• Marina Boccardi, Martina Bocchetta, Rossana Ganzola, Nicolas Robitaille, Alberto Redolfi, Simon Duchesne, Clifford R Jack, Giovanni B Frisoni, and EADC-ADNI Working Group on The Harmonized Protocol for Manual Hippocampal Segmentation and for the Alzheimer's Disease Neuroimaging Initiative.
• Laboratory of Epidemiology, Neuroimaging and Telemedicine, IRCCS - S. Giovanni di Dio - Fatebenefratelli, Brescia, Italy.
• Alzheimers Dement. 2015 Feb 1; 11 (2): 184-94.

BackgroundHippocampal volumetry on magnetic resonance imaging is recognized as an Alzheimer's disease (AD) biomarker, and manual segmentation is the gold standard for measurement. However, a standard procedure is lacking. We operationalize and quantitate landmark differences to help a Delphi panel converge on a set of landmarks.MethodsOne hundred percent of anatomic landmark variability across 12 different protocols for manual segmentation was reduced into four segmentation units (the minimum hippocampus, the alveus/fimbria, the tail, and the subiculum), which were segmented on magnetic resonance images by expert raters to estimate reliability and AD-related atrophy.ResultsIntra- and interrater reliability were more than 0.96 and 0.92, respectively, except for the alveus/fimbria, which were 0.86 and 0.77, respectively. Of all AD-related atrophy, the minimum hippocampus contributed to 67%; tail, 24%; alveus/fimbria, 4%; and the subiculum, 5%.ConclusionsAnatomic landmark variability in available protocols can be reduced to four discrete and measurable segmentation units. Their quantitative assessment will help a Delphi panel to define a set of landmarks for a harmonized protocol.Copyright © 2015 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

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