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. 2017 Jul 15:378:110-119.
doi: 10.1016/j.jns.2017.04.046. Epub 2017 Apr 27.

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

Adolfo Jiménez-Huete  1 , Susana Estévez-Santé  2 ; ADNI group
Affiliations

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

Adolfo Jiménez-Huete et al. J Neurol Sci. .

Abstract

Background/aims: 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.

Patients and methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Alzheimer disease (MeSH); Magnetic resonance imaging (MeSH); Mild cognitive impairment; Volumetry.

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Conflict of interest statement

Conflict of Interest/Disclosure Statement

AJH and SES have no conflict of interest to report.

Figures

Figure 1
Figure 1
Pipeline of brain MRI analysis. TIV: total intracranial volume.
Figure 2
Figure 2
Comparison of the hippocampal volumes in mL calculated with gm_extractor and SNT (upper row) or FIRST (lower row). Left panels are scatter plots with linear regression lines. Right panels are Bland-Altman plots, where the dotted lines represent the mean difference between methods, and the dashed lines correspond to the limits of agreement (±1.96*standard deviation of differences).
Figure 3
Figure 3
Boxplots of the normalized volumes of posterior limbic structures and anteroposterior and primary-to-posterior limbic ratios (APL and PPL) according to clinical group.
Figure 4
Figure 4
Boxplots of the normalized volumes of primary cortical regions (upper row) and rostral limbic structures (lower row) according to clinical group.
Figure 5
Figure 5
Receiver operating characteristic (ROC) curves of logistic regression models designed to differentiate the clinical groups in four contexts.
See this image and copyright information in PMC

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