Pathology-preserving intensity standardization framework for multi-institutional FLAIR MRI datasets

Fluid-Attenuated Inversion Recovery (FLAIR) MRI are used by physicians to analyze white matter lesions (WML) of the brain, which are related to neurodegenerative diseases such as dementia and vascular disease. To study the causes and progression of these diseases, multi-centre (MC) studies are conducted, with images acquired and analyzed from multiple institutions. Due to differences in acquisition software and hardware, there is variability in image properties, which creates challenges for automated algorithms. This work explores this variability, known as the MC effect, by analyzing nearly 5000 MC FLAIR volumes and proposes an intensity standardization framework to normalize intensity non-standardness in FLAIR MRI, while ensuring the appearance of WML. Results show that original image characteristics varied significantly between scanner vendors and centres, and that this variability was reduced with standardization. To further highlight the utility of intensity standardization, a threshold-based brain extraction algorithm is implemented and compared with a classifier-based approach. A competitive Dice Similarity Coefficient of 81% was achieved on 183 volumes, demonstrating that optimized pre-processing can effectively reduce the variability in MC studies, allowing for simplified algorithms to be applied on large datasets robustly.