Quantifying anatomical shape variations in neurological disorders

We develop a multivariate analysis of brain anatomy to identify the relevant shape deformation patterns and quantify the shape changes that explain corresponding variations in clinical neuropsychological measures. We use kernel Partial Least Squares (PLS) and formulate a regression model in the tangent space of the manifold of diffeomorphisms characterized by deformation momenta. The scalar deformation momenta completely encode the diffeomorphic changes in anatomical shape. In this model, the clinical measures are the response variables, while the anatomical variability is treated as the independent variable. To better understand the “shape—clinical response” relationship, we also control for demographic confounders, such as age, gender, and years of education in our regression model. We evaluate the proposed methodology on the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database using baseline structural MR imaging data and neuropsychological evaluation test scores. We demonstrate the ability of our model to quantify the anatomical deformations in units of clinical response. Our results also demonstrate that the proposed method is generic and generates reliable shape deformations both in terms of the extracted patterns and the amount of shape changes. We found that while the hippocampus and amygdala emerge as mainly responsible for changes in test scores for global measures of dementia and memory function, they are not a determinant factor for executive function. Another critical finding was the appearance of thalamus and putamen as most important regions that relate to executive function. These resulting anatomical regions were consistent with very high confidence irrespective of the size of the population used in the study. This data-driven global analysis of brain anatomy was able to reach similar conclusions as other studies in Alzheimer’s Disease based on predefined ROIs, together with the identification of other new patterns of deformation. The proposed methodology thus holds promise for discovering new patterns of shape changes in the human brain that could add to our understanding of disease progression in neurological disorders

A Non-parametric Statistical Shape Model for Assessment of the Surgically Repaired Aortic Arch in Coarctation of the Aorta: How Normal is Abnormal?

International audienceCoarctation of the Aorta (CoA) is a cardiac defect that requires surgical intervention aiming to restore an unobstructed aortic arch shape. Many patients suffer from complications post-repair, which are commonly associated with arch shape abnormalities. Determining the degree of shape abnormality could improve risk stratification in recommended screening procedures. Yet, traditional morphometry struggles to capture the highly complex arch geometries. Therefore, we use a non-parametric Statistical Shape Model based on mathematical currents to fully account for 3D global and regional shape features. By computing a template aorta of a population of healthy subjects and analysing its transformations towards CoA arch shape models using Partial Least Squares regression techniques, we derived a shape vector as a measure of subject-specific shape abnormality. Results were compared to a shape ranking by clinical experts. Our study suggests Statistical Shape Modelling to be a promising diagnostic tool for improved screening of complex cardiac defects

Modeling the brain morphology distribution in the general aging population

<p>Both normal aging and neurodegenerative diseases such as Alzheimer's disease cause morphological changes of the brain. To better distinguish between normal and abnormal cases, it is necessary to model changes in brain morphology owing to normal aging. To this end, we developed a method for analyzing and visualizing these changes for the entire brain morphology distribution in the general aging population. The method is applied to 1000 subjects from a large population imaging study in the elderly, from which 900 were used to train the model and 100 were used for testing. The results of the 100 test subjects show that the model generalizes to subjects outside the model population. Smooth percentile curves showing the brain morphology changes as a function of age and spatiotemporal atlases derived from the model population are publicly available via an interactive web application at agingbrain.bigr.nl.</p

Doctor of Philosophy

dissertationAn important aspect of medical research is the understanding of anatomy and its relation to function in the human body. For instance, identifying changes in the brain associated with cognitive decline helps in understanding the process of aging and age-related neurological disorders. The field of computational anatomy provides a rich mathematical setting for statistical analysis of complex geometrical structures seen in 3D medical images. At its core, computational anatomy is based on the representation of anatomical shape and its variability as elements of nonflat manifold of diffeomorphisms with an associated Riemannian structure. Although such manifolds effectively represent natural biological variability, intrinsic methods of statistical analysis within these spaces remain deficient at large. This dissertation contributes two critical missing pieces for statistics in diffeomorphisms: (1) multivariate regression models for cross-sectional study of shapes, and (2) generalization of classical Euclidean, mixed-effects models to manifolds for longitudinal studies. These models are based on the principle that statistics on manifold-valued information must respect the intrinsic geometry of that space. The multivariate regression methods provide statistical descriptors of the relationships of anatomy with clinical indicators. The novel theory of hierarchical geodesic models (HGMs) is developed as a natural generalization of hierarchical linear models (HLMs) to describe longitudinal data on curved manifolds. Using a hierarchy of geodesics, the HGMs address the challenge of modeling the shape-data with unbalanced designs typically arising as a result of follow-up medical studies. More generally, this research establishes a mathematical foundation to study dynamics of changes in anatomy and the associated clinical progression with time. This dissertation also provides efficient algorithms that utilize state-of-the-art high performance computing architectures to solve models on large-scale, longitudinal imaging data. These manifold-based methods are applied to predictive modeling of neurological disorders such as Alzheimer's disease. Overall, this dissertation enables clinicians and researchers to better utilize the structural information available in medical images

Recent publications from the Alzheimer's Disease Neuroimaging Initiative: Reviewing progress toward improved AD clinical trials

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 desig

Advanced Image Analysis for Modeling the Aging Brain

Both normal aging and neurodegenerative diseases such as Alzheimer’s disease (AD) cause morphological changes of the brain due to neurodegeneration. As neurodegeneration due to disease may be difficult to distinguish from that of normal aging, interpretation of magnetic resonance (MR) brain images in the context of diagnosis of neurodegenerative diseases is challenging, especially in the early stages of the disease. This thesis presented comprehensive models of the aging brain and novel computer-aided diagnosis methods, based on advanced, quantitative analysis of brain MR images, facilitating the differentiation between normal and abnormal neurodegeneration. I aimed to evaluate and develop methods for clinical decision support using features derived from MR brain images: I evaluated a classification method to predict global cognitive decline in the general population, evaluated five brain segmentation methods and developed a spatio-temporal model of morphological differences in the brain due to normal aging. To create this model I developed two novel techniques that allow performing non-rigid groupwise image registration on large imaging datasets. The novel aging brain models and computer-aided diagnosis methods facilitate the differentiation between normal and abnormal neurodegeneration. This will help in establishing more accurate diagnoses of patients, and in identifying patients at risk of developing neurodegenerative disease before symptoms emerge. In the future, the method’s performance and efficacy should be evaluated in clinical practice

Shape and function in congenital heart disease: a translational study using image, statistical and computational analyses

While medical image analysis techniques are becoming technically more advanced, analysis of shape and structure in clinical practice is often limited to two-dimensional morphometry, neglecting potentially crucial three-dimensional (3D) anatomical information provided by the original images. This thesis aims at closing this gap by combining state-of-the-art medical image analysis, engineering and data analysis tools to elucidate relationships between 3D shape features and clinically relevant functional outcomes. In particular, patient cohorts affected by congenital heart disease were studied since shape and structure of the heart and its components are crucial for diagnosis, therapy and management of those patients. At first, a statistical shape model was coupled with partial least squares regression to extract anatomical 3D shape biomarkers related to clinical parameters from cardiovascular magnetic resonance image data. After establishing a step-by-step protocol to guide the user with respect to parameter selection, results were shown to be in accordance with traditional morphometry as well as with clinical expert opinion. Novel aortic arch shape biomarkers relating to cardiac functional parameters were found in a cohort of patients post aortic coarctation repair (CoA). By combining statistical shape modelling results with computational fluid dynamics simulations, a mechanistic basis for the observed results was provided. Methods were then extended towards a hierarchical shape clustering framework, which achieved good unsupervised classification performance in a population of healthy and pathological aortic arch shapes. Applied to a cohort of CoA patients, previously unknown anatomical patterns were discovered. This thesis demonstrates that combining medical image analysis and engineering tools with data mining and statistics provides a powerful platform to detect novel shape biomarkers and patient sub-groups. Results may ultimately improve risk-stratification, treatment-planning and medical device development, thereby promoting translation of advanced computational analysis techniques into clinical practice