Open Access Highly Accessed Open Badges Research article

Fractal dimension analysis of malignant and benign endobronchial ultrasound nodes

José Antonio Fiz12*, Enrique Monte-Moreno2, Felipe Andreo15, Santiago José Auteri3, José Sanz-Santos1, Pere Serra1, Gloria Bonet1, Eva Castellà4 and Juan Ruiz Manzano1

Author Affiliations

1 Pulmonology Department, Hospital Universitari Germans Trias Pujol, Planta 8, Carretera del Canyet s/n. 08916, Badalona, Spain

2 TALP Research Center, UPC, Barcelona, Spain

3 Pulmonology Department Hospital de rehabilitación Respiratoria María Ferrer, Buenos Aires, Argentina

4 Pathology Department Hospital Universitari Germans Trias Pujol, Badalona, Spain

5 Ciber de Enfermedades Respiratorias (CiBERES), Bunyola, Balearic Islands, Spain

For all author emails, please log on.

BMC Medical Imaging 2014, 14:22  doi:10.1186/1471-2342-14-22

Published: 12 June 2014



Endobronchial ultrasonography (EBUS) has been applied as a routine procedure for the diagnostic of hiliar and mediastinal nodes. The authors assessed the relationship between the echographic appearance of mediastinal nodes, based on endobronchial ultrasound images, and the likelihood of malignancy.


The images of twelve malignant and eleven benign nodes were evaluated. A previous processing method was applied to improve the quality of the images and to enhance the details. Texture and morphology parameters analyzed were: the image texture of the echographies and a fractal dimension that expressed the relationship between area and perimeter of the structures that appear in the image, and characterizes the convoluted inner structure of the hiliar and mediastinal nodes.


Processed images showed that relationship between log perimeter and log area of hilar nodes was lineal (i.e. perimeter vs. area follow a power law). Fractal dimension was lower in the malignant nodes compared with non-malignant nodes (1.47(0.09), 1.53(0.10) mean(SD), Mann–Whitney U test p < 0.05)).


Fractal dimension of ultrasonographic images of mediastinal nodes obtained through endobronchial ultrasound differ in malignant nodes from non-malignant. This parameter could differentiate malignat and non-malignat mediastinic and hiliar nodes.