Assessing age-related gray matter decline with voxel-based morphometry depends significantly on segmentation and normalization procedures.

Healthy ageing coincides with a progressive decline of brain gray matter (GM) ultimately affecting the entire brain. For a long time, manual delineation-based volumetry within predefined regions of interest (ROI) has been the gold standard for assessing such degeneration. Voxel-Based Morphometry (VBM) offers an automated alternative approach that, however, relies critically on the segmentation and spatial normalization of a large collection of images from different subjects. This can be achieved via different algorithms, with SPM5/SPM8, DARTEL of SPM8 and FSL tools (FAST, FNIRT) being three of the most frequently used. We complemented these voxel based measurements with a ROI based approach, whereby the ROIs are defined by transforms of an atlas (containing different tissue probability maps as well as predefined anatomic labels) to the individual subject images in order to obtain volumetric information at the level of the whole brain or within separate ROIs. Comparing GM decline between 21 young subjects (mean age 23) and 18 elderly (mean age 66) revealed that volumetric measurements differed significantly between methods. The unified segmentation/normalization of SPM5/SPM8 revealed the largest age-related differences and DARTEL the smallest, with FSL being more similar to the DARTEL approach. Method specific differences were substantial after segmentation and most pronounced for the cortical structures in close vicinity to major sulci and fissures. Our findings suggest that algorithms that provide only limited degrees of freedom for local deformations (such as the unified segmentation and normalization of SPM5/SPM8) tend to overestimate between-group differences in VBM results when compared to methods providing more flexible warping. This difference seems to be most pronounced if the anatomy of one of the groups deviates from custom templates, a finding that is of particular importance when results are compared across studies using different VBM methods.