Multi‐channel segmentation allows simultaneous estimation of classic tissue compartments, WMH and enlarged perivascular spaces.

Background: Large neuroimaging studies like ADNI‐4 now include T1‐weighted, T2‐weighted and FLAIR images at isotropic1mm resolution for investigation of both neurodegenerative and cerebrovascular disease. These three input types allow segmentation of GM, WM, DeepGM, WMH, and CSF compartments. Additionally, this supports automated assessment of enlarged perivascular spaces (PVS). Our objective was to propose a unified framework for segmentation of intracranial classes and PVS while reducing human effort. Method: FLAIR and T2‐weighted images are aligned to the T1‐weighted image.. Standard SPM12 unified segmentation using all three input images establishes deformations between subject and template space and bias field corrections. Extended tissue priors including deep GM are deformed into subject space. Adding mean intensities from high probability deep GM voxels as seeds and using the extended prior set, segmentation is re‐started, refining model parameters, deformations and bias‐field estimates. The procedure repeats, adding a WMH channel, resulting in a segmentation including GM, WM, CSF, deep GM, WMH and nuisance classes. Frangi filters are applied to the T1‐ and T2‐ weighted images. Filter response images are smoothed, averaged, masked and inserted in place of the CSF prior. Probability maps of vessel‐like shapes with CSF‐like contrast are estimated to identify PVS. Visual grading was also performed for comparison. Result: The method was applied to 300 participants. Visual quality control found two instances of poor WMH over‐segmentation. Perivascular space maps were all visually reasonable. Standard segmentation classes were visibly superior to single T1‐based segmentation. Figures 1,2 present examples. Pearson correlations of PVS fractional volume with multiple human raters' PVS counts in CSO/CR was over 0.7 in a subset of 125 participants (Figure 3). Conclusion: Modern dementia protocols include high‐resolution T1‐weighted, T2‐weighted, and FLAIR images that can be used together as inputs to extend probabilistic segmentation adding deep grey and WMH classes with automated PVS assessment. [ABSTRACT FROM AUTHOR]