Three-dimensional computer-assisted dissection of pancreatic lymphatic anatomy on human fetuses: a step toward automatic image alignment.

PURPOSE: Pancreatic cancer is the fourth cause of death by cancer worldwide. Lymph node (LN) involvement is known to be the main prognostic factor. However, lymphatic anatomy is complex and only partially characterized. The aim of the study was to study the pancreatic lymphatic system using computer-assisted anatomic dissection (CAAD) technique and also to update CAAD technique by automatizing slice alignment. METHODS: We dissected three human fetuses aged from 18 to 34 WA. 5-µm serial sections of duodeno-pancreas and spleen blocks were stained (hematoxylin-eosin, hematoxylin of Mayer and Masson trichrome), scanned, aligned and modeled in three dimensions. RESULTS: We observed a rich, diffuse but not systematized lymphatic network in the peri-pancreatic region. There was an equal distribution of LNs between the cephalic and body-tail portions. The lymphatic vascularization appeared in continuity from the celiac trunk to the distal ends of its hepatic and splenic arterial branches parallel to the nerve ramifications of the celiac plexus. We also observed a continuity between the drainage of the pancreatic head and the para-aortic region posteriorly. CONCLUSION: In view of the wealth of peri-pancreatic LNs, the number of LNs to harvest could be increased to improve nodal staging and prognostic evaluation. Pancreatic anatomy as described does not seem to be compatible with the sentinel LN procedure in pancreatic surgery. Finally, we are now able to offer an alternative to manual alignment with a semi-automated alignment.

The enamel-dentine junction in the postcanine dentition of Australopithecus africanus: intra-individual metameric and antimeric variation.

We used micro-computed tomography and virtual tools to study metric and morphological features at the enamel-dentine junction and on the outer enamel surface in the postcanine dentition of an exceptionally well-preserved maxilla and mandible of an early hominin. The fossil, Sts 52 from Sterkfontein, South Africa, is attributed to Australopithecus africanus and is about 2.5 million years old. For comparative purposes in this exploratory study, we also used micro-computed tomography to analyse the dentition of a common chimpanzee (Pan troglodytes), a pygmy chimpanzee (Pan paniscus) and three extant humans. Metameric variation of the 3D enamel-dentine junction in the two chimpanzee mandibles was much smaller than in extant humans. Variation in metameric shape was high and complex. Notably, the mandibular metameric variation in extant humans can be greater within individuals, as compared with variation between individuals, with differences in shape appearing greater for M2 compared with M1. We recommend the use of a new approach in which individual metameric variation is systematically assessed before making inferences about differences between fossil hominin species. The fossil hominin examined in this study showed a metameric pattern of mandibular variation in shape that was comparable to the pattern seen in two chimpanzees. This degree of metameric variation appeared relatively small compared with the much larger patterns of variation observed within and between extant humans.

Automatic analysis of cerebral atrophy.

3D MR data obtained for 10 healthy control subjects have been used to build a brain atlas. The atlas is built in four stages. First, a set of features that are unambiguously definable and anatomically relevant need to be computed for each item in the database. The chosen features are crest lines along which the maximal principal curvature of the surface of the brain is maximal in its associated principal direction. Second, a nonrigid registration algorithm is used to determine the common crest lines among the subjects in the database. These crest lines form the structure of the atlas. Third, a set of crest lines is taken as a reference set and a modal analysis is performed to determine the fundamental deformations that are necessary to bring the individual data in line with the reference set. The deformations are averaged and the set of mean crest lines becomes the atlas. Finally, the standard deviation of the deformations between the atlas and the items in the database defines the normal variation in the relative positions of the crest lines in a healthy population. In a fully automatic procedure, the crest lines on the surface of the brain adjacent to the cerebral ventricles in a patient with primary progressive aphasia were compared to the atlas; confirmation that the brain of this patient demonstrates atrophy was provided by stereological analysis that showed that the volume of the left cerebral hemisphere is 48.8 ml (CE 2.8%) less than the volume of the right cerebral hemisphere in the region of the temporal and frontal lobes. When the amplitude of the deformations necessary to register the crest lines obtained for the patient with the atlas were greater than three standard deviations beyond the variability inherent in the atlas, the deformation was considered significant. Four of the main deformation modes of the longest crest line of the surface of the brain adjacent to the cerebral ventricles were significantly different in the patient with primary progressive aphasia compared to the atlas. The ventricles are preferentially enlarged in the left cerebral hemisphere. Furthermore, they are closer together posteriorly and further apart anteriorly than in the atlas. These observations may be indicative of the atrophy of the temporal and frontal lobes of the left cerebral hemisphere noted in the patient. Ultimately, the approach may provide a useful screening technique for identifying brain diseases involving cerebral atrophy. Serial studies of individual patients may provide insights into the processes controlling or affected by particular disease.

A scheme for automatically building three-dimensional morphometric anatomical atlases: application to a skull atlas.

We present a general scheme for automatically building a morphometric anatomical atlas. We detail each stage of the method, including the non-rigid registration algorithm, three-dimensional line averaging and statistical processes. We apply the method to obtain a quantitative atlas of skull crest lines. Finally, we use the resulting atlas to study a craniofacial disease; we show how we can obtain qualitative and quantitative results by contrasting a skull affected by a mandible deformation with the atlas.

Statistical analysis of normal and abnormal dissymmetry in volumetric medical images.

We present a general method to study the dissymmetry of anatomical structures such as those found in the human brain. Our method relies on the estimate of 3D dissymmetry fields, the use of 3D vector field operators, and T2 statistics to compute significance maps. We also present a fully automated implementation of this method which relies mainly on the intensive use of a 3D non-rigid inter-patient matching tool. Such a tool is applied successively between the images and their symmetric versions with respect to an arbitrary plane, both to realign the images with respect to the mid-plane of the subject and to compute a dense 3D dissymmetry map. Inter-patient matching is also used to fuse the data of a population of subjects. We then describe three main application fields: the study of the normal dissymmetry within a given population, the comparison of the dissymmetry between two populations, and the detection of the significant abnormal dissymmetries of a patient with respect to a reference population. Finally, we present preliminary results illustrating these three applications for the case of the human brain.

A fully three-dimensional method for facial reconstruction based on deformable models.

Two facial models corresponding to two deceased subjects have been manually created and the two corresponding skulls have been dissected and skeletonized. These pairs of skull/ facial data have been scanned with a CT scanner, and the computed geometric three-dimensional models of both skulls and facial tissue have been built. One set of skull/facial data will be used as a reference set whereas the second set is used as ground truth for validating our method. After a semi-automatic face-skull registration, we apply an original computing global parametric transformation T that turns the reference skull into the skull to be reconstructed. This algorithm is based upon salient lines of the skull called crest lines: more precisely the crest lines of the first skull are matched to the crest lines of the second skull by an iterative closest point algorithm. Then we apply this algorithm to the reference face to obtain the "unknown" face to be reconstructed. The reliability and difficulties of this original technique are then discussed.

Mandibular effects of maxillary distraction osteogenesis in cleft lip and palate.

Maxillary distraction osteogenesis (DO) is a reliable treatment for severe maxillary deficiency in cleft lip and palate (CLP). The objective was to analyze its long-term effects on the mandible. A retrospective study of 24 CLP treated with maxillary DO using the Polley and Figueroa technique was done; patients were followed for more than 4 years. Preoperative (T0), 6-12 months postoperative (T1), and ≥ 4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess treatment stability, and a Procrustes superimposition method was used to assess local changes in the shape of the mandible. The mean age of patients at T0 was 15.4 ± 4.1 years. SNA increased at T1 and T2 (P < 0.001), with no significant relapse between T1 and T2, indicating stability at 1 year after treatment (T0 = 72.4 ± 5.3°; T1 = 81.3 ± 6.2°; T2 = 79.9 ± 6.1°). SNB, facial angle, gonial angle, and symphyseal angle remained stable. Long-term analysis of the mandible demonstrated a minimal counter-clockwise rotation of the body (mandibular plane = -0.2 ± 3.2°) and ramus (-0.6 ± 4.3°). Maxillary DO in CLP had no significant effect on the shape or rotation of the mandible. The maxillary advancement remained stable after 1 year.