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International Journal of Biomedical Imaging
Volume 2018, Article ID 4303161, 13 pages
Review Article

Brain Midline Shift Measurement and Its Automation: A Review of Techniques and Algorithms

1Institute of Biomedical Engineering, National Taiwan University, No. 1, Sec. 1, Renai Rd., Taipei City 10051, Taiwan
2Department of Neurosurgery, Taipei Hospital, Ministry of Health and Welfare, No. 127, Siyuan Rd., New Taipei City 24213, Taiwan
3Department of Medical Imaging, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei City 10002, Taiwan
4Department of Neurosurgery, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei City 10002, Taiwan

Correspondence should be addressed to Furen Xiao; moc.liamg@nerufx

Received 19 December 2017; Accepted 4 March 2018; Published 12 April 2018

Academic Editor: Anne Clough

Copyright © 2018 Chun-Chih Liao et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Midline shift (MLS) of the brain is an important feature that can be measured using various imaging modalities including X-ray, ultrasound, computed tomography, and magnetic resonance imaging. Shift of midline intracranial structures helps diagnosing intracranial lesions, especially traumatic brain injury, stroke, brain tumor, and abscess. Being a sign of increased intracranial pressure, MLS is also an indicator of reduced brain perfusion caused by an intracranial mass or mass effect. We review studies that used the MLS to predict outcomes of patients with intracranial mass. In some studies, the MLS was also correlated to clinical features. Automated MLS measurement algorithms have significant potentials for assisting human experts in evaluating brain images. In symmetry-based algorithms, the deformed midline is detected and its distance from the ideal midline taken as the MLS. In landmark-based ones, MLS was measured following identification of specific anatomical landmarks. To validate these algorithms, measurements using these algorithms were compared to MLS measurements made by human experts. In addition to measuring the MLS on a given imaging study, there were newer applications of MLS that included comparing multiple MLS measurement before and after treatment and developing additional features to indicate mass effect. Suggestions for future research are provided.