Fully Automatic Adaptive Meshing Based Segmentation of the Ventricular System for Augmented Reality Visualization and Navigation

Objective: Effective image segmentation of cerebral structures is fundamental to 3-dimensional techniques such as augmented reality. To be clinically viable, segmentation algorithms should be fully automatic and easily integrated in existing digital infrastructure. We created a fully automatic adaptive-meshing-based segmentation system for T1-weighted magnetic resonance images (MRI) to automatically segment the complete ventricular system, running in a cloud-based environment that can be accessed on an augmented reality device. This study aims to assess the accuracy and segmentation time of the system by comparing it to a manually segmented ground truth dataset. Methods: A ground truth (GT) dataset of 46 contrast-enhanced and non–contrast-enhanced T1-weighted MRI scans was manually segmented. These scans also were uploaded to our system to create a machine-segmented (MS) dataset. The GT data were compared with the MS data using the Sørensen–Dice similarity coefficient and 95% Hausdorff distance to determine segmentation accuracy. Furthermore, segmentation times for all GT and MS segmentations were measured. Results: Automatic segmentation was successful for 45 (98%) of 46 cases. Mean Sørensen–Dice similarity coefficient score was 0.83 (standard deviation [SD] = 0.08) and mean 95% Hausdorff distance was 19.06 mm (SD = 11.20). Segmentation time was significantly longer for the GT group (mean = 14405 seconds, SD = 7089) when compared with the MS group (mean = 1275 seconds, SD = 714) with a mean difference of 13,130 seconds (95% confidence interval 10,130–16,130). Conclusions: The described adaptive meshing-based segmentation algorithm provides accurate and time-efficient automatic segmentation of the ventricular system from T1 MRI scans and direct visualization of the rendered surface models in augmented reality.