Early brain development in infants at high risk for autism spectrum disorder.

Brain enlargement has been observed in children with autism spectrum disorder (ASD), but the timing of this phenomenon, and the relationship between ASD and the appearance of behavioural symptoms, are unknown. Retrospective head circumference and longitudinal brain volume studies of two-year olds followed up at four years of age have provided evidence that increased brain volume may emerge early in development. Studies of infants at high familial risk of autism can provide insight into the early development of autism and have shown that characteristic social deficits in ASD emerge during the latter part of the first and in the second year of life. These observations suggest that prospective brain-imaging studies of infants at high familial risk of ASD might identify early postnatal changes in brain volume that occur before an ASD diagnosis. In this prospective neuroimaging study of 106 infants at high familial risk of ASD and 42 low-risk infants, we show that hyperexpansion of the cortical surface area between 6 and 12 months of age precedes brain volume overgrowth observed between 12 and 24 months in 15 high-risk infants who were diagnosed with autism at 24 months. Brain volume overgrowth was linked to the emergence and severity of autistic social deficits. A deep-learning algorithm that primarily uses surface area information from magnetic resonance imaging of the brain of 6-12-month-old individuals predicted the diagnosis of autism in individual high-risk children at 24 months (with a positive predictive value of 81% and a sensitivity of 88%). These findings demonstrate that early brain changes occur during the period in which autistic behaviours are first emerging.

Temporal Lobe Epilepsy Surgical Outcomes Can Be Inferred Based on Structural Connectome Hubs: A Machine Learning Study.

OBJECTIVE: Medial temporal lobe epilepsy (TLE) is the most common form of medication-resistant focal epilepsy in adults. Despite removal of medial temporal structures, more than one-third of patients continue to have disabling seizures postoperatively. Seizure refractoriness implies that extramedial regions are capable of influencing the brain network and generating seizures. We tested whether abnormalities of structural network integration could be associated with surgical outcomes. METHODS: Presurgical magnetic resonance images from 121 patients with drug-resistant TLE across 3 independent epilepsy centers were used to train feed-forward neural network models based on tissue volume or graph-theory measures from whole-brain diffusion tensor imaging structural connectomes. An independent dataset of 47 patients with TLE from 3 other epilepsy centers was used to assess the predictive values of each model and regional anatomical contributions toward surgical treatment results. RESULTS: The receiver operating characteristic area under the curve based on regional betweenness centrality was 0.88, significantly higher than a random model or models based on gray matter volumes, degree, strength, and clustering coefficient. Nodes most strongly contributing to the predictive models involved the bilateral parahippocampal gyri, as well as the superior temporal gyri. INTERPRETATION: Network integration in the medial and lateral temporal regions was related to surgical outcomes. Patients with abnormally integrated structural network nodes were less likely to achieve seizure freedom. These findings are in line with previous observations related to network abnormalities in TLE and expand on the notion of underlying aberrant plasticity. Our findings provide additional information on the mechanisms of surgical refractoriness. ANN NEUROL 2020;88:970-983.

The ENIGMA-Epilepsy working group: Mapping disease from large data sets.

Epilepsy is a common and serious neurological disorder, with many different constituent conditions characterized by their electro clinical, imaging, and genetic features. MRI has been fundamental in advancing our understanding of brain processes in the epilepsies. Smaller-scale studies have identified many interesting imaging phenomena, with implications both for understanding pathophysiology and improving clinical care. Through the infrastructure and concepts now well-established by the ENIGMA Consortium, ENIGMA-Epilepsy was established to strengthen epilepsy neuroscience by greatly increasing sample sizes, leveraging ideas and methods established in other ENIGMA projects, and generating a body of collaborating scientists and clinicians to drive forward robust research. Here we review published, current, and future projects, that include structural MRI, diffusion tensor imaging (DTI), and resting state functional MRI (rsfMRI), and that employ advanced methods including structural covariance, and event-based modeling analysis. We explore age of onset- and duration-related features, as well as phenomena-specific work focusing on particular epilepsy syndromes or phenotypes, multimodal analyses focused on understanding the biology of disease progression, and deep learning approaches. We encourage groups who may be interested in participating to make contact to further grow and develop ENIGMA-Epilepsy.

White matter connectomes at birth accurately predict cognitive abilities at age 2.

Cognitive ability is an important predictor of mental health outcomes that is influenced by neurodevelopment. Evidence suggests that the foundational wiring of the human brain is in place by birth, and that the white matter (WM) connectome supports developing brain function. It is unknown, however, how the WM connectome at birth supports emergent cognition. In this study, a deep learning model was trained using cross-validation to classify full-term infants (n = 75) as scoring above or below the median at age 2 using WM connectomes generated from diffusion weighted magnetic resonance images at birth. Results from this model were used to predict individual cognitive scores. We additionally identified WM connections important for classification. The model was also evaluated in a separate set of preterm infants (n = 37) scanned at term-age equivalent. Findings revealed that WM connectomes at birth predicted 2-year cognitive score group with high accuracy in both full-term (89.5%) and preterm (83.8%) infants. Scores predicted by the model were strongly correlated with actual scores (r = 0.98 for full-term and r = 0.96 for preterm). Connections within the frontal lobe, and between the frontal lobe and other brain areas were found to be important for classification. This work suggests that WM connectomes at birth can accurately predict a child's 2-year cognitive group and individual score in full-term and preterm infants. The WM connectome at birth appears to be a useful neuroimaging biomarker of subsequent cognitive development that deserves further study.

Hierarchical multi-atlas label fusion with multi-scale feature representation and label-specific patch partition.

Multi-atlas patch-based label fusion methods have been successfully used to improve segmentation accuracy in many important medical image analysis applications. In general, to achieve label fusion a single target image is first registered to several atlas images. After registration a label is assigned to each target point in the target image by determining the similarity between the underlying target image patch (centered at the target point) and the aligned image patch in each atlas image. To achieve the highest level of accuracy during the label fusion process it's critical for the chosen patch similarity measurement to accurately capture the tissue/shape appearance of the anatomical structure. One major limitation of existing state-of-the-art label fusion methods is that they often apply a fixed size image patch throughout the entire label fusion procedure. Doing so may severely affect the fidelity of the patch similarity measurement, which in turn may not adequately capture complex tissue appearance patterns expressed by the anatomical structure. To address this limitation, we advance state-of-the-art by adding three new label fusion contributions: First, each image patch is now characterized by a multi-scale feature representation that encodes both local and semi-local image information. Doing so will increase the accuracy of the patch-based similarity measurement. Second, to limit the possibility of the patch-based similarity measurement being wrongly guided by the presence of multiple anatomical structures in the same image patch, each atlas image patch is further partitioned into a set of label-specific partial image patches according to the existing labels. Since image information has now been semantically divided into different patterns, these new label-specific atlas patches make the label fusion process more specific and flexible. Lastly, in order to correct target points that are mislabeled during label fusion, a hierarchical approach is used to improve the label fusion results. In particular, a coarse-to-fine iterative label fusion approach is used that gradually reduces the patch size. To evaluate the accuracy of our label fusion approach, the proposed method was used to segment the hippocampus in the ADNI dataset and 7.0 T MR images, sub-cortical regions in LONI LBPA40 dataset, mid-brain regions in SATA dataset from MICCAI 2013 segmentation challenge, and a set of key internal gray matter structures in IXI dataset. In all experiments, the segmentation results of the proposed hierarchical label fusion method with multi-scale feature representations and label-specific atlas patches are more accurate than several well-known state-of-the-art label fusion methods.

Evaluation of machine learning algorithms for treatment outcome prediction in patients with epilepsy based on structural connectome data.

The objective of this study is to evaluate machine learning algorithms aimed at predicting surgical treatment outcomes in groups of patients with temporal lobe epilepsy (TLE) using only the structural brain connectome. Specifically, the brain connectome is reconstructed using white matter fiber tracts from presurgical diffusion tensor imaging. To achieve our objective, a two-stage connectome-based prediction framework is developed that gradually selects a small number of abnormal network connections that contribute to the surgical treatment outcome, and in each stage a linear kernel operation is used to further improve the accuracy of the learned classifier. Using a 10-fold cross validation strategy, the first stage in the connectome-based framework is able to separate patients with TLE from normal controls with 80% accuracy, and second stage in the connectome-based framework is able to correctly predict the surgical treatment outcome of patients with TLE with 70% accuracy. Compared to existing state-of-the-art methods that use VBM data, the proposed two-stage connectome-based prediction framework is a suitable alternative with comparable prediction performance. Our results additionally show that machine learning algorithms that exclusively use structural connectome data can predict treatment outcomes in epilepsy with similar accuracy compared with "expert-based" clinical decision. In summary, using the unprecedented information provided in the brain connectome, machine learning algorithms may uncover pathological changes in brain network organization and improve outcome forecasting in the context of epilepsy.

Seizure forecasting using machine learning models trained by seizure diaries.

Objectives.People with refractory epilepsy are overwhelmed by the uncertainty of their next seizures. Accurate prediction of future seizures could greatly improve the quality of life for these patients. New evidence suggests that seizure occurrences can have cyclical patterns for some patients. Even though these cyclicalities are not intuitive, they can be identified by machine learning (ML), to identify patients with predictable vs unpredictable seizure patterns.Approach.Self-reported seizure logs of 153 patients from the Human Epilepsy Project with more than three reported seizures (totaling 8337 seizures) were used to obtain inter-seizure interval time-series for training and evaluation of the forecasting models. Two classes of prediction methods were studied: (1) statistical approaches using Bayesian fusion of population-wise and individual-wise seizure patterns; and (2) ML-based algorithms including least squares, least absolute shrinkage and selection operator, support vector machine (SVM) regression, and long short-term memory regression. Leave-one-person-out cross-validation was used for training and evaluation, by training on seizure diaries of all except one subject and testing on the left-out subject.Main results.The leading forecasting models were the SVM regression and a statistical model that combined the median of population-wise seizure time-intervals with a test subject's prior seizure intervals. SVM was able to forecast 50%, 70%, 81%, 84%, and 87% of seizures of unseen subjects within 0, 1, 2, 3 to 4 d of mean absolute forecasting error, respectively. The subject-wise performances show that patients with more frequent seizures were generally better predicted.Significance.ML models can leverage non-random patterns within self-reported seizure diaries to forecast future seizures. While diary-based seizure forecasting alone is only one of many aspects of clinical care of patients with epilepsy, studying the level of predictability across seizures and patients paves the path towards a better understanding of predictable vs unpredictable seizures on individualized and population-wise bases.

Artificial intelligence for classification of temporal lobe epilepsy with ROI-level MRI data: A worldwide ENIGMA-Epilepsy study.

Artificial intelligence has recently gained popularity across different medical fields to aid in the detection of diseases based on pathology samples or medical imaging findings. Brain magnetic resonance imaging (MRI) is a key assessment tool for patients with temporal lobe epilepsy (TLE). The role of machine learning and artificial intelligence to increase detection of brain abnormalities in TLE remains inconclusive. We used support vector machine (SV) and deep learning (DL) models based on region of interest (ROI-based) structural (n = 336) and diffusion (n = 863) brain MRI data from patients with TLE with ("lesional") and without ("non-lesional") radiographic features suggestive of underlying hippocampal sclerosis from the multinational (multi-center) ENIGMA-Epilepsy consortium. Our data showed that models to identify TLE performed better or similar (68-75%) compared to models to lateralize the side of TLE (56-73%, except structural-based) based on diffusion data with the opposite pattern seen for structural data (67-75% to diagnose vs. 83% to lateralize). In other aspects, structural and diffusion-based models showed similar classification accuracies. Our classification models for patients with hippocampal sclerosis were more accurate (68-76%) than models that stratified non-lesional patients (53-62%). Overall, SV and DL models performed similarly with several instances in which SV mildly outperformed DL. We discuss the relative performance of these models with ROI-level data and the implications for future applications of machine learning and artificial intelligence in epilepsy care.

Identifying Relationships in Functional and Structural Connectome Data Using a Hypergraph Learning Method.

The brain connectome provides an unprecedented degree of information about the organization of neuronal network architecture, both at a regional level, as well as regarding the entire brain network. Over the last several years the neuroimaging community has made tremendous advancements in the analysis of structural connectomes derived from white matter fiber tractography or functional connectomes derived from time-series blood oxygen level signals. However, computational techniques that combine structural and functional connectome data to discover complex relationships between fiber density and signal synchronization, including the relationship with health and disease, has not been consistently performed. To overcome this shortcoming, a novel connectome feature selection technique is proposed that uses hypergraphs to identify connectivity relationships when structural and functional connectome data is combined. Using publicly available connectome data from the UMCD database, experiments are provided that show SVM classifiers trained with structural and functional connectome features selected by our method are able to correctly identify autism subjects with 88 % accuracy. These results suggest our combined connectome feature selection approach may improve outcome forecasting in the context of autism.

Detecting Anatomical Landmarks for Fast Alzheimer's Disease Diagnosis.

Structural magnetic resonance imaging (MRI) is a very popular and effective technique used to diagnose Alzheimer's disease (AD). The success of computer-aided diagnosis methods using structural MRI data is largely dependent on the two time-consuming steps: 1) nonlinear registration across subjects, and 2) brain tissue segmentation. To overcome this limitation, we propose a landmark-based feature extraction method that does not require nonlinear registration and tissue segmentation. In the training stage, in order to distinguish AD subjects from healthy controls (HCs), group comparisons, based on local morphological features, are first performed to identify brain regions that have significant group differences. In general, the centers of the identified regions become landmark locations (or AD landmarks for short) capable of differentiating AD subjects from HCs. In the testing stage, using the learned AD landmarks, the corresponding landmarks are detected in a testing image using an efficient technique based on a shape-constrained regression-forest algorithm. To improve detection accuracy, an additional set of salient and consistent landmarks are also identified to guide the AD landmark detection. Based on the identified AD landmarks, morphological features are extracted to train a support vector machine (SVM) classifier that is capable of predicting the AD condition. In the experiments, our method is evaluated on landmark detection and AD classification sequentially. Specifically, the landmark detection error (manually annotated versus automatically detected) of the proposed landmark detector is 2.41 mm , and our landmark-based AD classification accuracy is 83.7%. Lastly, the AD classification performance of our method is comparable to, or even better than, that achieved by existing region-based and voxel-based methods, while the proposed method is approximately 50 times faster.

Scalable High-Performance Image Registration Framework by Unsupervised Deep Feature Representations Learning.

Feature selection is a critical step in deformable image registration. In particular, selecting the most discriminative features that accurately and concisely describe complex morphological patterns in image patches improves correspondence detection, which in turn improves image registration accuracy. Furthermore, since more and more imaging modalities are being invented to better identify morphological changes in medical imaging data, the development of deformable image registration method that scales well to new image modalities or new image applications with little to no human intervention would have a significant impact on the medical image analysis community. To address these concerns, a learning-based image registration framework is proposed that uses deep learning to discover compact and highly discriminative features upon observed imaging data. Specifically, the proposed feature selection method uses a convolutional stacked autoencoder to identify intrinsic deep feature representations in image patches. Since deep learning is an unsupervised learning method, no ground truth label knowledge is required. This makes the proposed feature selection method more flexible to new imaging modalities since feature representations can be directly learned from the observed imaging data in a very short amount of time. Using the LONI and ADNI imaging datasets, image registration performance was compared to two existing state-of-the-art deformable image registration methods that use handcrafted features. To demonstrate the scalability of the proposed image registration framework, image registration experiments were conducted on 7.0-T brain MR images. In all experiments, the results showed that the new image registration framework consistently demonstrated more accurate registration results when compared to state of the art.

Domain Transfer Learning for MCI Conversion Prediction.

Machine learning methods have successfully been used to predict the conversion of mild cognitive impairment (MCI) to Alzheimer's disease (AD), by classifying MCI converters (MCI-C) from MCI nonconverters (MCI-NC). However, most existing methods construct classifiers using data from one particular target domain (e.g., MCI), and ignore data in other related domains (e.g., AD and normal control (NC)) that may provide valuable information to improve MCI conversion prediction performance. To address is limitation, we develop a novel domain transfer learning method for MCI conversion prediction, which can use data from both the target domain (i.e., MCI) and auxiliary domains (i.e., AD and NC). Specifically, the proposed method consists of three key components: 1) a domain transfer feature selection component that selects the most informative feature-subset from both target domain and auxiliary domains from different imaging modalities; 2) a domain transfer sample selection component that selects the most informative sample-subset from the same target and auxiliary domains from different data modalities; and 3) a domain transfer support vector machine classification component that fuses the selected features and samples to separate MCI-C and MCI-NC patients. We evaluate our method on 202 subjects from the Alzheimer's Disease Neuroimaging Initiative (ADNI) that have MRI, FDG-PET, and CSF data. The experimental results show the proposed method can classify MCI-C patients from MCI-NC patients with an accuracy of 79.4%, with the aid of additional domain knowledge learned from AD and NC.

Hierarchical and symmetric infant image registration by robust longitudinal-example-guided correspondence detection.

PURPOSE: To investigate anatomical differences across individual subjects, or longitudinal changes in early brain development, it is important to perform accurate image registration. However, due to fast brain development and dynamic tissue appearance changes, it is very difficult to align infant brain images acquired from birth to 1-yr-old. METHODS: To solve this challenging problem, a novel image registration method is proposed to align two infant brain images, regardless of age at acquisition. The main idea is to utilize the growth trajectories, or spatial-temporal correspondences, learned from a set of longitudinal training images, for guiding the registration of two different time-point images with different image appearances. Specifically, in the training stage, an intrinsic growth trajectory is first estimated for each training subject using the longitudinal images. To register two new infant images with potentially a large age gap, the corresponding images patches between each new image and its respective training images with similar age are identified. Finally, the registration between the two new images can be assisted by the learned growth trajectories from one time point to another time point that have been established in the training stage. To further improve registration accuracy, the proposed method is combined with a hierarchical and symmetric registration framework that can iteratively add new key points in both images to steer the estimation of the deformation between the two infant brain images under registration. RESULTS: To evaluate image registration accuracy, the proposed method is used to align 24 infant subjects at five different time points (2-week-old, 3-month-old, 6-month-old, 9-month-old, and 12-month-old). Compared to the state-of-the-art methods, the proposed method demonstrated superior registration performance. CONCLUSIONS: The proposed method addresses the difficulties in the infant brain registration and produces better results compared to existing state-of-the-art registration methods.

Evaluating shape correspondence for statistical shape analysis: a benchmark study.

This paper introduces a new benchmark study to evaluate the performance of landmark-based shape correspondence used for statistical shape analysis. Different from previous shape-correspondence evaluation methods, the proposed benchmark first generates a large set of synthetic shape instances by randomly sampling a given statistical shape model that defines a ground-truth shape space. We then run a test shape-correspondence algorithm on these synthetic shape instances to identify a set of corresponded landmarks. According to the identified corresponded landmarks, we construct a new statistical shape model, which defines a new shape space. We finally compare this new shape space against the ground-truth shape space to determine the performance of the test shape-correspondence algorithm. In this paper, we introduce three new performance measures that are landmark independent to quantify the difference between the ground-truth and the newly derived shape spaces. By introducing a ground-truth shape space that is defined by a statistical shape model and three new landmark-independent performance measures, we believe the proposed benchmark allows for a more objective evaluation of shape correspondence than previous methods. In this paper, we focus on developing the proposed benchmark for 2D shape correspondence. However it can be easily extended to 3D cases.

A new benchmark for shape correspondence evaluation.

This paper introduces a new benchmark study of evaluating landmark-based shape correspondence used for statistical shape analysis. Different from previous shape-correspondence evaluation methods, the proposed benchmark first generates a large set of synthetic shape instances by randomly sampling a specified ground-truth statistical shape model. We then run the test shape-correspondence algorithms on these synthetic shape instances to construct a new statistical shape model. We finally introduce a new measure to describe the difference between this newly constructed statistical shape model and the ground truth. This new measure is then used to evaluate the performance of the test shape-correspondence algorithm. By introducing the ground-truth statistical shape model, we believe the proposed benchmark allows for a more objective evaluation of the shape correspondence than those that do not specify any ground truth.