Phase-field boundary conditions for the voxel finite cell method: surface-free stress analysis of CT-based bone structures

The voxel finite cell method employs unfitted finite element meshes and voxel quadrature rules to seamlessly transfer CT data into patient-specific bone discretizations. The method, however, still requires the explicit parametrization of boundary surfaces to impose traction and displacement boundary conditions, which constitutes a potential roadblock to automation. We explore a phase-field based formulation for imposing traction and displacement constraints in a diffuse sense. Its essential component is a diffuse geometry model generated from metastable phase-field solutions of the Allen-Cahn problem that assumes the imaging data as initial condition. Phase-field approximations of the boundary and its gradient are then employed to transfer all boundary terms in the variational formulation into volumetric terms. We show that in the context of the voxel finite cell method, diffuse boundary conditions achieve the same accuracy as boundary conditions defined over explicit sharp surfaces, if the inherent length scales, i.e., the interface width of the phase-field, the voxel spacing and the mesh size, are properly related. We demonstrate the flexibility of the new method by analyzing stresses in a human femur and a vertebral body

Reconstruction of the Corticospinal Tract in Patients with Motor-Eloquent High-Grade Gliomas Using Multilevel Fiber Tractography Combined with Functional Motor Cortex Mapping

BACKGROUND AND PURPOSE: Tractography of the corticospinal tract is paramount to presurgical planning and guidance of intraoperative resection in patients with motor-eloquent gliomas. It is well-known that DTI-based tractography as the most frequently used technique has relevant shortcomings, particularly for resolving complex fiber architecture. The purpose of this study was to evaluate multilevel fiber tractography combined with functional motor cortex mapping in comparison with conventional deterministic tractography algorithms. MATERIALS AND METHODS: Thirty-one patients (mean age, 61.5 [SD, 12.2] years) with motor-eloquent high-grade gliomas underwent MR imaging with DWI (TR/TE ¼ 5000/78 ms, voxel size ¼ 2 × 2 × 2 mm3, 1 volume at b ¼ 0 s/mm2, 32 volumes at b ¼ 1000 s/mm2). DTI, constrained spherical deconvolution, and multilevel fiber tractography–based reconstruction of the corticospinal tract within the tumor-affected hemispheres were performed. The functional motor cortex was enclosed by navigated transcranial magnetic stimulation motor mapping before tumor resection and used for seeding. A range of angular deviation and fractional anisotropy thresholds (for DTI) was tested. RESULTS: For all investigated thresholds, multilevel fiber tractography achieved the highest mean coverage of the motor maps (eg, angular threshold = 60°; multilevel/constrained spherical deconvolution/DTI, 25% anisotropy threshold ¼ 71.8%, 22.6%, and 11.7%) and the most extensive corticospinal tract reconstructions (eg, angular threshold ¼ 60°; multilevel/constrained spherical deconvolution/DTI, 25% anisotropy threshold ¼ 26,485 mm3, 6308 mm3, and 4270 mm3). CONCLUSIONS: Multilevel fiber tractography may improve the coverage of the motor cortex by corticospinal tract fibers compared with conventional deterministic algorithms. Thus, it could provide a more detailed and complete visualization of corticospinal tract architecture, particularly by visualizing fiber trajectories with acute angles that might be of high relevance in patients with gliomas and distorted anatomy.</p

Radiolucent carbon-fiber reinforced pedicle screws for the treatment of spinal tumors: Advantages for radiation planning and follow-up imaging.

OBJECTIVE: Surgical treatment of spinal tumors regularly includes spinal instrumentation with pedicle screws. Most modern pedicle screws are made of titanium alloy, which is associated with artifacts on postoperative imaging such as CT and/or MRI. These artifacts hamper radiation treatment planning and execution and follow-up imaging. Recently, carbon fiber reinforced polyetheretherketone (CFRP) implants became available for posterior instrumentation with the aim to reduce imaging artifacts by implants. METHODS: Patients harboring spinal tumors underwent posterior stabilization using carbon-fiber reinforced polyetheretherketone (CFRP) pedicle screws. Postoperative imaging was evaluated for implant artifacts. Radiation planning was assessed. RESULTS: Thirtyfive patients with spinal tumors were assessed (metastases n=30, lymphoma n=2, myeloma n=1, chordoma n=1, fibrous dysplasia n=1). Implantation of CFRP implants was feasible in all but one case. Postoperative images show reduced artifacts in comparison to standard titanium alloy implants. Implant position and integrity is sufficiently assessable despite reduced image contrast. Radiation planning is improved. CONCLUSIONS: Carbon fiber reinforced PEEK pedicle screws reduce image artifacts on CT and MRI. Thereby, they are a valuable and feasible option for spinal instrumentations in patients harboring spinal tumors where postoperative imaging and radiation therapy planning are necessary and might be crucial for long-term outcome and overall survival

Predicting brain tumor regrowth in relation to motor areas by functional brain mapping.

Background: Due to frequent recurrences, high-grade gliomas still confer a poor prognosis. Several regrowth prediction models have been developed, but most of these models are based on cellular models or dynamic mathematical calculations, thus limiting direct clinical use. The present study aims to evaluate whether navigated transcranial magnetic stimulation (nTMS) or functional magnetic resonance imaging (fMRI) may be used to predict the direction of tumor regrowth. Methods: Sixty consecutive patients with high-grade gliomas were enrolled prospectively and analyzed in a case-control design after tumor recurrence. All patients underwent serial MRI after surgery and suffered from recurrent tumors during a mean follow-up of 13.2 &plusmn; 14.9 months. Tumor regrowth speed and direction were measured in relation to motor areas defined by nTMS, nTMS-based tractography, and fMRI. Depending on initial resection, patients were separated into three groups (group 1: without residual tumor, group 2: residual tumor away from motor areas, and group 3: residual tumor facing motor areas). Results: Sixty-nine percent of patients in group 1, 64.3% in group 2, and 66.7% in group 3 showed tumor recurrence towards motor eloquence on contrast-enhanced T1-weighted sequences (P = .9527). Average growth towards motor areas on contrast-enhanced T1-weighted sequences was 0.6 &plusmn; 1.5 (group 1), 0.6 &plusmn; 2.4 (group 2), and 2.3 &plusmn; 5.5 (group 3) mm/month (P = .0492). Conclusion: This study suggests a new strategy to predict tumor regrowth patterns in high-grade glioma patients. Our approach could be directly applied in the clinical setting, thus having clinical impact on both surgical treatment and radiotherapy planning. Ethics Committee Registration Number: 2793/10

Robust and parallel scalable iterative solutions for large-scale finite cell analyses

The finite cell method is a flexible discretization technique for numerical analysis on domains with complex geometries. By using a non-boundary conforming computational domain that can be easily meshed, automatized computations on a wide range of geometrical models can be performed. The application of the finite cell method, and other immersed methods, to large real-life and industrial problems is often limited due to the conditioning problems associated with these methods. These conditioning problems have caused researchers to resort to direct solution methods. This significantly limits the maximum size of solvable systems. Iterative solvers are better suited for large-scale computations than their direct counterparts due to their lower memory requirements and suitability for parallel computing. These benefits can, however, only be exploited when systems are properly conditioned. In this contribution we present an Additive-Schwarz type preconditioner that enables efficient and parallel scalable iterative solutions of large-scale multi-level hp-refined finite cell systems

Weakly-supervised biomechanically-constrained CT/MRI registration of&nbsp;the spine.

Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are two of the most informative modalities in spinal diagnostics and treatment planning. CT is useful when analysing bony structures, while MRI gives information about the soft tissue. Thus, fusing the information of both modalities can be very beneficial. Registration is the first step for this fusion. While the soft tissues around the vertebra are deformable, each vertebral body is constrained to move rigidly. We propose a weakly-supervised deep learning framework that preserves the rigidity and the volume of each vertebra while maximizing the accuracy of the registration. To achieve this goal, we introduce anatomy-aware losses for training the network. We specifically design these losses to depend only on the CT label maps since automatic vertebra segmentation in CT gives more accurate results contrary to MRI. We evaluate our method on an in-house dataset of 167 patients. Our results show that adding the anatomy-aware losses increases the plausibility of the inferred transformation while keeping the accuracy untouched

Multidetector Computed Tomography Imaging:Effect of Sparse Sampling and Iterative Reconstruction on Trabecular Bone Microstructure

Multidetector computed tomography-based trabecular bone microstructure analysis ensures promising results in fracture risk prediction caused by osteoporosis. Because multidetector computed tomography is associated with high radiation exposure, its clinical routine use is limited. Hence, in this study, we investigated in 11 thoracic midvertebral specimens whether trabecular texture parameters are comparable derived from (1) images reconstructed using statistical iterative reconstruction (SIR) and filtered back projection as criterion standard at different exposures (80, 150, 220, and 500 mAs) and (2) from SIR-based sparse sampling projections (12.5%, 25%, 50%, and 100%) and equivalent exposures as criterion standard. Twenty-four texture features were computed, and those that showed similar values between (1) filtered back projection and SIR at the different exposure levels and (2) sparse sampling and equivalent exposures and reconstructed with SIR were identified. These parameters can be of equal value in determining trabecular bone microstructure with lower radiation exposure using sparse sampling and SIR