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The severity of traumatic brain injury (TBI) is known to be characterized by the shift of the middle line in brain as the ventricular system often changes in size and position, depending on the location of the original injury. In this thesis, the focus is given to processing of the CT (Computer Tomography) brain images to automatically calculate midline shift in pathological cases and use it to predict Intracranial Pressure (ICP). The midline shift measurement can be divided into three steps. First the ideal midline of the brain, i.e., the midline before injury, is found via a hierarchical search based on skull symmetry and tissue features. Second, the ventricular system is segmented from the brain CT slices. Third, the actual midline is estimated from the deformed ventricles by shape matching method. The horizontal shift in the ventricles is then calculated based on the ideal midline and the actual midline in TBI CT images. The proposed method presents accurate detection of the ideal midline using anatomical features in the skull, accurate segmentation of ventricles for actual midline estimation using the information of anatomical features with a spatial template derived from a magnetic resonance imaging (MRI) scan, and an accurate estimation of the actual midline based on the robust proposed multiple regions shape matching algorithm. After the midline shift is successively measured, features including midline shift, texture information of CT images, as well as other demographic information are used to predict ICP. Machine learning algorithms are used to model the relation between the ICP and the extracted features. By using systematic feature selection and parameter selection of the learning model, promising results on ICP prediction are achieved. The prediction results also indicate the reliability of the proposed midline shift estimation.

Midline shift (MLS), the amount of displacement of the brain’s midline from its normal symmetric position due to illness or injury, is an important index for clinicians to assess the severity of traumatic brain injury (TBI). In this dissertation, an automated computer-aided midline shift estimation system is proposed. First, a CT slice selection algorithm (SSA) is designed to automatically select a subset of appropriate CT slices from a large number of raw images for MLS detection. Next, ideal midline detection is implemented based on skull bone anatomical features and global rotation assumptions. For the actual midline detection algorithm, a window selection algorithm (WSA) is applied first to confine the region of interest, then the variational level set method is used to segment the image and extract the ventricle contours. With a ventricle identification algorithm (VIA), the position of actual midline is detected based on the identified right and left lateral ventricle contours. Finally, the brain midline shift is calculated using the positions of detected ideal midline and actual midline. One of the important applications of midline shift in clinical medical decision making is to estimate the intracranial pressure (ICP). ICP monitoring is a standard procedure in the care of severe traumatic brain injury (TBI) patients. An automated ICP level prediction model based on machine learning method is proposed in this work. Multiple features, including midline shift, intracranial air cavities, ventricle size, texture patterns, and blood amount, are used in the ICP level prediction. Finally, the results are evaluated to assess the effectiveness of the proposed method in ICP level prediction.

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