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Follow-up MRI in multiple sclerosis patients: automated co-registration and lesion color-coding improves diagnostic accuracy and reduces reading time

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Abstract

Objectives

In multiple sclerosis (MS), the heterogeneous and numerous appearances of lesions may impair diagnostic accuracy. This study investigates if a combined automated co-registration and lesion color-coding method (AC) improves assessment of MS follow-up MRI compared with conventional reading (CR).

Methods

We retrospectively assessed 70 follow-up MRI of 53 patients. Heterogeneous datasets of diverse scanners and institutions were used. Two readers determined presence of (a) progression, (b) regression, (c) mixed change, or (d) stable disease between the two examinations using corresponding FLAIR sequences in CR and AC-assisted reading. Consensus reference reading was provided by two blinded radiologists. Kappa statistics tested interrater agreement, McNemar’s test dichotomous variables, and Wilcoxon’s test continuous variables (statistical significance p ≤ 0.05).

Results

The cohort comprised 41 female and 12 male patients with a mean age of 40 (± 14) years. Average rating time was reduced from 78 (± 36) to 44 (±22) s with the AC approach (p < 0.001). The time needed to start and match datasets with AC was 14 (± 1) s. Compared with CR, AC improved interrater agreement, both between raters (0.52 vs. 0.67) and between raters and consensus reference reading (0.47/0.5 vs. 0.83/0.78). Compared with CR, the diagnostic accuracy increased from 67 to 90% (reader 1, p < 0.01) and from 70 to 87% (reader 2, p < 0.05) in the AC-assisted reading.

Conclusions

Compared with CR, automated co-registration and lesion color-coding of MS-associated FLAIR-lesions in follow-up MRI increased diagnostic accuracy and reduced the time required for follow-up evaluation significantly. The AC algorithm therefore appears to be helpful to improve MS follow-up assessments in clinical routine.

Key Points

• Automated co-registration and lesion color-coding increases diagnostic accuracy in the assessment of MRI follow-up examinations in patients with multiple sclerosis.

• Automated co-registration and lesion color-coding reduces reading time of MRI follow-up examinations in patients with multiple sclerosis.

• Automated co-registration and lesion color-coding improved interrater agreement in the assessment of MRI follow-up examinations in patients with multiple sclerosis.

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Abbreviations

AC:

Automated co-registration and lesion color-coding image reading approach

CR:

Conventional reading

FLAIR:

Fluid-attenuated inversion recovery

MRI:

Magnetic resonance imaging

MS:

Multiple sclerosis

PACS:

Picture archiving and communication system

RIS:

Radiological information system

SD:

Standard deviation.

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany

    David Zopfs, Kai R. Laukamp, Stefanie Paquet, Simon Lennartz, Daniel Pinto dos Santos, Christoph Kabbasch, Alexander Bunck, Marc Schlamann & Jan Borggrefe

  2. Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Kai R. Laukamp

  3. Department of Radiology, Case Western Reserve University, Cleveland, OH, USA

    Kai R. Laukamp

Authors
  1. David Zopfs
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  2. Kai R. Laukamp
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  4. Simon Lennartz
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  5. Daniel Pinto dos Santos
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  6. Christoph Kabbasch
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  9. Jan Borggrefe
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Correspondence to David Zopfs.

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Guarantor

The scientific guarantor of this publication is Jan Borggrefe.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Jan Borggrefe received speaker honoraria from Philips.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Zopfs, D., Laukamp, K.R., Paquet, S. et al. Follow-up MRI in multiple sclerosis patients: automated co-registration and lesion color-coding improves diagnostic accuracy and reduces reading time. Eur Radiol 29, 7047–7054 (2019). https://doi.org/10.1007/s00330-019-06273-x

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  • DOI: https://doi.org/10.1007/s00330-019-06273-x

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