Computerized Analysis of Magnetic Resonance Images to Study Cerebral Anatomy in Developing Neonates

The study of cerebral anatomy in developing neonates is of great importance for the understanding of brain development during the early period of life. This dissertation therefore focuses on three challenges in the modelling of cerebral anatomy in neonates during brain development. The methods that have been developed all use Magnetic Resonance Images (MRI) as source data. To facilitate study of vascular development in the neonatal period, a set of image analysis algorithms are developed to automatically extract and model cerebral vessel trees. The whole process consists of cerebral vessel tracking from automatically placed seed points, vessel tree generation, and vasculature registration and matching. These algorithms have been tested on clinical Time-of- Flight (TOF) MR angiographic datasets. To facilitate study of the neonatal cortex a complete cerebral cortex segmentation and reconstruction pipeline has been developed. Segmentation of the neonatal cortex is not effectively done by existing algorithms designed for the adult brain because the contrast between grey and white matter is reversed. This causes pixels containing tissue mixtures to be incorrectly labelled by conventional methods. The neonatal cortical segmentation method that has been developed is based on a novel expectation-maximization (EM) method with explicit correction for mislabelled partial volume voxels. Based on the resulting cortical segmentation, an implicit surface evolution technique is adopted for the reconstruction of the cortex in neonates. The performance of the method is investigated by performing a detailed landmark study. To facilitate study of cortical development, a cortical surface registration algorithm for aligning the cortical surface is developed. The method first inflates extracted cortical surfaces and then performs a non-rigid surface registration using free-form deformations (FFDs) to remove residual alignment. Validation experiments using data labelled by an expert observer demonstrate that the method can capture local changes and follow the growth of specific sulcus

Improvements in the registration of multimodal medical imaging : application to intensity inhomogeneity and partial volume corrections

Alignment or registration of medical images has a relevant role on clinical diagnostic and treatment decisions as well as in research settings. With the advent of new technologies for multimodal imaging, robust registration of functional and anatomical information is still a challenge, particular in small-animal imaging given the lesser structural content of certain anatomical parts, such as the brain, than in humans. Besides, patient-dependent and acquisition artefacts affecting the images information content further complicate registration, as is the case of intensity inhomogeneities (IIH) showing in MRI and the partial volume effect (PVE) attached to PET imaging. Reference methods exist for accurate image registration but their performance is severely deteriorated in situations involving little images Overlap. While several approaches to IIH and PVE correction exist these methods still do not guarantee or rely on robust registration. This Thesis focuses on overcoming current limitations af registration to enable novel IIH and PVE correction methods.El registre d'imatges mèdiques té un paper rellevant en les decisions de diagnòstic i tractament clíniques així com en la recerca. Amb el desenvolupament de noves tecnologies d'imatge multimodal, el registre robust d'informació funcional i anatòmica és encara avui un repte, en particular, en imatge de petit animal amb un menor contingut estructural que en humans de certes parts anatòmiques com el cervell. A més, els artefactes induïts pel propi pacient i per la tècnica d'adquisició que afecten el contingut d'informació de les imatges complica encara més el procés de registre. És el cas de les inhomogeneïtats d'intensitat (IIH) que apareixen a les RM i de l'efecte de volum parcial (PVE) característic en PET. Tot i que existeixen mètodes de referència pel registre acurat d'imatges la seva eficàcia es veu greument minvada en casos de poc solapament entre les imatges. De la mateixa manera, també existeixen mètodes per la correcció d'IIH i de PVE però que no garanteixen o que requereixen un registre robust. Aquesta tesi es centra en superar aquestes limitacions sobre el registre per habilitar nous mètodes per la correcció d'IIH i de PVE

Towards efficient neurosurgery: Image analysis for interventional MRI

Interventional magnetic resonance imaging (iMRI) is being increasingly used for performing imageguided neurosurgical procedures. Intermittent imaging through iMRI can help a neurosurgeon visualise the target and eloquent brain areas during neurosurgery and lead to better patient outcome. MRI plays an important role in planning and performing neurosurgical procedures because it can provide highresolution anatomical images that can be used to discriminate between healthy and diseased tissue, as well as identify location and extent of functional areas. This is of significant clinical utility as it helps the surgeons maximise target resection and avoid damage to functionally important brain areas. There is clinical interest in propagating the pre-operative surgical information to the intra-operative image space as this allows the surgeons to utilise the pre-operatively generated surgical plans during surgery. The current state of the art neuronavigation systems achieve this by performing rigid registration of pre-operative and intra-operative images. As the brain undergoes non-linear deformations after craniotomy (brain shift), the rigidly registered pre-operative images do not accurately align anymore with the intra-operative images acquired during surgery. This limits the accuracy of these neuronavigation systems and hampers the surgeon’s ability to perform more aggressive interventions. In addition, intra-operative images are typically of lower quality with susceptibility artefacts inducing severe geometric and intensity distortions around areas of resection in echo planar MRI images, significantly reducing their utility in the intraoperative setting. This thesis focuses on development of novel methods for an image processing workflow that aims to maximise the utility of iMRI in neurosurgery. I present a fast, non-rigid registration algorithm that can leverage information from both structural and diffusion weighted MRI images to localise target lesions and a critical white matter tract, the optic radiation, during surgical management of temporal lobe epilepsy. A novel method for correcting susceptibility artefacts in echo planar MRI images is also developed, which combines fieldmap and image registration based correction techniques. The work developed in this thesis has been validated and successfully integrated into the surgical workflow at the National Hospital for Neurology and Neurosurgery in London and is being clinically used to inform surgical decisions

Methodological considerations for neuroimaging in deep brain stimulation of the subthalamic nucleus in Parkinson’s disease patients

Deep brain stimulation (DBS) of the subthalamic nucleus is a neurosurgical intervention for Parkinson’s disease patients who no longer appropriately respond to drug treatments. A small fraction of patients will fail to respond to DBS, develop psychiatric and cognitive side-effects, or incur surgery-related complications such as infections and hemorrhagic events. In these cases, DBS may require recalibration, reimplantation, or removal. These negative responses to treatment can partly be attributed to suboptimal pre-operative planning procedures via direct targeting through low-field and low-resolution magnetic resonance imaging (MRI). One solution for increasing the success and efficacy of DBS is to optimize preoperative planning procedures via sophisticated neuroimaging techniques such as high-resolution MRI and higher field strengths to improve visualization of DBS targets and vasculature. We discuss targeting approaches, MRI acquisition, parameters, and post-acquisition analyses. Additionally, we highlight a number of approaches including the use of ultra-high field (UHF) MRI to overcome limitations of standard settings. There is a trade-off between spatial resolution, motion artifacts, and acquisition time, which could potentially be dissolved through the use of UHF-MRI. Image registration, correction, and post-processing techniques may require combined expertise of traditional radiologists, clinicians, and fundamental researchers. The optimization of pre-operative planning with MRI can therefore be best achieved through direct collaboration between researchers and clinicians

Neurosurgical Ultrasound Pose Estimation Using Image-Based Registration and Sensor Fusion - A Feasibility Study

Modern neurosurgical procedures often rely on computer-assisted real-time guidance using multiple medical imaging modalities. State-of-the-art commercial products enable the fusion of pre-operative with intra-operative images (e.g., magnetic resonance [MR] with ultrasound [US] images), as well as the on-screen visualization of procedures in progress. In so doing, US images can be employed as a template to which pre-operative images can be registered, to correct for anatomical changes, to provide live-image feedback, and consequently to improve confidence when making resection margin decisions near eloquent regions during tumour surgery. In spite of the potential for tracked ultrasound to improve many neurosurgical procedures, it is not widely used. State-of-the-art systems are handicapped by optical tracking’s need for consistent line-of-sight, keeping tracked rigid bodies clean and rigidly fixed, and requiring a calibration workflow. The goal of this work is to improve the value offered by co-registered ultrasound images without the workflow drawbacks of conventional systems. The novel work in this thesis includes: the exploration and development of a GPU-enabled 2D-3D multi-modal registration algorithm based on the existing LC2 metric; and the use of this registration algorithm in the context of a sensor and image-fusion algorithm. The work presented here is a motivating step in a vision towards a heterogeneous tracking framework for image-guided interventions where the knowledge from intraoperative imaging, pre-operative imaging, and (potentially disjoint) wireless sensors in the surgical field are seamlessly integrated for the benefit of the surgeon. The technology described in this thesis, inspired by advances in robot localization demonstrate how inaccurate pose data from disjoint sources can produce a localization system greater than the sum of its parts

An ITK implementation of a physics-based non-rigid registration method for brain deformation in image-guided neurosurgery

As part of the ITK v4 project efforts, we have developed ITK filters for physics-based non-rigid registration (PBNRR), which satisfies the following requirements: account for tissue properties in the registration, improve accuracy compared to rigid registration, and reduce execution time using GPU and multi-core accelerators. The implementation has three main components: (1) Feature Point Selection, (2) Block Matching (mapped to both multi-core and GPU processors), and (3) a Robust Finite Element Solver. The use of multi-core and GPU accelerators in ITK v4 provides substantial performance improvements. For example, for the non-rigid registration of brain MRIs, the performance of the block matching filter on average is about 10 times faster when 12 hyperthreaded multi-cores are used and about 83 times faster when the NVIDIA Tesla GPU is used in Dell Workstation

On the Real-Time Performance, Robustness and Accuracy of Medical Image Non-Rigid Registration

Three critical issues about medical image non-rigid registration are performance, robustness and accuracy. A registration method, which is capable of responding timely with an accurate alignment, robust against the variation of the image intensity and the missing data, is desirable for its clinical use. This work addresses all three of these issues. Unacceptable execution time of Non-rigid registration (NRR) often presents a major obstacle to its routine clinical use. We present a hybrid data partitioning method to parallelize a NRR method on a cooperative architecture, which enables us to get closer to the goal: accelerating using architecture rather than designing a parallel algorithm from scratch. to further accelerate the performance for the GPU part, a GPU optimization tool is provided to automatically optimize GPU execution configuration.;Missing data and variation of the intensity are two severe challenges for the robustness of the registration method. A novel point-based NRR method is presented to resolve mapping function (deformation field) with the point correspondence missing. The novelty of this method lies in incorporating a finite element biomechanical model into an Expectation and Maximization (EM) framework to resolve the correspondence and mapping function simultaneously. This method is extended to deal with the deformation induced by tumor resection, which imposes another challenge, i.e. incomplete intra-operative MRI. The registration is formulated as a three variable (Correspondence, Deformation Field, and Resection Region) functional minimization problem and resolved by a Nested Expectation and Maximization framework. The experimental results show the effectiveness of this method in correcting the deformation in the vicinity of the tumor. to deal with the variation of the intensity, two different methods are developed depending on the specific application. For the mono-modality registration on delayed enhanced cardiac MRI and cine MRI, a hybrid registration method is designed by unifying both intensity- and feature point-based metrics into one cost function. The experiment on the moving propagation of suspicious myocardial infarction shows effectiveness of this hybrid method. For the multi-modality registration on MRI and CT, a Mutual Information (MI)-based NRR is developed by modeling the underlying deformation as a Free-Form Deformation (FFD). MI is sensitive to the variation of the intensity due to equidistant bins. We overcome this disadvantage by designing a Top-to-Down K-means clustering method to naturally group similar intensities into one bin. The experiment shows this method can increase the accuracy of the MI-based registration.;In image registration, a finite element biomechanical model is usually employed to simulate the underlying movement of the soft tissue. We develop a multi-tissue mesh generation method to build a heterogeneous biomechanical model to realistically simulate the underlying movement of the brain. We focus on the following four critical mesh properties: tissue-dependent resolution, fidelity to tissue boundaries, smoothness of mesh surfaces, and element quality. Each mesh property can be controlled on a tissue level. The experiments on comparing the homogeneous model with the heterogeneous model demonstrate the effectiveness of the heterogeneous model in improving the registration accuracy

Efficient dense non-rigid registration using the free-form deformation framework

Medical image registration consists of finding spatial correspondences between two images or more. It is a powerful tool which is commonly used in various medical image processing tasks. Even though medical image registration has been an active topic of research for the last two decades, significant challenges in the field remain to be solved. This thesis addresses some of these challenges through extensions to the Free-Form Deformation (FFD) registration framework, which is one of the most widely used and well-established non-rigid registration algorithm. Medical image registration is a computationally expensive task because of the high degrees of freedom of the non-rigid transformations. In this work, the FFD algorithm has been re-factored to enable fast processing, while maintaining the accuracy of the results. In addition, parallel computing paradigms have been employed to provide near real-time image registration capabilities. Further modifications have been performed to improve the registration robustness to artifacts such as tissues non-uniformity. The plausibility of the generated deformation field has been improved through the use of bio-mechanical models based regularization. Additionally, diffeomorphic extensions to the algorithm were also developed. The work presented in this thesis has been extensively validated using brain magnetic resonance imaging of patients diagnosed with dementia or patients undergoing brain resection. It has also been applied to lung X-ray computed tomography and imaging of small animals. Alongside with this thesis an open-source package, NiftyReg, has been developed to release the presented work to the medical imaging community