title: Automatic volumetry on MR brain images can support diagnostic decision making.
abstract: BACKGROUND
  Diagnostic decisions in clinical imaging currently rely almost exclusively on visual image interpretation. This can lead to uncertainty, for example in dementia disease, where some of the changes resemble those of normal ageing. We hypothesized that extracting volumetric data from patients' MR brain images, relating them to reference data and presenting the results as a colour overlay on the grey scale data would aid diagnostic readers in classifying dementia disease versus normal ageing.
  
  
  METHODS
  A proof-of-concept forced-choice reader study was designed using MR brain images from 36 subjects. Images were segmented into 43 regions using an automatic atlas registration-based label propagation procedure. Seven subjects had clinically probable AD, the remaining 29 of a similar age range were used as controls. Seven of the control subject data sets were selected at random to be presented along with the seven AD datasets to two readers, who were blinded to all clinical and demographic information except age and gender. Readers were asked to review the grey scale MR images and to record their choice of diagnosis (AD or non-AD) along with their confidence in this decision. Afterwards, readers were given the option to switch on a false-colour overlay representing the relative size of the segmented structures. Colorization was based on the size rank of the test subject when compared with a reference group consisting of the 22 control subjects who were not used as review subjects. The readers were then asked to record whether and how the additional information had an impact on their diagnostic confidence.
  
  
  RESULTS
  The size rank colour overlays were useful in 18 of 28 diagnoses, as determined by their impact on readers' diagnostic confidence. A not useful result was found in 6 of 28 cases. The impact of the additional information on diagnostic confidence was significant (p < 0.02).
  
  
  CONCLUSIONS
  Volumetric anatomical information extracted from brain images using automatic segmentation and presented as colour overlays can support diagnostic decision making.
authors.affiliation: Division of Neurosciences and Mental Health, Imperial College London, Hammersmith Campus, Du Cane Road, London, UK. soundray@imperial.ac.uk
authors.forename: Rolf A
authors.initials: RA
authors.lastname: Heckemann
authors.forename: Alexander
authors.initials: A
authors.lastname: Hammers
authors.forename: Daniel
authors.initials: D
authors.lastname: Rueckert
authors.forename: Richard I
authors.initials: RI
authors.lastname: Aviv
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Harvey
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Hajnal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000544:Alzheimer Disease / Q000175:diagnosis*; D001185:Artificial Intelligence; D001921:Brain / Q000473:pathology*; D003116:Color; D003196:Computer Graphics; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010363:Pattern Recognition, Automated / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014584:User-Computer Interface