• cerebral cortex;
  • tissue contrast;
  • MRI T1-weighted signal intensity;
  • cortical thickness;
  • disease prediction;
  • entorhinal;
  • hippocampus

Brain morphometry measures derived from magnetic resonance imaging (MRI) are important biomarkers for Alzheimer's disease (AD). The objective of the present study was to test whether we could improve morphometry-based detection and prediction of disease state by use of white matter/gray matter (WM/GM) signal intensity contrast obtained from conventional MRI scans. We hypothesized that including WM/GM contrast change along with measures of atrophy in the entorhinal cortex and the hippocampi would yield better classification of AD patients, and more accurate prediction of early disease progression. T1-weighted MRI scans from two sessions approximately 2 years apart from 78 participants with AD (Clinical Dementia Rating (CDR) = 0.5–2) and 71 age-matched controls were used to calculate annual change rates. Results showed that WM/GM contrast decay was larger in AD compared with controls in the medial temporal lobes. For the discrimination between AD and controls, entorhinal WM/GM contrast decay contributed significantly when included together with decrease in entorhinal cortical thickness and hippocampal volume, and increased the area under the curve to 0.79 compared with 0.75 when using the two morphometric variables only. Independent effects of WM/GM contrast decay and improved classification were also observed for the CDR-based subgroups, including participants converting from either a non-AD status to very mild AD, or from very mild to mild AD. Thus, WM/GM contrast decay increased diagnostic accuracy beyond what was obtained by well-validated morphometric measures alone. The findings suggest that signal intensity properties constitute a sensitive biomarker for cerebral degenration in AD. Hum Brain Mapp 34:2775–2785, 2013. © 2012 Wiley Periodicals, Inc.