Reduce MS surveillance MRI scan time

Purpose

Patients with Multiple Sclerosis (MS) undergo multiple surveillance MRIs, many with contrast, throughout their lifetime. Real-time AI should be able to reduce scan time without compromising necessary information for treatment.

Tag(s)

multiple sclerosis, MS, MRI, imaging, contrast, gadolinium

Panel

Neuroradiology Panel

Define-AI ID

19020007

Originator

Julie Bykowski
Lead Julie Bykowski

Panel Chair

Alexander Norbash

Panel Reviewers

Neuroradiology Panel

License

Creative Commons 4.0 
Status Public Commenting
RadElement Set RDES83
                               

Clinical Implementation


Value Proposition


Real-time comparison ensuring no significant change between prior and current exam would allow total scan time to be curtailed and contrast avoided. Benefits of this automation include improving patient comfort, reducing contrast exposure, and freeing up scanner time for other patients.

Narrative(s)


62 yr old woman with MS has had 13 brain MRIs (11 with contrast) since her diagnosis 14 years ago. She has had stable disease on the past 4 exams, however continues surveillance while on disease modifying medication.

Workflow Description


At time of patient intake, most recent prior brain MRI for MS is pushed to system.
MS MRI protocol is initiated with localizer and volumetric FLAIR as 1st exam.
(If other sequences are needed for AI in this effort, they would then be performed next.)
Data is sent from the scanner to the AI processing site for comparison between exam points, while the remainder of the non-contrast portion of the current MRI is being completed. An alert message is sent back to the technologist (via the scanner platform or other vendor-neutral means for real-time alert), with the AI decision (below). A set of summary DICOM images (e.g. subtraction or heat map overlay) should be provided back to PACS to be archived with the current exam, clearly demarcating the two exam dates with the images as a verification of the AI decision for the Radiologist to review.

AI decision/alert:
(1) No change = no new lesion(s) are present; exam may be truncated without contrast
(2) Change = new lesions identified or increase in lesion size; current MRI exam would proceed with post-contrast images (site would have capacity to set threshold for change in size e.g. >10% volume)
(3) Indeterminate = likely artifact or co-registration error. Sites may have capacity/desire to have real-time Radiologist review if AI provides this alert, otherwise current MRI exam would proceed with post-contrast images.

The ability to have this be a real-time application is essential. This will not be as useful if the data transfer and AI analysis/reporting takes more than 5-7 minutes.

While the ability to segment supra- and infra-tentorial demyelinating lesions on volumetric FLAIR images may be helpful, the main concern is assessing change between exams.

Considerations for Dataset Development



Procedures

MRI brain without contrast

View(s)

volumetric FLAIR sequence;

Ability to co-register MR images across scan types and time points.


Sex at Birth

{Male, Female}

Age

[0,100]

Comorbidities

“black holes” from MS (compared to demyelination), PML (progressive multifocal leukoencephalopathy), volume loss, chronic white matter/leukoaraiosis, midline shift


Tissue Involvement

cortical/juxtacortical, subcortical, periventricular, involving corpus callosum, infratentorial

Technical Specifications


Inputs

 

DICOM Study

Procedure

Brain MRI without contrast

Views

Volumetric FLAIR sequence

Data Type

DICOM

Modality

MRI

Body Region

Head

Anatomic Focus

Brain

Pharmaceutical

N/A

Scenario

Baseline and current exam for comparison




Primary Outputs


Lesion Count

RadElement ID

RDE467

Definition

Number of lesions detected

Data Type

Numeric

Value Set

N/A

Units

Number of lesions


New Lesion Detection

RadElement ID

RDE469

Definition

Detect new lesions from prior imaging

Data Type

Categorical

Value Set

  • No new lesion(s)
  • New Lesion(s)
  • Indeterminate

Units

N/A


Lesion Size

RadElement ID

RDE468

Definition

For each demyelinating lesion, measure the size

Data Type

Categorical

Value Set

  • No change from prior
  • Change
  • indeterminate

Units

N/A


Lesion Extent Change

RadElement ID

RDE470

Definition

For each lesion, compare with prior and alert if the lesion has changed in size based on the facility threshold (ex. if the lesion has increased in size by 10% from prior, send alert)

Data Type

Categorical

Value Set

  • No change from prior
  • Change in lesion size
  • Indeterminate

Units

N/A


Secondary Outputs


Comparison Overlay

RadElement ID

RDE466

Definition

Visual representation of comparison of lesion(s) between prior and current imaging. For example, subtraction or heat map overlay images of the change in demyelinating lesions.

Data Type

DICOM

Value Set

N/A

Units

N/A

Future Development Ideas


  • AI engine suggests artifacts or co-registration error