Neuroimaging of structural pathology and connectomics in traumatic brain injury: Toward personalized outcome prediction.

Recent contributions to the body of knowledge on traumatic brain injury (TBI) favor the view that multimodal neuroimaging using structural and functional magnetic resonance imaging (MRI and fMRI, respectively) as well as diffusion tensor imaging (DTI) has excellent potential to identify novel biomarkers and predictors of TBI outcome. This is particularly the case when such methods are appropriately combined with volumetric/morphometric analysis of brain structures and with the exploration of TBI-related changes in brain network properties at the level of the connectome. In this context, our present review summarizes recent developments on the roles of these two techniques in the search for novel structural neuroimaging biomarkers that have TBI outcome prognostication value. The themes being explored cover notable trends in this area of research, including (1) the role of advanced MRI processing methods in the analysis of structural pathology, (2) the use of brain connectomics and network analysis to identify outcome biomarkers, and (3) the application of multivariate statistics to predict outcome using neuroimaging metrics. The goal of the review is to draw the community's attention to these recent advances on TBI outcome prediction methods and to encourage the development of new methodologies whereby structural neuroimaging can be used to identify biomarkers of TBI outcome

Visual and Contextual Modeling for the Detection of Repeated Mild Traumatic Brain Injury.

Currently, there is a lack of computational methods for the evaluation of mild traumatic brain injury (mTBI) from magnetic resonance imaging (MRI). Further, the development of automated analyses has been hindered by the subtle nature of mTBI abnormalities, which appear as low contrast MR regions. This paper proposes an approach that is able to detect mTBI lesions by combining both the high-level context and low-level visual information. The contextual model estimates the progression of the disease using subject information, such as the time since injury and the knowledge about the location of mTBI. The visual model utilizes texture features in MRI along with a probabilistic support vector machine to maximize the discrimination in unimodal MR images. These two models are fused to obtain a final estimate of the locations of the mTBI lesion. The models are tested using a novel rodent model of repeated mTBI dataset. The experimental results demonstrate that the fusion of both contextual and visual textural features outperforms other state-of-the-art approaches. Clinically, our approach has the potential to benefit both clinicians by speeding diagnosis and patients by improving clinical care

Computer-aided segmentation and estimation of indices in brain CT scans

The importance of neuro-imaging as one of the biomarkers for diagnosis and prognosis of pathologies and traumatic cases is well established. Doctors routinely perform linear measurements on neuro-images to ascertain severity and extent of the pathology or trauma from significant anatomical changes. However, it is a tedious and time consuming process and manually assessing and reporting on large volume of data is fraught with errors and variation. In this paper we present a novel technique for segmentation of significant anatomical landmarks using artificial neural networks and estimation of various ratios and indices performed on brain CT scans. The proposed method is efficient and robust in detecting and measuring sizes of anatomical structures on non-contrast CT scans and has been evaluated on images from subjects with ages between 5 to 85 years. Results show that our method has average ICC of ≥0.97 and, hence, can be used in processing data for further use in research and clinical environment

Bioengineering Analysis of Traumatic Brain Injury

Traumatic brain injury (TBI) is a serious health concern affecting over a million people in the UK. Brain shift and herniation, which are closely related to severe disability or death, are important signs of abnormally elevated intracranial pressure (ICP) or space-occupying intracranial mass after trauma. This research aims to use medical image computing and biomechanical modelling techniques to characterise the specific deformation field of brain tissues under various TBI scenarios and strengthen the biomechanical understanding across the full spectrum of TBI. Medical image computing provides the research with a solid clinical grounding. To better interpret the neuro-images, three computational tools have been developed, including a CT preprocessing pipeline, an automatic mid-sagittal plane detector and an automatic brain extractor. Using these tools, a novel concept of midplane shift (MPS) is developed to quantitatively evaluate the brain herniation condition across the mid-sagittal plane. In the meantime, a lesion heatmap is generated to quantify the asymmetric haematoma volumes across the mid-sagittal plane. The MPS heatmaps generated for 33 TBI patients with heterogeneous brain pathologies demonstrate highly similar shift patterns. Together with the lesion heatmap, a brain deformation mechanism has been presented: the brain will not deform randomly in response to trauma, instead, it will only deform in a regulated mechanism so that the deformation is directed and restricted to the soft ventricular region, thanks to the anatomic structures of the head such as the falx. The MPS heatmap, the lesion heatmap, together with the novel CT parameters derived from them, provide a rich abundance of information on intracranial brain herniation, for a more complete overview of TBI from medical images. Biomechanical modelling, being one of the most important tools in trauma biomechanics, has been used to quantitatively simulate the brain shift and herniation condition caused by various intracranial lesions and increasing ICP. Preliminary finite element models reconstructed from the Virtual Human Project have demonstrated some limitations. To resolve the observed deficiencies, an advanced high-fidelity patient-specific FE brain model is constructed and explicitly assessed to optimise its injury simulation performance with the help of the developed medical image computing tools. During simulation, the patient-specific traumatic injuries have been reconstructed by imposing both the primary lesion and the secondary injury. The primary lesion simulation is achieved mechanically by ``indenting" a rigid lesion surface simulating the shape of the haematoma to the brain model. While the secondary swelling is modelled with a thermal-expansion-based method to simulate the bulging brain. Using this approach, the observed brain herniation can be decomposed into a deformation due to pure mass effect of space-occupying primary lesion and a shift as a result of secondary swelling. The head injuries of six different TBI patients have been reconstructed and simulated using the prescribed method. The realistic case study suggested that the subdural haematoma patients, as compared to the epidural haematoma patients, were exposed to more significant secondary swelling, which agrees well with the historical clinical findings. In addition to the realistic TBI case studies, an idealised traumatic lesion simulation is performed to investigate the role of lesion morphology and the lesion locations of onsets, in brain herniations during TBI. It is suggested by the idealised TBI cases that the brain is more sensitive to lesion that is more concentrated spatially, if lesion volumes and lesion locations were exactly the same. Moreover, in terms of lesion locations, lesions that strikes on the temporal region and the anterior region are more likely to lead to greater brain deformation, if other lesion morphologies were equal and no secondary swelling considered. Ultimately, the developed tools are expected to help clinicians better understand and predict the brain behaviour after the onset of TBI and during subsequent injury evolution.WD Armstrong Trus

Automated ventricular systems segmentation in brain CT images by combining low-level segmentation and high-level template matching

<p>Abstract</p> <p>Background</p> <p>Accurate analysis of CT brain scans is vital for diagnosis and treatment of Traumatic Brain Injuries (TBI). Automatic processing of these CT brain scans could speed up the decision making process, lower the cost of healthcare, and reduce the chance of human error. In this paper, we focus on automatic processing of CT brain images to segment and identify the ventricular systems. The segmentation of ventricles provides quantitative measures on the changes of ventricles in the brain that form vital diagnosis information.</p> <p>Methods</p> <p>First all CT slices are aligned by detecting the ideal midlines in all images. The initial estimation of the ideal midline of the brain is found based on skull symmetry and then the initial estimate is further refined using detected anatomical features. Then a two-step method is used for ventricle segmentation. First a low-level segmentation on each pixel is applied on the CT images. For this step, both Iterated Conditional Mode (ICM) and Maximum A Posteriori Spatial Probability (MASP) are evaluated and compared. The second step applies template matching algorithm to identify objects in the initial low-level segmentation as ventricles. Experiments for ventricle segmentation are conducted using a relatively large CT dataset containing mild and severe TBI cases.</p> <p>Results</p> <p>Experiments show that the acceptable rate of the ideal midline detection is over 95%. Two measurements are defined to evaluate ventricle recognition results. The first measure is a sensitivity-like measure and the second is a false positive-like measure. For the first measurement, the rate is 100% indicating that all ventricles are identified in all slices. The false positives-like measurement is 8.59%. We also point out the similarities and differences between ICM and MASP algorithms through both mathematically relationships and segmentation results on CT images.</p> <p>Conclusion</p> <p>The experiments show the reliability of the proposed algorithms. The novelty of the proposed method lies in its incorporation of anatomical features for ideal midline detection and the two-step ventricle segmentation method. Our method offers the following improvements over existing approaches: accurate detection of the ideal midline and accurate recognition of ventricles using both anatomical features and spatial templates derived from Magnetic Resonance Images.</p

AUTOMATED MIDLINE SHIFT DETECTION ON BRAIN CT IMAGES FOR COMPUTER-AIDED CLINICAL DECISION SUPPORT

Midline shift (MLS), the amount of displacement of the brain’s midline from its normal symmetric position due to illness or injury, is an important index for clinicians to assess the severity of traumatic brain injury (TBI). In this dissertation, an automated computer-aided midline shift estimation system is proposed. First, a CT slice selection algorithm (SSA) is designed to automatically select a subset of appropriate CT slices from a large number of raw images for MLS detection. Next, ideal midline detection is implemented based on skull bone anatomical features and global rotation assumptions. For the actual midline detection algorithm, a window selection algorithm (WSA) is applied first to confine the region of interest, then the variational level set method is used to segment the image and extract the ventricle contours. With a ventricle identification algorithm (VIA), the position of actual midline is detected based on the identified right and left lateral ventricle contours. Finally, the brain midline shift is calculated using the positions of detected ideal midline and actual midline. One of the important applications of midline shift in clinical medical decision making is to estimate the intracranial pressure (ICP). ICP monitoring is a standard procedure in the care of severe traumatic brain injury (TBI) patients. An automated ICP level prediction model based on machine learning method is proposed in this work. Multiple features, including midline shift, intracranial air cavities, ventricle size, texture patterns, and blood amount, are used in the ICP level prediction. Finally, the results are evaluated to assess the effectiveness of the proposed method in ICP level prediction

Computer aided assessment of CT scans of traumatic brain injury patients

A thesis submitted in partial fulfilment for the degree of Doctor of PhilosophyOne of the serious public health problems is the Traumatic Brain Injury, also known as silent epidemic, affecting millions every year. Management of these patients essentially involves neuroimaging and noncontrast CT scans are the first choice amongst doctors. Significant anatomical changes identified on the neuroimages and volumetric assessment of haemorrhages and haematomas are of critical importance for assessing the patients’ condition for targeted therapeutic and/or surgical interventions. Manual demarcation and annotation by experts is still considered gold standard, however, the interpretation of neuroimages is fraught with inter-observer variability and is considered ’Achilles heel’ amongst radiologists. Errors and variability can be attributed to factors such as poor perception, inaccurate deduction, incomplete knowledge or the quality of the image and only a third of doctors confidently report the findings. The applicability of computer aided dianosis in segmenting the apposite regions and giving ’second opinion’ has been positively appraised to assist the radiologists, however, results of the approaches vary due to parameters of algorithms and manual intervention required from doctors and this presents a gap for automated segmentation and estimation of measurements of noncontrast brain CT scans. The Pattern Driven, Content Aware Active Contours (PDCAAC) Framework developed in this thesis provides robust and efficient segmentation of significant anatomical landmarks, estimations of their sizes and correlation to CT rating to assist the radiologists in establishing the diagnosis and prognosis more confidently. The integration of clinical profile of the patient into image segmentation algorithms has significantly improved their performance by highlighting characteristics of the region of interest. The modified active contour method in the PDCAAC framework achieves Jaccard Similarity Index (JI) of 0.87, which is a significant improvement over the existing methods of active contours achieving JI of 0.807 with Simple Linear Iterative Clustering and Distance Regularized Level Set Evolution. The Intraclass Correlation Coefficient of intracranial measurements is >0.97 compared with radiologists. Automatic seeding of the initial seed curve within the region of interest is incorporated into the method which is a novel approach and alleviates limitation of existing methods. The proposed PDCAAC framework can be construed as a contribution towards research to formulate correlations between image features and clinical variables encompassing normal development, ageing, pathological and traumatic cases propitious to improve management of such patients. Establishing prognosis usually entails survival but the focus can also be extended to functional outcomes, residual disability and quality of life issues

Neuroimaging of structural pathology and connectomics in traumatic brain injury: Toward personalized outcome prediction☆

Recent contributions to the body of knowledge on traumatic brain injury (TBI) favor the view that multimodal neuroimaging using structural and functional magnetic resonance imaging (MRI and fMRI, respectively) as well as diffusion tensor imaging (DTI) has excellent potential to identify novel biomarkers and predictors of TBI outcome. This is particularly the case when such methods are appropriately combined with volumetric/morphometric analysis of brain structures and with the exploration of TBI-related changes in brain network properties at the level of the connectome. In this context, our present review summarizes recent developments on the roles of these two techniques in the search for novel structural neuroimaging biomarkers that have TBI outcome prognostication value. The themes being explored cover notable trends in this area of research, including (1) the role of advanced MRI processing methods in the analysis of structural pathology, (2) the use of brain connectomics and network analysis to identify outcome biomarkers, and (3) the application of multivariate statistics to predict outcome using neuroimaging metrics. The goal of the review is to draw the community's attention to these recent advances on TBI outcome prediction methods and to encourage the development of new methodologies whereby structural neuroimaging can be used to identify biomarkers of TBI outcome