title: Clinical Feasibility of Synthetic MRI in Multiple Sclerosis: A Diagnostic and Volumetric Validation Study.
abstract: Quantitative MR imaging techniques are gaining interest as methods of reducing acquisition times while additionally providing robust measurements. This study aimed to implement a synthetic MR imaging method on a new scanner type and to compare its diagnostic accuracy and volumetry with conventional MR imaging in patients with MS and controls.
  
  
  
  Twenty patients with MS and 20 healthy controls were enrolled after ethics approval and written informed consent. Synthetic MR imaging was implemented on a Siemens 3T scanner. Comparable conventional and synthetic proton-density-, T1-, and T2-weighted, and FLAIR images were acquired. Diagnostic accuracy, lesion detection, and artifacts were assessed by blinded neuroradiologic evaluation, and contrast-to-noise ratios, by manual tracing. Volumetry was performed with synthetic MR imaging, FreeSurfer, FMRIB Software Library, and Statistical Parametric Mapping. Repeatability was quantified by using the coefficient of variance.
  
  
  
  Synthetic proton-density-, T1-, and T2-weighted images were of sufficient or good quality and were acquired in 7% less time than with conventional MR imaging. Synthetic FLAIR images were degraded by artifacts. Lesion counts and volumes were higher in synthetic MR imaging due to differences in the contrast of dirty-appearing WM but did not affect the radiologic diagnostic classification or lesion topography (P = .50-.77). Synthetic MR imaging provided segmentations with the shortest processing time (16 seconds) and the lowest repeatability error for brain volume (0.14%), intracranial volume (0.12%), brain parenchymal fraction (0.14%), and GM fraction (0.56%).
  
  
  
  Synthetic MR imaging can be an alternative to conventional MR imaging for generating diagnostic proton-density-, T1-, and T2-weighted images in patients with MS and controls while additionally delivering fast and robust volumetric measurements suitable for MS studies.
authors.affiliation: From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Departments of Radiology (T.G., F.H., C.C., S.S., Y.F., P.A., M.K.-W) tobias.granberg@ki.se.
authors.forename: T
authors.identifier: 0000-0001-6700-1022
authors.initials: T
authors.lastname: Granberg
authors.affiliation: From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Diagnostic Medical Physics (M.U., L.E.N., J.B.).
authors.forename: M
authors.identifier: 0000-0001-7870-2668
authors.initials: M
authors.lastname: Uppman
authors.affiliation: From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Departments of Radiology (T.G., F.H., C.C., S.S., Y.F., P.A., M.K.-W).
authors.forename: F
authors.identifier: 0000-0003-1656-4217
authors.initials: F
authors.lastname: Hashim
authors.affiliation: Departments of Radiology (T.G., F.H., C.C., S.S., Y.F., P.A., M.K.-W).
authors.forename: C
authors.identifier: 0000-0003-4174-4885
authors.initials: C
authors.lastname: Cananau
authors.affiliation: From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Diagnostic Medical Physics (M.U., L.E.N., J.B.).
authors.forename: L E
authors.identifier: 0000-0002-9685-8583
authors.initials: LE
authors.lastname: Nordin
authors.affiliation: From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Departments of Radiology (T.G., F.H., C.C., S.S., Y.F., P.A., M.K.-W).
authors.forename: S
authors.identifier: 0000-0002-5133-0224
authors.initials: S
authors.lastname: Shams
authors.affiliation: From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Diagnostic Medical Physics (M.U., L.E.N., J.B.).
authors.forename: J
authors.identifier: 0000-0002-0853-9305
authors.initials: J
authors.lastname: Berglund
authors.affiliation: From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Departments of Radiology (T.G., F.H., C.C., S.S., Y.F., P.A., M.K.-W).
authors.forename: Y
authors.identifier: 0000-0001-7097-4765
authors.initials: Y
authors.lastname: Forslin
authors.affiliation: From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Departments of Radiology (T.G., F.H., C.C., S.S., Y.F., P.A., M.K.-W).
authors.forename: P
authors.identifier: 0000-0001-6222-6855
authors.initials: P
authors.lastname: Aspelin
authors.affiliation: Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden Neurology (S.F.), Karolinska University Hospital, Stockholm, Sweden.
authors.forename: S
authors.identifier: 0000-0002-8042-3286
authors.initials: S
authors.lastname: Fredrikson
authors.affiliation: From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Departments of Radiology (T.G., F.H., C.C., S.S., Y.F., P.A., M.K.-W).
authors.forename: M
authors.identifier: 0000-0001-6135-2999
authors.initials: M
authors.lastname: Kristoffersen-Wiberg
mesh_terms: D000328:Adult; D016477:Artifacts; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000473:pathology; D059906:Neuroimaging / Q000379:methods*; D012984:Software; D055815:Young Adult