LesionQuant for Assessment of MRI in Multiple Sclerosis—A Promising Supplement to the Visual Scan Inspection

Abstract

Background and Goals: Multiple sclerosis (MS) is a central nervous system inflammatory disease where magnetic resonance imaging (MRI) is an important tool for diagnosis and disease monitoring. Quantitative measurements of lesion volume, lesion count, distribution of lesions, and brain atrophy have a potentially significant value for evaluating disease progression. We hypothesize that utilizing software designed for evaluating MRI data in MS will provide more accurate and detailed analyses compared to the visual neuro-radiological evaluation.Methods: A group of 56 MS patients (mean age 35 years, 70% females and 96% relapsing-remitting MS) was examined with brain MRI one and 5 years after diagnosis. The T1 and FLAIR brain MRI sequences for all patients were analyzed using the LesionQuant (LQ) software. These data were compared with data from structured visual evaluations of the MRI scans performed by neuro-radiologists, including assessments of atrophy, and lesion count. The data from LQ were also compared with data from other validated research methods for brain segmentation, including assessments of whole brain volume and lesion volume. Correlations with clinical tests like the timed 25-foot walk test (T25FT) were performed to explore additional value of LQ analyses.Results: Lesion count assessments by LQ and by the neuro-radiologist were significantly correlated one year (cor = 0.92, p = 2.2 × 10−16) and 5 years (cor = 0.84, p = 2.7 × 10−16) after diagnosis. Analyzes of the intra- and interrater variability also correlated significantly (cor = 0.96, p < 0.001, cor = 0.97, p < 0.001). Significant positive correlation was found between lesion volume measured by LQ and by the software Cascade (cor = 0.7, p < 0.001. LQ detected a reduction in whole brain percentile >10 in 10 patients across the time-points, whereas the neuro-radiologist assessment identified six of these. The neuro-radiologist additionally identified five patients with increased atrophy in the follow-up period, all of them displayed decreasing low whole brain percentiles (median 11, range 8–28) in the LQ analysis. Significant positive correlation was identified between lesion volume measured by LQ and test performance on the T25FT both at 1 and 5 years after diagnosis.Conclusion: For the number of MS lesions at both time-points, we demonstrated strong correlations between the assessments done by LQ and the neuro-radiologist. Lesion volume evaluated with LQ correlated with T25FT performance. LQ-analyses classified more patients to have brain atrophy than the visual neuro-radiological evaluation. In conclusion, LQ seems like a promising supplement to the evaluation performed by neuro-radiologists, providing an automated tool for evaluating lesions in MS patients and also detecting early signs of atrophy in both a longitudinal and cross-sectional setting.

How far MS lesion detection and segmentation are integrated into the clinical workflow? A systematic review

“… volume of lesions 1st, 2nd ( Yildirim and Dandil, 2021a ) 38 MS T2-w mask R-CNN with ResNet101 as backbone / DSC, volume overlap error, LTPR, LFPR 1st, 2nd ( Tran et al, 2022 ) 30 MS T1-w and FLAIR intensity-based b.c. WM hyperintensities volume agreement, DSC, FPR, TPR, F1 score 1st, 2nd, 3rd ( Cavedo et al, 2022 ) 130 images multi-centric, different populations FLAIR intensity-based / WM hyperintensities volume, DSC, relative VD, absolute volume error 1st, 2nd, 3rd ( Brune et al, 2020 ) 56 MS MPRAGE and FLAIR intensity-based / lesion count of tool vs neuroradiologists, single and multiple timepoints 1st, 2nd, 3rd ( Jain et al, 2017 ) 22 MS T1-w and FLAIR maximum a posteriori model on image intensities of both time points b.c., normalisation DSC, F1, LTPR, LFPR, AVD 1st, 2nd ( Van Hecke et al, 2021 ) batches of 10 and 25 MS, plus 87 subjects with CIS and MS T1-w and FLAIR U-Net with attention gate layers MNI reg., skull stripping, z-score normalisation with vs without tool performances, surveys on patient’s perspective 1st, 2nd, 3rd, 4th, 5th, 6th ( Sousa et al, 2021 ) …”

Commercial volumetric MRI reporting tools in multiple sclerosis: a systematic review of the evidence

“…Technical: NeuroQuant MS has been tested for longitudinal consistency [20] and compared to visual radiological assessment [20], icobrain ms [28], and established brain and lesion segmentation methods (FIRST [71], LST [71], SIENA(X) [28], FreeSurfer [20], and Cascade [20]).…”

“…Clinical: NeuroQuant MS results were correlated with clinical variables, including EDSS and timed 25-foot walk test (T25FT) and 9-Hole Peg Test (9HPT) scores as measures of MS-related physical disability [20].…”

“…The development and use of automated and semi-automated brain and lesion segmentation methods, such as in quantitative volumetric reporting tools (QReports), has increased in recent years [11,17]. These tools aim to improve the objectivity of image interpretation by increasing the sensitivity of MRI analysis [18,19], the accuracy [20][21][22][23][24][25] and reproducibility of results [22,26], and potentially decreasing reporting time [18]. QReports can facilitate cross-sectional diagnosis [20,[26][27][28][29][30], longitudinal assessment [20,22,23,31], and therapy response monitoring [32] via user-friendly graphical displays.…”

“…These tools aim to improve the objectivity of image interpretation by increasing the sensitivity of MRI analysis [18,19], the accuracy [20][21][22][23][24][25] and reproducibility of results [22,26], and potentially decreasing reporting time [18]. QReports can facilitate cross-sectional diagnosis [20,[26][27][28][29][30], longitudinal assessment [20,22,23,31], and therapy response monitoring [32] via user-friendly graphical displays. QReports may also offer automatic contextualization of an individual patient's volumetric results against a relevant reference population [33], which could assist clinicians in disease course prognostication and deciding on therapeutic strategies.…”