A new automated color complement imaging approach can help better detect the progression of lesions in multiple sclerosis (MS), according to a new study published in the Journal of Digital Imaging

“Our proposed automated method can be implemented in a clinical environment without user supervision or specific expertise and may serve as a practical tool for routine clinical monitoring of MS lesions, if further validated,” the study authors said.

Most automated coregistration and subtraction techniques depend on T2-fluid-attenuated inversion recovery sequences to assess longitudinal changes in MS. 

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Here, a team of researchers led by Ranliang Hu, MD, of Emory University School of Medicine, in Atlanta, Georgia, assessed the usefulness of a novel automated temporal color complement imaging map overlapped on a 3-dimensional double inversion recovery in detecting disease progression in MS.

The researchers developed a fully automated system that coregisters 3-dimensional double inversion recovery at baseline and during the follow-up period. The system then generates a pseudo-color map in which red indicates enlarging lesions, blue and green indicates shrinking lesions, and gray indicates unchanged lesions.

The team then asked 3 neurologists to independently review 76 follow-up exams from 60 patients with MS using double-inversion recovery images only and color complement imaging maps based on double-inversion recovery images. 

The results showed that the color complement imaging approach could detect the progression of lesions in 67.1% of cases, while the standard review approach could only detect it in 22.4% of cases. 

Similarly, the color complement imaging approach detected 182 new or enlarged lesions, while the standard review approach only detected 28 such lesions.

The authors reported a statistically significant difference between the 2 approaches for all progressive lesions and cortical progressive lesions.


Park CC, Brummer ME, Sadigh G, et al. Automated registration and color labeling of serial 3D double inversion recovery MR imaging for detecting lesion progression in multiple sclerosis. J Digit Imaging. Published online November 9, 2022. doi:10.1007/s10278-022-00737-1