A rapid algorithm for robust, accurate, and automatic extraction of the midsagittal plane (MSP) of the human cerebrum from normal and pathological neuroimages is proposed. The MSP is defined as a plane formed from the interhemispheric fissure line segments having the dominant orientation. The algorithm extracts the MSP in four steps: (1) determine suitable axial slices for processing, (2) localize the fissure line segments on them, (3) select inliers from the extracted fissure line segments through histogram-based outlier removal, and (4) calculate the equation of the MSP from the selected inliers. The fissure line segments are localized by minimizing the local symmetry index characterizing anatomical properties of images in the vicinity of the interhemispheric fissure. A two-stage angular and distance outlier removal is introduced to handle abnormalities. The algorithm has been validated quantitatively with 125 structural MRI and CT cases from 10 centers on three continents by studying its accuracy; tolerance to rotation, noise, asymmetry, and bias field; sensitivity to parameters; and performance. A statistical relationship between algorithm accuracy and the data's adherence to planarity is also determined. The algorithm extracts the MSP below 6 s on Pentium 4 (2.4 GHz) with the average angular and distance errors of (0.40°; 0.63 mm) for normal and (0.59°; 0.73 mm) for pathological cases. The robustness to noise, asymmetry, rotation, and bias field is achieved by extracting the MSP based on the dominant orientation and local symmetry index. A low computational cost results from applying simple operations capturing intrinsic anatomic features, constraining the searching space to the local vicinity of the interhemispheric fissure, and formulating a noniterative algorithm with a coarse and fine fixed-step searching. In comparison to the existing methods, our algorithm is much faster, performs accurately and robustly for a wide range of diversified data, and is fully automatic and thoroughly validated, which make it suitable for clinical applications. © 2003 Elsevier Inc. All rights reserved.
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