A deep learning–based method for improving reliability of multicenter diffusion kurtosis imaging with varied acquisition protocols

Multicenter magnetic resonance imaging is gaining more popularity in large-sample projects. Since both varying hardware and software across different centers cause unavoidable data heterogeneity across centers, its impact on reliability in study outcomes has also drawn much attention recently. One fundamental issue arises in how to derive model parameters reliably from image data of varying quality. This issue is even more challenging for advanced diffusion methods such as diffusion kurtosis imaging (DKI). Recently, deep learning–based methods have been demonstrated with their potential for robust and efficient computation of diffusion-derived measures. Inspired by these approaches, the current study specifically designed a framework based on a three-dimensional hierarchical convolutional neural network, to jointly reconstruct and harmonize DKI measures from multicenter acquisition to reformulate these to a state-of-the-art hardware using data from traveling subjects. The results from the harmonized data acquired with different protocols show that: 1) the inter-scanner variation of DKI measures within white matter was reduced by 51.5% in mean kurtosis, 65.9% in axial kurtosis, 53.7% in radial kurtosis, and 61.5% in kurtosis fractional anisotropy, respectively; 2) data reliability of each single scanner was enhanced and brought to the level of the reference scanner; and 3) the harmonization network was able to reconstruct reliable DKI values from high data variability. Overall the results demonstrate the feasibility of the proposed deep learning–based method for DKI harmonization and help to simplify the protocol setup procedure for multicenter scanners with different hardware and software configurations

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362