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Dupuis A, Chen Y, Hansen M, Chow K, Sun JE, Badve C, Ma D, Griswold MA, Boyacioglu R. Quantifying 3D MR fingerprinting (3D-MRF) reproducibility across subjects, sessions, and scanners automatically using MNI atlases. Magn Reson Med 2024; 91:2074-2088. [PMID: 38192239 PMCID: PMC10950529 DOI: 10.1002/mrm.29983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Quantitative MRI techniques such as MR fingerprinting (MRF) promise more objective and comparable measurements of tissue properties at the point-of-care than weighted imaging. However, few direct cross-modal comparisons of MRF's repeatability and reproducibility versus weighted acquisitions have been performed. This work proposes a novel fully automated pipeline for quantitatively comparing cross-modal imaging performance in vivo via atlas-based sampling. METHODS We acquire whole-brain 3D-MRF, turbo spin echo, and MPRAGE sequences three times each on two scanners across 10 subjects, for a total of 60 multimodal datasets. The proposed automated registration and analysis pipeline uses linear and nonlinear registration to align all qualitative and quantitative DICOM stacks to Montreal Neurological Institute (MNI) 152 space, then samples each dataset's native space through transformation inversion to compare performance within atlas regions across subjects, scanners, and repetitions. RESULTS Voxel values within MRF-derived maps were found to be more repeatable (σT1 = 1.90, σT2 = 3.20) across sessions than vendor-reconstructed MPRAGE (σT1w = 6.04) or turbo spin echo (σT2w = 5.66) images. Additionally, MRF was found to be more reproducible across scanners (σT1 = 2.21, σT2 = 3.89) than either qualitative modality (σT1w = 7.84, σT2w = 7.76). Notably, differences between repeatability and reproducibility of in vivo MRF were insignificant, unlike the weighted images. CONCLUSION MRF data from many sessions and scanners can potentially be treated as a single dataset for harmonized analysis or longitudinal comparisons without the additional regularization steps needed for qualitative modalities.
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Affiliation(s)
- Andrew Dupuis
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yong Chen
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Radiology, University Hospitals, Cleveland, Ohio, USA
| | | | - Kelvin Chow
- Siemens Medical Solutions USA, Inc, Chicago, Illinois, USA
| | - Jessie E.P. Sun
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Chaitra Badve
- Department of Radiology, University Hospitals, Cleveland, Ohio, USA
| | - Dan Ma
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mark A. Griswold
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Rasim Boyacioglu
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
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Fujishima M, Kawasaki Y, Mitsuhashi T, Matsuda H. Impact of amyloid and tau positivity on longitudinal brain atrophy in cognitively normal individuals. Alzheimers Res Ther 2024; 16:77. [PMID: 38600602 PMCID: PMC11005141 DOI: 10.1186/s13195-024-01450-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Individuals on the preclinical Alzheimer's continuum, particularly those with both amyloid and tau positivity (A + T +), display a rapid cognitive decline and elevated disease progression risk. However, limited studies exist on brain atrophy trajectories within this continuum over extended periods. METHODS This study involved 367 ADNI participants grouped based on combinations of amyloid and tau statuses determined through cerebrospinal fluid tests. Using longitudinal MRI scans, brain atrophy was determined according to the whole brain, lateral ventricle, and hippocampal volumes and cortical thickness in AD-signature regions. Cognitive performance was evaluated with the Preclinical Alzheimer's Cognitive Composite (PACC). A generalized linear mixed-effects model was used to examine group × time interactions for these measures. In addition, progression risks to mild cognitive impairment (MCI) or dementia were compared among the groups using Cox proportional hazards models. RESULTS A total of 367 participants (48 A + T + , 86 A + T - , 63 A - T + , and 170 A - T - ; mean age 73.8 years, mean follow-up 5.1 years, and 47.4% men) were included. For the lateral ventricle and PACC score, the A + T - and A + T + groups demonstrated statistically significantly greater volume expansion and cognitive decline over time than the A - T - group (lateral ventricle: β = 0.757 cm3/year [95% confidence interval 0.463 to 1.050], P < .001 for A + T - , and β = 0.889 cm3/year [0.523 to 1.255], P < .001 for A + T + ; PACC: β = - 0.19 /year [- 0.36 to - 0.02], P = .029 for A + T - , and β = - 0.59 /year [- 0.80 to - 0.37], P < .001 for A + T +). Notably, the A + T + group exhibited additional brain atrophy including the whole brain (β = - 2.782 cm3/year [- 4.060 to - 1.504], P < .001), hippocampus (β = - 0.057 cm3/year [- 0.085 to - 0.029], P < .001), and AD-signature regions (β = - 0.02 mm/year [- 0.03 to - 0.01], P < .001). Cox proportional hazards models suggested an increased risk of progressing to MCI or dementia in the A + T + group versus the A - T - group (adjusted hazard ratio = 3.35 [1.76 to 6.39]). CONCLUSIONS In cognitively normal individuals, A + T + compounds brain atrophy and cognitive deterioration, amplifying the likelihood of disease progression. Therapeutic interventions targeting A + T + individuals could be pivotal in curbing brain atrophy, cognitive decline, and disease progression.
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Affiliation(s)
- Motonobu Fujishima
- Department of Radiology, Kumagaya General Hospital, 4-5-1 Nakanishi, Kumagaya, 360-8567, Japan.
| | - Yohei Kawasaki
- Department of Biostatistics, Graduate School of Medicine, Saitama Medical University, 38 Morohongo, Moroyama, 350-0495, Japan
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Hiroshi Matsuda
- Department of Biofunctional Imaging, Fukushima Medical University, 1 Hikariga-Oka, Fukushima, 960-1295, Japan
- Drug Discovery and Cyclotron Research Center, Southern Tohoku Research Institute for Neuroscience, 7-61-2 Yatsuyamada, Koriyama, 963-8052, Japan
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Parker TD, Hardy C, Keuss S, Coath W, Cash DM, Lu K, Nicholas JM, James SN, Sudre C, Crutch S, Bamiou DE, Warren JD, Fox NC, Richards M, Schott JM. Peripheral hearing loss at age 70 predicts brain atrophy and associated cognitive change. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-333101. [PMID: 38569877 DOI: 10.1136/jnnp-2023-333101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/04/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Hearing loss has been proposed as a modifiable risk factor for dementia. However, the relationship between hearing, neurodegeneration, and cognitive change, and the extent to which pathological processes such as Alzheimer's disease and cerebrovascular disease influence these relationships, is unclear. METHODS Data from 287 adults born in the same week of 1946 who underwent baseline pure tone audiometry (mean age=70.6 years) and two time point cognitive assessment/multimodal brain imaging (mean interval 2.4 years) were analysed. Hearing impairment at baseline was defined as a pure tone average of greater than 25 decibels in the best hearing ear. Rates of change for whole brain, hippocampal and ventricle volume were estimated from structural MRI using the Boundary Shift Integral. Cognition was assessed using the Pre-clinical Alzheimer's Cognitive Composite. Regression models were performed to evaluate how baseline hearing impairment associated with subsequent brain atrophy and cognitive decline after adjustment for a range of confounders including baseline β-amyloid deposition and white matter hyperintensity volume. RESULTS 111 out of 287 participants had hearing impairment. Compared with those with preserved hearing, hearing impaired individuals had faster rates of whole brain atrophy, and worse hearing (higher pure tone average) predicted faster rates of hippocampal atrophy. In participants with hearing impairment, faster rates of whole brain atrophy predicted greater cognitive change. All observed relationships were independent of β-amyloid deposition and white matter hyperintensity volume. CONCLUSIONS Hearing loss may influence dementia risk via pathways distinct from those typically implicated in Alzheimer's and cerebrovascular disease in cognitively unimpaired older adults.
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Affiliation(s)
- Thomas D Parker
- Department of Brain Sciences, Imperial College London, London, UK
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
- UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, London, UK
| | - Chris Hardy
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - Sarah Keuss
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - William Coath
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - David M Cash
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
- UK Dementia Research Institute at UCL, University College London, London, UK
| | - Kirsty Lu
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - Jennifer M Nicholas
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah-Naomi James
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Carole Sudre
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Centre for Medical Image Computing, University College London, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sebastian Crutch
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - Doris-Eva Bamiou
- UCL Ear Institute and UCLH Biomedical Research Centre, National Institute for Health Research, University College London, London, UK
| | - Jason D Warren
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - Nick C Fox
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Jonathan M Schott
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
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Reilmann R, Anderson KE, Feigin A, Tabrizi SJ, Leavitt BR, Stout JC, Piccini P, Schubert R, Loupe P, Wickenberg A, Borowsky B, Rynkowski G, Volkinshtein R, Li T, Savola JM, Hayden M, Gordon MF. Safety and efficacy of laquinimod for Huntington's disease (LEGATO-HD): a multicentre, randomised, double-blind, placebo-controlled, phase 2 study. Lancet Neurol 2024; 23:243-255. [PMID: 38280392 DOI: 10.1016/s1474-4422(23)00454-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 11/02/2023] [Accepted: 11/17/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Laquinimod modulates CNS inflammatory pathways thought to be involved in the pathology of Huntington's disease. Studies with laquinimod in transgenic rodent models of Huntington's disease suggested improvements in motor function, reduction of brain volume loss, and prolonged survival. We aimed to evaluate the safety and efficacy of laquinimod in improving motor function and reducing caudate volume loss in patients with Huntington's disease. METHODS LEGATO-HD was a multicentre, double-blind, placebo-controlled, phase 2 study done at 48 sites across ten countries (Canada, Czech Republic, Germany, Italy, Netherlands, Portugal, Russia, Spain, UK, and USA). Patients aged 21-55 years with a cytosine-adenosine-guanine (CAG) repeat length of between 36 and 49 who had symptomatic Huntington's disease with a Unified Huntington's Disease Rating Scale-Total Motor Score (UHDRS-TMS) of higher than 5 and a Total Functional Capacity score of 8 or higher were randomly assigned (1:1:1:1) by centralised interactive response technology to laquinimod 0·5 mg, 1·0 mg, or 1·5 mg, or to matching placebo, administered orally once daily over 52 weeks; people involved in the randomisation had no other role in the study. Participants, investigators, and study personnel were masked to treatment assignment. The 1·5 mg group was discontinued before recruitment was finished because of cardiovascular safety concerns in multiple sclerosis studies. The primary endpoint was change from baseline in the UHDRS-TMS and the secondary endpoint was percent change in caudate volume, both comparing the 1·0 mg group with the placebo group at week 52. Primary and secondary endpoints were assessed in the full analysis set (ie, all randomised patients who received at least one dose of study drug and had at least one post-baseline UHDRS-TMS assessment). Safety measures included adverse event frequency and severity, and clinical and laboratory examinations, and were assessed in the safety analysis set (ie, all randomised patients who received at least one dose of study drug). This trial is registered with ClinicalTrials.gov, NCT02215616, and EudraCT, 2014-000418-75, and is now complete. FINDINGS Between Oct 28, 2014, and June 19, 2018, 352 adults with Huntington's disease (179 [51%] men and 173 [49%] women; mean age 43·9 [SD 7·6] years and 340 [97%] White) were randomly assigned: 107 to laquinimod 0·5 mg, 107 to laquinimod 1·0 mg, 30 to laquinimod 1·5 mg, and 108 to matching placebo. Least squares mean change from baseline in UHDRS-TMS at week 52 was 1·98 (SE 0·83) in the laquinimod 1·0 mg group and 1·2 (0·82) in the placebo group (least squares mean difference 0·78 [95% CI -1·42 to 2·98], p=0·4853). Least squares mean change in caudate volume was 3·10% (SE 0·38) in the 1·0 mg group and 4·86% (0·38) in the placebo group (least squares mean difference -1·76% [95% CI -2·67 to -0·85]; p=0·0002). Laquinimod was well tolerated and there were no new safety findings. Serious adverse events were reported by eight (7%) patients on placebo, seven (7%) on laquinimod 0·5 mg, five (5%) on laquinimod 1·0 mg, and one (3%) on laquinimod 1·5 mg. There was one death, which occurred in the placebo group and was unrelated to treatment. The most frequent adverse events in all laquinimod dosed groups (0·5 mg, 1·0 mg, and 1·5 mg) were headache (38 [16%]), diarrhoea (24 [10%]), fall (18 [7%]), nasopharyngitis (20 [8%]), influenza (15 [6%]), vomiting (13 [5%]), arthralgia (11 [5%]), irritability (ten [4%]), fatigue (eight [3%]), and insomnia (eight [3%]). INTERPRETATION Laquinimod did not show a significant effect on motor symptoms assessed by the UHDRS-TMS, but significantly reduced caudate volume loss compared with placebo at week 52. Huntington's disease has a chronic and slowly progressive course, and this study does not address whether a longer duration of laquinimod treatment could have produced detectable and meaningful changes in the clinical assessments. FUNDING Teva Pharmaceutical Industries.
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Affiliation(s)
- Ralf Reilmann
- George Huntington Institute, Münster, Germany; Department of Clinical Radiology, University of Münster, Münster, Germany; Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
| | - Karen E Anderson
- Department of Psychiatry and Department of Neurology, Georgetown University School of Medicine, Washington, DC, USA
| | - Andrew Feigin
- New York University Langone Health, New York, NY, USA
| | - Sarah J Tabrizi
- University College London Queen Square Institute of Neurology, London, UK
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Julie C Stout
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Paola Piccini
- Department of Brain Sciences, Imperial College London, London, UK
| | | | - Pippa Loupe
- Research and Development, Teva Pharmaceutical Industries, Petah Tikva, Israel
| | | | | | - Gail Rynkowski
- Research and Development, Teva Pharmaceutical Industries, Petah Tikva, Israel
| | - Rita Volkinshtein
- Research and Development, Teva Pharmaceutical Industries, Petah Tikva, Israel
| | - Thomas Li
- Research and Development, Teva Pharmaceutical Industries, Petah Tikva, Israel
| | | | - Michael Hayden
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada; Prilenia Therapeutics, Herzliya, Israel
| | - Mark Forrest Gordon
- Research and Development, Teva Pharmaceutical Industries, Petah Tikva, Israel
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Chen YY, Chuang CH, Hsieh SL, Lin TL, Hsu CJ. A Combination of FPU-Net and Feature Clustering Methods for Accurate Segmentation of Femoral Neck in Radiographic Diagnosis. Diagnostics (Basel) 2023; 13:2855. [PMID: 37685393 PMCID: PMC10486373 DOI: 10.3390/diagnostics13172855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/08/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
In this study, we develop an innovative method that assists computer-aided diagnosis in the determination process of the exact location of the femoral neck junction in plain radiographs. Our algorithm consists of two phases, i.e., coarse prediction and fine matching, which are implemented by supervised deep learning method and unsupervised clustering, respectively. In coarse prediction, standard masks are first produced by a specialist and trained in our proposed feature propagation network (FPU-Net) with supervised learning on the femoral neck dataset. In fine matching, the standard masks are first classified into different categories using our proposed three parameters with unsupervised learning. The predicted mask from FPU-Net is matched with each category of standard masks by calculating the values of intersection of union (IOU), and finally the predicted mask is substituted by the standard mask with the largest IOU value. A total of 4320 femoral neck parts in anterior-posterior (AP) pelvis radiographs collected from China Medical University Hospital database were used to test our method. Simulation results show that, on the one hand, compared with other segmentation methods, the method proposed in this paper has a larger IOU value and better suppression of noise outside the region of interest; on the other hand, the introduction of unsupervised learning for fine matching can help in the accurate localization segmentation of femoral neck images. Accurate femoral neck segmentation can assist surgeons to diagnose and reduce the misdiagnosis rate and burden.
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Affiliation(s)
- Y. Y. Chen
- Department of Artificial Intelligence and Computer Engineering, National Chin-Yi University of Technology, Taichung 411030, Taiwan; (Y.Y.C.); (C.H.C.)
| | - C. H. Chuang
- Department of Artificial Intelligence and Computer Engineering, National Chin-Yi University of Technology, Taichung 411030, Taiwan; (Y.Y.C.); (C.H.C.)
| | - S. L. Hsieh
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404327, Taiwan; (T.L.L.); (C.J.H.)
| | - T. L. Lin
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404327, Taiwan; (T.L.L.); (C.J.H.)
| | - C. J. Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404327, Taiwan; (T.L.L.); (C.J.H.)
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Sun L, Zhang J, Li W, Sheng J, Xiao S. Neutrophil activation may trigger tau burden contributing to cognitive progression of chronic sleep disturbance in elderly individuals not living with dementia. BMC Med 2023; 21:205. [PMID: 37280592 PMCID: PMC10243051 DOI: 10.1186/s12916-023-02910-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND To investigate the complex connection between chronic sleep disturbance (CSD) and cognitive progression. METHODS The Alzheimer's Disease Neuroimaging Initiative (ADNI) database was used to assign 784 non-dementia elderly into two groups: a normal sleep group (528 participants) and a CSD group (256 participants) via the Neuropsychiatric Inventory (NPI)-sleep subitem. Blood transcriptomics, blood neutrophil, cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease (AD), and neutrophil-related inflammatory factors were measured. We also investigated gene set enrichment analysis (GSEA), Cox proportional hazards model for risk factors, and mediation and interaction effects between indicators. Cognitive progression is defined as the progression from cognitively normal to mild cognitive impairment (MCI)/dementia or from MCI to dementia. RESULTS CSD could significantly affect cognitive function. The activated neutrophil pathways for cognitive progression in CSD were identified by transcriptomics GSEA, which was reflected by increased blood neutrophil level and its correlation with cognitive progression in CSD. High tau burden mediated the influence of neutrophils on cognitive function and exacerbated the CSD-related risk of left hippocampal atrophy. Elevated neutrophil-related inflammatory factors were observed in the cognitive progression of CSD and were associated with brain tau burden. CONCLUSIONS Activated neutrophil pathway triggering tau pathology may underline the mechanism of cognitive progression in CSD.
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Affiliation(s)
- Lin Sun
- Department of Psychiatry, Alzheimer's Disease and Related Disorders Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Xuhui District, Shanghai, China.
| | - Jie Zhang
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Orthopedic Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Li
- Department of Psychiatry, Alzheimer's Disease and Related Disorders Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Xuhui District, Shanghai, China
| | - Jianhua Sheng
- Department of Psychiatry, Alzheimer's Disease and Related Disorders Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Xuhui District, Shanghai, China.
| | - Shifu Xiao
- Department of Psychiatry, Alzheimer's Disease and Related Disorders Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Xuhui District, Shanghai, China.
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Bozek J, Griffanti L, Lau S, Jenkinson M. Normative models for neuroimaging markers: Impact of model selection, sample size and evaluation criteria. Neuroimage 2023; 268:119864. [PMID: 36621581 DOI: 10.1016/j.neuroimage.2023.119864] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/13/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023] Open
Abstract
Modelling population reference curves or normative modelling is increasingly used with the advent of large neuroimaging studies. In this paper we assess the performance of fitting methods from the perspective of clinical applications and investigate the influence of the sample size. Further, we evaluate linear and non-linear models for percentile curve estimation and highlight how the bias-variance trade-off manifests in typical neuroimaging data. We created plausible ground truth distributions of hippocampal volumes in the age range of 45 to 80 years, as an example application. Based on these distributions we repeatedly simulated samples for sizes between 50 and 50,000 data points, and for each simulated sample we fitted a range of normative models. We compared the fitted models and their variability across repetitions to the ground truth, with specific focus on the outer percentiles (1st, 5th, 10th) as these are the most clinically relevant. Our results quantify the expected decreasing trend in variance of the volume estimates with increasing sample size. However, bias in the volume estimates only decreases a modest amount, without much improvement at large sample sizes. The uncertainty of model performance is substantial for what would often be considered large samples in a neuroimaging context and rises dramatically at the ends of the age range, where fewer data points exist. Flexible models perform better across sample sizes, especially for non-linear ground truth. Surprisingly large samples of several thousand data points are needed to accurately capture outlying percentiles across the age range for applications in research and clinical settings. Performance evaluation methods should assess both bias and variance. Furthermore, caution is needed when attempting to go near the ends of the age range captured by the source data set and, as is a well known general principle, extrapolation beyond the age range should always be avoided. To help with such evaluations of normative models we have made our code available to guide researchers developing or utilising normative models.
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Affiliation(s)
- Jelena Bozek
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Ludovica Griffanti
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, Warneford Hospital, University of Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom
| | - Stephan Lau
- Australian Institute for Machine Learning, School of Computer and Mathematical Sciences, The University of Adelaide, Adelaide, SA, Australia; South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom; Australian Institute for Machine Learning, School of Computer and Mathematical Sciences, The University of Adelaide, Adelaide, SA, Australia; South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.
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Park JH, Park KI, Kim D, Lee M, Kang S, Kang SJ, Yoon DH. Improving performance robustness of subject-based brain segmentation software. ENCEPHALITIS 2023; 3:24-33. [PMID: 37469714 PMCID: PMC10295817 DOI: 10.47936/encephalitis.2022.00108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 07/21/2023] Open
Abstract
Purpose Artificial intelligence (AI)-based image analysis tools to quantify the brain have become commercialized. However, insufficient data for learning and scanner specificity is a limitation for achieving high quality. In the present study, the performance of personalized brain segmentation software when applied to multicenter data using an AI model trained on data from a single institution was improved. Methods Preindicators of brain white matter (WM) information from the training dataset were utilized for preprocessing. During learning, data of cognitively normal (CN) individuals from a single center were utilized, and data of CN individuals and Alzheimer disease (AD) patients enrolled in multiple centers were considered the test set. Results The preprocessing based on the preindicator (dice similarity coefficient [DSC], 0.8567) resulted in a better performance than without (DSC, 0.7921). The standard deviation (SD) of the WM region intensity (DSC, 0.8303) had a more substantial influence on the performance than the average intensity (DSC, 0.6591). When the SD of the test data WM intensity was smaller than the learning data, the performance improved (0.03 increase in lower SD, 0.05 decrease in higher SD). Furthermore, preindicator-based pretreatment increased the correlation of mean cortical thickness of the entire gray matter between Atroscan and FreeSurfer, and data augmentation without preprocessing did not.Both preindicator processing and data augmentation improved the correlation coefficient from 0.7584 to 0.8165. Conclusion Data augmentation and preindicator-based preprocessing of training data can improve the performance of AI-based brain segmentation software, both increasing the generalizability and stability of brain segmentation software.
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Affiliation(s)
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Division of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | | | | | | | - Seung Joo Kang
- Division of Gastroenterology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Dae Hyun Yoon
- Division of Psychiatry, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
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Maikusa N, Shigemoto Y, Chiba E, Kimura Y, Matsuda H, Sato N. Harmonized Z-Scores Calculated from a Large-Scale Normal MRI Database to Evaluate Brain Atrophy in Neurodegenerative Disorders. J Pers Med 2022; 12:jpm12101555. [PMID: 36294692 PMCID: PMC9605567 DOI: 10.3390/jpm12101555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 12/05/2022] Open
Abstract
Alzheimer’s disease (AD), the most common type of dementia in elderly individuals, slowly and progressively diminishes the cognitive function. Mild cognitive impairment (MCI) is also a significant risk factor for the onset of AD. Magnetic resonance imaging (MRI) is widely used for the detection and understanding of the natural progression of AD and other neurodegenerative disorders. For proper assessment of these diseases, a reliable database of images from cognitively healthy participants is important. However, differences in magnetic field strength or the sex and age of participants between a normal database and an evaluation data set can affect the accuracy of the detection and evaluation of neurodegenerative disorders. We developed a brain segmentation procedure, based on 30 Japanese brain atlases, and suggest a harmonized Z-score to correct the differences in field strength and sex and age from a large data set (1235 cognitively healthy participants), including 1.5 T and 3 T T1-weighted brain images. We evaluated our harmonized Z-score for AD discriminative power and classification accuracy between stable MCI and progressive MCI. Our procedure can perform brain segmentation in approximately 30 min. The harmonized Z-score of the hippocampus achieved high accuracy (AUC = 0.96) for AD detection and moderate accuracy (AUC = 0.70) to classify stable or progressive MCI. These results show that our method can detect AD with high accuracy and high generalization capability. Moreover, it may discriminate between stable and progressive MCI. Our study has some limitations: the age groups in the 1.5 T data set and 3 T data set are significantly different. In this study, we focused on AD, which is primarily a disease of elderly patients. For other diseases in different age groups, the harmonized Z-score needs to be recalculated using different data sets.
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Affiliation(s)
- Norihide Maikusa
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, Tokyo 113-8654, Japan
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
- Correspondence: ; Tel.: +81-42-341-2711
| | - Yoko Shigemoto
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
| | - Emiko Chiba
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
| | - Yukio Kimura
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
| | - Hiroshi Matsuda
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
| | - Noriko Sato
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
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10
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Keuss SE, Coath W, Nicholas JM, Poole T, Barnes J, Cash DM, Lane CA, Parker TD, Keshavan A, Buchanan SM, Wagen AZ, Storey M, Harris M, Malone IB, Sudre CH, Lu K, James SN, Street R, Thomas DL, Dickson JC, Murray-Smith H, Wong A, Freiberger T, Crutch S, Richards M, Fox NC, Schott JM. Associations of β-Amyloid and Vascular Burden With Rates of Neurodegeneration in Cognitively Normal Members of the 1946 British Birth Cohort. Neurology 2022; 99:e129-e141. [PMID: 35410910 PMCID: PMC9280996 DOI: 10.1212/wnl.0000000000200524] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/01/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The goals of this work were to quantify the independent and interactive associations of β-amyloid (Aβ) and white matter hyperintensity volume (WMHV), a marker of presumed cerebrovascular disease (CVD), with rates of neurodegeneration and to examine the contributions of APOE ε4 and vascular risk measured at different stages of adulthood in cognitively normal members of the 1946 British Birth Cohort. METHODS Participants underwent brain MRI and florbetapir-Aβ PET as part of Insight 46, an observational population-based study. Changes in whole-brain, ventricular, and hippocampal volume were directly measured from baseline and repeat volumetric T1 MRI with the boundary shift integral. Linear regression was used to test associations with baseline Aβ deposition, baseline WMHV, APOE ε4, and office-based Framingham Heart Study Cardiovascular Risk Score (FHS-CVS) and systolic blood pressure (BP) at ages 36, 53, and 69 years. RESULTS Three hundred forty-six cognitively normal participants (mean [SD] age at baseline scan 70.5 [0.6] years; 48% female) had high-quality T1 MRI data from both time points (mean [SD] scan interval 2.4 [0.2] years). Being Aβ positive at baseline was associated with 0.87-mL/y faster whole-brain atrophy (95% CI 0.03, 1.72), 0.39-mL/y greater ventricular expansion (95% CI 0.16, 0.64), and 0.016-mL/y faster hippocampal atrophy (95% CI 0.004, 0.027), while each 10-mL additional WMHV at baseline was associated with 1.07-mL/y faster whole-brain atrophy (95% CI 0.47, 1.67), 0.31-mL/y greater ventricular expansion (95% CI 0.13, 0.60), and 0.014-mL/y faster hippocampal atrophy (95% CI 0.006, 0.022). These contributions were independent, and there was no evidence that Aβ and WMHV interacted in their effects. There were no independent associations of APOE ε4 with rates of neurodegeneration after adjustment for Aβ status and WMHV, no clear relationships between FHS-CVS or systolic BP and rates of neurodegeneration when assessed across the whole sample, and no evidence that FHS-CVS or systolic BP acted synergistically with Aβ. DISCUSSION Aβ and presumed CVD have distinct and additive effects on rates of neurodegeneration in cognitively normal elderly. These findings have implications for the use of MRI measures as biomarkers of neurodegeneration and emphasize the importance of risk management and early intervention targeting both pathways.
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Affiliation(s)
- Sarah E Keuss
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - William Coath
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Jennifer M Nicholas
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Teresa Poole
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Josephine Barnes
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - David M Cash
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Christopher A Lane
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Thomas D Parker
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Ashvini Keshavan
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Sarah M Buchanan
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Aaron Z Wagen
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Mathew Storey
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Matthew Harris
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Ian B Malone
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Carole H Sudre
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Kirsty Lu
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Sarah-Naomi James
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Rebecca Street
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - David L Thomas
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - John C Dickson
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Heidi Murray-Smith
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Andrew Wong
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Tamar Freiberger
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Sebastian Crutch
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Marcus Richards
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Nick C Fox
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK
| | - Jonathan M Schott
- From the Dementia Research Centre (S.E.K., W.C., J.M.N., T.P., J.B., D.M.C., C.A.L., A.K. S.M.B., A.Z.W., M.S., M.H., I.B.M., C.H.S., K.L., R.S., H.M.-S, T.F., S.C., N.C.F., J.M.S.), Dementia Research Institute (D.M.C., N.C.F.), Leonard Wolfson Experimental Neurology Centre (D.L.T.), and Department of Brain Repair and Neurorehabilitation (D.L.T.), UCL Queen Square Institute of Neurology; Department of Medical Statistics (J.M.N., T.P.), London School of Hygiene and Tropical Medicine; 4. Department of Medicine (T.D.P.), Division of Brain Sciences, Imperial College London; MRC Unit for Lifelong Health and Ageing at UCL (C.H.S., S.-N.J., A.W., M.R.); Centre for Medical Image Computing (C.H.S.), University College London; School of Biomedical Engineering & Imaging Sciences (C.H.S.), King's College London; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals, UK.
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11
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de Silva E, Sudre CH, Barnes J, Scelsi MA, Altmann A. Polygenic coronary artery disease association with brain atrophy in the cognitively impaired. Brain Commun 2022; 4:fcac314. [PMID: 36523268 PMCID: PMC9746681 DOI: 10.1093/braincomms/fcac314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/09/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
While a number of low-frequency genetic variants of large effect size have been shown to underlie both cardiovascular disease and dementia, recent studies have highlighted the importance of common genetic variants of small effect size, which, in aggregate, are embodied by a polygenic risk score. We investigate the effect of polygenic risk for coronary artery disease on brain atrophy in Alzheimer's disease using whole-brain volume and put our findings in context with the polygenic risk for Alzheimer's disease and presumed small vessel disease as quantified by white-matter hyperintensities. We use 730 subjects from the Alzheimer's disease neuroimaging initiative database to investigate polygenic risk score effects (beyond APOE) on whole-brain volumes, total and regional white-matter hyperintensities and amyloid beta across diagnostic groups. In a subset of these subjects (N = 602), we utilized longitudinal changes in whole-brain volume over 24 months using the boundary shift integral approach. Linear regression and linear mixed-effects models were used to investigate the effect of white-matter hyperintensities at baseline as well as Alzheimer's disease-polygenic risk score and coronary artery disease-polygenic risk score on whole-brain atrophy and whole-brain atrophy acceleration, respectively. All genetic associations were examined under the oligogenic (P = 1e-5) and the more variant-inclusive polygenic (P = 0.5) scenarios. Results suggest no evidence for a link between the polygenic risk score and markers of Alzheimer's disease pathology at baseline (when stratified by diagnostic group). However, both Alzheimer's disease-polygenic risk score and coronary artery disease-polygenic risk score were associated with longitudinal decline in whole-brain volume (Alzheimer's disease-polygenic risk score t = 3.3, P FDR = 0.007 over 24 months in healthy controls) and surprisingly, under certain conditions, whole-brain volume atrophy is statistically more correlated with cardiac polygenic risk score than Alzheimer's disease-polygenic risk score (coronary artery disease-polygenic risk score t = 2.1, P FDR = 0.04 over 24 months in the mild cognitive impairment group). Further, in our regional analysis of white-matter hyperintensities, Alzheimer's disease-polygenic risk score beyond APOE is predictive of white-matter volume in the occipital lobe in Alzheimer's disease subjects in the polygenic regime. Finally, the rate of change of brain volume (or atrophy acceleration) may be sensitive to Alzheimer's disease-polygenic risk beyond APOE in healthy individuals (t = 2, P = 0.04). For subjects with mild cognitive impairment, beyond APOE, a more inclusive polygenic risk score including more variants, shows coronary artery disease-polygenic risk score to be more predictive of whole-brain volume atrophy, than an oligogenic approach including fewer larger effect size variants.
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Affiliation(s)
- Eric de Silva
- Centre for Medical Image Computing, University College London, London, UK.,NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Carole H Sudre
- Centre for Medical Image Computing, University College London, London, UK.,MRC Unit for Lifelong Health and Ageing, University College London, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Josephine Barnes
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Marzia A Scelsi
- Centre for Medical Image Computing, University College London, London, UK
| | - Andre Altmann
- Centre for Medical Image Computing, University College London, London, UK
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12
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Eshaghzadeh Torbati M, Minhas DS, Ahmad G, O'Connor EE, Muschelli J, Laymon CM, Yang Z, Cohen AD, Aizenstein HJ, Klunk WE, Christian BT, Hwang SJ, Crainiceanu CM, Tudorascu DL. A multi-scanner neuroimaging data harmonization using RAVEL and ComBat. Neuroimage 2021; 245:118703. [PMID: 34736996 PMCID: PMC8820090 DOI: 10.1016/j.neuroimage.2021.118703] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/07/2021] [Accepted: 10/28/2021] [Indexed: 11/27/2022] Open
Abstract
Modern neuroimaging studies frequently combine data collected from multiple scanners and experimental conditions. Such data often contain substantial technical variability associated with image intensity scale (image intensity scales are not the same in different images) and scanner effects (images obtained from different scanners contain substantial technical biases). Here we evaluate and compare results of data analysis methods without any data transformation (RAW), with intensity normalization using RAVEL, with regional harmonization methods using ComBat, and a combination of RAVEL and ComBat. Methods are evaluated on a unique sample of 16 study participants who were scanned on both 1.5T and 3T scanners a few months apart. Neuroradiological evaluation was conducted for 7 different regions of interest (ROI’s) pertinent to Alzheimer’s disease (AD). Cortical measures and results indicate that: (1) RAVEL substantially improved the reproducibility of image intensities; (2) ComBat is preferred over RAVEL and the RAVEL-ComBat combination in terms of regional level harmonization due to more consistent harmonization across subjects and image-derived measures; (3) RAVEL and ComBat substantially reduced bias compared to analysis of RAW images, but RAVEL also resulted in larger variance; and (4) the larger root mean square deviation (RMSD) of RAVEL compared to ComBat is due mainly to its larger variance.
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Affiliation(s)
- Mahbaneh Eshaghzadeh Torbati
- Intelligent System Program, University of Pittsburgh School of Computing and Information, Pittsburgh, PA 15213, USA
| | - Davneet S Minhas
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ghasan Ahmad
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Erin E O'Connor
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - John Muschelli
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Charles M Laymon
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Zixi Yang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - William E Klunk
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Bradley T Christian
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Seong Jae Hwang
- Intelligent System Program, University of Pittsburgh School of Computing and Information, Pittsburgh, PA 15213, USA; Department of Computer Science, University of Pittsburgh School of Computing and Information, Pittsburgh, PA 15213, USA
| | - Ciprian M Crainiceanu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Dana L Tudorascu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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13
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Koval I, Bône A, Louis M, Lartigue T, Bottani S, Marcoux A, Samper-González J, Burgos N, Charlier B, Bertrand A, Epelbaum S, Colliot O, Allassonnière S, Durrleman S. AD Course Map charts Alzheimer's disease progression. Sci Rep 2021; 11:8020. [PMID: 33850174 PMCID: PMC8044144 DOI: 10.1038/s41598-021-87434-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/22/2021] [Indexed: 02/06/2023] Open
Abstract
Alzheimer's disease (AD) is characterized by the progressive alterations seen in brain images which give rise to the onset of various sets of symptoms. The variability in the dynamics of changes in both brain images and cognitive impairments remains poorly understood. This paper introduces AD Course Map a spatiotemporal atlas of Alzheimer's disease progression. It summarizes the variability in the progression of a series of neuropsychological assessments, the propagation of hypometabolism and cortical thinning across brain regions and the deformation of the shape of the hippocampus. The analysis of these variations highlights strong genetic determinants for the progression, like possible compensatory mechanisms at play during disease progression. AD Course Map also predicts the patient's cognitive decline with a better accuracy than the 56 methods benchmarked in the open challenge TADPOLE. Finally, AD Course Map is used to simulate cohorts of virtual patients developing Alzheimer's disease. AD Course Map offers therefore new tools for exploring the progression of AD and personalizing patients care.
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Affiliation(s)
- Igor Koval
- Institut du Cerveau et de la Moelle épinière (ICM) & Inserm, U 1127 & CNRS, UMR 7225, Sorbonne Université, 75013, Paris, France
- Inria, Aramis project-team, Paris, France
- Centre de Mathématiques Appliquées, Ecole Polytechnique, Palaiseau, France
| | - Alexandre Bône
- Institut du Cerveau et de la Moelle épinière (ICM) & Inserm, U 1127 & CNRS, UMR 7225, Sorbonne Université, 75013, Paris, France
- Inria, Aramis project-team, Paris, France
| | - Maxime Louis
- Institut du Cerveau et de la Moelle épinière (ICM) & Inserm, U 1127 & CNRS, UMR 7225, Sorbonne Université, 75013, Paris, France
- Inria, Aramis project-team, Paris, France
| | - Thomas Lartigue
- Institut du Cerveau et de la Moelle épinière (ICM) & Inserm, U 1127 & CNRS, UMR 7225, Sorbonne Université, 75013, Paris, France
- Inria, Aramis project-team, Paris, France
- Centre de Mathématiques Appliquées, Ecole Polytechnique, Palaiseau, France
| | - Simona Bottani
- Institut du Cerveau et de la Moelle épinière (ICM) & Inserm, U 1127 & CNRS, UMR 7225, Sorbonne Université, 75013, Paris, France
- Inria, Aramis project-team, Paris, France
| | - Arnaud Marcoux
- Institut du Cerveau et de la Moelle épinière (ICM) & Inserm, U 1127 & CNRS, UMR 7225, Sorbonne Université, 75013, Paris, France
- Inria, Aramis project-team, Paris, France
| | - Jorge Samper-González
- Institut du Cerveau et de la Moelle épinière (ICM) & Inserm, U 1127 & CNRS, UMR 7225, Sorbonne Université, 75013, Paris, France
- Inria, Aramis project-team, Paris, France
| | - Ninon Burgos
- Institut du Cerveau et de la Moelle épinière (ICM) & Inserm, U 1127 & CNRS, UMR 7225, Sorbonne Université, 75013, Paris, France
- Inria, Aramis project-team, Paris, France
| | - Benjamin Charlier
- Institut du Cerveau et de la Moelle épinière (ICM) & Inserm, U 1127 & CNRS, UMR 7225, Sorbonne Université, 75013, Paris, France
- Inria, Aramis project-team, Paris, France
- Laboratoire Alexandre Grotendieck, Université de Montpellier, Montpellier, France
| | - Anne Bertrand
- Institut du Cerveau et de la Moelle épinière (ICM) & Inserm, U 1127 & CNRS, UMR 7225, Sorbonne Université, 75013, Paris, France
- Inria, Aramis project-team, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Stéphane Epelbaum
- Institut du Cerveau et de la Moelle épinière (ICM) & Inserm, U 1127 & CNRS, UMR 7225, Sorbonne Université, 75013, Paris, France
- Inria, Aramis project-team, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Olivier Colliot
- Institut du Cerveau et de la Moelle épinière (ICM) & Inserm, U 1127 & CNRS, UMR 7225, Sorbonne Université, 75013, Paris, France
- Inria, Aramis project-team, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Stéphanie Allassonnière
- Centre de Recherche des Cordeliers, Université Paris Descartes, Paris, France
- Centre de Mathématiques Appliquées, Ecole Polytechnique, Palaiseau, France
| | - Stanley Durrleman
- Institut du Cerveau et de la Moelle épinière (ICM) & Inserm, U 1127 & CNRS, UMR 7225, Sorbonne Université, 75013, Paris, France.
- Inria, Aramis project-team, Paris, France.
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14
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A Fully Automatic Procedure for Brain Tumor Segmentation from Multi-Spectral MRI Records Using Ensemble Learning and Atlas-Based Data Enhancement. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11020564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The accurate and reliable segmentation of gliomas from magnetic resonance image (MRI) data has an important role in diagnosis, intervention planning, and monitoring the tumor’s evolution during and after therapy. Segmentation has serious anatomical obstacles like the great variety of the tumor’s location, size, shape, and appearance and the modified position of normal tissues. Other phenomena like intensity inhomogeneity and the lack of standard intensity scale in MRI data represent further difficulties. This paper proposes a fully automatic brain tumor segmentation procedure that attempts to handle all the above problems. Having its foundations on the MRI data provided by the MICCAI Brain Tumor Segmentation (BraTS) Challenges, the procedure consists of three main phases. The first pre-processing phase prepares the MRI data to be suitable for supervised classification, by attempting to fix missing data, suppressing the intensity inhomogeneity, normalizing the histogram of observed data channels, generating additional morphological, gradient-based, and Gabor-wavelet features, and optionally applying atlas-based data enhancement. The second phase accomplishes the main classification process using ensembles of binary decision trees and provides an initial, intermediary labeling for each pixel of test records. The last phase reevaluates these intermediary labels using a random forest classifier, then deploys a spatial region growing-based structural validation of suspected tumors, thus achieving a high-quality final segmentation result. The accuracy of the procedure is evaluated using the multi-spectral MRI records of the BraTS 2015 and BraTS 2019 training data sets. The procedure achieves high-quality segmentation results, characterized by average Dice similarity scores of up to 86%.
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15
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Schaeffer MJ, Chan L, Barber PA. The neuroimaging of neurodegenerative and vascular disease in the secondary prevention of cognitive decline. Neural Regen Res 2021; 16:1490-1499. [PMID: 33433462 PMCID: PMC8323688 DOI: 10.4103/1673-5374.303011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Structural brain changes indicative of dementia occur up to 20 years before the onset of clinical symptoms. Efforts to modify the disease process after the onset of cognitive symptoms have been unsuccessful in recent years. Thus, future trials must begin during the preclinical phases of the disease before symptom onset. Age related cognitive decline is often the result of two coexisting brain pathologies: Alzheimer’s disease (amyloid, tau, and neurodegeneration) and vascular disease. This review article highlights some of the common neuroimaging techniques used to visualize the accumulation of neurodegenerative and vascular pathologies during the preclinical stages of dementia such as structural magnetic resonance imaging, positron emission tomography, and white matter hyperintensities. We also describe some emerging neuroimaging techniques such as arterial spin labeling, diffusion tensor imaging, and quantitative susceptibility mapping. Recent literature suggests that structural imaging may be the most sensitive and cost-effective marker to detect cognitive decline, while molecular positron emission tomography is primarily useful for detecting disease specific pathology later in the disease process. Currently, the presence of vascular disease on magnetic resonance imaging provides a potential target for optimizing vascular risk reduction strategies, and the presence of vascular disease may be useful when combined with molecular and metabolic markers of neurodegeneration for identifying the risk of cognitive impairment.
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Affiliation(s)
- Morgan J Schaeffer
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Leona Chan
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Philip A Barber
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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16
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Maikusa N, Fukami T, Matsuda H. Longitudinal analysis of brain structure using existence probability. Brain Behav 2020; 10:e01869. [PMID: 33034427 PMCID: PMC7749599 DOI: 10.1002/brb3.1869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION We propose a method to evaluate quantitatively the longitudinal structural changes in brain atrophy to provide early detection of Alzheimer's disease (AD) and mild cognitive impairment (MCI). METHODS We used existence probabilities obtained by segmenting magnetic resonance (MR) images at two different time points into four regions: gray matter, white matter, cerebrospinal fluid, and background. This method was applied to T1-weighted MR images of 110 participants with normal cognition (NL), 165 with MCI, and 82 with AD, obtained from the Japanese Alzheimer's Disease Neuroimaging Initiative database. RESULTS We obtained the coefficients of probability change (CPC) for each dataset. We found high area under the receiver operating characteristic curve (ROC) values (up to 0.908 of the difference of ROCs) for some CPC regions that are considered indicators of atrophy. Additionally, we attempted to establish a machine-learning algorithm to classify participants as NL or AD. The maximum accuracy was 92.1% for NL-AD classification and 81.2% for NL-MCI classification using CPC values between images acquired at first and sixth months, respectively. CONCLUSION These results showed that the proposed method is effective for the early detection of AD and MCI.
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Affiliation(s)
- Norihide Maikusa
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tadanori Fukami
- Department of Informatics, Faculty of Engineering, Yamagata University, Yamagata, Japan
| | - Hiroshi Matsuda
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
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17
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Spinal cord atrophy in a primary progressive multiple sclerosis trial: Improved sample size using GBSI. NEUROIMAGE-CLINICAL 2020; 28:102418. [PMID: 32961403 PMCID: PMC7509079 DOI: 10.1016/j.nicl.2020.102418] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 08/29/2020] [Accepted: 09/03/2020] [Indexed: 01/18/2023]
Abstract
The GBSI provided clinically meaningful measurements of spinal cord atrophy, with low sample size. Deriving spinal cord atrophy from brain MRI using the GBSI is easier than spinal cord MRI. Spinal cord atrophy on GBSI could be used as a secondary outcome measure.
Background We aimed to evaluate the implications for clinical trial design of the generalised boundary-shift integral (GBSI) for spinal cord atrophy measurement. Methods We included 220 primary-progressive multiple sclerosis patients from a phase 2 clinical trial, with baseline and week-48 3DT1-weighted MRI of the brain and spinal cord (1 × 1 × 1 mm3), acquired separately. We obtained segmentation-based cross-sectional spinal cord area (CSA) at C1-2 (from both brain and spinal cord MRI) and C2-5 levels (from spinal cord MRI) using DeepSeg, and, then, we computed corresponding GBSI. Results Depending on the spinal cord segment, we included 67.4–98.1% patients for CSA measurements, and 66.9–84.2% for GBSI. Spinal cord atrophy measurements obtained with GBSI had lower measurement variability, than corresponding CSA. Looking at the image noise floor, the lowest median standard deviation of the MRI signal within the cerebrospinal fluid surrounding the spinal cord was found on brain MRI at the C1-2 level. Spinal cord atrophy derived from brain MRI was related to the corresponding measures from dedicated spinal cord MRI, more strongly for GBSI than CSA. Spinal cord atrophy measurements using GBSI, but not CSA, were associated with upper and lower limb motor progression. Discussion Notwithstanding the reduced measurement variability, the clinical correlates, and the possibility of using brain acquisitions, spinal cord atrophy using GBSI should remain a secondary outcome measure in MS studies, until further advancements increase the quality of acquisition and reliability of processing.
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Sunoqrot MRS, Nketiah GA, Selnæs KM, Bathen TF, Elschot M. Automated reference tissue normalization of T2-weighted MR images of the prostate using object recognition. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 34:309-321. [PMID: 32737628 PMCID: PMC8018925 DOI: 10.1007/s10334-020-00871-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/02/2020] [Accepted: 07/21/2020] [Indexed: 01/17/2023]
Abstract
Objectives To develop and evaluate an automated method for prostate T2-weighted (T2W) image normalization using dual-reference (fat and muscle) tissue. Materials and methods Transverse T2W images from the publicly available PROMISE12 (N = 80) and PROSTATEx (N = 202) challenge datasets, and an in-house collected dataset (N = 60) were used. Aggregate channel features object detectors were trained to detect reference fat and muscle tissue regions, which were processed and utilized to normalize the 3D images by linear scaling. Mean prostate pseudo T2 values after normalization were compared to literature values. Inter-patient histogram intersections of voxel intensities in the prostate were compared between our approach, the original images, and other commonly used normalization methods. Healthy vs. malignant tissue classification performance was compared before and after normalization. Results The prostate pseudo T2 values of the three tested datasets (mean ± standard deviation = 78.49 ± 9.42, 79.69 ± 6.34 and 79.29 ± 6.30 ms) corresponded well to T2 values from literature (80 ± 34 ms). Our normalization approach resulted in significantly higher (p < 0.001) inter-patient histogram intersections (median = 0.746) than the original images (median = 0.417) and most other normalization methods. Healthy vs. malignant classification also improved significantly (p < 0.001) in peripheral (AUC 0.826 vs. 0.769) and transition (AUC 0.743 vs. 0.678) zones. Conclusion An automated dual-reference tissue normalization of T2W images could help improve the quantitative assessment of prostate cancer. Electronic supplementary material The online version of this article (10.1007/s10334-020-00871-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammed R S Sunoqrot
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, 7030, Trondheim, Norway.
| | - Gabriel A Nketiah
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, 7030, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030, Trondheim, Norway
| | - Kirsten M Selnæs
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, 7030, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030, Trondheim, Norway
| | - Tone F Bathen
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, 7030, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030, Trondheim, Norway
| | - Mattijs Elschot
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, 7030, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030, Trondheim, Norway
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19
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Gates EDH, Lin JS, Weinberg JS, Hamilton J, Prabhu SS, Hazle JD, Fuller GN, Baladandayuthapani V, Fuentes D, Schellingerhout D. Guiding the first biopsy in glioma patients using estimated Ki-67 maps derived from MRI: conventional versus advanced imaging. Neuro Oncol 2020; 21:527-536. [PMID: 30657997 DOI: 10.1093/neuonc/noz004] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Undersampling of gliomas at first biopsy is a major clinical problem, as accurate grading determines all subsequent treatment. We submit a technological solution to reduce the problem of undersampling by estimating a marker of tumor proliferation (Ki-67) using MR imaging data as inputs, against a stereotactic histopathology gold standard. METHODS MR imaging was performed with anatomic, diffusion, permeability, and perfusion sequences, in untreated glioma patients in a prospective clinical trial. Stereotactic biopsies were harvested from each patient immediately prior to surgical resection. For each biopsy, an imaging description (23 parameters) was developed, and the Ki-67 index was recorded. Machine learning models were built to estimate Ki-67 from imaging inputs, and cross validation was undertaken to determine the error in estimates. The best model was used to generate graphical maps of Ki-67 estimates across the whole brain. RESULTS Fifty-two image-guided biopsies were collected from 23 evaluable patients. The random forest algorithm best modeled Ki-67 with 4 imaging inputs (T2-weighted, fractional anisotropy, cerebral blood flow, Ktrans). It predicted the Ki-67 expression levels with a root mean square (RMS) error of 3.5% (R2 = 0.75). A less accurate predictive result (RMS error 5.4%, R2 = 0.50) was found using conventional imaging only. CONCLUSION Ki-67 can be predicted to clinically useful accuracies using clinical imaging data. Advanced imaging (diffusion, perfusion, and permeability) improves predictive accuracy over conventional imaging alone. Ki-67 predictions, displayed as graphical maps, could be used to guide biopsy, resection, and/or radiation in the care of glioma patients.
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Affiliation(s)
- Evan D H Gates
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center (UT MDACC), Houston, Texas.,UT MDACC UTHealth Graduate School of Biomedical Sciences, Houston, Texas
| | - Jonathan S Lin
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center (UT MDACC), Houston, Texas.,Baylor College of Medicine, Houston, Texas.,Department of Bioengineering, Rice University, Houston, Texas
| | | | - Jackson Hamilton
- Department of Diagnostic Radiology, UT MDACC, Houston, Texas.,Radiology Partners, Houston, Texas
| | | | - John D Hazle
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center (UT MDACC), Houston, Texas
| | | | | | - David Fuentes
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center (UT MDACC), Houston, Texas
| | - Dawid Schellingerhout
- Department of Diagnostic Radiology, UT MDACC, Houston, Texas.,Department of Cancer Systems Imaging, UT MDACC, Houston, Texas
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20
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Gates EDH, Lin JS, Weinberg JS, Prabhu SS, Hamilton J, Hazle JD, Fuller GN, Baladandayuthapani V, Fuentes DT, Schellingerhout D. Imaging-Based Algorithm for the Local Grading of Glioma. AJNR Am J Neuroradiol 2020; 41:400-407. [PMID: 32029466 DOI: 10.3174/ajnr.a6405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Gliomas are highly heterogeneous tumors, and optimal treatment depends on identifying and locating the highest grade disease present. Imaging techniques for doing so are generally not validated against the histopathologic criterion standard. The purpose of this work was to estimate the local glioma grade using a machine learning model trained on preoperative image data and spatially specific tumor samples. The value of imaging in patients with brain tumor can be enhanced if pathologic data can be estimated from imaging input using predictive models. MATERIALS AND METHODS Patients with gliomas were enrolled in a prospective clinical imaging trial between 2013 and 2016. MR imaging was performed with anatomic, diffusion, permeability, and perfusion sequences, followed by image-guided stereotactic biopsy before resection. An imaging description was developed for each biopsy, and multiclass machine learning models were built to predict the World Health Organization grade. Models were assessed on classification accuracy, Cohen κ, precision, and recall. RESULTS Twenty-three patients (with 7/9/7 grade II/III/IV gliomas) had analyzable imaging-pathologic pairs, yielding 52 biopsy sites. The random forest method was the best algorithm tested. Tumor grade was predicted at 96% accuracy (κ = 0.93) using 4 inputs (T2, ADC, CBV, and transfer constant from dynamic contrast-enhanced imaging). By means of the conventional imaging only, the overall accuracy decreased (89% overall, κ = 0.79) and 43% of high-grade samples were misclassified as lower-grade disease. CONCLUSIONS We found that local pathologic grade can be predicted with a high accuracy using clinical imaging data. Advanced imaging data improved this accuracy, adding value to conventional imaging. Confirmatory imaging trials are justified.
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Affiliation(s)
- E D H Gates
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas.,University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences (E.D.H.G.), Houston, Texas
| | - J S Lin
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas.,Baylor College of Medicine (J.S.L.), Houston, Texas.,Department of Bioengineering (J.S.L.), Rice University, Houston, Texas
| | - J S Weinberg
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - S S Prabhu
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Hamilton
- Radiology Partners (J.H.), Houston, Texas
| | - J D Hazle
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G N Fuller
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - V Baladandayuthapani
- Department of Computational Medicine and Bioinformatics (V.B.), University of Michigan School of Public Health, Ann Arbor, Michigan
| | - D T Fuentes
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - D Schellingerhout
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
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21
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Generalised boundary shift integral for longitudinal assessment of spinal cord atrophy. Neuroimage 2019; 209:116489. [PMID: 31877375 DOI: 10.1016/j.neuroimage.2019.116489] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/18/2019] [Accepted: 12/21/2019] [Indexed: 12/18/2022] Open
Abstract
Spinal cord atrophy measurements obtained from structural magnetic resonance imaging (MRI) are associated with disability in many neurological diseases and serve as in vivo biomarkers of neurodegeneration. Longitudinal spinal cord atrophy rate is commonly determined from the numerical difference between two volumes (based on 3D surface fitting) or two cross-sectional areas (CSA, based on 2D edge detection) obtained at different time-points. Being an indirect measure, atrophy rates are susceptible to variable segmentation errors at the edge of the spinal cord. To overcome those limitations, we developed a new registration-based pipeline that measures atrophy rates directly. We based our approach on the generalised boundary shift integral (GBSI) method, which registers 2 scans and uses a probabilistic XOR mask over the edge of the spinal cord, thereby measuring atrophy more accurately than segmentation-based techniques. Using a large cohort of longitudinal spinal cord images (610 subjects with multiple sclerosis from a multi-centre trial and 52 healthy controls), we demonstrated that GBSI is a sensitive, quantitative and objective measure of longitudinal spinal cord volume change. The GBSI pipeline is repeatable, reproducible, and provides more precise measurements of longitudinal spinal cord atrophy than segmentation-based methods in longitudinal spinal cord atrophy studies.
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22
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Altmann A, Scelsi MA, Shoai M, de Silva E, Aksman LM, Cash DM, Hardy J, Schott JM. A comprehensive analysis of methods for assessing polygenic burden on Alzheimer's disease pathology and risk beyond APOE. Brain Commun 2019; 2:fcz047. [PMID: 32226939 PMCID: PMC7100005 DOI: 10.1093/braincomms/fcz047] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Genome-wide association studies have identified dozens of loci that alter the risk to develop Alzheimer's disease. However, with the exception of the APOE-ε4 allele, most variants bear only little individual effect and have, therefore, limited diagnostic and prognostic value. Polygenic risk scores aim to collate the disease risk distributed across the genome in a single score. Recent works have demonstrated that polygenic risk scores designed for Alzheimer's disease are predictive of clinical diagnosis, pathology confirmed diagnosis and changes in imaging biomarkers. Methodological innovations in polygenic risk modelling include the polygenic hazard score, which derives effect estimates for individual single nucleotide polymorphisms from survival analysis, and methods that account for linkage disequilibrium between genomic loci. In this work, using data from the Alzheimer's disease neuroimaging initiative, we compared different approaches to quantify polygenic disease burden for Alzheimer's disease and their association (beyond the APOE locus) with a broad range of Alzheimer's disease-related traits: cross-sectional CSF biomarker levels, cross-sectional cortical amyloid burden, clinical diagnosis, clinical progression, longitudinal loss of grey matter and longitudinal decline in cognitive function. We found that polygenic scores were associated beyond APOE with clinical diagnosis, CSF-tau levels and, to a minor degree, with progressive atrophy. However, for many other tested traits such as clinical disease progression, CSF amyloid, cognitive decline and cortical amyloid load, the additional effects of polygenic burden beyond APOE were of minor nature. Overall, polygenic risk scores and the polygenic hazard score performed equally and given the ease with which polygenic risk scores can be derived; they constitute the more practical choice in comparison with polygenic hazard scores. Furthermore, our results demonstrate that incomplete adjustment for the APOE locus, i.e. only adjusting for APOE-ε4 carrier status, can lead to overestimated effects of polygenic scores due to APOE-ε4 homozygous participants. Lastly, on many of the tested traits, the major driving factor remained the APOE locus, with the exception of quantitative CSF-tau and p-tau measures.
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Affiliation(s)
- Andre Altmann
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC), University College London (UCL), London WC1V 6LJ, UK
| | - Marzia A Scelsi
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC), University College London (UCL), London WC1V 6LJ, UK
| | - Maryam Shoai
- Reta Lilla Research Laboratories, Department of Neurodegeneration, Queen Square Institute of Neurology, University College London (UCL), London WC1V 6LJ, UK.,UK Dementia Research Institute, University College London (UCL), London WC1V 6LJ, UK
| | - Eric de Silva
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC), University College London (UCL), London WC1V 6LJ, UK.,Institute for Health Informatics, University College London (UCL), London WC1V 6LJ, UK
| | - Leon M Aksman
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC), University College London (UCL), London WC1V 6LJ, UK
| | - David M Cash
- UK Dementia Research Institute, University College London (UCL), London WC1V 6LJ, UK.,Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London WC1V 6LJ, UK
| | - John Hardy
- Reta Lilla Research Laboratories, Department of Neurodegeneration, Queen Square Institute of Neurology, University College London (UCL), London WC1V 6LJ, UK.,UK Dementia Research Institute, University College London (UCL), London WC1V 6LJ, UK
| | - Jonathan M Schott
- UK Dementia Research Institute, University College London (UCL), London WC1V 6LJ, UK.,Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London WC1V 6LJ, UK
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23
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Moccia M, Prados F, Filippi M, Rocca MA, Valsasina P, Brownlee WJ, Zecca C, Gallo A, Rovira A, Gass A, Palace J, Lukas C, Vrenken H, Ourselin S, Gandini Wheeler‐Kingshott CAM, Ciccarelli O, Barkhof F. Longitudinal spinal cord atrophy in multiple sclerosis using the generalized boundary shift integral. Ann Neurol 2019; 86:704-713. [DOI: 10.1002/ana.25571] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Marcello Moccia
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College London London United Kingdom
- Multiple Sclerosis Clinical Care and Research Center, Department of NeurosciencesFederico II University Naples Italy
| | - Ferran Prados
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College London London United Kingdom
- Centre for Medical Image Computing, Department of Medical Physics and BioengineeringUniversity College London London United Kingdom
- National Institute for Health ResearchUniversity College London Hospitals Biomedical Research Centre London United Kingdom
- Open University of Catalonia Barcelona Spain
| | - Massimo Filippi
- Division of Neuroscience, San Raffaele Scientific Institute, Vita‐Salute San Raffaele UniversityNeuroimaging Research Unit, Institute of Experimental Neurology Milan Italy
- Department of NeurologySan Raffaele Scientific Institute Milan Italy
| | - Maria A. Rocca
- Division of Neuroscience, San Raffaele Scientific Institute, Vita‐Salute San Raffaele UniversityNeuroimaging Research Unit, Institute of Experimental Neurology Milan Italy
- Department of NeurologySan Raffaele Scientific Institute Milan Italy
| | - Paola Valsasina
- Division of Neuroscience, San Raffaele Scientific Institute, Vita‐Salute San Raffaele UniversityNeuroimaging Research Unit, Institute of Experimental Neurology Milan Italy
| | - Wallace J. Brownlee
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College London London United Kingdom
| | - Chiara Zecca
- Neurocenter of Southern SwitzerlandLugano Regional Hospital Lugano Switzerland
| | - Antonio Gallo
- 3T‐MRI Research Center, Department of Advanced Medical and Surgical SciencesUniversity of Campania Luigi Vanvitelli Naples Italy
| | - Alex Rovira
- Section of Neuroradiology, Department of RadiologyVall d'Hebron University Hospital, Autonomous University of Barcelona Barcelona Spain
| | - Achim Gass
- Department of NeurologyUniversitätsmedizin Mannheim, University of Heidelberg Mannheim Germany
| | - Jacqueline Palace
- Nuffield Department of Clinical NeurosciencesJohn Radcliffe Hospital Oxford United Kingdom
| | | | - Hugo Vrenken
- Department of Radiology and Nuclear MedicineVU University Medical Center Amsterdam the Netherlands
| | - Sebastien Ourselin
- Department of Imaging and Biomedical EngineeringKing's College London London United Kingdom
| | - Claudia A. M. Gandini Wheeler‐Kingshott
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College London London United Kingdom
- Department of Brain and Behavioral SciencesUniversity of Pavia Pavia Italy
- Brain MRI 3T Research Center, Mondino FoundationScientific Institute for Research and Health Care Pavia Italy
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College London London United Kingdom
- National Institute for Health ResearchUniversity College London Hospitals Biomedical Research Centre London United Kingdom
| | - Frederik Barkhof
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College London London United Kingdom
- Centre for Medical Image Computing, Department of Medical Physics and BioengineeringUniversity College London London United Kingdom
- National Institute for Health ResearchUniversity College London Hospitals Biomedical Research Centre London United Kingdom
- Department of Radiology and Nuclear MedicineVU University Medical Center Amsterdam the Netherlands
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24
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Munir M, Ursenbach J, Reid M, Gupta Sah R, Wang M, Sitaram A, Aftab A, Tariq S, Zamboni G, Griffanti L, Smith EE, Frayne R, Sajobi TT, Coutts SB, d'Esterre CD, Barber PA. Longitudinal Brain Atrophy Rates in Transient Ischemic Attack and Minor Ischemic Stroke Patients and Cognitive Profiles. Front Neurol 2019; 10:18. [PMID: 30837927 PMCID: PMC6389669 DOI: 10.3389/fneur.2019.00018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/07/2019] [Indexed: 02/04/2023] Open
Abstract
Introduction: Patients with transient ischemic attack (TIA) and minor stroke demonstrate cognitive impairment, and a four-fold risk of late-life dementia. Aim: To study the extent to which the rates of brain volume loss in TIA patients differ from healthy controls and how they are correlated with cognitive impairment. Methods: TIA or minor stroke patients were tested with a neuropsychological battery and underwent T1 weighted volumetric magnetic resonance imaging scans at fixed intervals over a 3 years period. Linear mixed effects regression models were used to compare brain atrophy rates between groups, and to determine the relationship between atrophy rates and cognitive function in TIA and minor stroke patients. Results: Whole brain atrophy rates were calculated for the TIA and minor stroke patients; n = 38 between 24 h and 18 months, and n = 68 participants between 18 and 36 months, and were compared to healthy controls. TIA and minor stroke patients demonstrated a significantly higher whole brain atrophy rate than healthy controls over a 3 years interval (p = 0.043). Diabetes (p = 0.012) independently predicted higher atrophy rate across groups. There was a relationship between higher rates of brain atrophy and processing speed (composite P = 0.047 and digit symbol coding P = 0.02), but there was no relationship with brain atrophy rates and memory or executive composite scores or individual cognitive tests for language (Boston naming, memory recall, verbal fluency or Trails A or B score). Conclusion: TIA and minor stroke patients experience a significantly higher rate of whole brain atrophy. In this cohort of TIA and minor stroke patients changes in brain volume over time precede cognitive decline.
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Affiliation(s)
- Muhammad Munir
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
| | - Jake Ursenbach
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
| | - Meaghan Reid
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
| | - Rani Gupta Sah
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada.,Department of Radiology, Foothills Medical Centre, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Meng Wang
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Amith Sitaram
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Arooj Aftab
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
| | - Sana Tariq
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
| | - Giovanna Zamboni
- Nuffield Department of Clinical Neurosciences, FMRIB Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Ludovica Griffanti
- Nuffield Department of Clinical Neurosciences, FMRIB Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Eric E Smith
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Richard Frayne
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada.,Department of Radiology, Foothills Medical Centre, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Tolulope T Sajobi
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Shelagh B Coutts
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Christopher D d'Esterre
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
| | - Philip A Barber
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada.,Department of Radiology, Foothills Medical Centre, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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25
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Jacobsen N, Deistung A, Timmann D, Goericke SL, Reichenbach JR, Güllmar D. Analysis of intensity normalization for optimal segmentation performance of a fully convolutional neural network. Z Med Phys 2018; 29:128-138. [PMID: 30579766 DOI: 10.1016/j.zemedi.2018.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/24/2018] [Accepted: 11/12/2018] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Convolutional neural networks have begun to surpass classical statistical- and atlas based machine learning techniques in medical image segmentation in recent years, proving to be superior in performance and speed. However, a major challenge that the community faces are mismatch between variability within training and evaluation datasets and therefore a dependency on proper data pre-processing. Intensity normalization is a widely applied technique for reducing the variance of the data for which there are several methods available ranging from uniformity transformation to histogram equalization. The current study analyses the influence of intensity normalization on cerebellum segmentation performance of a convolutional neural network (CNN). METHOD The study included three population samples with a total number of 218 datasets, all including a T1w MRI data set acquired at 3T and a ground truth segmentation delineating the cerebellum. A 12 layer deep 3D fully convolutional neural network was trained using 150 datasets from one of the population samples. Four different intensity normalization methods were separately applied to pre-process the data, and the CNN was correspondingly trained four times with respect to the different normalization techniques. A quantitative analysis of the segmentation performance, assessed via the Sørensen-Dice similarity coefficient (DSC) of all four CNNs, was performed to investigate the intensity sensitivity of the CNNs. Additionally, the optimal network performance was determined by identifying the best parameter set for intensity normalization. RESULTS All four normalization methods led to excellent (mean DSC score=0.96) segmentation results when evaluated using known data; however, the segmentation performance differed depending on the applied intensity normalization method when testing with formerly unseen data, in which case the histogram equalization methods outperformed the unit distribution methods. A detailed, systematic analysis of intensity manipulations revealed, that the distribution of input intensities clearly affected the segmentation performance and that for each input dataset a linear intensity modification (shifting and scaling) existed leading to optimal segmentation results. This was further proven by an optimization analysis to find the optimal adjustment for an individual input evaluation sample within each normalization configuration. DISCUSSION The findings suggest that proper preparation of the evaluation data is more crucial than the exact choice of normalization method to prepare the training data. The histogram equalization methods tested in this study were found to perform this task best, although leaving room for further improvements, as shown by the optimization analysis.
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Affiliation(s)
- Nina Jacobsen
- Medical Physics Group, Institute for Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Andreas Deistung
- Medical Physics Group, Institute for Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany; Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Dagmar Timmann
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Sophia L Goericke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany
| | - Jürgen R Reichenbach
- Medical Physics Group, Institute for Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany; Michael Stifel Center for Data-Driven and Simulation Science, Friedrich Schiller University Jena, Jena, Germany
| | - Daniel Güllmar
- Medical Physics Group, Institute for Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany.
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van Opbroek A, Achterberg HC, Vernooij MW, Ikram MA, de Bruijne M. Transfer learning by feature-space transformation: A method for Hippocampus segmentation across scanners. NEUROIMAGE-CLINICAL 2018; 20:466-475. [PMID: 30128285 PMCID: PMC6098216 DOI: 10.1016/j.nicl.2018.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/26/2018] [Accepted: 08/05/2018] [Indexed: 11/09/2022]
Abstract
Many successful approaches in MR brain segmentation use supervised voxel classification, which requires manually labeled training images that are representative of the test images to segment. However, the performance of such methods often deteriorates if training and test images are acquired with different scanners or scanning parameters, since this leads to differences in feature representations between training and test data. In this paper we propose a feature-space transformation (FST) to overcome such differences in feature representations. The proposed FST is derived from unlabeled images of a subject that was scanned with both the source and the target scan protocol. After an affine registration, these images give a mapping between source and target voxels in the feature space. This mapping is then used to map all training samples to the feature representation of the test samples. We evaluated the benefit of the proposed FST on hippocampus segmentation. Experiments were performed on two datasets: one with relatively small differences between training and test images and one with large differences. In both cases, the FST significantly improved the performance compared to using only image normalization. Additionally, we showed that our FST can be used to improve the performance of a state-of-the-art patch-based-atlas-fusion technique in case of large differences between scanners. We present a feature-space transformation for image segmentation across scanners. This FST is trained on unlabeled images of subjects scanned with multiple scanners. These are used to transform training samples to values observed in target samples. The FST makes SVM hippocampus segmentation across scanners significantly better. Our FST can also increase performance of patch-based fusion methods.
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Affiliation(s)
- Annegreet van Opbroek
- Biomedical Imaging Group Rotterdam, Department of Medical Informatics and Radiology, Erasmus MC - University Medical Center Rotterdam, 3000, CA, Rotterdam, the Netherlands.
| | - Hakim C Achterberg
- Biomedical Imaging Group Rotterdam, Department of Medical Informatics and Radiology, Erasmus MC - University Medical Center Rotterdam, 3000, CA, Rotterdam, the Netherlands
| | - Meike W Vernooij
- Department of Radiology and Epidemiology, Erasmus MC - University Medical Center Rotterdam, Postbus 2040, 3000, CA, Rotterdam, the Netherlands
| | - M A Ikram
- Department of Radiology and Epidemiology, Erasmus MC - University Medical Center Rotterdam, Postbus 2040, 3000, CA, Rotterdam, the Netherlands
| | - Marleen de Bruijne
- Biomedical Imaging Group Rotterdam, Department of Medical Informatics and Radiology, Erasmus MC - University Medical Center Rotterdam, 3000, CA, Rotterdam, the Netherlands; Department of Computer Science, University of Copenhagen, DK-2100 Copenhagen, Denmark.
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Ledig C, Schuh A, Guerrero R, Heckemann RA, Rueckert D. Structural brain imaging in Alzheimer's disease and mild cognitive impairment: biomarker analysis and shared morphometry database. Sci Rep 2018; 8:11258. [PMID: 30050078 PMCID: PMC6062561 DOI: 10.1038/s41598-018-29295-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/06/2018] [Indexed: 12/22/2022] Open
Abstract
Magnetic resonance (MR) imaging is a powerful technique for non-invasive in-vivo imaging of the human brain. We employed a recently validated method for robust cross-sectional and longitudinal segmentation of MR brain images from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort. Specifically, we segmented 5074 MR brain images into 138 anatomical regions and extracted time-point specific structural volumes and volume change during follow-up intervals of 12 or 24 months. We assessed the extracted biomarkers by determining their power to predict diagnostic classification and by comparing atrophy rates to published meta-studies. The approach enables comprehensive analysis of structural changes within the whole brain. The discriminative power of individual biomarkers (volumes/atrophy rates) is on par with results published by other groups. We publish all quality-checked brain masks, structural segmentations, and extracted biomarkers along with this article. We further share the methodology for brain extraction (pincram) and segmentation (MALPEM, MALPEM4D) as open source projects with the community. The identified biomarkers hold great potential for deeper analysis, and the validated methodology can readily be applied to other imaging cohorts.
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Affiliation(s)
- Christian Ledig
- Imperial College London, Department of Computing, London, SW7 2AZ, UK.
| | - Andreas Schuh
- Imperial College London, Department of Computing, London, SW7 2AZ, UK
| | - Ricardo Guerrero
- Imperial College London, Department of Computing, London, SW7 2AZ, UK
| | - Rolf A Heckemann
- MedTech West, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.,Department of Radiation Therapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Division of Brain Sciences, Imperial College London, London, UK
| | - Daniel Rueckert
- Imperial College London, Department of Computing, London, SW7 2AZ, UK
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Fujishima M, Kawaguchi A, Maikusa N, Kuwano R, Iwatsubo T, Matsuda H. Sample Size Estimation for Alzheimer's Disease Trials from Japanese ADNI Serial Magnetic Resonance Imaging. J Alzheimers Dis 2018; 56:75-88. [PMID: 27911297 PMCID: PMC5240548 DOI: 10.3233/jad-160621] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Little is known about the sample sizes required for clinical trials of Alzheimer’s disease (AD)-modifying treatments using atrophy measures from serial brain magnetic resonance imaging (MRI) in the Japanese population. Objective: The primary objective of the present study was to estimate how large a sample size would be needed for future clinical trials for AD-modifying treatments in Japan using atrophy measures of the brain as a surrogate biomarker. Methods: Sample sizes were estimated from the rates of change of the whole brain and hippocampus by the k-means normalized boundary shift integral (KN-BSI) and cognitive measures using the data of 537 Japanese Alzheimer’s Neuroimaging Initiative (J-ADNI) participants with a linear mixed-effects model. We also examined the potential use of ApoE status as a trial enrichment strategy. Results: The hippocampal atrophy rate required smaller sample sizes than cognitive measures of AD and mild cognitive impairment (MCI). Inclusion of ApoE status reduced sample sizes for AD and MCI patients in the atrophy measures. Conclusion: These results show the potential use of longitudinal hippocampal atrophy measurement using automated image analysis as a progression biomarker and ApoE status as a trial enrichment strategy in a clinical trial of AD-modifying treatment in Japanese people.
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Affiliation(s)
- Motonobu Fujishima
- Integrative Brain Imaging Center (IBIC), National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.,Department of Diagnostic Radiology, Kojinkai Josai Clinic, Maebashi, Gunma, Japan
| | - Atsushi Kawaguchi
- Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Norihide Maikusa
- Integrative Brain Imaging Center (IBIC), National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Ryozo Kuwano
- Brain Research Institute, Niigata University, Niigata, Japan
| | - Takeshi Iwatsubo
- Department of Neuropathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center (IBIC), National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
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Amyloid and tau signatures of brain metabolic decline in preclinical Alzheimer's disease. Eur J Nucl Med Mol Imaging 2018; 45:1021-1030. [PMID: 29396637 PMCID: PMC5915512 DOI: 10.1007/s00259-018-3933-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/02/2018] [Indexed: 01/18/2023]
Abstract
Purpose We aimed to determine the amyloid (Aβ) and tau biomarker levels associated with imminent Alzheimer’s disease (AD) - related metabolic decline in cognitively normal individuals. Methods A threshold analysis was performed in 120 cognitively normal elderly individuals by modelling 2-year declines in brain glucose metabolism measured with [18F]fluorodeoxyglucose ([18F]FDG) as a function of [18F]florbetapir Aβ positron emission tomography (PET) and cerebrospinal fluid phosphorylated tau biomarker thresholds. Additionally, using a novel voxel-wise analytical framework, we determined the sample sizes needed to test an estimated 25% drugeffect with 80% of power on changes in FDG uptake over 2 years at every brain voxel. Results The combination of [18F]florbetapir standardized uptake value ratios and phosphorylated-tau levels more than one standard deviation higher than their respective thresholds for biomarker abnormality was the best predictor of metabolic decline in individuals with preclinical AD. We also found that a clinical trial using these thresholds would require as few as 100 individuals to test a 25% drug effect on AD-related metabolic decline over 2 years. Conclusions These results highlight the new concept that combined Aβ and tau thresholds can predict imminent neurodegeneration as an alternative framework with a high statistical power for testing the effect of disease-modifying therapies on [18F]FDG uptake decline over a typical 2-year clinical trial period in individuals with preclinical AD. Electronic supplementary material The online version of this article (10.1007/s00259-018-3933-3) contains supplementary material, which is available to authorized users.
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30
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Kinnunen KM, Cash DM, Poole T, Frost C, Benzinger TLS, Ahsan RL, Leung KK, Cardoso MJ, Modat M, Malone IB, Morris JC, Bateman RJ, Marcus DS, Goate A, Salloway SP, Correia S, Sperling RA, Chhatwal JP, Mayeux RP, Brickman AM, Martins RN, Farlow MR, Ghetti B, Saykin AJ, Jack CR, Schofield PR, McDade E, Weiner MW, Ringman JM, Thompson PM, Masters CL, Rowe CC, Rossor MN, Ourselin S, Fox NC. Presymptomatic atrophy in autosomal dominant Alzheimer's disease: A serial magnetic resonance imaging study. Alzheimers Dement 2018; 14:43-53. [PMID: 28738187 PMCID: PMC5751893 DOI: 10.1016/j.jalz.2017.06.2268] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/10/2017] [Accepted: 06/12/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Identifying at what point atrophy rates first change in Alzheimer's disease is important for informing design of presymptomatic trials. METHODS Serial T1-weighted magnetic resonance imaging scans of 94 participants (28 noncarriers, 66 carriers) from the Dominantly Inherited Alzheimer Network were used to measure brain, ventricular, and hippocampal atrophy rates. For each structure, nonlinear mixed-effects models estimated the change-points when atrophy rates deviate from normal and the rates of change before and after this point. RESULTS Atrophy increased after the change-point, which occurred 1-1.5 years (assuming a single step change in atrophy rate) or 3-8 years (assuming gradual acceleration of atrophy) before expected symptom onset. At expected symptom onset, estimated atrophy rates were at least 3.6 times than those before the change-point. DISCUSSION Atrophy rates are pathologically increased up to seven years before "expected onset". During this period, atrophy rates may be useful for inclusion and tracking of disease progression.
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Affiliation(s)
- Kirsi M. Kinnunen
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - David M. Cash
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK,Department of Medical Physics and Bioengineering, Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK,Corresponding author. Tel.: +44 203 448 3054; Fax: +44 (0)20 3448 3104.,
| | - Teresa Poole
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK,Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Frost
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK,Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | | | - R. Laila Ahsan
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Kelvin K. Leung
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - M. Jorge Cardoso
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK,Department of Medical Physics and Bioengineering, Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Marc Modat
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK,Department of Medical Physics and Bioengineering, Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Ian B. Malone
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - John C. Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Randall J. Bateman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel S. Marcus
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Alison Goate
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephen P. Salloway
- Department of Neurology, Butler Hospital, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Stephen Correia
- Department of Neurology, Butler Hospital, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Reisa A. Sperling
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jasmeer P. Chhatwal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard P. Mayeux
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Adam M. Brickman
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Ralph N. Martins
- Centre of Excellence for Alzheimer’s Disease Research and Care, School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Martin R. Farlow
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bernardino Ghetti
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andrew J. Saykin
- Department of Radiology and Imaging Sciences, Centre for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Peter R. Schofield
- Neuroscience Research Australia, Randwick, NSW, Australia,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Eric McDade
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael W. Weiner
- Department of Radiology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - John M. Ringman
- Department of Neurology, Keck USC School of Medicine, Los Angeles, CA, USA
| | - Paul M. Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Colin L. Masters
- The Florey Institute, University of Melbourne, Parkville, VIC, Australia
| | - Christopher C. Rowe
- Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, VIC, Australia,Department of Medicine, University of Melbourne, Austin Health, Heidelberg, VIC, Australia
| | - Martin N. Rossor
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Sebastien Ourselin
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK,Department of Medical Physics and Bioengineering, Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Nick C. Fox
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
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Kehoe PG, Blair PS, Howden B, Thomas DL, Malone IB, Horwood J, Clement C, Selman LE, Baber H, Lane A, Coulthard E, Passmore AP, Fox NC, Wilkinson IB, Ben-Shlomo Y. The Rationale and Design of the Reducing Pathology in Alzheimer's Disease through Angiotensin TaRgeting (RADAR) Trial. J Alzheimers Dis 2018; 61:803-814. [PMID: 29226862 DOI: 10.3233/jad-170101] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Anti-hypertensives that modify the renin angiotensin system may reduce Alzheimer's disease (AD) pathology and reduce the rate of disease progression. OBJECTIVE To conduct a phase II, two arm, double-blind, placebo-controlled, randomized trial of losartan to test the efficacy of Reducing pathology in Alzheimer's Disease through Angiotensin TaRgeting (RADAR). METHODS Men and women aged at least 55 years with mild-to-moderate AD will be randomly allocated 100 mg encapsulated generic losartan or placebo once daily for 12 months after successful completion of a 2-week open-label phase and 2-week placebo washout to establish drug tolerability. 228 participants will provide at least 182 subjects with final assessments to provide 84% power to detect a 25% difference in atrophy rate (therapeutic benefit) change over 12 months at an alpha level of 0.05. We will use intention-to-treat analysis, estimating between-group differences in outcomes derived from appropriate (linear or logistic) multivariable regression models adjusting for minimization variables. RESULTS The primary outcome will be rate of whole brain atrophy as a surrogate measure of disease progression. Secondary outcomes will include changes to 1) white matter hyperintensity volume and cerebral blood flow; 2) performance on a standard series of assessments of memory, cognitive function, activities of daily living, and quality of life. Major assessments (for all outcomes) and relevant safety monitoring of blood pressure and bloods will be at baseline and 12 months. Additional cognitive assessment will also be conducted at 6 months along with safety blood pressure and blood monitoring. Monitoring of blood pressure, bloods, and self-reported side effects will occur during the open-label phase and during the majority of the post-randomization dispensing visits. CONCLUSION This study will identify whether losartan is efficacious in the treatment of AD and whether definitive Phase III trials are warranted.
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Affiliation(s)
- Patrick G Kehoe
- Dementia Research Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Faculty of Health Sciences, Level 1 Learning and Research>, Southmead Hospital, Bristol, UK
| | - Peter S Blair
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Beth Howden
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David L Thomas
- Leonard Wolfson Experimental Neurology Centre, UCL Institute of Neurology, Queen Square, London, UK
- Dementia Research Centre (DRC), Institute of Neurology, University College London, Queen Square, London, UK
| | - Ian B Malone
- Dementia Research Centre (DRC), Institute of Neurology, University College London, Queen Square, London, UK
| | - Jeremy Horwood
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Clare Clement
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lucy E Selman
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hannah Baber
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Athene Lane
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Elizabeth Coulthard
- ReMemBr Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Faculty of Health Sciences, Brain Centre, Southmead Hospital, Bristol, UK
| | - Anthony Peter Passmore
- Institute of Clinical Sciences, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Nick C Fox
- Dementia Research Centre (DRC), Institute of Neurology, University College London, Queen Square, London, UK
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, School of Clinical Medicine, University of Cambridge, and Clinical Trials Unit, Addenbrookes Hospital, Cambridge, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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A phase III randomized trial of gantenerumab in prodromal Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2017; 9:95. [PMID: 29221491 PMCID: PMC5723032 DOI: 10.1186/s13195-017-0318-y] [Citation(s) in RCA: 329] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/30/2017] [Indexed: 12/22/2022]
Abstract
Background Gantenerumab is a fully human monoclonal antibody that binds aggregated amyloid-β (Aβ) and removes Aβ plaques by Fc receptor-mediated phagocytosis. In the SCarlet RoAD trial, we assessed the efficacy and safety of gantenerumab in prodromal Alzheimer’s disease (AD). Methods In this randomized, double-blind, placebo-controlled phase III study, we investigated gantenerumab over 2 years. Patients were randomized to gantenerumab 105 mg or 225 mg or placebo every 4 weeks by subcutaneous injection. The primary endpoint was the change from baseline to week 104 in Clinical Dementia Rating Sum of Boxes (CDR-SB) score. We evaluated treatment effects on cerebrospinal fluid biomarkers (all patients) and amyloid positron emission tomography (substudy). A futility analysis was performed once 50% of patients completed 2 years of treatment. Safety was assessed in patients who received at least one dose. Results Of the 3089 patients screened, 797 were randomized. The study was halted early for futility; dosing was discontinued; and the study was unblinded. No differences between groups in the primary (least squares mean [95% CI] CDR-SB change from baseline 1.60 [1.28, 1.91], 1.69 [1.37, 2.01], and 1.73 [1.42, 2.04] for placebo, gantenerumab 105 mg, and gantenerumab 225 mg, respectively) or secondary clinical endpoints were observed. The incidence of generally asymptomatic amyloid-related imaging abnormalities increased in a dose- and APOE ε4 genotype-dependent manner. Exploratory analyses suggested a dose-dependent drug effect on clinical and biomarker endpoints. Conclusions The study was stopped early for futility, but dose-dependent effects observed in exploratory analyses on select clinical and biomarker endpoints suggest that higher dosing with gantenerumab may be necessary to achieve clinical efficacy. Trial registration ClinicalTrials.gov, NCT01224106. Registered on October 14, 2010. Electronic supplementary material The online version of this article (doi:10.1186/s13195-017-0318-y) contains supplementary material, which is available to authorized users.
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Bertens D, Tijms BM, Vermunt L, Prins ND, Scheltens P, Visser PJ. The effect of diagnostic criteria on outcome measures in preclinical and prodromal Alzheimer's disease: Implications for trial design. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2017; 3:513-523. [PMID: 29124109 PMCID: PMC5671625 DOI: 10.1016/j.trci.2017.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction We investigated the influence of different inclusion criteria for preclinical and prodromal Alzheimer's disease (AD) on changes in biomarkers and cognitive markers and on trial sample size estimates. Methods We selected 522 cognitively normal subjects and 872 subjects with mild cognitive impairment from the Alzheimer's Disease Neuroimaging Initiative study. Compared inclusion criteria were (1) preclinical or prodromal AD (amyloid marker abnormal); (2) preclinical or prodromal AD stage-1 (amyloid marker abnormal, injury marker normal); and (3) preclinical or prodromal AD stage-2 (amyloid and injury markers abnormal). Outcome measures were amyloid, neuronal injury, and cognitive markers. Results In both subjects with preclinical and prodromal AD stage-2, inclusion criteria resulted in the largest observed decline in brain volumetric measures on magnetic resonance imaging and cognitive markers. Discussion Inclusion criteria influence the observed rate of worsening in outcome measures. This has implications for trial design.
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Affiliation(s)
- Daniela Bertens
- Alzheimer Centre, Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Betty M Tijms
- Alzheimer Centre, Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Lisa Vermunt
- Alzheimer Centre, Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Niels D Prins
- Alzheimer Centre, Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands.,Alzheimer Research Center, Amsterdam The Netherlands
| | - Philip Scheltens
- Alzheimer Centre, Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Pieter Jelle Visser
- Alzheimer Centre, Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands.,Alzheimer Centre, School for Mental Health and Neuroscience (MHeNS), University Medical Centre, Maastricht, The Netherlands
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Tariq S, Barber PA. Dementia risk and prevention by targeting modifiable vascular risk factors. J Neurochem 2017; 144:565-581. [PMID: 28734089 DOI: 10.1111/jnc.14132] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/23/2017] [Accepted: 07/15/2017] [Indexed: 01/04/2023]
Abstract
The incidence of dementia is expected to double in the next 20 years and will contribute to heavy social and economic burden. Dementia is caused by neuronal loss that leads to brain atrophy years before symptoms manifest. Currently, no cure exists and extensive efforts are being made to mitigate cognitive impairment in late life in order to reduce the burden on patients, caregivers, and society. The most common type of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) often co-exists in the brain and shares common, modifiable risk factors, which are targeted in numerous secondary prevention trials. There is a growing need for non-pharmacological interventions and infrastructural support from governments to encourage psychosocial and behavioral interventions. Secondary prevention trials need to be redesigned based on the risk profile of individual subjects, which require the use of validated and standardized clinical, biological, and neuroimaging biomarkers. Multi-domain approaches have been proposed in high-risk populations that target optimal treatment; clinical trials need to recruit individuals at the highest risk of dementia before symptoms develop, thereby identifying an enriched disease group to test preventative and disease modifying strategies. The underlying aim should be to reduce microscopic brain tissue loss by modifying vascular and lifestyle risk factors over a relatively short period of time, thus optimizing the opportunity for preventing dementia in the future. Collaboration between international research groups is of key importance to the optimal use and allocation of existing resources, and the development of new techniques in preventing dementia. This article is part of the Special Issue "Vascular Dementia".
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Affiliation(s)
- Sana Tariq
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada.,Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada
| | - Philip A Barber
- Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada.,Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
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Webster L, Groskreutz D, Grinbergs-Saull A, Howard R, O'Brien JT, Mountain G, Banerjee S, Woods B, Perneczky R, Lafortune L, Roberts C, McCleery J, Pickett J, Bunn F, Challis D, Charlesworth G, Featherstone K, Fox C, Goodman C, Jones R, Lamb S, Moniz-Cook E, Schneider J, Shepperd S, Surr C, Thompson-Coon J, Ballard C, Brayne C, Burke O, Burns A, Clare L, Garrard P, Kehoe P, Passmore P, Holmes C, Maidment I, Murtagh F, Robinson L, Livingston G. Development of a core outcome set for disease modification trials in mild to moderate dementia: a systematic review, patient and public consultation and consensus recommendations. Health Technol Assess 2017; 21:1-192. [PMID: 28625273 PMCID: PMC5494514 DOI: 10.3310/hta21260] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is currently no disease-modifying treatment available to halt or delay the progression of the disease pathology in dementia. An agreed core set of the best-available and most appropriate outcomes for disease modification would facilitate the design of trials and ensure consistency across disease modification trials, as well as making results comparable and meta-analysable in future trials. OBJECTIVES To agree a set of core outcomes for disease modification trials for mild to moderate dementia with the UK dementia research community and patient and public involvement (PPI). DATA SOURCES We included disease modification trials with quantitative outcomes of efficacy from (1) references from related systematic reviews in workstream 1; (2) searches of the Cochrane Dementia and Cognitive Improvement Group study register, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Latin American and Caribbean Health Sciences Literature and PsycINFO on 11 December 2015, and clinical trial registries [International Standard Randomised Controlled Trial Number (ISRCTN) and clinicaltrials.gov] on 22 and 29 January 2016; and (3) hand-searches of reference lists of relevant systematic reviews from database searches. REVIEW METHODS The project consisted of four workstreams. (1) We obtained related core outcome sets and work from co-applicants. (2) We systematically reviewed published and ongoing disease modification trials to identify the outcomes used in different domains. We extracted outcomes used in each trial, recording how many used each outcome and with how many participants. We divided outcomes into the domains measured and searched for validation data. (3) We consulted with PPI participants about recommended outcomes. (4) We presented all the synthesised information at a conference attended by the wider body of National Institute for Health Research (NIHR) dementia researchers to reach consensus on a core set of outcomes. RESULTS We included 149 papers from the 22,918 papers screened, referring to 125 individual trials. Eighty-one outcomes were used across trials, including 72 scales [31 cognitive, 12 activities of daily living (ADLs), 10 global, 16 neuropsychiatric and three quality of life] and nine biological techniques. We consulted with 18 people for PPI. The conference decided that only cognition and biological markers are core measures of disease modification. Cognition should be measured by the Mini Mental State Examination (MMSE) or the Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog), and brain changes through structural magnetic resonance imaging (MRI) in a subset of participants. All other domains are important but not core. We recommend using the Neuropsychiatric Inventory for neuropsychiatric symptoms: the Disability Assessment for Dementia for ADLs, the Dementia Quality of Life Measure for quality of life and the Clinical Dementia Rating scale to measure dementia globally. LIMITATIONS Most of the trials included participants with Alzheimer's disease, so recommendations may not apply to other types of dementia. We did not conduct economic analyses. The PPI consultation was limited to members of the Alzheimer's Society Research Network. CONCLUSIONS Cognitive outcomes and biological markers form the core outcome set for future disease modification trials, measured by the MMSE or ADAS-Cog, and structural MRI in a subset of participants. FUTURE WORK We envisage that the core set may be superseded in the future, particularly for other types of dementia. There is a need to develop an algorithm to compare scores on the MMSE and ADAS-Cog. STUDY REGISTRATION The project was registered with Core Outcome Measures in Effectiveness Trials [ www.comet-initiative.org/studies/details/819?result=true (accessed 7 April 2016)]. The systematic review protocol is registered as PROSPERO CRD42015027346. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Lucy Webster
- Division of Psychiatry, University College London, London, UK
| | - Derek Groskreutz
- Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Rob Howard
- Division of Psychiatry, University College London, London, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Gail Mountain
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sube Banerjee
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, UK
| | - Robert Perneczky
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Louise Lafortune
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Charlotte Roberts
- International Consortium for Health Outcomes Measurement, London, UK
| | | | | | - Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - David Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | | | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Roy Jones
- Research Institute for the Care of Older People, University of Bath, Bath, UK
| | - Sallie Lamb
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Esme Moniz-Cook
- Faculty of Health and Social Care, University of Hull, Hull, UK
| | - Justine Schneider
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Surr
- School of Health & Community Studies, Leeds Beckett University, Leeds, UK
| | - Jo Thompson-Coon
- Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter, Exeter, UK
| | - Clive Ballard
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Orlaith Burke
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alistair Burns
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Linda Clare
- Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter, Exeter, UK
- School of Psychology, University of Exeter, Exeter, UK
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Peter Garrard
- Neuroscience Research Centre, St George's, University of London, UK
| | - Patrick Kehoe
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Clive Holmes
- School of Medicine, University of Southampton, Southampton, UK
| | - Ian Maidment
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, UK
| | - Fliss Murtagh
- Cicely Saunders Institute, King's College London, London, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
- North Thames Collaboration for Leadership in Applied Health Research and Care, London, UK
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Lane CA, Parker TD, Cash DM, Macpherson K, Donnachie E, Murray-Smith H, Barnes A, Barker S, Beasley DG, Bras J, Brown D, Burgos N, Byford M, Jorge Cardoso M, Carvalho A, Collins J, De Vita E, Dickson JC, Epie N, Espak M, Henley SMD, Hoskote C, Hutel M, Klimova J, Malone IB, Markiewicz P, Melbourne A, Modat M, Schrag A, Shah S, Sharma N, Sudre CH, Thomas DL, Wong A, Zhang H, Hardy J, Zetterberg H, Ourselin S, Crutch SJ, Kuh D, Richards M, Fox NC, Schott JM. Study protocol: Insight 46 - a neuroscience sub-study of the MRC National Survey of Health and Development. BMC Neurol 2017; 17:75. [PMID: 28420323 PMCID: PMC5395844 DOI: 10.1186/s12883-017-0846-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/21/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Increasing age is the biggest risk factor for dementia, of which Alzheimer's disease is the commonest cause. The pathological changes underpinning Alzheimer's disease are thought to develop at least a decade prior to the onset of symptoms. Molecular positron emission tomography and multi-modal magnetic resonance imaging allow key pathological processes underpinning cognitive impairment - including β-amyloid depostion, vascular disease, network breakdown and atrophy - to be assessed repeatedly and non-invasively. This enables potential determinants of dementia to be delineated earlier, and therefore opens a pre-symptomatic window where intervention may prevent the onset of cognitive symptoms. METHODS/DESIGN This paper outlines the clinical, cognitive and imaging protocol of "Insight 46", a neuroscience sub-study of the MRC National Survey of Health and Development. This is one of the oldest British birth cohort studies and has followed 5362 individuals since their birth in England, Scotland and Wales during one week in March 1946. These individuals have been tracked in 24 waves of data collection incorporating a wide range of health and functional measures, including repeat measures of cognitive function. Now aged 71 years, a small fraction have overt dementia, but estimates suggest that ~1/3 of individuals in this age group may be in the preclinical stages of Alzheimer's disease. Insight 46 is recruiting 500 study members selected at random from those who attended a clinical visit at 60-64 years and on whom relevant lifecourse data are available. We describe the sub-study design and protocol which involves a prospective two time-point (0, 24 month) data collection covering clinical, neuropsychological, β-amyloid positron emission tomography and magnetic resonance imaging, biomarker and genetic information. Data collection started in 2015 (age 69) and aims to be completed in 2019 (age 73). DISCUSSION Through the integration of data on the socioeconomic environment and on physical, psychological and cognitive function from 0 to 69 years, coupled with genetics, structural and molecular imaging, and intensive cognitive and neurological phenotyping, Insight 46 aims to identify lifetime factors which influence brain health and cognitive ageing, with particular focus on Alzheimer's disease and cerebrovascular disease. This will provide an evidence base for the rational design of disease-modifying trials.
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Affiliation(s)
- Christopher A. Lane
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Thomas D. Parker
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Dave M. Cash
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Kirsty Macpherson
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Elizabeth Donnachie
- Leonard Wolfson Experimental Neurology Centre, Institute of Neurology, University College London, London, UK
| | - Heidi Murray-Smith
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Anna Barnes
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Suzie Barker
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Daniel G. Beasley
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Jose Bras
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
- Department of Medical Sciences and Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
| | - David Brown
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Ninon Burgos
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | | | - M. Jorge Cardoso
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Ana Carvalho
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Jessica Collins
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Enrico De Vita
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | - John C. Dickson
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Norah Epie
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Miklos Espak
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Susie M. D. Henley
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Chandrashekar Hoskote
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Michael Hutel
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Jana Klimova
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Ian B. Malone
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Pawel Markiewicz
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Andrew Melbourne
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Marc Modat
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Anette Schrag
- Department of Clinical Neuroscience, Institute of Neurology, University College London, London, UK
| | - Sachit Shah
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | - Nikhil Sharma
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Carole H. Sudre
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - David L. Thomas
- Leonard Wolfson Experimental Neurology Centre, Institute of Neurology, University College London, London, UK
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Hui Zhang
- Department of Computer Science and Centre for Medical Image Computing, University College London, London, UK
| | - John Hardy
- Reta Lila Weston Research Laboratories, Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Henrik Zetterberg
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Sebastian J. Crutch
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | | | - Nick C. Fox
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Jonathan M. Schott
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
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Manning EN, Leung KK, Nicholas JM, Malone IB, Cardoso MJ, Schott JM, Fox NC, Barnes J. A Comparison of Accelerated and Non-accelerated MRI Scans for Brain Volume and Boundary Shift Integral Measures of Volume Change: Evidence from the ADNI Dataset. Neuroinformatics 2017; 15:215-226. [PMID: 28316055 PMCID: PMC5443885 DOI: 10.1007/s12021-017-9326-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The aim of this study was to assess whether the use of accelerated MRI scans in place of non-accelerated scans influenced brain volume and atrophy rate measures in controls and subjects with mild cognitive impairment and Alzheimer's disease. We used data from 861 subjects at baseline, 573 subjects at 6 months and 384 subjects at 12 months from the Alzheimer's Disease Neuroimaging Initiative (ADNI). We calculated whole-brain, ventricular and hippocampal atrophy rates using the k-means boundary shift integral (BSI). Scan quality was visually assessed and the proportion of good quality accelerated and non-accelerated scans compared. We also compared MMSE scores, vascular burden and age between subjects with poor quality scans with those with good quality scans. Finally, we estimated sample size requirements for a hypothetical clinical trial when using atrophy rates from accelerated scans and non-accelerated scans. No significant differences in whole-brain, ventricular and hippocampal volumes and atrophy rates were found between accelerated and non-accelerated scans. Twice as many non-accelerated scan pairs suffered from at least some motion artefacts compared with accelerated scan pairs (p ≤ 0.001), which may influence the BSI. Subjects whose accelerated scans had significant motion had a higher mean vascular burden and age (p ≤ 0.05) whilst subjects whose non-accelerated scans had significant motion had poorer MMSE scores (p ≤ 0.05). No difference in estimated sample size requirements was found when using accelerated vs. non-accelerated scans. Accelerated scans reduce scan time and are better tolerated. Therefore it may be advantageous to use accelerated over non-accelerated scans in clinical trials that use ADNI-type protocols, especially in more cognitively impaired subjects.
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Affiliation(s)
- Emily N Manning
- Dementia Research Centre, Institute of Neurology, University College London, London, UK.
| | - Kelvin K Leung
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Jennifer M Nicholas
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Ian B Malone
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - M Jorge Cardoso
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Jonathan M Schott
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Nick C Fox
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Josephine Barnes
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
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Weiner MW, Veitch DP, Aisen PS, Beckett LA, Cairns NJ, Green RC, Harvey D, Jack CR, Jagust W, Morris JC, Petersen RC, Saykin AJ, Shaw LM, Toga AW, Trojanowski JQ. Recent publications from the Alzheimer's Disease Neuroimaging Initiative: Reviewing progress toward improved AD clinical trials. Alzheimers Dement 2017; 13:e1-e85. [PMID: 28342697 DOI: 10.1016/j.jalz.2016.11.007] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/21/2016] [Accepted: 11/28/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The Alzheimer's Disease Neuroimaging Initiative (ADNI) has continued development and standardization of methodologies for biomarkers and has provided an increased depth and breadth of data available to qualified researchers. This review summarizes the over 400 publications using ADNI data during 2014 and 2015. METHODS We used standard searches to find publications using ADNI data. RESULTS (1) Structural and functional changes, including subtle changes to hippocampal shape and texture, atrophy in areas outside of hippocampus, and disruption to functional networks, are detectable in presymptomatic subjects before hippocampal atrophy; (2) In subjects with abnormal β-amyloid deposition (Aβ+), biomarkers become abnormal in the order predicted by the amyloid cascade hypothesis; (3) Cognitive decline is more closely linked to tau than Aβ deposition; (4) Cerebrovascular risk factors may interact with Aβ to increase white-matter (WM) abnormalities which may accelerate Alzheimer's disease (AD) progression in conjunction with tau abnormalities; (5) Different patterns of atrophy are associated with impairment of memory and executive function and may underlie psychiatric symptoms; (6) Structural, functional, and metabolic network connectivities are disrupted as AD progresses. Models of prion-like spreading of Aβ pathology along WM tracts predict known patterns of cortical Aβ deposition and declines in glucose metabolism; (7) New AD risk and protective gene loci have been identified using biologically informed approaches; (8) Cognitively normal and mild cognitive impairment (MCI) subjects are heterogeneous and include groups typified not only by "classic" AD pathology but also by normal biomarkers, accelerated decline, and suspected non-Alzheimer's pathology; (9) Selection of subjects at risk of imminent decline on the basis of one or more pathologies improves the power of clinical trials; (10) Sensitivity of cognitive outcome measures to early changes in cognition has been improved and surrogate outcome measures using longitudinal structural magnetic resonance imaging may further reduce clinical trial cost and duration; (11) Advances in machine learning techniques such as neural networks have improved diagnostic and prognostic accuracy especially in challenges involving MCI subjects; and (12) Network connectivity measures and genetic variants show promise in multimodal classification and some classifiers using single modalities are rivaling multimodal classifiers. DISCUSSION Taken together, these studies fundamentally deepen our understanding of AD progression and its underlying genetic basis, which in turn informs and improves clinical trial design.
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Affiliation(s)
- Michael W Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, CA, USA.
| | - Dallas P Veitch
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Paul S Aisen
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | - Laurel A Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Nigel J Cairns
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA; Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | | | - William Jagust
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - John C Morris
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | | | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging, Institute of Neuroimaging and Informatics, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Alzheimer's Disease Core Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Udall Parkinson's Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Schindler S, Schreiber J, Bazin PL, Trampel R, Anwander A, Geyer S, Schönknecht P. Intensity standardisation of 7T MR images for intensity-based segmentation of the human hypothalamus. PLoS One 2017; 12:e0173344. [PMID: 28253330 PMCID: PMC5333904 DOI: 10.1371/journal.pone.0173344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 02/20/2017] [Indexed: 11/25/2022] Open
Abstract
The high spatial resolution of 7T MRI enables us to identify subtle volume changes in brain structures, providing potential biomarkers of mental disorders. Most volumetric approaches require that similar intensity values represent similar tissue types across different persons. By applying colour-coding to T1-weighted MP2RAGE images, we found that the high measurement accuracy achieved by high-resolution imaging may be compromised by inter-individual variations in the image intensity. To address this issue, we analysed the performance of five intensity standardisation techniques in high-resolution T1-weighted MP2RAGE images. Twenty images with extreme intensities in the GM and WM were standardised to a representative reference image. We performed a multi-level evaluation with a focus on the hypothalamic region—analysing the intensity histograms as well as the actual MR images, and requiring that the correlation between the whole-brain tissue volumes and subject age be preserved during standardisation. The results were compared with T1 maps. Linear standardisation using subcortical ROIs of GM and WM provided good results for all evaluation criteria: it improved the histogram alignment within the ROIs and the average image intensity within the ROIs and the whole-brain GM and WM areas. This method reduced the inter-individual intensity variation of the hypothalamic boundary by more than half, outperforming all other methods, and kept the original correlation between the GM volume and subject age intact. Mixed results were obtained for the other four methods, which sometimes came at the expense of unwarranted changes in the age-related pattern of the GM volume. The mapping of the T1 relaxation time with the MP2RAGE sequence is advertised as being especially robust to bias field inhomogeneity. We found little evidence that substantiated the T1 map’s theoretical superiority over the T1-weighted images regarding the inter-individual image intensity homogeneity.
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Affiliation(s)
- Stephanie Schindler
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- * E-mail:
| | - Jan Schreiber
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Pierre-Louis Bazin
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Robert Trampel
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Alfred Anwander
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Stefan Geyer
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Peter Schönknecht
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
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De Nunzio G, Cataldo R, Carlà A. Robust Intensity Standardization in Brain Magnetic Resonance Images. J Digit Imaging 2016; 28:727-37. [PMID: 25708893 DOI: 10.1007/s10278-015-9782-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The paper is focused on a tiSsue-Based Standardization Technique (SBST) of magnetic resonance (MR) brain images. Magnetic Resonance Imaging intensities have no fixed tissue-specific numeric meaning, even within the same MRI protocol, for the same body region, or even for images of the same patient obtained on the same scanner in different moments. This affects postprocessing tasks such as automatic segmentation or unsupervised/supervised classification methods, which strictly depend on the observed image intensities, compromising the accuracy and efficiency of many image analyses algorithms. A large number of MR images from public databases, belonging to healthy people and to patients with different degrees of neurodegenerative pathology, were employed together with synthetic MRIs. Combining both histogram and tissue-specific intensity information, a correspondence is obtained for each tissue across images. The novelty consists of computing three standardizing transformations for the three main brain tissues, for each tissue class separately. In order to create a continuous intensity mapping, spline smoothing of the overall slightly discontinuous piecewise-linear intensity transformation is performed. The robustness of the technique is assessed in a post hoc manner, by verifying that automatic segmentation of images before and after standardization gives a high overlapping (Dice index >0.9) for each tissue class, even across images coming from different sources. Furthermore, SBST efficacy is tested by evaluating if and how much it increases intertissue discrimination and by assessing gaussianity of tissue gray-level distributions before and after standardization. Some quantitative comparisons to already existing different approaches available in the literature are performed.
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Affiliation(s)
- Giorgio De Nunzio
- Dipartimento di Matematica e Fisica "Ennio De Giorgi", Università del Salento, Ecotekne, via per Monteroni, Corpo M, 73100, Lecce, Italy. .,Istituto Nazionale di Fisica Nucleare, sez di Lecce, Lecce, Italy.
| | - Rosella Cataldo
- Dipartimento di Matematica e Fisica "Ennio De Giorgi", Università del Salento, Ecotekne, via per Monteroni, Corpo M, 73100, Lecce, Italy.,Istituto Nazionale di Fisica Nucleare, sez di Lecce, Lecce, Italy
| | - Alessandra Carlà
- Dipartimento di Matematica e Fisica "Ennio De Giorgi", Università del Salento, Ecotekne, via per Monteroni, Corpo M, 73100, Lecce, Italy.,Istituto Nazionale di Fisica Nucleare, sez di Lecce, Lecce, Italy
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Multimodality Imaging of Neurodegenerative Processes: Part 1, The Basics and Common Dementias. AJR Am J Roentgenol 2016; 207:871-882. [PMID: 27505704 DOI: 10.2214/ajr.14.12842] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Multimodality imaging plays an important role in the structural and functional characterization of neurodegenerative conditions. This article illustrates the basic concepts of anatomic, metabolic, and amyloid imaging and describes the application of a multimodality approach in the evaluation of patients with the more common neurodegenerative dementia processes. Proper utilization of clinically available imaging techniques allows greater insight into these common disease processes. CONCLUSION Recognizing the strength of combined anatomic, metabolic, and amyloid imaging can allow a more complete and confident assessment of patients with common degenerative dementias. This added knowledge can improve clinical care, allow initiation of appropriate therapies and counseling, and improve prognostication.
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Fortin JP, Sweeney EM, Muschelli J, Crainiceanu CM, Shinohara RT. Removing inter-subject technical variability in magnetic resonance imaging studies. Neuroimage 2016; 132:198-212. [PMID: 26923370 PMCID: PMC5540379 DOI: 10.1016/j.neuroimage.2016.02.036] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/30/2016] [Accepted: 02/12/2016] [Indexed: 11/30/2022] Open
Abstract
Magnetic resonance imaging (MRI) intensities are acquired in arbitrary units, making scans non-comparable across sites and between subjects. Intensity normalization is a first step for the improvement of comparability of the images across subjects. However, we show that unwanted inter-scan variability associated with imaging site, scanner effect, and other technical artifacts is still present after standard intensity normalization in large multi-site neuroimaging studies. We propose RAVEL (Removal of Artificial Voxel Effect by Linear regression), a tool to remove residual technical variability after intensity normalization. As proposed by SVA and RUV [Leek and Storey, 2007, 2008, Gagnon-Bartsch and Speed, 2012], two batch effect correction tools largely used in genomics, we decompose the voxel intensities of images registered to a template into a biological component and an unwanted variation component. The unwanted variation component is estimated from a control region obtained from the cerebrospinal fluid (CSF), where intensities are known to be unassociated with disease status and other clinical covariates. We perform a singular value decomposition (SVD) of the control voxels to estimate factors of unwanted variation. We then estimate the unwanted factors using linear regression for every voxel of the brain and take the residuals as the RAVEL-corrected intensities. We assess the performance of RAVEL using T1-weighted (T1-w) images from more than 900 subjects with Alzheimer's disease (AD) and mild cognitive impairment (MCI), as well as healthy controls from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. We compare RAVEL to two intensity-normalization-only methods: histogram matching and White Stripe. We show that RAVEL performs best at improving the replicability of the brain regions that are empirically found to be most associated with AD, and that these regions are significantly more present in structures impacted by AD (hippocampus, amygdala, parahippocampal gyrus, enthorinal area, and fornix stria terminals). In addition, we show that the RAVEL-corrected intensities have the best performance in distinguishing between MCI subjects and healthy subjects using the mean hippocampal intensity (AUC=67%), a marked improvement compared to results from intensity normalization alone (AUC=63% and 59% for histogram matching and White Stripe, respectively). RAVEL is promising for many other imaging modalities.
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Affiliation(s)
- Jean-Philippe Fortin
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth M Sweeney
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Muschelli
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ciprian M Crainiceanu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Russell T Shinohara
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Jack CR, Barnes J, Bernstein MA, Borowski BJ, Brewer J, Clegg S, Dale AM, Carmichael O, Ching C, DeCarli C, Desikan RS, Fennema-Notestine C, Fjell AM, Fletcher E, Fox NC, Gunter J, Gutman BA, Holland D, Hua X, Insel P, Kantarci K, Killiany RJ, Krueger G, Leung KK, Mackin S, Maillard P, Malone IB, Mattsson N, McEvoy L, Modat M, Mueller S, Nosheny R, Ourselin S, Schuff N, Senjem ML, Simonson A, Thompson PM, Rettmann D, Vemuri P, Walhovd K, Zhao Y, Zuk S, Weiner M. Magnetic resonance imaging in Alzheimer's Disease Neuroimaging Initiative 2. Alzheimers Dement 2016; 11:740-56. [PMID: 26194310 DOI: 10.1016/j.jalz.2015.05.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/28/2015] [Accepted: 05/05/2015] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Alzheimer's Disease Neuroimaging Initiative (ADNI) is now in its 10th year. The primary objective of the magnetic resonance imaging (MRI) core of ADNI has been to improve methods for clinical trials in Alzheimer's disease (AD) and related disorders. METHODS We review the contributions of the MRI core from present and past cycles of ADNI (ADNI-1, -Grand Opportunity and -2). We also review plans for the future-ADNI-3. RESULTS Contributions of the MRI core include creating standardized acquisition protocols and quality control methods; examining the effect of technical features of image acquisition and analysis on outcome metrics; deriving sample size estimates for future trials based on those outcomes; and piloting the potential utility of MR perfusion, diffusion, and functional connectivity measures in multicenter clinical trials. DISCUSSION Over the past decade the MRI core of ADNI has fulfilled its mandate of improving methods for clinical trials in AD and will continue to do so in the future.
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Affiliation(s)
| | - Josephine Barnes
- Department of Neurodegenerative Disease, Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | | | | | - James Brewer
- Department of Neuroscience, University of California at San Diego, La Jolla, CA, USA
| | - Shona Clegg
- Department of Neurodegenerative Disease, Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Anders M Dale
- Department of Neuroscience, University of California at San Diego, La Jolla, CA, USA
| | - Owen Carmichael
- Department of Neurology, University of California at Davis, Davis, CA, USA
| | - Christopher Ching
- Department of Neurology, Imaging Genetics Center, Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA
| | - Charles DeCarli
- Department of Neurology, University of California at Davis, Davis, CA, USA; Center for Neuroscience, University of California at Davis, Davis, CA, USA
| | - Rahul S Desikan
- Department of Radiology, University of California at San Diego, La Jolla, CA, USA
| | - Christine Fennema-Notestine
- Department of Radiology, University of California at San Diego, La Jolla, CA, USA; Department of Psychiatry, University of California at San Diego, La Jolla, CA, USA
| | - Anders M Fjell
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Evan Fletcher
- Department of Neurology, University of California at Davis, Davis, CA, USA; Center for Neuroscience, University of California at Davis, Davis, CA, USA
| | - Nick C Fox
- Department of Neurodegenerative Disease, Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Jeff Gunter
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Boris A Gutman
- Department of Neurology, Imaging Genetics Center, Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA
| | - Dominic Holland
- Department of Neuroscience, University of California at San Diego, La Jolla, CA, USA
| | - Xue Hua
- Department of Neurology, Imaging Genetics Center, Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA
| | - Philip Insel
- Department of Radiology and Biomedical Imaging, Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ron J Killiany
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | | | - Kelvin K Leung
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Scott Mackin
- Department of Radiology and Biomedical Imaging, Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
| | - Pauline Maillard
- Department of Neurology, University of California at Davis, Davis, CA, USA; Center for Neuroscience, University of California at Davis, Davis, CA, USA
| | - Ian B Malone
- Department of Neurodegenerative Disease, Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Niklas Mattsson
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
| | - Linda McEvoy
- Department of Radiology, University of California at San Diego, La Jolla, CA, USA
| | - Marc Modat
- Department of Neurodegenerative Disease, Dementia Research Centre, Institute of Neurology, University College London, London, UK; Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Susanne Mueller
- Department of Radiology and Biomedical Imaging, Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Radiology, University of California at San Francisco, San Francisco, CA, USA
| | - Rachel Nosheny
- Department of Radiology and Biomedical Imaging, Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Radiology, University of California at San Francisco, San Francisco, CA, USA
| | - Sebastien Ourselin
- Department of Neurodegenerative Disease, Dementia Research Centre, Institute of Neurology, University College London, London, UK; Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Norbert Schuff
- Department of Radiology and Biomedical Imaging, Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Radiology, University of California at San Francisco, San Francisco, CA, USA
| | | | - Alix Simonson
- Department of Radiology and Biomedical Imaging, Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Paul M Thompson
- Department of Neurology, Imaging Genetics Center, Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA
| | - Dan Rettmann
- MR Applications and Workflow, GE Healthcare, Rochester, MN, USA
| | | | | | | | - Samantha Zuk
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Michael Weiner
- Department of Radiology and Biomedical Imaging, Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA; Department of Radiology, University of California at San Francisco, San Francisco, CA, USA; Department of Medicine, University of California at San Francisco, San Francisco, CA, USA; Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
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Andrews KA, Frost C, Modat M, Cardoso MJ, Rowe CC, Villemagne V, Fox NC, Ourselin S, Schott JM, Rowe CC, Villemagne V, Fox NC, Ourselin S, Schott JM. Acceleration of hippocampal atrophy rates in asymptomatic amyloidosis. Neurobiol Aging 2016; 39:99-107. [PMID: 26923406 DOI: 10.1016/j.neurobiolaging.2015.10.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 09/09/2015] [Accepted: 10/14/2015] [Indexed: 11/24/2022]
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Abstract
BACKGROUND The aim of this study was to compare the performance and power of the best-established diagnostic biological markers as outcome measures for clinical trials in patients with mild cognitive impairment (MCI). METHODS Magnetic resonance imaging, F-18 fluorodeoxyglucose positron emission tomography markers, and Alzheimer's Disease Assessment Scale-cognitive subscale were compared in terms of effect size and statistical power over different follow-up periods in 2 MCI groups, selected from Alzheimer's Disease Neuroimaging Initiative data set based on cerebrospinal fluid (abnormal cerebrospinal fluid Aβ1-42 concentration-ABETA+) or magnetic resonance imaging evidence of Alzheimer disease (positivity to hippocampal atrophy-HIPPO+). Biomarkers progression was modeled through mixed effect models. Scaled slope was chosen as measure of effect size. Biomarkers power was estimated using simulation algorithms. RESULTS Seventy-four ABETA+ and 51 HIPPO+ MCI patients were included in the study. Imaging biomarkers of neurodegeneration, especially MR measurements, showed highest performance. For all biomarkers and both MCI groups, power increased with increasing follow-up time, irrespective of biomarker assessment frequency. CONCLUSION These findings provide information about biomarker enrichment and outcome measurements that could be employed to reduce MCI patient samples and treatment duration in future clinical trials.
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STEAM — Statistical Template Estimation for Abnormality Mapping: A personalized DTI analysis technique with applications to the screening of preterm infants. Neuroimage 2016; 125:705-723. [DOI: 10.1016/j.neuroimage.2015.08.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/14/2015] [Accepted: 08/19/2015] [Indexed: 01/15/2023] Open
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Spatio-Temporal Regularization for Longitudinal Registration to Subject-Specific 3d Template. PLoS One 2015; 10:e0133352. [PMID: 26301716 PMCID: PMC4547713 DOI: 10.1371/journal.pone.0133352] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 06/25/2015] [Indexed: 01/18/2023] Open
Abstract
Neurodegenerative diseases such as Alzheimer's disease present subtle anatomical brain changes before the appearance of clinical symptoms. Manual structure segmentation is long and tedious and although automatic methods exist, they are often performed in a cross-sectional manner where each time-point is analyzed independently. With such analysis methods, bias, error and longitudinal noise may be introduced. Noise due to MR scanners and other physiological effects may also introduce variability in the measurement. We propose to use 4D non-linear registration with spatio-temporal regularization to correct for potential longitudinal inconsistencies in the context of structure segmentation. The major contribution of this article is the use of individual template creation with spatio-temporal regularization of the deformation fields for each subject. We validate our method with different sets of real MRI data, compare it to available longitudinal methods such as FreeSurfer, SPM12, QUARC, TBM, and KNBSI, and demonstrate that spatially local temporal regularization yields more consistent rates of change of global structures resulting in better statistical power to detect significant changes over time and between populations.
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Assessing atrophy measurement techniques in dementia: Results from the MIRIAD atrophy challenge. Neuroimage 2015; 123:149-64. [PMID: 26275383 PMCID: PMC4634338 DOI: 10.1016/j.neuroimage.2015.07.087] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/30/2015] [Accepted: 07/01/2015] [Indexed: 01/18/2023] Open
Abstract
Structural MRI is widely used for investigating brain atrophy in many neurodegenerative disorders, with several research groups developing and publishing techniques to provide quantitative assessments of this longitudinal change. Often techniques are compared through computation of required sample size estimates for future clinical trials. However interpretation of such comparisons is rendered complex because, despite using the same publicly available cohorts, the various techniques have been assessed with different data exclusions and different statistical analysis models. We created the MIRIAD atrophy challenge in order to test various capabilities of atrophy measurement techniques. The data consisted of 69 subjects (46 Alzheimer's disease, 23 control) who were scanned multiple (up to twelve) times at nine visits over a follow-up period of one to two years, resulting in 708 total image sets. Nine participating groups from 6 countries completed the challenge by providing volumetric measurements of key structures (whole brain, lateral ventricle, left and right hippocampi) for each dataset and atrophy measurements of these structures for each time point pair (both forward and backward) of a given subject. From these results, we formally compared techniques using exactly the same dataset. First, we assessed the repeatability of each technique using rates obtained from short intervals where no measurable atrophy is expected. For those measures that provided direct measures of atrophy between pairs of images, we also assessed symmetry and transitivity. Then, we performed a statistical analysis in a consistent manner using linear mixed effect models. The models, one for repeated measures of volume made at multiple time-points and a second for repeated “direct” measures of change in brain volume, appropriately allowed for the correlation between measures made on the same subject and were shown to fit the data well. From these models, we obtained estimates of the distribution of atrophy rates in the Alzheimer's disease (AD) and control groups and of required sample sizes to detect a 25% treatment effect, in relation to healthy ageing, with 95% significance and 80% power over follow-up periods of 6, 12, and 24 months. Uncertainty in these estimates, and head-to-head comparisons between techniques, were carried out using the bootstrap. The lateral ventricles provided the most stable measurements, followed by the brain. The hippocampi had much more variability across participants, likely because of differences in segmentation protocol and less distinct boundaries. Most methods showed no indication of bias based on the short-term interval results, and direct measures provided good consistency in terms of symmetry and transitivity. The resulting annualized rates of change derived from the model ranged from, for whole brain: − 1.4% to − 2.2% (AD) and − 0.35% to − 0.67% (control), for ventricles: 4.6% to 10.2% (AD) and 1.2% to 3.4% (control), and for hippocampi: − 1.5% to − 7.0% (AD) and − 0.4% to − 1.4% (control). There were large and statistically significant differences in the sample size requirements between many of the techniques. The lowest sample sizes for each of these structures, for a trial with a 12 month follow-up period, were 242 (95% CI: 154 to 422) for whole brain, 168 (95% CI: 112 to 282) for ventricles, 190 (95% CI: 146 to 268) for left hippocampi, and 158 (95% CI: 116 to 228) for right hippocampi. This analysis represents one of the most extensive statistical comparisons of a large number of different atrophy measurement techniques from around the globe. The challenge data will remain online and publicly available so that other groups can assess their methods. We compared numerous brain atrophy measurement techniques using multiple metrics. Each participant produced measures on the exact same dataset, blinded to disease. A central statistical analysis using linear mixed effect models was performed. Head to head comparisons for each region were performed using sample size estimates. Brain and ventricle measures were more consistent across groups than for hippocampi.
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Weiner MW, Veitch DP, Aisen PS, Beckett LA, Cairns NJ, Cedarbaum J, Green RC, Harvey D, Jack CR, Jagust W, Luthman J, Morris JC, Petersen RC, Saykin AJ, Shaw L, Shen L, Schwarz A, Toga AW, Trojanowski JQ. 2014 Update of the Alzheimer's Disease Neuroimaging Initiative: A review of papers published since its inception. Alzheimers Dement 2015; 11:e1-120. [PMID: 26073027 PMCID: PMC5469297 DOI: 10.1016/j.jalz.2014.11.001] [Citation(s) in RCA: 203] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/18/2013] [Indexed: 01/18/2023]
Abstract
The Alzheimer's Disease Neuroimaging Initiative (ADNI) is an ongoing, longitudinal, multicenter study designed to develop clinical, imaging, genetic, and biochemical biomarkers for the early detection and tracking of Alzheimer's disease (AD). The initial study, ADNI-1, enrolled 400 subjects with early mild cognitive impairment (MCI), 200 with early AD, and 200 cognitively normal elderly controls. ADNI-1 was extended by a 2-year Grand Opportunities grant in 2009 and by a competitive renewal, ADNI-2, which enrolled an additional 550 participants and will run until 2015. This article reviews all papers published since the inception of the initiative and summarizes the results to the end of 2013. The major accomplishments of ADNI have been as follows: (1) the development of standardized methods for clinical tests, magnetic resonance imaging (MRI), positron emission tomography (PET), and cerebrospinal fluid (CSF) biomarkers in a multicenter setting; (2) elucidation of the patterns and rates of change of imaging and CSF biomarker measurements in control subjects, MCI patients, and AD patients. CSF biomarkers are largely consistent with disease trajectories predicted by β-amyloid cascade (Hardy, J Alzheimer's Dis 2006;9(Suppl 3):151-3) and tau-mediated neurodegeneration hypotheses for AD, whereas brain atrophy and hypometabolism levels show predicted patterns but exhibit differing rates of change depending on region and disease severity; (3) the assessment of alternative methods of diagnostic categorization. Currently, the best classifiers select and combine optimum features from multiple modalities, including MRI, [(18)F]-fluorodeoxyglucose-PET, amyloid PET, CSF biomarkers, and clinical tests; (4) the development of blood biomarkers for AD as potentially noninvasive and low-cost alternatives to CSF biomarkers for AD diagnosis and the assessment of α-syn as an additional biomarker; (5) the development of methods for the early detection of AD. CSF biomarkers, β-amyloid 42 and tau, as well as amyloid PET may reflect the earliest steps in AD pathology in mildly symptomatic or even nonsymptomatic subjects and are leading candidates for the detection of AD in its preclinical stages; (6) the improvement of clinical trial efficiency through the identification of subjects most likely to undergo imminent future clinical decline and the use of more sensitive outcome measures to reduce sample sizes. Multimodal methods incorporating APOE status and longitudinal MRI proved most highly predictive of future decline. Refinements of clinical tests used as outcome measures such as clinical dementia rating-sum of boxes further reduced sample sizes; (7) the pioneering of genome-wide association studies that leverage quantitative imaging and biomarker phenotypes, including longitudinal data, to confirm recently identified loci, CR1, CLU, and PICALM and to identify novel AD risk loci; (8) worldwide impact through the establishment of ADNI-like programs in Japan, Australia, Argentina, Taiwan, China, Korea, Europe, and Italy; (9) understanding the biology and pathobiology of normal aging, MCI, and AD through integration of ADNI biomarker and clinical data to stimulate research that will resolve controversies about competing hypotheses on the etiopathogenesis of AD, thereby advancing efforts to find disease-modifying drugs for AD; and (10) the establishment of infrastructure to allow sharing of all raw and processed data without embargo to interested scientific investigators throughout the world.
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Affiliation(s)
- Michael W Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, CA, USA.
| | - Dallas P Veitch
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Paul S Aisen
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Laurel A Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Nigel J Cairns
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA; Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jesse Cedarbaum
- Neurology Early Clinical Development, Biogen Idec, Cambridge, MA, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | | | - William Jagust
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - Johan Luthman
- Neuroscience Clinical Development, Neuroscience & General Medicine Product Creation Unit, Eisai Inc., Philadelphia, PA, USA
| | - John C Morris
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | | | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Li Shen
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Adam Schwarz
- Tailored Therapeutics, Eli Lilly and Company, Indianapolis, IN, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging, Institute of Neuroimaging and Informatics, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - John Q Trojanowski
- Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Alzheimer's Disease Core Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Udall Parkinson's Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Vemuri P, Senjem ML, Gunter JL, Lundt ES, Tosakulwong N, Weigand SD, Borowski BJ, Bernstein MA, Zuk SM, Lowe VJ, Knopman DS, Petersen RC, Fox NC, Thompson PM, Weiner MW, Jack CR. Accelerated vs. unaccelerated serial MRI based TBM-SyN measurements for clinical trials in Alzheimer's disease. Neuroimage 2015; 113:61-9. [PMID: 25797830 DOI: 10.1016/j.neuroimage.2015.03.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 03/06/2015] [Accepted: 03/12/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Our primary objective was to compare the performance of unaccelerated vs. accelerated structural MRI for measuring disease progression using serial scans in Alzheimer's disease (AD). METHODS We identified cognitively normal (CN), early mild cognitive impairment (EMCI), late mild cognitive impairment (LMCI) and AD subjects from all available Alzheimer's Disease Neuroimaging Initiative (ADNI) subjects with usable pairs of accelerated and unaccelerated scans. There were a total of 696 subjects with baseline and 3 month scans, 628 subjects with baseline and 6 month scans and 464 subjects with baseline and 12 month scans available. We employed the Symmetric Diffeomorphic Image Normalization method (SyN) for normalization of the serial scans to obtain tensor based morphometry (TBM) maps which indicate the structural changes between pairs of scans. We computed a TBM-SyN summary score of annualized structural changes over 31 regions of interest (ROIs) that are characteristically affected in AD. TBM-SyN scores were computed using accelerated and unaccelerated scan pairs and compared in terms of agreement, group-wise discrimination, and sample size estimates for a hypothetical therapeutic trial. RESULTS We observed a number of systematic differences between TBM-SyN scores computed from accelerated and unaccelerated pairs of scans. TBM-SyN scores computed from accelerated scans tended to have overall higher estimated values than those from unaccelerated scans. However, the performance of accelerated scans was comparable to unaccelerated scans in terms of discrimination between clinical groups and sample sizes required in each clinical group for a therapeutic trial. We also found that the quality of both accelerated vs. unaccelerated scans were similar. CONCLUSIONS Accelerated scanning protocols reduce scan time considerably. Their group-wise discrimination and sample size estimates were comparable to those obtained with unaccelerated scans. The two protocols did not produce interchangeable TBM-SyN estimates, so it is arguably important to use either accelerated pairs of scans or unaccelerated pairs of scans throughout the study duration.
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Affiliation(s)
| | - Matthew L Senjem
- Departments of Radiology, MN, USA; Information Technology, MN, USA
| | - Jeffrey L Gunter
- Departments of Radiology, MN, USA; Information Technology, MN, USA
| | | | | | | | | | | | | | | | | | | | - Nick C Fox
- Dementia Research Center, UCL Institute of Neurology, London, UK
| | - Paul M Thompson
- Imaging genetics Center, Institute for Neuroimaging and Informatics, Department of Neurology, University of Southern California, Los Angeles, CA, USA; Department of Psychiatry, University of Southern California, Los Angeles, CA, USA; Department of Radiology, University of Southern California, Los Angeles, CA, USA; Department of Pediatrics, University of Southern California, Los Angeles, CA, USA; Department of Engineering, University of Southern California, Los Angeles, CA, USA; Department of Opthalmology , University of Southern California, Los Angeles, CA, USA
| | - Michael W Weiner
- University of California at San Francisco, Department of Veterans Affairs Medical Center, San Francisco, CA, USA; Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, San Francisco, CA, USA
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