Background and Purpose Diffusion tensor imaging tractography reconstruction of white matter pathways can help guide brain tumor resection. However, DTI tracts are complex mathematical objects and the validity of tractography-derived information in clinical settings has yet to be fully established. To address this issue, we initiated the DTI Challenge, an international working group of clinicians and scientists whose goal was to provide standardized evaluation of tractography methods for neurosurgery. The purpose of this empirical study was to evaluate different tractography techniques in the first DTI Challenge workshop. Methods Eight international teams from leading institutions reconstructed the pyramidal tract in four neurosurgical cases presenting with a glioma near the motor cortex. Tractography methods included deterministic, probabilistic, filtered, and global approaches. Standardized evaluation of the tracts consisted in the qualitative review of the pyramidal pathways by a panel of neurosurgeons and DTI experts and the quantitative evaluation of the degree of agreement among methods. Results The evaluation of tractography reconstructions showed a great inter-algorithm variability. Although most methods found projections of the pyramidal tract from the medial portion of the motor strip, only a few algorithms could trace the lateral projections from the hand, face, and tongue area. In addition, the structure of disagreement among methods was similar across hemispheres despite the anatomical distortions caused by pathological tissues. Conclusions The DTI Challenge provides a benchmark for the standardized evaluation of tractography methods on neurosurgical data. This study suggests that there are still limitations to the clinical use of tractography for neurosurgical decision-making.

Efficient segmentation of the left atrium (LA) wall from delayed enhancement MRI is challenging due to inconsistent contrast, combined with noise, and high variation in atrial shape and size. We present a surface-detection method that is capable of extracting the atrial wall by computing an optimal a-posteriori estimate. This estimation is done on a set of nested meshes, constructed from an ensemble of segmented training images, and graph cuts on an associated multi-column, proper-ordered graph. The graph/mesh is a part of a template/model that has an associated set of learned intensity features. When this mesh is overlaid onto a test image, it produces a set of costs which lead to an optimal segmentation. The 3D mesh has an associated weighted, directed multi-column graph with edges that encode smoothness and inter-surface penalties. Unlike previous graph-cut methods that impose hard constraints on the surface properties, the proposed method follows from a Bayesian formulation resulting in soft penalties on spatial variation of the cuts through the mesh. The novelty of this method also lies in the construction of proper-ordered graphs on complex shapes for choosing among distinct classes of base shapes for automatic LA segmentation. We evaluate the proposed segmentation framework on simulated and clinical cardiac MRI.

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A variety of medical image segmentation problems present significant technical challenges, including heterogeneous pixel intensities, noisy/ill-defined boundaries and irregular shapes with high variability. The strategy of estimating optimal segmentations within a statistical framework that combines image data with priors on anatomical structures promises to address some of these technical challenges. However, methods that rely on local optimization techniques and/or local shape penalties (e.g., smoothness) have been proven to be inadequate for many difficult segmentation problems. These challenging segmentation problems can benefit from the inclusion of global shape priors within a maximum-a-posteriori estimation framework, which biases solutions toward an object class of interest. In this paper, we propose a maximum-a-posteriori formulation that relies on a generative image model by incorporating both local and global shape priors. The proposed method relies on graph cuts as well as a new shape parameters estimation that provides a global updates-based optimization strategy. We demonstrate our approach on synthetic datasets as well as on the left atrial wall segmentation from late-gadolinium enhancement MRI, which has been shown to be effective for identifying myocardial fibrosis in the diagnosis of atrial fibrillation. Experimental results prove the effectiveness of the proposed approach in terms of the average surface distance between extracted surfaces and the corresponding ground-truth, as well as the clinical efficacy of the method in the identification of fibrosis and scars in the atrial wall.