Deep-learning-based reconstruction of undersampled MRI to reduce scan times: a multicentre, retrospective, cohort study

Background The extended acquisition times required for MRI limit its availability in resource-constrained settings. Consequently, accelerating MRI by undersampling k-space data, which is necessary to reconstruct an image, has been a long-standing but important challenge. We aimed to develop a deep convolutional neural network (dCNN) optimisation method for MRI reconstruction and to reduce scan times and evaluate its effect on image quality and accuracy of oncological imaging biomarkers. Methods In this multicentre, retrospective, cohort study, MRI data from patients with glioblastoma treated at Heidelberg University Hospital (775 patients and 775 examinations) and from the phase 2 CORE trial (260 patients, 1083 examinations, and 58 institutions) and the phase 3 CENTRIC trial (505 patients, 3147 examinations, and 139 institutions) were used to develop, train, and test dCNN for reconstructing MRI from highly undersampled single-coil k-space data with various acceleration rates (R=2, 4, 6, 8, 10, and 15). Independent testing was performed with MRIs from the phase 2/3 EORTC-26101 trial (528 patients with glioblastoma, 1974 examinations, and 32 institutions). The similarity between undersampled dCNN-reconstructed and original MRIs was quantified with various image quality metrics, including structural similarity index measure (SSIM) and the accuracy of undersampled dCNN-reconstructed MRI on downstream radiological assessment of imaging biomarkers in oncology (automated artificial intelligence-based quantification of tumour burden and treatment response) was performed in the EORTC-26101 test dataset. The public NYU Langone Health fastMRI brain test dataset (558 patients and 558 examinations) was used to validate the generalisability and robustness of the dCNN for reconstructing MRIs from available multi-coil (parallel imaging) k-space data. Findings In the EORTC-26101 test dataset, the median SSIM of undersampled dCNN-reconstructed MRI ranged from 0<middle dot>88 to 0<middle dot>99 across different acceleration rates, with 0<middle dot>92 (95% CI 0<middle dot>92-0<middle dot>93) for 10-times acceleration (R=10). The 10-times undersampled dCNN-reconstructed MRI yielded excellent agreement with original MRI when assessing volumes of contrast-enhancing tumour (median DICE for spatial agreement of 0<middle dot>89 [95% CI 0<middle dot>88 to 0<middle dot>89]; median volume difference of 0<middle dot>01 cm(3) [95% CI 0<middle dot>00 to 0<middle dot>03] equalling 0<middle dot>21%; p=0<middle dot>0036 for equivalence) or non-enhancing tumour or oedema (median DICE of 0<middle dot>94 [95% CI 0<middle dot>94 to 0<middle dot>95]; median volume difference of -0<middle dot>79 cm(3) [95% CI -0<middle dot>87 to -0<middle dot>72] equalling -1<middle dot>77%; p=0<middle dot>023 for equivalence) in the EORTC-26101 test dataset. Automated volumetric tumour response assessment in the EORTC-26101 test dataset yielded an identical median time to progression of 4<middle dot>27 months (95% CI 4<middle dot>14 to 4<middle dot>57) when using 10-times-undersampled dCNN-reconstructed or original MRI (log-rank p=0<middle dot>80) and agreement in the time to progression in 374 (95<middle dot>2%) of 393 patients with data. The dCNN generalised well to the fastMRI brain dataset, with significant improvements in the median SSIM when using multi-coil compared with single-coil k-space data (p<0<middle dot>0001). Interpretation Deep-learning-based reconstruction of undersampled MRI allows for a substantial reduction of scan times, with a 10-times acceleration demonstrating excellent image quality while preserving the accuracy of derived imaging biomarkers for the assessment of oncological treatment response. Our developments are available as open source software and hold considerable promise for increasing the accessibility to MRI, pending further prospective validation.