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Quantitative Volumetric Imaging of Dementia

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I mentioned earlier, quantitative volumetric imaging.

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

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to add on to an MRI of the brain.

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It really doesn't cost any extra time.

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And it identifies and labels anatomic

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structures in the brain,

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then quantifies the volumes of those brain structures

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and compares that to a large age and

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gender match normative database.

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And this allows for volumetric tracking to

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assess for rate of change over time.

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It improves the diagnostic value of our studies.

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It helps eliminate report bias.

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So, you know,

0:36

I may say that there's mo-

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you know, moderately severe cerebral atrophy

0:39

with a temporal parietal predilection,

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which would tell our referrals,

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"Raise a red flag."

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That this might be Alzheimer's.

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But then the patient may come back for a follow

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up study, and my colleague may say,

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mild cerebral atrophy commensurate with age.

0:51

And then the referral is like,

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"Well, which one is it?"

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So, using a quantitative tool,

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quantitative neuroimaging,

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is very, very helpful in eliminating that report bias.

1:00

As I mentioned,

1:01

it's easy to add on at negligible

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cost acquisition speed.

1:04

It doesn't require any external hardware.

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That's all cloud-based.

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It integrates seamlessly into the workflow

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and quickly into PACS.

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In fact,

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they're processed in less than seven minutes.

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

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the reports are always there.

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There's no radiology post-processing required.

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They're easy to interpret,

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and we'll talk about how to interpret it.

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And again,

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it offers a great referral advantage because

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our neurologists really love these reports.

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Now,

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we use quantitative volumetric imaging

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for several indications,

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

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We actually have quantitative volumetric

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imaging on our prescription pads.

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So the refer would just click

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brain and then click Quant,

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and then they would just click the box for dementia.

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And our technologists would know that it is...

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that they're going to be sending the study

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for quantitative neuroimaging.

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The protocol is very simple.

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

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T1 sequence for the dementia.

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We use other ones for other studies, like,

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we use the thin slice FLAIR for multiple sclerosis,

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but for dementia, we just need this one,

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and we prefer it at 1 mm

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collimation with a 3D acquisition.

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This is what segmentation looks like.

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This happens to be a NeuroQuant,

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and this is what it looks like.

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This is another company.

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This one happens to be iPro-Brain.

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And here again, you see the segmentation.

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This is, you know, individual segmentations

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of white matter lesions,

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that patient happens to have multiple sclerosis.

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Here's another company here.

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This happens to be Quantib,

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and that's what the segmentation looks like there.

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

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This is a NeuroQuant report.

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

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So the hippocampal occupancy score,

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the hippocampus,

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the entorhinal cortex,

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the superior and inferior lateral ventricles.

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And importantly,

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we're giving their normative percentile here.

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So anything in red is going to be more than two

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standard deviations outside of the mean.

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Here are plot graphs.

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Anything in the pink zone

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is two standard deviations outside of the mean.

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So you can see the hippocampal occupancy

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score is way down here in the red zone,

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as is the hippocampus and entorhinal cortex.

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And as the hippocampi shrink,

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there's compensatory enlargement of those inferior

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lateral ventricles.

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So we get enlargement here,

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statistically significant enlargement of the inferior

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lateral ventricles.

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The Triage Brain Atrophy report,

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which is the second page of the report.

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I tend to use this to look for patterns when trying

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to differentiate between different neurodementia syndromes.

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Anything red is statistically significant,

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

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This is another quantitative report.

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This happens to be an iPro-Brain report.

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

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frontal, parietal, temporal, and occipital cortex,

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and the hippocampus,

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and the normative percentiles are here.

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Anything in the blue zone is more than one

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standard deviation below the mean.

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And anything in this sort of yellow

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zone here is at tenth percentile.

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This bullseye graph points to areas that

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are most significant. So again,

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this is used to help differentiate between

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the different types of dementia,

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Alzheimer's versus frontotemporal dementia versus

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dementia with Lewy bodies, etc.

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Second page of the report gives the whole brain volume

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and the volumes of other key structures,

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as well as their normative percentile.

Report

Faculty

Suzie Bash, MD

Medical Director of Neuroradiology

San Fernando Valley Interventional Radiology & Imaging (SFI), RadNet

Tags

Syndromes

PET

Non-infectious Inflammatory

Neuroradiology

Neuro

MRI

Idiopathic

Brain

Acquired/Developmental

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