Exploiting Temporal Image Information in Minimally Invasive Surgery

Minimally invasive procedures rely on medical imaging instead of the surgeons direct vision. While preoperative images can be used for surgical planning and navigation, once the surgeon arrives at the target site real-time intraoperative imaging is needed. However, acquiring and interpreting these images can be challenging and much of the rich temporal information present in these images is not visible. The goal of this thesis is to improve image guidance for minimally invasive surgery in two main areas. First, by showing how high-quality ultrasound video can be obtained by integrating an ultrasound transducer directly into delivery devices for beating heart valve surgery. Secondly, by extracting hidden temporal information through video processing methods to help the surgeon localize important anatomical structures. Prototypes of delivery tools, with integrated ultrasound imaging, were developed for both transcatheter aortic valve implantation and mitral valve repair. These tools provided an on-site view that shows the tool-tissue interactions during valve repair. Additionally, augmented reality environments were used to add more anatomical context that aids in navigation and in interpreting the on-site video. Other procedures can be improved by extracting hidden temporal information from the intraoperative video. In ultrasound guided epidural injections, dural pulsation provides a cue in finding a clear trajectory to the epidural space. By processing the video using extended Kalman filtering, subtle pulsations were automatically detected and visualized in real-time. A statistical framework for analyzing periodicity was developed based on dynamic linear modelling. In addition to detecting dural pulsation in lumbar spine ultrasound, this approach was used to image tissue perfusion in natural video and generate ventilation maps from free-breathing magnetic resonance imaging. A second statistical method, based on spectral analysis of pixel intensity values, allowed blood flow to be detected directly from high-frequency B-mode ultrasound video. Finally, pulsatile cues in endoscopic video were enhanced through Eulerian video magnification to help localize critical vasculature. This approach shows particular promise in identifying the basilar artery in endoscopic third ventriculostomy and the prostatic artery in nerve-sparing prostatectomy. A real-time implementation was developed which processed full-resolution stereoscopic video on the da Vinci Surgical System

The pulsating brain: A review of experimental and clinical studies of intracranial pulsatility

The maintenance of adequate blood flow to the brain is critical for normal brain function; cerebral blood flow, its regulation and the effect of alteration in this flow with disease have been studied extensively and are very well understood. This flow is not steady, however; the systolic increase in blood pressure over the cardiac cycle causes regular variations in blood flow into and throughout the brain that are synchronous with the heart beat. Because the brain is contained within the fixed skull, these pulsations in flow and pressure are in turn transferred into brain tissue and all of the fluids contained therein including cerebrospinal fluid. While intracranial pulsatility has not been a primary focus of the clinical community, considerable data have accrued over the last sixty years and new applications are emerging to this day. Investigators have found it a useful marker in certain diseases, particularly in hydrocephalus and traumatic brain injury where large changes in intracranial pressure and in the biomechanical properties of the brain can lead to significant changes in pressure and flow pulsatility. In this work, we review the history of intracranial pulsatility beginning with its discovery and early characterization, consider the specific technologies such as transcranial Doppler and phase contrast MRI used to assess various aspects of brain pulsations, and examine the experimental and clinical studies which have used pulsatility to better understand brain function in health and with disease

Towards a better understanding of the impact of heart rate on the BOLD signal: a new method for physiological noise correction and its applications

Functional magnetic resonance imaging (fMRI) based on blood oxygenation level-dependent (BOLD) contrast allows non-invasive examination of brain activity and is widely used in the neuroimaging field. The BOLD contrast mechanism reflects hemodynamic changes resulting from a complex interplay of blood flow, blood volume, and oxygen consumption. Heart rate (HR) variations are the most intriguing and less understood physiological processes affecting the BOLD signal, as they are the result of a wide variety of interacting factors. The use of the response function that best models HR-induced signal changes, called cardiac response function (CRF), is an effective method to reduce HR noise in fMRI. However, current models of physiological noise correction based on CRF, i.e. canonical and individual, either do not take into account variations in HR between subjects, and are thus inadequate for cohorts with varying HR, or require time-consuming quality control of individual physiological recordings and derived CRFs. By analyzing a large cohort of healthy individuals, the results presented in this thesis show that different HRs influence the BOLD signal and their corresponding spectra differently. A further finding is that HR plays an essential role in determining the shape of the CRF. Slower HRs produce a smoothed CRF with a single well-defined maximum, while faster HRs cause a second maximum. Taking advantage of this dependence of the CRF on HR, a novel method is proposed to model HR-induced fluctuations in the BOLD signal more accurately than current approaches of physiological noise correction. This method, called HR-based CRF, consists of two CRFs: one for HRs below 68 bpm and one for HRs above this value. HR-based CRFs can be directly applied to the fMRI data without the time-consuming task of deriving a CRF for each subject while accounting for inter-subject variability in HR response

Catheter based magnetic resonance compatible perfusion probe

Thesis (S.M. and S.B.)--Massachusetts Institute of Technology, Dept. of Nuclear Science and Engineering, 2007.Includes bibliographical references (leaves 113-117).Neurosurgeons are using a thermal based technique to quantify brain perfusion. The thermal diffusion probe (TDP) technology measures perfusion in a relatively small volume of brain tissue. The neurosurgeon chooses the specific brain location and probe placement based on their clinical concern. When an early indication of compromised perfusion is detected by the TDP, it is generally necessary to confirm the local, absolute perfusion measurement taken with the TDP, with magnetic resonance (MR) perfusion imaging. MR perfusion imaging provides an excellent, but relative, global assessment of compromised tissue perfusion. Due to the many clinical and diagnostic benefits of real-time, absolute quantification of blood flow acquired by the TDP, there has been increased interest in having the TDP MR compatible. This thesis considers what it would take to render the TDP MR compatible in both the active and passive modes. The analysis considers effects of the EM field on the probe, and the probe on the MR image. The presence of cardiac and respiratory induced brain motion has been shown to provide an artifact in TDP-perfusion data. Consideration is given to ways in which to minimize this motion induced perfusion artifact.by Cara Lynn Toretta.S.M.and S.B

Frequency-specific network topologies in the resting human brain

A community is a set of nodes with dense inter-connections, while there are sparse connections between different communities. A hub is a highly connected node with high centrality. It has been shown that both communities and hubs exist simultaneously in the brain’s functional connectivity network, as estimated by correlations among low-frequency spontaneous fluctuations in functional magnetic resonance imaging (fMRI) signal changes (0.01–0.10 Hz). This indicates that the brain has a spatial organization that promotes both segregation and integration of information. Here, we demonstrate that frequency-specific network topologies that characterize segregation and integration also exist within this frequency range. In investigating the coherence spectrum among 87 brain regions, we found that two frequency bands, 0.01–0.03 Hz (very low frequency [VLF] band) and 0.07–0.09 Hz (low frequency [LF] band), mainly contributed to functional connectivity. Comparing graph theoretical indices for the VLF and LF bands revealed that the network in the former had a higher capacity for information segregation between identified communities than the latter. Hubs in the VLF band were mainly located within the anterior cingulate cortices, whereas those in the LF band were located in the posterior cingulate cortices and thalamus. Thus, depending on the timescale of brain activity, at least two distinct network topologies contributed to information segregation and integration. This suggests that the brain intrinsically has timescale-dependent functional organizations

Intracranial fluids dynamics: a quantitative evaluation by means of phase-contrast magnetic resonance imaging

El volumen intracraneal lo integran el volumen de líquido cefalorraquídeo (LCR), el de la sangre y el del parénquima cerebral. La entrada de sangre al cráneo en la sístole incrementa el volumen intracraneal. Según la ley de Monroe-Kellie debe ocurrir una descompensación en los volúmenes restantes para mantener constante el volumen total. Los desequilibrios que se producen en este proceso de la homeostasis cerebral se han asociado tanto a enfermedades neurodegenerativas como a cerebrovasculares. Por tanto, es necesario contar con metodologías adecuadas para analizar la dinámica de los fluidos intracraneales (LCR y sangre). Las secuencias dinámicas de resonancia magnética en contraste de fase (RM-CF) con sincronismo cardíaco permiten cuantificar el flujo de LCR y de sangre durante un ciclo cardíaco. La medición de flujo mediante secuencias de RM-CF es precisa y reproducible siempre que se use un protocolo de adquisición adecuado. La reproducibilidad y exactitud de las medidas dependen también del uso de técnicas adecuadas de posproceso que permitan segmentar las regiones de interés (ROI) independientemente del operador y admitan corregir los errores de fondo introducidos por la supresión imperfecta de las corrientes inducidas y la contribución a la señal de los pequeños movimientos que presenta el mesencéfalo por la transmisión del pulso vascular así como el submuestreo (aliasing), reflejado como un cambio abrupto y opuesto del sentido original del flujo. Estas técnicas de análisis deben también tener en cuenta los errores relacionados con el efecto de volumen parcial (EVP), causado por la presencia de tejido estacionario y de flujo en el interior de los vóxeles de la periferia de la región a estudiar El objetivo principal de esta tesis es desarrollar una metodología reproducible para evaluar cuantitativamente la dinámica de los fluidos intracraneales dentro de espacios de LCR (acueducto de Silvio, cisterna prepontina y espacio perimedular C2C3) y principales vaFlórez Ordóñez, YN. (2009). Intracranial fluids dynamics: a quantitative evaluation by means of phase-contrast magnetic resonance imaging [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/6029Palanci

Combining navigator and optical prospective motion correction for high-quality 500 μm resolution quantitative multi-parameter mapping at 7T

Purpose: High-resolution quantitative multi-parameter mapping shows promise for non-invasively characterizing human brain microstructure but is limited by physiological artifacts. We implemented corrections for rigid head movement and respiration-related B0-fluctuations and evaluated them in healthy volunteers and dementia patients. Methods: Camera-based optical prospective motion correction (PMC) and FID navigator correction were implemented in a gradient and RF-spoiled multi-echo 3D gradient echo sequence for mapping proton density (PD), longitudinal relaxation rate (R1) and effective transverse relaxation rate (R2*). We studied their effectiveness separately and in concert in young volunteers and then evaluated the navigator correction (NAVcor) with PMC in a group of elderly volunteers and dementia patients. We used spatial homogeneity within white matter (WM) and gray matter (GM) and scan-rescan measures as quality metrics. Results: NAVcor and PMC reduced artifacts and improved the homogeneity and reproducibility of parameter maps. In elderly participants, NAVcor improved scan-rescan reproducibility of parameter maps (coefficient of variation decreased by 14.7% and 11.9% within WM and GM respectively). Spurious inhomogeneities within WM were reduced more in the elderly than in the young cohort (by 9% vs. 2%). PMC increased regional GM/WM contrast and was especially important in the elderly cohort, which moved twice as much as the young cohort. We did not find a significant interaction between the two corrections. Conclusion: Navigator correction and PMC significantly improved the quality of PD, R1, and R2* maps, particularly in less compliant elderly volunteers and dementia patients. <br

Correlation time diffusion coefficient age related dependency: from 6 months to 24 years old

Diffusion MRI is established as an essential tool for both clinicians as well as biomedical scientists. Its application plays an important role in diagnosis and management of acute stroke, tumors, trauma, and infectious disease, among myriad other applications. Furthermore, diffusion studies are crucial for understanding disease processes caused by developmental and neurodegenerative disorders. The latest developments in quantitative diffusion imaging have broadened the potential application of the technique for both clinical and research applications. However, ongoing research is critical in order to further improve the accuracy and reproducibility of quantitative diffusion MRI techniques. Correlation time diffusion (D-CT) is emerging as an alternative technique for obtaining diffusion qMRI data[1][2][3]. Using the D-CT technique, T1 relaxation data is analyzed, using a modified BPP relaxation theory, in order to calculate the correlation times of protons’ stochastic processes and relate these times to solution viscosity in order to calculate proton diffusion coefficients, ADCs. The purpose of our study was to compare age related changes, during childhood and early adulthood, of global brain diffusion coefficients obtained by correlation time technique to global brain diffusion coefficients obtained by a conventional pulsed field gradient technique. In our study, we used the data of 27 subjects (0.5-24 years old), who were scanned with Mixed-TSE and DW-SS-SE-EPI pulse sequences. Subsequently, we processed the resulting directly acquired images to generate T1, T2, PD, ADC maps as well as volumetric data. We used the student t-test and linear regression analysis to compare and interpret our data. Our results show a strong positive correlation between the volumetric data. Good correlation between ADC values was observed, with the widest discrepancy between DCT, DPFG (about 17%) observed in the youngest subjects, and the smallest discrepancy noted in the older subjects

Combining navigator and optical prospective motion correction for high-quality 500 μm resolution quantitative multi-parameter mapping at 7T

PURPOSE: High-resolution quantitative multi-parameter mapping shows promise for non-invasively characterizing human brain microstructure but is limited by physiological artifacts. We implemented corrections for rigid head movement and respiration-related B0-fluctuations and evaluated them in healthy volunteers and dementia patients. METHODS: Camera-based optical prospective motion correction (PMC) and FID navigator correction were implemented in a gradient and RF-spoiled multi-echo 3D gradient echo sequence for mapping proton density (PD), longitudinal relaxation rate (R1) and effective transverse relaxation rate (R2*). We studied their effectiveness separately and in concert in young volunteers and then evaluated the navigator correction (NAVcor) with PMC in a group of elderly volunteers and dementia patients. We used spatial homogeneity within white matter (WM) and gray matter (GM) and scan-rescan measures as quality metrics. RESULTS: NAVcor and PMC reduced artifacts and improved the homogeneity and reproducibility of parameter maps. In elderly participants, NAVcor improved scan-rescan reproducibility of parameter maps (coefficient of variation decreased by 14.7% and 11.9% within WM and GM respectively). Spurious inhomogeneities within WM were reduced more in the elderly than in the young cohort (by 9% vs. 2%). PMC increased regional GM/WM contrast and was especially important in the elderly cohort, which moved twice as much as the young cohort. We did not find a significant interaction between the two corrections. CONCLUSION: Navigator correction and PMC significantly improved the quality of PD, R1, and R2* maps, particularly in less compliant elderly volunteers and dementia patients

ICP curve morphology and intracranial flow-volume changes: a simultaneous ICP and cine phase contrast MRI study in humans

Background: The intracranial pressure (ICP) curve with its different peaks has been extensively studied, but the exact physiological mechanisms behind its morphology are still not fully understood. Both intracranial volume change (ΔICV) and transmission of the arterial blood pressure have been proposed to shape the ICP curve. This study tested the hypothesis that the ICP curve correlates to intracranial volume changes. Methods: Cine phase contrast magnetic resonance imaging (MRI) examinations were performed in neuro-intensive care patients with simultaneous ICP monitoring. The MRI was set to examine cerebral arterial inflow and venous cerebral outflow as well as flow of cerebrospinal fluid over the foramen magnum. The difference in total flow into and out from the cranial cavity (Flowtot) over time provides the ΔICV. The ICP curve was compared to the Flowtot and the ΔICV. Correlations were calculated through linear and logarithmic regression. Student’s t test was used to test the null hypothesis between paired samples. Results: Excluding the initial ICP wave, P1, the mean R2 for the correlation between the ΔICV and the ICP was 0.75 for the exponential expression, which had a higher correlation than the linear (p = 0.005). The first ICP peaks correlated to the initial peaks of Flowtot with a mean R2 = 0.88. Conclusion: The first part, or the P1, of the ICP curve seems to be created by the first rapid net inflow seen in Flowtot while the rest of the ICP curve seem to correlate to the ΔICV