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Journal Articles Investigative Radiology Year : 2021

Can deep learning replace gadolinium in neuro-oncology?


Objectives: This study proposes and evaluates a deep learning method that predicts surrogate images for contrast-enhanced T1 from multiparametric magnetic resonance imaging (MRI) acquired using only a quarter of the standard 0.1 mmol/kg dose of gadolinium-based contrast agent. In particular, the predicted images are quantitatively evaluated in terms of lesion detection performance. Materials and methods : This monocentric retrospective study leveraged 200 multiparametric brain MRIs acquired between November 2019 and February 2020 at Gustave Roussy Cancer Campus (Villejuif, France). A total of 145 patients were included: 107 formed the training sample (age 55y±14, 58 women) and 38 the separate test sample (age 62±12, 22 women). Patients had glioma, brain metastases, meningioma, or no enhancing lesion. T1, T2-Flair, DWI, low-dose and standard-dose postcontrast T1 sequences were acquired. A deep network was trained to process the precontrast and low-dose sequences in order to predict “virtual” surrogate images for contrast-enhanced T1. Once trained, the deep learning method was evaluated on the test sample. The discrepancies between the predicted virtual images and the standard-dose MRIs were qualitatively and quantitatively evaluated using both automated voxel-wise metrics and a reader study, where two radiologists graded image qualities and marked all visible enhancing lesions. Results : The automated analysis of the test brain MRIs computed a structural similarity index of 87.1% (±4.8) between the predicted virtual sequences and the reference contrast-enhanced T1 MRIs, a peak signalto-noise ratio of 31.6dB (±2.0), and an area under the curve of 96.4% (±3.1). At Youden’s operating point, the voxel-wise sensitivity and specificity were 96.4% and 94.8% respectively. The reader study found that virtual images were preferred to standard-dose MRI in terms of image quality (p=.008). A total of 91 reference lesions were identified in the 38 test T1 sequences enhanced with full dose of contrast agent. On average across readers, the brain lesion sensitivity of the virtual images was 83% for lesions larger than 10mm (n=42), and the associated false detection rate was 0.08 lesion/patient. The corresponding positive predictive value of detected lesions was 92%, and the F1-score 88%. Lesion detection performance however dropped when smaller lesions were included: average sensitivity was 67% for lesions larger than 5mm (n=74), and 56% with all lesions included regardless of their size. The false detection rate remained below 0.50 lesion/patient in all cases, and the positive predictive value above 73%. The composite F1 score was 63% at worst. Conclusion : The proposed deep learning method for virtual contrast-enhanced T1 brain MRI prediction showed very high quantitative performance when evaluated with standard voxel-wise metrics. The reader study demonstrated that for lesions larger than 10mm, good detection performance could be maintained despite a 4-fold division in contrast agent usage, unveiling a promising avenue for reducing the gadolinium exposure of returning patients. Small lesions proved however difficult to handle for the deep network, showing that full-dose injections remain essential for accurate first-line diagnosis in neuro-oncology.
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hal-03527628 , version 1 (17-01-2022)



Samy Ammari, Alexandre Bône, Corinne Balleyguier, Eric Moulton, Émilie Chouzenoux, et al.. Can deep learning replace gadolinium in neuro-oncology?. Investigative Radiology, 2021, 57, pp.99 - 107. ⟨10.1097/rli.0000000000000811⟩. ⟨hal-03527628⟩
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