Population Imaging

What is Population Imaging?

Once patients presents with symptoms, in many cases irreversible damage is already present. This is true for many diseases that are common in the population, like cardiovascular disease and dementia. Clinical studies are usually limited to studying diagnosis, prognosis and treatment of disease. If we want to understand why disease develops and which factors drive its development, we need to study disease in its earliest forms, when symptoms are not yet present. This is the area in which population-based studies operate. Studies that start out with presumed healthy individuals, assess potential disease determinants and follow participants for occurrence of disease. Over the past decades, imaging is playing an increasingly important role in this study of associations between determinants and disease, by allowing us to non-invasively directly study the tissue at risk. Population Imaging, the large-scale acquisition of medical images in controlled population-based cohorts, allows to investigate structural and functional changes in the human body that may indicate early disease, can be used to identify persons at risk of developing disease, or may aid in disease prediction.

Population Imaging in Erasmus MC

Our Population Imaging studies at Erasmus MC primarily take place within two large cohorts. The Rotterdam Study is a prospective, population-based study aimed at investigating determinants of chronic and disabling diseases among nearly 15,000 persons aged 45 years and over. The Generation R Study is a prospective cohort study among 10,000 children who are followed from fetal life until young adulthood in a multi-ethnic urban population. Whereas the Rotterdam Study focuses at disease at old age, Generation R mainly aims to study child development, both physically and mentally.

Population imaging within the Rotterdam Study currently comprises brain MR imaging (more than 12,000 scans in over 8,000 individuals), CT-assessed arterial calcification (2,500 persons), carotid MR imaging (over 1,500 persons) and musculoskeletal imaging (knee MRI in over 800 subjects). 

Expectations & Directions

Imaging in population-based studies is becoming ever more important in studying determinants of disease and in disease prediction. Non-invasive imaging techniques, such as MRI, enable us to detect increasingly subtle and early pathologic changes in asymptomatic individuals, tremendously enlarging our power and sensitivity to study common diseases, like stroke and dementia. In the coming years, we expect particular progress to be made by integrating functional imaging in our structural imaging protocols; and exploring the interrelationship between structure and function. Furthermore, advances in image processing, yielding quantification of more and new markers (e.g. amyloid imaging, high field MRI) will bring the field of population imaging forward. Also, combining imaging with other high-dimensional data such as genomics, is highly promising in unravelling pathways of disease and better understand disease pathophysiology. Finally, we will focus in the next years on the clinical relevance and prognosis of the imaging markers assessed in our cohorts.

Below a selection of key publications. See the U.S. National Library of Medicine fora full list

1. Akoudad S, Wolters FJ, Viswanathan A, de Bruijn RF, van der Lugt A, Hofman A, Koudstaal PJ, Ikram MA, Vernooij MW. Association of Cerebral Microbleeds With Cognitive Decline and Dementia. JAMA Neurol. 2016 Aug 1;73(8):934-43. [Impact factor: 8.2]
2. de Groot M, Cremers LG, Ikram MA, Hofman A, Krestin GP, van der Lugt A, Niessen WJ, Vernooij MW. White Matter Degeneration with Aging: Longitudinal Diffusion MR Imaging Analysis.
   Radiology. 2016 May;279(2):532-41. [Impact factor: 6.8]
3. Akoudad S, Portegies ML, Koudstaal PJ, Hofman A, van der Lugt A, Ikram MA, Vernooij MW. Cerebral Microbleeds Are Associated With an Increased Risk of Stroke: The Rotterdam Study. Circulation. 2015 Aug 11;132(6):509-16. doi: 10.1161/CIRCULATIONAHA.115.016261. [Impact factor: 17.0]
4. Bos D, Vernooij MW, de Bruijn RF, Koudstaal PJ, Hofman A, Franco OH, van der Lugt A, Ikram MA. Atherosclerotic calcification is related to a higher risk of dementia and cognitive decline. Alzheimers Dement. 2015;11(6):639-47. [Impact factor: 12.4]
5. de Groot M, Ikram MA, Akoudad S, Krestin GP, Hofman A, van der Lugt A, Niessen WJ, Vernooij MW.
   Alzheimers Dement. 2015;11(3):321-30. [Impact factor: 12.4]
6. Adams HH, Verhaaren BF, Vrooman HA, Uitterlinden AG, Hofman A, van Duijn CM, van der Lugt A, Niessen WJ, Vernooij MW, Ikram MA. TMEM106B influences volume of left-sided temporal lobe and interhemispheric structures in the general population. Biol Psychiatry. 2014;76:503-8. [Impact factor: 10.3]
7. de Groot M, Verhaaren BF, de Boer R, Klein S, Hofman A, van der Lugt A, Ikram MA, Niessen WJ, Vernooij MW. Changes in normal-appearing white matter precede development of white matter lesions. Stroke. 2013 Apr;44(4):1037-42. [Impact factor: 6.4]
8. Greenberg SM, Vernooij MW, Cordonnier C, Viswanathan A, Al-Shahi Salman R, Warach S, Launer LJ, Van Buchem MA, Breteler MM; Microbleed Study Group. Cerebral microbleeds: a guide to detection and interpretation. Lancet Neurol. 2009 Feb;8(2):165-74. [Impact factor: 18.1]
9. Vernooij MW, Ikram MA, Vrooman HA, Wielopolski PA, Krestin GP, Hofman A, Niessen WJ, Van der Lugt A, Breteler MM. White matter microstructural integrity and cognitive function in a general elderly population. Arch Gen Psychiatry. 2009 May;66(5):545-53. [Impact factor: 15.3]
10. Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, Niessen WJ, Breteler MM, van der Lugt A. Incidental findings on brain MRI in the general population. N Engl J Med. 2007;357:1821-8. [Impact factor: 55.9]

Current funding from: ZonMW, ERC (H2020), Alzheimer Nederland, JPND, NWO, Bright Focus.