title: Stability, structure and scale: improvements in multi-modal vessel extraction for SEEG trajectory planning.
abstract: OBJECTIVE
  Brain vessels are among the most critical landmarks that need to be assessed for mitigating surgical risks in stereo-electroencephalography (SEEG) implantation. Intracranial haemorrhage is the most common complication associated with implantation, carrying significantly associated morbidity. SEEG planning is done pre-operatively to identify avascular trajectories for the electrodes. In current practice, neurosurgeons have no assistance in the planning of electrode trajectories. There is great interest in developing computer-assisted planning systems that can optimise the safety profile of electrode trajectories, maximising the distance to critical structures. This paper presents a method that integrates the concepts of scale, neighbourhood structure and feature stability with the aim of improving robustness and accuracy of vessel extraction within a SEEG planning system.
  
  
  METHODS
  The developed method accounts for scale and vicinity of a voxel by formulating the problem within a multi-scale tensor voting framework. Feature stability is achieved through a similarity measure that evaluates the multi-modal consistency in vesselness responses. The proposed measurement allows the combination of multiple images modalities into a single image that is used within the planning system to visualise critical vessels.
  
  
  RESULTS
  Twelve paired data sets from two image modalities available within the planning system were used for evaluation. The mean Dice similarity coefficient was 0.89 ± 0.04, representing a statistically significantly improvement when compared to a semi-automated single human rater, single-modality segmentation protocol used in clinical practice (0.80 ± 0.03).
  
  
  CONCLUSIONS
  Multi-modal vessel extraction is superior to semi-automated single-modality segmentation, indicating the possibility of safer SEEG planning, with reduced patient morbidity.
authors.affiliation: Translational Imaging Group, CMIC, University College London, London, UK, M.ZuluagaValencia@cs.ucl.ac.uk.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Zuluaga
authors.forename: Roman
authors.initials: R
authors.lastname: Rodionov
authors.forename: Mark
authors.initials: M
authors.lastname: Nowell
authors.forename: Sufyan
authors.initials: S
authors.lastname: Achhala
authors.forename: Gergely
authors.initials: G
authors.lastname: Zombori
authors.forename: Alex F
authors.initials: AF
authors.lastname: Mendelson
authors.forename: M Jorge
authors.initials: MJ
authors.lastname: Cardoso
authors.forename: Anna
authors.initials: A
authors.lastname: Miserocchi
authors.forename: Andrew W
authors.initials: AW
authors.lastname: McEvoy
authors.forename: John S
authors.initials: JS
authors.lastname: Duncan
authors.forename: Sébastien
authors.initials: S
authors.lastname: Ourselin
mesh_terms: D001921:Brain / Q000502:physiology*; D004566:Electrodes; D004569:Electroencephalography / Q000379:methods*; D006801:Humans
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