title: FLAIRfusion Processing with Contrast Inversion : Improving Detection and Reading Time of New Cerebral MS Lesions.
abstract: OBJECTIVE
  To evaluate the performance of an innovative image processing approach for detection of T2-weighted hyperintense multiple sclerosis (MS) lesions.
  
  
  METHODS
  In this study 20 consecutive patients with inflammatory demyelinating lesions were retrospectively evaluated of whom 10 patients featured progressive disease and 10 a stable lesion load. 3 mm transversal FLAIRfusion imaging was processed and archived. Image processing was performed through landmark-based 3D co-registration of the previous and current isotropic FLAIR examination followed by inversion of image contrast. Thereby, the hyperintense signals of the unchanged MS plaques extinguish each other, while newly developed lesions appear bright on FLAIRfusion. Diagnostic performance was evaluated by 4 experienced readers. Consensus reading supplied the reference standard. Sensitivity, specificity, NPV (negative predictive value), PPV (positive predictive value), interreader agreement and reading time were the outcome measures analyzed.
  
  
  RESULTS
  Combined sensitivity was 100% at a specificity of 88.2%, with PPV ranging from 83.3% to 90.1% and NPV at 100%. Reading time was nearly 5‑fold faster than conventional side by side comparison (35.6 s vs. 163.7 s, p < 0.001). Cohen's kappa was excellent (>0.75; p < 0.001) and Cronbach's alpha was 0.994.
  
  
  CONCLUSIONS
  FLAIRfusion provides reliable detection of newly developed MS lesions along with strong interreader agreement across all levels of expertise in 35 s of reading time.
authors.affiliation: Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany. manuel.schmidt@uk-erlangen.de.
authors.forename: M A
authors.initials: MA
authors.lastname: Schmidt
authors.affiliation: Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: R A
authors.initials: RA
authors.lastname: Linker
authors.affiliation: Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Lang
authors.affiliation: Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Lücking
authors.affiliation: Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Engelhorn
authors.affiliation: Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kloska
authors.affiliation: Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Uder
authors.affiliation: Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Cavallaro
authors.affiliation: Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Dörfler
authors.affiliation: Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.|Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Dankerl
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging*; D005260:Female; D005858:Germany; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging*; D011932:Reading; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: FLAIR; Follow-up; Image processing; Multiple sclerosis; T2 lesions