Synthetic T2-weighted fat sat based on a generative adversarial network shows potential for scan time reduction in spine imaging in a multicenter test dataset.

OBJECTIVES: T2-weighted (w) fat sat (fs) sequences, which are important in spine MRI, require a significant amount of scan time. Generative adversarial networks (GANs) can generate synthetic T2-w fs images. We evaluated the potential of synthetic T2-w fs images by comparing them to their true counterpart regarding image and fat saturation quality, and diagnostic agreement in a heterogenous, multicenter dataset. METHODS: A GAN was used to synthesize T2-w fs from T1- and non-fs T2-w. The training dataset comprised scans of 73 patients from two scanners, and the test dataset, scans of 101 patients from 38 multicenter scanners. Apparent signal- and contrast-to-noise ratios (aSNR/aCNR) were measured in true and synthetic T2-w fs. Two neuroradiologists graded image (5-point scale) and fat saturation quality (3-point scale). To evaluate whether the T2-w fs images are indistinguishable, a Turing test was performed by eleven neuroradiologists. Six pathologies were graded on the synthetic protocol (with synthetic T2-w fs) and the original protocol (with true T2-w fs) by the two neuroradiologists. RESULTS: aSNR and aCNR were not significantly different between the synthetic and true T2-w fs images. Subjective image quality was graded higher for synthetic T2-w fs (p = 0.023). In the Turing test, synthetic and true T2-w fs could not be distinguished from each other. The intermethod agreement between synthetic and original protocol ranged from substantial to almost perfect agreement for the evaluated pathologies. DISCUSSION: The synthetic T2-w fs might replace a physical T2-w fs. Our approach validated on a challenging, multicenter dataset is highly generalizable and allows for shorter scan protocols. KEY POINTS: • Generative adversarial networks can be used to generate synthetic T2-weighted fat sat images from T1- and non-fat sat T2-weighted images of the spine. • The synthetic T2-weighted fat sat images might replace a physically acquired T2-weighted fat sat showing a better image quality and excellent diagnostic agreement with the true T2-weighted fat images. • The present approach validated on a challenging, multicenter dataset is highly generalizable and allows for significantly shorter scan protocols.

Implementation of GAN-Based, Synthetic T2-Weighted Fat Saturated Images in the Routine Radiological Workflow Improves Spinal Pathology Detection.

(1) Background and Purpose: In magnetic resonance imaging (MRI) of the spine, T2-weighted (T2-w) fat-saturated (fs) images improve the diagnostic assessment of pathologies. However, in the daily clinical setting, additional T2-w fs images are frequently missing due to time constraints or motion artifacts. Generative adversarial networks (GANs) can generate synthetic T2-w fs images in a clinically feasible time. Therefore, by simulating the radiological workflow with a heterogenous dataset, this study's purpose was to evaluate the diagnostic value of additional synthetic, GAN-based T2-w fs images in the clinical routine. (2) Methods: 174 patients with MRI of the spine were retrospectively identified. A GAN was trained to synthesize T2-w fs images from T1-w, and non-fs T2-w images of 73 patients scanned in our institution. Subsequently, the GAN was used to create synthetic T2-w fs images for the previously unseen 101 patients from multiple institutions. In this test dataset, the additional diagnostic value of synthetic T2-w fs images was assessed in six pathologies by two neuroradiologists. Pathologies were first graded on T1-w and non-fs T2-w images only, then synthetic T2-w fs images were added, and pathologies were graded again. Evaluation of the additional diagnostic value of the synthetic protocol was performed by calculation of Cohen's ĸ and accuracy in comparison to a ground truth (GT) grading based on real T2-w fs images, pre- or follow-up scans, other imaging modalities, and clinical information. (3) Results: The addition of the synthetic T2-w fs to the imaging protocol led to a more precise grading of abnormalities than when grading was based on T1-w and non-fs T2-w images only (mean ĸ GT versus synthetic protocol = 0.65; mean ĸ GT versus T1/T2 = 0.56; p = 0.043). (4) Conclusions: The implementation of synthetic T2-w fs images in the radiological workflow significantly improves the overall assessment of spine pathologies. Thereby, high-quality, synthetic T2-w fs images can be virtually generated by a GAN from heterogeneous, multicenter T1-w and non-fs T2-w contrasts in a clinically feasible time, which underlines the reproducibility and generalizability of our approach.

Mapping of Arithmetic Processing by Navigated Repetitive Transcranial Magnetic Stimulation in Patients with Parietal Brain Tumors and Correlation with Postoperative Outcome.

BACKGROUND: Preserving functionality is important during neurosurgical resection of brain tumors. Specialized centers also map further brain functions apart from motor and language functions, such as arithmetic processing (AP). The mapping of AP by navigated repetitive transcranial magnetic stimulation (nrTMS) in healthy volunteers has been reported. OBJECTIVE: The present study aimed to correlate the results of mapping AP with functional patient outcomes. METHODS: We included 26 patients with parietal brain tumors. Because of preoperative impairment of AP, mapping was not possible in 8 patients (31%). We stimulated 52 cortical sites by nrTMS while patients performed a calculation task. Preoperatively and postoperatively, patients underwent a standardized number-processing and calculation test (NPCT). Tumor resection was blinded to nrTMS results, and the change in NPCT performance was correlated to resected AP-positive spots as identified by nrTMS. RESULTS: The resection of AP-positive sites correlated with a worsening of the postoperative NPCT result in 12 cases. In 3 cases, no AP-positive sites were resected and the postoperative NPCT result was similar to or better than preoperatively. Also, in 3 cases, the postoperative NPCT result was better than preoperatively, although AP-positive sites were resected. CONCLUSIONS: Despite presenting only a few cases, nrTMS might be a useful tool for preoperative mapping of AP. However, the reliability of the present results has to be evaluated in a larger series and by intraoperative mapping data.