The anteroposterior and primary-to-posterior limbic ratios as MRI-derived volumetric markers of Alzheimer's disease

• Published in: Journal of the neurological sciences Vol. 378; pp. 110 - 119
• Main Authors: Jiménez-Huete, Adolfo, Estévez-Santé, Susana
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.07.2017
• Subjects: Aged; Alzheimer disease (MeSH); Alzheimer Disease - diagnostic imaging; Atrophy; Bayes Theorem; Cognitive Dysfunction - diagnostic imaging; Cross-Sectional Studies; Diagnosis, Computer-Assisted - methods; Female; Gray Matter - diagnostic imaging; Humans; Limbic System - diagnostic imaging; Logistic Models; Magnetic resonance imaging (MeSH); Magnetic Resonance Imaging - methods; Male; Mild cognitive impairment; Neurology; Organ Size; Pattern Recognition, Automated; Reproducibility of Results; Sensitivity and Specificity; Volumetry; Mild cognitive impairment; Alzheimer disease (MeSH); Volumetry; Magnetic resonance imaging (MeSH)
• ISSN: 0022-510X; 1878-5883; 1878-5883
• DOI: 10.1016/j.jns.2017.04.046

Alzheimer's disease (AD) shows a characteristic pattern of brain atrophy, with predominant involvement of posterior limbic structures, and relative preservation of rostral limbic and primary cortical regions. We aimed to investigate the diagnostic utility of two gray matter volume ratios based on this pattern, and to develop a fully automated method to calculate them from unprocessed MRI files. Cross-sectional study of 118 subjects from the ADNI database, including normal controls and patients with mild cognitive impairment (MCI) and AD. Clinical variables and 3T T1-weighted MRI files were analyzed. Regional gray matter and total intracranial volumes were calculated with a shell script (gm_extractor) based on FSL. Anteroposterior and primary-to-posterior limbic ratios (APL and PPL) were calculated from these values. Diagnostic utility of variables was tested in logistic regression models using Bayesian model averaging for variable selection. External validity was evaluated with bootstrap sampling and a test set of 60 subjects. gm_extractor showed high test-retest reliability and high concurrent validity with FSL's FIRST. Volumetric measurements agreed with the expected anatomical pattern associated with AD. APL and PPL ratios were significantly different between groups, and were selected instead of hippocampal and entorhinal volumes to differentiate normal from MCI or cognitively impaired (MCI plus AD) subjects. APL and PPL ratios may be useful components of models aimed to differentiate normal subjects from patients with MCI or AD. These values, and other gray matter volumes, may be reliably calculated with gm_extractor. •gm_extractor is a script that allows the automated calculation of brain volumes.•Two volume ratios were designed to detect the pattern of atrophy associated with AD.•These ratios were useful to differentiate normal from cognitively impaired subjects.