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. 2025 Oct;63(10):2943-2953.
doi: 10.1007/s11517-025-03366-2. Epub 2025 May 8.

Using baseline MRI radiomic features to predict the efficacy of repetitive transcranial magnetic stimulation in Alzheimer's patients

Chandan Saha  1 , Chase R Figley  2 , Brian Lithgow  3   4 , Xikui Wang  5 , Paul B Fitzgerald  6 , Lisa Koski  7 , Behzad Mansouri  8 , Zahra Moussavi  3   4
Affiliations

Using baseline MRI radiomic features to predict the efficacy of repetitive transcranial magnetic stimulation in Alzheimer's patients

Chandan Saha et al. Med Biol Eng Comput. 2025 Oct.

Abstract

The efficacy of repetitive transcranial magnetic stimulation (rTMS) as a treatment for Alzheimer's disease (AD) is uncertain at baseline. Herein, we aimed to investigate whether radiomic features from the pre-treatment MRI data could predict rTMS efficacy for AD treatment. Out of 110 participants with AD in the active (n = 75) and sham (n = 35) rTMS treatment groups having T1-weighted brain MRI data, we had two groups of responders (active = 55 and sham = 24) and non-responders (active = 20 and sham = 11). We extracted histogram-based radiomic features from MRI data using 3D Slicer software; the most important features were selected utilizing a combination of a two-sample t-test, correlation test, least absolute shrinkage, and selection operator. The support vector machine classified rTMS responders and non-responders with a cross-validated mean accuracy/AUC of 81.9%/90.0% in the active group and 87.4%/95.8% in the sham group. Further, the radiomic features of the active group significantly correlated with participants' AD assessment scale-cognitive subscale (ADAS-Cog) change after treatment (false discovery rate corrected p < 0.05). Given that baseline radiomic features were able to accurately predict AD patients' responses to rTMS treatment, these radiomic features warrant further investigation for personalizing AD therapeutic strategies.

Keywords: Alzheimer’s disease; Efficacy prediction; Magnetic resonance imaging; Radiomic features; Repetitive transcranial magnetic stimulation.

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Conflict of interest statement

Declarations. Competing interests: In the last 3 years, the coauthor, P.B.F., has received equipment for research from Neurosoft and Nexstim. He has served on a scientific advisory board for Magstim and received speaker fees from Otsuka. He has also acted as a founder and board member for TMS Clinics Australia and Resonance Therapeutics. P.B.F. is supported by a National Health and Medical Research Council of Australia Investigator grant (1193596). For other authors, there is no conflict of interest.

References

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