Quantification of the human cerebrovasculature: a 7Tesla and 320-row CT in vivo study.

OBJECTIVE: Human cerebrovasculature has not been quantified in volume, length, and vascular-brain relationships. We investigated this using imaging. METHODS: From 0.5-mm 7T and 320-row CT acquisitions, 6 arterial and 4 venous systems were reconstructed, measured, and analyzed. RESULTS: The ratio of the volume of arterial to venous system is approximately 1:3. The ratio of the volume of dural sinuses to vasculature is 1:2. The ratio of the posterior (PCA) to anterior (ACA) to middle cerebral artery (MCA) is 1:2:4 in volume and length. Ratios of left to right vessels are 1:1 for arteries and veins. Ratios of branching frequency for the ACA, MCA, and PCA are 1:1:1. The branching frequency ratio for superficial to deep veins is 1:2. The MCA occupies 1/2 of arterial length and 1/4 of vascular length. The ratio of the length of superficial to deep veins is 1:1 and each is equal to 1/4 of the vascular length. The ratio of cerebrovasculature to brain volume is 2.5%. CONCLUSIONS: Despite its enormous complexity, cerebrovasculature is characterized by 4 approximate proportions, 1:1, 1:2, 1:3, 1:4, and their combinations, 1:1:1 and 1:2:4.

Comparison of magnetic resonance angiography scans on 1.5, 3, and 7 Tesla units: a quantitative study of 3-dimensional cerebrovasculature.

BACKGROUND: Although multiple studies demonstrate benefits of high field imaging of cerebrovasculature, a detailed quantitative analysis of complete cerebrovascular system is unavailable. To compare quality of MR angiography (MRA) acquisitions at various field strengths, we used 3-dimensional (3D) geometric cerebrovascular models extracted from 1.5 T/3 T/7 T scans. METHODS: The 3D cerebrovascular models were compared in volume, length, and number of branches. A relationship between the vascular length and volume was statistically derived. Acquisition performance was benchmarked against the maximum volume at infinitive length. RESULTS: The numbers of vessels discernible on 1.5 T/3 T/7 T are 138/363/907. 3T shows 3.3(1.9) and 7 T 1.2(9.1) times more arteries (veins) than 1.5 T. The vascular lengths and volumes at 1.5 T/3 T/7 T are 3.7/12.5/22.7 m and 15.8/26.6/28.0 cm(3). For arteries: 3T-1.5 T gain is very high in length, high in volume; 7 T-3T gain is medium in length, small in volume. For veins: 3 T-1.5 T gain is moderate in length, high in volume; 7 T-3T gain is very high in length, moderate in volume. 1.5 T shows merely half of vascular volume. At 3 T 6%, while at 7 T only 1% of vascular volume is missing. CONCLUSION: Our approach differs from standard approaches based on visual assessment and signal (contrast)-to-noise ratio. It also measures absolute acquisition performance, provides a unique length-volume relationship, and predicts length/volume for intermediate teslages.

Ventricle Boundary in CT: Partial Volume Effect and Local Thresholds.

We present a mathematical frame to carry out segmentation of cerebrospinal fluid (CSF) of ventricular region in computed tomography (CT) images in the presence of partial volume effect (PVE). First, the image histogram is fitted using the Gaussian mixture model (GMM). Analyzing the GMM, we find global threshold based on parameters of distributions for CSF, and for the combined white and grey matter (WGM). The parameters of distribution of PVE pixels on the boundary of ventricles are estimated by using a convolution operator. These parameters are used to calculate local thresholds for boundary pixels by the analysis of contribution of the neighbor pixels intensities into a PVE pixel. The method works even in the case of an almost unimodal histogram; it can be useful to analyze the parameters of PVE in the ground truth provided by the expert.

Simulation and assessment of cerebrovascular damage in deep brain stimulation using a stereotactic atlas of vasculature and structure derived from multiple 3- and 7-tesla scans.

OBJECT: The most severe complication of deep brain stimulation (DBS) is intracranial hemorrhage. Detailed knowledge of the cerebrovasculature could reduce the rate of this disorder. Morphological scans typically acquired in stereotactic and functional neurosurgery (SFN) by using 1.5-T (or sometimes even 3-T) imaging units poorly depict the vasculature. Advanced angiographic imaging, including 3- and 7-T 3D time-of-flight and susceptibility weighted imaging as well as 320-slice CT angiography, depict the vessels in great detail. However, these acquisitions are not used in SFN clinical practice, and robust methods for their processing are not available yet. Therefore, the authors proposed the use of a detailed 3D stereotactic cerebrovascular atlas to assist in SFN planning and to potentially reduce DBS-induced hemorrhage. METHODS: A very detailed 3D cerebrovascular atlas of arteries, veins, and dural sinuses was constructed from multiple 3- and 7-T scans. The atlas contained>900 vessels, each labeled with a name and diameter with the smallest having a 90-µm diameter. The cortical areas, ventricular system, and subcortical structures were fully segmented and labeled, including the main stereotactic target structures: subthalamic nucleus, ventral intermediate nucleus of the thalamus, and internal globus pallidus. The authors also developed a computer simulator with the embedded atlas that was able to compute the effective electrode trajectory by minimizing penetration of the cerebrovascular system and vital brain structures by a DBS electrode. The simulator provides the neurosurgeon with functions for atlas manipulation, target selection, trajectory planning and editing, 3D display and manipulation, and electrode-brain penetration calculation. RESULTS: This simulation demonstrated that a DBS electrode inserted in the middle frontal gyrus may intersect several arteries and veins including 1) the anteromedial frontal artery of the anterior cerebral artery as well as the prefrontal artery and the precentral sulcus artery of the middle cerebral artery (range of diameters 0.4-0.6 mm); and 2) the prefrontal, anterior caudate, and medullary veins (range of diameters 0.1-2.3 mm). This work also shows that field strength and pulse sequence have a substantial impact on vessel depiction. The numbers of 3D vascular segments are 215, 363, and 907 for 1.5-, 3-, and 7-T scans, respectively. CONCLUSIONS: Inserting devices into the brain during microrecording and stimulation may cause microbleeds not discernible on standard scans. A small change in the location of the DBS electrode can result in a major change for the patient. The described simulation increases the neurosurgeon's awareness of this phenomenon. The simulator enables the neurosurgeon to analyze the spatial relationships between the track and the cerebrovasculature, ventricles, subcortical structures, and cortical areas, which allows the DBS electrode to be placed more effectively, and thus potentially reducing the invasiveness of the stimulation procedure for the patient.

Vascular editor: from angiographic images to 3D vascular models.

Modern imaging techniques are able to generate high-resolution multimodal angiographic scans. The analysis of vasculature using numerous 2D tomographic images is time consuming and tedious, while 3D modeling and visualization enable presentation of the vasculature in a more convenient and intuitive way. This calls for development of interactive tools facilitating processing of angiographic scans and enabling creation, editing, and manipulation of 3D vascular models. Our objective is to develop a vascular editor (VE) which provides a suitable environment for experts to create and manipulate 3D vascular models correlated with surrounding anatomy. The architecture, functionality, and user interface of the VE are presented. The VE includes numerous interactive tools for building a vascular model from multimodal angiographic scans, editing, labeling, and manipulation of the resulting 3D model. It also provides comprehensive tools for vessel visualization, correlation of 2D and 3D representations, and tracing of small vessels of subpixel size. Education, research, and clinical applications of the VE are discussed, including the atlas of cerebral vasculature. To our best knowledge, there are no other systems offering similar functionality as the VE does.

Robust calculation of the midsagittal plane in CT scans using the Kullback-Leibler's measure.

OBJECTIVE: The identification of the interhemispheric fissure (IF) is important in clinical applications for brain landmark identification, registration, symmetry assessment, and pathology detection. The IF is usually approximated by the midsagittal plane (MSP) separating the brain into two hemispheres. We present a fast accurate, automatic, and robust algorithm for finding the MSP for CT scans acquired in emergency room (ER) with a large slice thickness, high partial volume effect, and substantial head tilt. MATERIALS AND METHODS: An earlier algorithm for MSP identification from MRI using the Kullback-Leibler's measure was extended for CT by estimating patient's head orientation using model fitting, image processing, and atlas-based techniques. The new algorithm was validated on 208 clinical scans acquired mainly in the ER with slice thickness ranging from 1.5 to 6 mm and severe head tilt. RESULTS: The algorithm worked robustly for all 208 cases. An angular discrepancy (degrees) and maximum distance (mm) between the calculated MSP and ground truth have the mean value (SD) 0.0258 degrees (0.9541 degrees) and 0.1472 (0.7373) mm, respectively. In average, the algorithm takes 10 s to process of a typical CT case. CONCLUSION: The proposed algorithm is robust to head rotation, and correctly identifies the MSP for a standard clinical CT scan with a large slice thickness. It has been applied in our several CT stroke CAD systems.

A three-dimensional interactive atlas of cerebral arterial variants.

The knowledge of cerebrovascular variants is essential in education, training, diagnosis and treatment. The current way of presentation of vasculature and, particularly, vascular variants is insufficient. Our purpose is to construct a three-dimensional (3D) interactive atlas of cerebral arterial variants along with exploration tools allowing the investigator just with a few clicks to better and faster understand the variants and their spatial relationships. A 3D model of the cerebral arterial system created earlier, fully labeled with names and diameters, is used as a reference. As the vast material about vascular variability is incomplete and not fully documented, our approach synthesizes variants in 3D based on existing knowledge. The variants are created from literature using a dedicated vascular editor and embedded into the reference model. Sixty 3D variants and branching patterns are created including the internal carotid, middle cerebral, anterior cerebral, posterior cerebral, vertebral and basilar arteries, and circle of Willis. Their prevalence rates are given. The atlas is developed to explore the variants individually or embedded into the reference vasculature. Real-time interactive manipulation of variants and reference vasculature (rotate/zoom/pan/view) is provided. This atlas facilitates the investigator to easily get familiarized with the variants and rapidly explore them. It aids in presentation of vascular variants and understanding their spatial relationships either individually or embedded into the surrounding reference cerebrovasculature. It is useful for medical students, educators to prepare teaching materials, and clinicians for scan interpretation. It is easily extensible with additional variant instances, new variants, branching patterns, and supporting textual materials.

Automatic testing and assessment of neuroanatomy using a digital brain atlas: method and development of computer- and mobile-based applications.

Preparation of tests and student's assessment by the instructor are time consuming. We address these two tasks in neuroanatomy education by employing a digital media application with a three-dimensional (3D), interactive, fully segmented, and labeled brain atlas. The anatomical and vascular models in the atlas are linked to Terminologia Anatomica. Because the cerebral models are fully segmented and labeled, our approach enables automatic and random atlas-derived generation of questions to test location and naming of cerebral structures. This is done in four steps: test individualization by the instructor, test taking by the students at their convenience, automatic student assessment by the application, and communication of the individual assessment to the instructor. A computer-based application with an interactive 3D atlas and a preliminary mobile-based application were developed to realize this approach. The application works in two test modes: instructor and student. In the instructor mode, the instructor customizes the test by setting the scope of testing and student performance criteria, which takes a few seconds. In the student mode, the student is tested and automatically assessed. Self-testing is also feasible at any time and pace. Our approach is automatic both with respect to test generation and student assessment. It is also objective, rapid, and customizable. We believe that this approach is novel from computer-based, mobile-based, and atlas-assisted standpoints.

A new presentation and exploration of human cerebral vasculature correlated with surface and sectional neuroanatomy.

The increasing complexity of human body models enabled by advances in diagnostic imaging, computing, and growing knowledge calls for the development of a new generation of systems for intelligent exploration of these models. Here, we introduce a novel paradigm for the exploration of digital body models illustrating cerebral vasculature. It enables dynamic scene compositing, real-time interaction combined with animation, correlation of 3D models with sectional images, quantification as well as 3D manipulation-independent labeling and knowledge-related meta labeling (with name, diameter, description, variants, and references). This novel exploration is incorporated into a 3D atlas of cerebral vasculature with arteries and veins along with the surrounding surface and sectional neuroanatomy derived from 3.0 Tesla scans. This exploration paradigm is useful in medical education, training, research, and clinical applications. It enables development of new generation systems for rapid and intelligent exploration of complicated digital body models in real time with dynamic scene compositing from highly parcellated 3D models, continuous navigation, and manipulation-independent labeling with multiple features.

A 3D model of human cerebrovasculature derived from 3T magnetic resonance angiography.

The human cerebrovasculature is extremely complicated and its three dimensional (3D) highly parcellated models, though necessary, are unavailable. We constructed a digital cerebrovascular model from a high resolution, 3T 3D time-of-flight magnetic resonance angiography scan. This model contains the arterial and venous systems and is 3D, geometric, highly parcellated, fully segmented, and completely labeled with name, diameter, and variants. Our approach replaces the tedious and time consuming process of checking and correcting automatic segmentation results done at 2D image level with an aggregate and faster process at 3D model level. The creation of the vascular model required vessel pre-segmentation, centerline extraction, vascular segments connection, centerline smoothing, vessel surface construction, vessel grouping, tracking, editing, labeling, setting diameter, and checking correctness and completeness. For comparison, the same scan was segmented automatically with 59.8% sensitivity and only 16.5% of vessels smaller than 1 pixel size were extracted. To check and correct this automatic segmentation requires 8 weeks. Conversely, the speedup of our approach (the number of 2D segmented areas/the number of 3D vascular segments) is 34. This cerebrovascular model can serve as a reference framework in clinical, research, and educational applications. The wealth of information aggregated with its quantification capabilities can augment or replace numerous textbook chapters. Five applications of the vascular model were described. The model is easily extendable in content, parcellation, and labeling, and the proposed approach is applicable for building a whole body vascular system.

On geometric modeling of the human intracranial venous system.

We describe a process aiming to construct a 3-D geometric model of the human normal intracranial venous system from MRA data. An analysis of geometric properties of the intracranial veins and sinuses results in proposing three models: circular, elliptic, and free-shape. We formulate a rule based on which a suitable geometric venous model can be selected. The cross-sectional shape of different parts of dural venous sinuses is found to be better approximated by ellipses and free shapes, while for veins the circular and elliptic models are comparable. An analysis of using splines for radii smoothing is also provided. The approach is useful for building venous models in education and clinical applications.

Extraction of the midsagittal plane from morphological neuroimages using the Kullback-Leibler's measure.

A theoretically simple and computationally efficient method to extract the midsagittal plane (MSP) from volumetric neuroimages is presented. The method works in two stages (coarse and fine) and is based on calculation of the Kullback and Leibler's (KL) measure, which characterizes the difference between two distributions. Slices along the sagittal direction are analyzed with respect to a reference slice to determine the coarse MSP. To calculate the final MSP, a local search algorithm is applied. The proposed method does not need any preprocessing, like reformatting, skull stripping, etc. The algorithm was validated quantitatively on 75 MRI datasets of different pulse sequences (T1WI, T2WI, FLAIR and SPGR) and MRA. The angular and distance errors between the calculated MSP and the ground truth lines marked by the expert were calculated. The average distance and angular deviation were 1.25 pixels and 0.63 degrees , respectively. In addition, the algorithm was tested qualitatively on PD, FLAIR, MRA, and CT datasets. To analyze the robustness of the method against rotation, inhomogeneity and noise, the phantom data were used.

A virtual reality simulator for remote interventional radiology: concept and prototype design.

We present a virtual reality simulator to realize interventional radiology (IR) procedures remotely. The simulator contains two subsystems: one at the local site and the other at the remote site. At the local site, the interventional radiologist interacts with a three-dimensional (3-D) vascular model extracted from the patient's data and inserts IR devices through the Motion Tracking Box (MTB), which converts physical motion (translation and rotation) of IR devices into digital signal. This signal is transferred to the Actuator Box (AB) at the remote site that drives the IR devices in the patient. The status of the IR devices is subsequently fed back to the local site and displayed on the vascular model. To prove the concept, the prototype developed employs a physical angiography phantom (mimicking the patient) and its corresponding 3-D digital model. A magnetic tracking system provides information about positioning of the IR devices in the phantom. The initial results are encouraging. The AB controlled remotely drives IR devices with resolution of 0.00288 mm/step in translation and 0.079 deg/step in rotation.

Quantitative analysis of brain asymmetry by using the divergence measure: normal-pathological brain discrimination.

RATIONALE AND OBJECTIVES: The human brain demonstrates approximate bilateral symmetry of anatomy, function, neurochemical activity, and electrophysiology. This symmetry reflected in radiological images may be affected by pathology. Hence quantitative analysis of brain symmetry may enable the normal and pathological brain discrimination. We propose a method based on the Jeffreys divergence measure (J-divergence), which attempts to quantify "approximate symmetry" and also aids to classify the brain as bilaterally symmetrical/asymmetrical (normal/abnormal). MATERIALS AND METHODS: The dataset included studies of 101 patients (59 without detectable pathologies and 42 with different abnormalities). First, the midsagittal plane is computed for the volume data that divides the head into two hemispheres. The J-divergence is calculated from the density functions of intensities of both the hemispheres. Statistical analysis was conducted to find the best distribution for normal/abnormal datasets. RESULTS: Statistical tests showed that the lognormal distribution best characterizes the values of the J-divergence for both normal and abnormal cases, and the threshold value for the Jeffreys divergence measure to classify the brains with and without detectable pathologies is T = 0.007. The threshold value had a sensitivity of 88.1% and specificity of 90.9%. CONCLUSION: The proposed method is fast and simple to compute. The high sensitivity and specificity indicate the results are encouraging. This method can be used for the initial analysis of data, detection of pathology, classification of dataset as presumably normal/abnormal, and localization of abnormality.

IVME: a tool for editing, manipulation, quantification, and labeling of cerebrovascular models.

Three-dimensional (3D) vascular models are important in medical education, interventional radiology and vascular surgery. Because of a limited quality of angiographic images and inaccuracies introduced during their processing, interactive enhancement of the resulting models is required. We introduce here a novel tool, the interactive vascular modeling environment (IVME) for editing, manipulation, quantification, and labeling of cerebrovascular models. We describe the IVME architecture and design along with the functionality supporting anatomy terminology linking, 2D and 3D labeling, editing, 2D-3D cross-referencing, measurements, and quantification. The IVME is a useful platform in education, research, and clinics to explore and manipulate the angiography data in 2D and 3D.

Rapid and automatic calculation of the midsagittal plane in magnetic resonance diffusion and perfusion images.

RATIONALE AND OBJECTIVES: A near real-time and fully automatic method for calculation of the midsagittal plane (MSP) for magnetic resonance (MR) diffusion and perfusion images is introduced. MATERIALS AND METHODS: The method is based on the Kullback-Leibler's (KL) measure quantifying the difference between two intensity distributions. The MSP is a sagittal plane with the highest KL measure. The method was validated quantitatively for 61 diffusion-weighted imaging (DWI), cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), peak height (PKHT), and time to peak (TPP) data sets of 11 stroke patients based on the ground truth provided by two raters. RESULTS: Average angular errors are less than 1 degrees for DWI and less than 2 degrees for CBF and CBV. Average distance errors measured in the worst case (on the brain's bounding box) are less than 2.5 mm for DWI and less than 5 mm for CBF and CBV. This algorithmic accuracy is at the level of interrater variability. Results obtained for the other perfusions maps (MTT, PKHT, TTP) were inferior; therefore, processing of CBF or CBV is preferred for accurate and robust calculation of the MSP from perfusion maps. Calculation of the MSP takes about half a second on a standard computer. CONCLUSIONS: The proposed method is near real-time and fully automatic, and neither user interaction nor parameter setting is needed. It does not require preprocessing of data. The method potentially is useful in rapid and automated processing of MR stroke diffusion and perfusion images.

Geometric modeling of the human normal cerebral arterial system.

We propose an anatomy-based approach for an efficient construction of a three-dimensional human normal cerebral arterial model from segmented and skeletonized angiographic data. The centerline-based model is used for an accurate angiographic data representation. A vascular tree is represented by tubular segments and bifurcations whose construction takes into account vascular anatomy. A bifurcation is defined quantitatively and the algorithm calculating it is given. The centerline is smoothed by means of a sliding average filter. As the vessel radius is sensitive to quality of data as well as accuracy of segmentation and skeletonization, radius outlier removal and radius regression algorithms are formulated and applied. In this way, the approach compensates for some inaccuracies introduced during segmentation and skeletonization. To create the frame of vasculature, we use two different topologies: tubular and B-subdivision based. We also propose a technique to prevent vessel twisting. The analysis of the vascular model is done on a variety of data containing 258 vascular segments and 131 bifurcations. Our approach gives acceptable results from anatomical, topological and geometrical standpoints as well as provides fast visualization and manipulation of the model. The approach is applicable for building a reference cerebrovascular atlas, developing applications for simulation and planning of interventional radiology procedures and vascular surgery, and in education.

Informatics in Radiology (infoRAD): three-dimensional atlas of the brain anatomy and vasculature.

Of the existing atlases of the brain anatomy and cerebrovasculature, none integrates the anatomy and vasculature by providing for direct manipulation of three-dimensional (3D) cerebral models. An atlas-based application was developed in four steps: (a) construction of 3D anatomic models, (b) construction of 3D vascular models, (c) interactive spatial coregistration of the anatomic and vascular models, and (d) development of functionality and a user interface for the application. Three-dimensional anatomic models were imported from an electronic brain atlas database derived from classic print atlases. A novel vascular modeling technique was developed and applied to create a vascular atlas from magnetic resonance angiographic data. The use of 3D polygonal models allows smooth navigation (rotation, zooming, panning) and interactive labeling of anatomic structures and vascular segments. This application enables the user to examine 3D anatomic structures and 3D cerebral vasculature and to gain a better understanding of the relationships between the two. The combined anatomic-vascular atlas is a user-friendly neuroeducational tool that is useful for medical students and neuroscience researchers as well as for educators in preparing teaching materials.