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DOI: 10.1055/s-2007-984061
Improved Planning of Skull Base Surgery by Coregistration of Three-Dimensional Data Sets of Different Angiographic Imaging Modalities Including rDSA, MRA, CTA, and T1-MRI Volume Data
Objectives: Vascular structures are frequently involved during skull base pathologies. Treatment planning often relies on the current gold standard in angiographic imaging, digital subtraction angiography (DSA). However, these data cannot easily be incorporated into the preoperative simulation and neuronavigation software. We use rotational DSA and the generated volume data sets to include this information for image fusion to other modalities. The purpose of our study is to utilize sophisticated software algorithms to match, visualize, and compare different three-dimensional (3D) imaging modalities in the planning and follow-up of skull base lesions.
Methods: Twelve patients were included in the study that harbored skull base tumors requiring DSA imaging in addition to conventional MRI. Informed consent was obtained to utilize imaging data for complex 3D analyses and visualization. For all patients, at least two different imaging modalities were used, mainly rDSA, MRA, CT, and MRI. A database was set up containing volume data sets of all imaging procedures. Image data sets were coregistered and visualized using commercial and self-developed software systems. In addition, autostereoscopic 3D displays and a 3D mouse were used for advanced segmentation and visualization purposes.
Results: A procedure was developed which allows import, preprocessing, segmentation, registration, and visualization employing a network of various image processing modules. Despite the large amount of data, the processing and visualization of high-resolution data were successfully performed on standard personal computers. Comparison of 3D reconstruction of vessels penetrating the skull base, including overlay and subtraction modes, improved detection of subtle luminal and conformational changes.
Conclusion: The integration of different modalities offers high-resolution analyses of conformational changes in vessels penetrating the skull base. Since some of these data sets are not used for neuronavigation, elastic transformation of the coregistered 3D imaging data provides additional diagnostic support. The application of this tool is further enhanced by inclusion of morphological MR data sets for planning of skull base procedures.