Purpose: Medical image visualization is an important step in the medical diagnosis of hydrocephalus. In this paper, we present planar representations called volumetric relief maps that are generated from three-dimensional images of the cerebrospinal fluid within the cortical subarachnoid space. Such maps are visually interpreted at once and allow to automatically characterize fluid distributions. Consequently, they help specialists to provide a diagnosis and to monitor patients instantly. Methods: Volumetric relief maps are generated by enclosing the cortical subarachnoid space with a hemisphere, and using a ray tracing method and a map projection technique from a hemisphere to a plane. Results: Visualization of maps indicates that healthy adults have more balanced fluid distributions with well-filled sulci, unlike hydrocephalus patients who have more or less large fluid depletions in the posterior regions of the brain. We showed that a moment-based approach allows to efficiently characterize such fluid distributions from maps. In particular, the center of mass of a distribution is an efficient discriminant factor to distinguish between healthy adults and hydrocephalus patients, with resulting sensitivity and specificity of 100%. In addition, we have noted that asymmetry of the fluid distribution increases with depletion for hydrocephalus patients; such asymmetry is generally oriented towards the frontal part of the fissura longitudinalis cerebri. Conclusions: This paper describes an innovative visualization tool used to analyze fluid distribution within the cortical subarachnoid space. It allows to efficiently discriminate between healthy adults and pathological cases, and to monitor patients before and after surgery.
