Hui Guo1, Xiaowei Song2, Matthias H Schmidt3, Robert Vandorpe3, Zhan Yang4, Emily LeBlanc5, Jing Zhang6, Steven Beyea7, Yunting Zhang6, Kenneth Rockwood8. 1. Neuroimaging Research Laboratory, Biomedical Translational Imaging Centre, QEII-IWK Health Sciences Centre (the former National Research Council Canada's Institute for Biodiagnostics - Atlantic), Halifax, NS, Canada Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China. 2. Neuroimaging Research Laboratory, Biomedical Translational Imaging Centre, QEII-IWK Health Sciences Centre (the former National Research Council Canada's Institute for Biodiagnostics - Atlantic), Halifax, NS, Canada Department of Medicine, Dalhousie University, Halifax, NS, Canada. 3. Department of Radiology, Dalhousie University, Halifax, NS, Canada Department of Diagnostic Imaging, Capital District Health Authority, NS, Canada. 4. Neuroimaging Research Laboratory, Biomedical Translational Imaging Centre, QEII-IWK Health Sciences Centre (the former National Research Council Canada's Institute for Biodiagnostics - Atlantic), Halifax, NS, Canada Department of Biology, Crandall University, Moncton, NB, Canada. 5. Neuroimaging Research Laboratory, Biomedical Translational Imaging Centre, QEII-IWK Health Sciences Centre (the former National Research Council Canada's Institute for Biodiagnostics - Atlantic), Halifax, NS, Canada. 6. Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China. 7. Neuroimaging Research Laboratory, Biomedical Translational Imaging Centre, QEII-IWK Health Sciences Centre (the former National Research Council Canada's Institute for Biodiagnostics - Atlantic), Halifax, NS, Canada Department of Radiology, Dalhousie University, Halifax, NS, Canada School of Health Sciences, Dalhousie University, Halifax, NS, Canada. 8. Department of Medicine, Dalhousie University, Halifax, NS, Canada Centre for Healthcare of the Elderly, Capital District Health Authority, NS, Canada.
Abstract
BACKGROUND: The Brain Atrophy and Lesion Index (BALI), a semi-quantitative rating scale, has been developed to evaluate whole brain structural changes in aging and Alzheimer's disease (AD). OBJECTIVE: This study describes a standard procedure to score the BALI and train new raters for reliable BALI evaluation following this procedure. METHODS: Structural MRI of subjects in the Alzheimer's Disease Neuroimaging Initiative dataset who had 3.0T, T1, and T2 weighted MRI scans at baseline and at 6, 12, and 24 month follow-ups were retrieved (n = 122, including 24 AD, 51 mild cognitive impairment patients, and 47 healthy control subjects). Images were evaluated by four raters following training with a step-by-step BALI process. Seven domains of structural brain changes were evaluated, and a total score was calculated as the sum of the sub-scores. RESULTS: New raters achieved >90% accuracy after two weeks of training. Reliability was shown in both intra-rater correlation coefficients (ICC ≥ 0.92, p < 0.001) and inter-rater correlation coefficients (ICC ≥0.88, p < 0.001). Mean BALI total scores differed by diagnosis (F ≥ 2.69, p ≤ 0.049) and increased consistently over two years. CONCLUSION: The BALI can be introduced using a standard procedure that allows new users to achieve highly reliable evaluation of structural brain changes. This can advance its potential as a robust method for assessing global brain health in aging, AD, and mild cognitive impairment.
BACKGROUND: The Brain Atrophy and Lesion Index (BALI), a semi-quantitative rating scale, has been developed to evaluate whole brain structural changes in aging and Alzheimer's disease (AD). OBJECTIVE: This study describes a standard procedure to score the BALI and train new raters for reliable BALI evaluation following this procedure. METHODS: Structural MRI of subjects in the Alzheimer's Disease Neuroimaging Initiative dataset who had 3.0T, T1, and T2 weighted MRI scans at baseline and at 6, 12, and 24 month follow-ups were retrieved (n = 122, including 24 AD, 51 mild cognitive impairmentpatients, and 47 healthy control subjects). Images were evaluated by four raters following training with a step-by-step BALI process. Seven domains of structural brain changes were evaluated, and a total score was calculated as the sum of the sub-scores. RESULTS: New raters achieved >90% accuracy after two weeks of training. Reliability was shown in both intra-rater correlation coefficients (ICC ≥ 0.92, p < 0.001) and inter-rater correlation coefficients (ICC ≥0.88, p < 0.001). Mean BALI total scores differed by diagnosis (F ≥ 2.69, p ≤ 0.049) and increased consistently over two years. CONCLUSION: The BALI can be introduced using a standard procedure that allows new users to achieve highly reliable evaluation of structural brain changes. This can advance its potential as a robust method for assessing global brain health in aging, AD, and mild cognitive impairment.
Entities:
Keywords:
Aging; Alzheimer's disease; Brain Atrophy and Lesion Index (BALI); brain; cognition; structural MRI
Authors: Michael W Weiner; Dallas P Veitch; Paul S Aisen; Laurel A Beckett; Nigel J Cairns; Robert C Green; Danielle Harvey; Clifford R Jack; William Jagust; John C Morris; Ronald C Petersen; Andrew J Saykin; Leslie M Shaw; Arthur W Toga; John Q Trojanowski Journal: Alzheimers Dement Date: 2017-03-22 Impact factor: 21.566
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