FAQ

Welcome to the CorTechs Labs Resource Center

Whether you need assistance or want to learn more about how our products are being used, our support team and resource center are here to help.

Technical Support
Monday – Friday
8 am to 5 pm PT
+1-858-459-9700, Extension 2
support@cortechslabs.com

Frequently Asked Questions

NeuroQuant FAQ

What does NeuroQuant provide?

NeuroQuant automatically analyzes 3D MR images and provides accurate, consistent and repeatable segmentation and measurements of brain structure volumes, which are compared them to age- and gender-matched reference data.

Who can use NeuroQuant?

NeuroQuant is used by radiologists, neurologists neuroradiologists and researchers, to obtain objective, valuable, enriching, quantitative data to aid in their clinical treatment planning and disease progression monitoring of patients with neurological conditions, such as Alzheimer’s disease, and other types of dementia, traumatic brain injury (TBI), multiple sclerosis and epilepsy and in the evaluation of brain development.

Can NeuroQuant be used in clinical practice?

Yes. NeuroQuant is FDA cleared (2006), CE marked (2014), and Health Canada licensed (2016).

Is NeuroQuant reimbursible?

In the US, reimbursement is possible using CPT code 76377 for medically indicated 3D volumetric post-processing.

Which MRI scanners are compatable with NeuroQuant?

NeuroQuant is compatible with most modern, closed-bore 1.5 T & 3.0 T scanners from GE, Siemens, Phillips and Toshiba and 1.5 T Hitachi scanners.

CorTechs Labs provides recommended scanner settings, which can be found here: http://www.cortechslabs.com/resources/scanner_setup/

Does CorTechs Labs provide a secure cloud-based solution or a locally installed solution?

Yes. We provide 3 different ways to use NeuroQuant. Use the links to learn more.

Is special hardware required to use NeuroQuant?

NeuroQuant is compatible with the following platforms:

  • Windows
  • Mac
  • Linux

Is special software or a PACS station required to view NeuroQuant results?

If you don’t have a DICOM viewer or PACS, we recommend the following free viewers: http://cortechsnews.cortechslabs.com/dicom-image-viewers

Is there a patient age limit that is recommended for NeuroQuant?

The current age range norms included in NeuroQuant are 3 to 100 years.

How can I tell if CTXNode is active?

CTXNode is actively listening when the CorTechs Labs icon is RED. When it is inactive, the icon will be GRAY. The CorTechs Labs icon can be found in the upper right hand corner of your desktop (on Macs) and the lower right hand corner (on PCs).

How does NeuroQuant account for variability in brain size?

All NeuroQuant measurements are normalized to the patient’s intracranial volume (brain size). Research has shown that measurements normalized this way are well correlated across the population.

How will NeuroQuant be supported in our current network environment?

NeuroQuant merely needs TCP/IP connections with a few standard ports where encryption is used. Our team of support engineers would need to perform an analysis of your network and/or speak with your network administrator to answer this fully.

How long does it take to upload a 3D T1 sequence to NeuroQuant and for the reports to become available?

A sequence generally takes 10-30 seconds to upload to NeuroQuant (depending on internet speed). Once the file is received, NeuroQuant completes segmentation and report output in about 5-7 minutes, at which point, the output report will be in the queue monitor and/or PACS system.

What is the output of the device?

The reports are provided in PDF format encapsulated in DICOM:

  • Age Related Atrophy Report
  • Hippocampal Volume Asymmetry Report
  • Multi Structure Atrophy Report
  • Triage Brain Atrophy Report
  • Brain Development Report
  • General Morphometry Report

Additional output includes:

  • Color-Coded Brain Segmentation: a 3D MR series with each color representing a specific segmental structure, in standard DICOM format viewable on standard PACS or other DICOM viewer
  • Longitudinal Study: A longitudinal assessment of the same patient at multiple scan intervals to examine regional atrophy over time

Can multiple reports be selected?

Physicians can request multiple reports in one processing session, thus improving the overall workflow when using NeuroQuant to assess complex conditions.

How can a patient's previous scan be combined with a new scan into a single report?

For patients that have been scanned previously and have existing NeuroQuant reports in PACS, simply send or upload a previous report to NeuroQuant – the multi-timepoint report will then be generated and show trajectory over time for that patient when a new scan is processed. If the previous scan is still on the NeuroQuant system there is no need to upload anything in advance – the multi-timepoint report will be created automatically when a follow-up scan is processed.

NOTE: Creating multi-timepoint reports between different software versions of NeuroQuant is not possible. If the previous report was created prior to version 2.0, the source DICOM data needs to be sent to NeuroQuant for processing in version 2.0. Then, the current NeuroQuant sequence can be processed in order to create the multi-timepoint report.

What factors can degare the techinical quality of MR images, thereby decreasing the accuracy of NeuroQuant?

These include:

  • Patient’s motion during scan
  • Artifacts affecting overall image quality
  • Brains showing gross amount of structural abnormality
  • Surgical resections larger than 30 cc
  • Tumors larger than 15 cc

In general, the accuracy of NeuroQuant output may decrease when the subject’s brain includes pathological features not present in the normal brain, lacks features normally present or is structurally different than that defined in a preexisting neuroanatomical atlas of the normal brain that drives the automated segmentation process.

If a study fails to process, are we charged for it by the system?

Only successfully processed scans are charged.

Why am I receiving an "Invalid or Corrupt DICOM Files in Archive" or similar error message?

The input file names (images or archives) might contain spaces, punctuation or other special characters.

Why am I receiving an "Unparsable DICOM Files" error message?

This is usually reported when the uploaded archive file contains:

  • Some files that are not DICOM
  • Two studies that are included as input

What does "Alignment of Brain to Atlas Unsucessful" mean?

NeuroQuant is designed with a cut-off threshold for “goodness of fit” of alignment of patient brain to neuroanatomical atlas. In moderate cases, enabling “Research mode” to relax this criterion may allow the scan to process correctly, but segmentation output should be reviewed by a radiologist to verify segmentation quality.

LesionQuant (a NeuroQuant product) FAQ

What does LesionQuant provide?

LesionQuant automatically analyzes 3D T1 and 2D or 3D FLAIR MR images and provides accurate, consistent and repeatable segmentation and measurements of lesions from DICOM images to provide lesion segmentation, counts and volumes and change, as well as, brain structure volumes, which are compared to age- and gender-matched reference data.

Who can use LesionQuant?

LesionQuant is used by radiologists, neurologists neuroradiologists and researchers, to obtain objective, valuable, enriching, quantitative data to aid in their clinical treatment planning and disease progression monitoring of patients with neurological conditions, such as Multiple Sclerosis.

Can LesionQuant be used in clinical practice?

Yes. NeuroQuant is FDA cleared (2006) and Health Canada licensed (2016). LesionQuant is part of the NeuroQuant family of products.

Is LesionQuant reimbursible?

In the US, reimbursement is possible using CPT code 76377 for medically indicated 3D volumetric post-processing.

Which MRI scanners are compatable with LesionQuant?

LesionQuant is compatible with most modern, closed-bore 1.5 T & 3.0 T scanners from GE, Siemens, Phillips and Toshiba.

CorTechs Labs provides recommended scanner settings, which can be found here: http://www.cortechslabs.com/resources/scanner_setup/

Does CorTechs Labs provide a secure cloud-based solution or a locally installed solution?

Yes. We provide 3 different ways to use LesionQuant. Use the links to learn more.

How long does the process take to upload the 3D T1 and FLAIR sequences to LesionQuant and for output to become available?

A sequence generally takes several minutes to upload to LesionQuant, upload speed generally depends on the institutions network speed. Once the files are received at the NeuroQuant server, processing starts automatically. LesionQuant completes segmentation and report output typically in under 30 minutes. At which point, the output will be available in the queue monitor and/or downloaded to your PACS system.

Is special software or a PACS station required to view LesionQuant results?

If you don’t have a DICOM viewer or PACS, we recommend the following free viewers: http://cortechsnews.cortechslabs.com/dicom-image-viewers

How reproducible are the brain structure and lesion segmentations?

This information will be provided in an upcoming white paper.

Is there a patient age limit that is recommended for LesionQuant?

The current age range norms included in LesionQuant are 3 to 100 years.

Is the LesionQuant brain volume quantification exactly as the same as NeuroQuant?

The brain structure volumes may be different from NeuroQuant since LesionQuant uses additional image data available in T2 FLAIR. Additionally, any lesion volumes are subtracted out from any brain structures, so volumes of brain structures may also be different.

Can I adjust the minimum lesion volume size?

Yes. The default setting for this parameter is 4 mm3. The user can set this parameter to up to 10 mm3 in order to increase the minimum size of a lesion being reported in the output.

How are lesions classified and defined by LesionQuant?

LesionQuant defines lesions as areas of increased FLAIR MRI signal intensity above a set threshold when compared to the surrounding tissue. Areas greater than or equal to 4 voxels will be considered a lesion.Touching lesions are counted as one lesion. For anatomical distribution, lesions located in the periventricular region are labeled as periventricular. If a lesion is touching gray matter, it is labeled leukocortical. Lesions in and touching the brain stem and cerebellum are labeled infratentorial. All remaining lesions are labeled as deep white.

How does LesionQuant account for variability in brain size?

All LesionQuant measurements are normalized to the patient’s intracranial volume (brain size). Research has shown that measurements normalized this way are well correlated across the population.

What is the output of LesionQuant?

  • FLAIR lesion segmentation overlay on top of FLAIR images in DICOM format: Lesions are color-coded based on where they are anatomically located in the brain.
  • FLAIR lesion change overlay on top of FLAIR images in DICOM format: Lesions are color-coded to distinguish between increasing and decreasing volumes (when current and prior scans are processed).
  • Report: PDF format encapsulated in DICOM

What does the color-coding indicate on the lesion change overlay images?

LesionQuant identifies areas of significant changes in image intensity, and color codes the region based on whether the intensity is decreasing or increasing. For example:

  • A growing MS lesion will likely increase in FLAIR intensity and size over time, which would appear red-to-yellow/orange in the LesionQuant Change volume.
  • A lesion that is in the process of resolving will shrink and become less FLAIR bright, which will then be labeled dark blue to cyan.

What does the color-coding indicate on the lesion segmentation overlay images?

In order to obtain the most lesion information possible in a quick revision of the images, LesionQuant classifies any identified lesion by a region-specific color code.

  • Leukocortical lesions are red
  • Periventricular lesions are purple
  • Infrantentorial lesions are orange
  • Lesions only touching white matter are yellow

Colors may appear lighter or darker due to image intensities.

What are the different report options?

  • LesionQuant FLAIR Lesion Report PLUS
    • Total number and volume of lesions, enlarging lesions and new lesions Anatomical distribution of lesions
    • White matter lesion burden
    • Histogram of lesion volume distributions
    • Current and prior volume with normative percentiles & volume and normative percentile change for 8 brain structures with age- and gender-matched reference charts
  • LesionQuant FLAIR Lesion Report
    • Total number and volume of lesions, enlarging lesions and new lesions
    • Current volume & normative percentile change of 4 brain structures with age-and gender-matched reference charts.

to cyan.

How can a patient’s prior/baseline scan be combined with a new/current scan?

For LesionQuant to generate output, at least one pair (3D T1 and 2D or 3D FLAIR) needs to be submitted for processing.

If two time points are available, first send the prior/baseline series images (paired 3D T1 and 2D or 3D FLAIR), and then send the new/current series of images (paired 3D T1 and 2D or 3D FLAIR). The Patient ID must match in both the submitted series and pairs of images.

Can more than 2 time points be compared? How do you handle multiple follow-ups over years?

Similar to NeuroQuant, LesionQuant can track brain structure volumes in the normative charts for multiple scans. Each 3D T1 and 2D or 3D paired scans must be (or have been processed and remain on the NeuroQuant system) for LesionQuant to create the multi time points on the single report.

For lesion volumes, however, only two time-points can be viewed in a single report.

When comparing two scans, do both time points need to be performed on the exact same scanner?

We recommend performing both scans on the same scanner using the same protocol for best results.  If different scanners or protocols are being used caution should be taken when interpreting the results.

In addition to the factors affecting NeuroQuant processing of 3D T1 volumetric MRI scans, the following factors apply to LesionQuant FLAIR reports:

Is there a difference in results if I use 2D or 3D FLAIR?

Yes. The resolution in 2D and 3D FLAIR images is significantly different and the results cannot be compared easily.

Can Gadolinium (Gd) be used?

Currently LesionQuant is not set up to interpret with Gd enhanced images. The 3D T1 image has to be taken prior to Gd. Contrast medium may significantly impact the accuracy of the brain segmentation algorithm.

For FLAIR images, though we recommend acquiring the images prior to Gd, the images can be taken immediately after Gd application.

What factors can degrade the technical quality of the MR images, thus decreasing the accuracy of LesionQuant?

Factors affecting quality include:

  • Patient’s motion during scan
  • Artifacts affecting overall image quality
  • Brains showing gross amount of structural abnormality
  • Surgical resections larger than 30 cc
  • Tumors larger than 15 cc

If a study fails to process, are we charged for it by the system?

Only successfully processed scans are charged.

Why am I receiving an “unparsable DICOM files” or “DICOM error” error message?

This is usually reported when the uploaded archive file contains:

  • Some files that are not DICOM
  • Two unsupported studies included as input
  • Missing required DICOM header information, eg due to anonymization that inadvertently removes scanner setting information.

Why am I receiving an “invalid or corrupt DICOM files in archive” or similar error message?

The input file names (images or archives) might contain spaces, punctuation or other special characters, or might be non-DICOM or non-image files.