Ⅰ. Introduction
According to a report by the World Health Organization (WHO), liver disease is one of the causes of approximately 1.1 million death worldwide[1]. According to the 2019 Death Statistics released by the Ministry of Health and Welfare, liver disease has consistently ranked among the top 10 leading causes of death for the past decade, from 2009 to 2019. Particularly, liver cancer is the second most common cancer in Korea, accounting for 20.6% of death, owing to its high frequency and difficult treatment[2]. Currently, medical devices such as computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound, are used to evaluate and diagnose liver diseases in the clinical field[3-5]. Liver ultrasound is essential in determining the shape and size of blood vessels and tissues inside and outside the liver[6-8].
Liver ultrasound has the advantage of evaluating the liver function in the form of real-time images without exposure to the radiation or contrast agents, and it is non-invasive[9,10]. In addition, liver ultrasound serves a very important role in the early detection of liver disease, such as liver cancer, cirrhosis, and liver cysts. Hence, it is currently the most actively used method for the prevention and diagnosis of most liver diseases[11-13]. Because liver function is determined based on the inflow and regulation of blood supplied by blood vessels, when examining the liver via ultrasound, the ability to differentiate between tissues and blood vessels is critical to assess the blood supply to the liver[14,15]. In particular, certain liver diseases cause abnormalities in the liver veins, such as blood flow status, vessel size, and blood clots, and hepatic vein examination is useful for the early detection and diagnosis of the early stages of liver diseases, such as liver cancer; therefore, observing the hepatic veins on liver ultrasound provides important information[16,17].
However, ultrasound imaging diagnostics suffer from lower image quality than other medical diagnostic modalities, such as CT, MRI, and X-ray imaging, and the main cause of this problem is small speckle noise. Speckle noise occurs in the form of multiplicative noise when ultrasound pulses randomly interfere with small particles or objects at a scale comparable to that of sound waves because of diffuse scattering[18,19]. In ultrasound examination, noisy images cause difficulty to distinguish between blood vessels and tissue structures and to detect abnormalities in the liver tissue because the noise inside the blood vessels interferes with the signal, thereby distorting the results of the examination. Thus, when examining the liver, a technique to reduce to the noise inside the blood vessels plays a critical role in improving the accuracy of the examination results[20].
Therefore, speckle noise reduction is one of the important preprocessing steps required for ultrasound image analysis and processing. Various techniques have been proposed for speckle noise reduction. Studies conducted earlier involved reducing speckle noise by improving the hardware of ultrasound transducer, thereby significantly impacting the quality of the ultrasound images; however, they had technical limitations, such as cost and complexity[21,22]. By contrast, software techniques, that is, filtering techniques are the most widely used, because they can be applied to images acquired using existing ultrasound equipment without modifying the existing hardware, are simple to implement, and have significant economic benefits[23,24].
Therefore, in this study, we applied widely used filters, including Wiener filter, MMWF, gamma filter, and Lee filter to reduce speckle noise in liver ultrasound images and quantitatively evaluated the degree of improvement in image quality to identify the most effective filter. In addition, to evaluate the efficiency of the filters according to the noise intensity, we added various noise intensities and changed the smoothing parameter, window size of the filters to quantitatively compare the performance of the filters in reducing speckle noise.
Ⅱ. Materials and methods
1. Acquisition of noisy image
This study was conducted under the ethical guidelines of the Helsinki Declaration and received prior approval for exemption from review by the Gachon University Institutional Review Board (IRB No.: 1044396-202204- HR-075-01). We acquired a clinical liver ultrasound image to compare the noise reduction performance of the filters in reducing speckle noise in liver ultrasound images. The clinical liver ultrasound image was obtained using a convex probe with a 3.5 MHz frequency through a subcostal scan. Subsequently, to quantitatively evaluate the efficacy of the filters based on varying levels of noise intensity, we introduced speckle noise with intensities of 0.01, 0.05, 0.10, and 0.50 to the acquired liver ultrasound images using the MATLAB software (ver. 2023a, MATHWORKS, Boston, United States of America).
2. Speckle noise reduction filter modeling
To reduce speckle noise, a Wiener filter, MMWF, gamma filter, and Lee filter were applied to noisy images of each intensity from the clinical liver ultrasound images. The smoothing parameters of each filter, that is window sizes, were set to 3×3, 5×5, and 7×7. After applying these to the noisy images, a comparative evaluation of the filters was conducted based on a quantitative evaluation.
The gamma filter is a maximum a posteriori (MAP) filter based on the Bayesian analysis of the image statistics. A gamma filter is used to minimize the loss of texture information and uses the coefficient of variation (COV) and contrast to noise ratio (CNR), the probability density function of which determines the smoothing process[25]. The formula for the gamma filter is as follows:
where and represent the sought value and local mean, respectively, DN denotes the input value of the digital number, and σ denotes the original image variance. Wiener filter, known as the least mean square filter, was proposed in the 1940s, and it has the ability to restore images even when they are corrupted or blurred. The Wiener filter computes the local image variance. Consequently, it applies less smoothing when the local variance of the image is large and more smoothing when the local variance is small. This approach of Wiener filter (gwiener) provides results superior to those of linear filtering[26]. The mathematical formula for the Wiener filter is as follows:
where m and σ represent the mean and standard deviation values of the signal within the window, respectively, and ν and f(i) represent the standard deviation and pixel values of noise, respectively. By substituting the mean value in the Wiener filter with the median value, the MMWF is formulated to enhance both resolution and image quality[27,28]. The MMWF is represented by replacing the mean value (m) of the Wiener filter in Eq. (2), with a median value (), as shown in Eq. (3).
The Lee filter, introduced in 1981, is based on a multiplicative speckle model and utilizes local statistics to preserve intricate features. The Lee filter operates based on variance; in other words, it applies smoothing to areas with low variance but not to those with high variance. This adaptability allows the Lee filter to preserve details at both low and high contrast[29]. The result of Lee filtering for the smoothed pixel’s gray level value R is as follows:
where Ic and Im are the central pixels of the filter window and the mean intensity within the filter window, respectively; W is , where Cn and Ci are and S/Im, respectively, and S is the standard deviation of the intensity within the filter window. Weighting function W is a measure of estimated noise variation coefficient Cn with respect to image variation coefficient Ci . The number of parameters, ∈ is used to estimate the noise variance and it controls the amount of smoothing applied to the image by the filter.
3. Quantitative evaluation of noise level
To quantitatively evaluate the speckle noise reduction ability of various filters with increasing window size in the blood vessel region of liver ultrasound images with various noise intensities, we a set background and a region of interest (ROI) with sizes of 20×20, respectively, and measured the COV and CNR (Fig. 1)[30,31]. Moreover, based on COV and CNR results, we conducted comparative evaluation with the filter that showed the most superior value in quantitative evaluation and the noisy image without the filter to evaluate speckle noise reduction ability.
The COV was calculated to compare the variances in the obtained liver ultrasound images.
where σR and σBK represent the standard deviation of signal intensity in the ROI and background, respectively, μ is the average value in the ROI, and SR and SBK denote the average value of signal intensity in the ROI and background, respectively.
4. Visual evaluation
We compared the filtered images with a window size of 7×7 with the noisy images. A visual evaluation was performed by enlarging the region indicated by the red box in Fig. 1. The visual assessment criteria were based on how effectively noise in tissue and blood vessel regions were removed and how accurately the signal of blood vessel walls with high pixel values was restored without distortion.
Ⅲ. Results
1. Quantitative evaluation
A quantitative evaluation showed that the COV values improved as the window size of the noise reduction filters increased at noise intensities of 0.01, 0.05, 0.10, and 0.50. Moreover, the Lee filter showed the lowest values for COV results, followed by the Wiener filter, MMWF, and gamma filter (Fig. 2). Additionally, we confirmed that the CNR values improved with increasing window size at various noise intensities, with the Lee filter performing the highest values, followed by the Wiener filter, MMWF, and gamma filters (Fig. 3).
Based on the results of these analyses, we derived the Lee filter as the most effective filter for speckle noise reduction. To evaluate its usefulness, we compared the COV and CNR values of the noisy image without the noise reduction filter and the Lee filter image with a window size of 7×7 (Fig. 4). The quantitative evaluation showed that at noise intensities of 0.01, 0.05, 0.10, and 0.50, the COV values of the noisy images were 0.30, 0.36, 0.43, and 0.77, respectively, and the CNR values were 1.85, 7.35, 0.93, and 0.57, respectively. Moreover, the COV and CNR values of the Lee filter with a window size of 7×7 showed COV values of 0.23, 0.23, 0.24, and 0.24, and CNR values of 4.06, 4.00, 3.64, and 3.16 at the respective noise intensities.
The comparative evaluation showed that the Lee filter image at noise intensities of 0.05, 0.01, 0.10, and 0.50 improved the COV by approximately 1.28, 1.51, 1.88, and 3.38 times, respectively, and the CNR values by approximately 2.18, 2.96, 3.91, and 5.50 times, respectively.
2. Visual evaluation
We performed the visual evaluation with a window size of 7×7 and the results are shown in Fig. 5. The visual evaluation showed that the Wiener filter and MMWF images were not effective in reducing the speckle noise in the blood vessel wall where the signal was strong, and the speckle noise in the liver tissue region intensified as the noise intensity increased. In addition, the gamma filter image exhibited a decrease in the overall signal value, thereby decreasing the contrast and brightness of the image. For the Lee filter image, the speckle noise was effectively reduced at all noise intensities; however, blurring was also considered, resulting in a decrease in resolution. Nonetheless, the Lee filter effectively reduced speckle noise at all noise intensities and there was no variation in contrast and brightness that occurred with the gamma filter. When comparing images with the Lee filter applied by noise intensity, we found that the smaller the noise intensity, the more effective the noise reduction, however, at a noise intensity of 0.50, speckle noise was reduced but a grid artifact was introduced.
Ⅳ. Discussion
Liver ultrasound is a widely used diagnostic method due to its real-time imaging capabilities, non-invasive nature, and absence of radiation or contrast agents [9,32,33]. However, ultrasound imaging diagnostic procedures have the disadvantage owing to the speckle noise[18,19]. To solve these problems, various techniques for speckle noise reduction have been proposed[25-29]. Although previous research was conducted by improving the hardware, thereby significantly impacting the ultrasound image quality, technical limitations such as economic difficulties and complexity existed. Hence, research was actively conducted by improving the software[21,22]. One software technique, filtering, is the most widely used because it can be applied to existing ultrasound equipment, is simple to modify, and is economically beneficial for simple maintenance[34].
A gamma filter, a widely used nonlinear filter for speckle noise reduction, can effectively reduce noise by recognizing the features of the input data. It has the advantage of correcting the spectrum by assigning higher weights to regions with large variations in the input data. However, this characteristic does not solve the problem of computational cost. Moreover, applying this to certain data is difficult because this requires assumptions about the distribution of the input data[25]. The Wiener filter, which is known to efficiently reduce speckle noise, is a common linear filter used for speckle noise reduction. The Wiener filter calculates the power spectral density of the input data and the average value of the spectral density to calculate the signal to noise ratio (SNR) for estimating the spectrum, and it uses the estimated spectrum to restore the image. However, the Wiener filter works most effectively when the noise distribution is Gaussian. However, the speckle noise generated in real ultrasound images is often irregular and nonlinear in distribution; therefore, it does not perform effectively[26]. To address the limitations of the Wiener filter, the median modified Wiener filter (MMWF) is proposed. The MMWF uses spatial and time correlations estimated from multiple frames to reduce the speckle noise. The MMWF is effective when noise has different intensities and directions. Moreover, the MMWF can effectively reduce speckle noise when the noise does not have a Gaussian distribution. However, the MMWF is highly computationally intensive and has many variables; therefore, the filtering result may depend on the setting of the variables[27,28].
To address these disadvantages, the Lee filter can be used because it is less computationally intensive and requires no assumptions about the input data; it can be applied to a wide variety of data. In addition, the Lee filter functions effectively when the input data are not uniform, because it considers the uniformity of the input data and the statistical information of the neighboring pixels to perform filtering. Compared with conventional filters, the Lee filter has the advantage of more accurately preserving information near the edge, enabling a detailed depiction of the anatomical structures[29].
In the case of liver disease, liver function depends on the inflow and regulation of blood; therefore, the ability to differentiate between tissues and blood vessels when performing an ultrasound scan is crucial to assess the blood supply to the liver. Specifically, liver veins are critical for diagnosing liver diseases such as liver cancer that can be difficult to detect at an early stage[15,16]. However, whereas many studies have been conducted to reduce speckle noise in liver ultrasound images, relatively few studies have been conducted on reducing noise in the blood vessel region of the liver[35,36]. Moreover, the intensity of speckle noise in ultrasound examinations is affected by the type of ultrasound equipment, survey location, and patient physiology, and the intensity of speckle noise in these clinical settings is different; however, research on the application of filters to images with various intensities of speckle noise is lacking[37,38]. Therefore, in this study, the noise intensity was varied to evaluate appropriate noise reduction techniques in various clinical environments. Furthermore, various speckle noise reduction filters were applied to reduce the speckle noise in the blood vessel region of the liver from the acquired noisy images to quantitatively evaluate the noise reduction performance of those filters.
A quantitative evaluation showed that the noise reduction performance of the speckle noise reduction filters improved as the window size increased. For noise intensities of 0.01, 0.05, 0.10, and 0.50, we confirmed that the Lee filter exhibited the most superior noise reduction performance, followed by the Wiener filter, MMWF, and gamma filter. The research findings are attributed to the Lee filter's ability to effectively reduce speckle noise by taking into account the statistical relationships among neighboring pixels, resulting in a better match with the distribution of neighboring pixel values. Moreover, when comparing the noisy image with the image of the Lee filter with a window size of 7×7 that showed the most improved noise reduction ability, the COV and CNR values improved significantly as the speckle noise intensity increased. The COV increased from a minimum of 0.23 to a maximum of 0.24, and the CNR increased from a minimum of 3.16 to a maximum of 4.06.
As a result, this study demonstrated the usefulness of the Lee filter in liver ultrasound images acquired in various clinical settings through studies performed at various noise intensities and is expected to serve as a basis for ultrasound studies of liver vessels that have not been sufficiently studied. Additionally, the application of the Lee filter in the process of observing the blood vessels of the liver that are relatively difficult to detect because of their small size and complex structure, such as the hepatic artery compared to the hepatic vein, is expected to contribute to the observation of blood vessel areas and increase the visibility of small structures by effectively reducing noise[39].
A limitation of this study is that the speckle denoising filters used in the experiments were applied to observe only the reduction in the amount of noise; hence, blurring and resolution degradation could not be evaluated. Additionally, a limitation of this study is that it conducted experiments using a single liver ultrasound image. Therefore, further research is required on various image quality evaluations, except for noise reduction performance and planned to validate the utility of the Lee filter for speckle noise reduction by acquiring additional liver ultrasound images. Moreover, we have plans for future research that will involve the comparative evaluation of filters across diverse liver ultrasound images based on varying window sizes. This research will also involves studies aimed at optimizing the window size.
Nevertheless, our study offer clinical application possibility. The incorporation of Lee filters into standard liver ultrasound image processing procedures offers healthcare practitioners a valuable tool for improving the clarity and diagnostic value of ultrasound scans. This advantage is further emphasized by the flexibility of Lee filters, allowing for patient-specific adjustments in window size. By aligning filter settings with individual patient characteristics and the clinical environment, optimal speckle noise reduction is achieved. Therefore, our study provide that implementation of this approach in routine clinical settings holds the potential to enhance diagnostic precision, ultimately contributing to improved patient outcomes. While our study currently emphasizes speckle noise reduction in the liver blood vessel region, it holds the potential for broader applications in liver ultrasound imaging. Extending these noise reduction approaches to other liver regions, including the parenchyma, biliary ducts, and lesions, promises enhanced overall image quality and diagnostic capabilities. This enhancement in ultrasound image quality, achieved through speckle noise reduction, supports accurate diagnoses, treatment planning, and underscores the significance of early detection in liver disease.
Additionally, our study suggests future possibilities for the advancement of speckle noise reduction techniques, which could lead to further research and application programs for better patient outcomes and disease management. In particular, in the rapidly developing field of deep learning, the application of the Lee filter to dataset construction is expected to provide accurate and generalized results through efficient speckle noise reduction[40]. This approach has the potential to improve the performance and efficiency of deep learning models by applying high-quality training data.
Ⅴ. Conclusions
In this study, to reduce the speckle noise in the liver blood vessel region, we modeled and used speckle noise reduction filters to reduce speckle noise in clinical liver ultrasound images. To simulate various clinical conditions, we added various noise intensities. Additionally, we performed a quantitative analysis by comparing the Lee filter with various filtering techniques and window size when applied to noisy images, confirming the speckle noise ability of the Lee filter. In the experimental results, we observed significant improvements across all quantitative evaluation factors with the application of the Lee filtering technique, surpassing the performances of various speckle noise reduction filters. These results suggest that the Lee filter can replace other speckle noise filters, and it is an effective noise reduction filter in the liver blood vessel region.