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Defining Thresholds for Changes in Size of Simulated T2-Hyperintense Brain Lesions on the Basis of Qualitative Comparisons

Elias R. Melhem1,2,3, Edward H. Herskovits1,4, Kader Karli-Oguz1, Xavier Golay3, Dima A. Hammoud1, Brian J. Fortman1, Fletcher M. Munter1 and Ryuta Itoh1,3

1 Division of Neuroradiology, The Johns Hopkins Medical Institutions, 600 N. Wolfe St., Baltimore, MD 21287-7619.
2 MR Perception Laboratory and the F. M. Kirby Center for Functional Magnetic Resonance Imaging of The Kennedy Krieger Institute, Baltimore, MD 21287-7619.
3 Present address: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.
4 Department of Biostatistics, The Johns Hopkins School of Public Health, Baltimore, MD 21287-7619.



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  		Fig. 1. —Color-coded T1, T2, and proton density ({rho}) pixel maps of multiple sclerosis lesion showing variability in pixel values in lesion.

 


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  		Fig. 2A. —Magnified view of simulated images containing examples of simulated lesions placed in right parietooccipital lobe. Simulated T2-weighted MR image (TR/TE, 4000/80) shows original lesion (6 mm).

 


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  		Fig. 2B. —Magnified view of simulated images containing examples of simulated lesions placed in right parietooccipital lobe. Simulated T2-weighted MR images (4000/80) show lesions 10% larger than original lesion (6.6 mm) (B)

 


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  		Fig. 2C. —Magnified view of simulated images containing examples of simulated lesions placed in right parietooccipital lobe. Simulated T2-weighted MR images (4000/80) show lesions 20% larger than original lesion (7.2 mm) (C)

 


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  		Fig. 2D. —Magnified view of simulated images containing examples of simulated lesions placed in right parietooccipital lobe. Simulated T2-weighted MR images (4000/80) show lesions 30% larger than original lesion (7.8 mm) (D)

 


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  		Fig. 2E. —Magnified view of simulated images containing examples of simulated lesions placed in right parietooccipital lobe. Simulated T2-weighted MR images (4000/80) show lesions 40% larger than original lesion (8.4 mm) (E)

 


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  		Fig. 2F. —Magnified view of simulated images containing examples of simulated lesions placed in right parietooccipital lobe. Simulated T2-weighted MR images (4000/80) show lesions 50% larger than original lesion (9.0 mm) (F)

 


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  		Fig. 3. —Plot of thresholds below which at least one reviewer assigned incorrect score compared to original lesion size. Plot shows that trained reviewers can detect smaller percentage increases in diameter of larger original lesion size.

 

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