Deep Learning Framework for Automated MRI Planimetry in Multiple Sclerosis.

Brain volume changes and infratentorial involvement are key predictors of disability in multiple sclerosis (MS) and can be assessed using magnetic resonance imaging (MRI) planimetry. Although MRI planimetry is less susceptible to methodological and patient-related confounders than volumetry, it currently depends on manual measurements by unblinded experts, an approach that is time-consuming and vulnerable to bias. In this study, we present a fully automated deep learning framework for deriving brainstem planimetric measurements from MRI. The pipeline integrates an automated midsagittal plane (MSP) detection algorithm with a convolutional neural network trained to perform the segmentations required for planimetry. The automated method shows strong agreement with manual measurements and remains robust across scanners and acquisition protocols. These findings suggest that the proposed framework enables reliable, reproducible, and scalable MRI planimetry, supporting objective assessment of disease progression and treatment response in patients with MS.