Quantitative Imaging Redefines Value in Neuroradiology

Recently Lawrence Tanenbaum, MD sat down with Suzie Bash, MD to discuss how volumetric and quantitative tools are reshaping diagnosis, longitudinal surveillance, and treatment decision-making.

Tanenbaum opened by noting how dramatically the field has shifted in the era of biomarker-driven diagnosis, particularly in Alzheimer’s disease. Bash agreed, explaining that quantitative MRI now plays a different, but increasingly important role. “Quantitative volumetric imaging has shifted into a new role in the era of anti-amyloid therapy,” she said, emphasizing that while amyloid PET remains central to diagnosis, quantitative MRI is critical for disease staging and prognosis. “One of the biomarkers is neurodegeneration, and you can directly assess neurodegeneration with quantitative MRI.”

Bash stressed that staging matters because therapeutic windows are narrow. “Over 50% of patients are diagnosed too late,” she noted, underscoring the neuroradiologist’s responsibility to help identify patients early enough to benefit from treatment. At RadNet, where Bash practices, demand reflects this clinical need. “Our volumes of quantitative MRI are up 206%,” she said, citing more than 24,000 studies performed in a single year to support staging and longitudinal assessment.

Beyond dementia, Bash identified multiple sclerosis as one of the most impactful applications for quantitative imaging. While experienced neuroradiologists may feel confident visually assessing plaque burden, Bash cautioned against overreliance on qualitative assessment. “Once you get into moderately severe or severe plaque burden, it is very difficult to see if a plaque is enlarged or new,” she explained, pointing to variability in slice positioning and head angulation. “Computers are better at pattern recognition. Humans are better at global reasoning, but together, we work really well.”

That same principle applies to tumor assessment. Bash argued that traditional caliper-based measurements are inherently limited. “We are relatively inaccurate at measuring masses over time,” she said. “In the future, all tumors, regardless of location, will be measured and tracked on a volumetric basis.” Quantitative tools not only improve accuracy, she added, but also dramatically reduce the time burden associated with tracking multiple lesions, particularly in metastatic disease.

The conversation also addressed advanced applications, including treatment response and complication surveillance. Bash highlighted the growing importance of quantitative tools in monitoring ARIA (amyloid-related imaging abnormalities) associated with anti-amyloid therapies. “Every single ARIA surveillance report must indicate whether or not ARIA  is present,” she said, adding that radiologist education is essential to patient safety. “If you haven’t had the training, you really shouldn’t be reading these studies.”

As the discussion wrapped, Tanenbaum posed a final question: should AI-assisted tools be standard when evaluating ARIA? Bash’s answer was unequivocal. “Yes,” she said.

From the Applied Radiology booth, the message was clear: quantitative imaging is no longer a niche capability. It is becoming foundational to how neuroradiologists deliver precision, longitudinal insight, and clinical value across an expanding range of neurologic diseases.