title: Evaluation of whole brain health in aging and Alzheimer's disease: a standard procedure for scoring an MRI-based brain atrophy and lesion index.
abstract: BACKGROUND
  The Brain Atrophy and Lesion Index (BALI), a semi-quantitative rating scale, has been developed to evaluate whole brain structural changes in aging and Alzheimer's disease (AD).
  
  
  OBJECTIVE
  This study describes a standard procedure to score the BALI and train new raters for reliable BALI evaluation following this procedure.
  
  
  METHODS
  Structural MRI of subjects in the Alzheimer's Disease Neuroimaging Initiative dataset who had 3.0T, T1, and T2 weighted MRI scans at baseline and at 6, 12, and 24 month follow-ups were retrieved (n = 122, including 24 AD, 51 mild cognitive impairment patients, and 47 healthy control subjects). Images were evaluated by four raters following training with a step-by-step BALI process. Seven domains of structural brain changes were evaluated, and a total score was calculated as the sum of the sub-scores.
  
  
  RESULTS
  New raters achieved >90% accuracy after two weeks of training. Reliability was shown in both intra-rater correlation coefficients (ICC ≥ 0.92, p < 0.001) and inter-rater correlation coefficients (ICC ≥0.88, p < 0.001). Mean BALI total scores differed by diagnosis (F ≥ 2.69, p ≤ 0.049) and increased consistently over two years.
  
  
  CONCLUSIONS
  The BALI can be introduced using a standard procedure that allows new users to achieve highly reliable evaluation of structural brain changes. This can advance its potential as a robust method for assessing global brain health in aging, AD, and mild cognitive impairment.
authors.affiliation: Neuroimaging Research Laboratory, Biomedical Translational Imaging Centre, QEII-IWK Health Sciences Centre (the former National Research Council Canada's Institute for Biodiagnostics - Atlantic), Halifax, NS, Canada Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Guo
authors.affiliation: Neuroimaging Research Laboratory, Biomedical Translational Imaging Centre, QEII-IWK Health Sciences Centre (the former National Research Council Canada's Institute for Biodiagnostics - Atlantic), Halifax, NS, Canada Department of Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Song
authors.affiliation: Department of Radiology, Dalhousie University, Halifax, NS, Canada Department of Diagnostic Imaging, Capital District Health Authority, NS, Canada.
authors.forename: Matthias H
authors.initials: MH
authors.lastname: Schmidt
authors.affiliation: Department of Radiology, Dalhousie University, Halifax, NS, Canada Department of Diagnostic Imaging, Capital District Health Authority, NS, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Vandorpe
authors.affiliation: Neuroimaging Research Laboratory, Biomedical Translational Imaging Centre, QEII-IWK Health Sciences Centre (the former National Research Council Canada's Institute for Biodiagnostics - Atlantic), Halifax, NS, Canada Department of Biology, Crandall University, Moncton, NB, Canada.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Neuroimaging Research Laboratory, Biomedical Translational Imaging Centre, QEII-IWK Health Sciences Centre (the former National Research Council Canada's Institute for Biodiagnostics - Atlantic), Halifax, NS, Canada.
authors.forename: Emily
authors.initials: E
authors.lastname: LeBlanc
authors.affiliation: Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Neuroimaging Research Laboratory, Biomedical Translational Imaging Centre, QEII-IWK Health Sciences Centre (the former National Research Council Canada's Institute for Biodiagnostics - Atlantic), Halifax, NS, Canada Department of Radiology, Dalhousie University, Halifax, NS, Canada School of Health Sciences, Dalhousie University, Halifax, NS, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Beyea
authors.affiliation: Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China.
authors.forename: Yunting
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, NS, Canada Centre for Healthcare of the Elderly, Capital District Health Authority, NS, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D000544:Alzheimer Disease / Q000150:complications / Q000473:pathology*; D001284:Atrophy / Q000209:etiology / Q000473:pathology; D001921:Brain / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D015203:Reproducibility of Results
keywords: Aging; Alzheimer's disease; Brain Atrophy and Lesion Index (BALI); brain; cognition; structural MRI