Psychophysical Evaluation of Visual vs. Computer-Aided Detection of Brain Lesions on Magnetic Resonance Images

BackgroundMagnetic 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.PurposeTo 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 TypeProspective.PopulationA total of 25 neuroradiologists (15 males, age 39 & PLUSMN; 9, 9 & PLUSMN; 9.8 years of experience) independently assessed all synthetic lesions.Field Strength/SequenceA 3.0 T, T-2-weighted multi-echo spin-echo (MESE) sequence.AssessmentMS lesions of varying severity levels were artificially generated in healthy volunteer MRI scans by manipulating T-2 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 T-2). 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 TestsDiagnostic 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-valueORs of identifying pathology were significantly higher for CAD vis-a-vis visual inspection for all lesions' severity levels. For a 6% change in T-2 value (lowest severity), radiologists' TP and FP rates were not significantly different (P = 0.12), while the corresponding CAD results remained statistically significant.Data ConclusionCAD 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 Evidence1Technical EfficacyStage 3