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•Development and presentation of normative modeling approach based on hierarchical Bayesian modeling that can be applied to large multi-site neuroimaging data sets.•Comparison of performance of hierarchical Bayesian model including site as covariate to several common ways to harmonize for multi-site effects.•Presentation of normative modeling as site correction tool. The potential of normative modeling to make individualized predictions from neuroimaging data has enabled inferences that go beyond the case-control approach. However, site effects are often confounded with variables of interest in a complex manner and can bias estimates of normative models, which has impeded the application of normative models to large multi-site neuroimaging data sets. In this study, we suggest accommodating for these site effects by including them as random effects in a hierarchical Bayesian model. We compared the performance of a linear and a non-linear hierarchical Bayesian model in modeling the effect of age on cortical thickness. We used data of 570 healthy individuals from the ABIDE (autism brain imaging data exchange) data set in our experiments. In addition, we used data from individuals with autism to test whether our models are able to retain clinically useful information while removing site effects. We compared the proposed single stage hierarchical Bayesian method to several harmonization techniques commonly used to deal with additive and multiplicative site effects using a two stage regression, including regressing out site and harmonizing for site with ComBat, both with and without explicitly preserving variance caused by age and sex as biological variation of interest, and with a non-linear version of ComBat. In addition, we made predictions from raw data, in which site has not been accommodated for. The proposed hierarchical Bayesian method showed the best predictive performance according to multiple metrics. Beyond that, the resulting z-scores showed little to no residual site effects, yet still retained clinically useful information. In contrast, performance was particularly poor for the regression model and the ComBat model in which age and sex were not explicitly modeled. In all two stage harmonization models, predictions were poorly scaled, suffering from a loss of more than 90% of the original variance. Our results show the value of hierarchical Bayesian regression methods for accommodating site variation in neuroimaging data, which provides an alternative to harmonization techniques. While the approach we propose may have broad utility, our approach is particularly well suited to normative modeling where the primary interest is in accurate modeling of inter-subject variation and statistical quantification of deviations from a reference model.

The present paper presents a fundamentally novel approach to model individual differences of persons with the same biologically heterogeneous mental disorder. Unlike prevalent case-control analyses, that assume a clear distinction between patient and control groups and thereby introducing the concept of an 'average patient', we describe each patient's biology individually, gaining insights into the different facets that characterize persistent attention-deficit/hyperactivity disorder (ADHD). Using a normative modeling approach, we mapped inter-individual differences in reference to normative structural brain changes across the lifespan to examine the degree to which case-control analyses disguise differences between individuals. At the level of the individual, deviations from the normative model were frequent in persistent ADHD. However, the overlap of more than 2% between participants with ADHD was only observed in few brain loci. On average, participants with ADHD showed significantly reduced gray matter in the cerebellum and hippocampus compared to healthy individuals. While the case-control differences were in line with the literature on ADHD, individuals with ADHD only marginally reflected these group differences. Case-control comparisons, disguise inter-individual differences in brain biology in individuals with persistent ADHD. The present results show that the 'average ADHD patient' has limited informative value, providing the first evidence for the necessity to explore different biological facets of ADHD at the level of the individual and practical means to achieve this end.

Abstract Background Clinical forecasting models have potential to optimize treatment and improve outcomes in psychosis, but predicting long-term outcomes is challenging and long-term follow-up data are scarce. In this 10-year longitudinal study, we aimed to characterize the temporal evolution of cortical correlates of psychosis and their associations with symptoms. Design Structural magnetic resonance imaging (MRI) from people with first-episode psychosis and controls (n = 79 and 218) were obtained at enrollment, after 12 months (n = 67 and 197), and 10 years (n = 23 and 77), within the Thematically Organized Psychosis (TOP) study. Normative models for cortical thickness estimated on public MRI datasets (n = 42 983) were applied to TOP data to obtain deviation scores for each region and timepoint. Positive and Negative Syndrome Scale (PANSS) scores were acquired at each timepoint along with registry data. Linear mixed effects models assessed effects of diagnosis, time, and their interactions on cortical deviations plus associations with symptoms. Results LMEs revealed conditional main effects of diagnosis and time × diagnosis interactions in a distributed cortical network, where negative deviations in patients attenuate over time. In patients, symptoms also attenuate over time. LMEs revealed effects of anterior cingulate on PANSS total, and insular and orbitofrontal regions on PANSS negative scores. Conclusions This long-term longitudinal study revealed a distributed pattern of cortical differences which attenuated over time together with a reduction in symptoms. These findings are not in line with a simple neurodegenerative account of schizophrenia, and deviations from normative models offer a promising avenue to develop biomarkers to track clinical trajectories over time.

Detecting and monitoring of abnormal movement behaviors in patients with Parkinson’s Disease (PD) and individuals with Autism Spectrum Disorders (ASD) are beneficial for adjusting care and medical treatment in order to improve the patient’s quality of life. Supervised methods commonly used in the literature need annotation of data, which is a time-consuming and costly process. In this paper, we propose deep normative modeling as a probabilistic novelty detection method, in which we model the distribution of normal human movements recorded by wearable sensors and try to detect abnormal movements in patients with PD and ASD in a novelty detection framework. In the proposed deep normative model, a movement disorder behavior is treated as an extreme of the normal range or, equivalently, as a deviation from the normal movements. Our experiments on three benchmark datasets indicate the effectiveness of the proposed method, which outperforms one-class SVM and the reconstruction-based novelty detection approaches. Our contribution opens the door toward modeling normal human movements during daily activities using wearable sensors and eventually real-time abnormal movement detection in neuro-developmental and neuro-degenerative disorders.

Abstract Background and Hypothesis Schizophrenia manifests with marked heterogeneity in both clinical presentation and underlying biology. Modeling individual differences within clinical cohorts is critical to translate knowledge reliably into clinical practice. We hypothesized that individualized brain atrophy in patients with schizophrenia may explain the heterogeneous outcomes of repetitive transcranial magnetic stimulation (rTMS). Study Design The magnetic resonance imaging (MRI) data of 797 healthy subjects and 91 schizophrenia patients (between January 1, 2015, and December 31, 2020) were retrospectively selected from our hospital database. The healthy subjects were used to establish normative reference ranges for cortical thickness as a function of age and sex. Then, a schizophrenia patient’s personalized atrophy map was computed as vertex-wise deviations from the normative model. Each patient’s atrophy network was mapped using resting-state functional connectivity MRI from a subgroup of healthy subjects (n = 652). In total 52 of the 91 schizophrenia patients received rTMS in a randomized clinical trial (RCT). Their longitudinal symptom changes were adopted to test the clinical utility of the personalized atrophy map. Results The personalized atrophy maps were highly heterogeneous across patients, but functionally converged to a putative schizophrenia network that comprised regions implicated by previous group-level findings. More importantly, retrospective analysis of rTMS-RCT data indicated that functional connectivity of the personalized atrophy maps with rTMS targets was significantly associated with the symptom outcomes of schizophrenia patients. Conclusions Normative modeling can aid in mapping the personalized atrophy network associated with treatment outcomes of patients with schizophrenia.

•CCVAEGAN generated high-fidelity fetal brain MRI for anomaly detection across gestational ages.•Cyclic consistency and covariate conditioning improved generation and detection performances.•CCVAEGAN achieved near-perfect AUROC (>0.99) in detecting fetal brain abnormalities.•External validation confirmed CCVAEGAN’s robustness across multi-site MRI variations. Fetal brain development is a complex and dynamic process, and its disruption can lead to significant neurological disorders. Early detection of brain aberrations during pregnancy is critical for optimizing postnatal medical intervention. We propose a deep generative anomaly detection framework, conditional cyclic variational autoencoding generative adversarial network (CCVAEGAN), that can identify structural brain anomalies using fetal brain magnetic resonance imaging. CCVAEGAN leverages covariate conditioning on gestational age and cyclic consistency training to generate high-fidelity normative fetal brain images to enhance anomaly detection across various neurodevelopmental stages and diagnoses. Using MRI data from typically developing and clinically abnormal fetuses across multiple sites, CCVAEGAN achieves superior image generation quality and anomaly detection accuracy than other comparable models, consistently producing anatomically precise images with lower reconstruction errors and higher structural similarities. Anomaly detection experiments yielded near-perfect AUROC values (>0.99) across various anomaly score metrics, and visual assessments confirmed the model's ability to localize and characterize structural abnormalities. Additionally, external validation on separated-site cohorts demonstrated the generalizability of the CCVAEGAN framework, showing robust detection performance despite data variations. These findings demonstrate CCVAEGAN's potential as a powerful tool for automated, objective anomaly screening, that could significantly enhance the efficiency of clinical workflows for early diagnosis of fetal brain anomalies. Furthermore, this approach has the potential universality to apply to other medical imaging not limited to specific organs or imaging modalities in the future.

Disruptive behavior disorders (DBD) are heterogeneous at the clinical and the biological level. Therefore, the aims were to dissect the heterogeneous neurodevelopmental deviations of the affective brain circuitry and provide an integration of these differences across modalities. We combined two novel approaches. First, normative modeling to map deviations from the typical age-related pattern at the level of the individual of (i) activity during emotion matching and (ii) of anatomical images derived from DBD cases (n = 77) and controls (n = 52) aged 8-18 years from the EU-funded Aggressotype and MATRICS consortia. Second, linked independent component analysis to integrate subject-specific deviations from both modalities. While cases exhibited on average a higher activity than would be expected for their age during face processing in regions such as the amygdala when compared to controls these positive deviations were widespread at the individual level. A multimodal integration of all functional and anatomical deviations explained 23% of the variance in the clinical DBD phenotype. Most notably, the top marker, encompassing the default mode network (DMN) and subcortical regions such as the amygdala and the striatum, was related to aggression across the whole sample. Overall increased age-related deviations in the amygdala in DBD suggest a maturational delay, which has to be further validated in future studies. Further, the integration of individual deviation patterns from multiple imaging modalities allowed to dissect some of the heterogeneity of DBD and identified the DMN, the striatum and the amygdala as neural signatures that were associated with aggression.

The diverse nature of stroke necessitates individualized assessment, presenting challenges to case-control neuroimaging studies. The normative model, measuring deviations from a normal distribution, provides a solution. We aim to evaluate stroke-induced white matter microstructural abnormalities at group and individual levels and identify potential prognostic biomarkers. Forty-six basal ganglia stroke patients and 46 healthy controls were recruited. Diffusion-weighted imaging and clinical assessment were performed within 7 days after stroke. We used automated fiber quantification to characterize intergroup alterations of segmental diffusion properties along 20 fiber tracts. Then each patient was compared to normative reference (46 healthy participants) by Mahalanobis distance tractometry for 7 significant fiber tracts. Mahalanobis distance-based deviation loads (MaDDLs) and fused MaDDL were extracted to quantify individual deviations. We also conducted correlation and logistic regression analyses to explore relationships between MaDDL metrics and functional outcomes. Disrupted microstructural integrity was observed across the left corticospinal tract, bilateral inferior fronto-occipital fasciculus, left inferior longitudinal fasciculus, bilateral thalamic radiation, and right uncinate fasciculus. The correlation coefficients between MaDDL metrics and initial functional impairment ranged from 0.364 to 0.618 (  < 0.05), with the highest being MaDDL . Furthermore, MaDDL demonstrated a significant enhancement in predictive efficacy compared to MaDDL (integrated discrimination improvement [IDI] = 9.62%,  = 0.005) and FA (IDI = 34.04%,  < 0.001) of the left corticospinal tract. MaDDL allows for assessing behavioral disorders and predicting prognosis, offering significant implications for personalized clinical decision-making and stroke recovery. Importantly, our method demonstrates prospects for widespread application in heterogeneous neurological diseases.

Neuroimaging is vital in quantifying brain atrophy due to typical aging and due to neurodegenerative diseases. To collect large samples necessary to model lifespan brain development, research consortiums aggregate images acquired across multiple study sites. Previous studies have demonstrated that this multi‐site study design can lead to site‐related bias, necessitating harmonization of these “site effects.” However, current methodologies are unable to generalize to new sites outside the original harmonized sample, limiting translation to new sites or clinical practice. Here, we propose a method called ComBat‐Predict (CB‐Predict) building upon the ComBat method for site effect adjustment, which extends to data from a new site with smaller sample sizes and unknown site effects. In data from the Alzheimer's Disease Neuroimaging Initiative, our proposed method mitigates bias and yields high accuracy in predicting cortical thickness measures when generalizing the model to new data. Furthermore, we demonstrate that our proposed harmonization method can reduce site‐related variance in centile scores estimated using data from the Lifespan Brain Chart Consortium. Altogether, our results demonstrate that CB‐Predict effectively harmonizes new sites and thereby enables effective translation of neuroimaging models to additional samples. ComBat‐Predict effectively harmonizes data from a new site, improving the applicability of normative models to private data. ComBat‐Predict is available for R in the ComBatFamily package.

INTRODUCTION Neuroanatomical normative modeling captures individual variability in Alzheimer's disease (AD). Here we used normative modeling to track individuals’ disease progression in people with mild cognitive impairment (MCI) and patients with AD. METHODS Cortical and subcortical normative models were generated using healthy controls (n ≈ 58k). These models were used to calculate regional z scores in 3233 T1‐weighted magnetic resonance imaging time‐series scans from 1181 participants. Regions with z scores < –1.96 were classified as outliers mapped on the brain and summarized by total outlier count (tOC). RESULTS tOC increased in AD and in people with MCI who converted to AD and also correlated with multiple non‐imaging markers. Moreover, a higher annual rate of change in tOC increased the risk of progression from MCI to AD. Brain outlier maps identified the hippocampus as having the highest rate of change. DISCUSSION Individual patients’ atrophy rates can be tracked by using regional outlier maps and tOC. Highlights Neuroanatomical normative modeling was applied to serial Alzheimer's disease (AD) magnetic resonance imaging (MRI) data for the first time. Deviation from the norm (outliers) of cortical thickness or brain volume was computed in 3233 scans. The number of brain‐structure outliers increased over time in people with AD. Patterns of change in outliers varied markedly between individual patients with AD. People with mild cognitive impairment whose outliers increased over time had a higher risk of progression from AD.