MIMoSA: An Approach to Automatically Segment T2 Hyperintense and T1 Hypointense Lesions in Multiple Sclerosis

Magnetic resonance imaging (MRI) is crucial for in vivo detection and characterization of white matter lesions (WML) in multiple sclerosis (MS). The most widely established MRI outcome measure is the volume of hyperintense lesions on T2-weighted images (T2L). Unfortunately, T2L are non-specific for the level of tissue destruction and show a weak relationship to clinical status. Interest in lesions appearing hypointense on T1-weighted images (T1L) (“black holes”), which provide more specificity for axonal loss and a closer link to neurologic disability, has thus grown. The technical difficulty of T1L segmentation has led investigators to rely on time-consuming manual assessments prone to inter- and intra-rater variability. We implement MIMoSA, a current T2L automatic segmentation approach, to delineate T1L. Using cross-validation, MIMoSA proved robust for segmenting both T2L and T1L. For T2L, a Sorensen-Dice coefficient (DSC) of 0.6 and partial AUC (pAUC) up to 1% false positive rate of 0.69 were achieved. For T1L, 0.48 DSC and 0.63 pAUC were achieved. The correlation between EDSS and manual versus automatic volumes were similar for T1L (0.32 manual vs. 0.34 MIMoSA) and T2L (0.34 vs. 0.34).