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Gadolinium-based contrast-enhanced MRI (CE-MRI) is the reference standard, as non-contrast MRI images lack sufficient contrast. However, gadolinium deposition, risk of nephrogenic system fibrosis in renally impaired patients, and patient discomfort limit its repeated administration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To develop deep learning-based synthetic-contrast-enhanced MRI (SynCE-MRI) using T1-weighted images to improve ChP visualization and evaluate its ability to detect morphological changes in Parkinsonian syndromes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This retrospective study included 265 (mean age\u2009=\u200965.7\u2009\u00b1\u20097.00\u2009years, males\/females: 120\/145) consecutive patients in the internal cohort (174 with Parkinson\u2019s disease [PD], 46 with essential tremor, and 45 with atypical Parkinsonian disorder [APD]) who underwent T1W and CE-MRI at 3T from Asan Medical Center (June 2021-December 2023), and an external cohort of 58 (mean age\u2009=\u200960.7\u2009\u00b1\u20097.8\u2009years, males\/females: 40\/18) patients (29\/29 PD\/APD) from Pusan National University, Yangsan Hospital (April 2011-December 2014). Nested-UNet was used for SynCE-MRI synthesis from T1W images. The 3D-UNet ChP segmentation model was trained by CE-MRI and tested using SynCE-MRI. Kruskal-Wallis and Bonferroni-corrected Mann-Whitney U tests assessed image synthesis, segmentation, and ChP morphometry (P\u2009&amp;lt;\u2009.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>SynCE-MRI achieved high-fidelity images with peak signal-to-noise ratio (PSNR) 35.37\u2009\u00b1\u20091.32 and structural similarity index measure (SSIM) 0.970\u202f\u00b10.0054. Segmentation accuracy for SynCE-MRI (dice score\u2009=\u20090.803\u2009\u00b1\u20090.029, 95% CI: 0.797-0.810) significantly outperformed manual (dice score\u2009=\u20090.59\u2009\u00b1\u20090.057, 95% CI: 0.578-0.603; P\u2009&amp;lt;\u2009.001) and automated (dice score\u2009=\u20090.489\u2009\u00b1\u20090.049, 95% CI: 0.479-0.500; P\u2009&amp;lt;\u2009.001) T1W-based segmentations. SynCE-MRI-based ChP volumes closely matched CE-MRI (mean absolute-volume difference [MAVD] = 6.7%; ICC\u2009=\u20090.88, 95% CI: 0.82-0.92). SynCE-MRI revealed significantly larger ChP volumes in APD versus PD using internal cohort (APD: 2.69\u2009\u00b1\u20090.39\u2009mL, 95% CI: 2.54-2.84 vs PD: 2.43\u2009\u00b1\u20090.47\u2009mL, 95% CI: 2.25-2.52; P\u2009=\u2009.04) and external cohort (APD: 2.81\u2009\u00b1\u20090.48\u2009mL, 95% CI: 2.60-3.02 vs PD: 2.52\u2009\u00b1\u20090.45\u2009mL, 95% CI: 2.36-2.69; P\u2009=\u2009.03).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SynCE-MRI accurately replicates CE-MRI for ChP imaging and morphometry, outperforms T1W imaging in segmentation, and detects ChP enlargement in APD versus PD across internal and external cohorts, consistent with CE-MRI findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/radadv\/umaf042","type":"journal-article","created":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T12:57:19Z","timestamp":1763816239000},"source":"Crossref","is-referenced-by-count":0,"title":["Automated synthetic contrast-enhanced MRI improves choroid plexus segmentation in Parkinsonian syndromes"],"prefix":"10.1093","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5067-9570","authenticated-orcid":false,"given":"Dagnachew Tessema","family":"Ambaye","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, Ulsan National Institute of Science and Technology , Ulsan, 44919,","place":["Republic of Korea"]},{"name":"Department of Electrical and Computer Engineering, Institute of Technology, Hawassa University , Hawassa, 05, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sungyang","family":"Jo","sequence":"additional","affiliation":[{"name":"Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, 05505,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huseyin","family":"Enes Candan","sequence":"additional","affiliation":[{"name":"Graduate School of Health Science and Technology, Ulsan National Institute of Science and Technology , Ulsan, 44919,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abel Worku","family":"Tessema","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Ulsan National Institute of Science and Technology , Ulsan, 44919,","place":["Republic of Korea"]},{"name":"School of Biomedical Engineering, Jimma Institute of Technology, Jimma University ,Jimma, 378, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nepes","family":"Myratgeldiyev","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Ulsan National Institute of Science and Technology , Ulsan, 44919,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chong Hyun","family":"Suh","sequence":"additional","affiliation":[{"name":"Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, 05505,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jihong","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, 05505,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sun Ju","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, 05505,","place":["Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hansol","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Ulsan National Institute of Science and Technology , Ulsan, 44919,","place":["Republic of Korea"]},{"name":"Athinoula A. 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