MRI assessment of whole-brain structural changes in aging

Guo, Hui; Siu, William; D’Arcy, Ryan C.N.; Black, Sandra E.; Grajauskas, Lukas A.; Singh, Sonia; Zhang, Yunting; Rockwood, Kenneth; Song, Xiaowei

doi:10.2147/cia.s139515

Cited by 29 publications

(27 citation statements)

References 36 publications

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“…Subcategory scores are summed to a total score with a maximum of 25. The BALI can be rated on both 1.5T and 3T images, and images from other common clinical MRI sequences can be included to increase our ability to see specific changes . Table describes the BALI evaluation method of how images are rated.…”

Section: Content Of the Balimentioning

confidence: 99%

“…Further work validated the application of the BALI to two more types of common clinical MRI sequences and assessed which types of images could best detect specific age‐related changes. Guo et al used 3T MR images from ADNI 2 (n = 950), the National Alzheimer's Coordinating Center Uniform Data Set (n = 722), as well as a local dataset generated from multiple research protocols at a MRI center (n = 170). Scores showed a characteristic pattern across all datasets, supporting the assertion that the BALI scale can be easily applied to data collected under different protocols, and to a diverse range of participants.…”

Section: Development Of the Balimentioning

confidence: 99%

“…Scores showed a characteristic pattern across all datasets, supporting the assertion that the BALI scale can be easily applied to data collected under different protocols, and to a diverse range of participants. In this study, alongside the previously validated sequences (T1 and T2), clinical T2*GRE and T2 FLAIR images were included, while the images were examined to determine which type would most effectively reveal specific changes . The investigation revealed that T2WI are best for GM and subcortical lesions; T2FLAIR images were best for DWM and PV, and suitable for investigating the BG and GA; T1WI and T2WI are also suitable for BG and GA, and well suited for investigating malacia and others category.…”

Section: Development Of the Balimentioning

confidence: 99%

“…In addition to the fact that the BALI is based on a number of well‐validated scales, there are a number of factors that further support the validity of the BALI. The whole‐brain assessment has shown strong criterion validity, as BALI scores have a robust correlation with other measures that are associated with brain aging, such as MMSE, ADAS‐Cog scores, Montreal Cognitive Assessment (MoCA), age, AD diagnosis, MTAS, and these patterns appear across multiple datasets, and in a diverse set of participants …”

Section: Bali Validationsmentioning

confidence: 99%

“…Some of these, such as atrophy and white matter lesions, are well recognized as markers of cognitive decline and dementia, and others, such as dilated perivascular spaces and microvascular changes, have received less attention . While most literature has focused on evaluating the impact of each of these changes, a number of studies have noted that certain changes are more likely to occur in tandem and can combine to increase the risk of cognitive decline and dementia . This makes intuitive sense.…”

Section: Introductionmentioning

confidence: 99%

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Toward MRI‐based whole‐brain health assessment: The brain atrophy and lesion index (BALI)

et al. 2018

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There have been many attempts to assess the elements of age-and dementia-related neurodegenerative changes in the brain using MRI; however, traditionally assessments focus only on single deficit. Over the past few years, our group has worked to create and validate the Brain Atrophy and Lesion Index (BALI) as an MRI-based whole-brain structural degeneration rating scale. The BALI can be used for applications in aging and dementia across the entire brain and can be applied to common clinical MR images. As a whole-brain structural health assessment, the BALI gives a more representative picture of how the brain ages. During the aging process, multiple elements of degeneration accumulate and interact to overwhelm repair processes and cause high-level failure in the function of the brain. To reflect this process, the BALI combines the assessment of several neurodegeneration changes into one scale. The BALI evaluation can be performed quickly and has been validated for use by nonneuroradiology expert raters trained with the method. This review gives a brief overview of the content of the BALI; covers the development, refinement, and application of the method; and provides insights about future development and clinical implementation of MRI-based whole-brain health assessment in aging and dementia. K E Y W O R D SAlzheimer's disease, brain aging, brain atrophy and lesion index, dementia, magnetic resonance imaging 1 | INTRODUCTION As we age, structural degeneration occurs throughout the brain.These degenerative changes are nearly inescapable; they are seen in normal aging, and with increased severity in individuals with dementia and cognitive decline. 1-4 Some of these, such as atrophy and white matter lesions, are well recognized as markers of cognitive decline and dementia, 5,6 and others, such as dilated perivascular spaces and microvascular changes, have received less attention. 1 While most literature has focused on evaluating the impact of each of these changes, a number of studies have noted that certain changes are more likely to occur in tandem and can combine to increase the risk of cognitive decline and dementia. 7-10 This makes intuitive sense. As a complex and interconnected system, the activities of the brain can be disrupted not only by a large insult, but also by diffuse damage from multiple smaller deficits across subsystems. While the individual effect of each of these small changes may be minor, their combined impact can cumulate to produce negative outcomes in the higherlevel functions of the brain. While research has pointed to this cumulative impact of small changes on general health, 11 a standardized methodology for assessing neurodegenerative changes across the entire brain is yet to be established.Even though it has not been extensively utilized to address this specific problem, magnetic resonance imaging (MRI) is a superb ---This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provide...

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Section: Content Of the Balimentioning

confidence: 99%

Section: Development Of the Balimentioning

confidence: 99%

Section: Development Of the Balimentioning

confidence: 99%

Section: Bali Validationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Toward MRI‐based whole‐brain health assessment: The brain atrophy and lesion index (BALI)

et al. 2018

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Association of Brain Atrophy and Masseter Sarcopenia With 1-Year Mortality in Older Trauma Patients

et al. 2019

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IMPORTANCE Older adults are disproportionately affected by trauma and accounted for 47% of trauma fatalities in 2016. In many populations and disease processes, described risk factors for poor clinical outcomes include sarcopenia and brain atrophy, but these remain to be fully characterized in older trauma patients. Sarcopenia and brain atrophy may be opportunistically evaluated via head computed tomography, which is often performed during the initial trauma evaluation. OBJECTIVE To investigate the association of masseter sarcopenia and brain atrophy with 1-year mortality among trauma patients older than 65 years by using opportunistic computed tomography imaging. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted in a level 1 trauma center from January 1, 2011, to December 31, 2014, with a 1-year follow-up to assess mortality. Washington state residents 65 years or older who were admitted to the trauma intensive care unit with a head Abbreviated Injury Scale score of less than 3 were eligible. Patients with incomplete data and death within 1 day of admission were excluded. Data analysis was completed from June 2017 to October 2018. EXPOSURES Masseter muscle cross-sectional area and brain atrophy index were measured using a standard clinical Picture Archiving and Communication System application to assess for sarcopenia and brain atrophy, respectively. MAIN OUTCOMES AND MEASURES Primary outcome was 1-year mortality. Secondary outcomes were discharge disposition and 30-day mortality. RESULTS The study cohort included 327 patients; 72 (22.0%) had sarcopenia only, 71 (21.7%) had brain atrophy only, 92 (28.1%) had both, and 92 (28.1%) had neither. The mean (SD) age was 77.8 (8.6) years, and 159 patients (48.6%) were women. After adjustment for age, comorbidity, complications, and injury characteristics, masseter sarcopenia and brain atrophy were both independently and cumulatively associated with mortality (masseter muscle cross-sectional area per SD less than the mean: hazard ratio, 2.0 [95% CI, 1.2-3.1]; P = .005; brain atrophy index per SD greater than the mean: hazard ratio, 2.0 [95% CI, 1.1-3.5]; P = .02). CONCLUSIONS AND RELEVANCE Masseter muscle sarcopenia and brain atrophy were independently and cumulatively associated with 1-year mortality in older trauma patients after adjustment for other clinical factors. These radiologic indicators are easily measured opportunistically through standard imaging software. The results can potentially guide conversations regarding prognosis and interventions with patients and their families.

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Reliability of the MRI‐based Brain Atrophy and Lesion Index in the evaluation of whole‐brain structural health

Guo

Song

2018

Aging Medicine

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BackgroundThe Brain Atrophy and Lesion Index (BALI), which evaluates several common aging‐related MRI changes in combination, has been validated as a feasible method to assess the status of structural brain health. Previous studies have been based primarily on older participants and high‐field MRI. Here, we tested the generalizability of the BALI by examining its measurement properties in a wide age range at both high and conventional MRI field strengths.MethodsSubjects (n = 229) who had T2WI at either 1.5T or 3.0T were grouped into younger (age ≤ 60 years) and older (age > 60 years) groups. Image evaluation and scoring were performed independently by two experienced neuroradiologists who have mastered the BALI method. Inter‐ and intrarater agreement rates were examined comparing age groups and field strengths.ResultsThe intraclass correlation coefficient for the BALI total score was consistently high under each experimental condition (interrater ICC ≥ 0.92, 95% CI: 0.84‐0.96), with no statistical difference between age groups (Fisher Z = 1.43) or field strengths (Z = 0.60). The reliability for BALI category subscores ranged between moderate and perfect (eg, 0.85 vs 0.57 for GA), similar for both age groups and typically greater at 3.0T than at 1.5T.ConclusionThe BALI based on T2WI can be reliably applied to the evaluation of the whole‐brain health of both younger and older adults at both field strengths, even though high‐field MRI is preferable.

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MRI assessment of whole-brain structural changes in aging

Cited by 29 publications

References 36 publications

Toward MRI‐based whole‐brain health assessment: The brain atrophy and lesion index (BALI)

Toward MRI‐based whole‐brain health assessment: The brain atrophy and lesion index (BALI)

Association of Brain Atrophy and Masseter Sarcopenia With 1-Year Mortality in Older Trauma Patients

Reliability of the MRI‐based Brain Atrophy and Lesion Index in the evaluation of whole‐brain structural health

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