Clinically Deployed Computational Assessment of Multiple Sclerosis Lesions

Abstract

Multiple Sclerosis (MS) is a demyelinating disease of the central nervous system that affects nearly 1 million adults in the United States. Magnetic Resonance Imaging (MRI) plays a vital role in diagnosis and treatment monitoring in MS patients. In particular, follow-up MRI with T2-FLAIR images of the brain, depicting white matter lesions, is the mainstay for monitoring disease activity and making treatment decisions. In this article, we present a computational approach that has been deployed and integrated into a real-world routine clinical workflow, focusing on two tasks: (a) detecting new disease activity in MS patients, and (b) determining the necessity for injecting Gadolinium Based Contract Agents (GBCAs). This computer-aided detection (CAD) software has been utilized for the former task on more than 19, 000 patients over the course of 10 years, while its added function of identifying patients who need GBCA injection, has been operative for the past 3 years, with > 85% sensitivity. The benefits of this approach are summarized in: (1) offering a reproducible and accurate clinical assessment of MS lesion patients, (2) reducing the adverse effects of GBCAs (and the deposition of GBCAs to the patient's brain) by identifying the patients who may benefit from injection, and (3) reducing healthcare costs, patients' discomfort, and caregivers' workload.