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Influence of thickening of the inner skull table on intracranial volume measurement in older people

Author(s): N. A. Royle, M. C. V. Hernandez, S. M. Maniega, B. S. Arabisala, M. E. Bastin, I. J. Deary, J. M. Wardlaw

Introduction: It is generally assumed that intracranial volume (ICV) remains constant after peaking in early adulthood. Thus ICV is used as a 'proxy' for original brain size when trying to estimate brain atrophy in older people in neuroimaging studies. However, physiological changes in the skull, such as thickening of the frontal inner table, are relatively common in older age and will reduce ICV. The potential influence that inner table skull thickening may have on ICV measurement in old age has yet to be investigated. Methods: We selected 60 (31 males, 29 females) representative older adults aged 71.1-74.3 years from a community-dwelling ageing cohort, the Lothian Birth Cohort 1936. A semi-automatically derived current ICV measurement obtained from high resolution T1-weighted volume scans was compared to the estimated original ICV by excluding inner skull table thickening using expert manual image processing. Results: Inner table skull thickening reduced ICV from an estimated original 1480.0 ml to a current 1409.1 ml, a median decrease of 7.3% (Z= -6.334; p<0.001), and this reduction was more prominent in women than men (median decrease 114.6 vs. 101.9 ml respectively). This led to potential significant underestimations of brain atrophy in this sample by 53% (p<0.001) and obscured potential gender differences. Conclusions: The effects of skull thickening are important to consider when conducting research in ageing, as they can obscure gender differences and result in underestimation of brain atrophy. Research into reliable methods of determining the estimated original ICV is required for research into brain ageing. (c) 2013 Elsevier Inc. All rights reserved.

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ISBN: 0730-725X
Publication Year: 2013
Periodical: Magnetic Resonance Imaging
Periodical Number: 6
Volume: 31
Pages: 918-922
Author Address: Wardlaw, JM Western Gen Hosp, Brain Res Imaging Ctr BRIC, Edinburgh EH4 2XU, Midlothian, Scotland Univ Edinburgh, Brain Res Imaging Ctr, Edinburgh EH4 2XU, Midlothian, Scotland Univ Edinburgh, Ctr Cognit Ageing & Cognit Epidemiol, Edinburgh EH8 9JZ, Midlothian, Scotland Univ Edinburgh, Dept Clin Neurosci, Scottish Imaging Network Platform Sci Excellence, Edinburgh EH4 2XU, Midlothian, Scotland Univ Edinburgh, Dept Psychol, Edinburgh EH4 2XU, Midlothian, Scotland