Development of a protocol to assess within-subject, regional white matter hyperintensity changes in aging and dementia

Ahmed A. Bahrani, Charles D. Smith, Justin M. Barber, Omar M. Al-Janabi, David K. Powell, Anders H. Andersen, Brandon D. Ramey, Erin L. Abner, Larry B. Goldstein, Zachary Winder, Brian T. Gold, Linda Van Eldik, Donna M. Wilcock, Gregory A. Jicha

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3 Scopus citations


Background: White matter hyperintensities (WMH), associated with both dementia risk and progression, can individually progress, remain stable, or even regress influencing cognitive decline related to specific cerebrovascular-risks. This study details the development and validation of a registration protocol to assess regional, within-subject, longitudinal WMH changes (ΔWMH) that is currently lacking in the field. New method: 3D-FLAIR images (baseline and one-year-visit) were used for protocol development and validation. The method was validated by assessing the correlation between forward and reverse longitudinal registration, and between summated regional progression-regression volumes and Global ΔWMH. The clinical relevance of growth-regression ΔWMH were explored in relation to an executive function test. Results: MRI scans for 79 participants (73.5 ± 8.8 years) were used in this study. Global ΔWMH vs. summated regional progression-regression volumes were highly associated (r2 = 0.90; p-value < 0.001). Bi-directional registration validated the registration method (r2 = 0.999; p-value < 0.001). Growth and regression, but not overall ΔWMH, were associated with one-year declines in performance on Trial-Making-Test-B. Comparison with existing method(s): This method presents a unique registration protocol for maximum tissue alignment, demonstrating three distinct patterns of longitudinal within-subject ΔWMH (stable, growth and regression). Conclusions: These data detail the development and validation of a registration protocol for use in assessing within-subject, voxel-level alterations in WMH volume. The methods developed for registration and intensity correction of longitudinal within-subject FLAIR images allow regional and within-lesion characterization of longitudinal ΔWMH. Assessing the impact of associated cerebrovascular-risks and longitudinal clinical changes in relation to dynamic regional ΔWMH is needed in future studies.

Original languageEnglish
Article number109270
JournalJournal of Neuroscience Methods
StatePublished - Aug 1 2021

Bibliographical note

Publisher Copyright:
© 2021 Elsevier B.V.


  • Aging
  • Cerebrovascular disease
  • Dementia
  • Longitudinal
  • Small vessel ischemic disease
  • White matter hyperintensity

ASJC Scopus subject areas

  • General Neuroscience


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