Visualization of multimodal images for the planning of skull base surgery

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Abstract
This paper describes our methodology for combining and visualizing registered MR, CT, and angiographic images of the head. We register the individual datasets using the location of a number of user identified anatomical point landmarks to derive the rigid body transformation between datasets. The combined images are displayed either as 2-D slices or as 3-D rendered scenes. Three independent observers performed a detailed assessment of the usefulness of the combined images in the planning of resection of skull base lesions in seven patients. We have shown that in all patients studied at least one of our observers obtained significant extra clinical information from the combined images, while all observers showed significantly increased confidence in the pre-operative surgical plan in all but one patient. Initial evaluation of the 3-D rendered displays showed that the size, shape, and extent of the tumors were better visualized, 3-D spatial relationships between structures were clarified, viewing the resection site in 3-D was very useful, and movie loops provided a very strong 3-D cue. An improved method of registering information from multiple imaging modalities is described and future directions for image combination and visualization are suggested.

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