OBJECTIVES: Double-dose contrast-enhanced brain imaging improves tumor delineation and detection of occult metastases but is limited by concerns about gadolinium-based contrast agents' effects on patients and the environment. The purpose of this study was to test the benefit of a deep learning-based contrast signal amplification in true single-dose T1-weighted (T-SD) images creating artificial double-dose (A-DD) images for metastasis detection in brain magnetic resonance imaging. MATERIALS AND METHODS: In this prospective, multicenter study, a deep learning-based method originally trained on noncontrast, low-dose, and T-SD brain images was applied to T-SD images of 30 participants (mean age ± SD, 58.5 ± 11.8 years
23 women) acquired externally between November 2022 and June 2023. Four readers with different levels of experience independently reviewed T-SD and A-DD images for metastases with 4 weeks between readings. A reference reader reviewed additionally acquired true double-dose images to determine any metastases present. Performances were compared using Mid-p McNemar tests for sensitivity and Wilcoxon signed rank tests for false-positive findings. RESULTS: All readers found more metastases using A-DD images. The 2 experienced neuroradiologists achieved the same level of sensitivity using T-SD images (62 of 91 metastases, 68.1%). While the increase in sensitivity using A-DD images was only descriptive for 1 of them (A-DD: 65 of 91 metastases, +3.3%, P = 0.424), the second neuroradiologist benefited significantly with a sensitivity increase of 12.1% (73 of 91 metastases, P = 0.008). The 2 less experienced readers (1 resident and 1 fellow) both found significantly more metastases on A-DD images (resident, T-SD: 61.5%, A-DD: 68.1%, P = 0.039
fellow, T-SD: 58.2%, A-DD: 70.3%, P = 0.008). They were therefore able to use A-DD images to increase their sensitivity to the neuroradiologists' initial level on regular T-SD images. False-positive findings did not differ significantly between sequences. However, readers showed descriptively more false-positive findings on A-DD images. The benefit in sensitivity particularly applied to metastases ≤5 mm (5.7%-17.3% increase in sensitivity). CONCLUSIONS: A-DD images can improve the detectability of brain metastases without a significant loss of precision and could therefore represent a potentially valuable addition to regular single-dose brain imaging.