Automatic detection of hippocampal sclerosis in patients with epilepsy.
Authors
Affiliations (13)
Affiliations (13)
- Department of Neurology, Epilepsy Center Hessen, Philipps Universität Marburg, Marburg, Germany.
- Landes-Offensive zur Entwicklung Wissenschaftlich-ökonomischer Exzellenz (LOEWE) Research Cluster for Advanced Medical Physics in Imaging and Therapy, Technische Hochschule (TH)-Mittelhessen University of Applied Sciences, Giessen, Germany.
- Center for Personalized Translational Epilepsy Research, Goethe Universität Frankfurt, Frankfurt am Main, Germany.
- Department of Neurology with Experimental Neurology, Computational Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Department of Life Science Engineering, Institute of Medical Physics and Radiation Protection, TH-Mittelhessen University of Applied Sciences, Giessen, Germany.
- Department of Diagnostic and Interventional Radiology, Philipps Universität Marburg, Marburg, Germany.
- Center for Brain, Mind, and Behavior, Philipps Universität Marburg, Marburg, Germany.
- Department of Psychiatry, Philipps Universität Marburg, Marburg, Germany.
- Department of Neuropathology, Philipps Universität Marburg, Marburg, Germany.
- Department of Neuroradiology, Philipps Universität Marburg, Marburg, Germany.
- Department of Neurosurgery, Philipps Universität Marburg, Marburg, Germany.
- Department of Neurology, Center of Neurology and Neurosurgery, Goethe Universität Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Frankfurt, Germany.
Abstract
This study was undertaken to develop and validate an automatic, artificial intelligence-enhanced software tool for hippocampal sclerosis (HS) detection, using a variety of standard magnetic resonance imaging (MRI) protocols from different MRI scanners for routine clinical practice. First, MRI scans of 36 epilepsy patients with unilateral HS and 36 control patients with epilepsy of other etiologies were analyzed. MRI features, including hippocampal subfield volumes from three-dimensional (3D) magnetization-prepared rapid acquisition gradient echo (MPRAGE) scans and fluid-attenuated inversion recovery (FLAIR) intensities, were calculated. Hippocampal subfield volumes were corrected for total brain volume and z-scored using a dataset of 256 healthy controls. Hippocampal subfield FLAIR intensities were z-scored in relation to each subject's mean cortical FLAIR signal. Additionally, left-right ratios of FLAIR intensities and volume features were obtained. Support vector classifiers were trained on the above features to predict HS presence and laterality. In a second step, the algorithm was validated using two independent, external cohorts, including 118 patients and 116 controls in sum, scanned with different MRI scanners and acquisition protocols. Classifiers demonstrated high accuracy in HS detection and lateralization, with slight variations depending on the input image availability. The best cross-validation accuracy was achieved using both 3D MPRAGE and 3D FLAIR scans (mean accuracy = 1.0, confidence interval [CI] = .939-1.0). External validation of trained classifiers in two independent cohorts yielded accuracies of .951 (CI = .902-.980) and .889 (CI = .805-.945), respectively. In both validation cohorts, the additional use of FLAIR scans led to significantly better classification performance than the use of MPRAGE data alone (p = .016 and p = .031, respectively). A further model was trained on both validation cohorts and tested on the former training cohort, providing additional evidence for good validation performance. Comparison to a previously published algorithm showed no significant difference in performance (p = 1). The method presented achieves accurate automated HS detection using standard clinical MRI protocols. It is robust and flexible and requires no image processing expertise.