Identification of salvageable brain tissue is a major challenge when planning the treatment of is... more Identification of salvageable brain tissue is a major challenge when planning the treatment of ischaemic stroke. As the standard technique used in this context, the perfusion–diffusion mismatch, has not shown total accuracy, there is an ongoing search for new imaging protocols that could better identify the region of the brain at risk and for new physiological models that could, on the one hand, incorporate the imaged parameters and predict the evolution of the condition for the individual, and, on the other hand, identify future biomarkers and thus suggest new directions for the design of imaging protocols. Recently, models of cellular metabolism after stroke and blood–brain barrier transport at tissue level have been introduced. We now extend these results by developing a model of the propagation of key metabolites in the brain's extracellular space owing to stroke-related oedema and chemical concentration gradients between the ischaemic and normal brain. We also couple the resulting chemical changes in the extracellular space with cellular metabolism. Our work enables the first patient-specific simulations of stroke progression with finite volume models to be made.
Treatment of arteriovenous malformations (AVMs) of the brain often requires the injection of a li... more Treatment of arteriovenous malformations (AVMs) of the brain often requires the injection of a liquid embolic material to reduce blood flow through the malformation. The type of the liquid and the location of injection have to be carefully planned in a pre-operative manner. We introduce a new model of the interaction of liquid embolic materials with blood for the simulation of their propagation and solidification in the AVM. Solidification is mimicked by an increase of the material's viscosity. Propagation is modelled by using the concept of two-fluids modelling and that of scalar transport. The method is tested on digital phantoms and on one anatomically derived patient AVM case. Simulations showed that intuitive behaviour of the two-fluid system can be confirmed and that two types of glue propagation through the malformation can be reproduced. Distinction between the two types of propagation could be used to identify fistulous and plexiform compartments composing the AVM and to characterize the solidification of the embolic material in them.
This work presents guidelines for a computationally efficient implementation of multiscale image ... more This work presents guidelines for a computationally efficient implementation of multiscale image filters based on eigenanalysis of the Hessian matrix, for the enhancement of tubular structures. Our focus is the application to 3D medical images of blood vessels. The method uses matrix trace, determinant and sign to discard voxels unlikely to belong to vessels, prior to the calculation of the Hessian eigenvalues. As example of time savings, we provide results obtained in four computed tomography datasets (300 × 300 × 300 voxels) containing coronary and pulmonary arteries. The test based on the Hessian trace avoided the computation of the eigenvalues in half of the voxels on average, while the test combining the Hessian determinant and sign eliminated up to 10% additional voxels. The actual time savings depend on the algorithm used to compute the eigenvalues for the remaining voxels. With a very fast algorithm using a closed-form solution, the computational time was reduced from 20.5 to 12.5 seconds per scale, but the time gained thanks to the more complex of the two tests was negligible. However, this fast algorithm is prone to numerical instabilities. Accurate computation of the eigenvalues requires the use of iterative or hybrid algorithms. In this case, both tests produce time savings and the computational time can be reduced by several minutes per scale.
The identification of salvageable brain tissue is a major challenge at stroke presentation. Stand... more The identification of salvageable brain tissue is a major challenge at stroke presentation. Standard techniques used in this context, such as the perfusion–diffusion mismatch, remain controversial. There is thus a need for new methods to help guide treatment. The potential role of pH imaging in this context is currently being investigated. Intracellular pH varies as a function of local perfusion, intracellular energy stores and time. Low pH triggers the production of free radicals and affects the calcium balance of the cells, which may lead to apoptosis and cell death. Thus, the characterization of pH dynamics may have predictive value for cell death after stroke, particularly when combined with novel imaging techniques. Therefore, we have extended an existing model of brain cellular metabolism to simulate the pH response of cells to ischaemia. Simulation results for conditions of reduced cerebral blood flow show good agreement for the evolution of intracellular pH with previously reported measurements and encourage the development of quantitative pH imaging to validate the predictive value of pH.
This paper presents a patient-derived model for the simulation of the hemodynamics of arterioveno... more This paper presents a patient-derived model for the simulation of the hemodynamics of arteriovenous malformations of the brain (BAVM). This new approach is a step toward the simulation of the outcome of the embolization of the BAVM during treatment planning. More specifically, two aspects of the planning are pursued: simulation of the change of blood flow in the brain vasculature after the blocking of the malformation and simulation of the transport of the embolic liquid. The method we propose is tested on 3 BAVM cases of varying complexity. Twenty two out of 24 main BAVM flow paths have been identified well by simulation.
The accuracy of 2D phase contrast (PC) magnetic resonance angiography (MRA) depends on the alignm... more The accuracy of 2D phase contrast (PC) magnetic resonance angiography (MRA) depends on the alignment between the vessels and the imaging plane. PC MRA imaging of blood flow is challenging when the flow in several vessels is to be evaluated with one acquisition. For this purpose, semi-automatic determination of the plane most perpendicular to several vessels is proposed based on centerlines extracted from 3D MRA. Arterial centerlines are extracted from 3D MRA based on iterative estimation-prediction, multi-scale analysis of image moments, and a second-order shape model. The optimal plane is determined by minimizing misalignment between its normal vector and the centerlines’ tangent vectors. The method was evaluated on a phantom and on 35 patients, by seeking the optimal plane for cerebral blood flow quantification simultaneously in internal carotids and vertebral arteries. In the phantom, difference of orientation and of height between known and calculated planes was 1.2° and 2.5 mm, respectively. In the patients, all but one centerline were correctly extracted and the misalignment of the plane was within 12° per artery. Semi-automatic centerline extraction simplifies and automates determination of the plane orthogonal to one vessel, thereby permitting automatic simultaneous minimization of the misalignment with several vessels in PC MRA.
Identification of salvageable brain tissue is a major challenge when planning the treatment of is... more Identification of salvageable brain tissue is a major challenge when planning the treatment of ischaemic stroke. As the standard technique used in this context, the perfusion–diffusion mismatch, has not shown total accuracy, there is an ongoing search for new imaging protocols that could better identify the region of the brain at risk and for new physiological models that could, on the one hand, incorporate the imaged parameters and predict the evolution of the condition for the individual, and, on the other hand, identify future biomarkers and thus suggest new directions for the design of imaging protocols. Recently, models of cellular metabolism after stroke and blood–brain barrier transport at tissue level have been introduced. We now extend these results by developing a model of the propagation of key metabolites in the brain's extracellular space owing to stroke-related oedema and chemical concentration gradients between the ischaemic and normal brain. We also couple the resulting chemical changes in the extracellular space with cellular metabolism. Our work enables the first patient-specific simulations of stroke progression with finite volume models to be made.
Treatment of arteriovenous malformations (AVMs) of the brain often requires the injection of a li... more Treatment of arteriovenous malformations (AVMs) of the brain often requires the injection of a liquid embolic material to reduce blood flow through the malformation. The type of the liquid and the location of injection have to be carefully planned in a pre-operative manner. We introduce a new model of the interaction of liquid embolic materials with blood for the simulation of their propagation and solidification in the AVM. Solidification is mimicked by an increase of the material's viscosity. Propagation is modelled by using the concept of two-fluids modelling and that of scalar transport. The method is tested on digital phantoms and on one anatomically derived patient AVM case. Simulations showed that intuitive behaviour of the two-fluid system can be confirmed and that two types of glue propagation through the malformation can be reproduced. Distinction between the two types of propagation could be used to identify fistulous and plexiform compartments composing the AVM and to characterize the solidification of the embolic material in them.
This work presents guidelines for a computationally efficient implementation of multiscale image ... more This work presents guidelines for a computationally efficient implementation of multiscale image filters based on eigenanalysis of the Hessian matrix, for the enhancement of tubular structures. Our focus is the application to 3D medical images of blood vessels. The method uses matrix trace, determinant and sign to discard voxels unlikely to belong to vessels, prior to the calculation of the Hessian eigenvalues. As example of time savings, we provide results obtained in four computed tomography datasets (300 × 300 × 300 voxels) containing coronary and pulmonary arteries. The test based on the Hessian trace avoided the computation of the eigenvalues in half of the voxels on average, while the test combining the Hessian determinant and sign eliminated up to 10% additional voxels. The actual time savings depend on the algorithm used to compute the eigenvalues for the remaining voxels. With a very fast algorithm using a closed-form solution, the computational time was reduced from 20.5 to 12.5 seconds per scale, but the time gained thanks to the more complex of the two tests was negligible. However, this fast algorithm is prone to numerical instabilities. Accurate computation of the eigenvalues requires the use of iterative or hybrid algorithms. In this case, both tests produce time savings and the computational time can be reduced by several minutes per scale.
The identification of salvageable brain tissue is a major challenge at stroke presentation. Stand... more The identification of salvageable brain tissue is a major challenge at stroke presentation. Standard techniques used in this context, such as the perfusion–diffusion mismatch, remain controversial. There is thus a need for new methods to help guide treatment. The potential role of pH imaging in this context is currently being investigated. Intracellular pH varies as a function of local perfusion, intracellular energy stores and time. Low pH triggers the production of free radicals and affects the calcium balance of the cells, which may lead to apoptosis and cell death. Thus, the characterization of pH dynamics may have predictive value for cell death after stroke, particularly when combined with novel imaging techniques. Therefore, we have extended an existing model of brain cellular metabolism to simulate the pH response of cells to ischaemia. Simulation results for conditions of reduced cerebral blood flow show good agreement for the evolution of intracellular pH with previously reported measurements and encourage the development of quantitative pH imaging to validate the predictive value of pH.
This paper presents a patient-derived model for the simulation of the hemodynamics of arterioveno... more This paper presents a patient-derived model for the simulation of the hemodynamics of arteriovenous malformations of the brain (BAVM). This new approach is a step toward the simulation of the outcome of the embolization of the BAVM during treatment planning. More specifically, two aspects of the planning are pursued: simulation of the change of blood flow in the brain vasculature after the blocking of the malformation and simulation of the transport of the embolic liquid. The method we propose is tested on 3 BAVM cases of varying complexity. Twenty two out of 24 main BAVM flow paths have been identified well by simulation.
The accuracy of 2D phase contrast (PC) magnetic resonance angiography (MRA) depends on the alignm... more The accuracy of 2D phase contrast (PC) magnetic resonance angiography (MRA) depends on the alignment between the vessels and the imaging plane. PC MRA imaging of blood flow is challenging when the flow in several vessels is to be evaluated with one acquisition. For this purpose, semi-automatic determination of the plane most perpendicular to several vessels is proposed based on centerlines extracted from 3D MRA. Arterial centerlines are extracted from 3D MRA based on iterative estimation-prediction, multi-scale analysis of image moments, and a second-order shape model. The optimal plane is determined by minimizing misalignment between its normal vector and the centerlines’ tangent vectors. The method was evaluated on a phantom and on 35 patients, by seeking the optimal plane for cerebral blood flow quantification simultaneously in internal carotids and vertebral arteries. In the phantom, difference of orientation and of height between known and calculated planes was 1.2° and 2.5 mm, respectively. In the patients, all but one centerline were correctly extracted and the misalignment of the plane was within 12° per artery. Semi-automatic centerline extraction simplifies and automates determination of the plane orthogonal to one vessel, thereby permitting automatic simultaneous minimization of the misalignment with several vessels in PC MRA.
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Papers by Piotr Orlowski