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The 3D visualization of intracranial vasculature can facilitate the planning of endovascular therapy and the evaluation of interventional result. To create 3D visualizations, volumetric datasets from x-ray computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are commonly rendered using maximum intensity projection (MIP), volume rendering, or surface rendering techniques. However, small aneurysms and mild stenoses are very difficult to detect using these methods. Furthermore, the instruments used during endovascular embolization or surgical treatment produce artifacts that typically make post-intervention CTA inapplicable, and the presence of magnetic material prohibits the use of MRA. Therefore, standard digital angiography is typically used. In order to address these problems, we developed a visualization and modeling system that displays 2D and 3D angiographic images using a simple Web-based interface. Polygonal models of vasculature were generated from CT and MR data using 3D segmentation of bones and vessels and polygonal surface extraction and simplification. A web-based 3D environment was developed for interactive examination of reconstructed surface models, creation of oblique cross- sections and maximum intensity projections, and distance measurements and annotations. This environment uses a multi- tier client/server approach employing VRML and Java. The 3D surface model and angiographic images can be aligned and displayed simultaneously to permit better perception of complex vasculature and to determine optical viewing positions and angles before starting an angiographic sessions. Polygonal surface reconstruction allows interactive display of complex spatial structures on inexpensive platforms such as personal computers as well as graphic workstations. The aneurysm assessment procedure demonstrated the utility of web-based technology for clinical visualization. The resulting system facilitated the treatment of serious vascular malformations by enabling better visualization of aneurysms. In addition, the improved understanding of complex vasculature may shorten angiographic sessions and reduce patient exposure to x-rays.
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