We visually rated silent cerebral lesion (SCLs) in Osirix DICOM Viewer Lite (Pixmeo SARL, Swiss, https://www.osirix-viewer.com)
First, we import the data, anonymize the subjects' information with a key in the tool bar.
We have pre-removed the subjects' identity information.
Now, we start the evaluation of the silent lacunes (SLs).
This work is mainly done on the T1 horizontal images.
Here's a suggestion, that the evaluators develop their habits of evaluating in a fixed order.
I always evaluate in the order of “the frontal lobe - island lobe - basal ganglion - thalamus - temporal lobe - parietal lobe - occipital lobe - cerebellum - brain stem”.
We evaluate two hemispheres separately. Complete all the evaluation of one side, then the other.
Visually scan each area 2 times. This effectively avoids omissions.
Here's a demonstration. I'll start with the frontal lobe on the right
Positioned to the bottom of the frontal lobe and began to glance up
layer by layer, up to the top.(speed up)
and then scan the frontal lobe across all the layers once more, from top to bottom.
After complete with the frontal lobe, we go on with the assessment of the island lobe.
Again, from bottom to top, and then once more from top to bottom.
Then, evaluates the rest of the right brain.
Then, continue with the left side.
In the course of scanning, if a suspicious lesion is found
Mark it with this dot marking tool.(speed up)
If more than one suspicious lesions are found, make multiple markers.
When all areas have been assessed and lesions have been marked
further explore each suspicious lesion one by one.
Open new sequences with right-click on the left panel.
Choose a windows tiling mode
Replace a repeating T2 window with Flair.
So that I can make a comparison.
On Flair and T1, lacunes are hypointense foci of 2-15 mm diameter.
On T2, they are hyperintense.