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Disproportionately Elevated Sulcal Index (DESI): An automatically driven index representing disproportionate subarachnoid space enlargement in brain MRI scans
Barough SS, Ohno S, Bilgel M, Sair HI, Luciano MG, Moghekar A.. medRxiv, 2025-12-02
Topic: Brain imaging, connectivity and assessment
Background Idiopathic normal pressure hydrocephalus (iNPH) is a reversible cause of dementia in older adults yet remains underdiagnosed due to nonspecific clinical presentation and reliance on invasive confirmatory tests. Conventional MRI biomarkers, including the Evans index and callosal angle, capture ventricular enlargement but incompletely characterize cerebrospinal fluid (CSF) redistribution. Disproportionately enlarged subarachnoid-space hydrocephalus (DESH) features, tight high-convexity sulci and enlarged Sylvian fissures, are more disease-specific but lack standardized quantitative measures. Methods We developed the Disproportionately Elevated Sulcal Index (DESI), an automated volumetric biomarker quantifying the ratio of Sylvian fissure volume to superior sulcal space volume. T1-weighted MRI scans were acquired from three independent cohorts: the Baltimore Longitudinal Study of Aging (n = 1,032), Johns Hopkins CSF Disorders Clinic (n = 216), and the Placebo-controlled Efficacy of iNPH Shunting trial (n = 94). Preprocessing included N4 bias correction, standard-space registration, and alignment. A U-Net segmentation model with an EfficientNet-B0 encoder delineated Sylvian fissures and sulcal compartments. DESI was computed from 3D reconstructions and evaluated using Dice similarity coefficients, landmark detection error, and classification performance across diagnostic groups. Results Segmentation achieved ∼0.80 DICE for Sylvian fissures; ∼0.74 for superior sulci. On external validation, DESI discriminated NPH with DESH from non-DESH NPH with AUC = 0.99, accuracy 97.9%, and from all other groups (healthy controls, Alzheimer’s disease, vascular dementia) with perfect classification (AUC = 1.00, 100% sensitivity and specificity at threshold = 4.83). In cognitively normal adults, DESI showed only a modest age-related increase and no sex differences, confirming specificity for hydrocephalic pathology. Conclusion DESI is a robust, fully automated MRI biomarker that sensitively detects CSF redistribution characteristic of DESH in iNPH. By outperforming traditional indices and achieving near-perfect diagnostic accuracy across independent cohorts, DESI offers a noninvasive tool for early detection, patient selection for shunting, and longitudinal monitoring of disease progression.
Key findings
- Results Segmentation achieved ∼0.80 DICE for Sylvian fissures; ∼0.74 for superior sulci.
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Study details
- Study designlongitudinal study
- Participants1,032
- Effect sizeAUC = 0.99; 97.9%; AUC = 1.00
- Evidence strengthModerate
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 48 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 30 of the 62 points we could judge it on, which is 48 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 7 / 12 | A longitudinal study following the same people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 3 / 4 | 1,032 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 30 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 30 of the 62 points we could judge it on is 48 out of 100. |
| Total | 48 / 100 | Capped to 16 because this is not a peer-reviewed article. |
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Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Barough, S. S., Ohno, S., Bilgel, M., Sair, H. I., Luciano, M. G., & Moghekar, A. (2025). Disproportionately Elevated Sulcal Index (DESI): An automatically driven index representing disproportionate subarachnoid space enlargement in brain MRI scans. medRxiv. https://doi.org/10.64898/2025.12.01.25341388
Vancouver
Barough SS, Ohno S, Bilgel M, Sair HI, Luciano MG, Moghekar A. Disproportionately Elevated Sulcal Index (DESI): An automatically driven index representing disproportionate subarachnoid space enlargement in brain MRI scans. medRxiv. 2025. doi:10.64898/2025.12.01.25341388.
BibTeX
@article{barough2025-4205cb47,
author = {Barough, S. S. and Ohno, S. and Bilgel, M. and Sair, H. I. and Luciano, M. G. and Moghekar, A.},
title = {{Disproportionately Elevated Sulcal Index (DESI): An automatically driven index representing disproportionate subarachnoid space enlargement in brain MRI scans}},
journal = {medRxiv},
year = {2025},
doi = {10.64898/2025.12.01.25341388},
url = {https://doi.org/10.64898/2025.12.01.25341388}
}
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