Bias in HD-ISS staging introduced by the FreeSurfer cross-sectional stream: Insights from the Huntington's Disease Young Adult Study (HD-YAS)

Abstract

Huntington's Disease Integrated Staging System (HD-ISS) stages are likely inclusion criteria in future clinical trials. Stage 1 volumetric cut-offs were derived using the FreeSurfer longitudinal stream (LG). However, trials will require cross-sectional stream (CS) application with one MRI. Volumetric outputs are not robust to software type or version. T1-weighted images from 88 participants with MRIs from baseline and follow-up HD-YAS visits were segmented using both streams. CS calculated smaller caudate and putamen volumes adjusted for total intracranial volume, with greater reduction for larger volumes, shifting towards HD-ISS stage 1. CS-specific cut-offs need to be established before application to clinical trials.

Keywords: FreeSurfer; HD-ISS; MRI; caudate; huntington's disease; putamen; segmentation.

Summary

This article looks at how MRI scan methods can change the stage given to people in early Huntington’s disease research.

The researchers found that one method measured some brain areas as smaller, which moved more people into stage 1. They say new cut-off points are needed before this method is used to decide who can join clinical trials.

Keywords: Huntington’s disease, disease stages, MRI scans, brain measurements, scan analysis, caudate, putamen, clinical trials