AVRA: Automatic Visual Ratings of Atrophy from MRI images using Recurrent Convolutional Neural Networks

Quantifying the degree of atrophy is done clinically by neuroradiologists following established visual rating scales. For these assessments to be reliable the rater requires substantial training and experience, and even then the rating agreement between two radiologists is not perfect. We have developed a model we call AVRA (Automatic Visual Ratings of Atrophy) based on machine learning methods and trained on 2350 visual ratings made by an experienced neuroradiologist. It provides fast and automatic ratings for Scheltens' scale of medial temporal atrophy (MTA), the frontal subscale of Pasquier's Global Cortical Atrophy (GCA-F) scale, and Koedam's scale of Posterior Atrophy (PA). We demonstrate substantial inter-rater agreement between AVRA's and a neuroradiologist ratings with Cohen's weighted kappa values of $\kappa_w$ = 0.74/0.72 (MTA left/right), $\kappa_w$ = 0.62 (GCA-F) and $\kappa_w$ = 0.74 (PA), with an inherent intra-rater agreement of $\kappa_w$ = 1. We conclude that automatic visual ratings of atrophy can potentially have great clinical and scientific value, and aim to present AVRA as a freely available toolbox.