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A comprehensive literature search was conducted across several databases for human studies from 2004 to 2024 related to AD, biological sex differences, and neuroimaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After a 3-step review process, the final extraction included 120 peer-reviewed studies using various neuroimaging modalities, such as MRI, amyloid-beta PET, tau-PET, and fluorodeoxyglucose (FDG) PET, to investigate sex as a biological predictor variable in adults with or at risk for AD. Over 90% of the reviewed studies identified clear sex-specific patterns of imaging biomarkers related to cognitive reserve, hormonal changes, APOE-\u025b4 genotype, inflammation, vascular health, and lifestyle factors. Machine learning studies increasingly incorporate sex as a key variable, revealing sex-specific biomarkers and improving model performance in predicting disease status and progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Considering biological sex in AD research is essential for improving diagnostic accuracy, tailoring interventions, and health outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Advances in knowledge<\/jats:title>\n                    <jats:p>This systematic review identifies sex-specific patterns in neuroimaging biomarkers of AD, influenced by cognitive reserve, hormones, APOE-\u025b4 genotype, inflammation, vascular health, and lifestyle. Recognizing these differences is crucial for understanding, diagnosis, and treatment efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjr\/tqag011","type":"journal-article","created":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T06:08:18Z","timestamp":1768630098000},"page":"702-713","source":"Crossref","is-referenced-by-count":8,"title":["Sex differences in Alzheimer\u2019s disease: a systematic review of two decades of neuroimaging research"],"prefix":"10.1093","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7510-7273","authenticated-orcid":false,"given":"Parinaz","family":"Massoumzadeh","sequence":"first","affiliation":[{"name":"Mallinckrodt Institute of Radiology, Washington University in St Louis , St Louis, MO 63110,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savannah","family":"Tiemann Powles","sequence":"additional","affiliation":[{"name":"Mallinckrodt Institute of Radiology, Washington 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