T2 heterogeneity: a novel marker of microstructural integrity associated with cognitive decline in people with mild cognitive impairment

Alfie R Wearn*, Volkan Nurdal, Esther Saunders-Jennings, Michael J Knight, Hanna K Isotalus, Serena Dillon, Demitra Tsivos, Risto A Kauppinen, Elizabeth J Coulthard

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

11 Citations (Scopus)
59 Downloads (Pure)


BACKGROUNDEarly Alzheimer’s disease (AD) diagnosis is vital for development of disease-modifying therapies. Prior to significant brain tissue atrophy, several microstructural changes take place as a result of Alzheimer’s pathology. These include deposition of amyloid, tau and iron, as well as altered water homeostasis in tissue and some cell death. T2 relaxation time, a quantitative MRI measure, is sensitive to these changes and may be a useful non-invasive, early marker of tissue integrity which could predict conversion to dementia. We propose that different microstructural changes affect T2 in opposing ways, such that average ‘midpoint’ measures of T2 are less sensitive than measuring distribution width (heterogeneity). T2 heterogeneity in the brain may present a sensitive early marker of AD pathology.
METHODSIn this cohort study, we tested 97 healthy older controls, 49 people with mild cognitive impairment (MCI) and 10 with a clinical diagnosis of AD. All participants underwent structural MRI including a multi-echo sequence for quantitative T2 assessment. Cognitive change over one year was assessed in 20 participants with MCI. T2 distributions were modelled in the hippocampus and thalamus using log-logistic distribution giving measures of log-median value (midpoint; T2μ) and distribution width (heterogeneity; T2σ).
RESULTSWe show an increase in T2 heterogeneity (T2σ; p<.0001) in MCI compared to healthy controls, which was not seen with midpoint (T2μ; p=.149) in the hippocampus and thalamus. Hippocampal T2 heterogeneity predicted cognitive decline over one year in MCI participants (p=.018), but midpoint (p=.132) and volume (p=.315) did not. Age affects T2, but the effects described here are significant even after correcting for age.
CONCLUSIONSWe show that T2 heterogeneity can identify subtle changes in microstructural integrity of brain tissue in MCI and predict cognitive decline over a year. We describe a new model that considers the competing effects of factors that both increase and decrease T2. These two opposing forces suggest that previous conclusions based on T2 midpoint may have obscured the true potential of T2 as a marker of subtle neuropathology. We propose that T2 heterogeneity reflects microstructural integrity with potential to be a widely used early biomarker of conditions such as AD.
Original languageEnglish
Article number105 (2020)
Number of pages14
JournalAlzheimer's Research and Therapy
Publication statusPublished - 10 Sept 2020

Structured keywords

  • CRICBristol
  • Magnetic Resonance Imaging
  • Alzheimer's disease
  • Early diagnosis
  • Ageing
  • Hippocampus
  • Relaxometry
  • Quantitative MRI
  • Microstructure
  • In vivo histology
  • Brain and Behaviour


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