Alzheimer’s Dementia Case Study: MRI Volumetric Analysis with Neuroreader®

Patient Overview

This case study examines a 78-year-old woman presenting with progressive memory loss, a common clinical scenario in suspected Alzheimer’s dementia. To objectively assess brain atrophy patterns, a 3D volumetric T1-weighted MRI sequence was acquired and analyzed using Neuroreader® automated brain volumetric software.

Neuroreader® generates a comprehensive brain volumetrics report that quantifies regional brain volumes and compares them against an age- and sex-matched normative database, supporting clinical decision-making in neurodegenerative disease evaluation.

Understanding the Neuroreader® Report

Brain Volume Assessment

The Neuroreader® Report provides detailed volumetric measurements for multiple brain structures, including:

• Absolute brain volume (measured in milliliters)
• Volume corrected for total intracranial volume (mTIV)
• Color-coded segmentation overlays for anatomical validation

Total intracranial volume represents the combined volume of gray matter, white matter, and cerebrospinal fluid (CSF) and is used to normalize individual brain structure measurements for accurate comparison.

Neuroreader® Index, Z-Scores, and Percentiles

Each segmented brain structure is statistically compared to a normative reference population using:

• Neuroreader® Index
• Z-scores
• Percentile rankings

For clinical interpretation:

• Brain structure volumes below the 25th percentile are considered abnormally low
• Ventricular volumes above the 75th percentile are considered abnormally high

These thresholds (25/75) are the default settings and are visually highlighted in orange within the report summary. Thresholds can be customized to meet specific clinical or institutional preferences.

Interpretation of Volumetric Findings

It is important to note that Neuroreader® values represent statistically derived normal ranges, not rigid diagnostic cutoffs. They are intended to support — not replace — expert clinical judgment.

Key Findings in This Patient

• Whole brain volume: Abnormally low
• Gray matter volume: Markedly reduced (approximately 10th percentile)
• White matter volume: Low-normal range but significantly reduced relative to the normative database (Neuroreader® Index ~6–7)
• Hippocampus: Abnormally low
• Amygdala and thalamus: Abnormally low
• Lateral ventricles: Abnormally enlarged (>75th percentile)

In addition, volumetric bar charts demonstrate diffuse cortical atrophy, particularly affecting:

• Medial temporal lobes
• Temporal lobes
• Parietal lobes

This combination of hippocampal atrophy, medial temporal volume loss, and ventricular enlargement is highly suggestive of Alzheimer’s dementia, especially when correlated with progressive memory decline.

While hippocampal volume loss is not exclusive to Alzheimer’s disease, in this clinical context it represents the most likely underlying pathology.

Quality Assurance: Segmentation Validation

The Neuroreader® Report includes color-coded segmentation overlay images, allowing clinicians to visually confirm segmentation accuracy.

In this case:

• Segmented brain regions align cleanly with anatomical boundaries
• No distortions or misregistrations are observed
• Image quality supports reliable volumetric interpretation

These overlays serve as an important quality control mechanism, ensuring confidence in the reported measurements.

Brain Heat Maps: Visual Correlation of Atrophy

Neuroreader® Brain Heat Maps provide a visual representation of regional brain volume deviations, highlighting:

• Areas of reduced brain volume
• Regions with abnormally enlarged ventricles

These heat maps offer an intuitive visual correlate to the statistical data, helping clinicians rapidly identify patterns consistent with neurodegenerative disease.

Validation: Automated vs. Manual Segmentation

Neuroreader® volumetric analysis has been validated in peer-reviewed literature, including studies demonstrating high agreement with manual “gold standard” segmentation, particularly for the hippocampus.

• Dissimilarity coefficients ~88% across:
  • Normal controls
  • Mild cognitive impairment
  • Alzheimer’s dementia
• Strong concordance between automated and expert manual tracing

Efficiency Advantage

• Neuroreader®: ~5 minutes to segment ~45 brain structures
• Manual segmentation: ~40 minutes or more per case

This efficiency enables scalable, reproducible brain volumetrics in routine clinical workflows without sacrificing accuracy.

Clinical Significance

This Alzheimer’s dementia case study demonstrates how automated MRI volumetric analysis with Neuroreader®:

• Detects early and subtle brain atrophy
• Provides objective, reproducible measurements
• Enhances diagnostic confidence beyond visual MRI interpretation alone
• Supports earlier intervention and longitudinal disease monitoring