Operationalizing postmortem pathology-MRI association studies in Alzheimer’s disease and related disorders with MRI-guided histology sampling

Abstract Postmortem neuropathological examination, while the gold standard for diagnosing neurodegenerative diseases, often relies on limited regional sampling that may miss critical areas affected by Alzheimer’s disease and related disorders. Ultra-high resolution postmortem MRI can help identify r...

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Main Authors: Chinmayee Athalye, Alejandra Bahena, Pulkit Khandelwal, Sheina Emrani, Winifred Trotman, Lisa M. Levorse, Zahra Khodakarami, Daniel T. Ohm, Eric Teunissen-Bermeo, Noah Capp, Shokufeh Sadaghiani, Sanaz Arezoumandan, Sydney A. Lim, Karthik Prabhakaran, Ranjit Ittyerah, John L. Robinson, Theresa Schuck, Edward B. Lee, M. Dylan Tisdall, Sandhitsu R. Das, David A. Wolk, David J. Irwin, Paul A. Yushkevich
Format: Article
Language:English
Published: BMC 2025-05-01
Series:Acta Neuropathologica Communications
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Online Access:https://doi.org/10.1186/s40478-025-02030-y
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author Chinmayee Athalye
Alejandra Bahena
Pulkit Khandelwal
Sheina Emrani
Winifred Trotman
Lisa M. Levorse
Zahra Khodakarami
Daniel T. Ohm
Eric Teunissen-Bermeo
Noah Capp
Shokufeh Sadaghiani
Sanaz Arezoumandan
Sydney A. Lim
Karthik Prabhakaran
Ranjit Ittyerah
John L. Robinson
Theresa Schuck
Edward B. Lee
M. Dylan Tisdall
Sandhitsu R. Das
David A. Wolk
David J. Irwin
Paul A. Yushkevich
author_facet Chinmayee Athalye
Alejandra Bahena
Pulkit Khandelwal
Sheina Emrani
Winifred Trotman
Lisa M. Levorse
Zahra Khodakarami
Daniel T. Ohm
Eric Teunissen-Bermeo
Noah Capp
Shokufeh Sadaghiani
Sanaz Arezoumandan
Sydney A. Lim
Karthik Prabhakaran
Ranjit Ittyerah
John L. Robinson
Theresa Schuck
Edward B. Lee
M. Dylan Tisdall
Sandhitsu R. Das
David A. Wolk
David J. Irwin
Paul A. Yushkevich
author_sort Chinmayee Athalye
collection DOAJ
description Abstract Postmortem neuropathological examination, while the gold standard for diagnosing neurodegenerative diseases, often relies on limited regional sampling that may miss critical areas affected by Alzheimer’s disease and related disorders. Ultra-high resolution postmortem MRI can help identify regions that fall outside the diagnostic sampling criteria for additional histopathologic evaluation. However, there are no standardized guidelines for integrating histology and MRI in a traditional brain bank. We developed a comprehensive protocol for whole hemisphere postmortem 7T MRI-guided histopathological sampling with whole-slide digital imaging and histopathological analysis, providing a reliable pipeline for high-volume brain banking in heterogeneous brain tissue. Our method uses patient-specific 3D printed molds built from postmortem MRI, allowing standardized tissue processing with a permanent spatial reference frame. To facilitate pathology-MRI association studies, we created a semi-automated MRI to histology registration pipeline and developed a quantitative pathology scoring system using weakly supervised deep learning. We validated this protocol on a cohort of 29 brains with diagnosis on the AD spectrum that revealed correlations between cortical thickness and phosphorylated tau accumulation. This pipeline has broad applicability across neuropathological research and brain banking, facilitating large-scale studies that integrate histology with neuroimaging. The innovations presented here provide a scalable and reproducible approach to studying postmortem brain pathology, with implications for advancing diagnostic and therapeutic strategies for Alzheimer’s disease and related disorders.
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spelling doaj-art-16685368a109432893e20e89318fdb592025-08-20T03:22:04ZengBMCActa Neuropathologica Communications2051-59602025-05-0113112510.1186/s40478-025-02030-yOperationalizing postmortem pathology-MRI association studies in Alzheimer’s disease and related disorders with MRI-guided histology samplingChinmayee Athalye0Alejandra Bahena1Pulkit Khandelwal2Sheina Emrani3Winifred Trotman4Lisa M. Levorse5Zahra Khodakarami6Daniel T. Ohm7Eric Teunissen-Bermeo8Noah Capp9Shokufeh Sadaghiani10Sanaz Arezoumandan11Sydney A. Lim12Karthik Prabhakaran13Ranjit Ittyerah14John L. Robinson15Theresa Schuck16Edward B. Lee17M. Dylan Tisdall18Sandhitsu R. Das19David A. Wolk20David J. Irwin21Paul A. Yushkevich22Department of Bioengineering, University of PennsylvaniaDepartment of Neurology, University of PennsylvaniaDepartment of Bioengineering, University of PennsylvaniaDepartment of Neurology, University of PennsylvaniaDepartment of Neurology, University of PennsylvaniaDepartment of Radiology, University of PennsylvaniaDepartment of Bioengineering, University of PennsylvaniaDepartment of Neurology, University of PennsylvaniaDepartment of Neurology, University of PennsylvaniaDepartment of Neurology, University of PennsylvaniaDepartment of Neurology, University of PennsylvaniaDepartment of Neurology, University of PennsylvaniaDepartment of Radiology, University of PennsylvaniaDepartment of Neurology, University of PennsylvaniaDepartment of Radiology, University of PennsylvaniaDepartment of Pathology and Laboratory Medicine, University of PennsylvaniaDepartment of Pathology and Laboratory Medicine, University of PennsylvaniaDepartment of Pathology and Laboratory Medicine, University of PennsylvaniaDepartment of Radiology, University of PennsylvaniaDepartment of Neurology, University of PennsylvaniaDepartment of Neurology, University of PennsylvaniaDepartment of Neurology, University of PennsylvaniaDepartment of Radiology, University of PennsylvaniaAbstract Postmortem neuropathological examination, while the gold standard for diagnosing neurodegenerative diseases, often relies on limited regional sampling that may miss critical areas affected by Alzheimer’s disease and related disorders. Ultra-high resolution postmortem MRI can help identify regions that fall outside the diagnostic sampling criteria for additional histopathologic evaluation. However, there are no standardized guidelines for integrating histology and MRI in a traditional brain bank. We developed a comprehensive protocol for whole hemisphere postmortem 7T MRI-guided histopathological sampling with whole-slide digital imaging and histopathological analysis, providing a reliable pipeline for high-volume brain banking in heterogeneous brain tissue. Our method uses patient-specific 3D printed molds built from postmortem MRI, allowing standardized tissue processing with a permanent spatial reference frame. To facilitate pathology-MRI association studies, we created a semi-automated MRI to histology registration pipeline and developed a quantitative pathology scoring system using weakly supervised deep learning. We validated this protocol on a cohort of 29 brains with diagnosis on the AD spectrum that revealed correlations between cortical thickness and phosphorylated tau accumulation. This pipeline has broad applicability across neuropathological research and brain banking, facilitating large-scale studies that integrate histology with neuroimaging. The innovations presented here provide a scalable and reproducible approach to studying postmortem brain pathology, with implications for advancing diagnostic and therapeutic strategies for Alzheimer’s disease and related disorders.https://doi.org/10.1186/s40478-025-02030-yAlzheimer’s diseasePostmortem imagingHistologyQuantitative pathologyMRI-histology registration
spellingShingle Chinmayee Athalye
Alejandra Bahena
Pulkit Khandelwal
Sheina Emrani
Winifred Trotman
Lisa M. Levorse
Zahra Khodakarami
Daniel T. Ohm
Eric Teunissen-Bermeo
Noah Capp
Shokufeh Sadaghiani
Sanaz Arezoumandan
Sydney A. Lim
Karthik Prabhakaran
Ranjit Ittyerah
John L. Robinson
Theresa Schuck
Edward B. Lee
M. Dylan Tisdall
Sandhitsu R. Das
David A. Wolk
David J. Irwin
Paul A. Yushkevich
Operationalizing postmortem pathology-MRI association studies in Alzheimer’s disease and related disorders with MRI-guided histology sampling
Acta Neuropathologica Communications
Alzheimer’s disease
Postmortem imaging
Histology
Quantitative pathology
MRI-histology registration
title Operationalizing postmortem pathology-MRI association studies in Alzheimer’s disease and related disorders with MRI-guided histology sampling
title_full Operationalizing postmortem pathology-MRI association studies in Alzheimer’s disease and related disorders with MRI-guided histology sampling
title_fullStr Operationalizing postmortem pathology-MRI association studies in Alzheimer’s disease and related disorders with MRI-guided histology sampling
title_full_unstemmed Operationalizing postmortem pathology-MRI association studies in Alzheimer’s disease and related disorders with MRI-guided histology sampling
title_short Operationalizing postmortem pathology-MRI association studies in Alzheimer’s disease and related disorders with MRI-guided histology sampling
title_sort operationalizing postmortem pathology mri association studies in alzheimer s disease and related disorders with mri guided histology sampling
topic Alzheimer’s disease
Postmortem imaging
Histology
Quantitative pathology
MRI-histology registration
url https://doi.org/10.1186/s40478-025-02030-y
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