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Left-Right Intensity Asymmetries Vary Depending on Scanner Model for FLAIR and T1 Weighted MRI Images
Arvin Arani1, Christopher G Schwarz1, Heather J Wiste2
1Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
Background:
Localized regions of left-right image intensity asymmetry (LRIA) were incidentally observed on T2 -weighted (T2 -w) and T1 -weighted (T1 -w) diagnostic magnetic resonance imaging (MRI) images. Suspicion of herpes encephalitis resulted in unnecessary follow-up imaging. A nonbiological imaging artifact that can lead to diagnostic uncertainty was identified.
Purpose:
To investigate whether systematic LRIA exist for a range of scanner models and to determine if LRIA can introduce diagnostic uncertainty.
Study Type:
A retrospective study using the Alzheimer's Disease Neuroimaging Initiative (ADNI) data base.
Subjects:
One thousand seven hundred fifty-three (median age: 72, males/females: 878/875) unique participants with longitudinal data were included.
Field Strength:
3T.
Sequences:
T1 -w three-dimensional inversion-recovery spoiled gradient-echo (IR-SPGR) or magnetization-prepared rapid gradient-echo (MP-RAGE) and T2 -w fluid-attenuated inversion recovery (FLAIR) long tau fast spin echo inversion recovery (LT-FSE-IR). Only General Electric, Philips, and Siemens' product sequences were used.
Assessment:
LRIA was calculated as the left-right percent difference with respect to the mean intensity from automated anatomical atlas segmented regions. Three neuroradiologists with 37 (**), 32 (**), and 3 (**) years of experience rated the clinical impact of 30 T2 -w three-dimensional FLAIR exams with LRIA to determine the diagnostic uncertainty. Statistical comparisons between retrospective intensity normalized T1 m and original T1 -w images were made.
Statistical Tests:
For each image type, a linear mixed effects model was fit using LRIA scores from all scanners, regions, and participants as the outcome and age and sex as predictors. Statistical significance was defined as having a P-value <0.05.
Results:
LRIA scores were significantly different from zero on most scanners. All clinicians were uncertain or recommended definite diagnostic follow-up in 62.5% of cases with LRIA >10%. Individuals with acute brain pathology or focal neurologic deficits are not enrolled in ADNI; therefore, focal signal abnormalities were considered false positives.
Data Conclusion:
LRIA is system specific, systematic, creates diagnostic uncertainty, and impacts IR-SPGR, MP-RAGE, and LT-FSE-IR product sequences.
Level Of Evidence:
2 Technical Efficacy Stage: 3.
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