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FLAIRfusion Processing with Contrast Inversion

Improving Detection and Reading Time of New Cerebral MS Lesions

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Abstract

Purpose

To evaluate the performance of an innovative image processing approach for detection of T2-weighted hyperintense multiple sclerosis (MS) lesions.

Methods

In this study 20 consecutive patients with inflammatory demyelinating lesions were retrospectively evaluated of whom 10 patients featured progressive disease and 10 a stable lesion load. 3 mm transversal FLAIRfusion imaging was processed and archived. Image processing was performed through landmark-based 3D co-registration of the previous and current isotropic FLAIR examination followed by inversion of image contrast. Thereby, the hyperintense signals of the unchanged MS plaques extinguish each other, while newly developed lesions appear bright on FLAIRfusion. Diagnostic performance was evaluated by 4 experienced readers. Consensus reading supplied the reference standard. Sensitivity, specificity, NPV (negative predictive value), PPV (positive predictive value), interreader agreement and reading time were the outcome measures analyzed.

Results

Combined sensitivity was 100% at a specificity of 88.2%, with PPV ranging from 83.3% to 90.1% and NPV at 100%. Reading time was nearly 5‑fold faster than conventional side by side comparison (35.6 s vs. 163.7 s, p < 0.001). Cohen’s kappa was excellent (>0.75; p < 0.001) and Cronbach’s alpha was 0.994.

Conclusion

FLAIRfusion provides reliable detection of newly developed MS lesions along with strong interreader agreement across all levels of expertise in 35 s of reading time.

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Funding

This work was supported by the Interdisciplinary Center for Clinical Research (IZKF Erlangen, project J53, MAS). RAL holds an endowed professorship supported by NovartisPharma.

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Authors and Affiliations

  1. Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany

    M. A. Schmidt, S. Lang, H. Lücking, T. Engelhorn, S. Kloska, A. Dörfler & P. Dankerl

  2. Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany

    R. A. Linker

  3. Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany

    M. Uder, A. Cavallaro & P. Dankerl

Authors
  1. M. A. Schmidt
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  2. R. A. Linker
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  3. S. Lang
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  4. H. Lücking
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  5. T. Engelhorn
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  6. S. Kloska
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  7. M. Uder
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  8. A. Cavallaro
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  9. A. Dörfler
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  10. P. Dankerl
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Corresponding author

Correspondence to M. A. Schmidt.

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Conflict of interest

M. A. Schmidt, R. A. Linker, S. Lang, H. Lücking, T. Engelhorn, S. Kloska, M. Uder, A. Cavallaro, A. Dörfler and P. Dankerl declare that they have no competing interests.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Schmidt, M.A., Linker, R.A., Lang, S. et al. FLAIRfusion Processing with Contrast Inversion. Clin Neuroradiol 28, 367–376 (2018). https://doi.org/10.1007/s00062-017-0567-y

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  • DOI: https://doi.org/10.1007/s00062-017-0567-y

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