0:01

I mentioned earlier, quantitative volumetric imaging.

0:04

So, this is an AI tool that's very easy

0:06

to add on to an MRI of the brain.

0:08

It really doesn't cost any extra time.

0:10

And it identifies and labels anatomic

0:13

structures in the brain,

0:14

then quantifies the volumes of those brain structures

0:18

and compares that to a large age and

0:20

gender match normative database.

0:23

And this allows for volumetric tracking to

0:26

assess for rate of change over time.

0:29

It improves the diagnostic value of our studies.

0:32

It helps eliminate report bias.

0:34

So, you know,

0:36

I may say that there's mo-

0:37

you know, moderately severe cerebral atrophy

0:39

with a temporal parietal predilection,

0:41

which would tell our referrals,

0:42

"Raise a red flag."

0:43

That this might be Alzheimer's.

0:44

But then the patient may come back for a follow

0:46

up study, and my colleague may say,

0:48

mild cerebral atrophy commensurate with age.

0:51

And then the referral is like,

0:52

"Well, which one is it?"

0:53

So, using a quantitative tool,

0:55

quantitative neuroimaging,

0:57

is very, very helpful in eliminating that report bias.

1:00

As I mentioned,

1:01

it's easy to add on at negligible

1:03

cost acquisition speed.

1:04

It doesn't require any external hardware.

1:07

That's all cloud-based.

1:08

It integrates seamlessly into the workflow

1:11

and quickly into PACS.

1:12

In fact,

1:13

they're processed in less than seven minutes.

1:15

So by the time you actually open the case on PACS,

1:17

the reports are always there.

1:19

There's no radiology post-processing required.

1:22

They're easy to interpret,

1:23

and we'll talk about how to interpret it.

1:25

And again,

1:26

it offers a great referral advantage because

1:28

our neurologists really love these reports.

1:30

Now,

1:31

we use quantitative volumetric imaging

1:33

for several indications,

1:34

but dementia is the one that we're focusing on today.

1:37

We actually have quantitative volumetric

1:39

imaging on our prescription pads.

1:41

So the refer would just click

1:43

brain and then click Quant,

1:45

and then they would just click the box for dementia.

1:47

And our technologists would know that it is...

1:49

that they're going to be sending the study

1:51

for quantitative neuroimaging.

1:53

The protocol is very simple.

1:54

All we need is a T1 SPGR, a thin slice,

1:57

T1 sequence for the dementia.

1:59

We use other ones for other studies, like,

2:01

we use the thin slice FLAIR for multiple sclerosis,

2:04

but for dementia, we just need this one,

2:06

and we prefer it at 1 mm

2:08

collimation with a 3D acquisition.

2:11

This is what segmentation looks like.

2:13

This happens to be a NeuroQuant,

2:17

and this is what it looks like.

2:18

This is another company.

2:20

This one happens to be iPro-Brain.

2:21

And here again, you see the segmentation.

2:24

This is, you know, individual segmentations

2:27

of white matter lesions,

2:28

that patient happens to have multiple sclerosis.

2:30

Here's another company here.

2:31

This happens to be Quantib,

2:33

and that's what the segmentation looks like there.

2:35

So, let's take a look at these reports.

2:38

This is a NeuroQuant report.

2:39

We're given the volume of key structures in the brain.

2:42

So the hippocampal occupancy score,

2:44

the hippocampus,

2:45

the entorhinal cortex,

2:47

the superior and inferior lateral ventricles.

2:49

And importantly,

2:50

we're giving their normative percentile here.

2:52

So anything in red is going to be more than two

2:55

standard deviations outside of the mean.

2:57

Here are plot graphs.

2:58

Anything in the pink zone

3:00

is two standard deviations outside of the mean.

3:02

So you can see the hippocampal occupancy

3:04

score is way down here in the red zone,

3:07

as is the hippocampus and entorhinal cortex.

3:10

And as the hippocampi shrink,

3:12

there's compensatory enlargement of those inferior

3:14

lateral ventricles.

3:15

So we get enlargement here,

3:17

statistically significant enlargement of the inferior

3:19

lateral ventricles.

3:20

The Triage Brain Atrophy report,

3:22

which is the second page of the report.

3:24

I tend to use this to look for patterns when trying

3:27

to differentiate between different neurodementia syndromes.

3:30

Anything red is statistically significant,

3:33

and it's just a more detailed breakdown of areas of the brain.

3:37

This is another quantitative report.

3:38

This happens to be an iPro-Brain report.

3:40

Again, we're given the volume of the key structures,

3:43

frontal, parietal, temporal, and occipital cortex,

3:46

and the hippocampus,

3:47

and the normative percentiles are here.

3:50

Anything in the blue zone is more than one

3:52

standard deviation below the mean.

3:55

And anything in this sort of yellow

3:57

zone here is at tenth percentile.

4:00

This bullseye graph points to areas that

4:03

are most significant. So again,

4:05

this is used to help differentiate between

4:07

the different types of dementia,

4:08

Alzheimer's versus frontotemporal dementia versus

4:11

dementia with Lewy bodies, etc.

4:13

Second page of the report gives the whole brain volume

4:16

and the volumes of other key structures,

4:18

as well as their normative percentile.