Flair MRI Biomarkers of the Normal Appearing Brain Matter are Related to Cognition

A novel biomarker panel was proposed to quantify macro and microstructural biomarkers from the normal-appearing brain matter (NABM) in multi-centre fluid-attenuation inversion recovery (FLAIR) MRI. The hypothesis was that NABM biomarkers from FLAIR MRI are related to cognition as determined by the Montreal Cognitive Assessment (MoCA). ANOVA analysis of seven biomarkers revealed significant differences between the means for three of the biomarkers in the cross-sectional and four biomarkers for all-data approaches, across all cognitive groups (p<0.01). An adjusted ANCOVA model found significant relationships between MoCA categories dependent on age and sex for four biomarkers exclusively in the all-data approach. Furthermore, quantification of microstructural changes was performed based on correlation analysis through diffusion MRI (dMRI), with up to r=0.87 (p<0.01) correlation to mean diffusivity (MD). These biomarkers demonstrate that structural differences in the NABM in FLAIR MRI are associated with cognition and that they have high potential for clinical translation.