Tech Science Press

DOI: 10.32604/cmc.2023.038398
Article

Medical Image Fusion Based on Anisotropic Diffusion and Non-Subsampled

Contourlet Transform
Bhawna Goyal1, *, Ayush Dogra2 , Rahul Khoond1 , Dawa Chyophel Lepcha1 , Vishal Goyal3 and
Steven L. Fernandes4

1
Department of ECE, Chandigarh University, Mohali, 140413, Punjab, India
2
Chitkara University Institute of Engineering and Technology, Chitkara University, Punjab, India
3
Department of Electronics and Communication Engineering, GLA University, Mathura, India
4
Department of Computer Science, Design and Journalism, Creighton University, NE, USA
*Corresponding Author: Bhawna Goyal. Email: [email protected]
Received: 11 December 2022; Accepted: 20 April 2023; Published: 09 June 2023

Abstract: The synthesis of visual information from multiple medical imaging

inputs to a single fused image without any loss of detail and distortion
is known as multimodal medical image fusion. It improves the quality of
biomedical images by preserving detailed features to advance the clinical util-
ity of medical imaging meant for the analysis and treatment of medical disor-
ders. This study develops a novel approach to fuse multimodal medical images
utilizing anisotropic diffusion (AD) and non-subsampled contourlet trans-
form (NSCT). First, the method employs anisotropic diffusion for decompos-
ing input images to their base and detail layers to coarsely split two features
of input images such as structural and textural information. The detail and
base layers are further combined utilizing a sum-based fusion rule which
maximizes noise filtering contrast level by effectively preserving most of the
structural and textural details. NSCT is utilized to further decompose these
images into their low and high-frequency coefficients. These coefficients are
then combined utilizing the principal component analysis/Karhunen-Loeve
(PCA/KL) based fusion rule independently by substantiating eigenfeature
reinforcement in the fusion results. An NSCT-based multiresolution analysis
is performed on the combined salient feature information and the contrast-
enhanced fusion coefficients. Finally, an inverse NSCT is applied to each coef-
ficient to produce the final fusion result. Experimental results demonstrate
an advantage of the proposed technique using a publicly accessible dataset
and conducted comparative studies on three pairs of medical images from
different modalities and health. Our approach offers better visual and robust
performance with better objective measurements for research development
since it excellently preserves significant salient features and precision without
producing abnormal information in the case of qualitative and quantitative
analysis.

This work is licensed under a Creative Commons Attribution 4.0 International License,
which permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.
312 CMC, 2023, vol.76, no.1

Keywords: Anisotropic diffusion; biomedical; medical; health; diseases;

adversarial attacks; image fusion; research and development; precision

1 Introduction
The possibility of imaging human body cells, organs, and pathological samples to diagnose dis-
eases has a revolutionary effect on medicine. Medical imaging informatics provides the foundation for
all medical imaging tasks including image storage, analysis, processing, retrieval, and comprehension.
The use of medical image processing, one of the best methods in computer vision to speed up clinical
decision-making tasks and enhance diagnosis is a recent development in medical imaging. Examples
of medical image processing include brain disease prediction [1], identification of pneumonia, cervical
cancer diagnosis, breast cancer prediction [2], and diabetic retinopathy diagnosis from fundus images
[3]. The study shows that medical image processing performs nearly as well as humans do and their
diagnosis is analogous to that of trained medical personnel [4,5]. However, the accuracy and security of
medical image processing are vital for researchers. According to recent studies on the segmentation and
classification assignments of medical imaging even modern image-processing techniques are noticeably
sensitive to adversarial attacks. Medical imaging techniques are significantly more vulnerable to
adversaries compared to techniques that use natural images as their input. These vulnerabilities allow
small constructed perturbations in image samples that have a significant impact on image processing
performance even if they are invisible to the human eye. Many image-processing techniques have been
developed to protect against adversarial attacks. One such popular domain is image fusion which
produces a detailed image by combining images taken by multiple imaging modalities for clinical
decision-making [6].
The visual and analytical image quality can be increased when two or more images from distinct
modalities are fused. Several types of information are provided by multimodal medical images: Vibro-
acoustography (VA) images provide details about the width and depth of the disease whereas computed
tomography (CT) images give information about dense structures like bones. Magnetic resonance
imaging (MRI) images give information about pathological soft tissues whereas magnetic resonance
angiography (MRA) images can quickly identify abnormalities in the brain and X-ray images can
identify fractures and abnormalities in bone positions. Functional and metabolic information on
the various brain regions is provided by positron emission tomography (PET) and single photon
emission computed tomography (SPECT), respectively. The multimodal medical image pairs such as
CT-MRI [7], MRI-SPECT [8], PET-CT [9], MRI-PET [10], MRICT-PET [11], MRI-SPECT [12], and
ultrasound-X-rays [13]” are combined for extraction of more clinical details. Doctors in the medical
industry prerequisite a high level of spectral and spatial features in a specific image for a variety of
purposes including study, monitoring, correct disease diagnosis, and therapy. The fact that a single
image could not give all the necessary details. Therefore, finding all the relevant information in a single
composite image is termed a fused image which is essentially essential in the field of medicine. Doctors
may diagnose anomalies quite effectively with this combined information. A medical image fusion
application has the advantage of simplifying disease diagnosis [14]. A successful image fusion can
retain essential information by extracting all relevant data from the input images without introducing
any discrepancies into the fused image. Machine and human perception are better adapted to the fused
image.
The main contributions of our medical image fusion approach are as follows: (1) This study
expands the field of fusion of medical images by introducing anisotropic diffusion and nonsubsampled
Shearlet transform (NSCT). The method decreases image noise without substantially reducing the
CMC, 2023, vol.76, no.1 313

amount of the image’s information by using anisotropic diffusion by a simple structure texture decom-
position of the input images to produce base and detail layers. (2) The method uses NSCT for obtaining
low and high-frequency coefficients for each scale and direction of the images. The “Nonsubsampled
pyramid filter banks (NSPFB) and nonsubsampled directional filter banks (NSDFB)” were used
for the decomposition by full multiscale and multidirectional, respectively. (3) The theory behind
principal component analysis also known as the Karhunen-Loeve transform is that the majority of
the information contained throughout all of the bands may be compressed into a significantly lower
number of bands with little information loss. It can enhance image corners, edges, and contrasts which
provides a fused image of much greater quality. (4) The experiments have been performed to determine
the efficiency of our fusion strategy for CT and MR fusion problems. It has been verified that both
the qualitative and quantitative assessments of our technique yield better results.
The remaining part of this study is organized as follows. We provide a summary of the existing
image fusion works in Section 2. An anisotropic diffusion (AD) and non-subsampled contourlet
transform (NSCT) are briefly described in Section 3. The proposed image fusion technique is
illustrated in Section 4 in detail. Extensive experiments are performed on the publicly available dataset
in Section 5 to measure its fusion performance and compare it with well-known medical image fusion
techniques. Section 6 provides conclusions and proposals for future work.

2 Literature Survey
This section presents the recent research works that have the same works or are related to our
fusion strategy based on both traditional-based and deep learning-based algorithms. In the end,
the main contributions of our technique are then illustrated in detail. Traditional techniques have
drawn considerable interest in the domain of fusion during the last few years. These techniques
frequently utilize edge-preserving filters for precise extraction of edge details at numerous scales that
help to preserve the shift-invariance and achieve higher preservation efficiency of edge details. These
techniques typically employ discriminative fusion techniques that take into account the properties
of each separated image to produce a fused image. Lepcha et al. [15] introduced a fusion strategy
using a “rolling guidance filter (RGF)” by preserving vital structural and textural information.
Ganasala et al. used texture energy measurements (TEMs) and stationary wavelet transform (SWT)
to address the issues of low contrast and high computing cost in fusion results [16]. SWT extracts
estimated and detailed information from input images. The technique based on “Laplacian pyramid
(LP) decomposition and adaptive sparse representation (ASR)” is presented by Wang et al. [17].
The ASR does not require a high redundancy dictionary to decrease the noise of high sub-band
details during the fusion process in contrast to the traditional sparse representation (SR) technique.
Kong et al. presented an image fusion approach that effectively retains detailed information for
medical images from SPECT and MRI [8]. This technique makes use of the framelet transform to
separate the input images into a basic layer and several detailed layers. A saliency layer of SPECT image
is then extracted from the original image using a “frequency-tuned filter”. Goyal et al. proposed a
fusion approach that combines medical images with low resolution and lowered computing complexity
to improve target recognition precision as well as serve as a basis for medical diagnosis [18]. This
method could be used by doctors to efficiently assess patients’ conditions. To obtain the focus area
to precisely denote the input image, an L0 Gradient minimization approach was developed for
medical image fusion [19]. Lepcha et al. used “pixel significance, anisotropic diffusion, and cross
bilateral filter (CBF)” that avoid detail loss produced by poor image descriptions [20]. This method
uses edge-preserving processing that combines linear low-pass filters with nonlinear procedures to
identify significant portions of the source images while maintaining the edges. Tirupal et al. [21] used
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“an interval-valued intuitionistic fuzzy set (IVIFS)” to effectively fuse images and the resulting
image was subsequently subjected to a “median filter” to eliminate noise. The multi-modal fusion
strategy based on “geometric algebra discrete cosine transform (GA-DCT)” was also published by
Wang et al. [22]. This approach integrates the properties of GA that denote the “multi-vector signal”
as a whole and could enhance the quality of the fusion image and avoid a lot of complex tasks based
on encoding and decoding procedures. Still, this strategy is vulnerable to abnormal edges.
A hybrid method was introduced based on “dual-tree complex wavelet transform (DTCWT) and
NSCT” [23]. Inputs for the experimental study included images from CT, MRI, and PET. This method
produces competitive fusion performance by effectively capturing gradient to separate individual edge
details from detailed information. Goyal et al. [24] introduced a fusion strategy based on the “pixel-
based fusion rule, the cross-bilateral filter, and edge-aware filtering”. A “domain transform filter” is
used to separate the small-scale components of detailed images from the adjacent large-scale structures.
This technique delivers exceptional image fusion performance by using hybrid domain filtering which
enables the complete preservation of image features. Zhang et al. proposed a “novel joint sparse model
with coupled dictionary learning” for fusing images [25]. This technique is constructed using a novel
fusion scheme for improving the capability of multi-source signal preservation as well as maintaining
texture or edge details. At initial, the input images were denoted by the typical sparse element and a
novelty sparse element with “over-complete coupled dictionaries”. Then a combined sparse element
is produced utilizing a newly constructed inventive scheme. This method is effective irrespective of
whether the input images are corrupted or clear. In [26], a quasi-cross bilateral filtering (QBF)-
based image decomposition method is introduced to restore the noise-damaged structural details of
both rough elements and fine information. An image is split into a structural layer that contains
extensive information and an energy layer that has simply information about intensity. The “visual
saliency detection map (VSDM)” is then utilized to control the fusing of energy layers to maximize
the advantages of edge contour extraction and enhance the edge contour sharpness of the fusion result
and fully restore the image details. The structural layer was combined utilizing the “weighted sum of
eight-neighborhood-based modified Laplacian (WSEML) and improved multi-level morphological
gradient (IMLMG)” that considerably enhanced the sharpness of the contour edges of the fusion
result.
Deep learning algorithms are successfully used in numerous image-processing tasks in recent
years [27,28]. Panigrahy et al. introduced a novel “weighted parameter adaptive dual-channel pulse
neural network (WPADC-PCNN)” based fusion in a “non-subsampled Shearlet transform (NSST)
domain” to fuse the MRI and SPECT images of patients with “acquired immunodeficiency syndrome
(AIDS), dementia complex and Alzheimer’s disease [29]”. WPADC-PCNN model’s inputs are used
to estimate its parameters using fractal dimension. However, this method falls short in terms of its
capacity to completely extract features from input images. Yang et al. propose “a medical Wasserstein
generative adversarial network (MWGAN) is an end-to-end model” to integrate medical images from
PET and MRI [30]. This method develops “two adversarial games between a generator and two
discriminators” to produce a fusion result including the features of soft tissue features in organs of
MRI images and the metabolic and functional information of PET images. A method for fusing
medical images has been proposed in [31] and is based on a “multiscale residual pyramid attention
network (MSRPAN)”. Fu et al. [32] employed dense blocks and generative adversarial networks
(GANs) to directly incorporate the input image such as a visible light image into every layer of the
whole network. This method protects the functional information from being compromised while
strengthening the structure information. Guo et al. [33] developed a novel generative adversarial
network-based multimodal fusion of medical images of the brain. In the generator’s design, this
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technique produces the combined detail texture block and the leftover attention mechanism block.
The input images are incorporated to generate a matrix which is then split into two blocks at once
for extraction of details including shape, size, spatial placement, and textural properties. The restored
properties are applied to the combining block to restore an image.
Zhao et al. proposed a fusion technique based on deep convolutional generative adversarial
networks and dense block models to produce a fused image with more details [34]. This network
structure especially combines two modules such as an image generator based on dense blocks and an
encoder-decoder along with a discriminator to improve features and retain image details. Furthermore,
the techniques described above are only useful for particular fusion applications. To address these
limitations, numerous fusion networks [35,36] are presented and they can produce high-quality fusion
images when carrying out many fusion tasks. Many fusion algorithms suffer from poor complementary
feature extraction and brightness degradation. A novel end-to-end unsupervised learning fusion model
called the pair “feature difference guided network (FDGNet)” is thus introduced to solve these
shortcomings [37]. Liu et al. present an original end-to-end unsupervised network to integrate medical
images. In made up of “a generator and two symmetrical discriminators” [38]. The previous aims to
create a fusion image that is “real-like” based on precisely prepared content and structural loss, whilst
the latter is concentrated on accentuating the variances between a fused image and the input ones. To
change the settings of a framework, however, often takes a lot of work with these deep learning-based
methodologies. Medical image fusion is still a challenging endeavor because recent techniques still
produce fusion results with color distortion, blurring, and noise.
This paper provides a two-level decomposition fusion technique to address some limitations.
We initially employ anisotropic diffusion to divide the source images into base and detail layers,
respectively to extract sharp and fine information from the images. The images are then further
divided into low and high-frequency coefficients utilizing NSCT decomposition. This framework uses
anisotropic diffusion to decompose images while simultaneously seeking to minimize image noise by
preserving important portions of the image’s information, particularly edges, lines, and other qualities
that are essential for the interpretation of images. The details of the source images are simultaneously
enhanced as the two layers are fused separately using a potent sum-based fusion algorithm. The
images are then subsequently divided into their low and high-frequency coefficient utilizing NSCT.
In general, the NSCT frequency selection function improves directionality and makes it easier to
record geometrical configurations for source images, and allows for a more accurate decomposition
of medical images. The PCA/KL fusion approach is then used to independently combine these
coefficients. The low and high-frequency coefficients are combined to produce a fusion result. The
final fusion result was reconstructed using an inverse NSCT. Our technique is compared qualitatively
and quantitatively with some of the well-known recent approaches. Our algorithm generates better
quality fusion results in less processing time and the optimal visualization in case of visual quality and
quantitative evaluation standards.

3 Related Work
3.1 Anisotropic Diffusion (AD)
The anisotropic diffusion procedure [39] preserves the non-homogeneous regions (edges) while
smoothing out the homogeneous portions of an image using partial differential equations (PDE).
It addresses the problem of isotropic diffusion. The inter-region smoothing is utilized in isotropic
diffusion, thus edge information is lost. In contrast, an anisotropic diffusion creates images with a
coarser lower resolution by using intra-region smoothing. At each coarser resolution, the edges are
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significant and sharp. A flux function is utilized by the equation of anisotropic diffusion to regulate
the diffusion of an image (I) as
It = c (x, y, t) I + ∇c.∇I, (1)
where  represents a Laplacian operator, ∇ represents a gradient operator, c (x, y, t) represents a flux
function or diffusion rate and t represents a time or iteration. The solution of Eq. (1) is retrieved by
the forward-time central-space (FTCS) method by considering it as a heat equation and is given by
 
Ii,jt+1 = Ii,jt + λ cN . ∇ N Ii,jt + cS . ∇S Ii,jt + cE . ∇ E Ii,jt + cW . ∇ W Ii,jt (2)

In Eq. (2), Ii,jt+1 is a coarser image resolution at t + 1 scale that relies on the prior coarse scale image
Ii,jt . where λ represents the stability constant that satisfies 0 ≤ λ ≤ 0.25. The ∇ N, ∇ S , ∇ E , and ∇ W are
the closest neighbor variations in the north, south, east, and west directions, respectively. They are
characterized as
∇ N Ii,j = Ii−1,j − Ii,j ,
∇ S Ii,j = Ii+1,j − Ii,j ,
(3)
∇ E Ii,j = Ii,j+1 − Ii,j ,
∇ W Ii,j = Ii,j−1 − Ii,j
In similar, cN , cS , cE , and cW are flux functions/conduction coefficients in the north, south, east,
and west directions as
   
ctNi,j = g (∇I)ti+1/2,j  = g ∇ N Ii,jt  ,
   
ctSi,j = g (∇I)ti−1/2,j  = g ∇ S Ii,jt  ,
    (4)
ctEi,j = g (∇I)ti,j+1/2  = g ∇ E Ii,jt  ,
   
ctWi,j = g (∇I)ti,j−1/2  = g ∇ W Ii,jt  .
In Eq. (4), g(.) is a monotonically reducing function with g (0) = 1. Perona and Malik [39] proposed
two functions as stated as
 
∇I 2
g (∇I) = e− k (5)
1
g (∇I) =  ∇I 2 . (6)
1+ k
These operations provide a trade-off between edge preservation and smoothing. The first equation
(Eq. (5)) is helpful when an image carries high contrast edges over low contrast edges and the
second function (Eq. (6)) is helpful when an image consists the broad regions over small regions.
A free parameter k is present in both functions. Based on the strength of the edge, this constant k
determines the validity of a region boundary. The limitation of anisotropic diffusion filtering is that it
is extremely dependent on some key factors such as a gradient threshold value, conductance function,
and the stopping time of the iterative procedure. Anisotropic diffusion is represented as aniso (I) for
a particular image (I).

3.2 Non-Subsampled Contourlet Transform (NSCT)

The NSCT is a well-organized technique that can be rapidly and easily implemented. Its increased
frequency selection feature makes it possible to decompose medical images and further improved direc-
tionality and multi-scaling sensitivity make it easier to capture the geometrical arrangements for input
CMC, 2023, vol.76, no.1 317

images. The NSCT [23] overcomes the frequency aliasing by down-and up-sampling on the contourlet
transformation. The nonsubsampled directional filter banks (NSDFB) and nonsubsampled pyramid
filter banks (NSPFB) are combined to construct NSCT. NSDFB provides NSCT with directionality
whereas NSPFB ensures the multiscale decomposition property. Shift-invariant, multiscale, and multi-
directional characteristics can be found in the discrete images produced by NSCT. Like the Laplacian
pyramid, which results from the shift-invariant filter structure, the non-subsampled pyramid exhibits
multiscale coefficient decomposition in NSCT. The source images are divided into low and high-
frequency coefficients via NSPFB. An iterative decomposition of NSPFB was utilized for low and
high-frequency coefficients to produce l + 1 sub-images with similar dimensions corresponding to the
source images. Several decomposition stages are defined by 1. The lth stage low pass filter is defined by
π  π  2
− l (7)
2 2l
Eq. (8) provides the l-level cascaded non-sampled pyramid decomposed filter as
⎧  n−1 
⎨P1 Z2 I n−2 l=0 Po Z
2lI
, 1≤n≤l
Pn (z) =
eq
  (8)
⎩n−2 Po Z2lI , n=l+1
l−0

The non-subsampled directional filter bank (NSSDB) is where the directional information in
NSCT is generated from. The up-sampler and down-sampler from the directional filter are removed
to create NSCT. The l-level directional decomposition is used to process high-frequency coefficients
obtained from NSCT to produce 2m directional sub-images that are about a similar size as the input
images [23]. The drawbacks of NSCT include that the contrast of the synthesized image is lowered or
that information is not precisely maintained. Fig. 1 shows the schematic flowchart of the proposed
method.
Base layer 1
High-frequency
coefficient 1

Noise-free image 1
Anisotropic Sum-
diffusion fusion
rule Low-frequency PCA/KL
Source image 1 coefficient 1

NSCT
Detail layer 1

Detail layer 2 Fused high-

NSCT frequency coefficient

Inverse
Source image 2 PCA/KL NSCT
High-frequency
Sum-
coefficient 2
Anisotropic fusion
diffusion rule
Noise-free image 2

Fused low- Fused image

Low-frequency frequency coefficient
coefficient 2
Base layer 2

Figure 1: Flowchart of the proposed method

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4 The Proposed Algorithm

The proposed algorithm mainly entails five stages: anisotropic decomposition, base and detail lay-
ers integration, NSCT decomposition, the fusion of low and high-frequency coefficients, and inverse
NSCT are illustrated in Fig. 1. First, Anisotropic diffusion (AD) decomposes source images into base
and detail layers. While important information about images is then simultaneously preserved as both
layers are combined utilizing the sum-based fusion scheme. Furthermore, the modified images are
then divided into low and high-frequency coefficients using NSCT. Both low and high-frequency
coefficients are combined utilizing PCA/KL transform by extracting the specific features. The use
of inverse NSCT results in the creation of the final fusion result. Fig. 1 demonstrates the schematic
flowchart of our fusion technique.

4.1 Anisotropic Diffusion for Edge Detail Reinforcement

An edge-preserving smoothing anisotropic diffusion is utilized to split a source image into base
and detail layers. Let the size of a source image {In (x, y)}Nn=1 } be m × n. The base layer is extracted as
B_Ln (x, y) = aniso (In (x, y)) (9)
where aniso (In (x, y)) signifies an anisotropic diffusion procedure on the n-th input image, and
B_Ln (x, y) is the n-th base layer. For further information on anisotropic diffusion refer to section
3.1. Thus, subtracting the base layer from the input image yields a detail layer as
D_Ln (x, y) = In (x, y) − B_Ln (x, y) (10)

We employ the sum-based fusion rule which is provided by Eq. (11) to produce enhanced images as
M_Sn (x, y) = wt1 B_Ln (x, y) + wt2 D_Ln (x, y) (11)
where wt1 and wt2 are the weight values for the coefficients B_Ln (x, y) and D_Ln (x, y), and M_Sn (x, y)
is the n-th source images. We select wt1 = wt2 = 1 in Eq. (11) to maintain more neighborhood struc-
ture, global structure, and brightness values in fused modified source images. This paper signifies
M_Sn1 (x, y) as an enhanced image of source image1 and M_Sn1 (x, y) as an enhanced image of source
image2 as demonstrated in Fig. 1.

4.2 PCA/KL Transform-Based Fusion of Low and High-Frequency Coefficients

The enhanced images M_Sn1 (x, y), and M_Sn2 (x, y) are further split into their low and high-
frequency coefficients using NSCT. The decomposition of M_Sn1 (x, y) by the NSCT yields HP2 (x, y),
and LP1 (x, y). In similar, the NSCT decomposition of M_Sn2 (x, y) yields HP1 (x, y), and LP2 (x, y).
Detailed elements of input images such as textures, edges, and regional boundaries are represented
by the high-frequency coefficients in the NSCT domain. In general, the sharper brightness in the
image is correlated with coefficients with higher absolute scores. It should be noted that noise is also
associated with high-frequency coefficients and may result in incorrectly calculating sharpness values
which would then influence the performance of the fusion process. Additionally, texture detail features
have a higher sensitivity in the human visual system than pixel values. An approximation element of the
input images is represented by low-frequency coefficients. The way that is most frequently employed is
to use averaging techniques to create fused coefficients. However, this regulation reduced contrast in
the fusion results and was unable to produce a high-quality fused sub-image for images. In this study,
a novel high-frequency fusion rule related to PCA/KL is employed to address the above-mentioned
flaw. A well-known PCA/KL rule is used for simultaneously fusing both frequency coefficients and
CMC, 2023, vol.76, no.1 319

extracting texture characteristics. The high-frequency coefficients fusion rule is defined as:
FHP (x, y) = KL1 HP1 (x, y) + KL2 HP2 (x, y) (12)

Similarly, a fusion rule on the low-frequency coefficients is provided by

FLP (x, y) = KL1 LP1 (x, y) + KL2 LP2 (x, y) (13)
where KL1 and KL2 is given by
ρmax (1) ρmax (2)
KL1 =  , KL2 =  (14)
ρ
i max (i)
ρ
i max (i)

where ρmax is the eigenvector associated with the maximum eigenvalue and denoted by
ρmax = max (σ1 , σ2 ) (15)

It is possible to determine the eigenvalues for an eigenvector as

   
ρ1 (1) ρ2 (1)
σ1 = and σ2 = of Cvxx (16)
ρ1 (2) ρ2 (2)
where Cvxx is the covariance matrix [39]. The general phrase for N layers is generated as
N
FN (x, y) = KLn Fn (x, y) (17)
n=1

4.3 Inverse NSCT for Fused Low and High-Frequency Coefficients

By applying inverse NSCT on the fused high-frequency coefficient FHP (x, y), and low-frequency
coefficient FLP (x, y) obtains the final fusion result Ffused as follows:
Ffused = in_nsct (FHP (x, y) , FLP (x, y)) (18)

5 Experiments
This study presents experimental results on three pairs of 256 × 256 registered medical images from
three different modalities due to space limitations to show the efficiency of the proposed technique for
fusing medical images. Three sets of CT and MRI images (Groups 1–3) are utilized in the experiments.
All of the input images are selected from the Harvard Medical School website [40] and demonstrated
in Fig. 2. The appropriate experimental findings and discussions are illustrated in detail. Nine repre-
sentative image fusion algorithms including “Wasserstein generative adversarial networks (WGAN)
[30], a weighted parameter adaptive dual-channel PCNN (WPADC-PCNN) [29], Laplacian pyramid
and adaptive sparse representation (LP-ASR) [17], Geometric algebra discrete cosine transform (GA-
DCT) [22], Image fusion using saliency capturing (IF-SC) [8], L0 gradient minimization (LGM) [19],
Hybrid approach of NSCT and DTCWT (NSCT-DTCWT) [23], Multimodal brain medical image
fusion based on the improvement of a generative adversarial network (MMFGAN) [33] and Multiscale
residual pyramid attention network (MRPAN) [31]”. The default values of the parameters were taken
for the above-mentioned fusion methods which are stated in each of the publications.
320 CMC, 2023, vol.76, no.1

(a) Group (1) (b) Group (2) (c) Group (3)

Figure 2: Source image pairs of multimodal medical images [40]. In (a–c), three pairs of CT and MRI
images. Left: CT image; right: MRI image

5.1 Objective Evaluation Metrics

The ten widely used quantitative indexes were utilized in our research to compare the effectiveness
of various approaches. These indexes include “average pixel intensity (API), standard deviation
(SD), average gradient (AG), entropy (H), mutual information (MI), fusion symmetry (FS), and
spatial frequency (SF)”. A comprehensive interpretation of these indexes is given in [15]. These
seven indicators with a high value
 indicate effective performance.
  In addition to these indexes, total
information transmitted Qab/f , total information lost Lab/f , and artifacts included in the final fusion
result (Nab/f ) are used to produce an in-depth
 analysis of fusion
 efficiency
 [24]. Effective performance
is indicated by the higher value of Qab/f and low values of Lab/f and (Nab/f ). Tables 1–3 display the
quantitative results of different algorithms and our method. Three different types of images are used
to evaluate the parameter configurations for the proposed framework through a series of experiments.
The proposed framework has some key parameters: In anisotropic diffusion [39]; an integration
constant (delta_t) is set to 0.15 (typically due to numerical stability is set to its maximum value), the
gradient modulus threshold (k) that regulates conduction is set to 20 and the conduction coefficients
function is set to 2 and the number of iterations is set to 10. The default parameter settings of NSCT are
based on the modified input images which are decomposed into eight and four-directional coefficients.
We considered the default parameter configurations recommended by the authors for other competing
approaches.

Table 1: Quantitative indices of fusion results (Group 1)

Method API SD AG Entropy MI FS SF Qab/f Lab/f Nab/f
LP-ASR 38.3499 37.7569 3.3144 6.2830 3.3768 1.6284 5.6066 0.7054 0.2942 0.2227
WGAN 45.8862 33.8827 4.1223 6.1552 2.8836 1.5825 5.9922 0.7241 0.1342 0.2672
WPADC-PCNN 61.3311 30.0406 4.7658 6.4833 1.4857 1.5111 6.1892 0.7133 0.2865 0.0121
LGM 36.6337 53.0486 4.4883 6.1566 2.5936 1.6322 12.0485 0.8660 0.0730 0.1125
IF-SC 53.2614 53.6806 5.3888 6.4568 5.0822 1.5896 9.7535 0.8299 0.0927 0.1219
MRPAN 43.9927 47.9927 3.8826 5.8926 4.8811 1.5625 7.6624 0.8452 0.0815 0.1027
MMFGAN 28.6404 34.2512 2.4638 6.1171 2.9016 1.5703 4.7416 0.7314 0.2685 0.1171
GA-DCT 58.3229 30.7358 3.0406 6.1379 2.2838 1.6746 5.3215 0.7698 0.1001 0.0281
NSCT-DTCWT 59.6718 49.1795 3.9513 6.6349 3.9516 1.6772 6.8274 0.8759 0.696 0.0198
Proposed 67.6478 67.6473 67.647 67.647 4.7863 1.6403 16.7204 0.8814 0.0626 0.0090
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Table 2: Quantitative indices of fusion results (Group 2)

Method API SD AG Entropy MI FS SF Qab/f Lab/f Nab/f
LP-ASR 61.2859 53.4289 4.4996 5.3101 3.8943 1.9316 9.1310 0.7286 0.2049 0.1307
WGAN 67.8726 56.8826 4.9082 5.6662 3.2761 1.9452 10.9862 0.7651 0.2551 0.1271
WPADC-PCNN 56.3188 43.3953 5.6448 5.0031 2.3694 1.9432 8.1734 0.7434 0.2543 0.0975
LGM 55.2151 52.7005 6.1506 5.3016 3.8097 1.9269 8.9583 0.7753 0.2151 0.0685
IF-SC 44.8918 51.5913 4.8231 5.3128 3.3591 1.8874 9.8594 0.7747 0.1809 0.1072
MRPAN 48.8716 53.8772 3.9928 4.9881 3.6251 1.7927 8.9651 0.7615 0.1982 0.1024
MMFGAN 50.3958 53.9736 3.5071 5.3929 3.4798 1.9333 7.2433 0.7468 0.2507 0.0317
GA-DCT 61.4767 45.2395 3.8614 6.3149 3.2671 1.9597 8.0808 0.7691 0.2211 0.0535
NSCT-DTCWT 60.5334 52.0540 4.0603 5.4488 3.4756 1.9602 8.0759 0.7853 0.2127 0.0463
Proposed 63.8278 54.1378 6.2764 5.8488 3.8506 1.9558 9.8372 0.7864 0.1054 0.0247

Table 3: Quantitative indices of fusion results (Group 3)

Method API SD AG Entropy MI FS SF Qab/f Lab/f Nab/f
LP-ASR 96.3913 62.2677 7.8748 7.4933 3.0778 1.6025 11.0157 0.6987 0.3013 0.0314
WGAN 89.6624 67.7251 8.6622 5.6626 2.1765 1.3567 10.7726 0.6741 0.2161 0.5614
WPADC-PCNN 100.724 48.0173 9.0632 7.3832 2.2724 1.6527 11.3875 0.6625 0.3372 0.0436
LGM 98.254 63.4612 17.4349 7.4236 3.3510 1.6676 26.9397 0.7264 0.2677 0.0312
IF-SC 97.8820 71.0525 12.6746 7.7586 3.1382 1.7623 17.1068 0.7597 0.0951 0.1417
MRPAN 87.6635 65.6662 9.5626 6.8926 2.6726 1.5992 15.6221 0.7451 0.1102 0.0451
MMFGAN 84.2996 53.7153 6.0607 7.5031 2.8106 1.7626 9.4684 0.7464 0.2235 0.0351
GA-DCT 91.8459 47.1212 7.3526 7.2723 2.4922 1.8897 10.5472 0.6876 0.1124 0.0241
NSCT-DTCWT 97.5691 57.3488 7.9617 7.4543 2.8848 1.8902 11.2761 0.7493 0.1005 0.0217
Proposed 102.878 80.1291 12.6340 7.8009 3.9482 1.8754 30.7082 0.8083 0.0981 0.0981

5.2 Results and Analysis

1) Qualitative Analysis
The complementary properties of the two types of images can be successfully restored in a single
image when CT and MRI images are fused. Experiments are performed on three sets of MRI and CT
images. The sets of fused CT and MRI imaging data are shown in Figs. 3 and 4. The two representative
regions are enlarged in each resultant image to help with better comparisons. The fused images of LP-
ASR and WGAN approaches demonstrated significant artifacts, notably in the bone sections [see the
right regions in Figs. 3a and 3b]. The fused images of the WPADC-PCNN are impacted by energy loss
in the image [see the enlarged region in Fig. 3c]. The bone areas of CT images appear to have blurry
by the LGM method [see Fig. 3d]. The noticeable features can be preserved almost entirely using the
IF-SC and MRPAN approaches however some details are lost and extra futile details are added to
the bone areas. The MMFGAN technique generates the finest visual interpretation because it almost
entirely recovers the soft tissue details from MRI images. Nonetheless, some artifacts are incorporated
in bone areas. The GA-DCT method emphasizes more on detail extraction which appears to be the
root cause of the spatial inconsistency problem. NSCT-DTCWT and the proposed method show
diverse benefits in the restoration of bone areas as they employ noise filtering to remove more aberrant
details when compared to other methods [see the enlarged regions in Figs. 3i and 3j]. The soft tissue
details in the MRI image are still poorer after utilizing NSCT-DTCWT [see the left region in Fig. 3i].
322 CMC, 2023, vol.76, no.1

The proposed method concurrently extracts the majority of the salient data as well as less significant
details from CT and MRI images. In contrast to the Group 1 image, Group 2 images have a more
noticeable bone structure. The fact that LP-ASR approach uses a large amount of energy and still
manages to extract almost all of the data from Group 2 images in the fused image [see Fig. 4a].
Besides, the fused image could not completely preserve several significant features of Group 2. The
WGAN algorithm does not preserve the salient features which resulted in a poor visual impression
[see Fig. 4b]. The LGM, IF-SC, MRPAN, and MMFGAN techniques did not effectively maintain the
essential elements of Group 2 images in the fused image. The GA-DCT method allows for the transfer
of nearly all significant characteristics from the source image to the fused image. Consequently, more
artifacts are introduced to the fused image since it is unable to distinguish the relevant and significant
features [see the enlarged region in Fig. 4h]. Moreover, NSCT-DTCWT fails to completely maintain
textures and is unable to extract the important features from Group 2 images [see the right region in
Fig. 4i]. In addition to performing better than NSCT-DTCWT at extracting essential features from
Group 2 images, the proposed technique also avoids certain undesired information. The fusion results
of Group 3 images are shown in Fig. 5. The structural details are generally poorly retained by the
fusion performance of the LP-ASR, WGAN, WPADC-PCNN, LGM, and MMFGAN methods that
lead to serious visual inconsistency concerns that make this condition unfit for medical diagnosis. The
IF-SC, MRPAN, and GA-DCT techniques typically perform well in terms of extracting functional
information from the CT image and also exhibit good visual effects even though there are still some
distortions. Also, the region with a high pixel value has a few unfavorable artifacts [see the white
region in Figs. 3e, 4f and 5h]. When it comes to feature preservation, the NSCT-DTCWT does an
excellent task. Nonetheless, there are some artifacts in the fused image [see the right side of Fig. 5i].
The proposed algorithm performs the best in terms of preserving detailed information [see the enlarged
regions in Fig. 5j].

(a) LP-ASR (b) WGAN (c) WPADC-PCNN (d) LGM (e) IF-SC

(f) MRPAN (g) MMFGAN (h) GA-DCT (i) NSCT-DTCWT (j) Proposed

Figure 3: Fusion results of Group 1. The two regions of interest (ROI) are shown for better comparisons
CMC, 2023, vol.76, no.1 323

(a) LP-ASR (b) WGAN (c) WPADC-PCNN (d) LGM (e) IF-SC

(f) MRPAN (g) MMFGAN (h) GA-DCT (i) NSCT-DTCWT (j) Proposed

Figure 4: Fusion results of Group 2. The two regions of interest (ROI) are shown for better comparisons

(a) LP-ASR (b) WGAN (c) WPADC-PCNN (d) LGM (e) IF-SC

(f) MRPAN (g) MMFGAN (h) GA-DCT (i) NSCT-DTCWT (j) Proposed

Figure 5: Fusion results of Group 3. The two regions of interest (ROI) are shown for better comparisons

2) Quantitative Analysis
The results of an objective evaluation of the nine fusion algorithms and the proposed method on
three pairs of CT and MRI images are demonstrated in Tables 1–3 which provide the average value for
each approach overall experimentally used images. For each of the 10 approaches, the metric with the
best score is bolded and the metric with the second-best score is underlined. Tables 1–3 clearly show
that the proposed technique regularly places in the top three positions for nearly all of the objective
measures except for the metric FS in all CT-MRI image fusion problems. Our technique consistently
achieves stable performance over the other nine fusion methods on all ten metrics; however, it is not
always the best. As a result, our fusion framework performs equally well as MRI fusion problems. In
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particular, the proposed method shows obvious advantages on all the metrics when compared to other
methods, proving that our strategy provides better results for preserving the general characteristics
and intensity of the original images. For metric Entropy, the proposed technique outperforms NSCT-
DTCWT in most of the fusion metrics. But the metrics scores of the proposed method are less than
those of the NSCT-DTCWT in some cases. The GA-DCT approach also performs very well objectively
for CT-MRI fusion problems. The NSCT-DTCWT approach works better for the metric FS, and this
finding validated that it obtains better visual performance. Unfortunately, it performs poorly on the
metrics API, SD, AG, MI, and SF since it concentrates on extracting structural details and often failed
to identify the main elements. The proposed algorithm outperforms the NSCT-DTCWT method on
the aforementioned metrics and represents a better benefit on almost all the metrics in the CT-MRI
fusion problems that show our technique achieves better objective evaluation results. Fig. 6 displays
the sensitivity analysis of fusion performance in terms of the number of iterations of our method.

Figure 6: The objective performance of our method in terms of the number of iterations

5.3 Discussion
Tables 1–3 explicitly show that our algorithm outperforms other fusion algorithms on three pairs
of CT-MRI fusion problems. Also, the proposed approach scores higher in metrics such as API,
SD, MI, and SF which indicates that it is more in-depth in the extraction of image energy and
prominent edge details. So, the fusion results generated by our algorithm appear more natural and are
in accord with human visual perception Likewise, Figs. 3–5 show how our algorithm can effectively
maintain bone areas while eliminating almost all aberrant characteristics in the same region of the
complementary images. The result of our fusion method is also consistent with its ability to maintain
decisive features while removing irrelevant ones. Unlike existing strategies, the proposed method puts
more of a focus on the preservation of broad features and the extraction of significant information and
details. In Figs. 3–5, some artifacts are present in the fusion results produced by other algorithms since
these methods fail to recognize the important and meaningful characteristics that consequence in poor
fusion results. The edge details seem to be strengthened by the IFSC and MRPAN approaches, but
textures are still lost. A few redundant CT-MRI image features are added by the MMFGAN approach.
MRPAN experiences texture degradation when referring to the CT-MRI images. This is primarily
caused by the fact that the detail layer of an MRI image consists of almost all of the texture details.
The proposed technique can successfully protect none details from the addition of unnecessary details
by forfeiting a few textures. Particularly, the proposed method emphasizes restoring global features
and appears more serious than other methods in the case of maintaining consistent information. The
proposed method might be further enhanced by using efficient contrast enhancement techniques to
the detail layer to enhance texture details. Table 4 displays an average running time for 10 different
algorithms.
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Table 4: The average processing durations for different techniques for fusing two 256 × 256-pixel
images (Units: Seconds)
Methods LP-ASR WGAN WPADC-PCNN LGM IF-SC MRPAN MMFGAN GA-DCT NSCT-DTCWT Proposed
Times 0.56 16.91 21.23 0.65 0.98 33.18 46.18 0.88 0.111 0.87

5.4 Computational Efficiency

In this section, the computing performance of several fusion algorithms is analyzed and compared.
The experimental setting is a machine running the “Win 10 64-bit operating system with an Intel(R)
Core (TM) i7-8750H CPU (2.20 GHz) and 8 GB RAM”. All of the source images in the fusion
experiments are utilized to estimate the average running time. As indicated in Table 4, the LP-ASR and
LGM algorithms run faster than other fusion algorithms. The IF-SC and GA-DCT algorithms exhibit
good computing efficiency and are simple to use. The NSCT-DTCWT technique has competitive
efficiency at the expense of running time. In addition, the WGAN, WPADC-PCNN, MRPAN, and
MMFGAN use pre-training which is needed to design a network model before the fusion procedure.
The time-consuming process is the main reason it takes longer to run. In conclusion, the proposed
approach requires a slightly average processing time but yields superior fused images.

6 Conclusion
A multimodal medical image fusion using anisotropic diffusion and non-subsampled contourlet
transform (NSCT) is presented in this study. Our method uses anisotropic diffusion for image
decomposition to improve edge information. The sum-based fusion rule is then utilized to fuse the
base and detail layers, respectively. To merge NSCT-decomposed low and high-frequency coefficients
and the majority of the information inside all the coefficients can be compressed into a much lower
number of coefficients with minimal information loss using a PCA/KL transform. The corners,
borders, and contrasts of the image can also be improved thus generating a fused image of far superior
quality. In the end, the final fusion result is reconstructed using inverse NSCT on the fused low and
high-frequency coefficients. Extensive experiments are conducted on three different types of medical
image pairs. Our method displays significant robustness and obtains competitive results in the visual
interpretation and objective evaluation of three pairs of CT-MRI images since it accurately extracts
relevant details and less aberrant information than state-of-the-art fusion approaches. Experimental
studies of the significant differences between the different algorithms and comparative experiments
confirmed that our fusion algorithm outperforms other algorithms in terms of both visual effect and
objective evaluation. However notable problem is that the proposed method is slightly time-consuming
due to the multilevel decomposition and fusion process. In the future, an alternative fusion rule to the
sum-and PCA-based fusion rules might be considered for the fusion process to improve performance.

Funding Statement: The authors received no specific funding for this study.

Conflicts of Interest: The authors declare that they have no conflicts of interest to report regarding the
present study.

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