Case Studies: Longitudinal MRI Volumetry in Alzheimer’s Disease and Traumatic Brain Injury

Case Study 1: Longitudinal Imaging of Alzheimer’s Disease (AD)

A 69-year-old woman with memory loss and depression underwent four MRI scans over seven years (ages 62, 64, 66, and 69). Using Neuroreader® volumetric software, progressive changes were quantified and tracked across key brain regions.

Findings

• Hippocampal atrophy was evident, shown by increased cerebrospinal fluid (CSF) surrounding the hippocampus.
• Neuroreader® reports demonstrated a consistent decline in hippocampal volume, with connected longitudinal data points shifting from the normal range into abnormally low volumes.
• Temporal lobe atrophy appeared earlier and more severely than frontal lobe changes — a classic hallmark of Alzheimer’s pathology.
• Occipital lobe remained stable until later stages.
• Lateral ventricles showed minimal expansion, suggesting the disease was caught before significant ventricular changes, which are commonly noted in radiology reports but lack specificity for Alzheimer’s.

Clinical Insight

Differentiating late-life depression from dementia can be difficult due to overlapping symptoms. However, longitudinal volumetry builds diagnostic confidence by objectively showing progressive hippocampal and temporal lobe atrophy consistent with Alzheimer’s disease.

Case Study 2: Traumatic Brain Injury (TBI)

A 62-year-old woman developed persistent post-concussive symptoms after a motor vehicle collision, including headaches, memory loss, attentional difficulty, and light sensitivity. MRI volumetry using Neuroreader® revealed a distinct atrophy pattern different from Alzheimer’s disease.

Findings

• Ventral diencephalon and pallidum showed asymmetric atrophy, a common volumetric signature of traumatic brain injury.
• Right pallidum demonstrated significant abnormality (highlighted in orange on Neuroreader®).
• Cerebellar asymmetry was noted — left cerebellum volume loss exceeded the right, even while remaining technically within the “normal” range.
• Unlike Alzheimer’s, hippocampal volume was relatively preserved, making hippocampal atrophy an unlikely driver of symptoms.

Supporting Research

Dr. Cyrus A. Raji and colleagues have published evidence in the Journal of Alzheimer’s Disease confirming that patients with cognitive impairment following TBI — especially from car accidents — often show low volumes in the ventral diencephalon and pallidum, distinguishing them from Alzheimer’s disease patients.

Why Volumetric MRI Matters

• Alzheimer’s disease signature: Hippocampal and temporal lobe dominant atrophy, with progressive decline over time.
• Traumatic brain injury signature: Asymmetric atrophy in ventral diencephalon, pallidum, and cerebellum, with sparing of hippocampal regions.
• Diagnostic value: Volumetric MRI helps clinicians differentiate causes of cognitive decline, guiding more accurate diagnosis and treatment planning.

Conclusion

These case studies highlight the power of longitudinal volumetric MRI with Neuroreader® in distinguishing between neurodegenerative processes and traumatic injuries. By quantifying subtle changes across multiple brain regions, volumetry provides objective, reproducible biomarkers that support earlier and more precise diagnoses.