In this paper, we present an algorithm to segment the liver in low-contrast CT images. As the first step of our algorithm, we define a search range for the liver boundary. Then, the EM algorithm is utilized to estimate parameters of a 'Gaussian Mixture' model that conforms to the intensity distribution of the liver. Using the statistical parameters of the intensity distribution, we introduce a new thresholding technique to classify image pixels. We assign a distance feature vectors to each pixel and segment the liver by a K-means clustering scheme. This initial boundary of the liver is conditioned by the Fourier transform. Then, a Geodesic Active Contour algorithm uses the boundaries to find the final surface. The novelty in our method is the proper selection and combination of sub-algorithms so as to find the border of an object in a low-contrast image. The number of parameters in the proposed method is low and the parameters have a low range of variations. We applied our method to 30 datasets including normal and abnormal cases of low-contrast/high-contrast images and it was extensively evaluated both quantitatively and qualitatively. Minimum of Dice similarity measures of the results is 0.89. Assessment of the results proves the potential of the proposed method for segmentation in low-contrast images.

Convolutional neural networks (CNNs) have become popular in medical image segmentation. The widely used deep CNNs are customized to extract multiple representative features for two-dimensional (2D) data, generally called 2D networks. However, 2D networks are inefficient in extracting three-dimensional (3D) spatial features from volumetric images. Although most 2D segmentation networks can be extended to 3D networks, the naively extended 3D methods are resource-intensive. In this paper, we propose an efficient and accurate network for fully automatic 3D segmentation. Specifically, we designed a 3D multiple-contextual extractor to capture rich global contextual dependencies from different feature levels. Then we leveraged an ROI-estimation strategy to crop the ROI bounding box. Meanwhile, we used a 3D ROI-attention module to improve the accuracy of in-region segmentation in the decoder path. Moreover, we used a hybrid Dice loss function to address the issues of class imbalance and blurry contour in medical images. By incorporating the above strategies, we realized a practical end-to-end 3D medical image segmentation with high efficiency and accuracy. To validate the 3D segmentation performance of our proposed method, we conducted extensive experiments on two datasets and demonstrated favorable results over the state-of-the-art methods.