Computational modelling of imaging markers to support the diagnosis and monitoring of multiple sclerosis

Multiple sclerosis is a leading cause of neurological disability in young adults which affects more than 2.5 million people worldwide. An important substrate of disability accrual is the loss of neurons and connections between them (neurodegeneration) which can be captured by serial brain imaging, especially in the cerebral grey matter. In this thesis in four separate subprojects, I aimed to assess the strength of imaging-derived grey matter volume as a biomarker in the diagnosis, predicting the evolution of multiple sclerosis, and developing a staging system to stratify patients. In total, I retrospectively studied 1701 subjects, of whom 1548 had longitudinal brain imaging data. I used advanced computational models to investigate cross-sectional and longitudinal datasets. In the cross-sectional study, I demonstrated that grey matter volumes could distinguish multiple sclerosis from another demyelinating disorder (neuromyelitis optica) with an accuracy of 74%. In longitudinal studies, I showed that over time the deep grey matter nuclei had the fastest rate of volume loss (up to 1.66% annual loss) across the brain regions in multiple sclerosis. The volume of the deep grey matter was the strongest predictor of disability progression. I found that multiple sclerosis affects different brain areas with a specific temporal order (or sequence) that starts with the deep grey matter nuclei, posterior cingulate cortex, precuneus, and cerebellum. Finally, with multivariate mechanistic and causal modelling, I showed that brain volume loss causes disability and cognitive worsening which can be delayed with a potential neuroprotective treatment (simvastatin). This work provides conclusive evidence that grey matter volume loss affects some brain regions more severely, can predict future disability progression, can be used as an outcome measure in phase II clinical trials, and causes clinical and cognitive worsening. This thesis also provides a subject staging system based on which patients can be scored during multiple sclerosis

Dimensionality reduction and unsupervised learning techniques applied to clinical psychiatric and neuroimaging phenotypes

Unsupervised learning and other multivariate analysis techniques are increasingly recognized in neuropsychiatric research. Here, finite mixture models and random forests were applied to clinical observations of patients with major depression to detect and validate treatment response subgroups. Further, independent component analysis and agglomerative hierarchical clustering were combined to build a brain parcellation solely on structural covariance information of magnetic resonance brain images. Übersetzte Kurzfassung: Unüberwachtes Lernen und andere multivariate Analyseverfahren werden zunehmend auf neuropsychiatrische Fragestellungen angewendet. Finite mixture Modelle wurden auf klinische Skalen von Patienten mit schwerer Depression appliziert, um Therapieantwortklassen zu bilden und mit Random Forests zu validieren. Unabhängigkeitsanalysen und agglomeratives hierarchisches Clustering wurden kombiniert, um die strukturelle Kovarianz von Magnetresonanz­tomographie-Bildern für eine Hirnparzellierung zu nutzen

Predicting the future:Clinical outcome prediction with machine learning in neuropsychiatry

Treatment of psychiatric disorders relies on subjective measures of symptoms to establish diagnoses and lacks an objective way to determine which treatments might work best for an individual patient. To improve the current state-of-the-art and to be able to help a growing number of patients with mental health disorders more efficiently, the discovery of biomarkers predictive of treatment outcome and prognosis is needed. In addition, the application of machine learning methods provides an improvement over the standard group-level analysis approach since it allows for individualized predictions. Machine learning models can also be tested for their generalization capabilities to new patients which would quantify their potential for clinical applicability. In this thesis, these approaches were combined and investigated across a set of different neuropsychiatric disorders. The investigated applications included the prediction of disease course in patients with anxiety disorders, early detection of behavioural frontotemporal dementia in at-risk individuals using structural magnetic resonance imaging (MRI), prediction of deep-brain stimulation treatment-outcome in patients with therapy-resistant obsessive compulsive disorder using structural MRI and prediction of treatment-response for adult and youth patients with posttraumatic stress disorder using resting-state functional MRI scans. Across all studies this thesis showed that machine learning methods combined with neuroimaging data can be utilized to identify biomarkers predictive of future clinical outcomes in neuropsychiatric disorders. Promising as it seems, this can only be the first step for the inclusion of these new approaches into clinical practice as further studies utilizing larger sample sizes are necessary to validate the discovered biomarkers

Quantitative texture analysis in MR imaging in the assessment of Alzheimer’s disease

Alzheimer’s disease (AD) is a progressive neurodegenerative disease which is clinically characterized by cognitive impairment and memory loss. Anatomically, AD initially affects specific structures within the Medial Temporal Lobe (MTL), which are essential for declarative memory. A definitive diagnosis of AD relies on post-mortem biopsy therefore, clinical assessment and cognitive tests are currently used. However, these tests are not sensitive to detect AD in an early stage. The aim of this research was to investigate the usefulness of quantitative Magnetic Resonance Imaging (MRI) and specifically of texture features in the assessment of Mild Cognitive Impairment (MCI) which is the pre-dementia stage and AD. Firstly, two types of magnetic fields where investigated in order to examine whether, a stronger MR magnetic field would benefit quantitative imaging analysis derived from texture features. Secondly, texture features were extracted from the entorhinal cortex and evaluated in the diagnosis and prediction of MCI and AD. To the best of our knowledge this is the first research that investigated how the MR field strength affects texture features and used entorhinal cortex texture features on the assessment of AD. The main results of this PhD showed that (1) texture features could provide more sensitive measures when they are extracted from stronger MRI magnetic field, such as 3T, compared to 1.5T. From a disease classification and prediction perspective, (2) entorhinal cortex texture features provide better classification between Normal Controls (NC), MCI and AD subjects, and (3) better prediction of the conversion from MCI to AD. In conclusion, this research has shown for the first time in the literature that entorhinal cortex texture features from MRI could contribute towards the early classification of AD

Structural brain networks from diffusion MRI: methods and application

Structural brain networks can be constructed at a macroscopic scale using diffusion magnetic resonance imaging (dMRI) and whole-brain tractography. Under this approach, grey matter regions, such as Brodmann areas, form the nodes of a network and tractography is used to construct a set of white matter fibre tracts which form the connections. Graph-theoretic measures may then be used to characterise patterns of connectivity. In this study, we measured the test-retest properties of such networks by varying several factors affecting network construction using ten healthy volunteers who underwent a dMRI protocol at 1.5 T on two separate occasions. High resolution T1-weighted brains were parcellated into regions-of-interest and network connections were identified using dMRI and two alternative tractography algorithms, two alternative seeding strategies, constraints on anatomical plausibility and three alternative network weightings. Test-retest performance was found to improve when: 1) seeding from white matter, rather than grey; and 2) using probabilistic tractography, rather than deterministic. In terms of network weighting, a measure of streamline density produced better test-retest performance than tract-averaged diffusion anisotropy, although it remains unclear which is most representative of the underlying axonal connections. These findings were then used to inform network construction for two further cohorts: a casecontrol analysis of 30 patients with amyotrophic lateral sclerosis (ALS) compared with 30 age-matched healthy controls; and a cross-sectional analysis of 80 healthy volunteers aged 25– 64 years. In both cases, networks were constructed using a weighting reflecting tract-averaged fractional anisotropy (FA). A mass-univariate statistical technique called network-based statistics, identified an impaired motor-frontal-subcortical subnetwork (10 nodes and 12 bidirectional connections), consistent with upper motor neuron pathology, in the ALS group compared with the controls. Reduced FA for three of the impaired network connections, which involved fibres of the cortico-spinal tract, were significantly correlated with the rate of disease progression. Cross-sectional analysis of the 80 healthy volunteers was intended to provide supporting evidence for the widely reported age-related decline in white matter integrity. However, no meaningful relationships were found between increasing age and impaired connectivity based on global, lobar and nodal network properties – findings which were confirmed with a conventional voxel-based analysis of the dMRI data. In conclusion, whilst current acquisition protocols and methods can produce networks capable of characterising the genuine between-subject differences in connectivity, it is challenging to measure subtle white matter changes, for example, due to normal ageing. We conclude that future work should be undertaken to address these concerns