Improving the Tractography Pipeline: on Evaluation, Segmentation, and Visualization

Recent advances in tractography allow for connectomes to be constructed in vivo. These have applications for example in brain tumor surgery and understanding of brain development and diseases. The large size of the data produced by these methods lead to a variety problems, including how to evaluate tractography outputs, development of faster processing algorithms for tractography and clustering, and the development of advanced visualization methods for verification and exploration. This thesis presents several advances in these fields. First, an evaluation is presented for the robustness to noise of multiple commonly used tractography algorithms. It employs a Monte–Carlo simulation of measurement noise on a constructed ground truth dataset. As a result of this evaluation, evidence for obustness of global tractography is found, and algorithmic sources of uncertainty are identified. The second contribution is a fast clustering algorithm for tractography data based on k–means and vector fields for representing the flow of each cluster. It is demonstrated that this algorithm can handle large tractography datasets due to its linear time and memory complexity, and that it can effectively integrate interrupted fibers that would be rejected as outliers by other algorithms. Furthermore, a visualization for the exploration of structural connectomes is presented. It uses illustrative rendering techniques for efficient presentation of connecting fiber bundles in context in anatomical space. Visual hints are employed to improve the perception of spatial relations. Finally, a visualization method with application to exploration and verification of probabilistic tractography is presented, which improves on the previously presented Fiber Stippling technique. It is demonstrated that the method is able to show multiple overlapping tracts in context, and correctly present crossing fiber configurations

Interactive Visualization of Multimodal Brain Connectivity: Applications in Clinical and Cognitive Neuroscience

Magnetic resonance imaging (MRI) has become a readily available prognostic and diagnostic method, providing invaluable information for the clinical treatment of neurological diseases. Multimodal neuroimaging allows integration of complementary data from various aspects such as functional and anatomical properties; thus, it has the potential to overcome the limitations of each individual modality. Specifically, functional and diffusion MRI are two non-invasive neuroimaging techniques customized to capture brain activity and microstructural properties, respectively. Data from these two modalities is inherently complex, and interactive visualization can assist with data comprehension. The current thesis presents the design, development, and validation of visualization and computation approaches that address the need for integration of brain connectivity from functional and structural domains. Two contexts were considered to develop these approaches: neuroscience exploration and minimally invasive neurosurgical planning. The goal was to provide novel visualization algorithms and gain new insights into big and complex data (e.g., brain networks) by visual analytics. This goal was achieved through three steps: 3D Graphical Collision Detection: One of the primary challenges was the timely rendering of grey matter (GM) regions and white matter (WM) fibers based on their 3D spatial maps. This challenge necessitated pre-scanning those objects to generate a memory array containing their intersections with memory units. This process helped faster retrieval of GM and WM virtual models during the user interactions. Neuroscience Enquiry (MultiXplore): A software interface was developed to display and react to user inputs by means of a connectivity matrix. This matrix displays connectivity information and is capable to accept selections from users and display the relevant ones in 3D anatomical view (with associated anatomical elements). In addition, this package can load multiple matrices from dynamic connectivity methods and annotate brain fibers. Neurosurgical Planning (NeuroPathPlan): A computational method was provided to map the network measures to GM and WM; thus, subject-specific eloquence metric can be derived from related resting state networks and used in objective assessment of cortical and subcortical tissue. This metric was later compared to apriori knowledge based decisions from neurosurgeons. Preliminary results show that eloquence metric has significant similarities with expert decisions

A hitchhiker's guide to diffusion tensor imaging

Diffusion Tensor Imaging (DTI) studies are increasingly popular among clinicians and researchers as they provide unique insights into brain network connectivity. However, in order to optimize the use of DTI, several technical and methodological aspects must be factored in. These include decisions on: acquisition protocol, artifact handling, data quality control, reconstruction algorithm, and visualization approaches, and quantitative analysis methodology. Furthermore, the researcher and/or clinician also needs to take into account and decide on the most suited software tool(s) for each stage of the DTI analysis pipeline. Herein, we provide a straightforward hitchhiker's guide, covering all of the workflow's major stages. Ultimately, this guide will help newcomers navigate the most critical roadblocks in the analysis and further encourage the use of DTI.The work was supported by SwitchBox-FP7-HEALTH-2010-grant 259772-2. The authors acknowledge Nadine Santos for her help in editing the manuscript

Doctor of Philosophy

dissertationDiffusion magnetic resonance imaging (dMRI) has become a popular technique to detect brain white matter structure. However, imaging noise, imaging artifacts, and modeling techniques, etc., create many uncertainties, which may generate misleading information for further analysis or applications, such as surgical planning. Therefore, how to analyze, effectively visualize, and reduce these uncertainties become very important research questions. In this dissertation, we present both rank-k decomposition and direct decomposition approaches based on spherical deconvolution to decompose the fiber directions more accurately for high angular resolution diffusion imaging (HARDI) data, which will reduce the uncertainties of the fiber directions. By applying volume rendering techniques to an ensemble of 3D orientation distribution function (ODF) glyphs, which we call SIP functions of diffusion shapes, one can elucidate the complex heteroscedastic structural variation in these local diffusion shapes. Furthermore, we quantify the extent of this variation by measuring the fraction of the volume of these shapes, which is consistent across all noise levels, the certain volume ratio. To better understand the uncertainties in white matter fiber tracks, we propose three metrics to quantify the differences between the results of diffusion tensor magnetic resonance imaging (DT-MRI) fiber tracking algorithms: the area between corresponding fibers of each bundle, the Earth Mover's Distance (EMD) between two fiber bundle volumes, and the current distance between two fiber bundle volumes. Based on these metrics, we discuss an interactive fiber track comparison visualization toolkit we have developed to visualize these uncertainties more efficiently. Physical phantoms, with high repeatability and reproducibility, are also designed with the hope of validating the dMRI techniques. In summary, this dissertation provides a better understanding about uncertainties in diffusion magnetic resonance imaging: where and how much are the uncertainties? How do we reduce these uncertainties? How can we possibly validate our algorithms

Visualisation en imagerie par résonance magnétique de diffusion : tractographie en temps réel des fibres de la matière blanche du cerveau

L'imagerie par résonance magnétique de diffusion est une technique non-invasive permettant de mesurer la diffusion des molécules d'eau selon plusieurs directions. Le résultat d'une telle acquisition contient de l'information implicite sur les structures microbiologiques qui composent le cerveau humain. La tractographie consiste à déterminer et visualiser, en trois dimensions, l'ensemble des connections neuronales de la matière blanche du cerveau en suivant la diffusion préférentielle de l'eau présente en chaque voxel. Les fibres de la matière blanche sont responsables de connecter les différentes aires fonctionnelles du cerveau entre-elles. En présence d'une tumeur, elles peuvent se réorganiser de multiples façons et refaire des connections pour assurer le suivi des fonctions importantes. L'imagerie du câblage cérébral est utilisée lors d'interventions neurochirurgicales afin d'aider le neurochirurgien à planifier son angle d'attaque pour réséquer le maximum de la tumeur sans léser la fonction du patient. La tractographie prend donc tout son sens pour le neurochirurgien avant et pendant l'opération. Dans ce mémoire, il sera question de tractographie en temps réel. La plupart des algorithmes de tractographie utilisent des paramètres fixes et prédéfinis pour l'ensemble du cerveau. Nous croyons que ces paramètres devraient être accessibles et modifiables afin de voir l'impact que ceux-ci ont sur la reconstruction des connections cérébrales. Nous proposons une méthode de visualisation de fibres en temps réel, permettant de calculer et d'afficher instantanément le résultat d'un nouvel algorithme de tractographie qui sera confronté aux méthodes existantes. Le nouveau module permet d'effectuer la tractographie des fibres de la matière blanche de manière interactive en offrant la possibilité d'ajuster les paramètres impliqués dans le processus de tractographie. Il a notamment été introduit plus d'une vingtaine de fois lors d'interventions neurochirurgicales au Centre Hospitalier Universitaire de Sherbrooke, grâce à la supervision du Dr. David Fortin. La tractographie en temps réel a changé la manière dont les données sont préparées en vue d'une intervention en bloc opératoire. Dans un contexte où le temps entre le traitement des données et l'intervention chirurgicale est une contrainte majeure, l'élimination de l'étape de tractographie du processus de prétraitement est un avantage non-négligeable

Towards Individualized Transcranial Electric Stimulation Therapy through Computer Simulation

Transkranielle Elektrostimulation (tES) beschreibt eine Gruppe von Hirnstimulationstechniken, die einen schwachen elektrischen Strom über zwei nicht-invasiv am Kopf angebrachten Elektroden applizieren. Handelt es sich dabei um einen Gleichstrom, spricht man von transkranieller Gleichstromstimulation, auch tDCS abgekürzt. Die allgemeine Zielstellung aller Hirnstimulationstechniken ist Hirnfunktion durch ein Verstärken oder Dämpfen von Hirnaktivität zu beeinflussen. Unter den Stimulationstechniken wird die transkranielle Gleichstromstimulation als ein adjuvantes Werkzeug zur Unterstützung der mikroskopischen Reorganisation des Gehirnes in Folge von Lernprozessen und besonders der Rehabilitationstherapie nach einem Schlaganfall untersucht. Aktuelle Herausforderungen dieser Forschung sind eine hohe Variabilität im erreichten Stimulationseffekt zwischen den Probanden sowie ein unvollständiges Verständnis des Zusammenspiels der der Stimulation zugrundeliegenden Mechanismen. Als Schlüsselkomponente für das Verständnis der Stimulationsmechanismen wird das zwischen den Elektroden im Kopf des Probanden aufgebaute elektrische Feld erachtet. Einem grundlegenden Konzept folgend wird angenommen, dass Hirnareale, die einer größeren elektrischen Feldstärke ausgesetzt sind, ebenso einen höheren Stimulationseffekt erfahren. Damit kommt der Positionierung der Elektroden eine entscheidende Rolle für die Stimulation zu. Allerdings verteilt sich das elektrische Feld wegen des heterogenen elektrischen Leitfähigkeitsprofil des menschlichen Kopfes nicht uniform im Gehirn der Probanden. Außerdem ist das Verteilungsmuster auf Grund anatomischer Unterschiede zwischen den Probanden verschieden. Die triviale Abschätzung der Ausbreitung des elektrischen Feldes anhand der bloßen Position der Stimulationselektroden ist daher nicht ausreichend genau für eine zielgerichtete Stimulation. Computerbasierte, biophysikalische Simulationen der transkraniellen Elektrostimulation ermöglichen die individuelle Approximation des Verteilungsmusters des elektrischen Feldes in Probanden basierend auf deren medizinischen Bildgebungsdaten. Sie werden daher zunehmend verwendet, um tDCS-Anwendungen zu planen und verifizieren, und stellen ein wesentliches Hilfswerkzeug auf dem Weg zu individualisierter Schlaganfall-Rehabilitationstherapie dar. Softwaresysteme, die den dahinterstehenden individualisierten Verarbeitungsprozess erleichtern und für ein breites Feld an Forschern zugänglich machen, wurden in den vergangenen Jahren für den Anwendungsfall in gesunden Erwachsenen entwickelt. Jedoch bleibt die Simulation von Patienten mit krankhaftem Hirngewebe und strukturzerstörenden Läsionen eine nicht-triviale Aufgabe. Daher befasst sich das hier vorgestellte Projekt mit dem Aufbau und der praktischen Anwendung eines Arbeitsablaufes zur Simulation transkranieller Elektrostimulation. Dabei stand die Anforderung im Vordergrund medizinische Bildgebungsdaten insbesondere neurologischer Patienten mit krankhaft verändertem Hirngewebe verarbeiten zu können. Der grundlegende Arbeitsablauf zur Simulation wurde zunächst für gesunde Erwachsene entworfen und validiert. Dies umfasste die Zusammenstellung medizinischer Bildverarbeitungsalgorithmen zu einer umfangreichen Verarbeitungskette, um elektrisch relevante Strukturen in den Magnetresonanztomographiebildern des Kopfes und des Oberkörpers der Probanden zu identifizieren und zu extrahieren. Die identifizierten Strukturen mussten in Computermodelle überführt werden und das zugrundeliegende, physikalische Problem der elektrischen Volumenleitung in biologischen Geweben mit Hilfe numerischer Simulation gelöst werden. Im Verlauf des normalen Alterns ist das Gehirn strukturellen Veränderungen unterworfen, unter denen ein Verlust des Hirnvolumens sowie die Ausbildung mikroskopischer Veränderungen seiner Nervenfaserstruktur die Bedeutendsten sind. In einem zweiten Schritt wurde der Arbeitsablauf daher erweitert, um diese Phänomene des normalen Alterns zu berücksichtigen. Die vordergründige Herausforderung in diesem Teilprojekt war die biophysikalische Modellierung der veränderten Hirnmikrostruktur, da die resultierenden Veränderungen im Leitfähigkeitsprofil des Gehirns bisher noch nicht in der Literatur quantifiziert wurden. Die Erweiterung des Simulationsablauf zeichnete sich vorrangig dadurch aus, dass mit unsicheren elektrischen Leitfähigkeitswerten gearbeitet werden konnte. Damit war es möglich den Einfluss der ungenau bestimmbaren elektrischen Leitfähigkeit der verschiedenen biologischen Strukturen des menschlichen Kopfes auf das elektrische Feld zu ermitteln. In einer Simulationsstudie, in der Bilddaten von 88 Probanden einflossen, wurde die Auswirkung der veränderten Hirnfaserstruktur auf das elektrische Feld dann systematisch untersucht. Es wurde festgestellt, dass sich diese Gewebsveränderungen hochgradig lokal und im Allgemeinen gering auswirken. Schließlich wurden in einem dritten Schritt Simulationen für Schlaganfallpatienten durchgeführt. Ihre großen, strukturzerstörenden Läsionen wurden dabei mit einem höheren Detailgrad als in bisherigen Arbeiten modelliert und physikalisch abermals mit unsicheren Leitfähigkeiten gearbeitet, was zu unsicheren elektrischen Feldabschätzungen führte. Es wurden individuell berechnete elektrische Felddaten mit der Hirnaktivierung von 18 Patienten in Verbindung gesetzt, unter Berücksichtigung der inhärenten Unsicherheit in der Bestimmung der elektrischen Felder. Das Ziel war zu ergründen, ob die Hirnstimulation einen positiven Einfluss auf die Hirnaktivität der Patienten im Kontext von Rehabilitationstherapie ausüben und so die Neuorganisierung des Gehirns nach einem Schlaganfall unterstützen kann. Während ein schwacher Zusammenhang hergestellt werden konnte, sind weitere Untersuchungen nötig, um diese Frage abschließend zu klären.:Kurzfassung Abstract Contents 1 Overview 2 Anatomical structures in magnetic resonance images 2 Anatomical structures in magnetic resonance images 2.1 Neuroanatomy 2.2 Magnetic resonance imaging 2.3 Segmentation of MR images 2.4 Image morphology 2.5 Summary 3 Magnetic resonance image processing pipeline 3.1 Introduction to human body modeling 3.2 Description of the processing pipeline 3.3 Intermediate and final outcomes in two subjects 3.4 Discussion, limitations & future work 3.5 Conclusion 4 Numerical simulation of transcranial electric stimulation 4.1 Electrostatic foundations 4.2 Discretization of electrostatic quantities 4.3 The numeric solution process 4.4 Spatial discretization by volume meshing 4.5 Summary 5 Simulation workflow 5.1 Overview of tES simulation pipelines 5.2 My implementation of a tES simulation workflow 5.3 Verification & application examples 5.4 Discussion & Conclusion 6 Transcranial direct current stimulation in the aging brain 6.1 Handling age-related brain changes in tES simulations 6.2 Procedure of the simulation study 6.3 Results of the uncertainty analysis 6.4 Findings, limitations and discussion 7 Transcranial direct current stimulation in stroke patients 7.1 Bridging the gap between simulated electric fields and brain activation in stroke patients 7.2 Methodology for relating simulated electric fields to functional MRI data 7.3 Evaluation of the simulation study and correlation analysis 7.4 Discussion & Conclusion 8 Outlooks for simulations of transcranial electric stimulation List of Figures List of Tables Glossary of Neuroscience Terms Glossary of Technical Terms BibliographyTranscranial electric current stimulation (tES) denotes a group of brain stimulation techniques that apply a weak electric current over two or more non-invasively, head-mounted electrodes. When employing a direct-current, this method is denoted transcranial direct current stimulation (tDCS). The general aim of all tES techniques is the modulation of brain function by an up- or downregulation of brain activity. Among these, transcranial direct current stimulation is investigated as an adjuvant tool to promote processes of the microscopic reorganization of the brain as a consequence of learning and, more specifically, rehabilitation therapy after a stroke. Current challenges of this research are a high variability in the achieved stimulation effects across subjects and an incomplete understanding of the interplay between its underlying mechanisms. A key component to understanding the stimulation mechanism is considered the electric field, which is exerted by the electrodes and distributes in the subjects' heads. A principle concept assumes that brain areas exposed to a higher electric field strength likewise experience a higher stimulation. This attributes the positioning of the electrodes a decisive role for the stimulation. However, the electric field distributes non-uniformly across subjects' brains due to the heterogeneous electrical conductivity profile of the human head. Moreover, the distribution pattern is variable between subjects due to their individual anatomy. A trivial estimation of the distribution of the electric field solely based on the position of the stimulating electrodes is, therefore, not precise enough for a well-targeted stimulation. Computer-based biophysical simulations of transcranial electric stimulation enable the individual approximation of the distribution pattern of the electric field in subjects based on their medical imaging data. They are, thus, increasingly employed for the planning and verification of tDCS applications and constitute an essential tool on the way to individualized stroke rehabilitation therapy. Software pipelines facilitating the underlying individualized processing for a wide range of researchers have been developed for use in healthy adults over the past years, but, to date, the simulation of patients with abnormal brain tissue and structure disrupting lesions remains a non-trivial task. Therefore, the presented project was dedicated to establishing and practically applying a tES simulation workflow. The processing of medical imaging data of neurological patients with abnormal brain tissue was a central requirement in this process. The basic simulation workflow was first designed and validated for the simulation of healthy adults. This comprised compiling medical image processing algorithms into a comprehensive workflow to identify and extract electrically relevant physiological structures of the human head and upper torso from magnetic resonance images. The identified structures had to be converted to computational models. The underlying physical problem of electric volume conduction in biological tissue was solved by means of numeric simulation. Over the course of normal aging, the brain is subjected to structural alterations, among which a loss of brain volume and the development of microscopic alterations of its fiber structure are the most relevant. In a second step, the workflow was, thus, extended to incorporate these phenomena of normal aging. The main challenge in this subproject was the biophysical modeling of the altered brain microstructure as the resulting alterations to the conductivity profile of the brain were so far not quantified in the literature. Therefore, the augmentation of the workflow most notably included the modeling of uncertain electrical properties. With this, the influence of the uncertain electrical conductivity of the biological structures of the human head on the electric field could be assessed. In a simulation study, including imaging data of 88 subjects, the influence of the altered brain fiber structure on the electric field was then systematically investigated. These tissue alterations were found to exhibit a highly localized and generally low impact. Finally, in a third step, tDCS simulations of stroke patients were conducted. Their large, structure-disrupting lesions were modeled in a more detailed manner than in previous stroke simulation studies, and they were physically, again, modeled by uncertain electrical conductivity resulting in uncertain electric field estimates. Individually simulated electric fields were related to the brain activation of 18 patients, considering the inherently uncertain electric field estimations. The goal was to clarify whether the stimulation exerts a positive influence on brain function in the context of rehabilitation therapy supporting brain reorganization following a stroke. While a weak correlation could be established, further investigation will be necessary to answer that research question.:Kurzfassung Abstract Contents 1 Overview 2 Anatomical structures in magnetic resonance images 2 Anatomical structures in magnetic resonance images 2.1 Neuroanatomy 2.2 Magnetic resonance imaging 2.3 Segmentation of MR images 2.4 Image morphology 2.5 Summary 3 Magnetic resonance image processing pipeline 3.1 Introduction to human body modeling 3.2 Description of the processing pipeline 3.3 Intermediate and final outcomes in two subjects 3.4 Discussion, limitations & future work 3.5 Conclusion 4 Numerical simulation of transcranial electric stimulation 4.1 Electrostatic foundations 4.2 Discretization of electrostatic quantities 4.3 The numeric solution process 4.4 Spatial discretization by volume meshing 4.5 Summary 5 Simulation workflow 5.1 Overview of tES simulation pipelines 5.2 My implementation of a tES simulation workflow 5.3 Verification & application examples 5.4 Discussion & Conclusion 6 Transcranial direct current stimulation in the aging brain 6.1 Handling age-related brain changes in tES simulations 6.2 Procedure of the simulation study 6.3 Results of the uncertainty analysis 6.4 Findings, limitations and discussion 7 Transcranial direct current stimulation in stroke patients 7.1 Bridging the gap between simulated electric fields and brain activation in stroke patients 7.2 Methodology for relating simulated electric fields to functional MRI data 7.3 Evaluation of the simulation study and correlation analysis 7.4 Discussion & Conclusion 8 Outlooks for simulations of transcranial electric stimulation List of Figures List of Tables Glossary of Neuroscience Terms Glossary of Technical Terms Bibliograph

Rapid development of applications for the interactive visual analysis of multimodal medical data

Multimodale medizinische Volumendaten gewinnen zunehmend an Verbreitung. Wir diskutieren verschiedene interaktive Applikationen welche den Nutzer bei der Analyse dieser Daten unterstützen. Alle Applikationen basieren auf Erweiterungen des Voreen Frameworks, welche ebenfalls in dieser Dissertation diskutiert werden. With multimodal volumetric medical data sets becoming more common due to the increasing availability of scanning hardware, software for the visualization and analysis of such data sets needs to become more efficient as well in order to prevent overloading the user with data. This dissertation presents several interactive techniques for the visual analysis of medical volume data. All applications are based on extensions to the Voreen volume rendering framework, which we will discuss first. Since visual analysis applications are interactive by definition, we propose a general-purpose navigation technique for volume data. Next, we discuss our concepts for the interactive planning of brain tumor resections. Finally, we present two systems designed to work with images of vasculature. First, we discuss an interactive vessel segmentation system enabling an efficient, visually supported workflow. Second, we propose an application for the visual analysis of PET tracer uptake along vessels