Magnetic Resonance Imaging 31 (2013) 761770

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Magnetic Resonance Imaging

journal homepage: www.mrijournal.com

Pattern-recognition system, designed on GPU, for discriminating between injured

normal and pathological knee cartilage
Spiros Kostopoulos a, Konstantinos Sidiropoulos b, Dimitris Glotsos a, Emmanouil Athanasiadis a,
Konstantina Boutsikou c, Eleftherios Lavdas c, Georgia Oikonomou c, Ioannis V. Fezoulidis d,
Marianna Vlychou d, Michael Hantes e, Dionisis Cavouras a,
a
Department of Medical Instruments Technology, Technological Educational Institute of Athens, Ag. Spyridonos, Egaleo, 12210 Athens, Greece
b
School of Engineering and Design, Brunel University West London, Uxbridge, UB83PH Middlesex, UK
c
Department of Medical Radiologic Technology, Technological Educational Institute of Athens, Ag. Spyridonos, Egaleo, Athens, 12210, Greece
d
Department of Radiology, Medical School of Thessaly, University Hospital of Larissa, Viopolis, Larissa, 41110, Greece
e
Department of Orthopaedic Surgery, Medical School of Thessaly, University Hospital of Larissa, Viopolis, Larissa, 41110, Greece

a r t i c l e i n f o a b s t r a c t

Article history: The aim was to design a pattern-recognition (PR) system for discriminating between normal and
Received 24 July 2012 pathological knee articular cartilage of the medial femoral (MFC) and tibial condyles (MTC). The data set
Revised 19 October 2012 comprised segmented regions of interest (ROIs) from coronal and sagittal 3-T magnetic resonance images
Accepted 30 October 2012
of the MFC and MTC cartilage of young patients, 28 with abnormality-free knee and 16 with pathological
ndings. The PR system was designed employing the probabilistic neural network classier, textural
Keywords:
Articular cartilage
features from the segmented ROIs and the leave-one-out evaluation method, while the PR system's
Knee injuries precision to unseen data was assessed by employing the external cross-validation method. Optimal
Magnetic resonance imaging system design was accomplished on a consumer graphics processing unit (GPU) using Compute Unied
Texture analysis Device Architecture parallel programming. PR system design on the GPU required about 3.5 min against
Pattern recognition 15 h on a CPU-based system. Highest classication accuracies for the MFC and MTC cartilages were 93.2%
Graphics processor unit (GPU) and 95.5%, and accuracies to unseen data were 89% and 86%, respectively. The proposed PR system is
Parallel processing housed in a PC, equipped with a consumer GPU, and it may be easily retrained when new veried data are
incorporated in its repository and may be of value as a second-opinion tool in a clinical environment.
2013 Elsevier Inc. All rights reserved.

1. Introduction T1rho [8,9]; and computer-based analysis of cartilage MR images [10

Knee injuries of the articular cartilage in young adults partici-
pating in sport activities regularly have been associated with early
cartilage changes, which may be undetected, yet they eventually
may lead to irreversible cartilage lesions and osteoarthritis [1,2]. This
is because articular cartilage has a very limited capacity to repair and,
thus, articular injuries result in premature joint degeneration [3].
Because chondral injuries may be asymptomatic, accurate diagnosis
is important in patient management.
Evaluation of articular cartilage damage is usually performed with
magnetic resonance imaging (MRI); however, arthroscopy is the gold
standard for in vivo articular cartilage evaluation [4]. The subjective
nature involved in the visual evaluation of cartilage lesions on MRI has
led physicians to use quantitative assessment that involves cartilage
morphology measurements (volume, thickness, surface) [57]; carti-
lage biochemical composition with methods such as dGERMIC, T2 and
Corresponding author. Department of Medical Instruments Technology, Techno-
logical Educational Institute of Athens, Ag. Spyridonos, Egaleo, 12210 Athens, Greece.
E-mail address: cavouras@teiath.gr (D. Cavouras).
0730-725X/$ see front matter 2013 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.mri.2012.10.029
13]. The latter comprises studies on osteoarthritis that have used
textural features and statistical analysis to identify individual textural
features with statistical signicant differences between normal and
pathological cartilage regions, and based on the mathematical
expressions of the features, they have derived interpretations as to
the structure of the normal and osteoarthritic cartilage.
In the present study, we propose a pattern-recognition (PR)
system to discriminate between injured normal and pathological
articular cartilages of the medial knee compartment, i.e., the cartilages
of the medial femoral (MFC) and tibial (MTC) condyles, often affected
by knee injuries in young adults participating in sports activities.
Regions of interest (ROIs) have been extracted, by custom-designed
software, from the MR images depicting the articular cartilages of the
MFC and MTC; textural features from those ROIs have been computed;
and the PR system has been designed employing the probabilistic
neural network (PNN) classier. To our knowledge, there are no
published studies that employ PR systems to deal with the particular
problem of assessing articular cartilage pathology in young adults.
Additionally, the design and evaluation of the PR system were
developed on a graphics processing unit (GPU) framework using the
762 S. Kostopoulos et al. / Magnetic Resonance Imaging 31 (2013) 761770
GPU's inherently parallel Single Instruction Multiple Data (SIMD)
architecture and the Compute Unied Device Architecture (CUDA)
programming environment [14] in order to attain optimal classier
design and to assess the PR system's classication accuracy to new
unseen articulate cartilage ROIs. The signicance of the present
study lies in the combination of PR methods for discriminating normal
and pathological knee cartilages and GPU technology for achieving
optimum design. The PR system was designed as a standalone
application, housed in a PC and equipped with a commercial NVIDIA
graphics card, with the capability of being redesigned by adding to its
repository new veried data.
2. Material and methods
2.1. Clinical material
The clinical material used in the present study comprised MR
images of 53 young patients examined for knee injury (age: 24.0
7.4 years; 45 males, age: 23.8 6.5 years and 8 females, age: 25.3
11.8 years); 22 of the patients had left knee injury, and 31 had right
knee injury. All patients underwent clinical, radiological and arthro-
scopic knee examination at the General University Hospital of Larissa,
Greece. It was found that 28 of the patients had no knee injury or
abnormality detected and the rest (25) had at least one knee
compartment injured, with most of the injuries (16) being conned
to the cartilage of the medial femoral condyle. All patients were
examined, shortly after injury, on a 3.0-T MRI system (SIGNA HDx; GE
Healthcare) using a quadrature knee coil. MR images were acquired
following a routine examination protocol consisting of three series:
intermediate-weighted (proton density) axial [echo time (TE): 30 ms,
repetition time (TR): 2500 ms, slice thickness: 3 mm], coronal (TE:
30 ms, TR: 1800 ms, slice thickness: 3 mm) and sagittal (TE: 30 ms, TR:
2300 ms, slice thickness: 2 mm) sequences Proton Density Fast Spin
Echo (PD-FSE) with fat saturation. Field of view was 18 cm in all planes.
All MRI examinations were reviewed by a trained radiologist with
more than 10 years of experience in MRI of the musculoskeletal
system. MR grading of cartilage lesions was based on the
International Cartilage Repair Society classication for traumatic
cartilage lesions and was compared directly with arthroscopic
ndings according to the Outerbridge classication [15]. The
articular cartilages of all three compartments of the knee joint
were examined on each patient, resulting in the assessment of six
chondral articular surfaces: the patella, the femoral trochlea, the
lateral and medial femoral condyles, and the lateral and medial tibial
condyles. Images from the sagittal and axial series were used for
examining the patella and femoral trochlea, and images from the
sagittal and coronal series were selected for analyzing the medial
and lateral knee compartments (Fig. 1). MR image series selection
criterion was based on the physician's opinion for best depiction of
the anatomy and/or pathology of each particular knee compartment.
Slices with image artifacts were avoided.
2.2. MRI ROIs delineation and feature extraction
From each selected image, one ROI was manually segmented by
an expert radiologist (M.V.) and an experienced radiographer (E.L.)
employing a software program developed for the purposes of the
present study. The software presents the radiologist with a series of
DICOM MR images and the capability to select appropriate images
and to delineate and eventually segment ROIs from the different
chondral articular surfaces of the knee. Fig. 2 shows the coronal view
of a right knee with the experts' delineations of the same MFC
cartilage, with their cartilage outlines superimposed.
The delineations of the ROIs were tested for inter- and
intraobserver variability by means of the segmentation matching
factor (SMF) [16], which shows the proximity of the experts'
delineations, and it is dened as:
 T 
A1 A2
SM F 1
A1 A2
i.e., the fraction of the intersection of A1 and A2 to the union of them,
where A1 and A2 are the areas contained within the ROI outlines
delineated by the two experts (Fig. 2). A factor nearer to unit
indicates a perfect match between the delineations. The delineation
reproducibility was assessed by the coefcient of variation (CV),
which was calculated as the standard deviation of the SMFs divided
by their mean value and expressed as percentage.
Additionally, as a measure of condence, the feature values,
calculated from the ROIs delineations by the two experts, were
tested for inter and intra statistically signicant differences
employing the KolmogorovSmirnov statistical test [17]. This is
more closely related to the approach followed by the current study
since the design of the proposed PR system is based on the textural
features from the knee cartilage.
For further processing, only ROIs from two cartilages, those of the
MFC and MTC, were retained for the purposes of the present study
since they were the only ones in which textural features from their
ROIs displayed statistically signicant differences between the two
classes (normal and pathological knee cartilage classes), employing
the Wilcoxon nonparametric statistical test [17]. The MFC cartilage
has been also found in previous studies, concerning large popula-
tions, to be one of the most frequently affected knee sites [3,18]. Such
statistical differences existed in both the coronal and sagittal MR
images through the MTC and MFC cartilages. Thus, the data set for
further processing consisted of arthroscopically veried coronal and
sagittal MR images through the MFC and MTC of 28 patients with
abnormality-free knee and 16 patients with pathological ndings in
the MFC, of whom four had also pathology in the MTC cartilage. For
each MFC and MTC cartilage, two classes were formed, one
containing the textural features from 28 normal and the other
from 16 pathological ROIs, extracted from the coronal MR images,
and two similar classes from the sagittal MRI images.
Using the coronal and sagittal MRI series, four ROIs were selected
from each knee, two ROIs from the coronal and sagittal images of the
MFC and, similarly, two ROIs of the MTC cartilages.
From each ROI, textural features were computed: 4 features from
the ROI's histogram [19], 13 from the gray-level co-occurrence
matrices (GLCM) [20] and 5 from the run-length (RL) matrices [21].
In fact, for GLCM and RL features, the average and the range in four
orientations (N, S, E, W) were determined, leading to 26 and 10n
features, respectively. Thus, from each ROI, a total of 40 textural
features were calculated [20,21]. Since the values of features most
probably are expected to differ from feature to feature, to avoid bias,
all features were normalized to zero mean and unit standard
deviation by Eq. (2):
x i
x
y i 2
s
where y(i) is the normalized version of feature x(i) an x and s are the
mean and standard deviations of feature x, both calculated over all
patterns of both classes [19].
2.3. System design
The PNN [22] classier with Gaussian kernel was employed for
the design of the PR system. The classier is at the core of the PR
system, and the choice of the classier was inuenced by the
dimensionality of the problem. Accordingly, the classier had to be
 S. Kostopoulos et al. / Magnetic Resonance Imaging 31 (2013) 761770 763

Fig. 1. Snapshots of the three PD-FSE FS MRI planes. In these planes and in their corresponding slices, the following ROIs were extracted: from the axial planes: (A) patella and (B)
femoral trochlea, from the coronal planes; (C) lateral and medial of femoral and tibial condyles, from the sagittal planes: (D) patella and femoral trochlea, and (E) lateral and
medial of the MFC and MTC cartilages.

fast in execution, which is important during the training stage, and of number of patterns in class j, is a smoothing parameter, here set to
high discriminatory ability. The PNN classier determines, for each 0.2 after experimentation, and p is the number of features employed
one of the two classes (the normal and pathological knee ROIs), a in the feature vector. The PNN classies the input vector x to class j
probability density function (PDF) by combining the kernel PDF with the higher discriminant value.
estimation for each training sample separately for a given class. The System design comprised implementation of a number of
discriminant function of the PNN for class j is given by Eq. (3): classier training and evaluation methods for determining the
optimum PR system design, i.e., obtaining the highest classication
Nj
X performance with the least number of textural features. At rst,
1
g j x w y i 3 features' reduction methods were used with the purpose of
2p=2p N j i1 determining the features combinations that would provide highest
classication accuracy.
kxx i k2
In one suboptimal method employed, the features ranking
where w y i e 22 is the Gaussian kernel, x is the test pattern
vector to be classied, xi is the ith training pattern vector, Nj is the method, features were rst ordered in descending order by means
764 S. Kostopoulos et al. / Magnetic Resonance Imaging 31 (2013) 761770

Table 1
Classication accuracy results for the MFC cartilage using the PNN, suboptimal and
optimal features selection methods, and the LOO evaluation method on ROIs from MRI
coronal and sagittal images.

MFC cartilage

Specicity Sensitivity Overall Features

(%) (%) (%)

1st suboptimal Coronal 89.3 93.8 90.9 SD, ACORa, SENTRa,

(features SREa, RPa
ranking) Sagittal 82.1 81.3 81.8 CONTa, CONTr, SOQr,
ENTRa, DVARa, RPr
2nd Coronal 85.7 81.3 84.1 MV, KURT, ACORr,
suboptimal IDFr, SENTRr, LREa
(SBS) Sagittal 82.1 81.2 81.8 STD, KURT, SOQr,
IDFr, DVARr, RPr
Optimal Coronal 92.9 93.8 93.2 MV, SOQr,
DVARr, LREa
Sagittal 92.9 87.5 90.9 MV, IDFr, DVARa,
GLNUr, RPa, VARr

Where ACOR: autocorrelation, CONT: contrast, DENTR: difference of entropy, DVAR:

difference of variance, ENTR: entropy, GLNU: gray level non uniformity, IDF: inverse
difference moment, KURT: kurtosis, LRE: long run emphasis, MV: mean value, RP: run
percentage, SD: standard deviation, SENTR: sum of entropy, SOQ: sum of squares, SRE:
short run emphasis, VAR: variance, and a, r: average, range.

of a ranking procedure, which combined, for each feature, a class

Fig. 2. The coronal view of the MFC cartilage with the two experts' delineations separability criterion, the Wilcoxon statistical test and the feature's
superimposed. correlation with the rest of the features [19]. The rst 10 highly

Fig. 3. Block diagram describing the training of the proposed PR system using either the host computer, steps 19 are sequentially executed on the CPU, or parallel processing on
the GPU; steps 1, 2, 4, 8 and 9 are sequentially executed on the CPU; steps 3, 5 and 7 refer to memory transactions between CPU and GPU; and step 6 is executed in parallel on the
GPU, employing numerous threads.
 S. Kostopoulos et al. / Magnetic Resonance Imaging 31 (2013) 761770 765

Table 2 ing the classier by each combination and testing its precision by
Classication accuracy results for the medial tibial condyle (MTC), using the PNN, sub- means of the LOO method. This, however, is a lengthy procedure
optimal and optimal features-selection methods, and the LOO evaluation method on
ROIs from MRI coronal and sagittal images.
that, depending on the dimensionality of the problem, may be
unrealizable. To reduce the dimensionality of the problem, a rule
MTC cartilage of thumb was adopted [23], i.e., that of forming features
Specicity Sensitivity Overall Features combinations of up to a third of the number of ROIs, contained
(%) (%) (%) in the smaller of the two classes, so as to avoid overtting. The
1st Suboptimal Coronal 89.3 81.3 86.4 SAVr, DVARa, DVARr smallest class in our data was the pathological ROIs class with 16
(features Sagittal 71.4 87.5 77.3 CONTa, SAVr, DENTRr ROIs; thus, we had to examine features combinations of up to six
ranking) features. However, this is still an enormous number if we consider
2nd Coronal 89.3 93.8 90.9 CONTa, CONTr, CORa, n!
Suboptimal CORr, ACORs,
that there are 40 features and there are nk !k! (where k = 1,2,,6
(SBS) SOQa, ENTRr and n = 40) possible features combinations of up to 6 features.
Sagittal 82.1 68.8 77.3 SKEW, CORr, ENTRa, Also, for each features combination, the classier had to be
ENTRr, SENTRr, redesigned 44 times (equal to the number of ROIs in both classes)
SAVr, DENTRr,
if we were to employ the LOO method.
RLNUr, RPs
Optimal Coronal 96.4 93.8 95.5 CORa, ENTRr, SENTRa, To get a realistic assessment of the system's performance to
SAVa, DVARa unseen data, the 10-fold external cross-validation (ECV) method
Sagittal 85.7 93.8 88.6 KURT, CORa, IDFa, [24] was applied. Data from both classes were split into two
SENTRr, DVARa, nonoverlapping subsets; one subset (70% of the data) was used to
DENTRr
design the system by the optimal method, using the exhaustive
ACOR: autocorrelation, CONT: contrast, COR: correlation, DENTR: difference of entropy, search and LOO methods, and then the so-designed system was
DVAR: difference of variance, ENTR: entropy, IDF: inverse difference moment, KURT:
used to classify the other subset (30% of the data). This procedure
kurtosis, RLNU: run length nonuniformity, RP: run percentage, SAV: sum average,
SENTR: sum of entropy, SKEW: skewness, SOQ: sum of squares, SVAR sum of variance, was repeated 10 times, and the average ECV accuracy was
a: average, r: range. calculated as an assessment of the system's classication accuracy
to new unseen data.
It was obvious that to optimally design the classication system
ranked features were retained for further processing. Those were the and to assess its performance to unseen data, more rigorous
following, presented in ranked order: standard deviation, autocor- processing techniques had to be employed to deal with the
relation, sum of squares, entropy, sum of entropy, sum average, sum enormous amount of calculations required. Thus, the design of the
of variance, short run emphasis, run length nonuniformity and run system was realized on a GPU, exploiting the inherently parallel
percentage. Next, all possible combinations (exhaustive search) [19] SIMD architecture of the GPU. It has been previously advocated [25]
of the selected features were formed, each combination was that transferring processing onto a GPU may provide signicant
separately used to train the classier, and the precision of the improvement of processing time as compared to executing the same
design was evaluated by means of the leave-one-out method (LOO) tasks on a desktop's CPU. The programming framework employed
[19]: leaving one pattern out (i.e., all the feature values correspond- was that of NVIDIA's CUDA version 4.0. The development of the
ing to a particular ROI), training the classier with the rest of the proposed GPU-based implementation was assisted by information
patterns and classifying the left-out pattern. This cycle was repeated and code examples found in NVIDIA's ofcial documentation
for all ROIs, each time leaving a different ROI out, testing each ROI's repository [26] and in Refs. [2729].
classication against its arthroscopic diagnosis (considered here as The challenge was to redesign the procedures developed for CPU
the gold standard) and nally presenting the result of correctly and/ processing by breaking them into small tasks and running those
or wrongly classied ROIs on a truth table [19]. tasks concurrently on the 16 processors of the GPU (GeForce GTX
In a second suboptimal search method employed, the best 580). One such task was the process of designing the PNN classier
features combination was identied by means of the sequential for one feature combination and then testing the system's accuracy
backward selection (SBS) technique by using as features selection by the LOO method. That task was performed on a single thread.
criterion the performance of the classier itself [19]. The precision of Since there was a huge number of possible feature combinations (i.e.,
the design was tested by means of the LOO evaluation method. tasks) to be formed, tasks were loaded on different threads, which
Finally, an optimal features selection method was adopted, that run concurrently on the GPU's processors. Similar tasks were formed
of exhaustively forming all possible features combinations, design- for applying the ECV method, where the whole ECV cycle of classier

Table 3
The average values the standard deviations (not normalized) of the best feature combinations employed in the optimum design of the PR system.

MFC cartilage MTC cartilage

Features Normal Pathological Features Normal Pathological

Coronal MV 9.39 1.19 8.33 1.47 CORa 0.60 0.12 0.76 0.09
SOQr 4.41 1.57 2.54 1.57 ENTRr 0.79 0.13 0.69 0.069
DVARr 1.07 0.72 0.84 0.36 SENTRa 2.78 0.19 2.87 0.16
LREa 190 128 389 212 SAVa 21.36 2.57 18.79 3.89
DVARa 1.50 0.45 1.00 0.29
Sagittal MV 9.66 0.88 9.1 1.0 KURT 2.87 0.53 2.88 0.35
IDFr 0.13 0.02 0.14 0.03 CORa 0.60 0.11 0.64 0.17
DVARa 1.24 0.36 0.86 0.21 IDFa 0.46 0.06 0.51 0.06
GLNUr 0.0096 0.0051 0.013 0.0065 SENTRr 0.18 0.06 0.15 0.06
RPa 0.78 0.099 0.57 0.14 DVARa 1.20 0.35 0.95 0.29
VARr 0.0007 0.0004 0.0009 0.0005 DENTRr 0.74 0.13 0.60 0.15

GLNU: gray-level nonuniformity, LRE: long run emphasis, MV: mean value, VAR: variance.
766 S. Kostopoulos et al. / Magnetic Resonance Imaging 31 (2013) 761770

training classication had to be repeated 10 times (Fig. 3, steps 19).
In particular, data were split on the host desktop computer into 10
training evaluation sets (70%30%), which were loaded sequentially
on the GPU's memory (1472 MB GDDR5). One data split would be
loaded on the GPU; the process of ECV would be executed based on a
similar training scheme of loading each feature combination on a
single thread, as described before; and results would be returned to
the host computer for presentation prior to loading the next data
split on the GPU (Fig. 3 step 6).
The benet, in terms of processing time, of employing parallel
processing techniques on the GPU processors was estimated by
comparing the time required for completing the same tasks on a

Fig. 4. LS mappings of the MFC ROIs using (A) best four-features combination from coronal MR images and (B) best six-features combination from sagittal MR images. v1 and v2
are the axes of the decision space, and V1 and V2 are the vertices of the unit vectors [1 0]T and [0 1]T accounting for class 1 and class 2, respectively.
 S. Kostopoulos et al. / Magnetic Resonance Imaging 31 (2013) 761770 767

Table 4
Truth tables of GPU results using PNN, exhaustive search and LOO for MFC ROIs (a)
coronal and (b) sagittal using four and six textural features (Table 1), respectively.
MFC ROIs Classied Accuracy (%)
Normal Pathological
(a) Coronal Normal 26 2 92.9
Pathological 1 15 93.8
Overall accuracy (%) 93.2
(b) Sagittal Normal 26 2 92.9
Pathological 2 14 87.5
Overall accuracy (%) 90.9
desktop (Intel Core 2 CPU at 2.83 GHz) and on a GPU (GeForce
GTX 580). The task used was the design of the PNN classier by
the exhaustive search and LOO methods using 44 patterns (28
normal and 16 pathological ROIs) and 40 features per pattern.
PNN designs were evaluated for all possible feature combination
of up to six features.
3. Results
The SMF of the expert radiologist in manually delineating the
ROIs within a week's time interval was found to be equal to 0.85
0.03. The reproducibility (CV%) for ROIs delineation was found to be
equal to 4.1%. The SMF for interobserver delineation accuracy was
found to be equal to 0.79 0.05. KolmogorovSmirnov test revealed
no statistical signicant differences (P N .05) either between intraob-
server or between interobserver delineations.
Tables 1 and 2 summarize the results obtained following
different features selection techniques and the LOO method for
evaluating the PR system's discrimination accuracies between
normal and pathological MFC and MTC cartilages, respectively.
The specicities and sensitivities refer to the system's classication
accuracies achieved for the normal and pathological ROIs, the
overall column provides the PR system's overall classication
accuracy, and the features column shows the features combinations
used in the best designs of the PR system.
As it may be observed from Table 1, highest classication
accuracies of 93.2% and 90.9% for the coronal and sagittal MR images
of the MFC cartilage, respectively, were achieved by the optimal
features selection method, using the PNN classier, the exhaustive
search, for testing all possible features combinations, and the LOO
evaluation method on the 16 processors of the GPU card. There were
4 and 6 textural features used in the optimal designs of the PR system
for classifying ROIs from the coronal and sagittal MR images,
respectively.
Similar ndings were recorded for the MTC cartilage as it may be
observed from Table 2. Best accuracies were achieved by the optimal
features selection method for both coronal and sagittal MR images of
the MTC cartilage. Here, the PR system displayed more balanced
specicity and sensitivity and achieved higher classication accuracy
for the coronal ROIs (95.5%) than for the sagittal ROIs (88.6%). Those
accuracies were achieved by designing the PR system with best
combinations of 5 and 6 textural features, respectively. Table 3
presents the average values and the standard deviations of the best
feature combinations concerning the coronal and sagittal planes of
the MFC and MTC cartilages.
Fig. 4A and Fig. 4AB display transformed scatter diagrams (by
least squares rule), where the four- and six-dimensional textural
features spaces of the coronal and sagittal MFC ROIs were
transformed into two-dimensional spaces (dimensionality is equal
to the number of classes) by the quadratic least squares (LS)
mapping process [30]. Circles and stars refer to normal and
pathological ROIs. As shown in Tables 4 and 5, two normal MFC
ROIs were misclassied as pathological and one pathological as
normal in the coronal MR images, and two normal and two
pathological MFC ROIs were misclassied in the sagittal MR images.
Similarly, Fig. 5A and Fig. 5B are LS mappings of the MTC ROIs. One
normal and one pathological MTC ROIs were misclassied in the coronal
MR images, and four normal and one pathological ROIs were
misclassied in the sagittal MR images. Details of correctly and
misclassied MFC and MTC ROIs can be seen in Tables 4 and 5,
respectively.
The improvement in terms of processing time achieved by
accomplishing the same task on the 16 processors of the GPU, using
parallel processing, or on the host computer's CPU, using sequential
processing, was evaluated. The task comprised training of the PNN
classier, using the exhaustive search for examining all possible
features combinations, for up to six features, and the LOO method, for
evaluating classication accuracy. Times recorded were 209 s (or
about 3.5 min) for the GPU against 54,402.7 s (about 15 h) for the
CPU.
To obtain an indication of the PR system's classication
performance to unseen data, the ECV method, using the optimal
design, was employed. Table 6 shows the classication results
obtained for the MFC and MTC cartilages in both coronal and
sagittal MR images. At each one of the 10 trials, the overall
precision achieved is presented. Mean classication accuracies
were approximately 88% and 82% for the coronal and sagittal MR
images of the MFC cartilage, and 86% and 84% for the coronal and
sagittal MR images of the MTC cartilage, respectively.
To provide solid evidence that results obtained by the optimal
method were not circumstantial and that a suboptimal method could
have been equally employed instead in the design of the PR system,
the ECV method was repeated, but this time employing the two
suboptimal methods in the design procedure. Tables 7 and 8 in the
Appendix present the ECV results employing the features ranking
and the sequential backward selection methods, respectively; the
suboptimal methods were used in the internal design stage of the
ECV process using 70% of the data. Evidently, the mean accuracies
achieved by the system, using suboptimal methods, were quite
inferior to those obtained by designing the system employing the
optimal method.

4. Discussion
Table 5
Truth tables of GPU results using PNN, exhaustive search, and LOO for MTC ROIs (a)
In the design of decision support systems, the dimensionality of
coronal and (b) sagittal using ve and six textural features (Table 2), respectively.
the problem is an important factor that may ultimately affect system
MTC ROIs Classied Accuracy (%) precision. In our case, by employing a large number of textural
Normal Pathological features, the dimensionality of the problem increased so that it
rendered the use of optimal design methods computationally
(a) Coronal Normal 27 1 96.4
Pathological 1 15 93.8 cumbersome to be performed on a single desktop computer. Thus,
Overall accuracy (%) 95.5 if we were to apply classier training on a desktop computer, we had
(b) Sagittal Normal 24 4 85.7 to employ suboptimal features selection methods, such as the
Pathological 1 15 93.8
features ranking and the sequential backward selection methods.
Overall accuracy (%) 88.6
Tables 1 and 2 present comparatively the results obtained by the two
768 S. Kostopoulos et al. / Magnetic Resonance Imaging 31 (2013) 761770

Fig. 5. LS mappings of the MTC ROIs using (A) best ve-features combination from sagittal MR images and (B) best six-features combination from sagittal MR images. v1 and v2 are
the axes of the decision space, and V1 and V2 are the vertices of the unit vectors [1 0]T and [0 1]T accounting for class 1 and class 2, respectively.

suboptimal methods, employed on the desktop computer, and the
optimal method, developed to run in parallel on the processors of the
GPU card. Although, in all tests, the optimal method scored higher
than the suboptimal methods, differences were not always signif-
icant, e.g., in the coronal images of the MFC cartilage (Table 1), the
rst suboptimal method scored 90.9% against 93.2% of the optimal
method, and in the same views of the MTC cartilage (Table 2), the
second suboptimal method scored 90.9% against the optimal
method's 95.5%. This nding, however, may be misleading since
these results have been obtained by the LOO evaluation method and
may well be biased [24]. This becomes evident when the PR system's
optimal and suboptimal designs were presented to new unseen
 S. Kostopoulos et al. / Magnetic Resonance Imaging 31 (2013) 761770 769

Table 6 sustain low mutual correlation with the rest of the features. In
Classication accuracies achieved employing the ECV method (optimal design) on contrast, the discriminatory ability of features with high statistical
GPU for the MFC and MTC cartilages in the coronal and sagittal planes.
signicance, when considered individually, may not be effective in
Trials MFC cartilage MTC cartilage solving complex PR problems, especially when forming features
Coronal Sagittal Coronal Sagittal combinations of high mutual correlation [19].
MR images MR images MRI- images MR images Another signicant nding of the present study was the precision
% accuracy % accuracy % accuracy % accuracy with which the system classied (95.5%) the MTC cartilages
1 78.6 92.9 92.9 92.9 (Table 2). Of the 16 cases with pathological MFC cartilages, only 4
2 85.7 85.7 85.7 78.6 were found on arthroscopy to have pathology in the MTC cartilage as
3 85.7 85.7 78.6 85.7 well. Also, the second suboptimal method gave a high precision of
4 100.0 85.7 78.6 85.7
5 85.7 71.4 78.6 64.3
90.9% (Table 2), and the optimal method gave a high precision of
6 92.9 78.6 92.9 92.9 95.5%, misclassifying only 2 out of 44 ROIs (Table 5). Thus, while
7 92.9 71.4 92.9 92.9 arthroscopy and radiological evaluation showed no pathology in 12
8 92.9 78.6 92.9 78.6 out of 16 MTC cartilages, with veried pathology in their corre-
9 85.7 85.7 85.7 85.7
sponding MFC cartilages, image analysis revealed signicant textural
10 85.7 85.7 78.6 85.7
Mean S.D. 88.6 6.0 82.1 6.9 85.7 6.7 84.3 8.8 variations. This may imply that there is an ongoing process of
textural changes in the MTC cartilage, which lies opposite to the
pathological MFC cartilage, undetected on arthroscopy but evident
on image analysis. This, however, would probably have to be
data (Tables 68); mean accuracies of the optimally designed PR investigated in a larger cohort of similar cases.
system were around 85% (Table 5) against mean accuracies of about The computational burden of the present study was further
70% achieved by the suboptimal designs (Tables 7 and 8). This is an magnied when the necessity arose to assess the system's
important nding since (a) it corresponds to the level of condence discriminatory power to unseen MFC and MTC ROIs, i.e., data
that the physicians should put on the system and (b) it reveals the that have not been used in the design of the system. This was
necessity of employing state-of-art technology to optimally design essential to assess since it is a question frequently raised by the
PR systems. physicians. For this, the ECV method was applied, according to
Adoption of an optimal classier design method involved the which the optimal training of the classier had to be repeated for
time-demanding procedure of (a) forming exhaustively all possible 10 different splits of 70% and 30% of the data. Such procedure could
features combinations, (b) designing the PNN classier with each only be realized on the GPU, by programming its 16 processors to
particular combination, (c) evaluating each design by the LOO optimally train the system in parallel, by testing all possible
method and (d) retaining the design that, with the minimum features combinations. As it may be observed from Tables 1 and 6,
number of textural features, provided the highest classication mean results of the classication accuracies obtained by the ECV
accuracy. Considering the enormous number of features combina- method were lower than the results obtained by the optimum
tions (all possible combinations of up to 6 features among 40 classication method shown in Table 1. This, however, is always
features) and the number of classier designs required in each the case since the optimal design method, using the LOO evaluation
feature combination [equal to the number of patterns (44) in both method, provides an optimistically biased estimate [24], while
classes], the time required was about 15 h on the CPU, which gave the ECV gives a generalization of the classier as to how it would
little room for experimentation in the design of the classier [e.g., perform if designed and placed at a clinical environment to be used
modifying the value of smoothing parameter in Eq. (2) for best as a second-opinion tool. Nevertheless, judging by the performance
classier performance]. On the other hand, such experimentations of the proposed PR system, achieving mean precisions to unseen
were feasible when training of the classier was transferred to the data of about 89% and 86% using coronal MR images of the MFC and
GPU unit. About 3 min of processing time on the GPU was enough MTC cartilages provides reasonable evidence of a useful second-
to accomplish the same 15-h CPU task. Modications in the design opinion diagnostic tool.
of the PNN were modestly fast to implement and test, employing a One of the virtues of parallel processing the GPU's 16 processors
trial-and-error methodology in the xation of the values of the PNN was that with the training speeds attained, the system could be
parameters. In particular, the value of = 0.2 in Eq. (2) was redesigned fast and on-site. Once ROIs from new cases have been
determined by repeating the classier design on the GPU for values attained and arthroscopically veried, they could be added into the
ranging between 0.1 and 0.9 and retaining the value that provided system's repository. The PR system could be then retrained fast using
the highest, more balanced, accuracies (specicity, sensitivity, more data, thus expanding its resources and, as a consequence, its
overall). Exploitation of the GPUs speed and parallel processing reliability in characterizing new cases. The whole procedure of
capabilities has been also noted in previous studies on image proposing a new optimum design and assessing the PR system's
processing and analysis [14,25,3134]. reliability to unseen data by the ECV method would not require
Considering the accuracies achieved, ROIs extracted from the more than 45 min, depending on the size of the data. This
coronal images of MFC cartilages for the normal and pathological assessment will indicate the condence that the physician should
cases could be discriminated with a high accuracy of 93.2% using four put on the suggestions of the system to new and unseen ROIs.
textural features (mean value, sum of squares, difference variance Retraining would not have to be performed frequently since the
and long run emphasis) for optimal PNN design (Table 1). Examining process of collecting reasonable numbers of new arthroscopically
those four features more closely, it was found that only two, the sum veried new cases may be rather slow.
of squares and the long run emphasis, displayed signicant statistical In conclusion, a PR system was designed to discriminate with
differences (P b .005) between the two classes, and additionally, only high accuracy normal from pathological MFC and MTC cartilages
one of them, the sum of squares, was a member of the 10 highest based on the PNN classier and on textural features from ROIs of the
ranked features, in which both statistical signicance and mutual coronal MR images. Successful system design could only be achieved
features correlation mattered. This indicates that the formation of by exploiting the high processing speed and parallel processing
optimal classier designs, by incorporating individual features with capabilities of a commercial GPU. The proposed system can be
low statistical signicance, may be possible provided that they employed in a clinical environment as a second-opinion tool with
770 S. Kostopoulos et al. / Magnetic Resonance Imaging 31 (2013) 761770

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