Abstract
PurposeWe evaluated in a clinical setting the INTERPRET decision-support system (DSS), a software generated to aid in MRS analysis to achieve a specific diagnosis for brain lesions.MethodsThe material consisted of 100 examinations of focal intracranial lesions with confirmed diagnoses. MRS was obtained at 1.5 T using TE 20–30 ms. Data were processed with the LCModel for conventional analysis. The INTERPRET DSS 3.1. was used to obtain specific diagnoses. MRI and MRS were reviewed by one interpreter. DSS analysis was made by another interpreter, in 80 cases by two interpreters. The diagnoses were compared with the definitive diagnoses. For comparisons between DSS, conventional MRS analysis, and MRI, the diagnoses were categorised: high-grade tumour, low-grade tumour, non-neoplastic lesion.ResultsInterobserver agreement in choosing the diagnosis from the INTERPRET database was 75%. The diagnosis was correct in 38/100 cases, incorrect in 57 cases. No good match was found in 5/100 cases. The diagnostic category was correct with DSS/conventional MRS/MRI in 67/58/52 cases, indeterminate in 5/8/20 cases, incorrect in 28/34/28 cases. Results with DSS were not significantly better than with conventional MRS analysis. All definitive diagnoses did not exist in the INTERPRET database. In the 61 adult patients with the diagnosis included in the database, DSS/conventional MRS/MRI yielded a correct diagnosis category in 48/32/29 cases (DSS vs conventional MRS: p = 0.002, DSS vs MRI: p = 0.0004).ConclusionUse of the INTERPRET DSS did not improve MRS categorisation of the lesions in the unselected clinical cases. In adult patients with lesions existing in the INTERPRET database, DSS improved the results, which indicates the potential of this software with an extended database.
Highlights
A noninvasive method to diagnose brain lesions would be extremely useful
Results with the INTERPRET decision-support system (DSS) were compared with results yielded by magnetic resonance spectroscopy (MRS) with conventional analysis combined with MRI and by MRI alone
Excluding diagnoses not found in the INTERPRET DSS, results for the same outcomes in patients at least 18 years of age, were significantly better for the DSS compared to conventional MRS analysis and MRI (Table 8, p values 0.002 and 0.0004, respectively)
Summary
A noninvasive method to diagnose brain lesions would be extremely useful. In order to improve the specificity of magnetic resonance spectroscopy (MRS), a multicentre project, funded by the European Commission, the Neuroradiology (2019) 61:43–53. International Network for Pattern Recognition of Tumours using Magnetic Resonance (INTERPRET), was conducted. Spectra of brain tumours from many European centres were collected into a database. The evaluation of spectra is made with graphical software, the INTERPRET decision-support system (DSS), which contains some non-tumourous spectra. The first version of the software was shown to improve the diagnosis for the most common intracranial tumours when used for MRS analysis compared to MRI alone [1]. A prospective study of brain tumour cases showed that the INTERPRET DSS outperformed three other systems for spectra classification. That study proved that the added information from spectral data could improve the radiologist’s diagnosis compared to a diagnosis made with MRI alone [2]
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