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磁共振MRI测定脑白质在脑瘤周围分市

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    标    签:脑白质

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    通过MRI测定病人脑白质,从而指导医生在放射疗时避开重要脑白质

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    &YQMPSJOH1FSJUVNPSBM8IJUF .BUUFS'JCFSTGPS/FVSPTVSHJDBM 1MBOOJOH
   Sonia  Pujol,  Ph.D.   Ron  Kikinis,  M.D.     Surgical  Planning  Laboratory   Harvard  University   Clinical  Goal   Image Courtesy of Dr. Alexandra Golby, Brigham and Women`s Hospital, Boston, MA.. Diffusion  Tensor  Imaging  (DTI)   Tractography  has  the  potenQal   to  bring  valuable  spaQal   informaQon  on  tumor   infiltraQon  and  tract   displacement  for  neurosurgical   planning  of  tumor  resecQon.     White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Clinical  Case   •  35  year-­‐old  male   diagnosed  with   Glioblastoma  mulQforme   (GBM)   •  Diffusion  Weighted   Imaging  (DWI)  acquisiQon   for  neurosurgical  planning   White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Clinical  Goal   White Matter tracts Ventricles The  goal  of  this  tutorial  is   to  explore  white  maUer   fibers  surrounding  a   Tumor tumor  using  Diffusion   Tensor  Imaging  (DTI)   Tractography.   White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tutorial  Material   •  So#ware:  Slicer4.1  release     •  Dataset:  WhiteMaUerExploraQonDataset   www.slicer.org   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Image  Analysis  Pipeline   The  image  analysis  pipeline   described  in  this  tutorial  uses  three   different  algorithms:  the  lGrow  Cutz   algorithm  for  segmentaQon  of  the   tumor  parts,  the  Marching  Cube   algorithm  for  surface  modeling,   and  the  single  tensor   streamline  tractography  algorithm   for  tract  generaQon.   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Overview  of  the  analysis  pipeline   •  Part  1:  Loading  &VisualizaQon  of  Diffusion  Data   •  Part  2:  SegmentaQon  of  the  ventricles,  and   solid  and  cysQc  parts  of  the  tumor   •  Part  3:  Tractography  reconstrucQon  of  the   white  maUer  fibers  in  the  peri-­‐tumoral  volume   •   Part  4:  Tractography  exploraQon    of  the   ipsilateral  and  contralateral  side   White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Part  1:  Loading   and  VisualizaQon   of  Diffusion  Data     White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Diffusion  Tensor  Imaging   (Stejskal and Tanner 1965, Basser 1994 ) D xx D= D yx D zx D xy D yy D zy D xz D yz D zz White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Loading DTI and Baseline Data Select ‘Load Data’ in the Welcome module White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Loading DTI and Baseline Data Click on ‘Choose Directory to Add’, and select the directory WhiteMatterExplorationData White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Loading DTI and Baseline Data White  MaUer  ExploraQon  for   Neurosurgical  Planning   Select the directory WhiteMatterExplorationData Select the files BaselineVolume.nrrd and DTIVolume.nhdr and click on OK Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Loading  DTI  and  Baseline  Data   White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia Pujol, Ph.D. – Ron Kikinis, M.D. NA-­‐MIC  ARR  2012-­‐2014   Loading  DTI  and  Baseline  Data   Click on the link icon to link the three anatomical viewers, and set the Baseline volume in Background White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia Pujol, Ph.D. – Ron Kikinis, M.D. NA-­‐MIC  ARR  2012-­‐2014   Loading  DTI  and  Baseline  Data   Select the module Volumes and adjust the Window and Level values of the Baseline Volume. White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Loading DTI and Baseline Data White  MaUer  ExploraQon  for   Neurosurgical  Planning   Select Red Slice Only Layout Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Part  1:     SegmenQng  the  tumor   and  ventricles   White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tumor  SegmentaQon   Solid part Tumor The tumor in this clinical case is composed of two parts: a solid part, and a cystic part. Cystic part In this section, we will segment the different parts of the tumor using a Grow Cut Segmentation algorithm. White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tumor  SegmentaQon   Select the module Editor from the main menu White  MaUer  ExploraQon  for   Neurosurgical  Planning   Select the color table ‘Generic Anatomy Colors’ and click on Apply Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tumor  SegmentaQon   Select the Paint tool from the Editor toolbox White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tumor  SegmentaQon   Set the label #293 region_1 and draw a short line in the cystic part of the tumor White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tumor  SegmentaQon   White  MaUer  ExploraQon  for   Neurosurgical  Planning   Select the label #7 (mass) and draw a short line in the solid part of the tumor Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tumor  SegmentaQon   Select the label # 295 region_3 and draw a line around the tumor White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tumor  SegmentaQon   Select the Grow Cut segmentation algorithm White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Grow  Cut  SegmentaQon   •  The Grow Cut Segmentation method is a competitive region growing algorithm using Cellular Automata. •  The algorithm performs multi-label image segmentation using a set of user input scribbles. •  V.  Vezhnevets,  V.  Konouchine.  "Grow-­‐Cut"  -­‐   InteracQve  MulQ-­‐Label  N-­‐D  Image   SegmentaQon".  Proc.  Graphicon.  2005  .   pp.  150–156.     White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tumor  SegmentaQon   Click on Apply to start the Grow Cut segmentation algorithm White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tumor  SegmentaQon   Slicer displays the results of the segmentation Solid part Cystic part White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tumor  SegmentaQon   Expand the Per-Structure Volumes Tab and click on bSplit Merge Volume` White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tumor  SegmentaQon   The label map BaselineVolume-label has been split into three volumes: - BaselineVolume-mass-label: solid part of the tumor - BaselineVolume-region_1-label: cystic part of the tumor - BaselineVolume-region_3-label: surrounding structures White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tumor  SegmentaQon   Select the module Data and note the different label maps that have been generated Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Ventricles  SegmentaQon   In the next section, we will manually segment the ventricles. We will use two tools of the Editor box: the Threshold tool and the Save Islands tool. White  MaUer  ExploraQon  for   Neurosurgical  Planning   Go back to the Editor module Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Ventricles  SegmentaQon   Select the volume bBaselineVolume-region_3-label` White  MaUer  ExploraQon  for   Neurosurgical  Planning   Select the Threshold tool in the Editor toolbox, set the lower threshold to 1700, and click on Apply Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Ventricles  SegmentaQon   Slicer displays the result of the threshold White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Ventricles  SegmentaQon   Select the tool Save Islands from the Editor toolbox, and click in the occipital horn of the ventricle. White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Final  Result  of  the  SegmentaQon   White  MaUer  ExploraQon  for   Neurosurgical  Planning   Slicer displays the result of the segmentation of the ventricles. Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Final  Result  of  the  SegmentaQon   Click on Merge and Build to merge the different label maps, and generate the 3D models of the tumor and ventricles using a Marching Cubes algorithm White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Final  Result  of  the  SegmentaQon   Select Conventional Layout White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Final  Result  of  the  SegmentaQon   Slicer displays the 3D surface reconstructions of the ventricles, and solid and cystic parts of the tumor. White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Part  2:  Tractography   exploraQon  of  peri-­‐ tumoral  white  maUer   fibers   White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   DefiniQon  of  the  peri-­‐tumoral  volume   Select the label map bBaselineVolume-region_1label`(blue), and select the tool bDilate` in the Editor toolbox White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   DefiniQon  of  the  peri-­‐tumoral  volume   Position the mouse the cystic part of the tumor in the axial slice, and click on Apply three times to generate the peritumoral volume White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   VisualizaQon  of  the  DTI  Volume   Note the dilatation of the cystic part of the tumor in the 3D viewer White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tractography  Parameters   Select the module Tractography Label Map Seeding ‘ - I/O: Set the following input and output volume: Input DTI Volume: DTIVolume Input Label Map: BaselineVolume-region_1-label Output Fiber Bundle: Create NewFiberBundle - Seed Placement Options: Check Use Index Space -  Stopping Value Set the FA threshold to 0.15 - Label Definition: Enter Seeding Label 293, and Click on Apply White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tractography  Results   Slicer displays the white matter fibers surrounding the tumor The fibers are colored according the fractional anisotropy values (red = low ; blue,green = high) White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Part  4:  Tractography   exploraQon  of  the   ipsilateral  and   contralateral  side     White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tractography  on-­‐the-­‐fly   Select the module Tractography Fiducial Seeding Click on the Fiducial Icon to create a fiducial Set the DTI volume in background and position the fiducial near the cystic part of the tumor in the 3D viewer White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tractography  on-­‐the-­‐fly   Set Input DTI Volume to DTIVolume Set Fiducial List or Model to FiducialsList Set Output Fiber Bundle to Create new Fiber Bundle Set the Minimum Path Length to 10 mm Set the FA Stopping Criteria to 0.15 White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Fiducial  Seeding   Position the fiducial in the cingulum on the contralateral side opposite to the tumor White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Tractography  on-­‐the-­‐fly   Explore the aspect of the cingulum in the contralateral and ipsilateral sides White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Conclusion   •  Fully  integrated  pipeline  for  semi-­‐automated     tumor  segmentaQon  and  white  maUer  tract   reconstrucQon   •  3D  interacQve  exploraQon  of  the  white  maUer   •  tracts  surrounding  a  tumor  (peri-­‐tumoral   tracts)  for  neurosurgical  planning        White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   MICCAI 2011 DTI Challenge Neurosurgical  Planning  Workshop,   October  1st,  2012  –  Nice,  France   DTI  Tractography  for   Neurosurgical  Planning:   A  Grand  Challenge           MICCAI  2012  Conference   Acropolis Convention Center Nice, France wwww.miccai-­‐org     Sonia  Pujol,  Ph.D.  –  Ron  Kikinis,  M.D.   NA-­‐MIC  ARR  2012-­‐2014   Acknowledgments   •  NaQonal  Alliance  for  Medical  Image   CompuQng  (NA-­‐MIC)    NIH  U54EB005149         •  Neuroimage  Analysis  Center  (NAC)    NIH  P41RR013218     White  MaUer  ExploraQon  for   Neurosurgical  Planning   Sonia  Pujol,  PhD  -­‐  Ron  Kikinis,  MD   NaQonal  Alliance  for   Medical  Image  CompuQng      ARR  2012-­‐2014  

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