Segmentation of brain tumors in 4D MR images using the hidden Markov model.

Tumor size is an objective measure that is used to evaluate the effectiveness of anticancer agents. Responses to therapy are categorized as complete response, partial response, stable disease and progressive disease. Implicit in this scheme is the change in the tumor over time; however, most tumor segmentation algorithms do not use temporal information. Here we introduce an automated method using probabilistic reasoning over both space and time to segment brain tumors from 4D spatio-temporal MRI data. The 3D expectation-maximization method is extended using the hidden Markov model to infer tumor classification based on previous and subsequent segmentation results. Spatial coherence via a Markov Random Field was included in the 3D spatial model. Simulated images as well as patient images from three independent sources were used to validate this method. The sensitivity and specificity of tumor segmentation using this spatio-temporal model is improved over commonly used spatial or temporal models alone.