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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleAdult Brain
Open Access

Automated Integration of Multimodal MRI for the Probabilistic Detection of the Central Vein Sign in White Matter Lesions

J.D. Dworkin, P. Sati, A. Solomon, D.L. Pham, R. Watts, M.L. Martin, D. Ontaneda, M.K. Schindler, D.S. Reich and R.T. Shinohara
American Journal of Neuroradiology October 2018, 39 (10) 1806-1813; DOI: https://doi.org/10.3174/ajnr.A5765
J.D. Dworkin
aFrom the Department of Biostatistics, Epidemiology, and Informatics (J.D.D., M.L.M., R.T.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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  • ORCID record for J.D. Dworkin
P. Sati
bTranslational Neuroradiology Section (P.S., M.K.S., D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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A. Solomon
cDepartments of Neurological Sciences (A.S.)
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D.L. Pham
eCenter for Neuroscience and Regenerative Medicine (D.L.P.), Henry M. Jackson Foundation, Bethesda, Maryland
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R. Watts
dRadiology (R.W.), Larner College of Medicine at the University of Vermont, Burlington, Vermont
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M.L. Martin
aFrom the Department of Biostatistics, Epidemiology, and Informatics (J.D.D., M.L.M., R.T.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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D. Ontaneda
fMellen Center for Multiple Sclerosis Treatment and Research (D.O.), Cleveland Clinic, Cleveland, Ohio
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M.K. Schindler
bTranslational Neuroradiology Section (P.S., M.K.S., D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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D.S. Reich
bTranslational Neuroradiology Section (P.S., M.K.S., D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
gDepartment of Neurology (D.S.R.), Johns Hopkins University School of Medicine, Baltimore, Maryland.
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R.T. Shinohara
aFrom the Department of Biostatistics, Epidemiology, and Informatics (J.D.D., M.L.M., R.T.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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    Fig 1.

    A, Axial slice of a lesion on T2-FLAIR volume. B, Axial slice of a lesion on T2*-EPI volume. C, MIMoSA lesion-probability map. D, Distance-to-lesion-boundary mask with the vesselness filter overlay. The lesion-level CVS probability following permutation was 0.975.

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    Fig 2.

    Boxplots of the patient-level central vein sign biomarker score by diagnostic group. The score can be interpreted as the proportion of lesions that are CVS+ according to the method described in this article. Groups shaded gray do not have an MS diagnosis, whereas groups shaded gold do. A, Boxplots for the unweighted biomarker. B, Boxplots for the noise-weighted biomarker. Points outside the boxplots represent outliers within their respective groups.

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    Fig 3.

    Receiver operating characteristic curves of MS diagnosis based on patient-level automated CVS biomarker scores. The receiver operating characteristic curve for the unweighted biomarker is shaded blue, and the receiver operating characteristic curve for the weighted biomarker is shaded green. The area under the curve (AUC) values for both curves are displayed in their respective colors.

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    Table 1:

    Demographics of the study samplea

    Demographics
    MS (n = 10)
        Age (yr)44 (16)
        Sex9/10 Female
        Disease duration (yr)9 (7)
        Disease subtype10/10 RRMS
    MS with comorbidities (n = 10)
        Age (yr)43 (9)
        Sex9/10 Female
        Disease duration (yr)9 (6)
        Disease subtype10/10 RRMS
    Migraine (n = 10)
        Age (yr)47 (13)
        Sex10/10 Female
    Misdiagnosed with MS (n = 10)
        Age (yr)53 (7)
        Sex9/10 Female
    • Note:—RRMS indicates relapsing-remitting MS.

    • ↵a The numbers in parentheses are standard deviations.

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    Table 2:

    Diagnostic performance of weighted and unweighted biomarkersa

    ThresholdSensitivitySpecificity
    Unweighted biomarker (ψi)0.381.00 (0.75–1.00)0.67 (0.42–0.84)
    0.400.94 (0.70–1.00)0.67 (0.42–0.84)
    0.440.75 (0.50–0.90)0.73 (0.47–0.89)
    0.500.56 (0.25–0.65)0.80 (0.58–0.94)
    Weighted biomarker (ψiw)0.370.94 (0.70–1.00)0.73 (0.42–0.84)
    0.400.75 (0.50–0.90)0.73 (0.42–0.84)
    0.460.63 (0.40–0.80)0.93 (0.68–1.00)
    0.500.56 (0.35–0.75)0.93 (0.74–1.00)
    • ↵a Data in column 2 represent the given cutoff values; data in parentheses are the relevant 95% confidence intervals.

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American Journal of Neuroradiology: 39 (10)
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J.D. Dworkin, P. Sati, A. Solomon, D.L. Pham, R. Watts, M.L. Martin, D. Ontaneda, M.K. Schindler, D.S. Reich, R.T. Shinohara
Automated Integration of Multimodal MRI for the Probabilistic Detection of the Central Vein Sign in White Matter Lesions
American Journal of Neuroradiology Oct 2018, 39 (10) 1806-1813; DOI: 10.3174/ajnr.A5765

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Automated Integration of Multimodal MRI for the Probabilistic Detection of the Central Vein Sign in White Matter Lesions
J.D. Dworkin, P. Sati, A. Solomon, D.L. Pham, R. Watts, M.L. Martin, D. Ontaneda, M.K. Schindler, D.S. Reich, R.T. Shinohara
American Journal of Neuroradiology Oct 2018, 39 (10) 1806-1813; DOI: 10.3174/ajnr.A5765
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