Observer performance in semi-automated microbleed detection

Cerebral microbleeds are small bleedings in the human brain, detectable with MRI. Microbleeds are associated with vascular disease and dementia. The number of studies involving microbleed detection is increasing rapidly. Visual rating is the current standard for detection, but is a time-consuming process, especially at high-resolution 7.0 T MR images, has limited reproducibility and is highly observer dependent. Recently, multiple techniques have been published for the semi-automated detection of microbleeds, attempting to overcome these problems. In the present study, a 7.0 T dual-echo gradient echo MR image was acquired in 18 participants with microbleeds from the SMART study. Two experienced observers identified 54 microbleeds in these participants, using a validated visual rating scale. The radial symmetry transform (RST) can be used for semi-automated detection of microbleeds in 7.0 T MR images. In the present study, the results of the RST were assessed by two observers and 47 microbleeds were identified: 35 true positives and 12 extra positives (microbleeds that were missed during visual rating). Hence, after scoring a total number of 66 microbleeds could be identified in the 18 participants. The use of the RST increased the average sensitivity of observers from 59% to 69%. More importantly, inter-observer agreement (ICC and Dice's coefficient) increased from 0.85 and 0.64 to 0.98 and 0.96, respectively. Furthermore, the required rating time was reduced from 30 to 2 minutes per participant. By fine-tuning the RST, sensitivities up to 90% can be achieved, at the cost of extra false positives.