Standardized Assessment of Automatic Segmentation of White Matter Hyperintensities and Results of the WMH Segmentation Challenge

Quantification of cerebral white matter hyperintensities (WMH) of presumed vascular origin is of key importance in many neurological research studies. Currently, measurements are often still obtained from manual segmentations on brain MR images, which is a laborious procedure. The automatic WMH segmentation methods exist, but a standardized comparison of the performance of such methods is lacking. We organized a scientific challenge, in which developers could evaluate their methods on a standardized multi-center/-scanner image dataset, giving an objective comparison: the WMH Segmentation Challenge. Sixty T1 + FLAIR images from three MR scanners were released with the manual WMH segmentations for training. A test set of 110 images from five MR scanners was used for evaluation. The segmentation methods had to be containerized and submitted to the challenge organizers. Five evaluation metrics were used to rank the methods: 1) Dice similarity coefficient; 2) modified Hausdorff distance (95th percentile); 3) absolute log-transformed volume difference; 4) sensitivity for detecting individual lesions; and 5) F1-score for individual lesions. In addition, the methods were ranked on their inter-scanner robustness; 20 participants submitted their methods for evaluation. This paper provides a detailed analysis of the results. In brief, there is a cluster of four methods that rank significantly better than the other methods, with one clear winner. The inter-scanner robustness ranking shows that not all the methods generalize to unseen scanners. The challenge remains open for future submissions and provides a public platform for method evaluation

Effects of cerebral small vessel disease in the brain beyond the visible lesions

Diseases of the brain’s small blood vessels (cerebral small vessel disease or SVD) are common. SVD is one of the major causes of stroke and dementia. Brain damage due to SVD can be seen on a normal MRI-scan. However, it seems that SVD does more to the brain than what can be seen with the naked eye on a normal MRI-scan. This ‘invisible’ brain damage can be measured using advanced techniques. Detecting ‘invisible’ brain damage offers the possibility to look at the disease process SVD in a different way. In my thesis I have used two different and very sensitive techniques to measure changes in both the gray and the white matter of the brain in patients with SVD. I used these techniques in patients presenting at a memory clinic. My thesis shows that patients with SVD indeed have more brain damage than what can be seen on a normal MRI-scan, namely brain shrinkage and a disruption of the brain network. This ‘invisible’ brain damage can better explain the functional impact of SVD than the visible brain damage alone, as we showed that an increase in visible brain damage due to SVD related to worse cognitive performance through the disruption of the brain network. Measuring and reporting the total amount of brain damage due to SVD can be of added value in a memory clinic, as it can help patients and their caregivers to better understand the impact of SVD on their daily functioning

Occurrence of Impaired Physical Performance in Memory Clinic Patients with Cerebral Small Vessel Disease

Cerebral small vessel disease (CSVD) occurs often in memory clinic patients. Apart from cognitive deficits, these patients can express physical decline, which predicts adverse health outcomes. In this study, we investigated the cooccurrence of clinically relevant impairments in physical performance and CSVD in memory clinic patients. We included 131 patients with vascular brain injury, mild cognitive impairment or Alzheimer disease with available 3T MRI and physical performance scores. CSVD was visually rated according to 3 subtypes and as a total burden score, composed of the presence of white matter hyperintensities (WMH), lacunar infarcts (LI), and cerebral microbleeds (MB). Physical performance was assessed with the Short Physical Performance Battery (SPPB), covering gait speed, balance, and chair stand performance. CSVD markers and impaired physical performance both occurred often. High total CSVD burdens cooccurred with impaired chair stand performances [odds ratio (OR) 2.67; 95% confidence interval (CI) (1.12-6.34)]. WMH cooccurred with impaired SPPB scores (OR, 3.76; 95% CI, 1.68-8.44), impaired gait speeds (OR, 4.11; 95% CI, 1.81-9.31) and impaired chair stand performances (OR, 5.62; 95% CI, 2.29-13.80). In memory clinic patients, high burdens of CSVD, particularly WMH, often cooccur with impairments in physical performance. The presence of WMH should alert clinicians to the presence of these, clinically relevant, physical impairments

Honey and honey-based sugars partially affect reproductive trade-offs in parasitoids exhibiting different life-history and reproductive strategies

Adult dietary regimes in insects may affect egg production, fecundity and ultimately fitness. This is especially relevant in parasitoid wasps where many species serve as important biological control agents of agricultural pests. Here, we tested the effect of honey and sugar diets on daily fecundity schedules, lifetime reproductive success and longevity in four species of parasitoid wasps when reared on their respective hosts. The parasitoid species were selected based on dichotomies in host usage strategies and reproductive traits. Gelis agilis and G. areator are idiobiont ecto-parasitoids that develop in non-growing hosts, feed on protein-rich host fluids to maximize reproduction as adults and produce small numbers of large eggs. Meteorus pulchricornis and Microplitis mediator are koinobiont endoparasitoids that develop inside the bodies of growing hosts, do not host-feed, and produce greater numbers of small eggs. Parasitoids were reared on diets of either pure honey (containing trace amounts of proteins), heated honey (with denatured proteins) and a honey-mimic containing sugars only. We hypothesized that the benefits of proteins in honey would enhance reproduction in the ectoparasitoids due to their high metabolic investment per egg, but not in the koinobionts. Pure honey diet resulted in higher lifetime fecundity in G. agilis compared with the honey-mimic, whereas in both koinobionts, reproductive success did not vary significantly with diet. Longevity was less affected by diet in all of the parasitoids, although there were variable trade-offs between host access and longevity in the four species. We argue that there are both trait-based and association-specific effects of supplementary nutrients in honey on reproductive investment and success in parasitoid wasps

The cumulative effect of small vessel disease lesions is reflected in structural brain networks of memory clinic patients

Background and purpose: Mechanisms underlying cognitive impairment in patients with small vessel disease (SVD) are still unknown. We hypothesized that cognition is affected by the cumulative effect of multiple SVD-related lesions on brain connectivity. We therefore assessed the relationship between the total SVD burden on MRI, global brain network efficiency, and cognition in memory clinic patients with vascular brain injury. Methods: 173 patients from the memory clinic of the University Medical Center Utrecht underwent a 3 T brain MRI scan (including diffusion MRI sequences) and neuropsychological testing. MRI markers for SVD were rated and compiled in a previously developed total SVD score. Structural brain networks were reconstructed using fiber tractography followed by graph theoretical analysis. The relationship between total SVD burden score, global network efficiency and cognition was assessed using multiple linear regression analyses. Results: Each point increase on the SVD burden score was associated with 0.260 [-0.404 - -0.117] SD units decrease of global brain network efficiency ( p < .001). Global network efficiency was associated with information processing speed (standardized B = -0.210, p = .004) and attention and executive functioning (B = 0.164, p = .042), and mediated the relationship between SVD burden and information processing speed ( p = .027) but not with executive functioning ( p = .12). Conclusion: Global network efficiency is sensitive to the cumulative effect of multiple manifestations of SVD on brain connectivity. Global network efficiency may therefore serve as a useful marker for functionally relevant SVD-related brain injury in clinical trials

Parietal Involvement in Constructional Apraxia as Measured Using the Pentagon Copying Task

Deficits in copying ("constructional apraxia") is generally defined as a multifaceted deficit. The exact neural correlates of the different types of copying errors are unknown. To assess whether the different categories of errors on the pentagon drawing relate to different neural correlates, we examined the pentagon drawings of the MMSE in persons with subjective cognitive complaints, mild cognitive impairment, or early dementia due to Alzheimer's disease. We adopted a qualitative scoring method for the pentagon copy test (QSPT) which categorizes different possible errors in copying rather than the dichotomous categories "correct" or "incorrect." We correlated (regional) gray matter volumes with performance on the different categories of the QSPT. Results showed that the total score of the QSPT was specifically associated with parietal gray matter volume and not with frontal, temporal, and occipital gray matter volume. A more fine-grained analysis of the errors reveals that the intersection score and the number of angles share their underlying neural correlates and are associated with specific subregions of the parietal cortex. These results are in line with the idea that constructional apraxia can be attributed to the failure to integrate visual information correctly from one fixation to the next, a process called spatial remapping

Robustness of Automated Methods for Brain Volume Measurements across Different MRI Field Strengths

<div><p>Introduction</p><p>Pooling of multicenter brain imaging data is a trend in studies on ageing related brain diseases. This poses challenges to MR-based brain segmentation. The performance across different field strengths of three widely used automated methods for brain volume measurements was assessed in the present study.</p><p>Methods</p><p>Ten subjects (mean age: 64 years) were scanned on 1.5T and 3T MRI on the same day. We determined robustness across field strength (i.e., whether measured volumes between 3T and 1.5T scans in the same subjects were similar) for SPM12, Freesurfer 5.3.0 and FSL 5.0.7. As a frame of reference, 3T MRI scans from 20 additional subjects (mean age: 71 years) were segmented manually to determine accuracy of the methods (i.e., whether measured volumes corresponded with expert-defined volumes).</p><p>Results</p><p>Total brain volume (TBV) measurements were robust across field strength for Freesurfer and FSL (mean absolute difference as % of mean volume ≤ 1%), but less so for SPM (4%). Gray matter (GM) and white matter (WM) volume measurements were robust for Freesurfer (1%; 2%) and FSL (2%; 3%) but less so for SPM (5%; 4%). For intracranial volume (ICV), SPM was more robust (2%) than FSL (3%) and Freesurfer (9%). TBV measurements were accurate for SPM and FSL, but less so for Freesurfer. For GM volume, SPM was accurate, but accuracy was lower for Freesurfer and FSL. For WM volume, Freesurfer was accurate, but SPM and FSL were less accurate. For ICV, FSL was accurate, while SPM and Freesurfer were less accurate.</p><p>Conclusion</p><p>Brain volumes and ICV could be measured quite robustly in scans acquired at different field strengths, but performance of the methods varied depending on the assessed compartment (e.g., TBV or ICV). Selection of an appropriate method in multicenter brain imaging studies therefore depends on the compartment of interest.</p></div

Accuracy of automated volume measurements (n = 20).

<p>Accuracy of automated volume measurements (n = 20).</p

Summary of robustness across field strength and accuracy results.

<p>Summary of robustness across field strength and accuracy results.</p