Interactive Transcript
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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,
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I may say that there's mo-
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you know, moderately severe cerebral atrophy
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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.
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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.
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As I mentioned,
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it's easy to add on at negligible
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cost acquisition speed.
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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.
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