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Lopez SM, Aksman LM, Oxtoby NP, Vos SB, Rao J, Kaestner E, Alhusaini S, Alvim M, Bender B, Bernasconi A, Bernasconi N, Bernhardt B, Bonilha L, Caciagli L, Caldairou B, Caligiuri ME, Calvet A, Cendes F, Concha L, Conde‐Blanco E, Davoodi‐Bojd E, de Bézenac C, Delanty N, Desmond PM, Devinsky O, Domin M, Duncan JS, Focke NK, Foley S, Fortunato F, Galovic M, Gambardella A, Gleichgerrcht E, Guerrini R, Hamandi K, Ives‐Deliperi V, Jackson GD, Jahanshad N, Keller SS, Kochunov P, Kotikalapudi R, Kreilkamp BAK, Labate A, Larivière S, Lenge M, Lui E, Malpas C, Martin P, Mascalchi M, Medland SE, Meletti S, Morita‐Sherman ME, Owen TW, Richardson M, Riva A, Rüber T, Sinclair B, Soltanian‐Zadeh H, Stein DJ, Striano P, Taylor P, Thomopoulos SI, Thompson PM, Tondelli M, Vaudano AE, Vivash L, Wang Y, Weber B, Whelan CD, Wiest R, Winston GP, Yasuda CL, McDonald CR, Alexander D, Sisodiya SM, Altmann A. Event-based modeling in temporal lobe epilepsy demonstrates progressive atrophy from cross-sectional data. Epilepsia 2022; 63:2081-2095. [PMID: 35656586 PMCID: PMC9540015 DOI: 10.1111/epi.17316] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Recent work has shown that people with common epilepsies have characteristic patterns of cortical thinning, and that these changes may be progressive over time. Leveraging a large multicenter cross-sectional cohort, we investigated whether regional morphometric changes occur in a sequential manner, and whether these changes in people with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS) correlate with clinical features. METHODS We extracted regional measures of cortical thickness, surface area, and subcortical brain volumes from T1-weighted (T1W) magnetic resonance imaging (MRI) scans collected by the ENIGMA-Epilepsy consortium, comprising 804 people with MTLE-HS and 1625 healthy controls from 25 centers. Features with a moderate case-control effect size (Cohen d ≥ .5) were used to train an event-based model (EBM), which estimates a sequence of disease-specific biomarker changes from cross-sectional data and assigns a biomarker-based fine-grained disease stage to individual patients. We tested for associations between EBM disease stage and duration of epilepsy, age at onset, and antiseizure medicine (ASM) resistance. RESULTS In MTLE-HS, decrease in ipsilateral hippocampal volume along with increased asymmetry in hippocampal volume was followed by reduced thickness in neocortical regions, reduction in ipsilateral thalamus volume, and finally, increase in ipsilateral lateral ventricle volume. EBM stage was correlated with duration of illness (Spearman ρ = .293, p = 7.03 × 10-16 ), age at onset (ρ = -.18, p = 9.82 × 10-7 ), and ASM resistance (area under the curve = .59, p = .043, Mann-Whitney U test). However, associations were driven by cases assigned to EBM Stage 0, which represents MTLE-HS with mild or nondetectable abnormality on T1W MRI. SIGNIFICANCE From cross-sectional MRI, we reconstructed a disease progression model that highlights a sequence of MRI changes that aligns with previous longitudinal studies. This model could be used to stage MTLE-HS subjects in other cohorts and help establish connections between imaging-based progression staging and clinical features.
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Affiliation(s)
- Seymour M. Lopez
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Leon M. Aksman
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
- Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Neil P. Oxtoby
- Centre for Medical Image Computing, Department of Computer ScienceUniversity College LondonLondonUK
| | - Sjoerd B. Vos
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
- Neuroradiological Academic Unit, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Jun Rao
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Erik Kaestner
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Saud Alhusaini
- Department of NeurologyAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
- Department of Molecular and Cellular TherapeuticsRoyal College of Surgeons in IrelandDublinIreland
| | - Marina Alvim
- Department of Neurology and Neuroimaging LaboratoryUniversity of CampinasCampinasBrazil
| | - Benjamin Bender
- Department of Radiology, Diagnostic and Interventional NeuroradiologyUniversity Hospital TübingenTübingenGermany
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy LaboratoryMontreal Neurological Institute, McGill UniversityMontrealQuebecCanada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy LaboratoryMontreal Neurological Institute, McGill UniversityMontrealQuebecCanada
| | - Boris Bernhardt
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and HospitalMcGill UniversityMontrealQuebecCanada
| | | | - Lorenzo Caciagli
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and HospitalMcGill UniversityMontrealQuebecCanada
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of Neurology, University College LondonLondonUK
| | - Benoit Caldairou
- Neuroimaging of Epilepsy LaboratoryMontreal Neurological Institute, McGill UniversityMontrealQuebecCanada
| | - Maria Eugenia Caligiuri
- Neuroscience Research Center, Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
| | - Angels Calvet
- Magnetic Resonance Image Core FacilityAugust Pi i Sunyer Biomedical Research Institute, University of BarcelonaBarcelonaSpain
| | - Fernando Cendes
- Department of Neurology and Neuroimaging LaboratoryUniversity of CampinasCampinasBrazil
| | - Luis Concha
- Institute of NeurobiologyNational Autonomous University of MexicoQuerétaroMexico
| | - Estefania Conde‐Blanco
- Epilepsy Program, Neurology DepartmentHospital Clinic of BarcelonaBarcelonaSpain
- August Pi i Sunyer Biomedical Research InstituteBarcelonaSpain
| | | | - Christophe de Bézenac
- Department of Pharmacology and TherapeuticsInstitute of Systems, Molecular and Integrative Biology, University of LiverpoolLiverpoolUK
| | - Norman Delanty
- Department of Molecular and Cellular TherapeuticsRoyal College of Surgeons in IrelandDublinIreland
- FutureNeuro SFI Research Centre for Rare and Chronic Neurological DiseasesDublinIreland
| | - Patricia M. Desmond
- Department of Radiology, Royal Melbourne HospitalUniversity of MelbourneMelbourneVictoriaAustralia
| | - Orrin Devinsky
- New York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Martin Domin
- Functional Imaging Unit, Department of Diagnostic Radiology and NeuroradiologyGreifswald University MedicineGreifswaldGermany
| | - John S. Duncan
- Department of NeurologyEmory UniversityAtlantaUSA
- Chalfont Centre for EpilepsyChalfont St PeterUK
| | - Niels K. Focke
- Department of NeurologyUniversity Medical CenterGöttingenGermany
| | - Sonya Foley
- Cardiff University Brain Research Imaging Centre, School of PsychologyCardiff UniversityCardiffUK
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
| | - Marian Galovic
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of Neurology, University College LondonLondonUK
- Department of NeurologyUniversity Hospital ZurichZurichSwitzerland
| | - Antonio Gambardella
- Neuroscience Research Center, Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
- Institute of Neurology, Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
| | | | - Renzo Guerrini
- Neuroscience DepartmentUniversity of FlorenceFlorenceItaly
| | - Khalid Hamandi
- Cardiff University Brain Research Imaging Centre, School of PsychologyCardiff UniversityCardiffUK
- Wales Epilepsy Unit, Department of NeurologyUniversity Hospital of WalesCardiffUK
| | | | - Graeme D. Jackson
- Florey Institute of Neuroscience and Mental Health, Austin CampusHeidelbergVictoriaAustralia
- University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAustin HealthHeidelbergVictoriaAustralia
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Simon S. Keller
- Institute of Systems, Molecular and Integrative BiologyUniversity of LiverpoolLiverpoolUK
| | - Peter Kochunov
- Department of PsychiatryUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Raviteja Kotikalapudi
- Department of Radiology, Diagnostic and Interventional NeuroradiologyUniversity Hospital TübingenTübingenGermany
- Department of Clinical NeurophysiologyUniversity Hospital GöttingenGöttingenGermany
- Department of Neurology and EpileptologyHertie Institute for Clinical Brain Research, University of TübingenTübingenGermany
| | - Barbara A. K. Kreilkamp
- Institute of Systems, Molecular and Integrative BiologyUniversity of LiverpoolLiverpoolUK
- Clinical NeurophysiologyUniversity Medical Center GöttingenGöttingenGermany
| | - Angelo Labate
- Neuroscience Research Center, Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
- Institute of Neurology, Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
| | - Sara Larivière
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and HospitalMcGill UniversityMontrealQuebecCanada
| | - Matteo Lenge
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and LaboratoriesA. Meyer Children's Hospital, University of FlorenceFlorenceItaly
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery DepartmentA. Meyer Children's Hospital, University of FlorenceFlorenceItaly
| | - Elaine Lui
- Department of Radiology, Royal Melbourne HospitalUniversity of MelbourneMelbourneVictoriaAustralia
| | - Charles Malpas
- Department of NeurologyRoyal Melbourne HospitalMelbourneVictoriaAustralia
- Department of Medicine, Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia
| | - Pascal Martin
- Department of PsychiatryUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Mario Mascalchi
- Mario Serio Department of Clinical and Experimental Medical SciencesUniversity of FlorenceFlorenceItaly
| | - Sarah E. Medland
- Psychiatric GeneticsQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- Neurology Unit, OCB HospitalModena University HospitalModenaItaly
| | - Marcia E. Morita‐Sherman
- Department of NeurologyUniversity of CampinasCampinasBrazil
- Cleveland Clinic Neurological InstituteClevelandOhioUSA
| | - Thomas W. Owen
- School of ComputingNewcastle UniversityNewcastle Upon TyneUK
| | | | - Antonella Riva
- Giannina Gaslini Institute, Scientific Institute for Research and Health CareGenoaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenoaGenoaItaly
| | - Theodor Rüber
- Department of EpileptologyUniversity Hospital BonnBonnGermany
| | - Ben Sinclair
- Department of Neuroscience, Central Clinical School, Alfred HospitalMonash UniversityMelbourneVictoriaAustralia
- Departments of Medicine and Radiology, Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia
| | - Hamid Soltanian‐Zadeh
- Radiology and Research AdministrationHenry Ford Health SystemDetroitMichiganUSA
- School of Electrical and Computer EngineeringCollege of Engineering, University of TehranTehranIran
| | - Dan J. Stein
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Pasquale Striano
- Giannina Gaslini Institute, Scientific Institute for Research and Health CareGenoaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenoaGenoaItaly
| | - Peter N. Taylor
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of Neurology, University College LondonLondonUK
- School of ComputingNewcastle UniversityNewcastle Upon TyneUK
| | - Sophia I. Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Manuela Tondelli
- Department of Biomedical, Metabolic, and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- Primary Care DepartmentLocal Health Authority of ModenaModenaItaly
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic, and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- Neurology Unit, OCB HospitalModena University HospitalModenaItaly
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, Alfred HospitalMonash UniversityMelbourneVictoriaAustralia
- Departments of Medicine and Radiology, Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia
| | - Yujiang Wang
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of Neurology, University College LondonLondonUK
- School of ComputingNewcastle UniversityNewcastle Upon TyneUK
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition ResearchUniversity of BonnBonnGermany
| | - Christopher D. Whelan
- Department of Molecular and Cellular TherapeuticsRoyal College of Surgeons in IrelandDublinIreland
| | - Roland Wiest
- Support Center for Advanced NeuroimagingUniversity Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Gavin P. Winston
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of Neurology, University College LondonLondonUK
- Chalfont Centre for EpilepsyChalfont St PeterUK
- Department of Medicine, Division of NeurologyQueen's UniversityKingstonOntarioCanada
| | - Clarissa Lin Yasuda
- Department of Neurology and Neuroimaging LaboratoryUniversity of CampinasCampinasBrazil
| | - Carrie R. McDonald
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Daniel C. Alexander
- Centre for Medical Image Computing, Department of Computer ScienceUniversity College LondonLondonUK
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of Neurology, University College LondonLondonUK
- Chalfont Centre for EpilepsyChalfont St PeterUK
| | - Andre Altmann
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
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Archetti D, Young AL, Oxtoby NP, Ferreira D, Mårtensson G, Westman E, Alexander DC, Frisoni GB, Redolfi A. Inter-Cohort Validation of SuStaIn Model for Alzheimer's Disease. Front Big Data 2021; 4:661110. [PMID: 34095821 PMCID: PMC8173213 DOI: 10.3389/fdata.2021.661110] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/04/2021] [Indexed: 01/15/2023] Open
Abstract
Alzheimer’s disease (AD) is a neurodegenerative disorder which spans several years from preclinical manifestations to dementia. In recent years, interest in the application of machine learning (ML) algorithms to personalized medicine has grown considerably, and a major challenge that such models face is the transferability from the research settings to clinical practice. The objective of this work was to demonstrate the transferability of the Subtype and Stage Inference (SuStaIn) model from well-characterized research data set, employed as training set, to independent less-structured and heterogeneous test sets representative of the clinical setting. The training set was composed of MRI data of 1043 subjects from the Alzheimer’s disease Neuroimaging Initiative (ADNI), and the test set was composed of data from 767 subjects from OASIS, Pharma-Cog, and ViTA clinical datasets. Both sets included subjects covering the entire spectrum of AD, and for both sets volumes of relevant brain regions were derived from T1-3D MRI scans processed with Freesurfer v5.3 cross-sectional stream. In order to assess the predictive value of the model, subpopulations of subjects with stable mild cognitive impairment (MCI) and MCIs that progressed to AD dementia (pMCI) were identified in both sets. SuStaIn identified three disease subtypes, of which the most prevalent corresponded to the typical atrophy pattern of AD. The other SuStaIn subtypes exhibited similarities with the previously defined hippocampal sparing and limbic predominant atrophy patterns of AD. Subject subtyping proved to be consistent in time for all cohorts and the staging provided by the model was correlated with cognitive performance. Classification of subjects on the basis of a combination of SuStaIn subtype and stage, mini mental state examination and amyloid-β1-42 cerebrospinal fluid concentration was proven to predict conversion from MCI to AD dementia on par with other novel statistical algorithms, with ROC curves that were not statistically different for the training and test sets and with area under curve respectively equal to 0.77 and 0.76. This study proves the transferability of a SuStaIn model for AD from research data to less-structured clinical cohorts, and indicates transferability to the clinical setting.
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Affiliation(s)
- Damiano Archetti
- Laboratory of Neuroinformatics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Alexandra L Young
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Computer Science, UCL Centre for Medical Image Computing, London, United Kingdom
| | - Neil P Oxtoby
- Department of Computer Science, UCL Centre for Medical Image Computing, London, United Kingdom
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Gustav Mårtensson
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Daniel C Alexander
- Department of Computer Science, UCL Centre for Medical Image Computing, London, United Kingdom
| | - Giovanni B Frisoni
- Memory Clinic and LANVIE - Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland.,Laboratory of Alzheimer's Neuroimaging and Epidemiology - LANE, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Alberto Redolfi
- Laboratory of Neuroinformatics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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