Aging Brain - Dementia


Purpose

Detecting different patterns of brain atrophy which can be helpful for diagnosis the underlying etiology of dementia

Tag(s)


Panel

Neuro

Define-AI ID

19020013

Originator

Houman Sotoudeh MD

Lead

Houman Sotoudeh MD

Panel Chair

Alex Norbash, MD

Panel Reviewers

Neuro Panel

License

Creative Commons 4.0 

Status

Public Comment

RadElement Set RDES116 

Clinical Implementation


Value Proposition

The number of people surviving into their 80s and beyond is expected to grow dramatically and it is expected to contain up to 20% of the total population by 2030. As the number of older people grows rapidly, neurodegenerative diseases and brain diseases associated with aging are also expected to rise significantly.  It is obvious that there will be a significant increase in imaging of the aging brain. The goal of this use case is to collect a large data set of brain imaging from healthy old population and patients with dementia. This use case then can be used to train different AI algorithms to detect different patterns of brain atrophy which can be helpful for diagnosis the underlying etiology of dementia. 

Most grading systems of brain volume loss are subjective with low inter and intra observer agreement. The value of this use case is to train AI models to detect the brain atrophy, calculate the brain volume, calculate the volume of each brain structure , determine the atrophy grading system and suggest the possible cause of dementia.

Narrative(s)

 An 80 year old man presents to the neurology clinic with slow onset cognitive decline, imbalance and abnormal gait. As a work up the neurologist orders the brain MRI with dementia protocol. The general radiologist who reports this MRI detects mild general volume loss and grade I atrophy of hippocampi but misses atrophy of midbrain. The diagnosis of progressive supra-nuclear palsy is missed in this patient because it is a rare condition and the radiologist has limited experience in this field. 

Workflow Description

To collect the high resolution T1 and FLAIR brain images in healthy old population as well as patients with different types of dementia. The images will be annotated by expert neuroradiologists regarding different grades of regional brain atrophy and presence of typical imaging pictures of dementia. In addition, the total brain volume,  volume of CSF and ventricles and volume of different brain structures such as hippocampi are documented.

Considerations for Dataset Development


Age: varied

Sex at birth: male, femal

Global cortical atrophy (GCA) scale: varied

Medial Temporal atrophy score: varied

Posterior Parietal Atrophy score ( Koedman Score): varied

Presence of Frontotemporal atrophy: absent, present

Presence of midbrain atrophy: absent, present

Presence of Caudate head atrophy: absent, present

Presence of cerebellar atrophy: absent, present

Estimation of Total brain Volume and comparison with normal cohort: varied

Estimation of CSF volume and comparison with normal cohort: varied

Estimation of Ventricular system volume and comparison with normal cohort: varied

Estimation of Volume of especial brain structures such as hippocampi, frontal lobes, temporal lobes, etc and comparison with normal cohort: varied

Fzekas Scale (from FLAIR sequence): varied


Technical Specifications


Inputs

 

DICOM Study


Procedure

MRI: 3D T1, 3D FLAIR

Views

all

Data Type

DICOM

Modality

MRI

Body Region

Head

Anatomic Focus

Brain



Primary Outputs

 

Global Cortical atrophy (GCA) scale

RadElement ID

RDE749

Definition

System to assess cerebral atrophy, especially in the context of neurodegenerative diseases.

Data Type

Numeric

Value Set

[0,3]

Units

N/A


Medial Temporal atrophy score

RadElement ID

RDE760

Definition

Visual score of the brain using coronal T1 weighted images through the hippocampus at the level of the anterior pons, based on width of the choroid fissure, width of the temporal horn of the lateral ventricle, and height of the hippocampus.

Data Type

Categorical

Value Set

  • no CSF is visible around the hippocampus
  • choroid fissure is slightly widened
  • moderate widening of the choroid fissure, mild enlargement of the temporal horn and mild loss of hippocampal height
  • marked widening of the choroid fissure, moderate enlargement of the temporal horn, and moderate loss of hippocampal height
  • marked widening of the choroid fissure, marked enlargement of the temporal horn, and the hippocampus is markedly atrophied and internal structure is lost

Units

N/A

 

Posterior Parietal Atrophy score (Koedman Score)

RadElement ID

RDE750

Definition

Visual rating scale to measure atrophy in the posterior regions

Data Type

Categorical

Value Set

[0,3]

Units

N/A


Presence of Frontotemporal atrophy

RadElement ID

RDE761

Definition

Shrinkage of the frontotemporal lobes

Data Type

Categorical

Value Set

  • Absent
  • Present
  • Unknown

Units

N/A


Presence of midbrain atrophy

RadElement ID

RDE762

Definition

Shrinkage of the midbrain

Data Type

Categorical

Value Set

  • Absent
  • Present
  • Unknown

Units

N/A


Presence of Caudate head atrophy

RadElement ID

RDE763

Definition

Shrinkage of the caudate head

Data Type

Categorical

Value Set

  • Absent
  • Present
  • Unknown

Units

N/A


Presence of cerebellar atrophy

RadElement ID

RDE764

Definition

Shrinkage of the cerebellar lobe

Data Type

Categorical

Value Set

  • Absent
  • Present
  • Unknown

Units

N/A



Total brain volume

RadElement ID

RDE751

Definition

Measure total brain volume. Compare this value to normal cohort.

Data Type

Numeric

Value Set

N/A

Units

mm3

CSF Volume

RadElement ID

RDE750

Definition

Measure cerebrospinal volume. Compare this value to normal cohort.

Data Type

Numeric

Value Set

N/A

Units

mm3

Ventricular system volume

RadElement ID

RDE752

Definition

Measure ventricular system volume. Compare this value to normal cohort.

Data Type

Numeric

Value Set

N/A

Units

mm3

 

Hippocampi volume

RadElement ID

RDE753

Definition

Measure hippocampi volume. Compare this value to normal cohort.

Data Type

Numeric

Value Set

N/A

Units

mm3

Frontal lobes volume

RadElement ID

RDE754

Definition

Measure frontal lobes volume. Compare this value to normal cohort.

Data Type

Numeric

Value Set

N/A

Units

mm3

 

Temporal lobes volume

RadElement ID

RDE755

Definition

Measure temporal lobes volume

Data Type

Numeric

Value Set

N/A

Units

mm3


Fzekas Scale (from FLAIR sequence)

RadElement ID

RDE756

Definition

Summing the periventricular and deep white matter scores

Data Type

Numeric

Value Set

[0,6]

Units

N/A

Future Development Ideas


  • Besides improving the accuracy of radiology reports, this use case can help the researcher to design better clinical trials by selecting similar patients.