Deep-Learning Generated Synthetic Double Inversion Recovery Images Improve Multiple Sclerosis Lesion Detection

Objectives The aim of the study was to implement a deep-learning tool to produce synthetic double inversion recovery (synthDIR) images and compare their diagnostic performance to conventional sequences in patients with multiple sclerosis (MS). Materials and Methods For this retrospective analysis, 100 MS patients (65 female, 37 [22-68] years) were randomly selected from a prospective observational cohort between 2014 and 2016. In a subset of 50 patients, an artificial neural network (DiamondGAN) was trained to generate a synthetic DIR (synthDIR) from standard acquisitions (T1, T2, and fluid-attenuated inversion recovery [FLAIR]). With the resulting network, synthDIR was generated for the remaining 50 subjects. These images as well as conventionally acquired DIR (trueDIR) and FLAIR images were assessed for MS lesions by 2 independent readers, blinded to the source of the DIR image. Lesion counts in the different modalities were compared using a Wilcoxon signed-rank test, and interrater analysis was performed. Contrast-to-noise ratios were compared for objective image quality. Results Utilization of synthDIR allowed to detect significantly more lesions compared with the use of FLAIR images (31.4 +/- 20.7 vs 22.8 +/- 12.7, P < 0.001). This improvement was mainly attributable to an improved depiction of juxtacortical lesions (12.3 +/- 10.8 vs 7.2 +/- 5.6, P < 0.001). Interrater reliability was excellent in FLAIR 0.92 (95% confidence interval [CI], 0.85-0.95), synthDIR 0.93 (95% CI, 0.87-0.96), and trueDIR 0.95 (95% CI, 0.85-0.98). Contrast-to-noise ratio in synthDIR exceeded that of FLAIR (22.0 +/- 6.4 vs 16.7 +/- 3.6, P = 0.009); no significant difference was seen in comparison to trueDIR (22.0 +/- 6.4 vs 22.4 +/- 7.9, P = 0.87). Conclusions Computationally generated DIR images improve lesion depiction compared with the use of standard modalities. This method demonstrates how artificial intelligence can help improving imaging in specific pathologies.