Graph Neural Network Reveals the Local Cortical Morphology of Brain Aging in Normal Cognition and Alzheimers Disease

Estimating brain age (BA) from T1-weighted magnetic resonance images (MRIs) provides a useful approach to map the anatomic features of brain senescence. Whereas global BA (GBA) summarizes overall brain health, local BA (LBA) can reveal spatially localized patterns of aging. Although previous studies have examined anatomical contributors to GBA, no framework has been established to compute LBA using cortical morphology. To address this gap, we introduce a novel graph neural network (GNN) that uses morphometric features (cortical thickness, curvature, surface area, gray/white matter intensity ratio and sulcal depth) to estimate LBA across the cortical surface at high spatial resolution (mean inter-vertex distance = 1.37 mm). Trained on cortical surface meshes extracted from the MRIs of cognitively normal adults (N = 14,250), our GNN identifies prefrontal and parietal association cortices as early sites of morphometric aging, in concordance with biological theories of brain aging. Feature comparison using integrated gradients reveals that morphological aging is driven primarily by changes in surface area (gyral crowns and highly folded regions) and cortical thickness (occipital lobes), with additional contributions from gray/white matter intensity ratio (frontal lobes and sulcal troughs) and curvature (sulcal troughs). In Alzheimers disease (AD), as expected, the model identifies widespread, excessive morphological aging in parahippocampal gyri and related temporal structures. Significant associations are found between regional LBA gaps and neuropsychological measures descriptive of AD-related cognitive impairment, suggesting an intimate relationship between morphological cortical aging and cognitive decline. These results highlight the ability of GNN-derived gero-morphometry to provide insights into local brain aging.

Uncertainty quantification for White Matter Hyperintensity segmentation detects silent failures and improves automated Fazekas quantification

White Matter Hyperintensities (WMH) are key neuroradiological markers of small vessel disease present in brain MRI. Assessment of WMH is important in research and clinics. However, WMH are challenging to segment due to their high variability in shape, location, size, poorly defined borders, and similar intensity profile to other pathologies (e.g stroke lesions) and artefacts (e.g head motion). In this work, we apply the most effective techniques for uncertainty quantification (UQ) in segmentation to the WMH segmentation task across multiple test-time data distributions. We find a combination of Stochastic Segmentation Networks with Deep Ensembles yields the highest Dice and lowest Absolute Volume Difference % (AVD) score on in-domain and out-of-distribution data. We demonstrate the downstream utility of UQ, proposing a novel method for classification of the clinical Fazekas score using spatial features extracted for WMH segmentation and UQ maps. We show that incorporating WMH uncertainty information improves Fazekas classification performance and calibration, with median class balanced accuracy for classification models with (UQ and spatial WMH features)/(spatial WMH features)/(WMH volume only) of 0.71/0.66/0.60 in the Deep WMH and 0.82/0.77/0.73 in the Periventricular WMH regions respectively. We demonstrate that stochastic UQ techniques with high sample diversity can improve the detection of poor quality segmentations. Finally, we qualitatively analyse the semantic information captured by UQ techniques and demonstrate that uncertainty can highlight areas where there is ambiguity between WMH and stroke lesions, while identifying clusters of small WMH in deep white matter unsegmented by the model.