Fast Interactive Exploration of 4D MRI Flow Data

A. Hennemutha , O. Frimana , C. Schumanna , J. Bockb , J. Drexla , M. Huellebranda , M. Marklb

and H.-O. Peitgena
a FraunhoferMEVIS, Universitaetsallee 29, Bremen, Germany;
b Department of Radiology Medical Physics, University Medical Center Freiburg, Germany

ABSTRACT
1- or 2-directional MRI blood flow mapping sequences are an integral part of standard MR protocols for di-
agnosis and therapy control in heart diseases. Recent progress in rapid MRI has made it possible to acquire
volumetric, 3-directional cine images in reasonable scan time. In addition to flow and velocity measurements
relative to arbitrarily oriented image planes, the analysis of 3-dimensional trajectories enables the visualization
of flow patterns, local features of flow trajectories or possible paths into specific regions. The anatomical and
functional information allows for advanced hemodynamic analysis in different application areas like stroke risk
assessment, congenital and acquired heart disease, aneurysms or abdominal collaterals and cranial blood flow.
The complexity of the 4D MRI flow datasets and the flow related image analysis tasks makes the development of
fast comprehensive data exploration software for advanced flow analysis a challenging task. Most existing tools
address only individual aspects of the analysis pipeline such as pre-processing, quantification or visualization, or
are difficult to use for clinicians. The goal of the presented work is to provide a software solution that supports
the whole image analysis pipeline and enables data exploration with fast intuitive interaction and visualization
methods. The implemented methods facilitate the segmentation and inspection of different vascular systems.
Arbitrary 2- or 3-dimensional regions for quantitative analysis and particle tracing can be defined interactively.
Synchronized views of animated 3D path lines, 2D velocity or flow overlays and flow curves offer a detailed insight
into local hemodynamics. The application of the analysis pipeline is shown for 6 cases from clinical practice,
illustrating the usefulness for different clinical questions. Initial user tests show that the software is intuitive to
learn and even inexperienced users achieve good results within reasonable processing times.
Keywords: Diagnosis, Visualization, Hemodynamics, PC MRI

1. INTRODUCTION
Knowledge about local hemodynamics can be crucial for differential diagnosis and therapy planning in several
congenital and acquired diseases. While catheter-based examinations, which are the current gold standard for
blood flow and pressure measurements, are invasive and provide only locally restricted information, Doppler
Ultrasound and Phase Contrast MRI (PC MRI) yield flow information non-invasively. Recent developments
in MRI technology and sequence design allow the acquisition of volumetric 3-directional cine velocity images.1
These images enable local blood flow quantification and analysis of flow trajectories but require sophisticated
processing. The image data are influenced by eddy currents induced by changes in the electromagnetic field of
the scanner as well as so-called phase wraps, which occur when the actual measured velocity exceeds the velocity
encoding sensitivity (venc) defined in the acquisition settings of the MR scanner.
The extraction of vasculature from PC MRI data is also a challenging task, because the image intensity depends
on the time varying flow velocity, or the data has to be matched with another angiographic image. Most published
approaches perform thresholding and morphological operations on temporal projection images.2 Few methods
also consider the actual vector information,3, 4 but these approaches require a model of the vascular system to
be extracted and are thus limited in their applicability.
The actual flow inspection is difficult because the flow phenomena of interest can be complex and assumptions
that allow an automatic focusing and data reduction are difficult to specify. For the overall inspection and
Further author information: (Send correspondence to A. Hennemuth.)
A. Hennemuth: E-mail: anja.hennemuth@mevis.fraunhofer.de, Telephone: +49 421 218-7772

Medical Imaging 2011: Visualization, Image-Guided Procedures, and Modeling,

edited by Kenneth H. Wong, David R. Holmes III, Proc. of SPIE Vol. 7964, 79640E
© 2011 SPIE · CCC code: 1605-7422/11/$18 · doi: 10.1117/12.878202

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 Figure 1. PC MRI data consist of four 4D images showing the flow magnitude and the velocity components for the three
spatial encoding directions. The analysis workflow contains a pre-processing step, a vessel segmentation, and an interactive
flow analysis. For each encoding direction, correction sequences are computed separately to compensate for eddy current
effects and phase wraps. After the vessel segmentation, flow measurements and animated particle flow visualizations are
generated interactively.

detection of suspicious regions, flow animations are typically provided.5 To enable the perception of trajectories
as 3D objects, pathlines are illuminated.6 Van Pelt et al.7 even propose to use an animated local highlighting
on pathlines to visualize the particle flow.
Visualized context information usually consists of the anatomical (magnitude) image or the vessel segmentation.
Existing approaches employ volume rendering or combine the texture rendering of image slices with the flow
information.8, 9 The image data used to provide anatomical context information is usually a separate angiographic
3D image, the magnitude image (fig. 1), or the PC MRA image derived from the flow velocity information
(see section 2.1). For the visualization of segmented vessels, most approaches apply surface rendering. Some
authors have proposed advanced methods like view-dependent transparency rendering or shaded silhouettes with
superimposed occluding contours.7, 10 These visualizations aim at avoiding visual obstruction through context
information.
Local and quantitative flow information are inspected at cross sections of the vessels of interest as in conventional
2D MR flow analysis or Doppler flow analysis. The interactive placement of these cross section planes is solely
based on the user navigation in image section plane views,8 defined through plane movement along the vessel
centerline11 or through a local analysis of the segmentation mask near a user-defined clickpoint.7 Whereas the
free navigation in the image data involve longer interaction times for the placement of regions of interest, the
assumption of tubular structures does not allow the placement of proper cross sectional planes in vascular regions
like the heart chambers.

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 Figure 3. The depicted pre-processing steps are performed separately for each encoding direction.

Some of the methods described above are already available in research prototypes and several pre-processing
tools have been co-developed with image acquisition sequences. To visualize the flow data, these tools are
combined with specialized visualization software packages like EnSight.12 Other software packages such as
MEDIFRAME and GT Flow offer broader functionality to support advanced research applications,9, 13 but 3D
analysis, visualization and exploration methods are still limited in these tools.
Because hemodynamics yield important information for a multitude of clinical questions, there is a growing
interest in 4D PC MRI flow analysis by clinicians working in different fields like cardiology, surgery, and neurology,
and the applicability of the PC MRI acquistion to flow measurements in different body regions has been shown
in various publications.14–16 The lack of suitable post-processing tools is a limiting factor here. The purpose of
the presented work is to introduce a software, which addresses the described tasks while requiring a minimum of
time and user interaction. The interactive exploration methods for the pre-processed images should enable the
data examination towards a multitude of relevant clinical questions.

2. METHODS
The introduced software MEVISFlow that is developed within
the MeVisLab platform17 contains the image processing pipeline
shown in fig.1, including pre-processing, segmentation and in-
teractive exploration. 4D PC MRI image data usually consist
of one magnitude image sequence M and three phase image
sequences vx , vy , vz , which represent the flow velocities in the
three spatial directions. These sequences have to be corrected
for errors that typically occur in MR acquisitions, and have to
be combined to interpretable images before the actual image
analysis methods can be applied.

2.1 Pre-processing Figure 2. Segmentation example: The vascular sys-

The error that is introduced by the eddy currents in the electro- tems of the liver are colored and labeled interac-
tively after segmentation.
magnetic field is assumed to introduce spatially and temporally
slowly varying image gradients, which are added to the phase
images that encode the flow velocities in the three dimensions.
As proposed by Lankhaar et al. the correction is performed by fitting polynomial planes to the velocities of static
non-moving regions.18 This static tissue mask ST is determined by thresholding the velocity standard deviation
over time. Phase wraps are detected by applying the reliability measure proposed by Diaz et al. in an iterative
process19 (fig.3).

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 2.2 Segmentation
The vessel segmentation is either performed on an additional angiographic image, the contrast enhanced mag-
nitude image or on a so-called PC MRA image, which is derived from the magnitude image sequence M and
velocity component sequences vx , vy , vz as follows:


1  N
 
P CM RA =  M 2 (t) · vx2 (t) + vy2 (t) + vz2 (t) (1)
N t=1

The 3D image that results from this temporal average of the magnitude weighted flow velocities shows high signal
intensity in regions with flow, while other image regions are suppressed. It is used as input for an interactive
watershed transformation. This method allows the separate segmentation and annotation of different vascular
systems20 as shown in fig. 2. Users place include- or exclude-markers to choose the vessels belonging to a vascular
region of interest. For segmented vascular regions, color and label can be chosen and later used to activate or
deactivate the vascular region for analysis and visualization.

2.3 Visualization and Exploration

The exploration starts with a 3D visualization of the anatomy. To this end,
a combination of the extracted vessel surfaces and a volume rendering of the
magnitude image are shown. Vessel surfaces are visualized with the user-
defined colors and an outline enhancement to improve the visual separability
of the vascular systems. For an overview of the blood flow the velocity
vectors can be visualized directly, or particle traces can be emitted from
evenly distributed seed points in the segmented vessels. Seed points are either
placed directly at voxel centers with an adjustable resolution or randomly
distributed with an adjustable σ-value. As suggested by Sobel et al., path
line calculation and visualization are separated.21 Path lines are extracted
with an adaptive temporal resolution considering the changes in the flow
velocities applying the Runge-Kutta method to determine the path points Figure 4. Flow visualization with
as proposed by Kainz et al.22 The resulting pathlines are resampled with point sprites and illuminated flow
lines.
equidistant temporal resolution for the visualization. Local features like
direction, absolute velocity and the change in direction are stored for each
visualization pathline point and can be selected for color coding.
The animated particles are represented by spheres,
which are sized according to their current velocity and
colored according to the selected feature value. As sug-
gested by Krüger et al.23 these spheres are rendered us-
ing point sprites that are shaded such that they appear
to be illuminated spheres. This way the amount of data
to be transfered to the GPU and the amount of geometry
to be rendered can be reduced significantly compared to
actual sphere objects. Hence, large amounts of particles
as required for the visualization of dense flow can be ren- Figure 5. Color coded pathline features. In the leftmost
dered in real time. The flow trajectories are visualized image, the velocity components are interpreted as RGB
by means of illuminated line segments,6 which depict the values. The middle image shows the application of a look
last visited path points. Figure 4 shows an example vi- up table to the absolute velocity values whereas color and
sualization, in which particle traces are emitted from a opacity of the flow lines in the right image are determined
user-defined region. Particle sprites as well as particle by the local change of direction.
traces are colored according to the actual velocity val-
ues.
To support the detection of regions with suspicious flow patterns, four modes are offered for the pathline color
and opacity based on different flow features:

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|vx | |vy | |vz |
Flow Directions The interpretation of the velocity components as RGB values venc , venc , venc depicts the
major flow directions and the flow uniformity.
Flow Velocities The absolute flow velocities are visualized with a rainbow look-up-table that applies low opac-
ity values to slow movement and thus enhances regions with strong acceleration like stenoses.
Direction Change The angular deviation between successive pathline segments is also presented with a rainbow
look-up-table. Here, small angular values are accentuated in order to support the detection of vortices.
Emitter/Target Region Pathlines are presented in the color assigned to the region of interest or vessel they
are released from. This method should help to examine path and mixture properties of flow lines from or
to specific regions.
An example for the usage of local flow features for coloring pathlines is shown in fig. 5.

Figure 6. The cross-section MPR planes are initialized with a user-defined click point. Starting from the hitpoint P1 on
the vessel surface two other points P2 and P3 are computed to determine the MPR plane. This MPR plane as well as its
orthogonal cross sections can then be adjusted interactively in the 2D MPR viewer.

To define regions of interest the user can specify arbitrarily oriented MPRs interactively by clicking onto the
vessel surface. To be independent of centerline computations, which may be complicated for some anatomical
regions, the proposed method works directly on the segmentation mask. As depicted in fig. 6, two additional
reference points are computed based on the hit point P1. The second point P2 should be close to the vessel
center line and can be found by tracing a path from P1 along the gradient direction until the maximum distance
to the vessel surface is reached (fig. 6, second image from the left). The third point P3 is located on the plane
that intersects this path at P2 perpendicularly. It is the surface point closest to P2. These three points define a
plane that is more or less perpendicular to the vessel center line even though this line has not been determined
explicitly. In addition to the cross-section plane, two orthogonal MPRs are created to enable a refinement of the
MPRs by moving and rotating the representing lines in the corresponding 2D views as proposed by Soerensen
et al.8 (fig. 6, rightmost image). The user-defined MPRs are used to visualize velocities and throughflow, derive
curves or specify emitter regions for particle tracing.
To calculate overlays depicting regional velocity and flow,

a subimage of interest is extracted from the velocity
data based on defined MPRs. Absolute velocities |v| = vx2 + vy2 + vz2 are derived for all MPR voxels within
the segmented vessels. The color map for the velocity overlay is the same as for the velocity encoded pathline
visualization.
To calculate the flow f through the MPR voxels, the velocity proportion perpendicular to the MPR plane is
determined through the projection onto the plane normal n and multiplied with the voxel area lx · ly .
⎛ ⎞ ⎛ ⎞
vx nx
f = ⎝ v y ⎠ · ⎝ ny ⎠ · lx · l y (2)
vz nz

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 For Doppler or 2D MRI flow measurements col-
ormaps usually apply blue to negative and red to
positive values. For the transition, there exist differ-
ent concepts regarding opacity and color. The color
scheme provided here is shown in fig. 7. Yellow and
green are chosen for the transition from negative to
positive values. Only very small values are suppressed
through low alpha values. As shown in the second row
of fig. 7, regions of interest are defined by drawing con-
tours onto the MPR planes. The bounding boxes and
normals of these regions are then used to perform fast
flow quantification. To this end the voxel-based veloc-
ity and flow values are calculated for each ROI voxel
at each timepoint as described above. For all ROI
voxels, minimum, maximum and average velocity and
throughflow are calculated per time point and visu-
alized as curves or tables (fig. 7, last row). The red
cursor in the curve diagram shows the temporal po-
sition of the image data that is presented in the 3D
and 2D viewers. If the user activates the temoral syn- Figure 7. Calculation and quantification of flow velocity and
chronization, the 2D views as well as the curve cursor throughflow in user-defined regions of interest.
position are updated in the flow animations as well.

3. RESULTS
To evaluate the applicability and the benefit of the software application, the described methods have been applied
to cases from different application areas showing the abdomen, head, heart, and aorta of volunteers and patients.

3.1 Case Studies

Heart and aorta: Plaque in the aorta is known to be a major risk factor for stroke. The decision how to treat
patients with aortic atheroma to minimize stroke depends on the expected trajectories of the plaque components
in case of rupture. Normally only plaques located in the ascending aorta before the orifices in the aortic arch
are considered high risk source of stroke. To examine reflow phenomena which could cause plaque in the ensuing
course of the aorta to enter the carotid arteries as well, ROIs can be defined in the truncus brachiocephalicus
and the arteria carotis communis. An accumulated backward tracking over the whole cardiac cycle can be used
then to determine the regions at risk in the aorta. Fig. 8 shows the results for three arbitrarily chosen patients
from the reflow study by Harloff et al.24 The regions of risk identified by the accumulated backtracking clearly
differ for the three cases.

Figure 8. Application to aorta images for stroke risk analysis. The path lines are colored according to their target region.

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 Figure 9. Flow into the pulmonary arteries visualized for a healthy volunteer (upper row) and a single-ventricle patient
with total cavopulmonary connection (lower row).

Another important application area for blood flow measurements are the hemodynamics in patients with
congenital heart disease. Figure 9 shows flow visualizations for a healthy volunteer and a patient with a single-
ventricle heart and a total cavopulmonary connection (TCPC). Because TCPC patients do not have a right
ventricle, surgery was performed to directly route the venous blood to the left and right lungs. To investigate
the hemodynamics, throughflow measurements are performed at the orifices of the pulmonary arteries. Figure 9
shows the segmentation results for the volunteer and the TCPC patient to illustrate the differences in anatomy.
The screenshots on the right show the path lines of the vasculature that transports blood into the lungs. The
curves in the lower right corner of the GUI represent the throughflow and velocity time courses in the orifices of
the right and left pulmonary arteries. It is clearly visible, that for the TCPC patient the velocity course looks
different but relatively similar for both sides. To explore how the blood from the vena cava and the left vena
brachiocephalica distributes into both lungs, fig. 10 displays a few time steps of the particle flow visualization
towards the target regions defined in the left and right pulmonary arteries.

Figure 10. The image shows snapshots of an animation of the backward tracking result with particle traces for a TCPC
patient. The target regions are placed in both pulmonary arteries and shown in orange and blue.

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 Liver: Abdominal blood flow can be very complicated to un-
derstand, especially if there are stenoses and collaterals causing
abnormal flow. Due to the different flow velocities and the vicin-
ity of the arteries and the portal venous system, the segmenta-
tion is a difficult task here. Figure 11 shows an example case,
where the flow into the liver via the portal vein is examined. To
this end regions of interest are placed into the vena mesenterica
superior and the vena lienalis as well as into the portal vein.
The particle traces are released from the vena mesenterica su-
perior and the vena lienalis to visualize the flow pattern in the
portal vein. For all three regions of interest velocity and flow
curves are derived to compare the portions of blood entering
the portal vein from the two vessels. Figure 11. Visualization of the flow into the portal
vein from vena mesenterica superior (orange ROI)
3.2 User Studies and vena lienalis (blue ROI). The aorta and the
To test the benefit of the software for clinical practice, four arteries are colored red whereas the hepatic veins
medical experts (a neurologist, a radiologist and two PhD stu- are blue
dents), got a 45-minute introduction to the described software
application. The neurologist and the radiologist already had
experience with the evaluation of PC MRI flow data using a combination of in house pre-processing tools for
quantitative measurements and EnSight for data visualization. The data analysis with this tool combination
usually takes them several hours. After the introduction into the new software application, the experts applied
the described methods to cranial and aorta datasets on a 64-bit Windows system with quad core processors, 8
GB RAM and a NVIDIA Quadro FX 1700M graphics card. The image data was arbitrarily chosen from ongoing
studies. The resolution of the aorta datasets was 1.7 mm2 to 1.8 mm2 in plane and 2.2 mm to 3.2 mm through
plane and temporal resolution was 0.037 s to 0.040 s. The image dimensions were 144x192x26 with 19 to 26
time points. Velocity encoding was 1.5 m s for all datasets. The cranial datasets were acquired with an in-plane
resolution of 0.9 mm2 to 1 mm2 , a through-plane resolution of 1 mm and a temporal resolution of 0.073 s to 0.08 s.
The image dimensions were 216x288x52 with 9 to 11 time points. Velocity encoding was 0.4 m s for all datasets.
The evaluations consisted of the segmentation of the vessels of interest, animated visualizations of overall flow,
placement of 3 to 7 regions of interest, inspection and export of quantitative measurements of velocity and flow.
All 11 cases were processed successfully by the clinicians. Table 3.2 shows the average times t̄ spent for the
applied processing steps.

Application Pre-processing Segmentation Flow Analysis Total

t̄ σ t̄ σ t̄ σ t̄ σ
Aorta 7.7 min 3.7 11.2 min 5.5 16.5 min 9.4 35.3 min 13.4
Cranial 9.6 min 5.4 21.2 min 8.5 13.4 min 8.9 44.2 min 11.1
Table 1. Average processing times of the major application steps in the user tests.

4. DISCUSSION
The application tests have shown, that the proposed composition of processing and visualization methods allows
performing flow analysis on standard hardware. The accuracy of particle tracing and flow visualization is however
still limited by the available RAM. The usage of straightforward processing and interaction methods and the
avoidance of limiting preassumptions resulted in a software that enables the application of flow analysis to cases
from different medical disciplines showing arbitrary vascular geometries.
The drawbacks of this strategy have become clear in the user studies. For the relatively slow flow in the cranial
vessels, parameter settings for eddy current correction have to be chosen differently from heart and abdomen.
Exploring different parameter settings resulted in pre-processing times of up to 20 minutes. This could be avoided

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 by a more adaptive concept for choosing parameters. The same applies for the vessel segmentation. The provided
method allowed segmenting all vessels of interest, but as there are no model assumptions regarding shape and
connectivity of vascular structures, the segmentation of regions with slow flow or moving vessels resulted in
processing times of up to 29 minutes for the cranial veins and 21 minutes for the aorta in single cases (fig. 12).

Figure 12. Problematic case for vessel segmentation. The orthogonal plane views on the left show the PC MRA image.
The initial segmentation result after one click is presented as an overlay on the other orthogonal plane view as well as the
3D rendering on the right. The low intensity values in the lower aorta and behind the aortic arch make the interactive
segmentation through the placement of include and exclude markers time-consuming for this case.

The duration of the actual flow analysis depended on the case complexity. Whereas the interactive inspection
steps could be performed very quickly by all users, the times spent for the examination of local flow phenomena
differed significantly. The proposed look-up-tables were changed by all users, because they ranked the compa-
rability with previous visualizations higher than the benefit through the provided region enhancements. This
implies that in future versions conventional coloring modes should be offered as well.
The placement of the MPRs for the inspection of local flow parameters and definition of regions of interest was
easy to use and offered a broad applicability. On the other hand workflow support like the automatic placement
of measurement regions for typical clinical questions or the generation of standard views could result in a more
convenient and quicker usage here as well.

5. CONCLUSIONS
We have presented a new software prototype for interactive exploration of hemodynamics based on 4D PC MRI
data. The software supports the complete image processing pipeline including pre-processing, segmentation and
interactive exploration, combining existing and newly developed techniques. The presented software has been
applied to cases from different medical application areas to test the applicability to a broad spectrum of data
and clinical questions. The results from the fields of neurology, cardiology and gastroenterology demonstrate
the suitability of the presented methods for the exploration of flow image data. Tests with clinical users showed
that the software was easy to learn for clinicians from different medical disciplines. All four test users were able
to produce good results for arbitrarily chosen aortic and cranial test cases within less than an hour. Thus, the
saving of time for the evaluation of study cases amounts to hours. Future work will be concerned with the further
optimization of the memory usage in the visualization to enable more accurate analyses and visualizations of
the particle traces. Visualization and interaction steps will be improved with the help of further application and
user studies.

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 REFERENCES
1. H.-H. Peng, S. Bauer, T.-Y. Huang, H.-W. Chung, J. Hennig, B. Jung, and M. Markl, “Optimized parallel
imaging for dynamic PC-MRI with multidirectional velocity encoding.,” Magn Reson Med 64, pp. 472–480,
Aug 2010.
2. J. Bock, K. M. Johnson, O. Wieben, J. Hennig, and M. Markl, “Aortic PC-MRA based on PC-MRI data,”
in MR-Angioclub Graz 2008, p. 81, 2008.
3. J. E. Solem, M. Persson, and A. Heyden, “Velocity Based Segmentation in Phase Contrast MRI Images,” in
Medical Image Computing and Computer-Assisted Intervention MICCAI 2004, C. Barillot, D. R. Haynor,
and P. Hellier, eds., Lecture Notes in Computer Science 3216, pp. 459–466, Springer Berlin / Heidelberg,
2004.
4. M. Schmidt, R. Unterhinninghofen, S. Ley, and R. Dillmann, “Flow-based segmentation of the large thoracic
arteries in tridirectional phase-contrast MRI,” in SPIE Medical Imaging, 7259, p. 725914, Bellingham, 2009.
5. L. Wigstroem, T. Ebbers, A. Fyrenius, M. Karlsson, J. Engvall, B. Wranne, and A. F. Bolger, “Particle
trace visualization of intracardiac flow using time-resolved 3d phase contrast mri.,” Magn Reson Med 41,
pp. 793–799, Apr 1999.
6. D. Stalling, M. Zockler, and H.-C. Hege, “Fast display of illuminated field lines,” Visualization and Computer
Graphics, IEEE Transactions on 3(2), pp. 118 –128, 1997.
7. R. van Pelt, J. O. Bescos, M. Breeuwer, R. E. Clough, M. E. Groeller, B. ter Haar Romenij, and A. Vilanova,
“Exploration of 4D MRI blood flow using stylistic visualization.,” IEEE Trans Vis Comput Graph 16(6),
pp. 1339–1347, 2010.
8. T. S. Soerensen, P. Beerbaum, H. Koerperich, and E. M. Pedersen, “Three-dimensional, isotropic MRI: a
unified approach to quantification and visualization in congenital heart disease.,” Int J Cardiovasc Imag-
ing 21(2-3), pp. 283–292, 2005.
9. R. Unterhinninghofen, S. Ley, J. Ley-Zaporozhan, H. von Tengg-Kobligk, M. Bock, H.-U. Kauczor, G. Szab,
and R. Dillmann, “Concepts for visualization of multidirectional phase-contrast MRI of the heart and large
thoracic vessels.,” Acad Radiol 15, pp. 361–369, Mar 2008.
10. R. Gasteiger, M. Neugebauer, C. Kubisch, and B. Preim, “Adapted Surface Visualization of Cerebral
Aneurysms with Embedded Blood Flow Information,” in Eurographics Workshop on Visual Computing
for Biology and Medicine (EG VCBM), pp. 25–32, 2010.
11. A. Barker, J. Bock, R. Lorenz, and M. Markl, “4d flow mr imaging,” Magnetom Flash , pp. 46–52, 11 2010.
12. EnSight Engineering Visualization Software, “Biomedical simulation visualization.”
http://www.ensight.com/Biomedical-Simulation-Visualization/, 2010.
13. GyroTools, “GT Flow.” http://www.gyrotools.com/products/gt-flow.html, 2010.
14. M. Markl, A. Harloff, T. A. Bley, M. Zaitsev, B. Jung, E. Weigang, M. Langer, J. Hennig, and A. Frydrychow-
icz, “Time-resolved 3D MR velocity mapping at 3T: improved navigator-gated assessment of vascular
anatomy and blood flow.,” J Magn Reson Imaging 25, pp. 824–831, Apr 2007.
15. Z. Stankovic, A. Frydrychowicz, Z. Csatari, E. Panther, P. Deibert, W. Euringer, W. Kreisel, M. Russe,
S. Bauer, M. Langer, and M. Markl, “MR-based visualization and quantification of three-dimensional flow
characteristics in the portal venous system.,” J Magn Reson Imaging 32, pp. 466–475, Aug 2010.
16. S. Wetzel, S. Meckel, A. Frydrychowicz, L. Bonati, E.-W. Radue, K. Scheffler, J. Hennig, and M. Markl,
“In vivo assessment and visualization of intracranial arterial hemodynamics with flow-sensitized 4D MR
imaging at 3T.,” AJNR Am J Neuroradiol 28, pp. 433–438, Mar 2007.
17. I. Bitter, R. V. Uitert, I. Wolf, L. Ibanez, and J.-M. Kuhnigk, “Comparison of four freely available frame-
works for image processing and visualization that use ITK.,” IEEE Trans Vis Comput Graph 13(3), pp. 483–
493, 2007.
18. J.-W. Lankhaar, M. B. M. Hofman, J. T. Marcus, J. J. M. Zwanenburg, T. J. C. Faes, and A. Vonk-
Noordegraaf, “Correction of phase offset errors in main pulmonary artery flow quantification.,” J Magn
Reson Imaging 22, pp. 73–79, Jul 2005.

Proc. of SPIE Vol. 7964 79640E-10

Downloaded From: http://proceedings.spiedigitallibrary.org/ on 06/04/2015 Terms of Use: http://spiedl.org/terms

 19. C. Diaz and L. Altamirano Robles, “Fast Noncontinuous Path Phase-Unwrapping Algorithm Based on
Gradients and Mask,” in Progress in Pattern Recognition, Image Analysis and Applications, A. Sanfeliu,
J. F. Martinez Trinidad, and J. A. Carrasco Ochoa, eds., Lecture Notes in Computer Science 3287, pp. 116–
123, Springer Berlin / Heidelberg, 2004.
20. H. Hahn and H.-O. Peitgen, “IWT Interactive Watershed Transform: A Hierarchical Method for Efficient
Interactive and Automated Segmentation of Multidimensional Gray-Scale Images,” in SPIE Med Imaging,
Image Processing, M. Sonka and J. Fitzpatrick, eds., 5032, pp. 643–653, SPIE, 2003.
21. J. S. Sobel, A. S. Forsberg, D. H. Laidlaw, R. C. Zeleznik, D. F. Keefe, I. Pivkin, G. E. Karniadakis,
P. Richardson, and S. Swartz, “Particle Flurries: Synoptic 3D Pulsatile Flow Visualization,” IEEE Computer
Graphics and Applications 24, pp. 76–85, 2004.
22. B. Kainz, U. Reiter, G. Reiter, and D. Schmalstieg, “In vivo interactive visualization of four-dimensional
blood flowpatterns,” The Visual Computer 25, pp. 853–862, 2009. 10.1007/s00371-009-0315-7.
23. J. Krueger, P. Kipfer, P. Konclratieva, and R. Westermann, “A particle system for interactive visualization
of 3D flows,” Visualization and Computer Graphics, IEEE Transactions on 11(6), pp. 744 –756, 2005.
24. A. Harloff, J. Simon, S. Brendecke, D. Assefa, T. Helbing, A. Frydrychowicz, J. Weber, M. Olschewski,
C. Strecker, J. Hennig, C. Weiller, and M. Markl, “Complex plaques in the proximal descending aorta: an
underestimated embolic source of stroke.,” Stroke 41, pp. 1145–1150, Jun 2010.

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