Improved CT and MR image registration with the introduction of a dual-modality contrast agent: Performance assessment using quantitative and information theoretic methods

The ability of computed tomography (CT) and magnetic resonance (MR) imaging to visualize and discriminate between normal and diseased tissues is improved with contrast agents, which are designed to differentially accumulate in tissues and modify their inherent imaging signal. Conventional contrast agents are limited to a single modality and require fast acquisitions due to rapid clearance following injection. Encapsulation of iohexol and gadoteridol within a nano-engineered liposome has been achieved and can increase their in vivo half-life to several days. We hypothesize that the persistence of this contrast agent in vivo, and the simultaneous co-localized contrast enhancement across modalities will improve longitudinal image registration. This work investigates the in vivo registration performance of the dual-modality contrast agent under realistic conditions. Previous characterizations of single-modality contrast agents were limited to qualitative inspections of signal intensity enhancement. We present quantitative, information theoretic methods for assessing image registration performance. The effect of increased localized contrast upon the mutual information of the MR and CT image sets was shown to increase post-injection. Images registered post- injection had a decreased registration error compared with pre-contrast images. Performance was maintained over extended time frames, contrast agent concentrations, and with decreased field-of-view. This characterization allows optimization of the contrast agent against desired performance for a given imaging task. The ability to perform robust longitudinal image registration is essential for pre-clinical investigations of tumor development, monitoring of therapy response, and therapy guidance over multiple fractions where registration of online cone-beam CT to planning CT and MR is necessary.