Deep Learning-Based Signal Amplification of T1-Weighted Single-Dose Images Improves Metastasis Detection in Brain MRI.
Authors
Affiliations (1)
Affiliations (1)
- From the Department of Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn, Germany (R.H., E.K., Z.B., S.Z., A.-H.S., F.C.S., S.P., A.M.S., D.P., A.R., K.D.); Institute of Applied Mathematics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany (T.P., A.E.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.P.); Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.P., H.-P.S.); Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany (M.F.-D., K.S., G.H., C.P.H.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.F.-D.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (V.W., C.P.H.); Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany (M.H., J.H., C.D.); Translational Lung Research Center Heidelberg (TLRC), Member of the German Center of Lung Research (DZL), Heidelberg, Germany (C.P.H.); Praxisnetz, Radiology and Nuclear Medicine, Bonn, Germany (M.V.); Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany (J.A.L.); German Center for Neurodegenerative Diseases (DZNE), Helmholtz Association of German Research Centers, Bonn, Germany (A.R., K.D.); and Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA (K.D.).
Abstract
Double-dose contrast-enhanced brain imaging improves tumor delineation and detection of occult metastases but is limited by concerns about gadolinium-based contrast agents' effects on patients and the environment. The purpose of this study was to test the benefit of a deep learning-based contrast signal amplification in true single-dose T1-weighted (T-SD) images creating artificial double-dose (A-DD) images for metastasis detection in brain magnetic resonance imaging. In this prospective, multicenter study, a deep learning-based method originally trained on noncontrast, low-dose, and T-SD brain images was applied to T-SD images of 30 participants (mean age ± SD, 58.5 ± 11.8 years; 23 women) acquired externally between November 2022 and June 2023. Four readers with different levels of experience independently reviewed T-SD and A-DD images for metastases with 4 weeks between readings. A reference reader reviewed additionally acquired true double-dose images to determine any metastases present. Performances were compared using Mid-p McNemar tests for sensitivity and Wilcoxon signed rank tests for false-positive findings. All readers found more metastases using A-DD images. The 2 experienced neuroradiologists achieved the same level of sensitivity using T-SD images (62 of 91 metastases, 68.1%). While the increase in sensitivity using A-DD images was only descriptive for 1 of them (A-DD: 65 of 91 metastases, +3.3%, P = 0.424), the second neuroradiologist benefited significantly with a sensitivity increase of 12.1% (73 of 91 metastases, P = 0.008). The 2 less experienced readers (1 resident and 1 fellow) both found significantly more metastases on A-DD images (resident, T-SD: 61.5%, A-DD: 68.1%, P = 0.039; fellow, T-SD: 58.2%, A-DD: 70.3%, P = 0.008). They were therefore able to use A-DD images to increase their sensitivity to the neuroradiologists' initial level on regular T-SD images. False-positive findings did not differ significantly between sequences. However, readers showed descriptively more false-positive findings on A-DD images. The benefit in sensitivity particularly applied to metastases ≤5 mm (5.7%-17.3% increase in sensitivity). A-DD images can improve the detectability of brain metastases without a significant loss of precision and could therefore represent a potentially valuable addition to regular single-dose brain imaging.