Abstract
Brain volumetric software is increasingly suggested for clinical routine. The present study quantifies the agreement across different software applications. Ten cases with and ten gender- and age-adjusted healthy controls without hippocampal atrophy (median age: 70; 25–75% range: 64–77 years and 74; 66–78 years) were retrospectively selected from a previously published cohort of Alzheimer’s dementia patients and normal ageing controls. Hippocampal volumes were computed based on 3 Tesla T1-MPRAGE-sequences with FreeSurfer (FS), Statistical-Parametric-Mapping (SPM; Neuromorphometrics and Hammers atlases), Geodesic-Information-Flows (GIF), Similarity-and-Truth-Estimation-for-Propagated-Segmentations (STEPS), and Quantib™. MTA (medial temporal lobe atrophy) scores were manually rated. Volumetric measures of each individual were compared against the mean of all applications with intraclass correlation coefficients (ICC) and Bland–Altman plots. Comparing against the mean of all methods, moderate to low agreement was present considering categorization of hippocampal volumes into quartiles. ICCs ranged noticeably between applications (left hippocampus (LH): from 0.42 (STEPS) to 0.88 (FS); right hippocampus (RH): from 0.36 (Quantib™) to 0.86 (FS). Mean differences between individual methods and the mean of all methods [mm3] were considerable (LH: FS −209, SPM-Neuromorphometrics −820; SPM-Hammers −1474; Quantib™ −680; GIF 891; STEPS 2218; RH: FS −232, SPM-Neuromorphometrics −745; SPM-Hammers −1547; Quantib™ −723; GIF 982; STEPS 2188). In this clinically relevant sample size with large spread in data ranging from normal aging to severe atrophy, hippocampal volumes derived by well-accepted applications were quantitatively different. Thus, interchangeable use is not recommended.
Highlights
Assessment of atrophy aids in distinguishing clinically and cognitively deteriorating subjects and allows prediction of those who will have a less favorable clinical outcome in various neurological diseases [1]
One subject could not be processed with QuantibTM due to software-related reasons but was otherwise assessed with all other applications
The differentiation between the two groups via quartile ratings was best reproduced by STEPS and medial temporal lobe atrophy (MTA) scores
Summary
Assessment of atrophy aids in distinguishing clinically and cognitively deteriorating subjects and allows prediction of those who will have a less favorable clinical outcome in various neurological diseases [1]. The measurement of atrophy in routine clinical practice remains an unmet need While these applications have repeatedly been shown to be highly consistent within themselves when applied repeatedly to the same MRI acquisition, consistency has remained less clear when the same subject is scanned twice within the same imaging session using similar MRI parameters [6]. Even more, and this point is most relevant for consistency across both clinical care providers and across research groups, their relative performance against each other is rarely investigated. For reasons of availability of cerebral regions segmented by all included applications, the analyses of the present study were limited to the hippocampus
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