Statistical analysis for longitudinal MR imaging of dementia

Serial Magnetic Resonance (MR) Imaging can reveal structural atrophy in the brains of subjects with neurodegenerative diseases such as Alzheimer’s Disease (AD). Methods of computational neuroanatomy allow the detection of statistically significant patterns of brain change over time and/or over multiple subjects. The focus of this thesis is the development and application of statistical and supporting methodology for the analysis of three-dimensional brain imaging data. There is a particular emphasis on longitudinal data, though much of the statistical methodology is more general. New methods of voxel-based morphometry (VBM) are developed for serial MR data, employing combinations of tissue segmentation and longitudinal non-rigid registration. The methods are evaluated using novel quantitative metrics based on simulated data. Contributions to general aspects of VBM are also made, and include a publication concerning guidelines for reporting VBM studies, and another examining an issue in the selection of which voxels to include in the statistical analysis mask for VBM of atrophic conditions. Research is carried out into the statistical theory of permutation testing for application to multivariate general linear models, and is then used to build software for the analysis of multivariate deformation- and tensor-based morphometry data, efficiently correcting for the multiple comparison problem inherent in voxel-wise analysis of images. Monte Carlo simulation studies extend results available in the literature regarding the different strategies available for permutation testing in the presence of confounds. Theoretical aspects of longitudinal deformation- and tensor-based morphometry are explored, such as the options for combining within- and between-subject deformation fields. Practical investigation of several different methods and variants is performed for a longitudinal AD study

A comparison of Voxel compression mapping & longitudinal Voxel-Based morphometry

Clinical motivation: Serial brain imaging can reveal patterns of change over time with important clinical implications for neurodegenerative disease [1]. We investigate the performance of four analysis methods, in terms of a comparison of 20 patients with probable AD to 20 age- and sex-matched controls, characterising differences in change from baseline to later scans

Ten simple rules for reporting voxel-based morphometry studies

Voxel-based morphometry [Ashburner, J. and Friston, K.J., 2000. Voxel-based morphometry—the methods. NeuroImage 11(6 Pt 1), 805–821] is a commonly used tool for studying patterns of brain change in development or disease and neuroanatomical correlates of subject characteristics. In performing a VBM study, many methodological options are available; if the study is to be easily interpretable and repeatable, the processing steps and decisions must be clearly described. Similarly, unusual methods and parameter choices should be justified in order to aid readers in judging the importance of such options or in comparing the work with other studies. This editorial suggests core principles that should be followed and information that should be included when reporting a VBM study in order to make it transparent, replicable and useful

Longitudinal multivariate tensor- and searchlight-based morphometry using permutation testing

Tensor based morphometry [1] was used to detect statistically significant regions of neuroanatomical change over time in a comparison between 36 probable Alzheimer's Disease patients and 20 age- and sexmatched controls. Baseline and twelve-month repeat Magnetic Resonance images underwent tied spatial normalisation [10] and longitudinal high-dimensional warps were then estimated. Analyses involved univariate and multivariate data derived from the longitudinal deformation fields. The most prominent findings were expansion of the fluid spaces, and contraction of the hippocampus and temporal region. Multivariate measures were notably more powerful, and have the potential to identify patterns of morphometric difference that would be overlooked by conventional mass-univariate analysis

Diffeomorphic demons using normalized mutual information, evaluation on multimodal brain MR images

The demons algorithm is a fast non-parametric non-rigid registration method. In recent years great efforts have been made to improve the approach; the state of the art version yields symmetric inverse-consistent largedeformation diffeomorphisms. However, only limited work has explored inter-modal similarity metrics, with no practical evaluation on multi-modality data. We present a diffeomorphic demons implementation using the analytical gradient of Normalised Mutual Information (NMI) in a conjugate gradient optimiser. We report the first qualitative and quantitative assessment of the demons for inter-modal registration. Experiments to spatially normalise real MR images, and to recover simulated deformation fields, demonstrate (i) similar accuracy from NMI-demons and classical demons when the latter may be used, and (ii) similar accuracy for NMI-demons on T1w-T1w and T1w-T2w registration, demonstrating its potential in multi-modal scenarios

Evaluation of local and global atrophy measurement techniques with simulated Alzheimer's disease data

The main goal of this work was to evaluate several well-known methods which provide global (BSI and SIENA) or local (Jacobian integration) estimates of atrophy in brain structures using Magnetic Resonance images. For that purpose, we have generated realistic simulated Alzheimer's disease images in which volume changes are modelled with a Finite Element thermoelastic model, which mimic the patterns of change obtained from a cohort of 19 real controls and 27 probable Alzheimer's disease patients. SIENA and BSI results correlate very well with gold standard data (BSI mean absolute error <0.29%; SIENA <0.44%). Jacobian integration was guided by both fluid and FFD-based registration techniques and resulting deformation fields and associated Jacobians were compared, region by region, with gold standard ones. The FFD registration technique provided more satisfactory results than the fluid one. Mean absolute error differences between volume changes given by the FFD-based technique and the gold standard were: sulcal CSF <2.49%; lateral ventricles 2.25%; brain <0.36%; hippocampi <0.42%

Longitudinal Voxel-based morphometry with unified segmentation: evaluation on simulated Alzheimer’s disease

The goal of this work is to evaluate Voxel-Based Morphometry and three longitudinally-tailored methods of VBM.We use a cohort of simulated images produced by deforming original scans using a Finite Element Method, guided to emulate Alzheimer-like changes. The simulated images provide quite realistic data with a known pattern of spatial atrophy, with which VBM’s findings can be meaningfully compared. We believe this is the first evaluation of VBM for which anatomically-plausible ‘gold-standard’ results are available. The three longitudinal VBM methods have been implemented within the unified segmentation framework of SPM5; one of the techniques is a newly developed procedure, which shows promising potential

Phenomenological model of diffuse global and regional atrophy using finite-element methods

The main goal of this work is the generation of ground-truth data for the validation of atrophy measurement techniques, commonly used in the study of neurodegenerative diseases such as dementia. Several techniques have been used to measure atrophy in cross-sectional and longitudinal studies, but it is extremely difficult to compare their performance since they have been applied to different patient populations. Furthermore, assessment of performance based on phantom measurements or simple scaled images overestimates these techniques' ability to capture the complexity of neurodegeneration of the human brain. We propose a method for atrophy simulation in structural magnetic resonance (MR) images based on finite-element methods. The method produces cohorts of brain images with known change that is physically and clinically plausible, providing data for objective evaluation of atrophy measurement techniques. Atrophy is simulated in different tissue compartments or in different neuroanatomical structures with a phenomenological model. This model of diffuse global and regional atrophy is based on volumetric measurements such as the brain or the hippocampus, from patients with known disease and guided by clinical knowledge of the relative pathological involvement of regions and tissues. The consequent biomechanical readjustment of structures is modelled using conventional physics-based techniques based on biomechanical tissue properties and simulating plausible tissue deformations with finite-element methods. A thermoelastic model of tissue deformation is employed, controlling the rate of progression of atrophy by means of a set of thermal coefficients, each one corresponding to a different type of tissue. Tissue characterization is performed by means of the meshing of a labelled brain atlas, creating a reference volumetric mesh that will be introduced to a finite-element solver to create the simulated deformations. Preliminary work on the simulation of acquisition artefa- - cts is also presented. Cross-sectional and

Multiparameter MR Imaging in the 6-OPRI

BACKGROUND AND PURPOSE: Inherited prion diseases represent over 15% of human prion cases and are a frequent cause of early onset dementia. The purpose of this study was to define the distribution of changes in cerebral volumetric and microstructural parenchymal tissues in a specific inherited human prion disease mutation combining VBM with VBA of cerebral MTR and MD. MATERIALS AND METHODS: VBM and VBA of cerebral MTR and MD were performed in 16 healthy control participants and 9 patients with the 6-OPRI mutation. An analysis of covariance consisting of diagnostic grouping with age and total intracranial volume as covariates was performed. RESULTS: On VBM, there was a significant reduction in gray matter volume in patients compared with control participants in the basal ganglia, perisylvian cortex, lingual gyrus, and precuneus. Significant MTR reduction and MD increases were more anatomically extensive than volume differences on VBM in the same cortical areas, but MTR and MD changes were not seen in the basal ganglia. CONCLUSIONS: Gray matter and WM changes were seen in brain areas associated with motor and cognitive functions known to be impaired in patients with the 6-OPRI mutation. There were some differences in the anatomic distribution of MTR-VBA and MD-VBA changes compared with VBM, likely to reflect regional variations in the type and degree of the respective pathophysiologic substrates. Combined analysis of complementary multiparameter MR imaging data furthers our understanding of prion disease pathophysiology