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The variable \u2018Age\u2019 \u00d7 (\u2018CAG\u2019\u2014L), where \u2018Age\u2019 is the current age of the individual, \u2018CAG\u2019 is the repeat length and L is a constant (reflecting an approximation of the threshold), termed the \u2018CAG Age Product\u2019 (CAP) enables the consideration of many individuals with different CAG repeat expansions at the same time for analysis of any variable and graphing using the CAG Age Product score as the X axis. Structural MRI studies have showed that progressive striatal atrophy begins many years prior to the onset of diagnosable motor Huntington\u2019s disease, confirmed by longitudinal multicentre studies on three continents, including PREDICT-HD, TRACK-HD and IMAGE-HD. However, previous studies have not clarified the relationship between striatal atrophy, atrophy of other basal ganglia structures, and atrophy of other brain regions. The present study has analysed all three longitudinal datasets together using a single image segmentation algorithm and combining data from a large number of subjects across a range of CAG Age Product score. In addition, we have used a strategy of normalizing regional atrophy to atrophy of the whole brain, in order to determine which regions may undergo preferential degeneration. This made possible the detailed characterization of regional brain atrophy in relation to CAG Age Product score. There is dramatic selective atrophy of regions involved in the basal ganglia circuit\u2014caudate, putamen, nucleus accumbens, globus pallidus and substantia nigra. Most other regions of the brain appear to have slower but steady degeneration. These results support (but certainly do not prove) the hypothesis of circuit-based spread of pathology in Huntington\u2019s disease, possibly due to spread of mutant Htt protein, though other connection-based mechanisms are possible. Therapeutic targets related to prion-like spread of pathology or other mechanisms may be suggested. In addition, they have implications for current neurosurgical therapeutic approaches, since delivery of therapeutic agents solely to the caudate and putamen may miss other structures affected early, such as nucleus accumbens and output nuclei of the striatum, the substantia nigra and the globus pallidus.<\/jats:p>","DOI":"10.1093\/braincomms\/fcad214","type":"journal-article","created":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T16:46:54Z","timestamp":1692290814000},"source":"Crossref","is-referenced-by-count":29,"title":["Longitudinal imaging highlights preferential basal ganglia circuit atrophy in Huntington\u2019s disease"],"prefix":"10.1093","volume":"5","author":[{"given":"Chin-Fu","family":"Liu","sequence":"first","affiliation":[{"name":"Center for Imaging Science, Johns Hopkins University , Baltimore, MD 21218 , USA"},{"name":"Institute for Computational Medicine, Johns Hopkins University , Baltimore, MD 21218 , USA"},{"name":"Department of Biomedical Engineering, Johns 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