MosMedReg Subtraction Software effectiveness in Multiple Sclerosis Diagnosis Using Magnetic Resonance Imaging Data

The aim of this study was to evaluate the effectiveness of the automated MosMedReg software for subtraction analysis of longitudinal brain MRI in patients with multiple sclerosis in a routine outpatient setting. The study included 30 paired MRI examinations performed on 1.5 T scanners from different manufacturers using T2, FLAIR, and contrast-enhanced T1 sequences with variable slice thicknesses. Image processing was performed using registration and subtraction algorithms based on the SimpleElastix library. Images were assessed manually by an expert and with the assistance of the software; results were evaluated using clinical and technical scoring systems. The software provided successful registration and subtraction in all cases, including series different in slice thickness and projections. The average number of newly identified lesions using MosMedReg did not differ from expert assessment (p = 0.25); however, in several cases, subtraction enabled the detection of clinically significant changes that were not observed in standard analysis. False-positive findings associated with technical artifacts due to scan parameter mismatches were also noted. The results confirm the reproducibility and practical applicability of subtraction analysis with MosMedReg for improving the objectivity and standardization of multiple sclerosis diagnosis in outpatient practice.