Background
Magnetic resonance imaging (MRI) diagnosis is usually performed by analyzing contrast‐weighted images, where pathology is detected once it reached a certain visual threshold. Computer‐aided diagnosis (CAD) has been proposed as a way for achieving higher sensitivity to early pathology.
Purpose
To compare conventional (i.e., visual) MRI assessment of artificially generated multiple sclerosis (MS) lesions in the brain's white matter to CAD based on a deep neural network.
Study Type
Prospective.
Population
A total of 25 neuroradiologists (15 males, age 39 ± 9, 9 ± 9.8 years of experience) independently assessed all synthetic lesions.
Field Strength/Sequence
A 3.0 T, T2‐weighted multi‐echo spin‐echo (MESE) sequence.
Assessment
MS lesions of varying severity levels were artificially generated in healthy volunteer MRI scans by manipulating T2 values. Radiologists and a neural network were tasked with detecting these lesions in a series of 48 MR images. Sixteen images presented healthy anatomy and the rest contained a single lesion at eight increasing severity levels (6%, 9%, 12%, 15%, 18%, 21%, 25%, and 30% elevation in T2). True positive (TP) rates, false positive (FP) rates, and odds ratios (ORs) were compared between radiological diagnosis and CAD across the range lesion severity levels.
Statistical Tests
Diagnostic performance of the two approaches was compared using z‐tests on TP rates, FP rates, and the logarithm of ORs across severity levels. A P‐value <0.05 was considered statistically significant.
Results
ORs of identifying pathology were significantly higher for CAD vis‐à‐vis visual inspection for all lesions' severity levels. For a 6% change in T2 value (lowest severity), radiologists' TP and FP rates were not significantly different (P = 0.12), while the corresponding CAD results remained statistically significant.
Data Conclusion
CAD is capable of detecting the presence or absence of more subtle lesions with greater precision than the representative group of 25 radiologists chosen in this study.
Level of Evidence
1
Technical Efficacy
Stage 3
Objectives
To determine the rate of fetal and neonatal brain lesions and define risk factors for such lesions in pregnancies complicated by Twin Anemia Polycythemia Sequence (TAPS).
Methods
A retrospective cohort study of monochorionic twin pregnancies which were diagnosed with TAPS in a single tertiary medical center between 2013 and 2021. Pregnancies were followed with fetal brain neurosonogram every 2 weeks and fetal brain MRI (magnetic resonance imaging) was performed when indicated at 28–32 weeks of gestation; post‐natal brain imaging included neonatal brain ultrasound. Pregnancies with pre‐ and post‐natal brain lesions were compared to those without such findings.
Results
Overall, 23 monochorionic diamniotic pregnancies were diagnosed with TAPS over the study period resulting in perinatal survival of 91.3% (42/46). In 6/23 (26%) pregnancies and 7/46 (15.2%) fetuses pre‐ or post‐natal brain lesions were detected, of whom five were the polycythemic twins and two were the anemic twins. Brain findings included intra‐cerebral hemorrhage and ischemic lesions and were diagnosed prenatally in 6/7 (85.7%) cases. No risk factors for severe brain lesions were identified.
Conclusions
TAPS may place the fetuses and neonates at increased risk for cerebral injuries. Incorporation of fetal brain imaging protocols may enhance precise prenatal diagnosis and allow for accurate parental counseling and post‐natal care.
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