Therapeutic Impact of MRI in Acute Stroke. In: von Kummer R, Back T, editors. Magnetic Resonance Imaging in Ischemic Stroke. Berlin: Springer Berlin Heidelberg; 2006. pp. 23-40. [DOI: 10.1007/3-540-27738-2_3]

Human Brain Atlases in Stroke Management

Stroke is a leading cause of death and a major cause of permanent disability. Its management is demanding because of variety of protocols, imaging modalities, pulse sequences, hemodynamic maps, criteria for treatment, and time constraints to promptly evaluate and treat. To cope with some of these issues, we propose novel, patented solutions in stroke management by employing multiple brain atlases for diagnosis, treatment, and prediction. Numerous and diverse CT and MRI scans are used: ARIC cohort, ischemic and hemorrhagic stroke CT cases, MRI cases with multiple pulse sequences, and 128 stroke CT patients, each with 170 variables and one year follow-up. The method employs brain atlases of anatomy, blood supply territories, and probabilistic stroke atlas. It rapidly maps an atlas to scan and provides atlas-assisted scan processing. Atlas-to-scan mapping is application-dependent and handles three types of regions of interest (ROIs): atlas-defined ROIs, atlas-quantified ROIs, and ROIs creating an atlas. An ROI is defined by atlas-guided anatomy or scan-derived pathology. The atlas defines ROI or quantifies it. A brain atlas potential has been illustrated in four atlas-assisted applications for stroke occurrence prediction and screening, rapid and automatic stroke diagnosis in emergency room, quantitative decision support in thrombolysis in ischemic stroke, and stroke outcome prediction and treatment assessment. The use of brain atlases in stroke has many potential advantages, including rapid processing, automated and robust handling, wide range of applications, and quantitative assessment. Further work is needed to enhance the developed prototypes, clinically validate proposed solutions, and introduce them to clinical practice.

Usefulness of brain atlases in neuroradiology: Current status and future potential

Human brain atlases, although prevalent in medical education and stereotactic and functional neurosurgery, are not yet applied practically in neuroradiology. In a step towards introducing brain atlases to neuroradiology, we discuss nine different situations of potential atlas use: (1) to support interpretation of brain scans with clearly visible structures (to increase confidence of non-neuroradiologists); (2) to delineate and label scans of low anatomical content (with indiscernible or poorly visible anatomy); (3) to assist in generating the structured report; (4) to assist in interpreting small deep lesions, since an atlas's anatomical parcellation is higher than that of the interpreted scan; (5) to approximate distorted due to pathology (and unknown to the interpreter) anatomy and label it; (6) to cope with data explosion; (7) to assist in the interpretation of functional scans (to label the activation foci with the underlying anatomy and Brodmann's areas); (8) to support ischemic stroke image handling by means of atlases of anatomy and blood supply territories; and (9) to communicate image interpretation results (diagnosis) to others. The usefulness of the atlas for automatic structure identification, localisation, delineation, labelling and quantification, as well as for reporting and communication, potentially increases the interpreter's efficiency and confidence, as well as expedites image interpretation.