Robust processing of intracranial CT angiograms for 3D volume rendering

The goal of this study was to develop a robust and simple technique for processing of cranial CT angiograms (CTA) in the clinical setting. The method described in this paper involves segmentation of the bone, then dilation of the skull by adding three or four layers of voxels. This dilated skull is subtracted from the vessels object on a voxel-by-voxel basis, allowing segmentation and subsequent display of the vessels only. For evaluation of the technique, three groups of operators processed one CTA, and the quality of the 3D views obtained and the times taken were compared. One group was given training by an expert and a "recipe" for guidance, the second was given only the "recipe," and the third group consisted of expert operators. All operators were able to produce good or acceptable shaded-surface displays when compared with digital subtraction angiography, within 10 min for experienced users, an average of 17 min for trained operators and 26 min for those using only the recipe sheet. Using a simple scoring system for the appearance of feeding vessels and draining veins, no significant differences were found between the three levels of training and experience. This technique simplifies the processing of CTAs and is quick enough to make such examinations part of a routine clinical service.