDCT images. Int J Comput Assist Radiol Surg. 2016;11:767–776.

    Article  PubMed  Google Scholar 

  5. Karami E, Wang Y, Gaede S, Lee TY, Samani A. Anatomy-based algorithm for automatic segmentation of human diaphragm in non-contrast computed tomography images. J Med Imaging (Bellingham). 2016;3:046004.

    Article  PubMed  Google Scholar 

  6. Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin JC, Pujol S, Bauer C, Jennings D, Fennessy F, Sonka M, Buatti J, Aylward S, Miller JV, Pieper S, Kikinis R. 3D Slicer as an image computing platform for the quantitative imaging network. Magn Reson Imaging. 2012;30:1323–1341.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nardelli P, Jaeger A, O'Shea C, Khan KA, Kennedy MP, Cantillon-Murphy P. Pre-clinical validation of virtual bronchoscopy using 3D Slicer. Int J Comput Assist Radiol Surg. 2017;12:25–38.

    Article  PubMed  Google Scholar 

  8. Rios Velazquez E, Aerts HJWL, Gu Y, Goldgof DB, De Ruysscher D, Dekker A, Korn R, Gillies RJ, Lambin P. A semiautomatic CT-based ensemble segmentation of lung tumors: comparison with oncologists’ delineations and with the surgical specimen. Radiother Oncol. 2012;105:167–173.

    Article  PubMed  Google Scholar 

  9. Rios Velazquez E, Parmar C, Jermoumi M, Mak RH, van Baardwijk A, Fennesy FM, Lewis JH, De Ruysscher D, Kikinis R, Lambin P, Aerts HJWL. Volumetric CT-based segmentation of NSCLC using 3D-Slicer. Sci Rep. 2013;3:3529.

    Article  Google Scholar 

  10. Yip SSF, Parmar C, Blezek D, San Jose Estepar R, Piper S, Kim J, Aerts HJWL. Application of the 3D slicer chest imaging platform segmentation algorithm for large lung nodule delineation. PLoS One. 2017;12(6):e0178944.

  11. Negroni D, Zagaria D, Paladini A, Falaschi Z, Arcoraci A, Barini M, Carriero A. COVID-19 CT scan segmentation: how we do it. J Digit Imaging. 2022;35:424–431.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cassart M, Pettiaux N, Gevenois PA, Paiva M, Estenne M. Effect of chronic hyperinflation on diaphragm length and surface area. Am J Respir Crit Care Med. 1997;156:504–508.

    Article  CAS  PubMed  Google Scholar 

  13. Rangayyan RM, Vu RH, Boag GS. Automatic delineation of the diaphragm in computed tomographic images. J Digit Imaging. 2008;21:S134–147.

    Article  PubMed  Google Scholar 

  14. Cassart M, Hamacher J, Verbandt Y, Wildermuth S, Ritscher D, Russi EW, de Francquen P, Cappello M, Weder W, Estenne M. Effects of lung volume reduction surgery for emphysema on diaphragm dimensions and configuration. Am J Respir Crit Care Med. 2001;163:1171–1175.

    Article  CAS  PubMed  Google Scholar 

  15. Boyko M, Vonderdank S, Gürleyen H, Gibis N, Schulz A, Erbuth A, Bastian A. Endoscopic lung volume reduction results in improvement of diaphragm mobility as measured by sonography. Int J Chron Obstruct Pulmon Dis. 2020;15:1465–1470.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Estenne M. Effect of lung transplant and volume reduction surgery on respiratory muscle function. J Appl Physiol. 2009;107:977–986.

    Article  PubMed  Google Scholar 

  17. Chang Y, Bae J, Kim N, Park JY, Lee SM, Seo JB. Three-dimensional quadratic modeling and quantitative evaluation of the diaphragm on a volumetric CT scan in patients with chronic obstructive pulmonary disease. Med Phys. 2016;43:4273.

    Article  PubMed  Google Scholar 

  18. Salito C, Luoni E, Aliverti A. Alterations of diaphragm and rib cage morphometry in severe COPD patients by CT analysis. Annu Int Conf IEEE Eng Med Biol Soc. 2015;2015:6390–6393.

    CAS  PubMed  Google Scholar 

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Acknowledgements

The authors thank Benoit Beyer for advice in diaphragm segmentation, and Samantha Phillips for editing their manuscript.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Pneumology, Hôpital Erasme, Université libre de Bruxelles (ULB), 808 Route de Lennik, 1070, Brussels, Belgium

    Olivier Taton, Alain Van Muylem, Dimitri Leduc & Pierre Alain Gevenois

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  1. Olivier Taton
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  2. Alain Van Muylem
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  3. Dimitri Leduc
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  4. Pierre Alain Gevenois
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Contributions

All authors contributed to the study conception, design, material preparation, data collection, and analysis. The first draft of the manuscript was written by Olivier Taton and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Olivier Taton.

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The authors declare that the study was approved by the institutional ethics committee and certify that the study was performed in accordance with ethical standards as laid down in 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in Figs. 1, 2, and 3.

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Taton, O., Van Muylem, A., Leduc, D. et al. CT-Based Evaluation of the Shape of the Diaphragm Using 3D Slicer. J Digit Imaging. Inform. med. (2024). https://doi.org/10.1007/s10278-024-01069-y

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