Volumetric relief map for intracranial cerebrospinal fluid distribution analysis

International audienceCerebrospinal fluid imaging plays a significant role in the clinical diagnosis of brain disorders, such as hydrocephalus and Alzheimer's disease. While three-dimensional images of cerebrospinal fluid are very detailed, the complex structures they contain can be time-consuming and laborious to interpret. This paper presents a simple technique that represents the intracranial cerebrospinal fluid distribution as a two-dimensional image in such a way that the total fluid volume is preserved. We call this a volumetric relief map, and show its effectiveness in a characterization and analysis of fluid distributions and networks in hydrocephalus patients and healthy adults

Volumetric relief map for the cortical subarachnoid space analysis

Purpose: Medical image visualization is an important step in the medical diagnosis of hydrocephalus. In this paper, we present planar representations called volumetric relief maps that are generated from three-dimensional images of the cerebrospinal fluid within the cortical subarachnoid space. Such maps are visually interpreted at once and allow to automatically characterize fluid distributions. Consequently, they help specialists to provide a diagnosis and to monitor patients instantly. Methods: Volumetric relief maps are generated by enclosing the cortical subarachnoid space with a hemisphere, and using a ray tracing method and a map projection technique from a hemisphere to a plane. Results: Visualization of maps indicates that healthy adults have more balanced fluid distributions with well-filled sulci, unlike hydrocephalus patients who have more or less large fluid depletions in the posterior regions of the brain. We showed that a moment-based approach allows to efficiently characterize such fluid distributions from maps. In particular, the center of mass of a distribution is an efficient discriminant factor to distinguish between healthy adults and hydrocephalus patients, with resulting sensitivity and specificity of 100%. In addition, we have noted that asymmetry of the fluid distribution increases with depletion for hydrocephalus patients; such asymmetry is generally oriented towards the frontal part of the fissura longitudinalis cerebri. Conclusions: This paper describes an innovative visualization tool used to analyze fluid distribution within the cortical subarachnoid space. It allows to efficiently discriminate between healthy adults and pathological cases, and to monitor patients before and after surgery

Intra cranial volume quantification from 3D reconstruction based on CT-scan data

The evolution of some congenital diseases impacting the shape of the skull such as the Chiari malformation or Craniosynostosis condition can be quantify measuring the increasing of the intra cranial volume (ICV) (Gault et al. 1993). This volume could be calculated from ana-tomic measurements (Gordon 1966). Nevertheless, in case of important variations of shape, these techniques were not suitable to accurately assess ICV from measure-ments of global parameters. Some studies, using automatic segmentation combined with manual adjustments from MRI acquisition were used to assess the ICV (Reite et al. 2010). However, 3-4 hours were required for each patient to complete the process. Other studies used total auto-matic segmentation to calculate volume of the brain and the ICV (de Jong et al. 2017). But high quality of MRI was necessary to get accurate results.The purpose of this study was to develop a fast, efficient and reproducible procedure to calculate the ICV, based on 3D skull reconstruction obtained from scanner imaging

Quantification of the stress generated by theendoscopic movement in the brain parenchymaduring intra ventricular surgical procedure

Endoscopy is increasingly used for intra ventricular surgeries such as hydrocephalus and tumor removal (Miwa et al. 2015 Miwa T, Hayashi N, Endo S, Ohira T. 2015. Neuroendoscopic biopsy and the treatment of tumor-associated hydrocephalus of the ventricular and paraventricular region in pediatric patients: a nationwide study in Japan. Neurosurg Rev.[Crossref], [PubMed], [Web of Science ®], , [Google Scholar]). Robotic based surgeries are more and more developed to control the trajectory and the movement of the endoscope and then to enhance the accuracy of surgical procedures and to reduce post-operative issues. The use of computer- aided robot is then well-suited to accurately reach ventricles cavities through the brain parenchyma and to minimize cerebral damage caused by the movement of the endoscope. On a mechanical point of view, moderate and severe traumatic brain injury (TBI) had a 50% risk to locally occur when Von Mises stress respectively exceeds 18 and 38 kPa (Willinger & Baumgartner 2003 Willinger R, Baumgartner D. 2003. Human head tolerance limits to specific injury mechanisms. Int J Crashworthiness.[Taylor & Francis Online], , [Google Scholar]). The purpose of this study was to assess the Von Mises stress generated in the brain by the endoscopic movement

It’s time to give concussion an operational definition: A 3-step process to diagnose (or rule out) concussion within 48 hours of injury: World Rugby Guideline

World Rugby has introduced an operational definition of concussion into Rugby to better identify and manage concussion and to support injury surveillance studies. This definition acknowledges the variability in clinical concussion presentation by incorporating a three-point in time diagnostic process with the recommended times aligning with the times that team doctor’s normal responsibilities involve team contact. The current content of each assessment is based on SCAT 3 and will continue to be modified as the evidence around concussion diagnosis evolves. This operational definition of concussion also includes the recommendation that any abnormal assessment be considered as being due to concussion. This default can be overruled if the team doctor decides that the abnormal assessment is not related to a concussion. Finally with World Rugby’s operational definition, a concussion following a head injury cannot be excluded until an assessment is completed at 36-48 hours post injury.The authors gratefully acknowledge the support and input of the following members of the IRB HIA working group for their expert recommendations. Roles identified were those at time of working group involvement: Conor McCarthy (Irish RFU Medical Director), Deborah Robinson (New Zealand Rugby Union Team Physician), Rob Nichol (CEO International Rugby Players' Association), Vincenzo Ieracitano (Chairman Medical Commission of Italian FIR), Mike England (Director English RFU Injured Players Foundation), Paul Watson (Medical Director Rugby Canada); Eanna Falvey (Team Physician Irish Rugby Union), Mark Harrington (IRB Training and Medical Manager – World Rugby representative

Surface reconstruction from routine CT-scan shows large anatomical variations of falx cerebri and tentorium cerebelli

Background: Finite element modeling of the human head offers an alternative to experimental methods in understanding the biomechanical response of the head in trauma brain injuries. Falx, tentorium, and their notches are important structures surrounding the brain, and data about their anatomical variations are sparse. Objective: To describe and quantify anatomical variations of falx cerebri, tentorium cerebelli, and their notches. Methods: 3D reconstruction of falx and tentorium was performed by points identification on 40 brain CT-scans in a tailored Matlab program. A scatter plot was obtained for each subject, and 8 anatomical landmarks were selected. A reference frame was defined to determine the coordinates of landmarks. Segments and areas were computed. A reproducibility study was done. Results: The height of falx was 34.9 ± 3.9 mm and its surface area 56.5 ± 7.7 cm2. The width of tentorium was 99.64 ± 4.79 mm and its surface area 57.6 ± 5.8 cm2. The mean length, height, and surface area of falx notch were respectively 96.9 ± 8 mm, 41.8 ± 5.9 mm, and 28.8 ± 5.8 cm2 (range 15.8-40.5 cm2). The anterior and maximal widths of tentorial notch were 25.5 ± 3.5 mm and 30.9 ± 2.5 mm; its length 54.9 ± 5.2 mm and its surface area 13.26 ± 1.6 cm2. The length of falx notch correlated with the length of tentorial notch (r = 0.62, P < 0.05). Conclusion: We observe large anatomical variations of falx, tentorium, and notches, crucial to better understand the biomechanics of brain injury, in personalized finite element models

Long-term consequences of recurrent sports concussion

BACKGROUND: Recurrent concussions are suspected to promote the development of long-term neurological disorders. The study was designed to assess the prevalence of major depressive disorder, mild cognitive disorders and headache in a population of retired high-level sportsmen and rugby players and to study the link between scores evaluating these disorders and the number of reported concussions (RCs). METHODS: A total of 239 retired rugby players (RRPs) and 138 other retired sportsmen (ORSs) who had reached the French national or international championship level between 1985 and 1990 filled in a self-administered questionnaire describing their sociodemographic data, comorbidities and reported history of RC. A phone interview was then conducted using validated questionnaires for the detection of major depressive disorder (PHQ-9), mild cognitive disorders (F-TICS-m) and headache (HIT-6). RESULTS: RRPs reported a higher number of RCs than ORSs (p 9) was observed among RRPs compared to ORSs (9% versus 6%) (p = 0.04), and the PHQ-9 score increased with the number of RCs regardless of the type of sport (p = 0.026). A higher rate of mild cognitive disorders (TICS-m score ≤30) was observed in RRPs compared to ORSs (57% versus 40%, p = 0.005), but no association was found with the number of RC. The HIT-6 score increased with the number of RCs (p = 0.019) CONCLUSIONS: More than 20 years after the end of their career, RRPs present higher rates of depression and lower F-TICS-m scores in favor of mild cognitive impairment compared with ORSs. PHQ-9 and HIT-6 scores were significantly associated with the number of RCs.The Fédération Française de Rugby (FFR) and la Ligue Nationale de Rugby (LNR) provided financial support in the form of research technician funding. The sponsor had no role in the design or conduct of this research

LES KYSTES COLLOIDES DU TROISIEME VENTRICULE

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

A framework for analysis of brain cine MR sequences

International audienceIn this paper, we propose a framework to automate the assessment of the movements of a third cerebral ventricle in a cine MR sequence. Indeed, the goal of this assessment is to build an atlas of the movements of the healthy ventricles in the context of the hydrocephalus pathology. This approach is composed of two phases: a contour extraction, using fractional integration and a registration method, based on dynamic evolutionary optimization. The first phase of the framework is based on the fractional integration thresholding, that allows delineating the contours of the area of interest. In order to track over time each point of the primitive and achieve the assessment of the deformation, a matching method, based on a new dynamic optimization algorithm, called Dynamic Covariance Matrix Adaptation Evolution Strategy (D-CMAES), is used. The obtained results for quantification have been clinically validated by an expert and compared to those presented in the literature

A framework for analysis of brain cine MR sequences

International audienc