2006, Merhof, Dorit, Sonntag, Markus, Enders, Frank, Nimsky, Christopher, Hastreiter, Peter, Greiner, Günther

Diffusion tensor imaging is of high value in neurosurgery, providing information about the location of white matter tracts in the human brain. For their reconstruction, streamline techniques commonly referred to as fiber tracking model the underlying fiber structures and have therefore gained interest. To meet the requirements of surgical planning and to overcome the visual limitations of line representations, a new real-time visualization approach of high visual quality is introduced. For this purpose, textured triangle strips and point sprites are combined in a hybrid strategy employing GPU programming. The triangle strips follow the fiber streamlines and are textured to obtain a tube-like appearance. A vertex program is used to orient the triangle strips towards the camera. In order to avoid triangle flipping in case of fiber segments where the viewing and segment direction are parallel, a correct visual representation is achieved in these areas by chains of point sprites. As a result, a high quality visualization similar to tubes is provided allowing for interactive multimodal inspection. Overall, the presented approach is faster than existing techniques of similar visualization quality and at the same time allows for real-time rendering of dense bundles encompassing a high number of fibers, which is of high importance for diagnosis and surgical planning.

2006, Enders, Frank, Merhof, Dorit, Hastreiter, Peter, Stamminger, Marc, Fahlbusch, Rudolf, Nimsky, Christopher

With the introduction of diffusion tensor imaging a method became available which is capable to detect major white matter tracts in-vivo. For the visualization of the data several techniques have been developed which, however, show various drawbacks for a comprehensive medical and technical analysis. Although fractional anisotropy maps and streamlines, typically denoted as fiber tracking, are widely used they are suboptimal in several situations of pre- and intraoperative application. Going beyond these standard approaches, several new and more advanced visualization techniques, namely directional volume growing, hulls and hardware-accelerated glyphs are introduced for an improved exploration of the pyramidal tract. The approaches have been evaluated with respect to diagnosis and therapy planning in neurosurgery. Overall, it is shown that the presented strategies for the visualization of diffusion tensor imaging data are capable to significantly support neurosurgical planning and intervention.

2006, Nimsky, Christopher, Ganslandt, Oliver, Merhof, Dorit, Sorensen, A. Gregory, Fahlbusch, Rudolf

Functional neuronavigation allows intraoperative visualization of cortical eloquent brain areas. Major white matter tracts, such as the pyramidal tract, can be delineated by diffusion-tensor-imaging based fiber tracking. These tractography data were integrated into 3-D datasets applied for neuronavigation by rigid registration of the diffusion images with standard anatomical image data so that their course could be superimposed onto the surgical field during resection of gliomas. Intraoperative high-field magnetic resonance imaging was used to compensate for the effects of brain shift, which amounted up to 8 mm. Despite image distortion of echo planar images, which was identified by non-linear registration techniques, navigation was reliable. In none of the 19 patients new postoperative neurological deficits were encountered. Intraoperative visualization of major white matter tracts allows save resection of gliomas near eloquent brain areas. A possible shifting of the pyramidal tract has to be taken into account after major tumor parts are resected.