Stability, structure and scale: improvements in multi-modal vessel extraction for SEEG trajectory planning

PURPOSE: 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 [Formula: see text] , representing a statistically significantly improvement when compared to a semi-automated single human rater, single-modality segmentation protocol used in clinical practice ([Formula: see text] ). CONCLUSIONS: Multi-modal vessel extraction is superior to semi-automated single-modality segmentation, indicating the possibility of safer SEEG planning, with reduced patient morbidity.