Quantitative Mri Biomarkers Of Neurodegenerative Diseases: Moving From Scientific Insights Toward Clinical Practice

OBJECTIVE: To illustrate the use of quantitative MRI biomarkers in a series of cases from a subspecialty academic medical center practice of patients with neurodegenerative diseases. BACKGROUND: Patients with Alzheimer9s disease, Frontotemporal Dementia, Posterior Cortical Atrophy, and other neurodegenerative diseases may present diagnostic challenges to the neurologist, especially early in their course or in atypical cases. Although a brain MRI scan is usually obtained in the evaluation of patients suspected of having these conditions, at present most clinical practices visually inspect these scans but do not routinely perform quantitative analyses to try to identify abnormalities of brain structure. DESIGN/METHODS: Employing publicly available software (FreeSurfer), we developed a method to apply this suite of software tools to MRI scans obtained in our clinical practice and produce quantitative reports of brain structure readable by clinicians, producing Z scores across the cerebral cortex and for specific subcortical brain structures which are used to identify abnormalities. We then compare the spatial patterns of abnormal brain structure to “disease signature” patterns from groups of individuals with neurodegenerative diseases. RESULTS: In many patients, the quantitative maps of cortical atrophy and other abnormalities in brain structure are consistent with known patterns of one of the neurodegenerative diseases. In some cases, abnormalities were subtle enough that they were not confidently identified from visual inspection of MRI scans but were readily detectable from quantitative analysis. CONCLUSIONS: Our findings underscore the potential value of quantitative analysis of MRI scans in clinical practice as part of the diagnostic evaluation of patients with neurodegenerative diseases. Further work is in progress to compare these findings with FDG-PET and to analyze MRI scans from patients with molecular markers of neuropathology. Supported by: Grants from the NINDS (R21 NS077059), the NIA (R01 AG0323065; P50-AG005134), and the Alzheimer9s Association. Disclosure: Dr. Dickerson has received personal compensation for activities with Pfizer Inc and En Vivo as a consultant. Dr. Domoto-Reilly has received research support from TauRX. Dr. Hollenbeck has nothing to disclose. Dr. Sapolsky has nothing to disclose. Dr. Brickhouse has nothing to disclose.