Comparing 1.5 T and 3.0 T MR data for 3D visualization of neurovascular relationships in the posterior fossa.

BACKGROUND: Neurovascular relationships in the posterior fossa are more frequently investigated due to the increasing availability of 3.0 Tesla MRI. For an assessment with 3D visualization, no systematic analyzes are available so far and the question arises as to whether 3.0 Tesla MRI should be given preference over 1.5 Tesla MRI. METHODS: In a prospective study, a series of 25 patients each underwent MRI investigations with 3D-CISS and 3D-TOF at 1.5 and 3.0 Tesla. For both field strengths separately, blood vessel information from the TOF data was fused into the CISS data after segmentation and registration. Four visualizations were created for each field strength, with and without optimization before and after fusion, which were evaluated with a rating system and verified with the intraoperative situation. RESULTS: When only CISS data was used, nerves and vessels were better visualized at 1.5 Tesla. After fusion, flow and pulsation artifacts were reduced in both cases, missing vessel sections were supplemented at 3.0 Tesla and 3D visualization at 1.5 and 3.0 Tesla led to anatomically comparable results. By subsequent manual correction, the remaining artifacts were further eliminated, with the 3D visualization being significantly better at 3.0 Tesla, since the higher field strength led to sharper contours of small vessel and nerve structures. CONCLUSION: 3D visualizations at 1.5 Tesla are sufficiently detailed for planning microvascular decompression and can be used without restriction. Fusion further improves the quality of 3D visualization at 3.0 Tesla and enables an even more accurate delineation of cranial nerves and vessels.

Data fusion and 3D visualization for optimized representation of neurovascular relationships in the posterior fossa.

BACKGROUND: Reliable 3D visualization of neurovascular relationships in the posterior fossa at the surface of the brainstem is still critical due to artifacts of imaging. To assess neurovascular compression syndromes more reliably, a new approach of 3D visualization based on registration and fusion of high-resolution MR data is presented. METHODS: A total of 80 patients received MRI data with 3D-CISS and 3D-TOF at 3.0 Tesla. After registration and subsequent segmentation, the vascular information of the TOF data was fused into the CISS data. Two 3D visualizations were created for each patient, one before and one after fusion, which were verified with the intraoperative situation during microvascular decompression (MVD). The reproduction quality of vessels was evaluated with a rating system. RESULTS: In all cases, the presented approach compensated for typical limitations in the 3D visualization of neurovascular compression such as the partial or complete suppression of larger vessels, suppression of smaller vessels at the CSF margin, and artifacts from heart pulsation. In more than 95% of the cases of hemifacial spasm and glossopharyngeal neuralgia, accurate assessment of the compression was only possible after registration and fusion. In more than 50% of the cases with trigeminal neuralgia, the presented approach was crucial to finding the actually offending vessel. CONCLUSIONS: 3D visualization of fused image data allows for a more complete representation of the vessel-nerve situation. The results from this approach are reproducible and the assessment of neurovascular compression is safer. It is a powerful tool for planning MVD.

3D-Visualization of Neurovascular Compression at the Ventrolateral Medulla in Patients with Arterial Hypertension.

PURPOSE: Controversy exists on the association of arterial hypertension (HTN) and neurovascular compression (NVC) at the ventrolateral medulla (VLM). No standardized and reproducible technique has been introduced yet for detection of NVC in HTN. This study aimed to generate, analyze and compare different results of exact reproducible anatomical 3D-representations of the VLM in patients with HTN, based on magnetic resonance imaging (MRI). METHODS: A 3T scanner provided MRI (T2-constructive interference in steady state (CISS) high resolution imaging and three-dimensional Time-of-flight (3D-TOF) angiography) from the posterior fossa of 44 patients with clinical treatment-resistant HTN. Image processing consists of segmentation of the CISS data, registration and fusion of the CISS and TOF data and visualization. For each patient two 3D-visualizations (before and after fusion) were obtained. The reproduction quality of the vessels, flow-related signal variability and pulsation artifacts were analyzed and compared, using a ranking score. RESULTS: Integrating vascular information from TOF into CISS data reduced artifacts in 3D-visualizations of exclusively processed CISS data. The quality of 3D-visualization of the vessels near the brain stem was significantly improved (p = 0.004). The results were reproducible and reliable. The quality of the 3D-presentations of neurovascular relationships at the VLM improved significantly (p < 0.001). CONCLUSION: The 3D-visualization of fused image data provides an excellent overview of the relationship between cranial nerves and vessels at the VLM and simplifies the detection of NVC in HTN. It provides a powerful tool for future clinical and scientific research. Although microvascular decompression (MVD) in treatment resistant HTN is not a standard procedure, it can be discussed in selected patients with intractable severe HTN.

New Clinical and Morphologic Aspects in Trigeminal Neuralgia.

OBJECTIVE: High-resolution magnetic resonance imaging can be used to delineate the morphology of neurovascular compression (NVC) in detail. This study focuses on essential morphologic parameters in relation to the clinical appearance of patients with trigeminal neuralgia (TN). METHODS: A total of 180 patients with TN underwent magnetic resonance-constructive interference in steady state/time of flight. Parameters of the affected nerves (length) and causative vessels were examined: (1) the relationship between the NVC site (caudal/cranial/laterocaudal/mediocranial) and affected area (V1, V2, V3); (2) nerve deformity; (3) vascular loop; (4) existence of a "cerebrospinal fluid (CSF) sign" by a separation of trigeminal fascicles by a vessel; and (5) localization of the causative vessel. RESULTS: A total of 10 patients with V1 affection showed 6 caudal, 0 cranial and laterocaudal, and 4 mediocranial NVC; 26 patients with V2 affection showed 17 caudal, 0 cranial, 1 laterocaudal, and 8 mediocranial NVC; 29 patients with V3 affection showed 23 caudal, 1 cranial, 3 laterocaudal, and 2 mediocranial NVC; 25 patients with V1 and V2 affection showed 17 caudal, 1 cranial, 0 laterocaudal, and 7 mediocranial NVC; 36 patients with V2 and V3 affection showed 30 caudal, 3 cranial, 1 laterocaudal, and 2 mediocranial NVC; and 6 patients with V1, V2, and V3 affection showed 4 caudal, 1 cranial, 0 laterocaudal, and 1 mediocranial NVC. A total of 63 patients (35%) showed nerval deformity by distorsion of the trigeminal fascicles from compressing vessel; 37 of 39 patients (95%) with right-sided deformity showed right-sided TN; and 21 of 22 patients (95%) with left-sided TN showed left-sided nerve deformation. Two patients with bilateral nerve deformity showed bilateral TN. Rostral superior cerebellar artery (SCA) loop compression was seen in 24 patients (17%), caudal SCA loop compression was seen in 10 patients (7%), and double SCA loop compression was seen in 33 patients (23%). Sandwich compression was seen in 18 (12%), and a CSF sign was seen in 24 patients. All 24 patients (100%) with a CSF sign had V1 affection. CONCLUSIONS: The CSF sign is pathognomonic for V1 affection. Vascular loops from cranial on the nerve were the most frequent types of compression in all areas of pain, followed by mediocranial loops. This evaluation is reproducible and contributes to the role of magnetic resonance imaging and a classification of findings in the preoperative evaluation of NVC.

Classification of neurovascular compression in glossopharyngeal neuralgia: Three-dimensional visualization of the glossopharyngeal nerve.

BACKGROUND: We introduce a method of noninvasive topographical analysis of the neurovascular relationships of the glossopharyngeal nerve (CN IX) by three-dimensional (3D) visualization. Patients with glossopharyngeal neuralgia (GN) resulting from neurovascular compression (NVC) were studied. METHODS: 15 patients with GN were prospectively examined with 3D visualization using high-resolution magnetic resonance imaging with constructive interference in steady state (MR-CISS). The datasets were segmented and visualized with the real, individual neurovascular relationships by direct volume rendering. Segmentation and 3D visualization of the CN IX and corresponding blood vessels were performed. The 3D visualizations were interactively compared with the intraoperative setup during microvascular decompression (MVD) in order to verify the results by the observed surgical-anatomical findings. RESULTS: 15 patients (female/male: 5/10) were examined. All of them underwent MVD (100%). Microvascular details were documented. The posterior inferior cerebellar artery (PICA) was the most common causative vessel in 12 of 15 patients (80%), the vertebral artery (VA) alone in one case (6.7%), and the combination of compression by the VA and PICA in 3 patients (13.3%). We identified three distinct types of NVC within the root entry zone of CN IX. CONCLUSION: 3D visualization by direct volume rendering of MR-CISS data offers the opportunity of noninvasive exploration and anatomical categorization of the CN IX. It proves to be advantageous in supporting to establish the diagnosis and microneurosurgical interventions by representing original, individual patient data in a 3D fashion. It provides an excellent global individual view over the entire neurovascular relationships of the brainstem and corresponding nerves in each case.

Color-encoded distance visualization of cranial nerve-vessel contacts.

PURPOSE: Visualization of pathological contact between cranial nerves and vascular structures at the surface of the brainstem is important for diagnosis and treatment of neurovascular compression (NVC) syndromes. We developed a method for improved visualization of this abnormality. METHODS: Distance fields were computed using preoperative MRI scans of individuals with NVC syndromes to support the topological representation of brainstem surface structures with quantitative information. Polygonal models of arteries, cranial nerves and the brainstem were generated using segmented T2 weighted MR data. After color-coding the polygonal models with the respective distances, enhanced color visualization of vessel-nerve locations with possible contacts was achieved. RESULTS: The proposed method was implemented and applied to surgical planning in a dozen cases of NVC syndrome. Two selected cases were chosen to demonstrate the feasibility and subjective improvement provided by our visualization technique. Expert neurosurgeons found the improvement valuable and useful for these cases. CONCLUSION: Color-encoded distance information significantly improves the perceptibility of potential nerve-vessel contacts. This method contributes to a better understanding of the complex anatomical situation at the surface of the brainstem and assists in planning of surgery.

Intraoperative three-dimensional visualization in microvascular decompression.

OBJECT: The authors systematically analyzed 3D visualization of neurovascular compression (NVC) syndromes in the operating room (OR) during microvascular decompression (MVD). METHODS: A total of 50 patients (26 women and 24 men) with trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GN) were examined and underwent MVD. Preoperative imaging of the neurovascular structures was performed using constructive interference in the steady state magnetic resonance (CISS MR) imaging, which consisted of 2D image slices. The 3D visualization of the neurovascular anatomy is generated after segmentaion of the CISS MR imaging in combination with direct volume rendering (DVR). The 3D representations were stored on a personal computer (PC) that was mounted on a mobile unit and transferred to the OR. During surgery, 3D visualization was applied by the surgeon with remotely controlled plasma-sterilized devices such as a wireless mouse and keyboard. The position of the 3D visualized neurovascular structures at the PC monitor was determined according to the intraoperative findings observed through the operating microscope. RESULTS: The system was stable during all neurosurgical procedures, and there were no operative or technical complications. Interactive adjustment of the 3D visualization guided by the view through the microscope permitted observation of the neurovascular relationships at the brainstem. Vessels covered by the cranial nerves could be noninvasively viewed by intraoperative 3D visualization. Postoperatively, the patients with TN and GN experienced pain relief, and the patients with HFS attained resolution of their facial tics. Vascular compression of nerves was explored in all 50 patients during MVD. Intraoperative 3D visualization delineated the compressing vessels and respective cranial nerves in 49 (98%) of 50 patients. CONCLUSIONS: Interactive 3D visualization by DVR of high-resolution MR imaging data offered the opportunity for noninvasive virtual exploration of the neurovascular structures during surgery. An extended global survey of the neurovascular relationships was provided during MVD in each case. The presented method proved to be extremely advantageous for optimizing microneurosurgical procedures, supporting superior safety and improving the operative results when compared with the conventional strategy. This modality proved to be a very valuable teaching instrument and ensured the improvement of neurosurgical quality.

Classification of neurovascular compression in typical hemifacial spasm: three-dimensional visualization of the facial and the vestibulocochlear nerves.

OBJECT: In this paper, the authors introduce a method of noninvasive anatomical analysis of the facial nerve-vestibulocochlear nerve complex and the depiction of the variable vascular relationships by using 3D volume visualization. With this technique, a detailed spatial representation of the facial and vestibulocochlear nerves was obtained. Patients with hemifacial spasm (HFS) resulting from neurovascular compression (NVC) were examined. METHODS: A total of 25 patients (13 males and 12 females) with HFS underwent 3D visualization using magnetic resonance (MR) imaging with 3D constructive interference in a steady state (CISS). Each data set was segmented and visualized with respect to the individual neurovascular relationships by direct volume rendering. Segmentation and visualization of the facial and vestibulocochlear nerves were performed with reference to their root exit zone (REZ), as well as proximal and distal segments including corresponding blood vessels. The 3D visualizations were interactively compared with the intraoperative situation during microvascular decompression (MVD) to verify the results with the observed microneurosurgical anatomy. RESULTS: Of the 25 patients, 20 underwent MVD (80%). Microvascular details were recorded on the affected and unaffected sides. On the affected sides, the anterior inferior cerebellar artery (AICA) was the most common causative vessel. The posterior inferior cerebellar artery, vertebral artery, internal auditory artery, and veins at the REZ of the facial nerve (the seventh cranial nerve) were also found to cause vascular contacts to the REZ of the facial nerve. In addition to this, the authors identified three distinct types of NVC within the REZ of the facial nerve at the affected sides. The authors analyzed the varying courses of the vessels on the unaffected sides. There were no bilateral clinical symptoms of HFS and no bilateral vascular compression of the REZ of the facial nerve. The authors discovered that the AICA is the most common vessel that interferes with the proximal and distal portions of the facial nerve without any contact between vessels and the REZ of the facial nerve on the unaffected sides. CONCLUSIONS: Three-dimensional visualization by direct volume rendering of 3D CISS MR imaging data offers the opportunity of noninvasive exploration and anatomical categorization of the facial nerve-vestibulocochlear nerve complex. Furthermore, it proves to be advantageous in establishing the diagnosis and guiding neurosurgical procedures by representing original MR imaging patient data in a 3D fashion. This modality provides an excellent overview of the entire neurovascular relationship of the cerebellopontine angle in each case.

Preoperative and intraoperative diffusion tensor imaging-based fiber tracking in glioma surgery.

OBJECTIVE: To investigate the intraoperative displacement of major white matter tracts during glioma resection by comparing preoperative and intraoperative diffusion tensor imaging-based fiber tracking. METHODS: In 37 patients undergoing glioma surgery, preoperative and intraoperative diffusion tensor imaging was performed with a 1.5-T magnetic resonance scanner applying an echo-planar imaging sequence with six diffusion directions. For three-dimensional tractography, we implemented a knowledge-based multiple-region-of-interest approach applying user-defined seed regions in the color-coded maps of fractional anisotropy. Tracking was initiated in both the retrograde and orthograde directions according to the direction of the principal eigenvector in each voxel of the region of interest. The tractography results were also assigned color, applying the convention used in color-coded fractional anisotropy maps. RESULTS: Preoperative and intraoperative fiber tracking was technically feasible in all patients. Fiber tract visualization gave a quick and intuitive overview of the displaced course of white matter tracts in three-dimensional space. Comparison of preoperative and intraoperative tractography depicted a marked shifting of major white matter tracts during glioma removal. Maximum white matter tract shifting ranged from -8 to +15 mm (+2.7 +/- 6.0 mm; mean +/- standard deviation); in 29.7%, an inward and in 62.2%, an outward shifting was detected. CONCLUSION: Comparing preoperative and intraoperative fiber tracking visualizes a marked shifting and deformation of major white matter tracts because of tumor removal. This shifting emphasizes the need for an intraoperative update of navigation systems during resection of deep-seated tumor portions near eloquent brain areas. Fiber tracking is a method not only for preoperative neurosurgical visualization but also for further intraoperative planning.

Hybrid visualization for white matter tracts using triangle strips and point sprites.

Diffusion tensor imaging is of high value in neurosurgery, providing information about the location of white matter tracts in the human brain. For their reconstruction, streamline techniques commonly referred to as fiber tracking model the underlying fiber structures and have therefore gained interest. To meet the requirements of surgical planning and to overcome the visual limitations of line representations, a new real-time visualization approach of high visual quality is introduced. For this purpose, textured triangle strips and point sprites are combined in a hybrid strategy employing GPU programming. The triangle strips follow the fiber streamlines and are textured to obtain a tube-like appearance. A vertex program is used to orient the triangle strips towards the camera. In order to avoid triangle flipping in case of fiber segments where the viewing and segment direction are parallel, a correct visual representation is achieved in these areas by chains of point sprites. As a result, a high quality visualization similar to tubes is provided allowing for interactive multimodal inspection. Overall, the presented approach is faster than existing techniques of similar visualization quality and at the same time allows for real-time rendering of dense bundles encompassing a high number of fibers, which is of high importance for diagnosis and surgical planning.

Fast and accurate connectivity analysis between functional regions based on DT-MRI.

Diffusion tensor and functional MRI data provide insight into function and structure of the human brain. However, connectivity analysis between functional areas is still a challenge when using traditional fiber tracking techniques. For this reason, alternative approaches incorporating the entire tensor information have emerged. Based on previous research employing pathfinding for connectivity analysis, we present a novel search grid and an improved cost function which essentially contributes to more precise paths. Additionally, implementation aspects are considered making connectivity analysis very efficient which is crucial for surgery planning. In comparison to other algorithms, the presented technique is by far faster while providing connections of comparable quality. The clinical relevance is demonstrated by reconstructed connections between motor and sensory speech areas in patients with lesions located in between.

Intraoperative diffusion-tensor MR imaging: shifting of white matter tracts during neurosurgical procedures--initial experience.

PURPOSE: To prospectively evaluate the location of white matter tracts with diffusion-tensor imaging (DTI) during neurosurgical procedures. MATERIALS AND METHODS: Ethical committee approval and signed informed consent were obtained. A 1.5-T magnetic resonance imager with an adapted rotating surgical table that is placed in a radiofrequency-shielded operating theater was used for pre- and intraoperative imaging. DTI was performed by applying an echo-planar imaging sequence with six diffusion directions in 38 patients (20 female patients, 18 male patients; age range, 7-77 years; mean age, 45.6 years) who were undergoing surgery (35 craniotomy and three burr hole procedures). Color-encoded maps of fractional anisotropy were generated by depicting white matter tracts. A rigid registration algorithm was used to compare pre- and intraoperative images. RESULTS: Intraoperative DTI was technically feasible in all patients, and no major image distortions occurred in the areas of interest. Pre- and intraoperative color-encoded maps of fractional anisotropy could be registered; these maps depicted marked and highly variable shifting of white matter tracts during neurosurgical procedures. In the 27 patients who underwent brain tumor resection, white matter tract shifting ranged from an inward shift of 8 mm to an outward shift of 15 mm (mean shift +/- standard deviation, outward shift of 2.5 mm +/- 5.8). In 16 (59%) of 27 patients, outward shifting was detected; in eight (30%), inward shifting was detected. In eight patients who underwent temporal lobe resections for drug-resistant epilepsy, shifting was only inward and ranged from 2 to 14 mm (9 mm +/- 3.3). In two of the three patients who underwent burr hole procedures, outward shifting occurred. CONCLUSION: Intraoperative DTI can depict shifting of major white matter tracts that is caused by surgical intervention.

Preoperative and intraoperative diffusion tensor imaging-based fiber tracking in glioma surgery.

OBJECTIVE: To investigate the intraoperative displacement of major white matter tracts during glioma resection by comparing preoperative and intraoperative diffusion tensor imaging-based fiber tracking. METHODS: In 37 patients undergoing glioma surgery, preoperative and intraoperative diffusion tensor imaging was performed with a 1.5-T magnetic resonance scanner applying an echo-planar imaging sequence with six diffusion directions. For three-dimensional tractography, we implemented a knowledge-based multiple-region-of-interest approach applying user-defined seed regions in the color-coded maps of fractional anisotropy. Tracking was initiated in both the retrograde and orthograde directions according to the direction of the principal eigenvector in each voxel of the region of interest. The tractography results were also assigned color, applying the convention used in color-coded fractional anisotropy maps. RESULTS: Preoperative and intraoperative fiber tracking was technically feasible in all patients. Fiber tract visualization gave a quick and intuitive overview of the displaced course of white matter tracts in three-dimensional space. Comparison of preoperative and intraoperative tractography depicted a marked shifting of major white matter tracts during glioma removal. Maximum white matter tract shifting ranged from -8 to +15 mm (+2.7 +/- 6.0 mm; mean +/- standard deviation); in 29.7%, an inward and in 62.2%, an outward shifting was detected. CONCLUSION: Comparing preoperative and intraoperative fiber tracking visualizes a marked shifting and deformation of major white matter tracts because of tumor removal. This shifting emphasizes the need for an intraoperative update of navigation systems during resection of deep-seated tumor portions near eloquent brain areas. Fiber tracking is a method not only for preoperative neurosurgical visualization but also for further intraoperative planning.

Strategies for brain shift evaluation.

For the analysis of the brain shift phenomenon different strategies were applied. In 32 glioma cases pre- and intraoperative MR datasets were acquired in order to evaluate the maximum displacement of the brain surface and the deep tumor margin. After rigid registration using the software of the neuronavigation system, a direct comparison was made with 2D- and 3D visualizations. As a result, a great variability of the brain shift was observed ranging up to 24 mm for cortical displacement and exceeding 3 mm for the deep tumor margin in 66% of all cases. Following intraoperative imaging the neuronavigation system was updated in eight cases providing reliable guidance. For a more comprehensive analysis a voxel-based nonlinear registration was applied. Aiming at improved speed of alignment we performed all interpolation operations with 3D texture mapping based on OpenGL functions supported in graphics hardware. Further acceleration was achieved with an adaptive refinement of the underlying control point grid focusing on the main deformation areas. For a quick overview the registered datasets were evaluated with different 3D visualization approaches. Finally, the results were compared to the initial measurements contributing to a better understanding of the brain shift phenomenon. Overall, the experiments clearly demonstrate that deformations of the brain surface and deeper brain structures are uncorrelated.

Three-dimensional visualization of neurovascular relationships in the posterior fossa: technique and clinical application.

OBJECT: The goal of this study was to describe the authors' technique for three-dimensional (3D) visualization of neurovascular relationships in the posterior fossa at the surface of the brainstem. This technique is based on the processing of high-resolution magnetic resonance (MR) imaging data. The principles and technical details involved in the accurate simultaneous visualization of vessels and cranial nerves as tiny structures are presented using explicit and implicit segmentation as well as volume rendering. METHODS: In this approach 3D MR constructive interference in steady state imaging data served as the source for image processing, which was performed using the Linux-based software tools SegMed for segmentation and Qvis for volume rendering. A sequence of filtering operations (including noise reduction and closing) and other software tools such as volume growing are used for a semiautomatic coarse segmentation. The subsequent 3D visualization in which implicit segmentation is used for the differentiation of cranial nerves, vessels, and brainstem is achieved by allocating opacity and color values and adjusting the related transfer functions. This method was applied to the presurgical evaluation in a consecutive series of 55 patients with neurovascular compression syndromes and the results were correlated to surgical findings. The potential for its use, further developments, and remaining problems are discussed. CONCLUSIONS: This method provides an excellent intraoperative real-time virtual view of difficult anatomical relationships.

CT angiography of intracranial aneurysms: a focus on postprocessing.

Computed tomographic (CT) angiography is a well-known tool for detection of intracranial aneurysms and the planning of therapeutic intervention. Despite a wealth of existing studies and an increase in image quality due to use of multisection CT and increasingly sophisticated postprocessing tools such as direct volume rendering, CT angiography has still not replaced digital subtraction angiography as the standard of reference for detection of intracranial aneurysms. One reason may be that CT angiography is still not a uniformly standardized method, particularly with regard to image postprocessing. Several methods for two- and three-dimensional visualization can be used: multiplanar reformation, maximum intensity projection, shaded surface display, and direct volume rendering. Pitfalls of CT angiography include lack of visibility of small arteries, difficulty differentiating the infundibular dilatation at the origin of an artery from an aneurysm, the kissing vessel artifact, demonstration of venous structures that can simulate aneurysms, inability to identify thrombosis and calcification on three-dimensional images, and beam hardening artifacts produced by aneurysm clips. Finally, an algorithm for the safe and useful application of CT angiography in patients with subarachnoid hemorrhage has been developed, which takes into account the varying quality of equipment and software at different imaging centers.

Analysis and 3-dimensional visualization of neurovascular compression syndromes.

RATIONALE AND OBJECTIVES: Neurovascular compression syndromes are currently examined with 2-dimensional representations of tomographic volumes. To overcome this drawback, coarse segmentation followed by direct volume rendering of magnetic resonance (MR) data is introduced supporting a detailed 3-dimensional analysis of the related structures. MATERIALS AND METHODS: This approach is based on MR-CISS (constructive interference in steady state) volumes providing the required high resolution to achieve an improved spatial understanding. In relation to the size of the involved nerves and vessels, an explicit segmentation is extremely difficult. Therefore, a semi-automatic preprocessing sequence was developed consisting of noise reduction, morphologic filtering, and volume growing. To delineate the target structures within the segmented and labeled subvolumes, interactive direct volume rendering was applied that allows delineating the target structures in the area of the cerebrospinal fluid with implicit segmentation based on predefined transfer functions assigning opacity and color values to the intensity values of the image data. For a further improved analysis, registration of the MR-CISS volumes with MR angiography is recommended to support differentiating vessels and nerves on the one side and arteries and veins on the other. RESULTS: The presented method was applied in a consecutive series of 47 cases of different neurovascular compression syndromes, supporting the presurgical analysis of the image data. Additionally, the results were compared with the operative findings. CONCLUSION: Overall, this approach contributes significantly to an optimized 3-dimensional analysis and understanding of neurovascular compression syndromes. Based on the obtained results, it is of high value for the planning of surgery.

Standardized evaluation of CT angiography with remote generation of 3D video sequences for the detection of intracranial aneurysms.

Computed tomography (CT) angiography is a well-known imaging technique commonly applied to both the detection and therapy planning of intracranial aneurysms. For this purpose, current studies predominantly focus on three-dimensional (3D) representations of CT angiographic volumes obtained with varying visualization approaches on different computers. Interactive manipulation performed by users individually is an important prerequisite for data analysis. However, this leads to inconsistent and barely reproducible 3D visualization results. Furthermore, the quality of any 3D representation depends on the applied visualization strategy (eg, maximum-intensity projection, shaded-surface display, direct volume rendering). To overcome these limitations, the authors present a novel method for standardized visualization of CT angiographic volumes, consisting of three steps: (a) transfer of the image data to a remote high-end graphics workstation, (b) automatic 3D visualization with high-resolution direct volume rendering, and (c) consecutive video generation performed according to a standardized protocol. The recorded video sequences are transferred for evaluation to a local desktop computer. In the experimental setup, high-quality videos based on 3D visualizations were produced in less than 60 minutes per patient. Although aneurysms above the skull base are usually visualized with excellent quality, the analysis of aneurysms at the skull base is still difficult.

Standardized 3D documentation for neurosurgery.

OBJECTIVE: Although direct volume visualization is now a standard tool for diagnosis and therapy planning for medical conditions in the brain, its application is normally restricted to radiological workstations. We propose the use of standardized digital video sequences which can be easily ported to mobile computing platforms and thereby to diverse clinical environments. The effectiveness of this approach is demonstrated in the operating room. MATERIALS AND METHODS: Segmented MR data corresponding to neurovascular compression syndrome pathologies was examined with 3D visualization based on tagged volumes. CT-angiography data containing aneurysms close to the skull base was analyzed with volume visualization based on bidimensional transfer functions. Furthermore, automatic adjustment of bidimensional transfer function templates was implemented. An extension of the applied volume visualization tool made it possible to standardize the creation of pathology-specific digital video sequences. RESULTS: Five cases of neurovascular compression syndromes and 4 cases of aneurysms close to the skull base were examined. One-dimensional transfer function templates were successfully applied for the visualization of neurovascular compression syndromes. Automatic adjustment of transfer function templates made it possible to achieve good-quality results for visualization of aneurysms without external adjustment. The resulting digital video sequences were successfully used in the operating room. CONCLUSION: The portability of the 3D video sequences broadens their application spectrum, making them adequate not only for database purposes, but also for surgical support and cooperative environments. Furthermore, the required technical knowledge is encapsulated, making this approach more suitable for clinical applications.