DOI: 10.1101/2023.05.24.23289773

Choroid Plexus Volume in Multiple Sclerosis can be estimated on structural MRI avoiding contrast injection

V.Visani F. B. Pizzini V. Natale A. Tamanti A. Bertoldo M. Calabrese M. Castellaro

V.Visani F. B. Pizzini V. Natale ...+3 M. Castellaro

摘要

Background: Choroid Plexus (ChP) manual segmentation performance evaluation on non-contrast-enhanced MRI sequences compared to the gold-standard contrast-enhanced T1-w has never been done on a relevant cohort of subjects. Purpose: To investigate whether contrast-enhancing can be avoided when performing ChP manual segmentation. To select which non-contrast-enhanced sequence between T1-w and FLAIR could be used as a contrast-enhanced T1-w surrogate. To provide a quantification of the ChP volume error that non-contrast-enhanced sequences introduce. Materials and methods: Sixty-one prospective Multiple Sclerosis patients were included in the study. ChP was separately segmented on T1-w, FLAIR, and contrast-enhanced T1-w sequences. Quantitative contrast metrics between the ChP and surrounding ventricles were calculated. Quantitative segmentation metrics were obtained using gold-standard segmentation as reference. To assess the spatial agreement between non-contrast-enhanced and contrast-enhanced sequences, the segmentations were non-linearly coregistered to the standard MNI152 space and the error distribution per slice was evaluated spanning axially and coronally. Results: Concerning contrast metrics, ANOVA test revealed a statistically significant main effect between the sequences (pvalue<0.01). The post-hoc t-tests revealed higher Contrast-to-Noise-Ratio and Signal-to-Noise-Ratio for contrast-enhanced sequences than others. T1-w exhibits the lower Contrast-to-Noise-Ratio while Signal-to-Noise-Ratio was comparable between FLAIR and T1-w (mean Signal-to-Noise-Ratio/Contrast-to-Noise-Ratio: contrast-enhanced T1-w=23.77/18.49, T1-w=13.73/7.44, FLAIR=13.09/10.77). The segmentation metrics revealed that non-contrast-enhanced sequences had comparable Dice. FLAIR overestimated the ChP volume while T1-w introduced a lower bias (Percentage Volume Difference FLAIR:28.02 {+/-} 19.02%; T1-w:3.52 {+/-} 12.61%). The spatial variability analysis confirmed that ChP volume depiction presents spatial differences between segmentations. FLAIR generally underperformed T1-w. Conclusion: The quantitative analyses suggest that T1-w might be a good candidate as a surrogate of contrast-enhanced sequence for the ChP manual segmentation task to estimate ChP volume. On the contrary, FLAIR introduces a systematic overestimation bias.

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