Evaluation of surface-based hippocampal registration using ground-truth subfield definitions

Reviewer #1 (Public Review):

This paper proposes and evaluates a new approach for the registration of human hippocampal anatomy between individuals. Such registration is an essential step in group analysis of hippocampal structure and function, and in most studies to date, volumetric registration of MRI scans has been employed. However, it is known that volumetric deformable registration, due to its formulation as an optimization problem that minimizes the combination of an image similarity term and relatively simple geometric regularization terms, fails to preserve the topology of complex structures. In the cerebral cortex, surface-based registration of inflated cortical surfaces is broadly preferred over volumetric registration, which often causes voxels of different tissue types to be matched (e.g., voxels belonging to a sulcus in one individual mapping onto voxels belonging to a gurys in another). The authors recognize that hippocampal anatomy is similarly complex, and, with proper tools, can benefit from surface-based registration. They propose to first unfold the hippocampus to a two-dimensional rectangle domain using their prior HippUnfold technique, and then to perform deformable registration in this rectangle domain, matching geometric features (curvature, thickness, gyrification) between individuals. This registration approach is evaluated by comparing how well hippocampal subfields traced by experts using cytoarchitectural information align between individuals after registration. The authors indeed show that surface-based registration aligns subfields better than volumetric registration applied to binary segmentations of the hippocampal gray matter.

Overall, I find the methods and results in this paper to be convincing. The authors framed the comparison between surface-based and volumetric registration in a fair way, and the results convincingly show the advantage of surface-based registration. One slight limitation of the current study is that it is uncertain whether the benefits demonstrated here translate to in vivo MRI data for which the authors' HippUnfold algorithm is tailored. The current study utilized the unfolding technique used in HippUnfold on manual segmentations of high-resolution ex vivo MRI and blockface 3D volumes, which are likely closer to anatomical ground truth than automated segmentations of in vivo MRI. However, it is reasonable to assume that given that the volumetric registration to which the proposed approach was compared also used this high-detail data, the advantages of surface-based over volumetric registration would extend to in vivo MRI as well. However, I would encourage the authors to perform future evaluations on datasets with available in vivo and ex vivo MRI from the same individuals.

I would also like to point out the relevance of the 2021 paper "Unfolding the Medial Temporal Lobe Cortex to Characterize Neurodegeneration Due to Alzheimer's Disease Pathology Using Ex vivo Imaging" by Ravikumar et al. (https://link.springer.com/chapter/10.1007/978-3-030-87586-2_1) to the current work. This paper applied an earlier version of the unfolding method in HippUnfold to ex vivo extrahippocampal cortex and performed registration using curvature features in the rectangular unfolded space, also finding slight improvement with surface-based vs. volumetric registration, so its findings support the current paper.

Overall, the paper has the potential to significantly influence future research on hippocampal involvement in cognition and disease. Outside of simple volumetry studies, most hippocampal morphometry studies rely on volumetric deformable registration of some kind, typically applied to whole-brain T1-weighted MRI scans. With HippUnfold available for anyone to use and not requiring manual registration, the paper provides a strong impetus for using this approach in future studies, particularly where one is interested in localizing effects of interest to specific areas of the hippocampus. Additional evaluation of in vivo HippUnfold using in vivo / ex vivo datasets, would make the use of this approach even more appealing.

Reviewer #2 (Public Review):

DeKraker et al. propose a new method for hippocampal registration using a surface-based approach that preserves the topology of the curvature of the hippocampus and boundaries of hippocampal subfields. The surface-based registration method proved to be more precise and resulted in better alignment compared to traditional volumetric-based registration. Moreover, the authors demonstrated that this method can be performed across image modalities by testing the method with seven different histological samples. While the conclusions of this paper are mostly well supported by data, some aspects of the method need to be clarified. This work has the potential to be a powerful new registration technique that can enable precise hippocampal registration and alignment across subjects, datasets, and image modalities.

Regarding the methodological clarification of the surfaced-based registration method, the last step of the process needs further clarification. Specifically, after creating the averaged 2D template, it is unclear how each individual sample is registered to sample1's space. If I understand correctly, after creating the averaged 2D template, each individual sample is then registered to sample1's space via the transform from each sample to the averaged template and then the inverse transform from the template to sample1's space. Samples included both left and right hemispheres, so were all samples being propagated to left hemisphere sample 1 space? The authors also note that a measure of the subfield labels overlap with that sample's ground-truth subfield definitions was calculated. Is this a measure of overlap, for example, between sample 3 (registered to sample 1 space) and the ground-truth (unfolded, not registered) sample 3 labels? It would be beneficial to provide a full walkthrough of one example sample to clarify the steps. Clarification of this aspect of the method is critical for understanding the evaluation of the method.

Reviewer #3 (Public Review):

Dekraker and colleagues previously developed a new computational tool that creates a "surface representation" of the hippocampal subfields. This surface representation was previously constructed using histology from a single case. However, it was previously unclear how to best register and compare these surface-based representations to other cases with different morphology.

In the current manuscript, Dekraker and colleagues have demonstrated the ability to align hippocampal subfield parcellations across disparate 3D histology samples that differ in contrast, resolution, and processing/staining methods. In doing so, they validated the previously generated Big-Brain atlas by comparing seven different ground-truth subfield definitions. This is an impressive and valuable effort that provides important groundwork for future in vivo multi-atlas methods.