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Apse RR, Zdanovskis N, Šneidere K, Karelis G, Platkājis A, Stepens A. Morphometric Measurement of Mean Cortical Curvature: Analysis of Alterations in Cognitive Impairment. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:531. [PMID: 40142342 PMCID: PMC11944146 DOI: 10.3390/medicina61030531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Revised: 03/13/2025] [Accepted: 03/16/2025] [Indexed: 03/28/2025]
Abstract
Background and Objectives: Cognitive impairment, including mild cognitive impairment (MCI) and Alzheimer's disease (AD), is a growing public health concern. Early detection and an understanding of structural changes are crucial for accurate diagnosis and timely intervention. Cortical curvature, a morphometric measure derived from structural magnetic resonance imaging (MRI), has emerged as a potential biomarker for neurodegenerative processes. This study investigates the relationship between mean cortical curvature and cognitive impairment. Materials and Methods: A cross-sectional study was conducted with 58 participants, categorized into, first, cognitively impaired (CI) and non-cognitively impaired (NC) groups and, second, a normal cognitive group (NC), a mild cognitive performance group (MPG), and a low cognitive performance group (LPG) based on the Montreal Cognitive Assessment (MoCA) score. MRI data were acquired using a 3.0 Tesla scanner, and cortical reconstruction was performed using FreeSurfer 7.2.0. Mean cortical curvature values were extracted for 34 brain regions per hemisphere. Results: Significant differences in mean cortical curvature were found between the CI and NC groups. In the right hemisphere, statistically significant changes in mean curvature were observed in the isthmus cingulate (U = 188.5, p = 0.006), lingual (U = 202.5, p = 0.013), pars orbitalis (U = 221.5, p = 0.031), and posterior cingulate regions (U = 224.5, p = 0.035). In the left hemisphere, significant differences were detected in the cuneus (U = 226.5, p = 0.038) and posterior cingulate (U = 231.5, p = 0.046) regions. Analysis across three cognitive performance groups (NC, MPG, and LPG) showed significant curvature differences in the right isthmus cingulate (H(2) = 7.492, p = 0.024) and lingual regions (H(2) = 6.250, p = 0.044). Conclusions: Decreased mean cortical curvature in brain regions associated with cognitive function could be indicative of cognitive impairment and may reflect early neurodegenerative changes. These results highlight cortical curvature as a potential structural sign for cognitive impairment, showing the need for further investigation in longitudinal studies.
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Affiliation(s)
- Renāte Rūta Apse
- Department of Radiology, Riga Stradins University, LV-1007 Riga, Latvia; (R.R.A.); (A.P.)
- Department of Radiology, Riga East University Hospital, LV-1038 Riga, Latvia
| | - Nauris Zdanovskis
- Department of Radiology, Riga Stradins University, LV-1007 Riga, Latvia; (R.R.A.); (A.P.)
- Department of Radiology, Riga East University Hospital, LV-1038 Riga, Latvia
- Institute of Public Health, Riga Stradins University, LV-1007 Riga, Latvia; (K.Š.); (A.S.)
| | - Kristīne Šneidere
- Institute of Public Health, Riga Stradins University, LV-1007 Riga, Latvia; (K.Š.); (A.S.)
- Department of Health Psychology and Pedagogy, Riga Stradins University, LV-1007 Riga, Latvia
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Radiology, Riga East University Hospital, LV-1038 Riga, Latvia;
- Department of Infectiology, Riga Stradins University, LV-1007 Riga, Latvia
| | - Ardis Platkājis
- Department of Radiology, Riga Stradins University, LV-1007 Riga, Latvia; (R.R.A.); (A.P.)
- Department of Radiology, Riga East University Hospital, LV-1038 Riga, Latvia
| | - Ainārs Stepens
- Institute of Public Health, Riga Stradins University, LV-1007 Riga, Latvia; (K.Š.); (A.S.)
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Liu Y, Wang M, Yu X, Han Y, Jiang J, Yan Z. An effective and robust lattice Boltzmann model guided by atlas for hippocampal subregions segmentation. Med Phys 2024; 51:4105-4120. [PMID: 38373278 DOI: 10.1002/mp.16984] [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: 09/05/2023] [Revised: 12/19/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Given the varying vulnerability of the rostral and caudal regions of the hippocampus to neuropathology in the Alzheimer's disease (AD) continuum, accurately assessing structural changes in these subregions is crucial for early AD detection. The development of reliable and robust automatic segmentation methods for hippocampal subregions (HS) is of utmost importance. OBJECTIVE Our aim is to propose and validate a HS segmentation model that is both training-free and highly generalizable. This method should exhibit comparable accuracy and efficiency to state-of-the-art techniques. The segmented HS can serve as a biomarker for studying the progression of AD. METHODS We utilized the functional magnetic resonance imaging of the Brain's Integrated Registration and Segmentation Tool (FIRST) to segment the entire hippocampus. By intersecting the segmentation results with the Brainnetome (BN) atlas, we obtained coarse segmentation of the four HS regions. This coarse segmentation was then employed as a shape prior term in the lattice Boltzmann (LB) model, as well as for initializing contours. Additionally, image gradients and local gray levels were integrated into the external force terms of the LB model to refine the coarse segmentation results. We assessed the segmentation accuracy of the model using the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset and evaluated the potential of the segmentation results as AD biomarkers on both the ADNI and Xuanwu datasets. RESULTS The median Dice similarity coefficients (DSC) for the left caudal, right caudal, left rostral, and right rostral hippocampus were 0.87, 0.88, 0.88, and 0.89, respectively. The proportion of segmentation results with a DSC exceeding 0.8 was 77%, 78%, 77%, and 94% for the respective regions. In terms of volume, the correlation coefficients between the segmentation results of the four HS regions and the gold standard were 0.95, 0.93, 0.96, and 0.96, respectively. Regarding asymmetry, the correlation coefficient between the segmentation result's right caudal minus left caudal and the corresponding gold standard was 0.91, while for right rostral minus left rostral, it was 0.93. Over time, we observed a decline in the volumes of the four HS regions and the total hippocampal volume of mild cognitive impairment (MCI) converters. Analysis of inter-group differences revealed that, except for the right rostral region in the ADNI dataset, the p-values for the four HS regions in the normal controls (NC), MCI, and AD groups from both datasets were all below 0.05. The right caudal hippocampal volume demonstrated correlation coefficients of 0.47 and 0.43 with the mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA), respectively. Similarly, the left rostral hippocampal volume showed correlation coefficients of 0.50 and 0.58 with MMSE and MoCA, respectively. CONCLUSIONS Our framework allows for direct application to different brain magnetic resonance (MR) datasets without the need for training. It eliminates the requirement for complex image preprocessing steps while achieving segmentation accuracy comparable to deep learning (DL) methods even with small sample sizes. Compared to traditional active contour models (ACM) and atlas-based methods, our approach exhibits significant speed advantages. The segmented HS regions hold promise as potential biomarkers for studying the progression of AD.
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Affiliation(s)
- Yingqian Liu
- School of Communication and Information Engineering, Shanghai University, Shanghai, China
- Institute of Biomedical Engineering, School of Life Sciences, Shanghai University, Shanghai, China
- School of Electrical Engineering, Shandong University of Aeronautics, Binzhou, China
| | - Min Wang
- Institute of Biomedical Engineering, School of Life Sciences, Shanghai University, Shanghai, China
| | - Xianfeng Yu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Ying Han
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jiehui Jiang
- Institute of Biomedical Engineering, School of Life Sciences, Shanghai University, Shanghai, China
| | - Zhuangzhi Yan
- School of Communication and Information Engineering, Shanghai University, Shanghai, China
- Institute of Biomedical Engineering, School of Life Sciences, Shanghai University, Shanghai, China
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Chen Y, Su Y, Wu J, Chen K, Atri A, Caselli RJ, Reiman EM, Wang Y. Combining Blood-Based Biomarkers and Structural MRI Measurements to Distinguish Persons with and without Significant Amyloid Plaques. J Alzheimers Dis 2024; 98:1415-1426. [PMID: 38578889 PMCID: PMC11789004 DOI: 10.3233/jad-231162] [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] [Indexed: 04/07/2024]
Abstract
Background Amyloid-β (Aβ) plaques play a pivotal role in Alzheimer's disease. The current positron emission tomography (PET) is expensive and limited in availability. In contrast, blood-based biomarkers (BBBMs) show potential for characterizing Aβ plaques more affordably. We have previously proposed an MRI-based hippocampal morphometry measure to be an indicator of Aβ plaques. Objective To develop and validate an integrated model to predict brain amyloid PET positivity combining MRI feature and plasma Aβ42/40 ratio. Methods We extracted hippocampal multivariate morphometry statistics from MR images and together with plasma Aβ42/40 trained a random forest classifier to perform a binary classification of participant brain amyloid PET positivity. We evaluated the model performance using two distinct cohorts, one from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and the other from the Banner Alzheimer's Institute (BAI), including prediction accuracy, precision, recall rate, F1 score, and AUC score. Results Results from ADNI (mean age 72.6, Aβ+ rate 49.5%) and BAI (mean age 66.2, Aβ+ rate 36.9%) datasets revealed the integrated multimodal (IMM) model's superior performance over unimodal models. The IMM model achieved prediction accuracies of 0.86 in ADNI and 0.92 in BAI, surpassing unimodal models based solely on structural MRI (0.81 and 0.87) or plasma Aβ42/40 (0.73 and 0.81) predictors. CONCLUSIONS Our IMM model, combining MRI and BBBM data, offers a highly accurate approach to predict brain amyloid PET positivity. This innovative multiplex biomarker strategy presents an accessible and cost-effective avenue for advancing Alzheimer's disease diagnostics, leveraging diverse pathologic features related to Aβ plaques and structural MRI.
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Affiliation(s)
- Yanxi Chen
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, USA
| | - Yi Su
- Banner Alzheimer’s Institute, Phoenix, AZ, USA
| | - Jianfeng Wu
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, USA
| | - Kewei Chen
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Alireza Atri
- Banner Alzheimer’s Institute, Phoenix, AZ, USA
- Banner Sun Health Research Institute, Sun City, AZ, USA
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Yalin Wang
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, USA
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Veitch DP, Weiner MW, Miller M, Aisen PS, Ashford MA, Beckett LA, Green RC, Harvey D, Jack CR, Jagust W, Landau SM, Morris JC, Nho KT, Nosheny R, Okonkwo O, Perrin RJ, Petersen RC, Rivera Mindt M, Saykin A, Shaw LM, Toga AW, Tosun D. The Alzheimer's Disease Neuroimaging Initiative in the era of Alzheimer's disease treatment: A review of ADNI studies from 2021 to 2022. Alzheimers Dement 2024; 20:652-694. [PMID: 37698424 PMCID: PMC10841343 DOI: 10.1002/alz.13449] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 09/13/2023]
Abstract
The Alzheimer's Disease Neuroimaging Initiative (ADNI) aims to improve Alzheimer's disease (AD) clinical trials. Since 2006, ADNI has shared clinical, neuroimaging, and cognitive data, and biofluid samples. We used conventional search methods to identify 1459 publications from 2021 to 2022 using ADNI data/samples and reviewed 291 impactful studies. This review details how ADNI studies improved disease progression understanding and clinical trial efficiency. Advances in subject selection, detection of treatment effects, harmonization, and modeling improved clinical trials and plasma biomarkers like phosphorylated tau showed promise for clinical use. Biomarkers of amyloid beta, tau, neurodegeneration, inflammation, and others were prognostic with individualized prediction algorithms available online. Studies supported the amyloid cascade, emphasized the importance of neuroinflammation, and detailed widespread heterogeneity in disease, linked to genetic and vascular risk, co-pathologies, sex, and resilience. Biological subtypes were consistently observed. Generalizability of ADNI results is limited by lack of cohort diversity, an issue ADNI-4 aims to address by enrolling a diverse cohort.
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Affiliation(s)
- Dallas P. Veitch
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterCenter for Imaging of Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
| | - Michael W. Weiner
- Department of Veterans Affairs Medical CenterCenter for Imaging of Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Melanie Miller
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterCenter for Imaging of Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
| | - Paul S. Aisen
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Miriam A. Ashford
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
| | - Laurel A. Beckett
- Division of BiostatisticsDepartment of Public Health SciencesUniversity of CaliforniaDavisCaliforniaUSA
| | - Robert C. Green
- Division of GeneticsDepartment of MedicineBrigham and Women's HospitalBroad Institute Ariadne Labs and Harvard Medical SchoolBostonMassachusettsUSA
| | - Danielle Harvey
- Division of BiostatisticsDepartment of Public Health SciencesUniversity of CaliforniaDavisCaliforniaUSA
| | | | - William Jagust
- Helen Wills Neuroscience InstituteUniversity of California BerkeleyBerkeleyCaliforniaUSA
| | - Susan M. Landau
- Helen Wills Neuroscience InstituteUniversity of California BerkeleyBerkeleyCaliforniaUSA
| | - John C. Morris
- Knight Alzheimer's Disease Research CenterWashington University School of MedicineSaint LouisMissouriUSA
- Department of NeurologyWashington University School of MedicineSaint LouisMissouriUSA
- Department of Pathology and ImmunologyWashington University School of MedicineSaint LouisMissouriUSA
| | - Kwangsik T. Nho
- Department of Radiology and Imaging Sciences and the Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- Center for Computational Biology and BioinformaticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Rachel Nosheny
- Department of Veterans Affairs Medical CenterCenter for Imaging of Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Ozioma Okonkwo
- Wisconsin Alzheimer's Disease Research Center and Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Richard J. Perrin
- Knight Alzheimer's Disease Research CenterWashington University School of MedicineSaint LouisMissouriUSA
- Department of NeurologyWashington University School of MedicineSaint LouisMissouriUSA
- Department of Pathology and ImmunologyWashington University School of MedicineSaint LouisMissouriUSA
| | | | - Monica Rivera Mindt
- Department of PsychologyLatin American and Latino Studies InstituteAfrican and African American StudiesFordham UniversityNew YorkNew YorkUSA
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andrew Saykin
- Department of Radiology and Imaging Sciences and the Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Leslie M. Shaw
- Department of Pathology and Laboratory Medicine and the PENN Alzheimer's Disease Research CenterCenter for Neurodegenerative ResearchPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Arthur W. Toga
- Laboratory of Neuro ImagingInstitute of Neuroimaging and InformaticsKeck School of Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Duygu Tosun
- Department of Veterans Affairs Medical CenterCenter for Imaging of Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Dong Q, Li Z, Liu W, Chen K, Su Y, Wu J, Caselli RJ, Reiman EM, Wang Y, Shen J. Correlation studies of Hippocampal Morphometry and Plasma NFL Levels in Cognitively Unimpaired Subjects. IEEE TRANSACTIONS ON COMPUTATIONAL SOCIAL SYSTEMS 2023; 10:3602-3608. [PMID: 38084365 PMCID: PMC10713345 DOI: 10.1109/tcss.2023.3313819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Alzheimer's disease(AD) is being the burden of society and family. Applying computing-aided strategies to reveal its pathology is one of the research highlights. Plasma neurofilament light (NFL) is an emerging noninvasive and economic biomarker for AD molecular pathology. It is valuable to reveal the correlations between the plasma NFL levels and neurodegeneration, especially hippcampal deformations at the preclinical stage. The negative correlation between plasma NFL levels and hippocampal volumes has been documented. However, the relationship between the plasma NFL levels and the hippocampal morphometry details at the preclinical stage is still elusive. This study seeks to demonstrate the capacity of our proposed surface-based hippocampal morphometry system to discern the plasma NFL positive (NFL+>41.9 pg/L) level and plasma NFL negative (NFL-<41.9pg/L) level and illustrate its superiority to the hippocampal volume measurement by drawing the cohort of 154 CU middle aged and elderly adults. We also apply this morphometry measure and a proposed sparse coding based classification algorithm to classify CU individuals with NFL+ and NFL- levels. Experimental results show that the proposed hippocampal morphometry system offers stronger statistical power to discriminate CU subjects with NFL+ and NFL- levels, comparing with the hippocampal volume measure. Furthermore, this system can discriminate plasma NFL levels in CU individuals (Accuracy=0.86). Both the group level and individual level analysis results indicate that the association between plasma NFL levels and the hippocampal shapes can be mapped at the preclinical stage.
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Affiliation(s)
- Qunxi Dong
- School of Medical Technology, Beijing Institute of Technology, Beijing, 100081, China
| | - Zhigang Li
- School of Medical Technology, Beijing Institute of Technology, Beijing, 100081, China
| | - Weijia Liu
- School of Medical Technology, Beijing Institute of Technology, Beijing, 100081, China
| | - Kewei Chen
- Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - Yi Su
- Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - Jianfeng Wu
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State Univ., Tempe, AZ, USA
| | | | | | - Yalin Wang
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State Univ., Tempe, AZ, USA
| | - Jian Shen
- School of Medical Technology, Beijing Institute of Technology, Beijing, 100081, China
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Zheng W, Liu H, Li Z, Li K, Wang Y, Hu B, Dong Q, Wang Z. Classification of Alzheimer's disease based on hippocampal multivariate morphometry statistics. CNS Neurosci Ther 2023; 29:2457-2468. [PMID: 37002795 PMCID: PMC10401169 DOI: 10.1111/cns.14189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is a neurodegenerative disease characterized by progressive cognitive decline, and mild cognitive impairment (MCI) is associated with a high risk of developing AD. Hippocampal morphometry analysis is believed to be the most robust magnetic resonance imaging (MRI) markers for AD and MCI. Multivariate morphometry statistics (MMS), a quantitative method of surface deformations analysis, is confirmed to have strong statistical power for evaluating hippocampus. AIMS We aimed to test whether surface deformation features in hippocampus can be employed for early classification of AD, MCI, and healthy controls (HC). METHODS We first explored the differences in hippocampus surface deformation among these three groups by using MMS analysis. Additionally, the hippocampal MMS features of selective patches and support vector machine (SVM) were used for the binary classification and triple classification. RESULTS By the results, we identified significant hippocampal deformation among the three groups, especially in hippocampal CA1. In addition, the binary classification of AD/HC, MCI/HC, AD/MCI showed good performances, and area under curve (AUC) of triple-classification model achieved 0.85. Finally, positive correlations were found between the hippocampus MMS features and cognitive performances. CONCLUSIONS The study revealed significant hippocampal deformation among AD, MCI, and HC. Additionally, we confirmed that hippocampal MMS can be used as a sensitive imaging biomarker for the early diagnosis of AD at the individual level.
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Affiliation(s)
- Weimin Zheng
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Honghong Liu
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Zhigang Li
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yalin Wang
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, Arizona, USA
| | - Bin Hu
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Qunxi Dong
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Zhiqun Wang
- Department of Radiology, Aerospace Center Hospital, Beijing, China
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Fu X, Qin M, Liu X, Cheng L, Zhang L, Zhang X, Lei Y, Zhou Q, Sun P, Lin L, Su Y, Wang J. Decreased GABA levels of the anterior and posterior cingulate cortex are associated with executive dysfunction in mild cognitive impairment. Front Neurosci 2023; 17:1220122. [PMID: 37638325 PMCID: PMC10450953 DOI: 10.3389/fnins.2023.1220122] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
Background and purpose Executive function impairment, a slight but noticeable cognitive deficit in mild cognitive impairment (MCI) patients, is influenced by gamma-aminobutyric acid (GABA) levels. Reduced cognitive function is accompanied by thinning of the cerebral cortex, which has higher GABA levels than white matter. However, the relationships among GABA levels, cortical thickness, and executive function in MCI patients have not yet been elucidated. We investigated the relationships among GABA levels, cortical thickness, and executive function in MCI patients. Methods In this study, a total of 36 MCI patients and 36 sex-, age-, and education-matched healthy controls (HC) were recruited. But 33 MCI patients and 35 HC were included because of head motion or poor data quality for three MCI patients and one HC. The levels of gamma-aminobutyric acid plus relative to creatine (GABA+/Cr) and glutamate-glutamine relative to creatine (Glx/Cr) in the anterior cingulate cortex (ACC) and posterior cingulate cortex (PCC) were measured using the Meshcher-Garwood point resolved spectroscopy (MEGA-PRESS) sequence. Metabolite ratios, cortical thickness, and executive function and their interrelationships were determined in the MCI and HC groups. Results Patients with MCI showed lower GABA+/Cr levels in the ACC and PCC. Combined levels of GABA+ and Glx in the ACC and GABA+ in the PCC showed good diagnostic efficacy for MCI (AUC: 0.82). But no differences in cortical thickness were found between the two groups. In the MCI group, lower GABA+/Cr level was correlated to worse performance on the digit span test backward, and the shape trail test-B. The cortical thickness was not associated with GABA+ levels and executive function in patients. Conclusion These results implied that decreased GABA levels in the ACC and PCC had a critical role in the early diagnosis of impaired executive function of MCI. Therefore, GABA in the ACC and PCC could be a potential diagnostic marker of the executive function decline of MCI.
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Affiliation(s)
- Xiaona Fu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mengting Qin
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoming Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lan Cheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lan Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xinli Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yu Lei
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qidong Zhou
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Sun
- Clinical & Technical Solutions, Philips Healthcare, Beijing, China
| | - Liangjie Lin
- Clinical & Technical Solutions, Philips Healthcare, Beijing, China
| | - Ying Su
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Qu Z, Yao T, Liu X, Wang G. A Graph Convolutional Network Based on Univariate Neurodegeneration Biomarker for Alzheimer's Disease Diagnosis. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2023; 11:405-416. [PMID: 37492469 PMCID: PMC10365071 DOI: 10.1109/jtehm.2023.3285723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/20/2023] [Accepted: 06/05/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Alzheimer's disease (AD) is a progressive and irreversible neurodegenerative disease that is not easily detectable in the early stage. This study proposed an efficient method of applying a graph convolutional network (GCN) on the early prediction of AD. METHODS We proposed a univariate neurodegeneration biomarker (UNB) based GCN semi-supervised classification framework. We generated UNB by comparing the similarity of individual morphological atrophy pattern and the atrophy pattern of [Formula: see text] AD group according to the brain morphological abnormalities induced by AD. For the GCN semi-supervised classification model, we took the UNBs of individuals as the features of nodes and constructed the weight of edges according to the similarity of phenotypic information between individuals, which explored the essential features of individuals through spectral graph convolution. The attention module was constructed and embedded into the GCN framework, which may refine the input morphological features to highlight the main impact of AD on the cerebral cortex and weaken the instability caused by individual diversities, thereby identifying the significant ROIs affected by AD and improving the classification accuracy. RESULTS We tested the UNB-GCN framework on the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. The estimated minimum sample sizes were 156, 349 and 423 for the longitudinal [Formula: see text] AD, [Formula: see text] mild cognitive impairment (MCI) and [Formula: see text] cognitively unimpaired (CU) groups, respectively. And the proposed UNB-GCN framework combined with the attention module can effectively improve the classification performance with 93.90% classification accuracy for AD vs. CU and 82.05% for AD vs. MCI on the validation set. CONCLUSION The proposed UNB measures were superior to the conventional volume measures in describing the AD-induced cerebral cortex morphological changes. And the UNB-GCN framework combined with attention module may effectively improve the classification performance between MCI subjects and AD patients. Clinical and Translational Impact Statement: This study aims to predict the early AD patients, so as to help clinicians develop effective interventions to delay the deterioration of AD symptoms.
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Affiliation(s)
- Zongshuai Qu
- School of Information and Electrical EngineeringLudong UniversityYantai264025China
| | - Tao Yao
- School of Information and Electrical EngineeringLudong UniversityYantai264025China
| | - Xinghui Liu
- Shandong Vheng Data Technology Company Ltd.Yantai264003China
| | - Gang Wang
- School of Ulsan Ship and Ocean CollegeLudong UniversityYantai264025China
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Li Z, Dong Q, Hu B, Wu H. Every individual makes a difference: A trinity derived from linking individual brain morphometry, connectivity and mentalising ability. Hum Brain Mapp 2023; 44:3343-3358. [PMID: 37051692 PMCID: PMC10171537 DOI: 10.1002/hbm.26285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 02/01/2023] [Accepted: 03/08/2023] [Indexed: 04/14/2023] Open
Abstract
Mentalising ability, indexed as the ability to understand others' beliefs, feelings, intentions, thoughts and traits, is a pivotal and fundamental component of human social cognition. However, considering the multifaceted nature of mentalising ability, little research has focused on characterising individual differences in different mentalising components. And even less research has been devoted to investigating how the variance in the structural and functional patterns of the amygdala and hippocampus, two vital subcortical regions of the "social brain", are related to inter-individual variability in mentalising ability. Here, as a first step toward filling these gaps, we exploited inter-subject representational similarity analysis (IS-RSA) to assess relationships between amygdala and hippocampal morphometry (surface-based multivariate morphometry statistics, MMS), connectivity (resting-state functional connectivity, rs-FC) and mentalising ability (interactive mentalisation questionnaire [IMQ] scores) across the participants ( N = 24 $$ N=24 $$ ). In IS-RSA, we proposed a novel pipeline, that is, computing patching and pooling operations-based surface distance (CPP-SD), to obtain a decent representation for high-dimensional MMS data. On this basis, we found significant correlations (i.e., second-order isomorphisms) between these three distinct modalities, indicating that a trinity existed in idiosyncratic patterns of brain morphometry, connectivity and mentalising ability. Notably, a region-related mentalising specificity emerged from these associations: self-self and self-other mentalisation are more related to the hippocampus, while other-self mentalisation shows a closer link with the amygdala. Furthermore, by utilising the dyadic regression analysis, we observed significant interactions such that subject pairs with similar morphometry had even greater mentalising similarity if they were also similar in rs-FC. Altogether, we demonstrated the feasibility and illustrated the promise of using IS-RSA to study individual differences, deepening our understanding of how individual brains give rise to their mentalising abilities.
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Affiliation(s)
- Zhaoning Li
- Centre for Cognitive and Brain Sciences and Department of Psychology, University of Macau, Taipa, China
| | - Qunxi Dong
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Bin Hu
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Haiyan Wu
- Centre for Cognitive and Brain Sciences and Department of Psychology, University of Macau, Taipa, China
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10
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Wu J, Su Y, Zhu W, Mallak NJ, Lepore N, Reiman EM, Caselli RJ, Thompson PM, Chen K, Wang Y. Improved Prediction of Amyloid-β and Tau Burden Using Hippocampal Surface Multivariate Morphometry Statistics and Sparse Coding. J Alzheimers Dis 2023; 91:637-651. [PMID: 36463452 PMCID: PMC9940990 DOI: 10.3233/jad-220812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Amyloid-β (Aβ) plaques and tau protein tangles in the brain are the defining 'A' and 'T' hallmarks of Alzheimer's disease (AD), and together with structural atrophy detectable on brain magnetic resonance imaging (MRI) scans as one of the neurodegenerative ('N') biomarkers comprise the "ATN framework" of AD. Current methods to detect Aβ/tau pathology include cerebrospinal fluid (invasive), positron emission tomography (PET; costly and not widely available), and blood-based biomarkers (promising but mainly still in development). OBJECTIVE To develop a non-invasive and widely available structural MRI-based framework to quantitatively predict the amyloid and tau measurements. METHODS With MRI-based hippocampal multivariate morphometry statistics (MMS) features, we apply our Patch Analysis-based Surface Correntropy-induced Sparse coding and max-pooling (PASCS-MP) method combined with the ridge regression model to individual amyloid/tau measure prediction. RESULTS We evaluate our framework on amyloid PET/MRI and tau PET/MRI datasets from the Alzheimer's Disease Neuroimaging Initiative. Each subject has one pair consisting of a PET image and MRI scan, collected at about the same time. Experimental results suggest that amyloid/tau measurements predicted with our PASCP-MP representations are closer to the real values than the measures derived from other approaches, such as hippocampal surface area, volume, and shape morphometry features based on spherical harmonics. CONCLUSION The MMS-based PASCP-MP is an efficient tool that can bridge hippocampal atrophy with amyloid and tau pathology and thus help assess disease burden, progression, and treatment effects.
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Affiliation(s)
- Jianfeng Wu
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, USA
| | - Yi Su
- Banner Alzheimer’s Institute, Phoenix, AZ, USA
| | - Wenhui Zhu
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, USA
| | - Negar Jalili Mallak
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, USA
| | - Natasha Lepore
- CIBORG Lab, Department of Radiology Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | - Paul M. Thompson
- Imaging Genetics Center, Stevens Neuroimaging and Informatics Institute, University of Southern California, Marina del Rey, CA, USA
| | - Kewei Chen
- Banner Alzheimer’s Institute, Phoenix, AZ, USA
| | - Yalin Wang
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, USA
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11
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Wu J, Su Y, Chen Y, Zhu W, Reiman EM, Caselli RJ, Chen K, Thompson PM, Wang J, Wang Y. A Surface-Based Federated Chow Test Model for Integrating APOE Status, Tau Deposition Measure, and Hippocampal Surface Morphometry. J Alzheimers Dis 2023; 93:1153-1168. [PMID: 37182882 PMCID: PMC10329869 DOI: 10.3233/jad-230034] [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] [Indexed: 05/16/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is the most common type of age-related dementia, affecting 6.2 million people aged 65 or older according to CDC data. It is commonly agreed that discovering an effective AD diagnosis biomarker could have enormous public health benefits, potentially preventing or delaying up to 40% of dementia cases. Tau neurofibrillary tangles are the primary driver of downstream neurodegeneration and subsequent cognitive impairment in AD, resulting in structural deformations such as hippocampal atrophy that can be observed in magnetic resonance imaging (MRI) scans. OBJECTIVE To build a surface-based model to 1) detect differences between APOE subgroups in patterns of tau deposition and hippocampal atrophy, and 2) use the extracted surface-based features to predict cognitive decline. METHODS Using data obtained from different institutions, we develop a surface-based federated Chow test model to study the synergistic effects of APOE, a previously reported significant risk factor of AD, and tau on hippocampal surface morphometry. RESULTS We illustrate that the APOE-specific morphometry features correlate with AD progression and better predict future AD conversion than other MRI biomarkers. For example, a strong association between atrophy and abnormal tau was identified in hippocampal subregion cornu ammonis 1 (CA1 subfield) and subiculum in e4 homozygote cohort. CONCLUSION Our model allows for identifying MRI biomarkers for AD and cognitive decline prediction and may uncover a corner of the neural mechanism of the influence of APOE and tau deposition on hippocampal morphology.
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Affiliation(s)
- Jianfeng Wu
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, USA
| | - Yi Su
- Banner Alzheimer’s Institute, Phoenix, USA
| | - Yanxi Chen
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, USA
| | - Wenhui Zhu
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, USA
| | | | | | - Kewei Chen
- Banner Alzheimer’s Institute, Phoenix, USA
| | - Paul M. Thompson
- Imaging Genetics Center, Stevens Neuroimaging and Informatics Institute, University of Southern California, Marina del Rey, USA
| | - Junwen Wang
- Division of Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Yalin Wang
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, USA
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12
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Wu J, Dong Q, Zhang J, Su Y, Wu T, Caselli RJ, Reiman EM, Ye J, Lepore N, Chen K, Thompson PM, Wang Y. Federated Morphometry Feature Selection for Hippocampal Morphometry Associated Beta-Amyloid and Tau Pathology. Front Neurosci 2021; 15:762458. [PMID: 34899166 PMCID: PMC8655732 DOI: 10.3389/fnins.2021.762458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/01/2021] [Indexed: 12/03/2022] Open
Abstract
Amyloid-β (Aβ) plaques and tau protein tangles in the brain are now widely recognized as the defining hallmarks of Alzheimer's disease (AD), followed by structural atrophy detectable on brain magnetic resonance imaging (MRI) scans. One of the particular neurodegenerative regions is the hippocampus to which the influence of Aβ/tau on has been one of the research focuses in the AD pathophysiological progress. This work proposes a novel framework, Federated Morphometry Feature Selection (FMFS) model, to examine subtle aspects of hippocampal morphometry that are associated with Aβ/tau burden in the brain, measured using positron emission tomography (PET). FMFS is comprised of hippocampal surface-based feature calculation, patch-based feature selection, federated group LASSO regression, federated screening rule-based stability selection, and region of interest (ROI) identification. FMFS was tested on two Alzheimer's Disease Neuroimaging Initiative (ADNI) cohorts to understand hippocampal alterations that relate to Aβ/tau depositions. Each cohort included pairs of MRI and PET for AD, mild cognitive impairment (MCI), and cognitively unimpaired (CU) subjects. Experimental results demonstrated that FMFS achieves an 89× speedup compared to other published state-of-the-art methods under five independent hypothetical institutions. In addition, the subiculum and cornu ammonis 1 (CA1 subfield) were identified as hippocampal subregions where atrophy is strongly associated with abnormal Aβ/tau. As potential biomarkers for Aβ/tau pathology, the features from the identified ROIs had greater power for predicting cognitive assessment and for survival analysis than five other imaging biomarkers. All the results indicate that FMFS is an efficient and effective tool to reveal associations between Aβ/tau burden and hippocampal morphometry.
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Affiliation(s)
- Jianfeng Wu
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Qunxi Dong
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States
- Institute of Engineering Medicine, Beijing Institute of Technology, Beijing, China
| | - Jie Zhang
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Yi Su
- Banner Alzheimer’s Institute, Phoenix, AZ, United States
| | - Teresa Wu
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Richard J. Caselli
- Department of Neurology, Mayo Clinic Arizona, Scottsdale, AZ, United States
| | - Eric M. Reiman
- Banner Alzheimer’s Institute, Phoenix, AZ, United States
| | - Jieping Ye
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | - Natasha Lepore
- CIBORG Lab, Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Kewei Chen
- Banner Alzheimer’s Institute, Phoenix, AZ, United States
| | - Paul M. Thompson
- Imaging Genetics Center, Stevens Neuroimaging and Informatics Institute, University of Southern California, Marina del Rey, CA, United States
| | - Yalin Wang
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States
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13
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Wu J, Zhu W, Su Y, Gui J, Lepore N, Reiman EM, Caselli RJ, Thompson PM, Chen K, Wang Y. Predicting Tau Accumulation in Cerebral Cortex with Multivariate MRI Morphometry Measurements, Sparse Coding, and Correntropy. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2021; 12088:120880O. [PMID: 34961803 PMCID: PMC8710175 DOI: 10.1117/12.2607169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Biomarker-assisted diagnosis and intervention in Alzheimer's disease (AD) may be the key to prevention breakthroughs. One of the hallmarks of AD is the accumulation of tau plaques in the human brain. However, current methods to detect tau pathology are either invasive (lumbar puncture) or quite costly and not widely available (Tau PET). In our previous work, structural MRI-based hippocampal multivariate morphometry statistics (MMS) showed superior performance as an effective neurodegenerative biomarker for preclinical AD and Patch Analysis-based Surface Correntropy-induced Sparse coding and max-pooling (PASCS-MP) has excellent ability to generate low-dimensional representations with strong statistical power for brain amyloid prediction. In this work, we apply this framework together with ridge regression models to predict Tau deposition in Braak12 and Braak34 brain regions separately. We evaluate our framework on 925 subjects from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Each subject has one pair consisting of a PET image and MRI scan which were collected at about the same times. Experimental results suggest that the representations from our MMS and PASCS-MP have stronger predictive power and their predicted Braak12 and Braak34 are closer to the real values compared to the measures derived from other approaches such as hippocampal surface area and volume, and shape morphometry features based on spherical harmonics (SPHARM).
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Affiliation(s)
- Jianfeng Wu
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, USA
| | - Wenhui Zhu
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, USA
| | - Yi Su
- Banner Alzheimer’s Institute, Phoenix, USA
| | - Jie Gui
- School of Cyber Science and Engineering, Southeast University, Nanjing, China
| | - Natasha Lepore
- CIBORG Lab, Department of Radiology Children’s Hospital Los Angeles, Los Angeles, USA
| | | | | | - Paul M. Thompson
- Imaging Genetics Center, Stevens Neuroimaging and Informatics Institute, University of Southern California, Marina del Rey, USA
| | - Kewei Chen
- Banner Alzheimer’s Institute, Phoenix, USA
| | - Yalin Wang
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, USA
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14
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Yang Z, Wu J, Thompson PM, Wang Y. Deep Learning on SDF for Classifying Brain Biomarkers. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1051-1054. [PMID: 34891469 PMCID: PMC8669623 DOI: 10.1109/embc46164.2021.9630850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Biomarkers are one of the primary medical signs to facilitate the early detection of Alzheimer's disease. The small beta-amyloid (Aβ) peptide is an important indicator for the disease. However, current methods to detect Aβ pathology are either invasive (lumbar puncture) or quite costly and not widely available (amyloid PET). Thus a less invasive and cheaper approach is demanded. MRI which has been used widely in preclinical AD has recently shown the capability to predict brain Aβ positivity. This motivates us to develop a method, SDF sparse convolution, taking MRI to predict Aβ positivity. We obtain subjects from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and use our method to discriminate Aβ positivity. Theoretically, we provide analysis towards the understanding of what the network has learned. Empirically, it shows strong performance on par or even better than state of the art.
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